[Speech processor upgrade increases speech comprehension in patients with cochlear implants]. / Durch Upgrade von Sprachprozessoren erhöhtes Sprachverständnis bei Patienten mit Cochleaimplantat.

BACKGROUND: Hearing rehabilitation of patients with severe hearing loss by cochlear implant (CI) enhances their opportunities for communication immensely with regard to their normal-hearing social environment. The degree of participation depends decisively on speech discrimination. This study examines whether speech discrimination can be improved by equipping patients with next-generation speech processors (SP). METHODS: The changes in speech discrimination of 420 CI patients upon receiving a newer SP from 2003-2012 were retrospectively analyzed. Audiometry comprised the Freiburg number and monosyllable tests and the Oldenburg sentence test in quiet and noise, with a presentation volume of 70 dB. RESULTS: In all audiometric tests, the newer SP showed a significant improvement compared to the preceding SP. This improvement was attainable for the majority of patients and was independent of age. CONCLUSION: Upgrade of the SP results in improved speech discrimination. This holds true for several test settings. We therefore recommend earlier upgrades and that the costs for new SP be met.

Warming up to a cold-sick spouse.

This paper has examined the cold-sick/love-sick pattern of a couple's interaction and presented a schema for intervening with the less accessible, but pivotal partner--usually the husband. The importance of carefully attending to the wife's needs, expectations, wishes, and frustrations has been understood. She is not to be considered an ace-in-the-hole. Acknowledging her needs, while gently urging her husband out of his protective covering will enhance a therapist's ability to enter the relationship system. The love-sick spouse need not frighten off a therapist, and if her rage is reframed as a desperate cry for help, she may be more approachable. While difficult to engage, the cold-sick partner can be reached if his discomfort is acknowledged and his defenses initially honored. With carefully plotted and sensitive attempts to form an alliance with each partner, these couples can be engaged in successful treatment.

The couple assessment summary: a bridge from assessment to treatment.

Treatment of couples presenting for therapy typically necessitates a process of riding out the storm of contention, entering the contextual framework in which the couple is relating and developing an understanding of the couple's interactive as well as intrapsychic world. The therapist's emerging conceptualization of the relational problems addressed in the assessment process provides an important foundation for the treatment process to follow. This formulation is recorded in the "Couple Assessment Summary" (CAS), which is developed in the diagnostic stage of the treatment process. A clearly conceptualized and structured document, the CAS is the suggested vehicle for engaging the couple in the treatment process to follow. The CAS serves as a logical extension of the Couple Assessment Outline, which is a therapist's tool for engaging the partners in the process of self-assessment and formulation. The CAS offers the therapist's perspective on the problems presented to the couple for review. This paper will demonstrate the utilization of the CAS with couples in distress and will illustrate its use with a couple engaged in the assessment process. The CAS is seen as a useful method for developing a shared understanding of the problems presented as the assessment process is often fraught with tension, anger, and chaotic interaction.

Effect of socioeconomic factors on bovine somatotropin adoption choices.

Adoption and use of bST by dairy farmers will likely be influenced by socioeconomic factors. This article examines the effects of dairy farmers' socioeconomic characteristics on the probability of adopting bST. Hypotheses that adoption is associated with herd size, specialization, financial status, management skills, educational level, and age of operator were tested. Potential adopters of bST are characterized as being young, having more formal education, having larger herds, and operating with relatively low net worth.