Network-level consequences of outgroup threats in banded mongooses: Grooming and aggression between the sexes.

Animal groups are heterogeneous assemblages of individuals with differing fitness interests, which may lead to internal conflict over investment in group territorial defence. Differences between individuals may lead to different behavioural responses to intergroup conflict, particularly between the sexes. These potential impacts have been little studied. We used social network analysis to investigate the impact of simulated intergroup conflicts on social relationships in groups of wild banded mongooses Mungos mungo, in which intergroup fights are more costly for males than females. We predicted that social cohesion (specifically male-to-male and female-to-male grooming) would increase after conflict, and aggression would decrease, to minimize conflict between the sexes. Simulated intergroup conflicts were performed by exposing banded mongoose groups to scents, 'war cry' playbacks, and live intruders from a rival group. All grooming and aggression interactions between individuals were recorded, and grooming and aggression social networks were created for the 2 days preceding a simulated intergroup conflict (pre-conflict network) and the 2 days after (post-conflict network). We found no evidence of an increase in social cohesion after simulated conflicts, measured as grooming eigenvector centrality. Male-to-male, male-to-female and female-to-male grooming strength decreased after simulated intrusions compared to female-to-female grooming strength. However, male-female aggression decreased in intrusion trials compared to other interaction types, consistent with the hypothesis that intergroup encounters reduce the level of intragroup conflict between males and females. Males were more affected socially by intergroup encounters than females, which may be because they are investing in defence rather than internal relationships. Focusing on individual relationship changes, using social network analysis, can reveal changes in the directionality of behaviour in response to intergroup encounters, and highlight how individual responses to conflict may scale up to affect social networks and, potentially, group performance. This study highlights the importance of studying both group-level behaviours and individual relationships to more fully understand responses to intergroup encounters.

Paediatric hearing aid management: a demonstration project for using virtual visits to enhance parent support.

OBJECTIVE: The purpose of this study was to explore the use of virtual visits to monitor hearing aid use with data logging measurements and provide parent support for hearing aid management. DESIGN: A 6-month longitudinal case study design was used. STUDY SAMPLE: Four families and two providers participated. RESULTS: Average hours of daily hearing aid use increased 3.5 h from the beginning to the end of the study period. Prior to receiving virtual visits, the parents and the clinicians generally indicated they were hopeful about the benefits of virtual visits including the frequency and convenience of the appointments but had some concerns about technical difficulties. These concerns diminished at the conclusion of the study. CONCLUSION: Virtual visits provided benefits to families including flexibility and timely access to support. The ability to collect data logging information more frequently was important for effective problem-solving to increase hearing aid use. Both parents and clinicians were accepting of tele-support. Parents and professionals would benefit from technology that allows them to access data logging information more easily and frequently.

Pediatric Hearing Aid Management: Parent-Reported Needs for Learning Support.

OBJECTIVES: The aim of this study was to investigate parent learning and support needs related to hearing aid management for young children, and factors that influence parent-reported hours of hearing aid use. DESIGN: A cross-sectional survey design was used to collect survey data in seven states. The child's primary caregiver completed a demographic form, a questionnaire to explore parent learning and support needs as well as their challenges with hearing aid use, and the patient health questionnaire to identify symptoms of depression. Three hundred and eighteen parents completed the questionnaires. RESULTS: Responses were analyzed for 318 parents of children (M = 23.15 months; SD = 10.43; range: 3 to 51) who had been wearing hearing aids (M = 15.52; SD = 10.11; range: <1 to 50 months). Even though the majority of parents reported receiving the educational support queried, approximately one-third wanted more information on a variety of topics such as loaner hearing aids, what their child can/cannot hear, financial assistance, how to meet other parents, how to do basic hearing aid maintenance, and how to keep the hearing aids on their child. The most frequently reported challenges that interfered with hearing aid use (rated often or always) were child activities, child not wanting to wear the hearing aids, and fear of losing or damaging the hearing aids. Forty-two percent of parents reported that, on good days, their child used hearing aids all waking hours. Multiple regression was used to compare the effect on parent-reported typical hours of hearing aid use based on good days for the variables of (1) presence of depressive symptoms for the parent, (2) child age, (3) family income, (4) primary caregiver education level, (5) presence of additional disabilities for the child, (6) degree of hearing loss, and (7) length of time since the child was fitted with hearing aids. There were statistically significantly fewer hours of reported hearing aid use when parents reported mild to severe symptoms of depression, lower income, less education level, and when children had mild hearing loss or additional disabilities. CONCLUSION: Although parents reported overall that their needs for hearing aid education and support had generally been met, there were important suggestions for how audiologists and other service providers could better meet parent needs. Hearing aid use for young children was variable and influenced by a variety of factors. Understanding parent experiences and challenges can help audiologists more effectively focus support. Audiologists are more likely to meet the needs of families if they take care to provide access to thorough and comprehensive education and ongoing support that is tailored to address the unique needs of individual families.

Pediatric hearing aid use: parent-reported challenges.

OBJECTIVES: The aim of this study was to investigate parent-reported challenges related to hearing aid management and parental psychosocial characteristics during the first 3 years of the child's life. DESIGN: Using a cross-sectional survey design, surveys were distributed to parents of children with hearing loss via state Early Intervention programs in Utah and Indiana. Packets contained one family demographic form and two sets of three questionnaires to obtain responses from mothers and fathers separately: the Parent Hearing Aid Management Inventory explored parent access to information, parent confidence in performing skills, expectations, communication with the audiologist, and hearing aid use challenges. The Acceptance and Action Questionnaire measured psychological flexibility, experiential avoidance, and internal thought processes that can affect problem-solving ability and decrease an individual's ability to take value-based actions. The Patient Health Questionnaire identified symptoms of depression. Thirty-seven families completed questionnaires (35 mothers and 20 fathers). RESULTS: Most responses were parents of toddlers (M = 22 months) who had been wearing binaural hearing aids for an average of 15 months. Both mothers and fathers reported that even though the amount of information they received was overwhelming, most (84%) preferred to have all the information at the beginning, rather than to receive it over an extended time period. Parents reported an array of challenges related to hearing aid management, with the majority related to daily management, hearing aid use, and emotional adjustment. Sixty-six percent of parents reported an audiologist taught them how to complete a listening check using a stethoscope, however, only one-third reported doing a daily hearing aid listening check. Both mothers and fathers reported a wide range of variability in their confidence in performing activities related to hearing aid management, and most reported minimal confidence in their ability to troubleshoot hearing aid problems. More than half of the parents reported child behavior and activities, such as playing outside, as a major hearing aid use challenge. Parents reported hearing aids were worn all waking hours by 35% of children and less than 5 hr/day by 31%. Almost half of the parents (47%) did not feel that they had enough time to talk about their emotions when speaking with their audiologist(s), 69% reported the audiologist did not help them know what to expect related to emotions about their child's hearing loss, and 22% reported symptoms of depression. CONCLUSIONS: Parents reported an array of challenges, even after their child had been wearing hearing aids for a prolonged time, revealing critical implications for how to provide audiological care. Audiologists have an important role in partnering with parents to identify and jointly problem-solving challenges related to their child's hearing aid use. Supporting parents includes not only addressing technical aspects of hearing testing and hearing aid function but also addressing parent thoughts, feelings, and emotions.

Developing basic robotic skills using virtual reality simulation and automated assessment tools: a multidisciplinary robotic virtual reality-based curriculum using the Da Vinci Skills Simulator and tracking progress with the Intuitive Learning platform.

This study sought to develop basic robotic surgical skills among surgical trainees across multiple specialties using a VR-based curriculum and provided objective, on-demand, automated assessments using the Intuitive Learning platform. This curriculum was developed using the Da Vinci Skills Simulator and included 24 exercises. A pre-test and post-test were required for completion of the curriculum. Scores > 90 on individual exercises and the post-test were required for successful completion. The Intuitive learning platform provided automated performance metrics and tracked trainee progression. The curriculum was implemented and data collected over a 12-month period. 21 trainees completed the entire curriculum. Post-test scores were significantly higher than pre-test scores and trainees reported improvement in their robotic skills after curriculum completion. A comparison based on training level revealed that junior residents had significantly lower number of attempts per exercise, fewer penalties, and higher completion scores when compared to senior residents and fellows. Individual exercise analysis demonstrated that exercises, such as 'Three-Arm Relay' and 'Ring Rollercoaster', required the longest time and most attempts to achieve a passing score. The 'Energy Pedals' and 'Knot Tying' skills were the least-utilized skills addressed in the curriculum. Virtual reality-based curriculums using the Intuitive Learning platform can be standardized across multiple specialties allowing for the development of basic robotic skills, shared interdisciplinary surgical education, and provides powerful objective and automated performance metrics of trainees.

Comparison of test methods to assess the implanted ear alone for pediatric cochlear implant recipients with single-sided deafness.

OBJECTIVES: The purpose of this investigation was to compare three test methods for isolating the test ear for children with single-sided deafness (SSD) who use a cochlear implant (CI). METHODS: Word recognition was assessed for five CI recipients with SSD and six bilateral CI recipients with no acoustic hearing. For the SSD subjects, performance was compared: 1) in the sound field with masking in the normal-hearing ear, 2) in the sound field with an earplug and earmuff ("plug-and-muff"), and 3) via direct connect (DC). For the bilateral CI subjects, performance was compared: 1) in the sound field and 2) via DC. RESULTS: For the bilateral CI subjects, word recognition was similar when assessed in the sound field versus via DC. For the SSD subjects, performance was similar when assessed with the plug-and-muff and DC methods but was significantly poorer with masking presented to the normal-hearing ear. DISCUSSION: Masking the normal-hearing ear to isolate the CI for word recognition is problematic in this population. The plug-and-muff and DC test methods may provide a more accurate assessment. CONCLUSION: DC or plug-and-muff methods are recommended to isolate the CI-ear for word recognition testing in children with SSD. Patient specific variables should be considered.

Sound Opportunities: Factors That Impact Referral for Pediatric Cochlear Implant Evaluation.

OBJECTIVES/HYPOTHESIS: To identify barriers to and opportunities for referral among children who could be considered for cochlear implantation. STUDY DESIGN: Retrospective review. METHODS: Audiological and medical records were reviewed on all children who had diagnostic or hearing aid care through a statewide healthcare system over 5-year span to identify children who met newly established clinical cochlear implant (CI) referral criteria. Data were collected for 869 potential CI candidates regarding demographic, socio-economic, audiological, medical, and family factors that may influence referral. A binomial logistic regression was completed to investigate the potential contributions of these predictors toward referral for a CI evaluation. RESULTS: Children who met traditional candidacy criteria of severe-to-profound bilateral hearing loss were referred at very high rates, while nontraditional candidates were referred less frequently. Factors influencing referral included race, age, insurance source, hearing thresholds, audiologist, physician, and family request. CONCLUSIONS: Results suggest that bilateral traditional candidates are being referred at high percentages; however, current practices and trends in pediatric cochlear implantation should be shared with families and providers to increase referral rates for nontraditional candidates. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2904-E2910, 2021.

The dynamics of social cohesion in response to simulated intergroup conflict in banded mongooses.

Intergroup conflict is widespread in nature and is proposed to have strong impacts on the evolution of social behavior. The conflict-cohesion hypothesis predicts that exposure to intergroup conflict should lead to increased social cohesion to improve group success or resilience in future conflicts. There is evidence to support this prediction from studies of affiliative responses to outgroup threats in some animal societies. However, most of these studies have focused on behavioral changes over short time periods (minutes and hours after exposure to an outgroup), and hence very little is known about the dynamics and durability of responses to intergroup conflict over the longer term. We investigated this question by simulating intergroup encounters in wild banded mongooses (Mungos mungo) and measuring social behavior before, during, and after these encounters over a 5-day period. We also ran control trials with non-threatening stimuli. Banded mongooses reacted immediately to intrusion stimuli by vocalizing, grouping together, and advancing on the stimulus. In the first 5 min after simulated intrusions, we saw an elevation in grooming levels, but in the hour after exposure grooming rates declined sharply, contrary to our expectation. In the two subsequent days, grooming rates remained at this depressed rate. In control trials, the initial increase in grooming was not seen, but grooming declined compared to the longer-term time periods. Grooming changed across time, but not in the same pattern as during intrusions, suggesting that intrusions had an impact above and beyond that of the experimental setup. The dynamics of grooming responses were short lived and more complex than we initially expected. We suggest this unexpected result may be linked to the frequency of aggressive intergroup encounters in this system. As control and experimental trials were run at different times of year, future work would be needed to confirm that these relative patterns are replicable. Our results indicate short-lived impacts of outgroup threat on measures of social cohesion in this species, but cannot confirm longer-term changes.

Molecular population genetics of SLC4A1 and Southeast Asian ovalocytosis.

Southeast Asian ovalocytosis (SAO) is an erythrocyte abnormality that protects affected individuals from cerebral malaria. This trait is caused by a 27-bp deletion in the SLC4A1 gene, which is lethal when homozygous. We reseqeunced approximately 5 kb of SLC4A1 in an Indonesian population where SAO is prevalent to better understand the evolution of this clinically important trait. The four SAO chromosomes we resequenced share a single haplotype that differs from a sampled non-SAO haplotype only by the 27-bp deletion. Comparison of Indonesian sequence data to that from two other Asian populations (aboriginal Taiwanese and Japanese) shows Indonesian SLC4A1 to be strongly differentiated from the Taiwanese, but not the Japanese. Indeed, the Taiwanese sample contains only chromosomes that are highly divergent from all sampled SAO chromosomes. Because earlier studies have found an association between Austronesian-speakers (who most likely originated in Taiwan) and SAO, our failure to find SAO-like chromosomes in Taiwan is unexpected. Finally, our data find a strong excess of high-frequency derived alleles in all three populations. These alleles include the non-synonymous 'Memphis' variant, which is known to affect anion transport across the erythrocyte membrane. Our data suggest a role for recent natural selection acting on Memphis or a linked variant.

Borrowing from Peter to pay Paul: managing threatened predators of endangered and declining prey species.

Conservation policy and practice can sometimes run counter to their mutual aims of ensuring species survival. In Kenya, where threatened predators such as lion deplete endangered prey such as Grevy's zebra, conservation practitioners seek to ensure species success through exclusive strategies of protection, population increase and preservation. We found strong selection for the endangered Grevy's zebra by both lion and hyena on two small fenced conservancies in Kenya. Despite abundant diversity of available prey, Grevy's zebra were selected disproportionately more than their availability, while other highly available species such as buffalo were avoided. Lions were therefore not alone in presenting a credible threat to Grevy's zebra survival. Conservation practitioners must consider interlinked characteristics of prey selection, resource availability and quality, the interplay between carnivore guild members and landscape scale population trends performance in wildlife management decisions.

Implementation and evaluation of a pilot education programme in colorectal cancer management for nurses in Scotland.

This paper describes the results of an evaluation of a nursing education programme for nurses caring for patients with colorectal cancer. A sample of 67 registered nurses from 6 location sites within the 3 Regional Cancer Networks in Scotland were recruited to the pilot. The programme was adapted from an evidence-based education manual for nurses in the management of colorectal cancer developed by the European Oncology Nursing Society as part of a Nursing in Colorectal Cancer Initiative (NICCI) [Hawthorn, J., Redmond, K., 1999. A Guide to Colorectal Cancer. AstraZeneca Oncology, UK]. The format for evaluating the programme was based on the TELER method of treatment evaluation [Le Roux, A.A., 1995. TELER: the concept. Physiotherapy 79 (11), 755-758] that had previously been developed along side the training manual [Grocott, P., Richardson, A., Ambaum, B., Kearney, N., Redmond, K, 2001a. Nursing in colorectal cancer initiative--the audit phase. Part 1. Development of the audit tool. European Journal of Oncology Nursing 5 (2), 100-111; Grocott, P., Richardson, A., Ambaum, B., Kearney, N., Redmond, K., 2001b. Nursing in colorectal cancer initiative: the audit phase. Part 2. Content validity of the audit tool and implications of the standards set for clinical practice. European Journal of Oncology Nursing 5 (3), 165-173] for cytotoxic chemotherapy to provide the NICCI Audit Tool (Le Roux, 2003). This model was developed further in the current study to include the domains of: Disease, Diagnosis and Staging, Treatment, Nursing Issues and General Issues. Data were analysed descriptively and are discussed. Overall the results from this study demonstrate a statistically significant improvement in disease-related knowledge (p=<0.001) and in the best practice statements for nursing issues (p=<0.001) and general issues (including attitudes) (p=0.023) that were maintained at four months post completion of the course.

Consequences of in utero exposure to Zika virus in offspring of AG129 mice.

Zika virus (ZIKV) can cause various diseases in offspring after congenital infection. The purpose of this study was to identify disease phenotypes in pups exposed to ZIKV in utero. Female interferon-α/ß, -γ receptor knockout mice (AG129) were infected intraperitoneally with ZIKV 7.5 days' post coitus (dpc). Viral RNA, antigen and infectious virus were detected in some, but not all, maternal and fetal tissues at various times during gestation. Fetuses of infected dams had significant intrauterine growth restriction (IUGR), which was more pronounced as females neared parturition. Pups born to infected dams were significantly smaller and had significantly shortened skull lengths, as determined by measurement with a caliper and by micro-CT analysis, as compared with age-matched controls. Growth rates of exposed pups after birth, however, was similar to sham-exposed offspring. Viral RNA was detected in pups of infected dams after birth. A lower survival rate was observed in neonates exposed to ZIKV in utero. A mortality rate of over 50%, attributed to consequences of ZIKV infection, occurred after birth in pups born to infected dams. A transient hearing loss was observed in some animals exposed to virus in utero. No motor deficits or cognitive deficits were detected using running wheel or viral paresis scoring assays. Abnormalities in offspring included smaller size, shorter skull length and increased neonatal mortality, while the only functional deficit we could detect was a low incidence of transient hearing loss.

Developing and piloting a nurse-led model of follow-up in the multidisciplinary management of colorectal cancer.

One of the main challenges of colorectal cancer follow-up is the detection of early disease in order to influence survival and improve outcome. Yet, the benefits of follow-up are not only related to survival. It is well documented that patients can experience an array of problems following colorectal cancer surgery which impact upon quality of life, therefore symptom management plays an important part in the overall spectrum of follow-up care. In addition, there is emerging evidence to suggest that clinical nurse specialists are well placed in the multidisciplinary team to co-ordinate such follow-up programmes. This paper reports on a pilot study designed to assess the feasibility of a follow-up programme led by nurse specialists for patients with colorectal cancer. Key outcome areas were adherence to an agreed follow-protocol, quality of life, patient and clinician satisfaction and a cost-analysis of the new model. The study was conducted over one year with 60 patients. This redesign resulted in a smoother pathway of follow-up care, improved quality of life and acceptance to both patients and clinicians alike. The introduction of a nurse-led follow-up model is expected to demonstrate cost savings over a 3 year rolling follow-up programme.

Audiologist Practices: Parent Hearing Aid Education and Support.

BACKGROUND: Early identification of hearing loss has led to routine fitting of hearing aids in infants and young children. Amplification provides opportunities to optimize child development, although it also introduces challenges for parents to navigate. Audiologists have a central role in providing parents with support to achieve effective management strategies and habits. PURPOSE: The purpose of this study was to explore current practices of pediatric audiologists who work with children birth to 5 yr of age, regarding their support of parent learning in achieving effective hearing aid management, identify existing gaps in service delivery, and to determine if audiologists were receptive to receiving training related to effective approaches to provide counseling and support to parents. RESEARCH DESIGN: A cross-sectional, population-based survey was used. STUDY SAMPLE: Three hundred and forty-nine surveys were analyzed from pediatric audiologists who provided services to children birth to 5 yr of age. Responses were received from 22 states in the United States. DATA COLLECTION AND ANALYSIS: Responses were collected through the mail and online. Descriptive statistics were used to analyze the information. RESULTS: More than half (61%) of the audiologists in the study had been providing pediatric hearing aid services to children birth to 5 yr of age for >10 yr. Of the audiologists who reported monitoring hours of hearing aid use, the majority reported that they used data logging (90%). More than half of the audiologists (57%) who shared data logging with parents reported that they encountered defensiveness from parents when addressing hearing aid use. Information and skills that were not routinely provided by one-third to one-half of the audiologists included the following: how to get access to loaner hearing aids (30%), available hearing aid options/accessories (33%), available financial assistance (36%), how to teach hearing aid management to other caregivers (38%), how to do hearing aid maintenance (44%), and how to do a Ling 6 sound check (52%). Many audiologists reported they did not frequently collaborate with speech-language pathologists (48%), early interventionists (47%), or physicians (68%). More than half of the audiologists indicated a desire for more training in counseling skills, for all 14 items queried, to support parents with hearing aid management (53-79%), regardless of their previous training experience. CONCLUSIONS: For young children with hearing loss to achieve optimal benefit from auditory experiences for speech and language development, they need evidence-based, comprehensive, and coordinated hearing aid management. Audiologists have an important role for teaching information and skills related to hearing aids, supporting parent learning, and collaborating with other providers. Pediatric audiologists in this study recognized and desired the need for further training in counseling skills that can better prepare them to meet the emotional needs of parents in the hearing aid management process.

Comparison of the efficacy of two name-learning techniques: expanding rehearsal and name-face imagery.

Two name-learning techniques were compared: expanding rehearsal and name-face imagery. Participants studied name-face associations and were given a cued recall test in which they were presented with a face and were to recall the name. They were presented with either an expanding rehearsal schedule (expanding condition), a distinctive facial feature coupled with a word phonologically similar to the last name and an interactive image linking the name and facial feature (name-face imagery condition), or a no memory (control) strategy. The expanding rehearsal schedule led to superior name learning relative to the name-face imagery and control conditions after a 15-min (Experiment 1) or 48-hr (Experiment 2) retention interval. In Experiment 3, the retrieval practice explanation was tested but not supported; we argue that an encoding variability interpretation is consistent with the overall pattern of results. Applied implications are also discussed.

Pediatric hearing aid use: how can audiologists support parents to increase consistency?

BACKGROUND: Children need consistent access to the full range of speech sounds for spoken language development, making daily hearing aid management a fundamental component of effective intervention. In addition to receiving services from professionals with expertise in childhood hearing loss, parents play a central role in the intervention process. However, parents can experience an array of barriers and challenges in learning to cope with the demands of daily management. Feedback about hearing aid use time might offer parents insight into challenges and lead to the identification of strategies to increase use, optimizing child outcomes. PURPOSE: This exploratory study had 2 primary purposes: (1) to examine hearing aid use time for a cohort of children 7 mo to 6 yr of age and (2) to examine whether hearing aid use time increased when parents were given periodic objective feedback (i.e., data-logging results) about average daily use time. RESEARCH DESIGN: A retrospective chart review was used to collect data on eligible participants. RESULTS: Findings for 29 children (7 mo to 6 yr of age) revealed variability in hours of hearing aid use and an increase in hours of use with age and severity of hearing loss. Reports of typical hearing aid use from seven parents revealed that parents overestimated use by an average of 3.36 hr. Review of challenges reported revealed issues with retention, awareness of the effect of nonuse on average daily access to sound, and lack of perceived benefit of hearing aid use. Hearing aid use increased with communication about data logging for some, but not all, parents. CONCLUSIONS: For effective integration of essential hearing aid management skills into the daily lives of primary caregivers, audiologists must consider caregiver needs in the overall child management and monitoring plan. The ability to optimize child outcomes might depend in part on the extent audiologists embrace family-centered services, engage in collaborative problem solving, and support parents in applying individualized strategies.

Can we rely on the Dermatology Life Quality Index as a measure of the impact of psoriasis or atopic dermatitis?

The Dermatology Life Quality Index (DLQI) is a widely used health-related quality of life measure. However, little research has been conducted on its dimensionality. The objectives of the current study were to apply Rasch analysis to DLQI data to determine whether the scale is unidimensional, to assess its measurement properties, test the response format, and determine whether the measure exhibits differential item functioning (DIF) by disease (atopic dermatitis versus psoriasis), gender, or age group. The results show that there were several problems with the scale, including misfitting items, DIF by disease, age, and gender, disordered response thresholds, and inadequate measurement of patients with mild illness. As the DLQI did not benefit from the application of Rasch analysis in its development, it is argued that a new measure of disability related to dermatological disease is required. Such a measure should use a coherent measurement model and ensure that items are relevant to all potential respondents. The current use of the DLQI as a guide to treatment selection is of concern, given its inadequate measurement properties.