Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment.

INTRODUCTION: Many neurocognitive evaluations involve auditory stimuli, yet there are no standard testing guidelines for individuals with hearing loss. The ensuring speech understanding (ESU) test was developed to confirm speech understanding and determine whether hearing accommodations are necessary for neurocognitive testing. METHODS: Hearing was assessed using audiometry. The probability of ESU test failure by hearing status was estimated in 2679 participants (mean age: 81.4 ± 4.6 years) using multivariate logistic regression. RESULTS: Only 2.2% (N = 58) of participants failed the ESU test. The probability of failure increased with hearing loss severity; similar results were observed for those with and without mild cognitive impairment or dementia. DISCUSSION: The ESU test is appropriate for individuals who have variable degrees of hearing loss and cognitive function. This test can be used prior to neurocognitive testing to help reduce the risk of hearing loss and compromised auditory access to speech stimuli causing poorer performance on neurocognitive evaluation.

Feasibility and Assessment of a Hybrid Audiology Service Delivery Model for Older Adult Hearing Aid Users: A Pilot Study.

PURPOSE: The aim of this study was to provide insight for the feasibility and outcomes of hybrid (combination of in-person office and Internet-based appointments) audiology services. METHOD: This pilot included two phases. First, we surveyed audiologists regarding what elements of a best-practice, in-person delivery of a hearing intervention could be delivered via Internet-based appointments. Next, we piloted the feasibility and assessed outcomes of the procedures identified. Ten first-time hearing aid users aged 70 years and older were fit with Phonak Audeo M90-312T hearing aids. Two Internet-based follow-up appointments were completed using the myPhonak app. We administered the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), the Client Oriented Scale of Improvement (COSI), the Quick Speech-in-Noise Test (QuickSIN), and real-ear aided responses (REARs) to determine whether participants experienced improvements on hearing-related outcomes. The Telehealth Acceptance Questionnaire (TAQ) and the Visit-Specific Satisfaction Questionnaire (VSQ-9) were administered to gauge comfort with telehealth and satisfaction with Internet-based appointments. RESULTS: Survey results revealed that after an initial in-person appointment, nearly all follow-up hearing intervention components could be delivered remotely. We performed Wilcoxon signed-ranks tests to determine if the baseline and outcome results differed for outcomes. Baseline scores improved after 6 weeks (ps = .02 and. 005 for QuickSIN and HHIE-S) for speech-in-noise performance and self-perceived hearing difficulties. REARs from 500 to 4000 Hz measured after 6 weeks did not differ from baseline (ps = .612 and .398 for the right and left ears), suggesting no significant deviation from prescriptive targets because of remote fitting adjustments. All participants reported improvement in COSI goals after the intervention. TAQ results suggested that comfort with telehealth improved after attending Internet-based appointments (p = .005). VSQ-9 results revealed no differences in reported patient satisfaction between in-person and Internet-based appointments. CONCLUSIONS: We were able to develop a feasible hybrid audiology service delivery model for older adults. Our results enhance the evidence base for the implementation of telehealth audiology services.

Development, assessment, and monitoring of audiologic treatment fidelity in the aging and cognitive health evaluation in elders (ACHIEVE) randomised controlled trial.

OBJECTIVE: Studies investigating hearing interventions under-utilise and under-report treatment fidelity planning, implementation, and assessment. This represents a critical gap in the field that has the potential to impede advancements in the successful dissemination and implementation of interventions. Thus, our objective was to describe treatment fidelity planning and implementation for hearing intervention in the multi-site Ageing and Cognitive Health Evaluation in Elders (ACHIEVE) randomised controlled trial. DESIGN: Our treatment fidelity plan was based on a framework defined by the National Institutes of Health Behaviour Change Consortium (NIH BCC), and included strategies to enhance study design, provider training, and treatment delivery, receipt, and enactment. STUDY SAMPLE: To assess the fidelity of the ACHIEVE hearing intervention, we distributed a checklist containing criteria from each NIH BCC core treatment fidelity category to nine raters. RESULTS: The ACHIEVE hearing intervention fidelity plan satisfied 96% of NIH BCC criteria. Our assessment suggested a need for including clear, objective definitions of provider characteristics and non-treatment aspects of intervention delivery in future fidelity plans. CONCLUSIONS: The ACHIEVE hearing intervention fidelity plan can serve as a framework for the application of NIH BCC fidelity strategies for future studies and enhance the ability of researchers to reliably implement evidence-based interventions.

Practicing Hope: Enhancing Empowerment in Primary Health Care through Community-based Participatory Research.

The World Health Organization's (WHO's) Declaration of Alma Ata in 1978 made Primary Health Care (PHC) the official health policy of all WHO member countries, stressing the importance of multisectoral collaboration and community empowerment as critical for delivering quality primary healthcare and public health services to achieve social justice and health equity. Over forty years later, a divide remains between seeing individual patients in the traditional biomedical model and addressing population-level social determinants of health. One promising approach for the intentional and active integration of multi-sectoral partnering practices and community empowerment into Primary Health Care is the use of community-based participatory research (CBPR). The power of CBPR lies in its systematic approach to facilitating equitable collaboration of partners based on community priorities and strengths and is increasingly recognized for improving health equity outcomes. This paper highlights the use of CBPR as a promising practice for healthcare organizations to bridge the gap between the traditional individual patient focus and the comprehensive primary healthcare approach from WHO. We use a narrative case study from A Ministry of Sharing (AMOS) Health and Hope, a PHC organization in Nicaragua, to illustrate the use of the CBPR model as an implementation framework that facilitated the transformation of structures, policies, and practices as AMOS created multi-sector partnerships and embraced community empowerment as part of its strategic and comprehensive approach to health equity.

CBPR Implementation Framework for Community-Academic Partnerships.

The Engage for Equity (E2) study is an intervention trial for community-academic research partnerships that seeks to improve partnering practices and health equity outcomes by providing community and academic partners with tools to enhance and advance power sharing and health equity. Twenty-five community/academic research teams completed a two-day training intervention where they were introduced to the CBPR Conceptual Model and corresponding applied tools to their partnerships. We report on team interviews conducted immediately after the training, where teams discussed opportunities and challenges using the CBPR Model as an implementation framework as they considered their own contexts, their partnering processes/practices, actions, and their desired outcomes. We applied Diffusion of Innovation theory to guide data collection and analysis; augmented by intent to use and collective reflection. Results pointed to the flexibility of the CBPR model, concrete use of tools (e.g., planning/evaluation), and broader use in inspiring collective reflection to improve partnering practices and inform equity values. As an implementation framework, the CBPR model incorporates collaborative processes and strategies to mitigate power differentials into key phases of implementation studies, adding factors central to health equity work, not existing in previous implementation frameworks.

Development and Formative Assessment of the Hearing Loss Toolkit for Self-Management.

Hearing aids are a demonstrated efficacious intervention for age-related hearing loss, and research suggests that good hearing loss self-management skills improve amplification satisfaction and outcomes. One way to foster self-management skills is through the provision of patient education materials. However, many of the available resources related to the management of hearing loss do not account for health literacy and are not suitable for use with adults from varying health literacy backgrounds. To address this issue, we developed the Hearing Loss Toolkit for Self-Management as part of a manualized, best practices hearing intervention used in large clinical trial. We incorporated health literacy recommendations from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality in a series of modules that address a variety of common problem areas reported by adults with hearing loss. A formative assessment consisting of feedback questionnaires, semistructured interviews, and a focus group session with representatives from the target audience was conducted. Findings from the development assessment process demonstrate that the Hearing Loss Toolkit for Self-Management is suitable for use with adults with age-related hearing loss who have varying health literacy backgrounds and abilities.

The Mental Health of the Organic Farmer: Psychosocial and Contextual Actors.

Despite the large body of research and literature on the health and mental health of farmers, we should not assume that research findings necessarily apply to the organic farmer. The limited literature on the mental health of the organic farmer points to potential differences. Research has found that workers on organic farms may be happier than their counterparts; others have identified added sources of stress related to the perceived need of organic farmers to embrace concepts linked to the organic movement. However, further research is needed to identify both risk and protective factors for mental health among organic farmers. The purpose of this qualitative descriptive study was to explore the psychosocial and contextual factors that may relate to the mental health of the organic farmer. Key informant interviews were conducted with 10 farm producers and 20 farm workers. The findings indicated that respondents recognized mental health as influential in the workplace and the future of organic practices (e.g., the mental, financial, physical stress). Some of the risk factors mentioned by participants reflected those experienced by conventional, nonorganic farmers. Participants also reported contentment with farming as an occupation, the benefits of being connected to the land, feelings of social and environmental responsibility, and engagement in social activities that may promote human and social capital. These feelings and activities ultimately benefit the farmer, contribute to social cohesion, and may have positive implications for mental health. Results suggest that there may be protective mental health factors unique to the organic farmer.

New Mexico Community Health Councils: Documenting Contributions to Systems Changes.

CONTEXT: Coalition research has shifted from delineating structures and processes to identifying intermediate, systems changes (e.g., changes in policies) that contribute to longterm community health improvement. OBJECTIVE: The University of New Mexico, the New Mexico Department of Health, and community health councils entered a multiyear participatory evaluation process to answer: What actions did health councils take that led to improving health through intermediate, systems changes? DESIGN: The evaluation system was created over several phases through an iterative, participatory process. Data were collected for councils' health priority areas (e.g., substance abuse) from 2009 to 2011. PARTICIPANTS: Twenty-three community health councils participated. MAIN OUTCOME MEASURES: Intermediate systems changes were measured: 1) networking and partnering, 2) joint planning of strategies, programs, and services, 3) leveraging resources, and 4) policy initiatives. RESULTS: Health councils reported data for each intermediate outcome by health priority area. Data showed councils identified local public health priorities and addressed those priorities through strengthening networks and partnerships, which lead to the creation and enhancement of strategies, services, and programs. Data also showed councils influenced policies in several ways (e.g., developing policy, identifying new policy, or sponsoring informational forums). Additionally, data showed councils leveraged $1.10 for every dollar invested by the state. When funding was suspended in July 2010, data showed dramatic decreases in activity levels from 2010 to 2011. CONCLUSIONS: The data demonstrate the feasibility and utility of an Internet-based system designed to gather intermediate systems changes evaluation data. This process is a model for similar efforts to capture common outcomes across diverse coalitions and partnerships.

A new signal characterization and signal-based Chou's PseAAC representation of protein sequences.

Most of the algorithms used for information extraction and for processing the amino acid chains that make up proteins treat them as symbolic chains. Fewer algorithms exploit signal processing techniques that require a numerical representation of amino acid chains. However, these algorithms are very powerful for extracting regularities that cannot be detected when working with a symbolic chain, which may be important for understanding the biological meaning of a sequence or in classification tasks. In this study, a new mathematical representation of amino acid chains is proposed, which is derived using a similarity measure based on the PAM250 amino acid substitution matrix and that generates 20 signals for each protein sequence. Using this representation 20 consensus spectra for a protein family are determined and the relevance of the frequency peaks is established, obtaining a group of significant frequency peaks that manifest common periodicities of the amino acid sequences that belong to a protein family. We also show that the proposed representation in 20 signals can be integrated into Chou's pseudo amino acid composition (PseAAC) and constitute a useful alternative to amino acid physicochemical properties in Chou's PseAAC.

Semen analysis: update on clinical value, current needs and future perspectives.

At present, evaluation of male reproductive function consists primarily of routine semen analysis, a collection of conventional microscopic assessments ideally performed following the guidelines set by the World Health Organization. While providing some insight into testicular function, these long-performed tests are limited in the information that they impart; more specifically, they are unable to predict true fertility potential. As a consequence, there is a need for the appraisal and consideration of newer semen parameters that may be more indicative of reproductive success. Although various novel assays have been introduced that broaden the scope of information available to both researcher and clinician, the utility of these tests remains limited due to the lack of standardisation of protocols and the absence of clinically established, dependable reference ranges. As such, it is not surprising that most of these parameters and their associated methods remain recommended for 'research purposes only'. With the burgeoning 'omics' revolution, nanotechnology and the development of new analytical instruments, there is now an opportunity for the identification and measurement of previously unknown features that may prove to be more indicative of each sperm's true functional status and capability. Once optimised, simplified, clinically validated and made more readily accessible, these new approaches hold the promise of forming the fulcrum upon which andrological investigations can enter a new era.

Industry support and correlation to study outcome for papers published in Spine.

STUDY DESIGN: Retrospective review of articles published in the journal Spine. OBJECTIVES: To evaluate potential correlations between research sponsorship and study outcome. SUMMARY OF BACKGROUND DATA: Industry sponsorship has traditionally been associated with more positive results than non-funded or peer-reviewed funded projects in other areas of medicine. The association of such sponsorship and study outcome has not been addressed previously in spine research. METHODS: Articles from the journal Spine from January 2002 to July 2003 were reviewed. These were examined for the subject evaluated, type of study design, funding source, and conclusion reached. RESULTS: Of 1143 articles, 527 met inclusion criteria of having abstract, materials/methods, and conclusion sections. Industry support was reported for 84 (15.9%), foundation support for 67 (12.7%), government support for 54 (10.2%), institution support for 17 (3.2%), and no funding was reported for 304 (57.9%). The odds ratio of industry funded reporting positive results was 3.3 times that of studies with any other funding sources (P < 0.001). CONCLUSIONS: Industry funded studies demonstrated a statistically greater likelihood to report positive results than studies with other funding sources. Potential explanations for this are biased study design, biased experimental technique, biased result interpretation, or publication bias. Although the expense of research and limited funding sources have forced an increased reliance on industry support for funding basic science and clinical spine research, this does introduce the potential for bias and must be recognized by the reader.