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Biomedical subjects

M E Koch

Publications and source records attributed to M E Koch.

10 recordsLinked to original sources
PubMed1999

Trends in educational placement and cost-benefit considerations in children with cochlear implants.

OBJECTIVES: To study the effect of cochlear implantation on the use of educational resources by profoundly hearing-impaired children and to determine trends in educational cost vs benefit. DESIGN: Retrospective study and cost-benefit analysis. SETTING: Outpatient pediatric cochlear implant program in an academic institution (The Listening Center at Johns Hopkins University School of Medicine, Baltimore, Md), in collaboration with public schools in Maryland and surrounding states. PATIENTS OR OTHER PARTICIPANTS: School-aged children with profound prelingual hearing impairment without other clearly defined disabilities. Thirty-five children with multiple-channel cochlear prostheses and a comparison group of 10 children without implants from 'total communication' programs in the Maryland public school system. INTERVENTIONS: Multiple-channel cochlear implantation and at least 1 year of a systematic auditory skill development program at the Listening Center, compared with standard educational management of children with conventional amplification. MAIN OUTCOME MEASURES: Classroom placement and number of hours of special educational support used. RESULTS: A correlation was observed between the length of cochlear implant experience and the rate of full-time placement in mainstream classrooms (r = 0.10; P= .04). There was also a negative correlation between the length of implant experience and the number of hours of special educational support used by fully mainstreamed children (Pearson product moment correlation = -0.10; P = .03). Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. They were also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30000 to $200000. CONCLUSIONS: Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.

Adolescent↗
PubMed1998

The sedative and analgesic sparing effect of music.

BACKGROUND: To determine whether music influences intraoperative sedative and analgesic requirements, two randomized controlled trials were performed. METHODS: In phase 1, 35 adults undergoing urologic procedures with spinal anesthesia and patient-controlled intravenous propofol sedation were randomly assigned to hear favorable intraoperative music via headset or to have no music. In phase 2, 43 adults undergoing lithotripsy treatment of renal or ureteral calculi and receiving patient-controlled intravenous opioid analgesia were randomly assigned to either a music or no-music group. The effect of music on sedatives and analgesics requirements, recovery room duration, and adverse outcomes was assessed. RESULTS: In phase 1, patients in the music group required significantly less propofol for sedation than patients in the control group (0 [0-150] mg vs. 90 [0-240] mg, median[range]; P < 0.001). These findings persisted after adjusting for duration of surgery (0.3+/-0.1 mg/min vs. 1.6+/-0.4 mg/min; P < 0.001). Similarly, in phase 2, patients who listened to music had a significant reduction in alfentanil requirements (1,600 [0-4,250] microg vs. 3,900 [0-7,200] microg; P = 0.005). This persisted after adjusting for duration of surgery (52+/-9 microg/min vs. 119 +/-16 microg/min, mean +/- SD, P < 0.001). Duration of stay in the postanesthesia care unit and the rate of adverse events was similar in both groups (P = NS). CONCLUSIONS: Use of intraoperative music in awake patients decreases patient-controlled sedative and analgesic requirements. It should be noted, however, that patients in the no-music group did not use a headset during operation. Thus, the decrease in sedative and analgesic requirements could be caused by elimination of ambient operating room noise and not by the effects of music.

Analgesia, Patient-Controlled↗
PubMed1997

A model of educational resource use by children with cochlear implants.

We have tracked patterns of use of educational and rehabilitative resources as part of an initial assessment of cost-benefit ratios of cochlear implants in children. Forty-two children with cochlear implants in the Listening Center at Johns Hopkins program of aural rehabilitation have served as our study cohort to develop the measures to be assessed. An educational resource matrix stratifies school setting (residential vs special education vs non-specialized "mainstream" setting) and levels of rehabilitative support (speech and language therapy and interpreter use) to map past and current use of these services. Initial cost-benefit projections based on observed advancement toward educational independence in the educational resource matrix indicate an extremely favorable net present value of the implant (cost savings minus cost). These cost-benefit projections will need to be supplemented with measures of the impact on quality of life and future educational and vocational options to determine the overall cost-effectiveness of cochlear implants in children.

Baltimore↗
PubMed1997

Wet tomato pomace ensiled with corn plants for dairy cows.

The fermentation characteristics and nutritive value of a mixture of whole corn plants and wet tomato pomace were studied. Laboratory silos were filled with mixtures of corn plant dry matter (DM) and tomato pomace DM in the following ratios: 100:0, 94:6, and 88:12. The initial pH of the mixtures decreased linearly as the amount of tomato pomace increased, but no treatment effects were found after 3 d of ensiling. At d 56, concentrations of lactic acid and nonprotein N (as a percentage of total N) decreased linearly as tomato pomace increased. Whole corn plants were chopped from a single field, mixed with 0 or 12% tomato pomace (percentage of DM), and ensiled in two concrete stave silos. The addition of tomato pomace increased concentrations of crude protein (7.6 to 9.8%), lignin (2.4 to 6.1%), and fatty acids (2.5 to 3.8%). Both silages were mixed into an isonitrogenous total mixed ration that contained 40% concentrate. The total mixed rations were fed to lactating dairy cows for 60 d. Milk production (35.5 kg/d), milk composition, DMI (22.7 kg/d), nutrient digestibility, and N balance were not affected by the addition of tomato pomace. Wet tomato pomace can be blended with corn plants before ensiling without greatly altering fermentation. The nutritional value of the mixture was equivalent to that of untreated corn silage.

Animal Feed↗
PubMed1994

Changes in total and individual proteins during drying, ensiling, and ruminal fermentation of forages.

Effects of wilting, drying, and ensiling on concentrations of proteins in alfalfa, crown vetch, perennial ryegrass, orchardgrass, and tall fescue were studied using SDS-PAGE. Seven to nine proteins were identified in the samples. Wilting forages for 24 h on a laboratory bench had little effect on the relative amounts of proteins. Drying forage (on a laboratory bench) for 5 d resulted in a 25 to 30% loss in electrophoretically identified proteins. A 45-kDa protein was more susceptible to hydrolysis during drying than were most other proteins. After ensiling, < 10% of the proteins in fresh alfalfa and fescue remained, but crown vetch silage contained 46% of its original proteins. A 54-kDa protein was extremely susceptible to hydrolysis during ensiling, but a 30-kDa protein was relatively resistant. Fresh forage and hay samples were incubated in vitro for 5 h to determine degradation of proteins. In general, the 54-kDa protein was most susceptible, and the 30-kDa protein was least susceptible, to ruminal hydrolysis. Certain proteins in hay were more degradable than those in fresh forage. Among fresh forages, alfalfa and fescue contained the lowest concentrations of undegradable proteins. Differences among forage species were considerably less for hay samples.

Animal Feed↗
PubMed1986

Biological characteristics for assessing low phosphorus intake in finishing swine.

Three replicates of a randomized complete-block design in a 3 x 3 factorial arrangement of treatments involving 141 pigs were conducted to evaluate the effect of low P intake on various response criteria in swine from 65 to 95 kg body weight. Total dietary P levels of .09, .21 and .31% were each fed in a Ca:P ratio of 1.1, 1.5:1 or 2:1 for a 35-d experimental period. The basal diet was formulated using corn starch, dextrin and a soy protein concentrate with monosodium phosphate and limestone supplying desired treatment levels of Ca and P. Blood and bones were collected for mineral analysis. Gain and feed performance responses were not affected by Ca:P ration or dietary P level for the 35-d period. Serum inorganic P concentrations declined as Ca:P ratio increased, but increased as dietary P increased. Serum alkaline phosphatase activity increased with higher Ca:P ratios, and decreased as dietary P level increased. Percent bone ash was not influenced by Ca:P ratio, but increased as dietary P level increased. Bone-bending moment was influenced by Ca:P ratio, and increased linearly as dietary P increased. Dietary P level resulted in a linear increase in total bone and its ash component weight, and in the accretion of the ash and organic matrix component. These data suggest that between 65 to 95 kg body weight, percent bone ash was affected by dietary P level, while bone-bending moment, bone component weights, their accretion, both dietary p level and Ca:P ratio.

Animals↗
PubMed1985

Biological characteristics for assessing low phosphorus intake in growing swine.

A total of 195 swine from 18 to 35 kg were used to evaluate various biological responses of growing swine fed low P diets at different Ca:P ratios. Three replicates of a randomized complete-block design in a 3 X 3 factorial arrangement of treatments were used. Total dietary P levels of .12, .31 and .50% were fed in 1:1, 1.5:1 or 3:1 Ca:P ratios. Diets were formulated using corn starch, dextrin and soy protein concentrate, with monosodium phosphate and limestone used to supply appropriate dietary treatment levels of Ca and P. Gain and feed performance were generally influenced by both Ca:P ratio and dietary P level. Serum inorganic P decreased linearly as Ca:P ratio widened and increased linearly as dietary P increased. Serum Ca concentrations responded inversely to serum inorganic P in response to both Ca:P ratio and dietary P level. Serum alkaline phosphatase was not affected by Ca:P ratio, but declined quadratically with increasing dietary P level. Bone bending moment was influenced by both dietary P level and Ca:P ratio. Bone component weights (ash, organic matrix), percentage bone ash and net accretion of bone ash and organic component weights were not influenced by Ca:P ratio but increased linearly as dietary P level increased. These results suggest that bone component weights, net ash accretion and percentage bone ash were more sensitive criteria than bone bending moment or serum alkaline phosphatase, which in turn were more sensitive than serum inorganic P, Ca, Mg and growth performance characteristics in response to dietary P level.

Alkaline Phosphatase↗
PubMed1984

An evaluation of various biological characteristics in assessing low phosphorus intake in weanling swine.

A total of 204 weanling pigs were utilized in an experiment of 3 X 3 factorial design (in three replicates) to evaluate the effects of feeding low P diets for a 35 d period on various growth, serum and bone measurement characteristics. Total dietary P levels of .23, .35 and .55% were fed in a Ca:P ratio of 1:1, 1.5:1 or 3:1. The basal diet was formulated using cornstarch, dextrin and soy protein concentrate with monosodium phosphate and limestone used to supply appropriate dietary levels of Ca and P. Growth, serum minerals and serum alkaline phosphatase were evaluated at 21 and 35 d of the trial. At the end of the experiment six pigs/treatment group were killed and bones were collected for various measurement criteria. Daily gain, feed intake and feed conversion were not affected by Ca:P ratio, but there was an increased gain and feed intake response to dietary P level. Serum inorganic P decreased with increasing dietary Ca:P ratio and also increased linearly as dietary P level increased. Serum alkaline phosphatase activity was not influenced by dietary Ca:P ratio, but did decrease as dietary P level increased. Bone bending moment increased quadratically as Ca:P ratio increased, but also increased linearly with dietary P level. Percentage bone ash, bone ash and organic matrix weights and the accretion of both the mineral and matrix components were not affected by Ca:P ratio, but each was influenced as dietary P increased. These data suggest that percentage bone ash, bone component weights and accretion measurement characteristics were more sensitive indicators of dietary P levels than bone bending moment, serum alkaline phosphatase and serum P, which in turn were superior to serum Ca, Mg and growth performance.

Alkaline Phosphatase↗