Combined effects of age and hearing impairment on utterances and requests for clarification in spontaneous conversation and a referential communication task.

BACKGROUND: The impact of hearing impairment is typically studied in terms of its effects on speech perception, yet this fails to account for the interactive nature of communication. Recently, there has been a move towards studying the effects of age-related hearing impairment on interaction, often using referential communication tasks; however, little is known about how interaction in these tasks compares to everyday communication. AIMS: To investigate utterances and requests for clarification used in one-to-one conversations between older adults with hearing impairment and younger adults without hearing impairment, and between two younger adults without hearing impairment. METHODS & PROCEDURES: A total of 42 participants were recruited to the study and split into 21 pairs, 10 with two younger adults without hearing impairment and 11 with one younger adult without hearing impairment and one older participant with age-related hearing impairment (hard of hearing). Results from three tasks-spontaneous conversation and two trials of a referential communication task-were compared. A total of 5 min of interaction in each of the three tasks was transcribed, and the frequency of requests for clarification, mean length of utterance and total utterances were calculated for individual participants and pairs. OUTCOMES & RESULTS: When engaging in spontaneous conversation, participants made fewer requests for clarification than in the referential communication, regardless of hearing status/age (p ≤ 0.012). Participants who were hard of hearing made significantly more requests for clarification than their partners without hearing impairment in only the second trial of the referential communication task (U = 25, p = 0.019). Mean length of utterance was longer in spontaneous conversation than in the referential communication task in the pairs without hearing impairment (p ≤ 0.021), but not in the pairs including a person who was hard of hearing. However, participants who were hard of hearing used significantly longer utterances than their partners without hearing impairment in the spontaneous conversation (U = 8, p < 0.001) but not in the referential communication tasks. CONCLUSIONS & IMPLICATIONS: The findings suggest that patterns of interaction observed in referential communication tasks differ to those observed in spontaneous conversation. The results also suggest that fatigue may be an important consideration when planning studies of interaction that use multiple conditions of a communication task, particularly when participants are older or hard of hearing. WHAT THIS PAPER ADDS: What is already known on this subject Age-related hearing impairment is known to affect communication; however, the majority of studies have focused on its impact on speech perception in controlled conditions. This indicates little about the impact on everyday, interactive, communication. What this study adds to the existing knowledge We investigated utterance length and requests for clarification in one-to-one conversations between pairs consisting of one older adult who is hard of hearing and one younger adult without hearing impairment, or two younger adults without hearing impairment. Results from three tasks (two trials of a referential communication task and spontaneous conversation) were compared. The findings demonstrated a significant effect of task type on requests for clarification in both groups. Furthermore, in spontaneous conversation, older adults who were hard of hearing used significantly longer utterances than their partners without hearing impairment. This pattern was not observed in the referential communication task. What are the potential or actual clinical implications of this work? These findings have important implications for generalizing results from controlled communication tasks to more everyday conversation. Specifically, they suggest that the previously observed strategy of monopolizing conversation, possibly as an attempt to control it, may be more frequently used by older adults who are hard of hearing in natural conversation than in a more contrived communication task.

Motor performance and attention outcomes in children born very preterm.

AIM: To examine the relationship between motor performance and attention in children born very preterm and at term, and investigate the presence of individual profiles of motor and attention performance. METHOD: Attention and motor performance at 7 and 13 years were assessed in 197 children born very preterm (52.5% male) and 69 children born at term (47.8% male) between 2001 and 2003. Linear regression models were fitted including an interaction term for birth group. Subgroups of children with similar attention and motor performance profiles were identified using latent profile analysis. RESULTS: Balance was positively associated with all attention outcomes at both ages (p < 0.006). There were specific birth group interactions for aiming and catching and manual dexterity with attention at 13 years, with positive associations observed only for children born very preterm (p < 0.001). At 7 years, three profiles were observed: average attention and motor functioning; average motor functioning and low attention functioning; and low attention and motor functioning. At 13 years, two profiles of average attention and motor functioning emerged, as well as one profile of below-average attention and motor functioning. Children born very preterm were overrepresented in the lower functioning profiles (born very preterm 56%; born at term 29%). INTERPRETATION: Motor functioning at age 7 years may be a useful marker of later attention skills, particularly for children born very preterm who are at greater risk of poorer long-term cognitive outcomes. WHAT THIS PAPER ADDS: Balance was positively associated with attention in children born very preterm and at term. Relationships between motor performance and attention at age 13 years differed between children born very preterm and at term. Heterogeneous motor functioning and attention outcomes were noted for children born very preterm and at term. Children born very preterm were more likely to have lower attention and motor functioning profiles than children born at term. There was greater movement in motor functioning and attention profiles between the ages of 7 and 13 years in children born very preterm.

Relationships between behavioural and self-report measures in speech recognition in noise.

OBJECTIVE: Using data from the n200-study, we aimed to investigate the relationship between behavioural (the Swedish HINT and Hagerman speech-in-noise tests) and self-report (Speech, Spatial and Qualities of Hearing Questionnaire (SSQ)) measures of listening under adverse conditions. DESIGN: The Swedish HINT was masked with a speech-shaped noise (SSN), the Hagerman was masked with a SSN and a four-talker babble, and the subscales from the SSQ were used as a self-report measure. The HINT and Hagerman were administered through an experimental hearing aid. STUDY SAMPLE: This study included 191 hearing aid users with hearing loss (mean PTA4 = 37.6, SD = 10.8) and 195 normally hearing adults (mean PTA4 = 10.0, SD = 6.0). RESULTS: The present study found correlations between behavioural measures of speech-in-noise and self-report scores of the SSQ in normally hearing individuals, but not in hearing aid users. CONCLUSION: The present study may help identify relationships between clinically used behavioural measures, and a self-report measure of speech recognition. The results from the present study suggest that use of a self-report measure as a complement to behavioural speech in noise tests might help to further our understanding of how self-report, and behavioural results can be generalised to everyday functioning.

Retracted Article: Temporal fine structure: relations to cognition and aided speech recognition.

Retraction statementWe, the Editor and Publisher of the International Journal of Audiology, have retracted the following article.Rachel J. Ellis, and Jerker Rönnberg. 2019. "Temporal fine structure: relations to cognition and aided speech recognition." International Journal of Audiology. doi:10.1080/14992027.2019.1672899.The authors of the above-mentioned article published in the International Journal of Audiology have identified errors in the reported analysis (relating to the inclusion of data that should have been excluded) which impact the validity of the findings. The authors have, therefore, requested that the article be retracted.We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as "Retracted".

Temporal fine structure: associations with cognition and speech-in-noise recognition in adults with normal hearing or hearing impairment.

OBJECTIVES: To investigate associations between sensitivity to temporal fine structure (TFS) and performance in cognitive and speech-in-noise recognition tests. DESIGN: A binaural test of TFS sensitivity (the TFS-LF) was used. Measures of cognition included the reading span, Raven's, and text-reception threshold tests. Measures of speech recognition included the Hearing in noise (HINT) and the Hagerman matrix sentence tests in three signal processing conditions. STUDY SAMPLE: Analyses are based on the performance of 324/317 adults with and without hearing impairment. RESULTS: Sensitivity to TFS was significantly correlated with both the reading span test and the recognition of speech-in-noise processed using noise reduction, the latter only when limited to participants with hearing impairment. Neither association was significant when the effects of age were partialled out. CONCLUSIONS: The findings are consistent with previous research in finding no evidence of a link between sensitivity to TFS and working memory once the effects of age had been partialled out. The results provide some evidence of an influence of signal processing strategy on the association between TFS sensitivity and speech-in-noise recognition. However, further research is necessary to assess the generalisability of the findings before any claims can be made regarding any clinical implications of these findings.

Near-Peer Teaching in Radiation Oncology: a Proof of Principle Study for Learning Treatment Planning.

Radiotherapy techniques are expanding in range and complexity; therefore, protecting learning environments where residents nurture treatment planning skills is critical. The evidence base for 'near-peer' teaching (NPT), where professionals at a similar career stage assist in each other's learning, is growing in hospital-based disciplines, but has not been reported in radiation oncology. The feasibility of a resident-led teaching programme for developing treatment planning skills was investigated herein with quality improvement (QI) methodology. Following consultation with attendings (n = 10) and all residents (n = 17) at the two cancer centres in the region, a regular NPT session focused on planning skills was initiated at the largest centre, with video-linking to the second centre. Tutorials were case-based and pitched at the level of qualifying examinations. Plan-Do-Study-Act (PDSA) cycles were designed based on primary and secondary improvement drivers derived by group consensus among residents, with tutorials adopted accordingly. Participation, content, and satisfaction were monitored for 20 months. Six PDSA cycles reformed the tutorial format, leading to logistical and pedagogical benefits including interprofessional contributions and enhanced interactivity. Tutorials occurred on 85% prescribed occasions (n = 45) during the subsequent 18-month follow-up, with 25 distinct tumour sites featured. Resident participation and satisfaction increased, independent of resident seniority. Tutorials were paused for the first 2 months of the SARS-CoV-2 pandemic only. A high-quality and cost-effective regional, trainee-led teaching programme on treatment planning was feasible and cost-effective in this study.

Rates of Developmental Coordination Disorder in Children Born Very Preterm.

OBJECTIVE: To examine the stability of developmental coordination disorder (DCD) throughout childhood in children born very preterm and term. Further, in the very preterm group, to compare perinatal variables and neurobehavioral outcomes at 13 years of age for children with persisting DCD and those with typical motor development. STUDY DESIGN: Prospective study of 180 very preterm and 73 term-born children assessed at 5, 7, and/or 13 years of age using the Movement Assessment Battery for Children, with scores ≤16th percentile used to classify DCD. Children with cerebral palsy or an IQ of <80 were excluded. RESULTS: Children born very preterm had increased odds for DCD at 5 (OR, 5.53; 95% CI, 2.53-12.0; P < .001), 7 (OR, 3.63; 95% CI, 1.43-9.18; P = .06), and 13 years (OR, 4.34; 95% CI, 1.61-11.7; P = .004) compared with term-born children. The rates of DCD in very preterm children reduced from 47.9% at 5 years of age, to 28.5% at 7 years and 27.8% at 13 years of age (OR per year of age, 0.81; 95% CI, 0.75-0.87; P < .001), but less so for term-born children (15.3%, 10.0%, and 8.5% at 5, 7, and 13-years respectively [OR, 0.91; 95% CI, 0.75-1.09; P = .31]). Within the very preterm group at 13 years of age, there was evidence that children with persisting DCD performed poorer across several cognitive domains compared with children with typical motor development, with differences in the order of 0.5-1.0 SD. CONCLUSIONS: Although the rates of DCD decreased across middle childhood for both groups, the odds for DCD were consistently higher for very preterm children compared with term, with important implications for cognitive functioning in the very preterm group.

Vibration overtone hyperpolarizability measured for H2.

The second hyperpolarizability (γ) of the H2 molecule was measured by gas-phase electric field induced second harmonic generation at the frequencies of the one-photon resonance for the 3-0 Q(J) overtone transitions (v, J = 0, J → 3, J for J = 0, 1, 2, and 3). The magnitude of the resonant contribution to γ was measured with 2% accuracy using the previously determined non-resonant γ for calibration. Pressure broadening and frequency shift for the transitions were also measured. A theoretical expression for the resonant vibrational γ contribution in terms of transition polarizabilities is compared to the observations. The measured γ resonance strength is 4%-14% larger than the results obtained from this theoretical expression evaluated using ab initio transition polarizabilities.

Goal Setting Deficits at 13 Years in Very Preterm Born Children.

OBJECTIVES: Preterm children demonstrate deficits in executive functions including inhibition, working memory, and cognitive flexibility; however, their goal setting abilities (planning, organization, strategic reasoning) remain unclear. This study compared goal setting abilities between very preterm (VP: <30 weeks/<1250 grams) and term born controls during late childhood. Additionally, early risk factors (neonatal brain abnormalities, medical complications, and sex) were examined in relationship to goal setting outcomes within the VP group. METHODS: Participants included 177 VP and 61 full-term born control children aged 13 years. Goal setting was assessed using several measures of planning, organization, and strategic reasoning. Parents also completed the Behavior Rating Inventory of Executive Function. Regression models were performed to compare groups, with secondary analyses adjusting for potential confounders (sex and social risk), and excluding children with major neurosensory impairment and/or IQ<70. Within the VP group, regression models were performed to examine the relationship between brain abnormalities, medical complications, and sex, on goal setting scores. RESULTS: The VP group demonstrated a clear pattern of impairment and inefficiency across goal setting measures, consistent with parental report, compared with their full-term born peers. Within the VP group, moderate/severe brain abnormalities on neonatal MRI predicted adverse goal setting outcomes at 13. CONCLUSIONS: Goal setting difficulties are a significant area of concern in VP children during late childhood. These difficulties are associated with neonatal brain abnormalities, and are likely to have functional consequences academically, socially and vocationally. (JINS, 2018, 24, 372-381).

Keeping it together: Semantic coherence stabilizes phonological sequences in short-term memory.

Our ability to hold a sequence of speech sounds in mind, in the correct configuration, supports many aspects of communication, but the contribution of conceptual information to this basic phonological capacity remains controversial. Previous research has shown modest and inconsistent benefits of meaning on phonological stability in short-term memory, but these studies were based on sets of unrelated words. Using a novel design, we examined the immediate recall of sentence-like sequences with coherent meaning, alongside both standard word lists and mixed lists containing words and nonwords. We found, and replicated, substantial effects of coherent meaning on phoneme-level accuracy: The phonemes of both words and nonwords within conceptually coherent sequences were more likely to be produced together and in the correct order. Since nonwords do not exist as items in long-term memory, the semantic enhancement of phoneme-level recall for both item types cannot be explained by a lexically based item reconstruction process employed at the point of retrieval ("redintegration"). Instead, our data show, for naturalistic input, that when meaning emerges from the combination of words, the phonological traces that support language are reinforced by a semantic-binding process that has been largely overlooked by past short-term memory research.

Longitudinal Trajectories of Depression Symptoms in Adolescence: Psychosocial Risk Factors and Outcomes.

Variations in symptom trajectories within a population may represent distinct groups with different etiologies and outcomes. This study aimed to identify subgroups of depression symptom trajectories in a sample of adolescents, and to describe psychosocial attributes of the different groups. In a longitudinal study, 243 adolescents (121 males and 122 females), were assessed using a battery of measures of temperament, psychopathology, and psychological and behavioral functioning. Four phases of data collection over 7 years spanned average ages of the participants from 12 to 18 years old. Depressive symptoms from each phase were used to model latent class growth trajectories. A 4-group solution was selected as the best-fitting model: (1) ongoing stable low levels of depression; (2) very high depressive symptoms initially, but a steep decrease in symptoms over time; (3) moderately high depressive symptoms initially, but symptoms decreased over time; and (4) initially low levels of symptoms that increased over time. Trajectory group membership was associated with a range of psychosocial variables including temperament, childhood maltreatment, and young adult quality of life. Characterising these subgroups allows for a better understanding of how the interaction of risk factors increases the likelihood of depression and other poor outcomes, and highlights the importance of early interventions to prevent and treat adolescent depression.

Structural connectivity relates to perinatal factors and functional impairment at 7years in children born very preterm.

OBJECTIVE: To use structural connectivity to (1) compare brain networks between typically and atypically developing (very preterm) children, (2) explore associations between potential perinatal developmental disturbances and brain networks, and (3) describe associations between brain networks and functional impairments in very preterm children. METHODS: 26 full-term and 107 very preterm 7-year-old children (born <30weeks' gestational age and/or <1250g) underwent T1- and diffusion-weighted imaging. Global white matter fibre networks were produced using 80 cortical and subcortical nodes, and edges were created using constrained spherical deconvolution-based tractography. Global graph theory metrics were analysed, and regional networks were identified using network-based statistics. Cognitive and motor function were assessed at 7years of age. RESULTS: Compared with full-term children, very preterm children had reduced density, lower global efficiency and higher local efficiency. Those with lower gestational age at birth, infection or higher neonatal brain abnormality score had reduced connectivity. Reduced connectivity within a widespread network was predictive of impaired IQ, while reduced connectivity within the right parietal and temporal lobes was associated with motor impairment in very preterm children. CONCLUSIONS: This study utilised an innovative structural connectivity pipeline to reveal that children born very preterm have less connected and less complex brain networks compared with typically developing term-born children. Adverse perinatal factors led to disturbances in white matter connectivity, which in turn are associated with impaired functional outcomes, highlighting novel structure-function relationships.

A case of indeterminate dendritic cell tumor presenting with leonine facies.

BACKGROUND: Indeterminate dendritic cell tumor is an extremely rare neoplastic proliferation of dendritic cells that share immunophenotypic features of Langerhans cells and macrophages but lack Birbeck granules and Langerin expression. METHODS: We report a 55-year-old female presenting with a leonine facies and generalized multiple confluent papules, nodules and plaques on neck, upper trunk, arms and thighs. Laboratory evaluations were performed including skin biopsies, peripheral blood flow cytometry and positron emission tomography-computed tomography. RESULTS: The lesional skin biopsy showed a dense dermal and perifollicular infiltrate composed of histiocytoid cells with nuclear grooves lacking dendritic processes in a background of lymphocytes. Eosinophils were absent. The histiocytoid cells were CD68+CD1a+Langerin- and only focally S100+. Special stains including GMS, Gram and Fite were all negative for infectious organisms. Although an initial diagnosis suggesting Langerhans cell histiocytosis was proposed due to CD1a positivity, a diagnosis of indeterminate dendritic cell tumor was finally rendered based on the histopathological findings and the lack of expression of Langerin. CONCLUSION: This case illustrates the variegated clinical presentation of indeterminate cell tumor and the necessity of appropriate immunohistochemical workup for its diagnosis.

Autoimmune dermatologic toxicities from immune checkpoint blockade with anti-PD-1 antibody therapy: a report on bullous skin eruptions.

Monoclonal antibodies against the immune checkpoint programmed cell death receptor 1 (PD-1) improve the hosts' antitumor immune response and have showed tremendous promise in the treatment of advanced solid tumors and hematologic malignancies. Reports of serious autoimmune dermatologic toxicities from immune checkpoint blockade therapy, however, are emerging. We report our experience with five patients who presented with pruritic vesicles and blisters on the skin while treated with anti-PD-1 antibody immunotherapy with either nivolumab or pembrolizumab. Four of the patients' skin biopsies revealed subepidermal bullae with immunohistochemical study for type IV collagen labeling the floor of the blister cavity and direct immunofluorescence studies (in three of the four patients tested) decorated linear IgG and C3 immune deposits on the blister roof, diagnostic of bullous pemphigoid. One patient developed bullous erythema multiforme. All patients had partial or complete resolution of skin lesions following treatment with systemic corticosteroid and cessation of checkpoint blockade. Recognition and treatment of rare immune-related bullous dermatologic toxicities will become increasingly important as more patients are treated with effective and newer immune checkpoint blockade therapy.

Predicting Speech-in-Noise Recognition From Performance on the Trail Making Test: Results From a Large-Scale Internet Study.

OBJECTIVE: The aim of the study was to investigate the utility of an internet-based version of the trail making test (TMT) to predict performance on a speech-in-noise perception task. DESIGN: Data were taken from a sample of 1509 listeners between ages 18 and 91 years old. Participants completed computerized versions of the TMT and an adaptive speech-in-noise recognition test. All testing was conducted via the internet. RESULTS: The results indicate that better performance on both the simple and complex subtests of the TMT are associated with better speech-in-noise recognition scores. Thirty-eight percent of the participants had scores on the speech-in-noise test that indicated the presence of a hearing loss. CONCLUSIONS: The findings suggest that the TMT may be a useful tool in the assessment, and possibly the treatment, of speech-recognition difficulties. The results indicate that the relation between speech-in-noise recognition and TMT performance relates both to the capacity of the TMT to index processing speed and to the more complex cognitive abilities also implicated in TMT performance.

Eccentric exercise in adults with cardiorespiratory disease: a systematic review.

OBJECTIVE: To determine if eccentric exercise is effective, tolerable and safe for adults with chronic cardiorespiratory disease. DATA SOURCES: We searched electronic databases from inception until January 2015 (Medline, CINAHL, Embase, SportDiscus, PEDro, Cochrane Central and AMED) supplemented by citation tracking and reference list scanning. REVIEW METHODS: Included articles had to report effects of eccentric exercise, alone or as a primary component of intervention, of any intensity and duration, on adults with chronic cardiorespiratory disease. Trials needed to be reported as full text in a peer-reviewed journal and include control data (randomised, quasi-randomised and single group cross-over design trials). Any outcomes or comparison interventions were accepted. Methodological rigor was assessed using the PEDro scale. RESULTS: Of 22 potentially relevant articles, 10 met inclusion criteria. They reported results from seven trials with a total of 112 participants across the diseases. PEDro scores were low (median 3). Eccentric exercise increased strength and mobility to comparable levels as concentric exercise, however, it did so with lower oxygen consumption (effect size as large as d = -3.07 (-4.12, -1.80)), and four-fold power output (effect size d = -3.60 (-5.03, -1.66)). There were no adverse events reported for eccentric exercise. Pain was avoided with familiarisation sessions and individual exercise prescription. CONCLUSION: Eccentric exercise is beneficial and at least comparable with traditional exercise in improving walking and strength for people with chronic cardiorespiratory disease. It was well tolerated and we identified no safety concerns for the use of this intervention for this population.

Benefit from, and acclimatization to, frequency compression hearing aids in experienced adult hearing-aid users.

OBJECTIVE: The aim was to investigate whether frequency compression (FC) hearing aids provide additional benefit to that conferred by conventional amplification. DESIGN: Participants wore the same hearing aid with FC enabled and disabled for six weeks (ABA design) in each condition. Speech recognition tests (in both quiet and in noise) were administered alongside two questionnaires. Performance was compared across the two signal processing conditions and at different time points. STUDY SAMPLE: Twelve experienced hearing-aid users (aged 65-84 years old) with moderate-to-severe high-frequency hearing loss participated in the study. RESULTS: FC resulted in statistically significantly higher mean scores in all of the administered speech tests. Improvements over time were limited to high frequency phoneme perception. No effect of FC on self-report outcomes was observed. CONCLUSIONS: FC may lead to significant improvements in speech perception outcomes in both quiet and noise for many individuals. No participant was significantly disadvantaged by the use of FC.

Predictors of aided speech recognition, with and without frequency compression, in older adults.

OBJECTIVE: The aim was to investigate whether cognitive and/or audiological measures predict aided speech recognition, both with and without frequency compression (FC). DESIGN: Participants wore hearing aids, with and without FC for a total of 12 weeks (six weeks in each signal processing condition, ABA design). Performance on a sentence-in-noise recognition test was assessed at the end of each six-week period. Audiological (severity of high frequency hearing loss, presence of dead regions) and cognitive (reading span and trail making test scores) measures were obtained and assessed as predictors of sentence-in-noise recognition with and without FC enabled. STUDY SAMPLE: Twelve experienced hearing-aid users (aged 65-84 years old) with moderate-to-severe high-frequency hearing loss took part in the study. RESULTS: The results suggest that both auditory and cognitive factors can be predictive of sentence-in-noise recognition with conventional amplification. However, only auditory factors were significantly correlated with the degree of benefit obtained from FC. CONCLUSIONS: The strongest predictor of aided speech recognition, both with and without FC, was high frequency hearing loss. Cognitive performance was also a predictor of benefit from conventional amplification, but not of additional benefit from the use of FC.

Cognitive skills and the effect of noise on perceived effort in employees with aided hearing impairment and normal hearing.

The aim of the following study was to examine the relationship between working memory capacity (WMC), executive functions (EFs) and perceived effort (PE) after completing a work-related task in quiet and in noise in employees with aided hearing impairment (HI) and normal hearing. The study sample consisted of 20 hearing-impaired and 20 normally hearing participants. Measures of hearing ability, WMC and EFs were tested prior to performing a work-related task in quiet and in simulated traffic noise. PE of the work-related task was also measured. Analysis of variance was used to analyze within- and between-group differences in cognitive skills, performance on the work-related task and PE. The presence of noise yielded a significantly higher PE for both groups. However, no significant group differences were observed in WMC, EFs, PE and performance in the work-related task. Interestingly, significant negative correlations were only found between PE in the noise condition and the ability to update information for both groups. In summary, noise generates a significantly higher PE and brings explicit processing capacity into play, irrespective of hearing. This suggest that increased PE involves other factors such as type of task that is to be performed, performance in the cognitive skill required solving the task at hand and whether noise is present. We therefore suggest that special consideration in hearing care should be made to the individual's prerequisites on these factors in the labor market.