scholarly journals The Effects of Preprocessing Strategies for Pediatric Cochlear Implant Recipients

2016 ◽  
Vol 27 (02) ◽  
pp. 085-102 ◽  
Author(s):  
Bernadette Rakszawski ◽  
Rose Wright ◽  
Jamie H. Cadieux ◽  
Lisa S. Davidson ◽  
Christine Brenner
Keyword(s):  
Speech Perception ◽  
Repeated Measures ◽  
Background Noise ◽  
Dynamic Range ◽  
Individual Data ◽  
Cross Sectional ◽  
Low Level ◽  
Group Data ◽  
Significant Difference ◽  
Listening Environments

Background: Cochlear implants (CIs) have been shown to improve children’s speech recognition over traditional amplification when severe-to-profound sensorineural hearing loss is present. Despite improvements, understanding speech at low-level intensities or in the presence of background noise remains difficult. In an effort to improve speech understanding in challenging environments, Cochlear Ltd. offers preprocessing strategies that apply various algorithms before mapping the signal to the internal array. Two of these strategies include Autosensitivity Control™ (ASC) and Adaptive Dynamic Range Optimization (ADRO®). Based on the previous research, the manufacturer’s default preprocessing strategy for pediatrics’ everyday programs combines ASC + ADRO®. Purpose: The purpose of this study is to compare pediatric speech perception performance across various preprocessing strategies while applying a specific programming protocol using increased threshold levels to ensure access to very low-level sounds. Research Design: This was a prospective, cross-sectional, observational study. Participants completed speech perception tasks in four preprocessing conditions: no preprocessing, ADRO®, ASC, and ASC + ADRO®. Study Sample: Eleven pediatric Cochlear Ltd. CI users were recruited: six bilateral, one unilateral, and four bimodal. Intervention: Four programs, with the participants’ everyday map, were loaded into the processor with different preprocessing strategies applied in each of the four programs: no preprocessing, ADRO®, ASC, and ASC + ADRO®. Data Collection and Analysis: Participants repeated consonant–nucleus–consonant (CNC) words presented at 50 and 70 dB SPL in quiet and Hearing in Noise Test (HINT) sentences presented adaptively with competing R-SpaceTM noise at 60 and 70 dB SPL. Each measure was completed as participants listened with each of the four preprocessing strategies listed above. Test order and conditions were randomized. A repeated-measures analysis of was used to compare each preprocessing strategy for the group. Critical differences were used to determine significant score differences between each preprocessing strategy for individual participants. Results: For CNC words presented at 50 dB SPL, the group data revealed significantly better scores using ASC + ADRO® compared to all other preprocessing conditions while ASC resulted in poorer scores compared to ADRO® and ASC + ADRO®. Group data for HINT sentences presented in 70 dB SPL of R-SpaceTM noise revealed significantly improved scores using ASC and ASC + ADRO® compared to no preprocessing, with ASC + ADRO® scores being better than ADRO® alone scores. Group data for CNC words presented at 70 dB SPL and adaptive HINT sentences presented in 60 dB SPL of R-SpaceTM noise showed no significant difference among conditions. Individual data showed that the preprocessing strategy yielding the best scores varied across measures and participants. Conclusions: Group data reveal an advantage with ASC + ADRO® for speech perception presented at lower levels and in higher levels of background noise. Individual data revealed that the optimal preprocessing strategy varied among participants, indicating that a variety of preprocessing strategies should be explored for each CI user considering his or her performance in challenging listening environments.

The Effect of a High Upper Input Limiting Level on Word Recognition in Noise, Sound Quality Preferences, and Subjective Ratings of Real-World Performance

2015 ◽  
Vol 26 (06) ◽  
pp. 547-562
Author(s):  
Kristi Oeding ◽  
Michael Valente
Keyword(s):  
Word Recognition ◽  
Hearing Aids ◽  
Real World ◽  
Repeated Measures ◽  
Dynamic Range ◽  
Sound Quality ◽  
Subjective Ratings ◽  
Analog To Digital ◽  
Significant Difference ◽  
Listening Environments

Background: One important factor that plays a role in front-end processing is the analog-to-digital converter within current hearing aids. The average input dynamic range of hearing aids is 96 dB SPL with an upper input limiting level (UILL) of 95–105 dB SPL. The UILL of standard hearing aids could distort loud signals, such as loud speech or music, which have root-mean-square values of 90 and 105 dB SPL with crest factors of 12 dB SPL to 14–20 dB SPL, respectively. This indicates that these loud sounds could create a distorted signal for patients when the input limiting level is reached. Purpose: To examine if significant differences in word recognition in noise, sound quality preferences, and subjective ratings of real-world performance exist between conventional and high UILL hearing aids. Research Design: Words in noise and sound quality preferences were assessed using recordings on a Knowles Electronic Manikin for Acoustic Research with conventional and high UILL hearing aids, different microphone modes, and listening conditions. Participants wore the hearing aids for 2 mo and completed questionnaires on subjective performance. Study Sample: Ten adults with bilateral slight to moderately severe sensorineural hearing loss were recruited. Results: A four-factor repeated-measures analysis of variance (ANOVA) revealed significant differences between the conventional and high UILL across microphone modes and listening conditions for words in noise [F (2, 18) = 6.0; p < 0.05]. A three-factor repeated-measures ANOVA for sound quality preferences revealed a significant difference only for presentation level [F (1, 9) = 81.0; p < 0.001]. A one-factor ANOVA did not reveal significant differences between the conventional and high UILL on subjective ratings of real-world performance. Conclusions: Word recognition and sound quality preferences revealed significant differences between the conventional and high UILL; however, there were no differences in subjective ratings of real-world performance. One participant preferred the conventional UILL, two the high UILL, and seven thought performance was equal, which may be due to the listening environments participants encountered, as evidenced by datalogging.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss

2017 ◽  
Vol 28 (01) ◽  
pp. 058-067 ◽  
Author(s):  
Samuel R. Atcherson ◽  
Lisa Lucks Mendel ◽  
Wesley J. Baltimore ◽  
Chhayakanta Patro ◽  
Sungmin Lee ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Speech Perception ◽  
Hearing Impairment ◽  
Visual Input ◽  
Acoustic Properties ◽  
Speech Understanding ◽  
Profound Hearing Loss ◽  
Cross Sectional ◽  
Surgical Masks ◽  
Significant Difference

AbstractIt is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent (“see-through”) surgical mask may help to overcome this issue.To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks.Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study.A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss.Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only).A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group.Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

scholarly journals Upgrade to Nucleus® 6 in Previous Generation Cochlear™ Sound Processor Recipients

2018 ◽  
Vol 29 (09) ◽  
pp. 802-813 ◽  
Author(s):  
Allison Biever ◽  
Jan Gilden ◽  
Teresa Zwolan ◽  
Megan Mears ◽  
Anne Beiter
Keyword(s):  
Speech Perception ◽  
User Satisfaction ◽  
Repeated Measures ◽  
Background Noise ◽  
First Generation ◽  
Repeated Measures Design ◽  
Signal Processing Algorithms ◽  
Final Speech ◽  
New Algorithms ◽  
Sound Processor

AbstractThe Nucleus® 6 sound processor is now compatible with the Nucleus® 22 (CI22M)—Cochlear’s first generation cochlear implant. The Nucleus 6 offers three new signal processing algorithms that purportedly facilitate improved hearing in background noise.These studies were designed to evaluate listening performance and user satisfaction with the Nucleus 6 sound processor.The research design was a prospective, single-participant, repeated measures designA group of 80 participants implanted with various Nucleus internal implant devices (CI22M, CI24M, Freedom® CI24RE, CI422, and CI512) were recruited from a total of six North American sites.Participants had their external sound processor upgraded to the Nucleus 6 sound processor. Final speech perception testing in noise and subjective questionnaires were completed after four or 12 weeks of take-home use with the Nucleus 6.Speech perception testing in noise showed significant improvement and participants reported increased satisfaction with the Nucleus 6.These studies demonstrated the benefit of the new algorithms in the Nucleus 6 over previous generations of sound processors.

Penggunaan Alat Bantu Mengajar Dan Hubungannya Dengan Pencapaian Kemahiran Mendengar Bahasa Arab

2012 ◽  
Author(s):  
Nik Mohd Rahimi Nik Yusoff ◽  
Kamarulzaman Ab. Ghani
Keyword(s):  
Key Words ◽  
Research Design ◽  
Arabic Language ◽  
Listening Skills ◽  
Cross Sectional ◽  
Listening Test ◽  
Low Level ◽  
Teaching Aids ◽  
Significant Difference ◽  
Teaching Technique

Tujuan kajian ini adalah untuk mengenal pasti pengamalan teknik pengajaran kemahiran mendengar bahasa Arab, mengenal pasti tahap penggunaan Alat Bantu Mengajar (ABM) dalam pengajaran bahasa Arab, mengenal pasti tahap pencapaian kemahiran mendengar bahasa Arab dan akhir sekali mengenal pasti perbezaan pencapaian kemahiran mendengar bahasa Arab antara kumpulan yang menggunakan ABM dengan yang tidak menggunakan ABM. Kajian ini menggunakan reka bentuk kajian tinjauan semasa dengan menggunakan dua set soal selidik untuk pelajar dan satu set ujian kemahiran mendengar bahasa Arab. Dapatan kajian menunjukkan bahawa pengamalan teknik pengajaran berada pada tahap rendah; tahap penggunaan ABM juga berada pada rendah; tahap pencapaian kemahiran mendengar bahasa Arab berada pada tahap sederhana; dan terdapat perbezan yang signifikan antara kumpulan pelajar yang didedahkan dengan ABM dengan kumpulan pelajar yang tidak didedahkan dengan ABM. Kata kunci: Kemahiran mendengar bahasa Arab; teknik pengajaran kemahiran mendengar bahasa Arab; alat bantu mengajar The aims of this study are to identify the practice of Arabic listening teaching technique in teaching Arabic, to identify the use of the teaching aids in teaching Arabic, to identify the level of Arabic listening skills, and lastly to identify the differences of Arabic listening skills between students who were exposed and students who were not exposed to the teaching aids. This study used the cross sectional research design and employed two sets of questionnaires for students and one set of Arabic listening test. The results showed that the practice of Arabic listening teaching technique in teaching Arabic was at the low level; the use of teaching aids in teaching Arabic was also at the low level; the Arabic listening skills was however at the moderate level; and there was a significant difference in Arabic listening achievement between students who were exposed and students who were not exposed to the teaching aids. Key words: Arabic language listening skills; teaching of Arabic language listening skills; teaching aids material

Electromyography Activation Levels of the 3 Gluteus Medius Subdivisions During Manual Strength Testing

2015 ◽  
Vol 24 (3) ◽  
pp. 244-251
Author(s):  
Roald Otten ◽  
Johannes L. Tol ◽  
Per Holmich ◽  
Rodney Whiteley
Keyword(s):  
Study Design ◽  
Repeated Measures ◽  
Gluteus Medius ◽  
Strength Testing ◽  
Cross Sectional ◽  
Physically Active ◽  
Rehabilitation Programs ◽  
Significant Difference ◽  
The Individual ◽  
Hip Internal Rotation

Study Design:Cross-sectional.Context:Gluteus medius (GM) muscle dysfunction is associated with overuse injury. The GM is functionally composed of 3 separate subdivisions: anterior, middle, and posterior. Clinical assessment of the GM subdivisions is relevant to detect strength and activation deficits and guide specific rehabilitation programs. However, the optimal positions for assessing the strength and activation of these subdivisions are unknown.Objective:The first aim was to establish which strength-testing positions produce the highest surface electromyography (sEMG) activation levels of the individual GM subdivisions. The second aim was to evaluate differences in sEMG activation levels between the tested and contralateral (stabilizing) leg.Method:Twenty healthy physically active male subjects participated in this study. Muscle activity using sEMG was recorded for the GM subdivisions in 8 different strength-testing positions and analyzed using repeated-measures analysis of variance.Results:Significant differences between testing positions for all 3 GM subdivisions were found. There were significant differences between the tested and the contralateral anterior and middle GM subdivisions (P < .01). The posterior GM subdivision showed no significant difference (P = .154).Conclusion:Side-lying in neutral and side-lying with hip internal rotation are the 2 positions recommended to evaluate GM function and guide specific GM rehabilitation.

scholarly journals Speech Perception for Adult Cochlear Implant Recipients in a Realistic Background Noise: Effectiveness of Preprocessing Strategies and External Options for Improving Speech Recognition in Noise

2010 ◽  
Vol 21 (07) ◽  
pp. 441-451 ◽  
Author(s):  
René H. Gifford ◽  
Lawrence J. Revit
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Recognition Performance ◽  
Single Subject ◽  
Repeated Measures Design ◽  
Listening Environments ◽  
Improved Performance ◽  
Listening In Noise

Background: Although cochlear implant patients are achieving increasingly higher levels of performance, speech perception in noise continues to be problematic. The newest generations of implant speech processors are equipped with preprocessing and/or external accessories that are purported to improve listening in noise. Most speech perception measures in the clinical setting, however, do not provide a close approximation to real-world listening environments. Purpose: To assess speech perception for adult cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE™) array in order to determine whether commercially available preprocessing strategies and/or external accessories yield improved sentence recognition in noise. Research Design: Single-subject, repeated-measures design with two groups of participants: Advanced Bionics and Cochlear Corporation recipients. Study Sample: Thirty-four subjects, ranging in age from 18 to 90 yr (mean 54.5 yr), participated in this prospective study. Fourteen subjects were Advanced Bionics recipients, and 20 subjects were Cochlear Corporation recipients. Intervention: Speech reception thresholds (SRTs) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the subjects' preferred listening programs as well as with the addition of either Beam™ preprocessing (Cochlear Corporation) or the T-Mic® accessory option (Advanced Bionics). Data Collection and Analysis: In Experiment 1, adaptive SRTs with the Hearing in Noise Test sentences were obtained for all 34 subjects. For Cochlear Corporation recipients, SRTs were obtained with their preferred everyday listening program as well as with the addition of Focus preprocessing. For Advanced Bionics recipients, SRTs were obtained with the integrated behind-the-ear (BTE) mic as well as with the T-Mic. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the preprocessing strategy or external accessory in reducing the SRT in noise. In addition, a standard t-test was run to evaluate effectiveness across manufacturer for improving the SRT in noise. In Experiment 2, 16 of the 20 Cochlear Corporation subjects were reassessed obtaining an SRT in noise using the manufacturer-suggested “Everyday,” “Noise,” and “Focus” preprocessing strategies. A repeated-measures ANOVA was employed to assess the effects of preprocessing. Results: The primary findings were (i) both Noise and Focus preprocessing strategies (Cochlear Corporation) significantly improved the SRT in noise as compared to Everyday preprocessing, (ii) the T-Mic accessory option (Advanced Bionics) significantly improved the SRT as compared to the BTE mic, and (iii) Focus preprocessing and the T-Mic resulted in similar degrees of improvement that were not found to be significantly different from one another. Conclusion: Options available in current cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise with both Cochlear Corporation and Advanced Bionics systems. For Cochlear Corporation recipients, Focus preprocessing yields the best speech-recognition performance in a complex listening environment; however, it is recommended that Noise preprocessing be used as the new default for everyday listening environments to avoid the need for switching programs throughout the day. For Advanced Bionics recipients, the T-Mic offers significantly improved performance in noise and is recommended for everyday use in all listening environments.

Improving Speech Perception in Noise for Children with Cochlear Implants

2011 ◽  
Vol 22 (09) ◽  
pp. 623-632 ◽  
Author(s):  
René H. Gifford ◽  
Amy P. Olund ◽  
Melissa DeJong
Keyword(s):  
Speech Recognition ◽  
Speech Perception ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Repeated Measures ◽  
Background Noise ◽  
Normal Hearing ◽  
Speech Understanding ◽  
The Mean ◽  
Experimental Subjects

Background: Current cochlear implant recipients are achieving increasingly higher levels of speech recognition; however, the presence of background noise continues to significantly degrade speech understanding for even the best performers. Newer generation Nucleus cochlear implant sound processors can be programmed with SmartSound strategies that have been shown to improve speech understanding in noise for adult cochlear implant recipients. The applicability of these strategies for use in children, however, is not fully understood nor widely accepted. Purpose: To assess speech perception for pediatric cochlear implant recipients in the presence of a realistic restaurant simulation generated by an eight-loudspeaker (R-SPACE™) array in order to determine whether Nucleus sound processor SmartSound strategies yield improved sentence recognition in noise for children who learn language through the implant. Research Design: Single subject, repeated measures design. Study Sample: Twenty-two experimental subjects with cochlear implants (mean age 11.1 yr) and 25 control subjects with normal hearing (mean age 9.6 yr) participated in this prospective study. Intervention: Speech reception thresholds (SRT) in semidiffuse restaurant noise originating from an eight-loudspeaker array were assessed with the experimental subjects’ everyday program incorporating Adaptive Dynamic Range Optimization (ADRO) as well as with the addition of Autosensitivity control (ASC). Data Collection and Analysis: Adaptive SRTs with the Hearing In Noise Test (HINT) sentences were obtained for all 22 experimental subjects, and performance—in percent correct—was assessed in a fixed +6 dB SNR (signal-to-noise ratio) for a six-subject subset. Statistical analysis using a repeated-measures analysis of variance (ANOVA) evaluated the effects of the SmartSound setting on the SRT in noise. Results: The primary findings mirrored those reported previously with adult cochlear implant recipients in that the addition of ASC to ADRO significantly improved speech recognition in noise for pediatric cochlear implant recipients. The mean degree of improvement in the SRT with the addition of ASC to ADRO was 3.5 dB for a mean SRT of 10.9 dB SNR. Thus, despite the fact that these children have acquired auditory/oral speech and language through the use of their cochlear implant(s) equipped with ADRO, the addition of ASC significantly improved their ability to recognize speech in high levels of diffuse background noise. The mean SRT for the control subjects with normal hearing was 0.0 dB SNR. Given that the mean SRT for the experimental group was 10.9 dB SNR, despite the improvements in performance observed with the addition of ASC, cochlear implants still do not completely overcome the speech perception deficit encountered in noisy environments accompanying the diagnosis of severe-to-profound hearing loss. Conclusion: SmartSound strategies currently available in latest generation Nucleus cochlear implant sound processors are able to significantly improve speech understanding in a realistic, semidiffuse noise for pediatric cochlear implant recipients. Despite the reluctance of pediatric audiologists to utilize SmartSound settings for regular use, the results of the current study support the addition of ASC to ADRO for everyday listening environments to improve speech perception in a child's typical everyday program.

scholarly journals Optimization of Programming Parameters in Children with the Advanced Bionics Cochlear Implant

2012 ◽  
Vol 23 (05) ◽  
pp. 302-312 ◽  
Author(s):  
Jacquelyn Baudhuin ◽  
Jamie Cadieux ◽  
Jill B. Firszt ◽  
Ruth M. Reeder ◽  
Jerrica L. Maxson
Keyword(s):  
Speech Recognition ◽  
Cochlear Implant ◽  
Repeated Measures ◽  
Mixed Model ◽  
Dynamic Range ◽  
Profound Hearing Loss ◽  
Detection Thresholds ◽  
Speech Processor ◽  
Low Level ◽  
Pediatric Recipients

Background: Cochlear implants provide access to soft intensity sounds and therefore improved audibility for children with severe-to-profound hearing loss. Speech processor programming parameters, such as threshold (or T-level), input dynamic range (IDR), and microphone sensitivity, contribute to the recipient's program and influence audibility. When soundfield thresholds obtained through the speech processor are elevated, programming parameters can be modified to improve soft sound detection. Adult recipients show improved detection for low-level sounds when T-levels are set at raised levels and show better speech understanding in quiet when wider IDRs are used. Little is known about the effects of parameter settings on detection and speech recognition in children using today's cochlear implant technology. Purpose: The overall study aim was to assess optimal T-level, IDR, and sensitivity settings in pediatric recipients of the Advanced Bionics cochlear implant. Research Design: Two experiments were conducted. Experiment 1 examined the effects of two T-level settings on soundfield thresholds and detection of the Ling 6 sounds. One program set T-levels at 10% of most comfortable levels (M-levels) and another at 10 current units (CUs) below the level judged as “soft.” Experiment 2 examined the effects of IDR and sensitivity settings on speech recognition in quiet and noise. Study Sample: Participants were 11 children 7–17 yr of age (mean 11.3) implanted with the Advanced Bionics High Resolution 90K or CII cochlear implant system who had speech recognition scores of 20% or greater on a monosyllabic word test. Data Collection and Analysis: Two T-level programs were compared for detection of the Ling sounds and frequency modulated (FM) tones. Differing IDR/sensitivity programs (50/0, 50/10, 70/0, 70/10) were compared using Ling and FM tone detection thresholds, CNC (consonant-vowel nucleus-consonant) words at 50 dB SPL, and Hearing in Noise Test for Children (HINT-C) sentences at 65 dB SPL in the presence of four-talker babble (+8 signal-to-noise ratio). Outcomes were analyzed using a paired t-test and a mixed-model repeated measures analysis of variance (ANOVA). Results: T-levels set 10 CUs below “soft” resulted in significantly lower detection thresholds for all six Ling sounds and FM tones at 250, 1000, 3000, 4000, and 6000 Hz. When comparing programs differing by IDR and sensitivity, a 50 dB IDR with a 0 sensitivity setting showed significantly poorer thresholds for low frequency FM tones and voiced Ling sounds. Analysis of group mean scores for CNC words in quiet or HINT-C sentences in noise indicated no significant differences across IDR/sensitivity settings. Individual data, however, showed significant differences between IDR/sensitivity programs in noise; the optimal program differed across participants. Conclusions: In pediatric recipients of the Advanced Bionics cochlear implant device, manually setting T-levels with ascending loudness judgments should be considered when possible or when low-level sounds are inaudible. Study findings confirm the need to determine program settings on an individual basis as well as the importance of speech recognition verification measures in both quiet and noise. Clinical guidelines are suggested for selection of programming parameters in both young and older children.

scholarly journals Dear Program Director: Deciphering Letters of Recommendation

2018 ◽  
Vol 10 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Kris Saudek ◽  
David Saudek ◽  
Robert Treat ◽  
Peter Bartz ◽  
Rachel Weigert ◽  
...  
Keyword(s):  
Principal Component Analysis ◽  
Repeated Measures ◽  
Principal Component ◽  
Component Analysis ◽  
Program Director ◽  
Cross Sectional ◽  
Likert Score ◽  
Significant Difference ◽  
Fellowship Programs ◽  
Letters Of Recommendation

ABSTRACT Background  Letters of recommendation (LORs) are an important part of applications for residency and fellowship programs. Despite anecdotal use of a “code” in LORs, research on program director (PD) perceptions of the value of these documents is sparse. Objective  We analyzed PD interpretations of LOR components and discriminated between perceived levels of applicant recommendations. Methods  We conducted a cross-sectional, descriptive study of pediatrics residency and fellowship PDs. We developed a survey asking PDs to rate 3 aspects of LORs: 13 letter features, 10 applicant abilities, and 11 commonly used phrases, using a 5-point Likert scale. The 11 phrases were grouped using principal component analysis. Mean scores of components were analyzed with repeated-measures analysis of variance. Median Likert score differences between groups were analyzed with Mann-Whitney U tests. Results  Our survey had a 43% response rate (468 of 1079). “I give my highest recommendation” was rated the most positive phrase, while “showed improvement” was rated the most negative. Principal component analysis generated 3 groups of phrases with moderate to strong correlation with each other. The mean Likert score for each group from the PD rating was calculated. Positive phrases had a mean (SD) of 4.4 (0.4), neutral phrases 3.4 (0.5), and negative phrases 2.6 (0.6). There was a significant difference among all 3 pairs of mean scores (all P &lt; .001). Conclusions  Commonly used phrases in LORs were interpreted consistently by PDs and influenced their impressions of candidates. Key elements of LORs include distinct phrases depicting different degrees of endorsement.

Albuterol aids resistance exercise in reducing unloading-induced ankle extensor strength losses

2005 ◽  
Vol 98 (5) ◽  
pp. 1705-1711 ◽  
Author(s):  
John Caruso ◽  
John Hamill ◽  
Miki Yamauchi ◽  
Dean Mercado ◽  
Tim Cook ◽  
...  
Keyword(s):  
Resistance Exercise ◽  
Repeated Measures ◽  
Weight Bearing ◽  
Average Power ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Short Term ◽  
Cross Sectional ◽  
Honestly Significant Difference ◽  
Significant Difference

While resistance exercise (REX) reduces ankle extensor (AE) mass and strength deficits during short-term unloading; additional treatments, concurrently administered with REX, are required to attenuate the greater losses seen with longer unloading periods. Subjects performed left leg REX, which otherwise refrained from ambulatory and weight-bearing activity for 40 days, while randomized to a capsule (placebo, albuterol) dosing regimen with no crossover to note whether albuterol helps REX mitigate unloading-induced AE losses. A third group of subjects served as unloaded controls. On days 0, 20, and 40, the following data were collected from the left leg: calf cross-sectional area and AE strength measures. Cross-sectional area was estimated using anthropometric methodology, whereas AE strength data were obtained from eight unilateral calf-press repetitions on an inertial-based REX device. Repeated-measures mixed-factorial 3 × 3 analyses of covariance, with day 0 values as a covariate, revealed group × time interactions for the strength variables eccentric total work (ETW) and average power (EAP). Tukey's honestly significant difference shows REX-placebo subjects incurred significant ETW and EAP losses by day 40, whereas the REX-albuterol treatment evoked strength gains to those same variables without concurrent muscle accretion. Corresponding concentric variables did not display similar changes. Day 40 control data significantly declined for many variables; relative to the REX-albuterol treatment, some losses were significant after 20 days. ETW and EAP gains to unloaded AE may be due to one or more mechanisms. Continued research identifying mechanisms responsible for such changes, as well as the safety of REX-albuterol administration in other models, is warranted.

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