Incidence of intrauterine adhesion after ultrasound-guided manual vacuum aspiration (USG-MVA) for first-trimester miscarriages: a prospective cohort study.

PURPOSE: Ultrasound-guided manual vacuum aspiration (USG-MVA) is a feasible and effective outpatient treatment to treat early pregnancy loss. METHODS: This was a prospective observational study at a university-affiliated hospital. All women undergoing either a USG-MVA or electric vacuum aspiration (EVA) were invited to return 3-6 months later for follow-up at which women completed a questionnaire to document their post-evacuation menstrual and reproductive history, and underwent a hysteroscopy if they were not pregnant. The severity of intrauterine adhesion (IUA), if present, was graded (Stage I-III) according to the American fertility society classification. RESULTS: A total of 292 women had a hysteroscopy after their initial surgical evacuation, USG-MVA 169(57.9%) versus EVA 123(42.1%). Women undergoing EVA as opposed to a USG-MVA had a 12.9% higher incidence of IUA (24.1% vs. 37.0%, p = 0.042) equivalent to 1.84 times higher risk (95% CI 1.01-3.34; p = 0.048). Women having EVA continued to show an increased but not statistically significant trend towards an increased risk of IUA after adjusting for the type of miscarriage (aOR = 1.3; 95% CI 0.66-2.50; p = 0.46). CONCLUSION: There were no significant differences in their reproductive outcomes and fewer women post-USG-MVA complained of hypomenorrhea. IUA may still occur in women undergoing USG-MVA but it is lower than the rate in women undergoing EVA. Clinical trials registry The trial was registered with the Centre for Clinical Research and Biostatistics - Clinical Trials Registry (CCRBCTR), a partner registry of the WHO Primary Registry-Chinese Clinical Trials Registry (ChiCTR) with a Unique Trial Number: CUHK_CCRB00541 on 22 Dec 2016.

Longitudinal analysis of anti-SARS-CoV-2 neutralizing antibody (NAb) titers in vaccinees using a novel giant magnetoresistive (GMR) assay.

The COVID-19 pandemic has highlighted the need to monitor important correlates of immunity on a population-wide level. To this end, we have developed a competitive assay to assess neutralizing antibody (NAb) titer on the giant magnetoresistive (GMR) biosensor platform. We compared the clinical performance of our biosensor with established techniques such as Ortho's VITROS Anti-SARS-CoV-2 IgG Quantitative Antibody test. Results obtained between the VITROS test and the GMR assay showed correlation (r = -0.93). We then validated the assay with patient plasma samples that had been tested using focus reduction neutralization testing (FRNT). The results obtained from our GMR assay exhibit a previously identified trend of increased NAb titers 2 weeks post-vaccination. We further evaluated NAb titers 6 months post-vaccination and observed waning neutralizing antibody titers over that time in vaccinated patients. In addition, we calibrated our assay to an arbitrary unit (IU/mL) using World Health Organization (WHO) reference plasma provided by the National Institute of Biological Standards and Control (NIBSC). Our biosensor provides highly specific and sensitive results in serum and plasma with analytical, clinical, and point-of-care (POC) applications due to quick turnaround times on samples and the cost-effectiveness of the platform.

The Effects of Task Difficulty Predictability and Noise Reduction on Recall Performance and Pupil Dilation Responses.

OBJECTIVES: Communication requires cognitive processes which are not captured by traditional speech understanding tests. Under challenging listening situations, more working memory resources are needed to process speech, leaving fewer resources available for storage. The aim of the current study was to investigate the effect of task difficulty predictability, that is, knowing versus not knowing task difficulty in advance, and the effect of noise reduction on working memory resource allocation to processing and storage of speech heard in background noise. For this purpose, an "offline" behavioral measure, the Sentence-Final Word Identification and Recall (SWIR) test, and an "online" physiological measure, pupillometry, were combined. Moreover, the outcomes of the two measures were compared to investigate whether they reflect the same processes related to resource allocation. DESIGN: Twenty-four experienced hearing aid users with moderate to moderately severe hearing loss participated in this study. The SWIR test and pupillometry were measured simultaneously with noise reduction in the test hearing aids activated and deactivated in a background noise composed of four-talker babble. The task of the SWIR test is to listen to lists of sentences, repeat the last word immediately after each sentence and recall the repeated words when the list is finished. The sentence baseline dilation, which is defined as the mean pupil dilation before each sentence, and task-evoked peak pupil dilation (PPD) were analyzed over the course of the lists. The task difficulty predictability was manipulated by including lists of three, five, and seven sentences. The test was conducted over two sessions, one during which the participants were informed about list length before each list (predictable task difficulty) and one during which they were not (unpredictable task difficulty). RESULTS: The sentence baseline dilation was higher when task difficulty was unpredictable compared to predictable, except at the start of the list, where there was no difference. The PPD tended to be higher at the beginning of the list, this pattern being more prominent when task difficulty was unpredictable. Recall performance was better and sentence baseline dilation was higher when noise reduction was on, especially toward the end of longer lists. There was no effect of noise reduction on PPD. CONCLUSIONS: Task difficulty predictability did not have an effect on resource allocation, since recall performance was similar independently of whether task difficulty was predictable or unpredictable. The higher sentence baseline dilation when task difficulty was unpredictable likely reflected a difference in the recall strategy or higher degree of task engagement/alertness or arousal. Hence, pupillometry captured processes which the SWIR test does not capture. Noise reduction frees up resources to be used for storage of speech, which was reflected in the better recall performance and larger sentence baseline dilation toward the end of the list when noise reduction was on. Thus, both measures captured different temporal aspects of the same processes related to resource allocation with noise reduction on and off.

How Do We Allocate Our Resources When Listening and Memorizing Speech in Noise? A Pupillometry Study.

OBJECTIVES: Actively following a conversation can be demanding and limited cognitive resources must be allocated to the processing of speech, retaining and encoding the perceived content, and preparing an answer. The aim of the present study was to disentangle the allocation of effort into the effort required for listening (listening effort) and the effort required for retention (memory effort) by means of pupil dilation. DESIGN: Twenty-five normal-hearing German speaking participants underwent a sentence final word identification and recall test, while pupillometry was conducted. The participants' task was to listen to a sentence in four-talker babble background noise and to repeat the final word afterward. At the end of a list of sentences, they were asked to recall as many of the final words as possible. Pupil dilation was recorded during different list lengths (three sentences versus six sentences) and varying memory load (recall versus no recall). Additionally, the effect of a noise reduction algorithm on performance, listening effort, and memory effort was evaluated. RESULTS: We analyzed pupil dilation both before each sentence (sentence baseline) as well as the dilation in response to each sentence relative to the sentence baseline (sentence dilation). The pupillometry data indicated a steeper increase of sentence baseline under recall compared to no recall, suggesting higher memory effort due to memory processing. This increase in sentence baseline was most prominent toward the end of the longer lists, that is, during the second half of six sentences. Without a recall task, sentence baseline declined over the course of the list. Noise reduction appeared to have a significant influence on effort allocation for listening, which was reflected in generally decreased sentence dilation. CONCLUSION: Our results showed that recording pupil dilation in a speech identification and recall task provides valuable insights beyond behavioral performance. It is a suitable tool to disentangle the allocation of effort to listening versus memorizing speech.

Three New Outcome Measures That Tap Into Cognitive Processes Required for Real-Life Communication.

To increase the ecological validity of outcomes from laboratory evaluations of hearing and hearing devices, it is desirable to introduce more realistic outcome measures in the laboratory. This article presents and discusses three outcome measures that have been designed to go beyond traditional speech-in-noise measures to better reflect realistic everyday challenges. The outcome measures reviewed are: the Sentence-final Word Identification and Recall (SWIR) test that measures working memory performance while listening to speech in noise at ceiling performance; a neural tracking method that produces a quantitative measure of selective speech attention in noise; and pupillometry that measures changes in pupil dilation to assess listening effort while listening to speech in noise. According to evaluation data, the SWIR test provides a sensitive measure in situations where speech perception performance might be unaffected. Similarly, pupil dilation has also shown sensitivity in situations where traditional speech-in-noise measures are insensitive. Changes in working memory capacity and effort mobilization were found at positive signal-to-noise ratios (SNR), that is, at SNRs that might reflect everyday situations. Using stimulus reconstruction, it has been demonstrated that neural tracking is a robust method at determining to what degree a listener is attending to a specific talker in a typical cocktail party situation. Using both established and commercially available noise reduction schemes, data have further shown that all three measures are sensitive to variation in SNR. In summary, the new outcome measures seem suitable for testing hearing and hearing devices under more realistic and demanding everyday conditions than traditional speech-in-noise tests.

Fertility preservation in Hong Kong Chinese society: awareness, knowledge and acceptance.

BACKGROUND: Fertility preservation for both medical and non-medical reasons are gaining increasing attention world-wide. This study aimed to evaluate the awareness, knowledge and acceptance on fertility preservation in Hong Kong Chinese. METHODS: This was a cross-sectional study carried out between June 2016 to March 2017. A self-administered questionnaire was distributed by convenience sampling. RESULTS: Forty two percent of subjects returned the questionnaire (n = 296/697). Among them, only 54.3% were aware of any means of fertility preservation. Tertiary educated individuals are more aware than less educated individuals (73.6% versus 46.6%, p < 0.001). The most commonly known method is oocyte cryopreservation (94.3%). Most of the respondents (80%) were interested to know about fertility preservation, 84.1% considered fertility preservation counselling necessary and 83.3% would consider undergoing fertility preservation if a treatment has a high chance of causing infertility despite the possibility of delay in cancer treatment. Up to 93.9% agreed to set up a dedicated referral centre with government funding and 73.4% agreed that fertility preservation for medical indication should be provided as a government funded service. In terms of fertility preservation for non-medical reason, 65.5 and 70.4% agreed that fertility preservation should be offered to single men and women without partner respectively, while only 53.3 and 50% agreed that fertility preservation is acceptable for delay in childbearing for career development in female and male respectively. CONCLUSION: There was a low awareness but positive attitude towards fertility preservation among Hong Kong Chinese. Acceptance towards medically indicated fertility preservation is high while a considerable number also accepts it for non-medical reasons. Educational campaigns are required to arouse awareness of fertility preservation to prevent individuals being deprived of the option due to lack of knowledge. Dedicated referral centre with established efficient patient referral pathways and financial support should be provided to improve the provision and uptake of fertility preservation service to enhance the reproductive potential and life options of women.

Hearing aid experience and background noise affect the robust relationship between working memory and speech recognition in noise.

Objective: The aim of this study was to examine how background noise and hearing aid experience affect the robust relationship between working memory and speech recognition.Design: Matrix sentences were used to measure speech recognition in noise. Three measures of working memory were administered. Study sample: 148 participants with at least 2 years of hearing aid experience.Results: A stronger overall correlation between working memory and speech recognition performance was found in a four-talker babble than in a stationary noise background. This correlation was significantly weaker in participants with most hearing aid experience than those with least experience when background noise was stationary. In the four-talker babble, however, no significant difference was found between the strength of correlations between users with different experience.Conclusion: In general, more explicit processing of working memory is invoked when listening in a multi-talker babble. The matching processes (cf. Ease of Language Understanding model, ELU) were more efficient for experienced than for less experienced users when perceiving speech. This study extends the existing ELU model that mismatch may also lead to the establishment of new phonological representations in the long-term memory.

The effects of task difficulty, background noise and noise reduction on recall.

OBJECTIVE: In the present study, we investigated whether varying the task difficulty of the Sentence-Final Word Identification and Recall (SWIR) Test has an effect on the benefit of noise reduction, as well as whether task difficulty predictability affects recall. The relationship between working memory and recall was examined. DESIGN: Task difficulty was manipulated by varying the list length with noise reduction on and off in competing speech and speech-shaped noise. Half of the participants were informed about list length in advance. Working memory capacity was measured using the Reading Span. STUDY SAMPLE: Thirty-two experienced hearing aid users with moderate sensorineural hearing loss. RESULTS: Task difficulty did not affect the noise reduction benefit and task difficulty predictability did not affect recall. Participants may have employed a different recall strategy when task difficulty was unpredictable and noise reduction off. Reading Span scores positively correlated with the SWIR test. Noise reduction improved recall in competing speech. CONCLUSIONS: The SWIR test with varying list length is suitable for detecting the benefit of noise reduction. The correlation with working memory suggests that the SWIR test could be modified to be adaptive to individual cognitive capacity. The results on noise and noise reduction replicate previous findings.

Perceptual Doping: An Audiovisual Facilitation Effect on Auditory Speech Processing, From Phonetic Feature Extraction to Sentence Identification in Noise.

OBJECTIVE: We have previously shown that the gain provided by prior audiovisual (AV) speech exposure for subsequent auditory (A) sentence identification in noise is relatively larger than that provided by prior A speech exposure. We have called this effect "perceptual doping." Specifically, prior AV speech processing dopes (recalibrates) the phonological and lexical maps in the mental lexicon, which facilitates subsequent phonological and lexical access in the A modality, separately from other learning and priming effects. In this article, we use data from the n200 study and aim to replicate and extend the perceptual doping effect using two different A and two different AV speech tasks and a larger sample than in our previous studies. DESIGN: The participants were 200 hearing aid users with bilateral, symmetrical, mild-to-severe sensorineural hearing loss. There were four speech tasks in the n200 study that were presented in both A and AV modalities (gated consonants, gated vowels, vowel duration discrimination, and sentence identification in noise tasks). The modality order of speech presentation was counterbalanced across participants: half of the participants completed the A modality first and the AV modality second (A1-AV2), and the other half completed the AV modality and then the A modality (AV1-A2). Based on the perceptual doping hypothesis, which assumes that the gain of prior AV exposure will be relatively larger relative to that of prior A exposure for subsequent processing of speech stimuli, we predicted that the mean A scores in the AV1-A2 modality order would be better than the mean A scores in the A1-AV2 modality order. We therefore expected a significant difference in terms of the identification of A speech stimuli between the two modality orders (A1 versus A2). As prior A exposure provides a smaller gain than AV exposure, we also predicted that the difference in AV speech scores between the two modality orders (AV1 versus AV2) may not be statistically significantly different. RESULTS: In the gated consonant and vowel tasks and the vowel duration discrimination task, there were significant differences in A performance of speech stimuli between the two modality orders. The participants' mean A performance was better in the AV1-A2 than in the A1-AV2 modality order (i.e., after AV processing). In terms of mean AV performance, no significant difference was observed between the two orders. In the sentence identification in noise task, a significant difference in the A identification of speech stimuli between the two orders was observed (A1 versus A2). In addition, a significant difference in the AV identification of speech stimuli between the two orders was also observed (AV1 versus AV2). This finding was most likely because of a procedural learning effect due to the greater complexity of the sentence materials or a combination of procedural learning and perceptual learning due to the presentation of sentential materials in noisy conditions. CONCLUSIONS: The findings of the present study support the perceptual doping hypothesis, as prior AV relative to A speech exposure resulted in a larger gain for the subsequent processing of speech stimuli. For complex speech stimuli that were presented in degraded listening conditions, a procedural learning effect (or a combination of procedural learning and perceptual learning effects) also facilitated the identification of speech stimuli, irrespective of whether the prior modality was A or AV.

Simulation-based assessment in anesthesia: an international multicentre validation study.

PURPOSE: Simulated clinical events provide a means to evaluate a practitioner's performance in a standardized manner for all candidates that are tested. We sought to provide evidence for the validity of simulation-based assessment tools in simulated pediatric anesthesia emergencies. METHODS: Nine centres in two countries recruited subjects to participate in simulated operating room events. Participants ranged in anesthesia experience from junior residents to staff anesthesiologists. Performances were video recorded for review and scored by specially trained, blinded, expert raters. The rating tools consisted of scenario-specific checklists and a global rating scale that allowed the rater to make a judgement about the subject's performance, and by extension, preparedness for independent practice. The reliability of the tools was classified as "substantial" (intraclass correlation coefficients ranged from 0.84 to 0.96 for the checklists and from 0.85 to 0.94 for the global rating scale). RESULTS: Three-hundred and ninety-one simulation encounters were analysed. Senior trainees and staff significantly out-performed junior trainees (P = 0.04 and P < 0.001 respectively). The effect size of grade (junior vs senior trainee vs staff) on performance was classified as "medium" (partial η2 = 0.06). Performance deficits were observed across all grades of anesthesiologist, particularly in two of the scenarios. CONCLUSIONS: This study supports the validity of our simulation-based anesthesiologist assessment tools in several domains of validity. We also describe some residual challenges regarding the validity of our tools, some notes of caution in terms of the intended consequences of their use, and identify opportunities for further research.

Magneto-nanosensor smartphone platform for the detection of HIV and leukocytosis at point-of-care.

The advent of personalized medicine has brought an increased interest in personal health among general consumers. As a result, there is a great need for user-centric point-of-care (POC) health devices. Such devices are equally pertinent in developing countries or resource-limited settings for performing diagnostic tests. However, current POC tests for diseases such as human immunodeficiency virus (HIV) or leukocytosis do not provide adequate levels of sensitivity or do not exist at all. Here, we extend our mobile magneto-nanosensor platform to point-of-care HIV and leukocytosis detection. The platform can be multiplexed, and the circuitry enables portability and sensitivity in the POC setting. A smartphone application simplifies operation and provides guidance to facilitate self-testing. Commercially available POC test kits typically provide only qualitative or semi-quantitative results of a single analyte. The magneto-nanosensor platform can provide users with pleasant user-experience while demonstrating robust sensitive and specific multiplexed quantification and detection of common diseases.

Using Speech Recall in Hearing Aid Fitting and Outcome Evaluation Under Ecological Test Conditions.

In adaptive Speech Reception Threshold (SRT) tests used in the audiological clinic, speech is presented at signal to noise ratios (SNRs) that are lower than those generally encountered in real-life communication situations. At higher, ecologically valid SNRs, however, SRTs are insensitive to changes in hearing aid signal processing that may be of benefit to listeners who are hard of hearing. Previous studies conducted in Swedish using the Sentence-final Word Identification and Recall test (SWIR) have indicated that at such SNRs, the ability to recall spoken words may be a more informative measure. In the present study, a Danish version of SWIR, known as the Sentence-final Word Identification and Recall Test in a New Language (SWIRL) was introduced and evaluated in two experiments. The objective of experiment 1 was to determine if the Swedish results demonstrating benefit from noise reduction signal processing for hearing aid wearers could be replicated in 25 Danish participants with mild to moderate symmetrical sensorineural hearing loss. The objective of experiment 2 was to compare direct-drive and skin-drive transmission in 16 Danish users of bone-anchored hearing aids with conductive hearing loss or mixed sensorineural and conductive hearing loss. In experiment 1, performance on SWIRL improved when hearing aid noise reduction was used, replicating the Swedish results and generalizing them across languages. In experiment 2, performance on SWIRL was better for direct-drive compared with skin-drive transmission conditions. These findings indicate that spoken word recall can be used to identify benefits from hearing aid signal processing at ecologically valid, positive SNRs where SRTs are insensitive.

Hearing impairment, cognition and speech understanding: exploratory factor analyses of a comprehensive test battery for a group of hearing aid users, the n200 study.

OBJECTIVE: The aims of the current n200 study were to assess the structural relations between three classes of test variables (i.e. HEARING, COGNITION and aided speech-in-noise OUTCOMES) and to describe the theoretical implications of these relations for the Ease of Language Understanding (ELU) model. STUDY SAMPLE: Participants were 200 hard-of-hearing hearing-aid users, with a mean age of 60.8 years. Forty-three percent were females and the mean hearing threshold in the better ear was 37.4 dB HL. DESIGN: LEVEL1 factor analyses extracted one factor per test and/or cognitive function based on a priori conceptualizations. The more abstract LEVEL 2 factor analyses were performed separately for the three classes of test variables. RESULTS: The HEARING test variables resulted in two LEVEL 2 factors, which we labelled SENSITIVITY and TEMPORAL FINE STRUCTURE; the COGNITIVE variables in one COGNITION factor only, and OUTCOMES in two factors, NO CONTEXT and CONTEXT. COGNITION predicted the NO CONTEXT factor to a stronger extent than the CONTEXT outcome factor. TEMPORAL FINE STRUCTURE and SENSITIVITY were associated with COGNITION and all three contributed significantly and independently to especially the NO CONTEXT outcome scores (R(2) = 0.40). CONCLUSIONS: All LEVEL 2 factors are important theoretically as well as for clinical assessment.

Noise reduction improves memory for target language speech in competing native but not foreign language speech.

OBJECTIVES: A hearing aid noise reduction (NR) algorithm reduces the adverse effect of competing speech on memory for target speech for individuals with hearing impairment with high working memory capacity. In the present study, we investigated whether the positive effect of NR could be extended to individuals with low working memory capacity, as well as how NR influences recall performance for target native speech when the masker language is non-native. DESIGN: A sentence-final word identification and recall (SWIR) test was administered to 26 experienced hearing aid users. In this test, target spoken native language (Swedish) sentence lists were presented in competing native (Swedish) or foreign (Cantonese) speech with or without binary masking NR algorithm. After each sentence list, free recall of sentence final words was prompted. Working memory capacity was measured using a reading span (RS) test. RESULTS: Recall performance was associated with RS. However, the benefit obtained from NR was not associated with RS. Recall performance was more disrupted by native than foreign speech babble and NR improved recall performance in native but not foreign competing speech. CONCLUSIONS: Noise reduction improved memory for speech heard in competing speech for hearing aid users. Memory for native speech was more disrupted by native babble than foreign babble, but the disruptive effect of native speech babble was reduced to that of foreign babble when there was NR.

Microfluidic immunodetection of cancer cells via site-specific microcontact printing of antibodies on nanoporous surface.

We demonstrate an efficient method for cancer cell capture via cell line-specific protein deposition on nanoporous surface in microfluidic channels. Specifically, anti-epithelial cell adhesion molecules (EpCAM) were microcontact printed onto nanoporous silica substrate with optimal pore size of 4 nm, porosity of 52.4 ± 0.2%, and thin film thickness of 130 ± 0.5 nm. SkBr3, Colo205, and MDA-MB-435 cancer cells suspended in buffer solution were captured on the stamped nanoporous silica substrate. The method demonstrated significantly higher numbers of captured EpCAM-positive cancer cells within anti-EpCAM stamped areas. For site-selective cell capture, grooved microfluidic channels were designed to investigate effects of local confinement due to the laminar flows. Both theoretical modeling and experiments show that the integration of the microfluidic channels greatly enhances cell capture. Patterning of anti-EpCAM in areas of downward flow (optimal regions for cell capture), generated by grooves of the microchannel, enables higher capture numbers than that of stamped areas of upward flow (non-optimal). Fluorescence microscopy images were acquired for captured SkBr3 and Colo205 cells using anti-EpCAM on the nanoporous silica substrate. It was shown that higher numbers of cells were captured across all EpCAM-positive cell lines in optimal areas versus non-optimal areas. Spatial control and large scale patterning of proteins enable novel designs and productions of cost effective, high throughput, and integrated detection and analysis systems. Site-selective detection provides the capability of defining optimal locations for cell capture based on various channel geometries and flow profile. The demonstrated method shows great potential for point-of-care cancer diagnostic tools to quantify the progression and status of the disease.

The Managing Emergencies in Paediatric Anaesthesia global rating scale is a reliable tool for simulation-based assessment in pediatric anesthesia crisis management.

INTRODUCTION: The use of simulation-based assessments for high-stakes physician examinations remains controversial. The Managing Emergencies in Paediatric Anaesthesia course uses simulation to teach evidence-based management of anesthesia crises to trainee anesthetists in the United Kingdom (UK) and Canada. In this study, we investigated the feasibility and reliability of custom-designed scenario-specific performance checklists and a global rating scale (GRS) assessing readiness for independent practice. METHODS: After research ethics board approval, subjects were videoed managing simulated pediatric anesthesia crises in a single Canadian teaching hospital. Each subject was randomized to two of six different scenarios. All 60 scenarios were subsequently rated by four blinded raters (two in the UK, two in Canada) using the checklists and GRS. The actual and predicted reliability of the tools was calculated for different numbers of raters using the intraclass correlation coefficient (ICC) and the Spearman-Brown prophecy formula. RESULTS: Average measures ICCs ranged from 'substantial' to 'near perfect' (P ≤ 0.001). The reliability of the checklists and the GRS was similar. Single measures ICCs showed more variability than average measures ICC. At least two raters would be required to achieve acceptable reliability. CONCLUSIONS: We have established the reliability of a GRS to assess the management of simulated crisis scenarios in pediatric anesthesia, and this tool is feasible within the setting of a research study. The global rating scale allows raters to make a judgement regarding a participant's readiness for independent practice. These tools may be used in the future research examining simulation-based assessment.

Effects of noise and working memory capacity on memory processing of speech for hearing-aid users.

OBJECTIVES: It has been shown that noise reduction algorithms can reduce the negative effects of noise on memory processing in persons with normal hearing. The objective of the present study was to investigate whether a similar effect can be obtained for persons with hearing impairment and whether such an effect is dependent on individual differences in working memory capacity. DESIGN: A sentence-final word identification and recall (SWIR) test was conducted in two noise backgrounds with and without noise reduction as well as in quiet. Working memory capacity was measured using a reading span (RS) test. STUDY SAMPLE: Twenty-six experienced hearing-aid users with moderate to moderately severe sensorineural hearing loss. RESULTS: Noise impaired recall performance. Competing speech disrupted memory performance more than speech-shaped noise. For late list items the disruptive effect of the competing speech background was virtually cancelled out by noise reduction for persons with high working memory capacity. CONCLUSIONS: Noise reduction can reduce the adverse effect of noise on memory for speech for persons with good working memory capacity. We argue that the mechanism behind this is faster word identification that enhances encoding into working memory.

Phonological discrimination and contrast detection in pupillometry.

Introduction: The perception of phonemes is guided by both low-level acoustic cues and high-level linguistic context. However, differentiating between these two types of processing can be challenging. In this study, we explore the utility of pupillometry as a tool to investigate both low- and high-level processing of phonological stimuli, with a particular focus on its ability to capture novelty detection and cognitive processing during speech perception. Methods: Pupillometric traces were recorded from a sample of 22 Danish-speaking adults, with self-reported normal hearing, while performing two phonological-contrast perception tasks: a nonword discrimination task, which included minimal-pair combinations specific to the Danish language, and a nonword detection task involving the detection of phonologically modified words within sentences. The study explored the perception of contrasts in both unprocessed speech and degraded speech input, processed with a vocoder. Results: No difference in peak pupil dilation was observed when the contrast occurred between two isolated nonwords in the nonword discrimination task. For unprocessed speech, higher peak pupil dilations were measured when phonologically modified words were detected within a sentence compared to sentences without the nonwords. For vocoded speech, higher peak pupil dilation was observed for sentence stimuli, but not for the isolated nonwords, although performance decreased similarly for both tasks. Conclusion: Our findings demonstrate the complexity of pupil dynamics in the presence of acoustic and phonological manipulation. Pupil responses seemed to reflect higher-level cognitive and lexical processing related to phonological perception rather than low-level perception of acoustic cues. However, the incorporation of multiple talkers in the stimuli, coupled with the relatively low task complexity, may have affected the pupil dilation.

Facilitators and barriers to implementation of a patient and staff reported measure for screening of palliative concerns of patients with heart failure: a qualitative analysis using the Consolidated Framework for Implementation Research.

Background: Screening patients with patient-reported outcome measures allows identification of palliative care concerns. The Integrated Palliative Care Outcome Scale (IPOS) was developed in the United Kingdom for this purpose. Tools developed in another setting might not be readily usable locally. We previously evaluated the validity and reliability of the IPOS in our cardiology setting. However, it remains uncertain what factors would influence the subsequent implementation of IPOS for routine screening of patients with advanced heart failure in future practice. Objectives: This study aimed to identify the factors that could affect the IPOS implementation for patients with advanced heart failure. Design: This was a qualitative study conducted at the National Heart Centre Singapore. Methods: Patients with advanced heart failure who participated in our previous IPOS validation study were purposively recruited for semi-structured interviews. Healthcare workers caring for these patients and involved in the testing of the IPOS tool were also invited for interviews. The interviews were analyzed thematically and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: Our analysis identified six potential facilitators and six potential barriers to implementation across five major domains of the CFIR (intervention characteristics, inner setting, outer setting, individual characteristics, and process). Facilitators include: (i) perception of utility, (ii) perception of minimal complexity, (iii) perception of relatability, (iv) conducive culture, (v) dedicated resources, and (vi) advocates for implementation. Barriers include: (i) need for adaptation, (ii) mindsets/role strains, (iii) resource constraints, (iv) cultural concerns, (v) individual needs, and (vi) change process. Conclusion: Institutions could focus on cultivating appropriate perceptions and conducive cultures, providing dedicated resources for implementation and introducing facilitators to advocate for implementation. Adaptation of IPOS to suit workflows and individual needs, consideration of change processes, and systemic changes to alleviate cultural, resource, and staff role strains would improve IPOS uptake during actual implementation in clinical services. Trial registration: Not applicable.

Characterization of speech understanding in various types of noise.

This study examined (1) the effects of noise on speech understanding and (2) whether performance in real-life noises could be predicted based on performance in steady-state speech-spectrum-shaped noise. The noise conditions included a steady-state speech-spectrum-shaped noise and six types of real-life noise. Thirty normal-hearing adults were tested using sentence materials from the Cantonese Hearing In Noise Test (CHINT). To achieve the first aim, the performance-intensity function slopes in these noise conditions were estimated and compared. Variations in performance-intensity function slopes were attributed to differences in the amount of amplitude fluctuations and the presence of competing background speech. How well the data obtained in real-life noises fit the performance-intensity functions obtained in steady-state speech-spectrum-shaped noises was examined for the second aim of the study. Four out of six types of noise yielded performance-intensity function slopes similar to that in steady-state speech-spectrum-shaped noise. After accounting for individual differences in sentence reception threshold (SRT) and the offset between the signal-to-noise ratio for 50% intelligibility across different types of noise, performance in steady-state speech-spectrum-shaped noise was found to predict well the performance in most of the real-life noise conditions.