Water quality dynamics and underlying controls in the Halton Region, Ontario.

We assessed the hydrochemistry of 15 watersheds in the Halton Region, southern Ontario, in high resolution (n > 500 samples across n > 40 streams) to characterize water quality dynamics and governing controls on major and trace element concentrations in this rapidly urbanizing region. In 2022, major water quality parameters were generally in line with historic monitoring data yet significantly different across catchments, e.g., in specific conductance, turbidity, phosphate and chloride, and trace element concentrations. Distinct hydrochemical signatures were observed between urban and rural creeks, with urban stream sections and sites near the river mouths close to Lake Ontario having consistently higher chloride (up to 700 mg/L) and occasional enrichment in nutrients levels (up to 8 and 20 mg/L phosphate and nitrate, respectively). Particularly upper reaches exhibited hydrochemical signatures that were reflective of the catchment surface lithologies, for instance through higher dissolved Ca to Mg ratios. Unlike for chloride and phosphate, provincial water quality guidelines for trace elements and heavy metals were seldom surpassed (on < 10 occasions for copper, zinc, cadmium, and uranium). Concentrations of other trace elements (e.g., platinum group elements or rare earth elements) were expectedly low (< 0.3 µg/L) but showed spatiotemporal concentration patterns and concentration-discharge dynamics different from those of the major water quality parameters. Our results help improve the understanding of surface water conditions within Halton's regional Natural Heritage Systems and demonstrate how enhanced environmental monitoring can deliver actionable information for watershed decision-making.

Using smartphone-GPS data to quantify human activity in green spaces.

Cities are growing in density and coverage globally, increasing the value of green spaces for human health and well-being. Understanding the interactions between people and green spaces is also critical for biological conservation and sustainable development. However, quantifying green space use is particularly challenging. We used an activity index of anonymized GPS data from smart devices provided by Mapbox (www.mapbox.com) to characterize human activity in green spaces in the Greater Toronto Area, Canada. The goals of our study were to describe i) a methodological example of how anonymized GPS data could be used for human-nature research and ii) associations between park features and human activity. We describe some of the challenges and solutions with using this activity index, especially in the context of green spaces and biodiversity monitoring. We found the activity index was strongly correlated with visitation records (i.e., park reservations) and that these data are useful to identify high or low-usage areas within green spaces. Parks with a more extensive trail network typically experienced higher visitation rates and a substantial proportion of activity remained on trails. We identified certain land covers that were more frequently associated with human presence, such as rock formations, and find a relationship between human activity and tree composition. Our study demonstrates that anonymized GPS data from smart devices are a powerful tool for spatially quantifying human activity in green spaces. These could help to minimize trade-offs in the management of green spaces for human use and biological conservation will continue to be a significant challenge over the coming decades because of accelerating urbanization coupled with population growth. Importantly, we include a series of recommendations when using activity indexes for managing green spaces that can assist with biomonitoring and supporting sustainable human use.

Is heart rate variability associated with frequency and intensity of vasomotor symptoms among healthy perimenopausal and postmenopausal women?

OBJECTIVE: Research has suggested that the autonomic nervous system (ANS) is involved in the experience of vasomotor symptoms (VMS) during menopause. We examined the relationship of VMS intensity and heart rate variability (HRV), a measure of ANS function. METHODS: Women (n = 282) were recruited from three American states for a clinical trial of yoga, exercise, and omega-3 fatty acid supplements for VMS. To be eligible, women had to report at least 14 VMS per week, with some being moderate to severe. Sitting electrocardiograms were recorded for 15 min using Holter monitors at both baseline and 12-week follow-up. Time and frequency domain HRV measures were calculated. Women completed daily diary measures of VMS frequency and intensity for 2 weeks at baseline and for 1 week at the follow-up assessment 12 weeks later. Multivariable linear regression was used to assess the relationship between VMS and baseline HRV measures and to compare change in HRV with change in VMS over the 12 weeks. RESULTS: Baseline HRV was not associated with either VMS frequency or intensity at baseline. Change in HRV was not associated with change in VMS frequency or intensity across the follow-up. INTERPRETATION: Heart rate variability (HRV) was not associated with basal VMS frequency or intensity in perimenopausal and postmenopausal women experiencing high levels of VMS. Autonomic function may be associated with the onset or presence of VMS, but not with the number or intensity of these symptoms.

"My hair or my health:" Overcoming barriers to physical activity in African American women with a focus on hairstyle-related factors.

Physical activity disparities among African American (AA) women may be related to sociocultural barriers, including difficulties with restyling hair after exercise. We sought to identify physical activity barriers and facilitators in AA women with a focus on sociocultural factors related to hairstyle maintenance. Participants (n = 51) were AA women aged 19-73 years who completed valid surveys and participated in structured focus groups, stratified by age and physical activity levels, from November 2012 to February 2013. The Constant Comparison method was used to develop qualitative themes for barriers and facilitators. The most frequently reported general physical activity barrier among exercisers was "lack of money" (27%) and among non-exercisers was "lack of self-discipline" (57%). A hairstyle-related barrier of "sweating out my hairstyle" was reported by 7% of exercisers and 29% of non-exercisers. This hairstyle-related barrier included the need for extra time and money to restyle hair due to perspiration. Hairstyle-related facilitators included: prioritizing health over hairstyle and high self-efficacy to restyle hair after perspiration. Participants were interested in resources to simplify hairstyle maintenance. AA women whose hairstyle is affected by perspiration may avoid physical activity due to time and financial burdens. Increasing self-efficacy to restyle hair after perspiration may help to overcome this barrier.

Assessing speech perception in children with hearing loss: what conventional clinical tools may miss.

OBJECTIVES: This study tested the hypothesis that word recognition in a complex, two-talker masker is more closely related to real-world speech perception for children with hearing loss than testing performed in quiet or steady-state noise. DESIGN: Sixteen school-age hearing aid users were tested on aided word recognition in noise or two-talker speech. Unaided estimates of speech perception in quiet were retrospectively obtained from the clinical record. Ten parents completed a questionnaire regarding their children's ease of communication and understanding in background noise. RESULTS: Unaided performance in quiet was correlated with aided performance in competing noise, but not in two-talker speech. Only results in the two-talker masker were correlated with parental reports of their children's functional hearing abilities. CONCLUSIONS: Speech perception testing in a complex background such as two-talker speech may provide a more accurate predictor of the communication challenges of children with hearing loss than testing in steady noise or quiet.

Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements.

OBJECTIVE: The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms. STUDY DESIGN: We conducted a 12-week 3 × 2 randomized, controlled, factorial design trial. Peri- and postmenopausal women, 40-62 years old, were assigned randomly to yoga (n = 107), exercise (n = 106), or usual activity (n = 142) and also assigned randomly to a double-blind comparison of omega-3 (n = 177) or placebo (n = 178) capsules. We performed the following interventions: (1) weekly 90-minute yoga classes with daily at-home practice, (2) individualized facility-based aerobic exercise training 3 times/week, and (3) 0.615 g omega-3 supplement, 3 times/day. The outcomes were assessed with the following scores: Menopausal Quality of Life Questionnaire (MENQOL) total and domain (vasomotor symptoms, psychosocial, physical and sexual). RESULTS: Among 355 randomly assigned women who average age was 54.7 years, 338 women (95%) completed 12-week assessments. Mean baseline vasomotor symptoms frequency was 7.6/day, and the mean baseline total MENQOL score was 3.8 (range, 1-8 from better to worse) with no between-group differences. For yoga compared to usual activity, baseline to 12-week improvements were seen for MENQOL total -0.3 (95% confidence interval, -0.6 to 0; P = .02), vasomotor symptom domain (P = .02), and sexuality domain (P = .03) scores. For women who underwent exercise and omega-3 therapy compared with control subjects, improvements in baseline to 12-week total MENQOL scores were not observed. Exercise showed benefit in the MENQOL physical domain score at 12 weeks (P = .02). CONCLUSION: All women become menopausal, and many of them seek medical advice on ways to improve quality of life; little evidence-based information exists. We found that, among healthy sedentary menopausal women, yoga appears to improve menopausal quality of life; the clinical significance of our finding is uncertain because of the modest effect.

Effects of nonlinear frequency compression on speech identification in children with hearing loss.

OBJECTIVES: This study evaluated effects of nonlinear frequency compression (NLFC) processing in children with hearing loss for consonant identification in quiet and for spondee identification in competing noise or speech. It was predicted that participants would benefit from NLFC for consonant identification in quiet when access to high-frequency information was critical, but that NLFC would be less beneficial, or even detrimental, when identification relied on mid-frequency cues. Further, it was hypothesized that NLFC could result in greater susceptibility to masking in the spondee task. The rationale for these predictions is that improved access to high-frequency information comes at the cost of decreased spectral resolution. DESIGN: A repeated-measures design compared speech-perception outcomes in 17 pediatric hearing aid users (9 to 17 years of age) wearing Naida V SP "laboratory" hearing aids with NLFC on and off. Data were also collected in an initial baseline session in which children wore their personal hearing aids. Children with a wide range of audiometric configurations were included, but all participants were full-time users of hearing aids with active NLFC. For each hearing aid condition, speech perception was assessed in the sound field by using a closed-set 12-alternative consonant-vowel identification measure in quiet, and a closed-set four-alternative spondee-identification measure in a speech-shaped noise or in a two-talker speech masker. RESULTS: No significant differences in performance were observed between laboratory hearing aid conditions with NLFC activated or deactivated for either speech-perception measure. An unexpected finding was that the majority of participants had no difficulty identifying the high-frequency consonant /s/ even when NLFC was deactivated. Investigation into individual differences revealed that subjects with a greater difference in audible bandwidth with NLFC on versus NLFC off were less likely to demonstrate improvements in high-frequency consonant identification in quiet, but were more likely to demonstrate improvements in spondee identification in speech-shaped noise. Group results observed in the initial baseline assessment using personal aids fitted with more aggressive NLFC settings than used in laboratory aids indicated better consonant identification accuracy in quiet. However, spondee identification in the two-talker masker was poorer with personal compared with laboratory hearing aids. Comparisons across personal and laboratory hearing aids are tempered, however, by the potential of an order effect. CONCLUSIONS: The observation of comparable performance with NLFC on and NLFC off in the laboratory aids provides evidence that NLFC is neither detrimental nor advantageous when modest in strength. Results with personal hearing aids fitted with stronger compression settings than laboratory aids (NLFC on) highlight the critical need for further research to determine the impact of NLFC processing on speech perception for a wider range of speech-perception measures and compression settings.

Type 2 diabetes is linked to higher physiologic markers of effort during exercise.

Background: People with type 2 diabetes (T2D) have lower rates of physical activity (PA) than the general population. This is significant because insufficient PA is linked to cardiovascular morbidity and mortality, particularly in individuals with T2D. Previously, we identified a novel barrier to physical activity: greater perceived effort during exercise in women. Specifically, women with T2D experienced exercise at low-intensity as greater effort than women without T2D at the same low-intensity - based on self-report and objective lactate measurements. A gap in the literature is whether T2D confers greater exercise effort in both sexes and across a range of work rates. Objectives: Our overarching objective was to address these gaps regarding the influence of T2D and relative work intensity on exercise effort. We hypothesized that T2D status would confer greater effort during exercise across a range of work rates below the aerobic threshold. Methods: This cross-sectional study enrolled males and post-menopausal females aged 50-75 years. Measures of exercise effort included: 1) heart rate, 2) lactate and 3) self-report of Rating of Perceived Exertion (RPE); each assessment was during the final minute of a 5-minute bout of treadmill exercise. Treadmill exercise was performed at 3 work rates: 1.5 mph, 2.0 mph, and 2.5 mph, respectively. To determine factors influencing effort, separate linear mixed effect models assessed the influence of T2D on each outcome of exercise effort, controlling for work rate intensity relative to peak oxygen consumption (%VO2peak). Models were adjusted for any significant demographic associations between effort and age (years), sex (male/female), baseline physical activity, or average blood glucose levels. Results: We enrolled n=19 people with T2D (47.4% female) and n=18 people (55.6% female) with no T2D. In the models adjusted for %VO2peak, T2D status was significantly associated with higher heart rate (p = 0.02) and lactate (p = 0.01), without a significant association with RPE (p = 0.58). Discussions: Across a range of low-to-moderate intensity work rates in older, sedentary males and females, a diagnosis of T2D conferred higher objective markers of effort but did not affect RPE. Greater objective effort cannot be fully attributed to impaired fitness, as it persisted despite adjustment for %VO2peak. In order to promote regular exercise and reduce cardiovascular risk for people with T2D, 1) further efforts to understand the mechanistic targets that influence physiologic exercise effort should be sought, and 2) comparison of the effort and tolerability of alternative exercise training prescriptions is warranted.

Reduced cardiorespiratory fitness in adult survivors of childhood acute lymphoblastic leukemia.

BACKGROUND: Adult survivors of childhood acute lymphoblastic leukemia (ALL) are at increased cardiovascular risk. Studies of factors including treatment exposures that may modify risk of low cardiorespiratory fitness in this population have been limited. PROCEDURE: To assess cardiorespiratory fitness, maximal oxygen uptake (VO2 max) was measured in 115 ALL survivors (median age, 23.5 years; range 18-37). We compared VO2 max measurements for ALL survivors to those estimated from submaximal testing in a frequency-matched (age, gender, race/ethnicity) 2003-2004 National Health and Nutritional Examination Survey (NHANES) cohort. Multivariable linear regression models were constructed to evaluate the association between therapeutic exposures and outcomes of interest. RESULTS: Compared to NHANES participants, ALL survivors had a substantially lower VO2 max (mean 30.7 vs. 39.9 ml/kg/min; adjusted P < 0.0001). For any given percent total body fat, ALL survivors had an 8.9 ml/kg/min lower VO2 max than NHANES participants. For key treatment exposure groups (cranial radiotherapy [CRT], anthracycline chemotherapy, or neither), ALL survivors had substantially lower VO2 max compared with NHANES participants (all comparisons, P < 0.001). Almost two-thirds (66.7%) of ALL survivors were classified as low cardiorespiratory fitness compared with 26.3% of NHANES participants (adjusted P < 0.0001). In multivariable models including only ALL survivors, treatment exposures were modestly associated with VO2 max. Among females, CRT was associated with low VO2 max (P = 0.02), but anthracycline exposure was not (P = 0.58). In contrast, among males, anthracycline exposure ≥ 100 mg/m(2) was associated with low VO2 max (P = 0.03), but CRT was not (P = 0.54). CONCLUSION: Adult survivors of childhood ALL have substantially lower levels of cardiorespiratory fitness compared with a similarly aged non-cancer population.

Influence of hearing loss on children's identification of spondee words in a speech-shaped noise or a two-talker masker.

OBJECTIVE: This study evaluated the influence of hearing loss on children's speech-perception abilities in a speech-shaped noise or a two-talker masker. For both masker conditions, it was predicted that children with hearing loss would require a more advantageous signal to noise ratio (SNR) than children with normal hearing to achieve the same criterion level of performance. However, it was hypothesized that the performance gap between children with hearing loss and children with normal hearing would be larger in the two-talker than in the speech-shaped noise masker. DESIGN: A repeated-measures design compared the spondee identification performance of two age groups of children with hearing loss (9-11 and 13-17 years of age) and a group of children with normal hearing (9-11 years of age) in continuous speech-shaped noise or a two-talker masker. Estimates of the SNR required for 70.7% correct spondee identification were obtained using an adaptive, four-alternative, forced-choice procedure. Children were tested in the sound field. Children with hearing loss wore their personal hearing aids at their regular settings during testing. RESULTS: Both groups of children with hearing loss performed more poorly than children with normal hearing in the speech-shaped noise masker. Younger children required an additional 2.7 dB SNR and older children required an additional 4.7 dB SNR to achieve the same level of performance as children with normal hearing. This disadvantage decreased to 8.1 dB for both age groups of children with hearing loss in the two-talker masker. For children with hearing loss, degree of hearing loss was significantly correlated with performance in the speech-shaped noise masker, but not in the two-talker masker. CONCLUSIONS: A larger performance gap was observed between children with hearing loss and children with normal hearing in competing speech than in steady state noise. These results are consistent with the hypothesis that hearing loss influenced children's perceptual processing abilities.

Patient Weight Should Be Included on All Medication Prescriptions.

Medication prescriptions for both children and adults often require the patient's current weight to determine a safe and effective dose. Medication orders in the inpatient setting typically require a patient weight be recorded prior to order verification. However, in the ambulatory setting a very different standard exists; weights are not required on prescriptions and are rarely provided by practitioners. Without this information, the community pharmacist must either ask the caregiver, who may not know an accurate weight, or simply assume that the prescriber used a current and accurate weight and calculated the dose correctly. Standard doses are prescribed for most adult prescriptions, which makes it possible for the pharmacist to identify a dosing error. Without a current patient weight, the pharmacist is not able to provide the same level of patient care to pediatric patients or adults whose prescriptions require weight-based doses. The Pediatric Pharmacy Association recommends that patient weight, recorded in kilograms, be required on all medication prescriptions in both the inpatient and outpatient settings.

Modulation of tau tubulin kinases (TTBK1 and TTBK2) impacts ciliogenesis.

Tau tubulin kinase 1 and 2 (TTBK1/2) are highly homologous kinases that are expressed and mediate disease-relevant pathways predominantly in the brain. Distinct roles for TTBK1 and TTBK2 have been delineated. While efforts have been devoted to characterizing the impact of TTBK1 inhibition in diseases like Alzheimer's disease and amyotrophic lateral sclerosis, TTBK2 inhibition has been less explored. TTBK2 serves a critical function during cilia assembly. Given the biological importance of these kinases, we designed a targeted library from which we identified several chemical tools that engage TTBK1 and TTBK2 in cells and inhibit their downstream signaling. Indolyl pyrimidinamine 10 significantly reduced the expression of primary cilia on the surface of human induced pluripotent stem cells (iPSCs). Furthermore, analog 10 phenocopies TTBK2 knockout in iPSCs, confirming a role for TTBK2 in ciliogenesis.

Developmental changes in the multisensory temporal binding window persist into adolescence.

We live in a world rich in sensory information, and consequently the brain is challenged with deciphering which cues from the various sensory modalities belong together. Determinations regarding the relatedness of sensory information appear to be based, at least in part, on the spatial and temporal relationships between the stimuli. Stimuli that are presented in close spatial and temporal correspondence are more likely to be associated with one another and thus 'bound' into a single perceptual entity. While there is a robust literature delineating behavioral changes in perception induced by multisensory stimuli, maturational changes in multisensory processing, particularly in the temporal realm, are poorly understood. The current study examines the developmental progression of multisensory temporal function by analyzing responses on an audiovisual simultaneity judgment task in 6- to 23-year-old participants. The overarching hypothesis for the study was that multisensory temporal function will mature with increasing age, with the developmental trajectory for this change being the primary point of inquiry. Results indeed reveal an age-dependent decrease in the size of the 'multisensory temporal binding window', the temporal interval within which multisensory stimuli are likely to be perceptually bound, with changes occurring over a surprisingly protracted time course that extends into adolescence.

Baseline results from Hawaii's Na Mikimiki Project: a physical activity intervention tailored to multiethnic postpartum women.

During the postpartum period, ethnic minority women have higher rates of inactivity/under-activity than white women. The Na Mikimiki ("the active ones") Project is designed to increase moderate-to-vigorous physical activity over 18 months among multiethnic women with infants 2-12 months old. The study was designed to test, via a randomized controlled trial, the effectiveness of a tailored telephone counseling of moderate-to-vigorous physical activity intervention compared to a print/website materials-only condition. Healthy, underactive women (mean age = 32 ± 5.6 years) with a baby (mean age = 5.7 ± 2.8 months) were enrolled from 2008-2009 (N = 278). Of the total sample, 84% were ethnic minority women, predominantly Asian-American and Native Hawaiian. Mean self-reported baseline level of moderate-to-vigorous physical activity was 40 minutes/week with no significant differences by study condition, ethnicity, infant's age, maternal body mass index, or maternal employment. Women had high scores on perceived benefits, self-efficacy, and environmental support for exercise but low scores on social support for exercise. This multiethnic sample's demographic and psychosocial characteristics and their perceived barriers to exercise were comparable to previous physical activity studies conducted largely with white postpartum women. The Na Mikimiki Project's innovative tailored technology-based intervention and unique population are significant contributions to the literature on moderate-to-vigorous physical activity in postpartum women.

Evaluation of Potential Benefits and Limitations of Noise-Management Technologies for Children with Hearing Aids.

BACKGROUND: Children with hearing loss frequently experience difficulty understanding speech in the presence of noise. Although remote microphone systems are likely to be the most effective solution to improve speech recognition in noise, the focus of this study centers on the evaluation of hearing aid noise management technologies including directional microphones, adaptive noise reduction (ANR), and frequency-gain shaping. These technologies can improve children's speech recognition, listening comfort, and/or sound quality in noise. However, individual contributions of these technologies as well as the effect of hearing aid microphone mode on localization abilities in children is unknown. PURPOSE: The objectives of this study were to (1) compare children's speech recognition and subjective perceptions across five hearing aid noise management technology conditions and (2) compare localization abilities across three hearing aid microphone modes. RESEARCH DESIGN: A single-group, repeated measures design was used to evaluate performance differences and subjective ratings. STUDY SAMPLE: Fourteen children with mild to moderately severe hearing loss. DATA COLLECTION AND ANALYSIS: Children's sentence recognition, listening comfort, sound quality, and localization were assessed in a room with an eight-loudspeaker array. RESULTS AND CONCLUSION: The use of adaptive directional microphone technology improves children's speech recognition in noise when the signal of interest arrives from the front and is spatially separated from the competing noise. In contrast, the use of adaptive directional microphone technology may result in a decrease in speech recognition in noise when the signal of interest arrives from behind. The use of a microphone mode that mimics the natural directivity of the unaided auricle provides a slight improvement in speech recognition in noise compared with omnidirectional use with limited decrement in speech recognition in noise when the signal of interest arrives from behind. The use of ANR and frequency-gain shaping provide no change in children's speech recognition in noise. The use of adaptive directional microphone technology, ANR, and frequency-gain shaping improve children's listening comfort, perceived ability to understand speech in noise, and overall listening experience. Children prefer to use each of these noise management technologies regardless of whether the signal of interest arrives from the front or from behind. The use of adaptive directional microphone technology does not result in a decrease in children's localization abilities when compared with the omnidirectional condition. The best localization performance occurred with use of the microphone mode that mimicked the directivity of the unaided auricle.

Low-Level Speech Recognition of Children with Hearing Aids.

BACKGROUND: For children with hearing loss, the primary goal of hearing aids is to provide improved access to the auditory environment within the limits of hearing aid technology and the child's auditory abilities. However, there are limited data examining aided speech recognition at very low (40 decibels A [dBA]) and low (50 dBA) presentation levels. PURPOSE: Due to the paucity of studies exploring aided speech recognition at low presentation levels for children with hearing loss, the present study aimed to (1) compare aided speech recognition at different presentation levels between groups of children with "normal" hearing and hearing loss, (2) explore the effects of aided pure tone average and aided Speech Intelligibility Index (SII) on aided speech recognition at low presentation levels for children with hearing loss ranging in degree from mild to severe, and (3) evaluate the effect of increasing low-level gain on aided speech recognition of children with hearing loss. RESEARCH DESIGN: In phase 1 of this study, a two-group, repeated-measures design was used to evaluate differences in speech recognition. In phase 2 of this study, a single-group, repeated-measures design was used to evaluate the potential benefit of additional low-level hearing aid gain for low-level aided speech recognition of children with hearing loss. STUDY SAMPLE: The first phase of the study included 27 school-age children with mild to severe sensorineural hearing loss and 12 school-age children with "normal" hearing. The second phase included eight children with mild to moderate sensorineural hearing loss. INTERVENTION: Prior to the study, children with hearing loss were fitted binaurally with digital hearing aids. Children in the second phase were fitted binaurally with digital study hearing aids and completed a trial period with two different gain settings: (1) gain required to match hearing aid output to prescriptive targets (i.e., primary program), and (2) a 6-dB increase in overall gain for low-level inputs relative to the primary program. In both phases of this study, real-ear verification measures were completed to ensure the hearing aid output matched prescriptive targets. DATA COLLECTION AND ANALYSIS: Phase 1 included monosyllabic word recognition and syllable-final plural recognition at three presentation levels (40, 50, and 60 dBA). Phase 2 compared speech recognition performance for the same test measures and presentation levels with two differing gain prescriptions. CONCLUSION: In phase 1 of the study, aided speech recognition was significantly poorer in children with hearing loss at all presentation levels. Higher aided SII in the better ear (55 dB sound pressure level input) was associated with higher Consonant-Nucleus-Consonant word recognition at a 40 dBA presentation level. In phase 2, increasing the hearing aid gain for low-level inputs provided a significant improvement in syllable-final plural recognition at very low-level inputs and resulted in a nonsignificant trend toward better monosyllabic word recognition at very low presentation levels. Additional research is needed to document the speech recognition difficulties children with hearing aids may experience with low-level speech in the real world as well as the potential benefit or detriment of providing additional low-level hearing aid gain.

Increased rate of listening difficulties in autistic children.

INTRODUCTION: Auditory challenges are both common and disruptive for autistic children and evidence suggests that listening difficulties may be linked to academic underachievement (Ashburner, Ziviani & Rodger, 2008). Such deficits may also contribute to issues with attention, behavior, and communication (Ashburner et al., 2008; Riccio, Cohen, Garrison & Smith, 2005). The present study aims to summarize the auditory challenges of autistic children with normal pure-tone hearing thresholds, and perceived listening difficulties, seen at auditory-ASD clinics in the US and Australia. METHODS: Data were compiled on a comprehensive, auditory-focused test battery in a large clinical sample of school-age autistic children with normal pure-tone hearing to date (N = 71, 6-14 years). Measures included a parent-reported auditory sensory processing questionnaire and tests of speech recognition in noise, binaural integration, attention, auditory memory and listening comprehension. Individual test performance was compared to normative data from children with no listening difficulties. RESULTS: Over 40% of patients exhibited significantly reduced speech recognition in noise and abnormal dichotic integration that were not attributed to deficits in attention. The majority of patients (86%) performed abnormally on at least one auditory measure, suggesting that functional auditory issues can exist in autistic patients despite normal pure-tone sensitivity. CONCLUSION: Including functional listening measures during audiological evaluations may improve clinicians' ability to detect and manage the auditory challenges impacting this population. Learner Outcomes: 1) Readers will be able to describe the auditory difficulties experienced by some autistic patients (ASD). 2) Readers will be able to describe clinical measures potentially useful for detecting listening difficulties in high-functioning autistic children.

Integrating a physical activity coaching intervention into diabetes care: a mixed-methods evaluation of a pilot pragmatic trial.

Physical activity (PA) counseling is under-utilized in primary care for patients with type 2 diabetes mellitus (T2D), despite improving important health outcomes, including physical function. We adapted evidence-based PA counseling programs to primary care patients, staff, and leader's needs, resulting in "Be ACTIVE" comprised of shared PA tracker data (FitBit©), six theory-informed PA coaching calls, and three in-person clinician visits. In a pilot randomized pragmatic trial, we evaluated the feasibility, acceptability, and effectiveness of Be ACTIVE. Sedentary patients with T2D were randomized to Be ACTIVE versus an enhanced control condition. Mixed methods assessments of feasibility and acceptability included costs. Objective pilot effectiveness outcomes included PA (primary outcome, accelerometer steps/week), the Short Physical Performance Battery (SPPB) physical function measure, and behavioral PA predictors. Fifty patients were randomized to Be ACTIVE or control condition. Acceptability was >90% for patients and clinic staff. Coaching and PA tracking costs of ~$90/patient met Medicare reimbursement criteria. Pre-post PA increased by ~11% (Be ACTIVE) and ~6% in controls (group difference: 1574 ± 4391 steps/week, p = .72). As compared to controls, Be ACTIVE participants significantly improved SPPB (0.9 ± 0.3 vs. -0.1 ± 0.3, p = .01, changes >0.5 points prevent falls clinically), and PA predictors of self-efficacy (p = .02) and social-environmental support (p < .01). In this pilot trial, Be ACTIVE was feasible and highly acceptable to stakeholders and yielded significant improvements in objective physical function consistent with lower fall risk, whereas PA changes were less than anticipated. Be ACTIVE may need additional adaptation or a longer duration to improve PA outcomes.

We report results from a pragmatic and behavioral theory-based physical activity (PA) coaching program, termed "Be ACTIVE," for patients with type 2 diabetes that was designed to improve PA and function for patients and to be reimbursable and feasible for primary care teams. As compared to those who did not receive coaching, patients who received Be ACTIVE had physical function improvements that lowered their risk of falls. Be ACTIVE was delivered with fidelity and was highly acceptable to the key primary care stakeholders of patients, clinic staff coaches, and clinicians. Patients particularly liked the focus on setting goals to do enjoyable activities, the accountability of wearing a PA monitor, and the support of their coach. Clinical care professionals felt that their role of encouraging behavior change (coach) and safety monitoring (clinician) aligned well with their clinical expertise, and was professionally rewarding. Coaches felt the program helped them guide many patients to overcome preexisting negative perceptions of PA and develop intrinsic motivations to be active. The costs of clinic coach time and PA tracker rental needed to deliver the 12-week program could be reimbursed by the Medicare Chronic Disease Management programs, albeit with a patient co-payment required.

Educational Challenges During the Pandemic for Students Who Have Hearing Loss.

Purpose The COVID-19 pandemic introduced new educational challenges for students, teachers, and caregivers due to the changed and varied learning environments, use of face masks, and social distancing requirements. These challenges are particularly pronounced for students with hearing loss who often require specific accommodations to allow for equal access to the curriculum. The purpose of this study was to document the potential difficulties that students with hearing loss faced during the pandemic and to generate recommendations to promote learning and engagement based on findings. Method A qualitative survey was designed to document the frequency of various learning situations (i.e., in person, remote virtual, and blended), examine the accessibility of technology and course content, and quantify hearing issues associated with safety measures and technology use in school-age students with hearing loss. Survey questions were informed from key educational issues reported in published articles and guidelines. The survey was completed by 416 educational personnel who work with students with hearing loss. Results Respondents indicated that most of their schools were providing remote or blended (in-person and remote) learning consisting of synchronous and asynchronous learning. Common accommodations for students with hearing loss were only provided some of the time with the exception of sign language interpreters, which were provided for almost all students who required them. According to the respondents, both students and caregivers reported issues or discomfort with the technology required for remote learning. Conclusion To ensure that students with hearing loss are provided equal access to the curriculum, additional accommodations should be considered to address issues arising from pandemic-related changes to school and learning practices including closed captioning, transcripts/notes, recordings of lectures, sign language interpreters, student check-ins, and family-directed resources to assist with technology issues.

Psychosocial mediators of physical activity and fitness changes in the activity counseling trial.

BACKGROUND: Improved understanding of the mediators of physical activity (PA) interventions could lead to improvements in theory and programs. PURPOSE: To examine the 24-month mediating effects of psychosocial variables on PA and cardiorespiratory fitness (CRF) outcomes in 878 initially sedentary adults aged 35-75 participating in the Activity Counseling Trial. METHODS: Participants were assigned to one of three intervention arms: physician advice, assistance, or counseling. MacKinnon's product of coefficients was used to test for longitudinal and contemporaneous mediation. RESULTS: Changes in behavioral processes of change from baseline to 24 months significantly mediated the relationship between the active intervention arms and improvements in PA and CRF from baseline to 24 months in both men and women. None of the other psychosocial variables tested met criteria for mediation. CONCLUSIONS: Results indicate that behavioral interventions should incorporate methods to encourage participants to use these behavioral strategies as they attempt to become more active.