Using Community-Based Participatory Research Strategies in Age-Friendly Communities to Solve Mobility Challenges.

The number of older adults is steadily increasing in the United States and across the globe. Aging is linked to an increased risk of disability. Disabilities that limit one or more major life activities such as seeing, hearing, walking, and motor skills impact a person's ability to drive a car. Low utilization of alternative transportation by older adults and people with disabilities may put them at risk for social isolation. Social isolation is associated with a variety of negative health outcomes. While communities are challenged to create available, acceptable, accessible, adaptable and affordable mobility options, there are widely held, inaccurate biases around older adults' abilities to contribute to the development and improvement of alternative transportation options. Gerontological social workers are well-positioned to address this bias. This paper presents a case study of a large metropolitan county in the Midwest where community-based participatory research (CBPR) strategies were used to engage older residents to support the development of alternative transportation options supporting the tenets of environmental justice.

Pure-Tone Audiometry With Forward Pressure Level Calibration Leads to Clinically-Relevant Improvements in Test-Retest Reliability.

OBJECTIVES: Clinical pure-tone audiometry is conducted using stimuli delivered through supra-aural headphones or insert earphones. The stimuli are calibrated in an acoustic (average ear) coupler. Deviations in individual-ear acoustics from the coupler acoustics affect test validity, and variations in probe insertion and headphone placement affect both test validity and test-retest reliability. Using an insert earphone designed for otoacoustic emission testing, which contains a microphone and loudspeaker, an individualized in-the-ear calibration can be calculated from the ear-canal sound pressure measured at the microphone. However, the total sound pressure level (SPL) measured at the microphone may be affected by standing-wave nulls at higher frequencies, producing errors in stimulus level of up to 20 dB. An alternative is to calibrate using the forward pressure level (FPL) component, which is derived from the total SPL using a wideband acoustic immittance measurement, and represents the pressure wave incident on the eardrum. The objective of this study is to establish test-retest reliability for FPL calibration of pure-tone audiometry stimuli, compared with in-the-ear and coupler sound pressure calibrations. DESIGN: The authors compared standard audiometry using a modern clinical audiometer with TDH-39P supra-aural headphones calibrated in a coupler to a prototype audiometer with an ER10C earphone calibrated three ways: (1) in-the-ear using the total SPL at the microphone, (2) in-the-ear using the FPL at the microphone, and (3) in a coupler (all three are derived from the same measurement). The test procedure was similar to that commonly used in hearing-conservation programs, using pulsed-tone test frequencies at 0.5, 1, 2, 3, 4, 6, and 8 kHz, and an automated modified Hughson-Westlake audiometric procedure. Fifteen adult human participants with normal to mildly-impaired hearing were selected, and one ear from each was tested. Participants completed 10 audiograms on each system, with test-order randomly varied and with headphones and earphones refitted by the tester between tests. RESULTS: Fourteen of 15 ears had standing-wave nulls present between 4 and 8 kHz. The mean intrasubject SD at 6 and 8 kHz was lowest for the FPL calibration, and was comparable with the low-frequency reliability across calibration methods. This decrease in variability translates to statistically-derived significant threshold shift criteria indicating that 15 dB shifts in hearing can be reliably detected at 6 and 8 kHz using FPL-calibrated ER10C earphones, compared with 20 to 25 dB shifts using standard TDH-39P headphones with a coupler calibration. CONCLUSIONS: These results indicate that reliability is better with insert earphones, especially with in-the-ear FPL calibration, compared with a standard clinical audiometer with supra-aural headphones. However, in-the-ear SPL calibration should not be used due to its sensitivity to standing waves. The improvement in reliability is clinically meaningful, potentially allowing hearing-conservation programs to more confidently determine significant threshold shifts at 6 kHz-a key frequency for the early detection of noise-induced hearing loss.

Effects of Negative Middle Ear Pressure on Wideband Acoustic Immittance in Normal-Hearing Adults.

OBJECTIVES: Wideband acoustic immittance (WAI) measurements are capable of quantifying middle ear performance over a wide range of frequencies relevant to human hearing. Static pressure in the middle ear cavity affects sound transmission to the cochlea, but few datasets exist to quantify the relationship between middle ear transmission and the static pressure. In this study, WAI measurements of normal ears are analyzed in both negative middle ear pressure (NMEP) and ambient middle ear pressure (AMEP) conditions, with a focus on the effects of NMEP in individual ears. DESIGN: Eight subjects with normal middle ear function were trained to induce consistent NMEPs, quantified by the tympanic peak pressure (TPP) and WAI. The effects of NMEP on the wideband power absorbance level are analyzed for individual ears. Complex (magnitude and phase) WAI quantities at the tympanic membrane (TM) are studied by removing the delay due to the residual ear canal (REC) volume between the probe tip and the TM. WAI results are then analyzed using a simplified classical model of the middle ear. RESULTS: For the 8 ears presented here, NMEP has the largest and most significant effect across ears from 0.8 to 1.9 kHz, resulting in reduced power absorbance by the middle ear and cochlea. On average, NMEP causes a decrease in the power absorbance level for low- to mid-frequencies, and a small increase above about 4 kHz. The effects of NMEP on WAI quantities, including the absorbance level and TM impedance, vary considerably across ears. The complex WAI at the TM and fitted model parameters show that NMEP causes a decrease in the aggregate compliance at the TM. Estimated REC delays show little to no dependence on NMEP. CONCLUSIONS: In agreement with previous results, these data show that the power absorbance level is most sensitive to NMEP around 1 kHz. The REC effect is removed from WAI measurements, allowing for direct estimation of complex WAI at the TM. These estimates show NMEP effects consistent with an increased stiffness in the middle ear, which could originate from the TM, tensor tympani, annular ligament, or other middle ear structures. Model results quantify this nonlinear, stiffness-related change in a systematic way, that is not dependent on averaging WAI results in frequency bands. Given the variability of pressure effects, likely related to intersubject variability at AMEP, TPP is not a strong predictor of change in WAI at the TM. More data and modeling will be needed to better quantify the relationship between NMEP, WAI, and middle ear transmission.

"Is It My Responsibility?": A Qualitative Review of University Students' Perspectives on Bystander Behavior.

Bystander interventions focus on framing violence as a community problem and encourage all community members to act as prosocial bystanders if they witness a dangerous situation. Research has demonstrated there are multiple barriers and facilitators that might discourage or encourage an individual to act as a prosocial bystander. A qualitative interpretive meta-synthesis (QIMS) of existing literature was conducted to determine university students' perspectives on bystander facilitators and barriers. A systematic search of the literature was completed to identify articles that included university students' perspectives on bystander facilitators and barriers, utilized a qualitative methodology, and contained participant quotations in the published article. The search yielded 181 articles and after screening 10 articles were included in the QIMS. The original themes and participant quotations were qualitatively coded to develop five new themes: (1) the impact of alcohol, (2) beliefs about responsibility, (3) peer perceptions, (4) indicators and situational dilemmas, and (5) the role of friendship and group impact. The results of this synthesis reveal important implications for the continued development of bystander intervention programs for universities. By incorporating the perspectives of university students, bystander intervention programs may be more effective at encouraging students to be prosocial bystanders by confronting perceived barriers to intervention.

Facilitators of Formal Help-Seeking for Adult Survivors of IPV in the United States: A Systematic Review.

A survivor's decision to engage with formal services for experiences of intimate partner violence (IPV) is influenced by factors at the individual, interpersonal, and sociocultural levels. Understanding factors that facilitate survivors' choice to seek services could be beneficial to formal service providers including community agencies, health professionals, and the criminal justice system, providing guidance toward the development and implementation of accessible services for survivors of IPV. This systematic review of the literature aims to identify key factors that facilitate survivors' formal help-seeking. Ten electronic databases were searched for key terms related to help-seeking from formal services and facilitators of formal help-seeking. Articles were included in the review if the studies were conducted in the United States, focused on adults with experiences of IPV, and discussed facilitators of formal help-seeking. A total of 1,155 studies were initially identified, and after screening, 24 were included in the review. Seven factors were identified including provider knowledge, support, accessibility, desire to provide protection and to prevent future violence, and other factors such as knoweldge of and desire for services, policy factors, and personal factors. Findings demonstrate a need for more research on the facilitators of help-seeking among East Asian, South Asian, and Middle Eastern survivors living in the United States, as well as male-identified, trans, and gender nonconforming survivors. The review also indicates a need for culturally sensitive and accessible services that support survivors and the importance of raising awareness of the services and resources available for survivors.

A Systematic Review of Barriers to Formal Help Seeking for Adult Survivors of IPV in the United States, 2005-2019.

For individuals experiencing intimate partner violence (IPV), formal services, including community agencies, health services, or the criminal justice system, are critical resources. Understanding the specific barriers that hinder or prevent survivors from seeking help from formal services could reveal important implications for the development of services for IPV as well as for members of other organizations who encounter survivors. The authors conducted a systematic review of the literature to identify barriers to help-seeking from formal services for survivors. Ten electronic databases were searched for key terms related to IPV, help seeking from formal services, and barriers to help seeking. Articles were included in the review if they were U.S.-based, contained samples that were adults who had experienced IPV, and discussed barriers to seeking help from formal services. An initial search yielded 1,155 articles and after screening, 29 articles were included in the review. Data were extracted to reveal the state of the literature regarding help-seeking barriers for survivors. Six barriers to help seeking were identified as follows: (1) lack of awareness, (2) access challenges, (3) consequences of disclosure, (4) lack of material resources, (5) personal barriers, and (6) system failures. These findings demonstrate the need for continued education surrounding available services for IPV as well as the continued development of resources that can mitigate personal barriers that survivors may face. Furthermore, these findings illuminate the necessity to increase the access of services, particularly for non-English speakers, immigrants and refugees, individuals with disabilities, men, and LGBTQIA identified individuals.

The Role of Social Support in the Link Between Economic Abuse and Economic Hardship.

More data is needed about the pathways through which intimate partner violence (IPV) impacts the economic well-being of survivors. The current study assesses the moderating influence of social support on the association between economic abuse (EA) and economic hardship. Female participants (n = 435) were recruited to participate in a web-based survey which included standardized measures of EA, other forms of IPV, domains of social support, and economic hardship. Analysis included bivariate and multivariate regression with an investigation into interaction effects.Experiencing EA was significantly correlated with economic hardship, even with extent of physical and emotional IPV controlled. Both tangible and appraisal support had significant negative association with extent of material hardship. Significant interactions between forms of social support and economic abuse were observed. For those at high levels of economic abuse, support had less influence on economic hardship. A mix of direct economic aid, advocacy, education and support could provide a blueprint for addressing the economic hardship experiences of community-dwelling survivors of economic abuse. A comprehensive response to EA requires interventions aimed directly at economically controlling and exploitative tactics, including credit building, individual economic advocacy, and education. Interventions that seek to enhance survivors' access to social support may be necessary but not sufficient to buffer the impacts of violence on survivors' economic outcomes.

"I keep it to myself": A qualitative meta-interpretive synthesis of experiences of postpartum depression among marginalised women.

Postpartum depression (PPD) is a significant public health concern due to the physical, emotional, economic, and life course outcomes. Rates of PPD are significantly higher for marginalised populations and can impact low-income, minority, and/or immigrant women differently when compared to white middle-class women. Commonly studied negative effects of PPD include poor health outcomes, mother-child bonding challenges, and negative child educational outcomes. However, research surveying the postpartum experience and negative outcomes among marginalised women is sparse. This study implemented a qualitative meta-interpretive synthesis (QIMS) methodology to synthesise themes across 12 qualitative research articles surveying postpartum experiences of marginalised women in North American countries. Articles included in the QIMS were extracted from online databases from a 10-year window spanning January 2008-2018. The guiding research question was "What are the PPD experiences of women belonging to marginalized populations?" Constant comparative analysis was used with coding in atlas.ti and themes were synthesised with input of all three authors. Five main themes emerged. The themes are (a) intersections of PPD and poverty, (b) culture and PPD, (c) pressures of mothering, (d) strengths and coping, and (e) abuse affects my PPD experience. Subthemes such as "I keep it to myself" relating to cultural response to PPD and idealised mothering were also discovered. Implications for social workers, nurses, and future research are discussed.

Qualitative, Interpretive Metasynthesis of Women's Experiences of Intimate Partner Violence During Pregnancy.

OBJECTIVE: To describe the perspectives of women who experienced intimate partner violence (IPV) during pregnancy through a qualitative, interpretive metasynthesis. DATA SOURCES: We searched 12 electronic databases to identify articles on qualitative studies pertaining to women's experiences of IPV during pregnancy. We searched Academic Search Complete, AgeLine, CINAHL Complete, Family Studies Abstracts, MEDLINE, PsycARTICLES, Psychology and Behavioral Sciences, PsycINFO, Social Work Abstracts, Health Source-Consumer Edition, Health Source-Nursing/Academic Edition, and Humanities Full Text for articles published from 2008 through 2018. DATA EXTRACTION: We used inclusion and exclusion criteria to identify eight reports of qualitative studies that contained direct quotations in which women described their experiences of IPV. DATA SYNTHESIS: We used a methodologic reduction to provide a theoretical context that helped us synthesize the data to five key themes: Pregnancy Escalates Abuse, Concern for Unborn Fetus, Importance ofSupport, My Child Saved Me, and Pregnancy Is a Catalyst for Reflection. CONCLUSION: The results of our synthesis illustrate the unique perspectives of women who experienced IPV during pregnancy. Understanding these experiences can help health care providers assist pregnant women through enhanced screenings and education. Health care providers can also help women identify resources for emotional and financial support as they determine the best courses of action for themselves and their children.

Characterizing the ear canal acoustic impedance and reflectance by pole-zero fitting.

This study characterizes middle ear complex acoustic reflectance (CAR) and impedance by fitting poles and zeros to real-ear measurements. The goal of this work is to establish a quantitative connection between pole-zero locations and the underlying physical properties of CAR data. Most previous studies have analyzed CAR magnitude; while the magnitude accounts for reflected power, it does not encode latency information. Thus, an analysis that studies the real and imaginary parts of the data together, being more general, should be more powerful. Pole-zero fitting of CAR data is examined using data compiled from various studies, dating back to Voss and Allen (1994). Recent CAR measurements were taken using the Mimosa Acoustics HearID system, which makes complex acoustic impedance and reflectance measurements in the ear canal over a 0.2-6.0 [kHz] frequency range. Pole-zero fits to measurements over this range are achieved with an average RMS relative error of less than 3% with 12 poles. Factoring the reflectance fit into its all-pass and minimum-phase components estimates the effect of the residual ear canal, allowing for comparison of the eardrum impedance and admittance across measurements. It was found that individual CAR magnitude variations for normal middle ears in the 1-4 [kHz] range often give rise to closely-placed pole-zero pairs, and that the locations of the poles and zeros in the s-plane may systematically differ between normal and pathological middle ears. This study establishes a methodology for examining the physical and mathematical properties of CAR using a concise parametric model. Pole-zero modeling accurately parameterizes CAR data, providing a foundation for detection and identification of middle ear pathologies. This article is part of a special issue entitled "MEMRO 2012".

Investigation of bacterial biofilm in the human middle ear using optical coherence tomography and acoustic measurements.

Children with chronic otitis media (OM) often have conductive hearing loss which results in communication difficulties and requires surgical treatment. Recent studies have provided clinical evidence that there is a one-to-one correspondence between chronic OM and the presence of a bacterial biofilm behind the tympanic membrane (TM). Here we investigate the acoustic effects of bacterial biofilms, confirmed using optical coherence tomography (OCT), in adult ears. Non-invasive OCT images are collected to visualize the cross-sectional structure of the middle ear, verifying the presence of a biofilm behind the TM. Wideband measurements of acoustic reflectance and impedance (0.2-6 [kHz]) are used to study the acoustic properties of ears with confirmed bacterial biofilms. Compared to known acoustic properties of normal middle ears, each of the ears with a bacterial biofilm has an elevated power reflectance in the 1 to 3 [kHz] range, corresponding to an abnormally small resistance (real part of the impedance). These results provide assistance for the clinical diagnosis of a bacterial biofilm, which could lead to improved treatment of chronic middle ear infection and further understanding of the impact of chronic OM on conductive hearing loss. This article is part of a special issue entitled "MEMRO 2012".

Safety of wireless capsule endoscopy in patients with implantable cardiac defibrillators.

OBJECTIVES: Wireless video capsule endoscopy (CE) is a new technology that allows visualization of the entire small intestinal mucosa. It is indicated for the evaluation of obscure gastrointestinal bleeding (OGIB) and other disorders of the small intestine. Studies to date suggest that CE is safe and associated with few adverse events. A concern, which has not been studied, is the potential effect of CE on implanted cardiac devices such as implantable cardiac defibrillators (ICD) and other electromedical devices. We previously found CE to be safe in patients with cardiac pacemakers. The primary aim of this study was to evaluate the safety of CE in patients with ICDs who were being evaluated for OGIB. In addition, a secondary aim of the study was to determine whether ICDs had any effect on the images captured by CE. METHODS: Patients referred for the evaluation of OGIB and who also had an ICD were enrolled into the study after informed consent. Five consecutive patients (four females and one male; mean age: 72 yr; range: 60-81 yr) with ICDs were studied. All patients had transvenous endocardial ICDs located in the chest. Prior to CE, patients had a baseline electrocardiogram (ECG) and ICD interrogation. Thereafter, CE was performed in a hospital setting with telemetry monitoring performed simultaneously. A post-procedure ICD interrogation was carried out to evaluate changes in programmed parameters. A cardiologist and ICD nurse specialist together reviewed both the telemetry monitor and the post-procedure ICD interrogation on each patient. When CE studies were reviewed, observations pertaining to technical difficulties and interference with video imaging were documented. RESULTS: No arrhythmia or other adverse cardiac events were noted during capsule transmission. No interference by the ICD on the CE video images was seen. CONCLUSIONS: CE was performed safely in these five patients with ICDs, and was not associated with any adverse cardiac events. ICDs also do not appear to interfere with video capsule imaging.