A Scoping Review and Field Guide of Theoretical Approaches and Recommendations to Studying the Decision to Adopt Hearing Aids.

OBJECTIVES: Given the low rates of hearing aid adoption among individuals with hearing loss, it is imperative to better understand the decision-making processes leading to greater hearing aid uptake. A careful analysis of the existing literature on theoretical approaches to studying these processes is needed to help researchers frame hypotheses and methodology in studies on audiology. Therefore, we conducted a scoping review with two aims. First, we examine theories that have been used to study research on hearing aid adoption. Second, we propose additional theories from the behavioral sciences that have not yet been used to examine hearing aid uptake but that can inform future research. DESIGN: We identified peer-reviewed publications whose research was driven by one or more theoretical approaches by searching through PubMed, ProQuest PsycINFO, CINHAL Plus, Web of Science, Scopus, and OVID Medline/Embase/PsycINFO. The publications were examined by two researchers for eligibility. RESULTS: Twenty-three papers were included in the analysis. The most common theoretical approaches studied include the Health Belief Model, the Transtheoretical Model of Behavior Change, Self-Determination Theory, and the COM-B Model. Seven other theoretical frameworks based on cognitive psychology and behavioral economics have also appeared in the literature. In addition, we propose considering nudge theory, framing effect, prospect theory, social learning theory, social identity theory, dual process theories, and affective-based theories of decision making when studying hearing aid adoption. CONCLUSIONS: We conclude that, although a number of theories have been considered in research on hearing aid uptake, there are considerable methodological limitations to their use. Furthermore, the field can benefit greatly from the inclusion of novel theoretical approaches drawn from outside of audiology.

Subjective Impact of Age-Related Hearing Loss Is Worse for Those Who Routinely Experience Boredom and Failures of Attention.

OBJECTIVES: Despite extensive evidence supporting the benefits of hearing treatments for individuals affected by hearing loss, many leave their hearing issues unaddressed. This underscores the need to better understand the individual factors influencing decision-making regarding hearing loss treatments. One consideration regarding the low uptake of treatment is the finding that the subjective impact of hearing loss is greater for some individuals than for others, yielding a significant discrepancy between subjective measures of hearing loss (e.g., self-report hearing-handicap scales) and objective audiometric assessments (e.g., audiograms). The current study seeks to elucidate some of the cognitive-affective factors that give rise to these individual differences in the subjective impact of hearing loss. Specifically, we hypothesized that a stronger trait tendency to experience boredom would be correlated with more intensely negative experiences of hearing-related issues, and that this relationship would be mediated by underlying attentional difficulties. METHODS: Through a partnership with hearing care clinics (Connect Hearing Canada), we recruited a large sample of older adults (n = 1840) through their network of hearing-care clinics. Audiometric thresholds provided an objective measure of hearing ability for each participant, while self-report questionnaires assessed individual differences in the subjective impact of hearing-related issues (hearing handicap), subjective strain experienced when listening (listening effort), tendency to experience boredom, tendency to experience difficulty maintaining task-focused attention (mind-wandering), and self-perceived level of cognitive functioning. RESULTS: The subjective impact of hearing loss-both in terms of hearing handicap and strain when listening-was found to be more intensely negative for those who are characteristically more susceptible to experiencing boredom, and this relationship was shown to be mediated by self-reported differences in the ability to maintain task-focused attention. This relationship between trait boredom proneness and the subjective impact of hearing-related issues was evident across all levels of objective hearing abilities. Moreover, there was no evidence that the subjective impact of hearing loss is worse for those who routinely experience boredom because of objectively-poorer hearing abilities in those individuals. CONCLUSIONS: A greater trait susceptibility to experiencing boredom was associated with a more aversive subjective experience of hearing loss, and this relationship is mediated by attentional difficulties. This is a novel discovery regarding the cognitive-affective factors that are linked to individual differences in the effect that hearing loss has on individuals' daily functioning. These results may be helpful for better understanding the determinants of hearing-rehabilitation decisions and how to improve the uptake of treatments for hearing loss. The observational nature of the current study restricts us from drawing any definitive conclusions about the casual directions among the factors being investigated. Further research is therefore needed to establish how individual differences in the characteristic tendency to experience boredom are related to attentional-control difficulties and the experience of hearing-related issues. More research is also required to determine how all of these factors may influence decisions regarding hearing-loss treatments.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health.

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Mitochondrial DNA methyltransferases and their regulation under freezing and dehydration stresses in the freeze-tolerant wood frog, Rana sylvatica.

Wood frogs are a few vertebrate species that can survive whole-body freezing. Multiple adaptations support this, including cryoprotectant production (glucose), metabolic rate depression, and selective changes in gene and protein expression to activate pro-survival pathways. The role of DNA methylation machinery (DNA methyltransferases, DNMTs) in regulating nuclear gene expression to support freezing survival has already been established. However, a comparable role for DNMTs in the mitochondria has not been explored in wood frogs. We examined the mitochondrial protein levels of DNMT-1, DNMT-3A, DNMT-3B, and DNMT-3L as well as mitochondrial DNMT activity in the liver and heart to assess the involvement of DNMT in the survival of freezing and dehydration stresses (cellular dehydration being a component of freezing). Our results showed stress- and tissue-specific responses to mitochondrial DNMT-1 in the liver and heart, respectively. During 24 h of freezing and whole-body dehydration, we observed an overall downregulation of mitochondrial DNMT-1, a major protein involved in maintaining methylation levels related to its role in the selective transcription of mitochondrial genes as well as antioxidant response. Tissue-specific responses of protein levels of DNMT-3A, DNMT-3B, DNMT-3L, and DNMT activity in the liver suggested a preference for a higher methylation state in the liver under both freezing and dehydration stress, but not in the heart.

Descriptions of Hearing Aids Influence the Experience of Listening to Hearing Aids.

OBJECTIVES: Experiences can be strongly influenced by expectations. In hearing healthcare, previous studies have shown that descriptions of hearing aids or contextual factors during the hearing aid fitting process can change subjective and even objective outcomes with hearing aids via the placebo effect. Personality factors have also been shown to affect susceptibility to placebo effects. The purposes of the present study were to (a) investigate the effects of communicating narratives designed to foster positive, negative, or neutral expectations about hearing aids on short-term patient outcomes, and (b) to determine if the degree to which the narratives affected end-user outcomes could be predicted by personality factors. DESIGN: Nineteen adults between the ages of 54 and 81 (mean age = 68.5, SD = 8.9) had 3 separate research appointments, each exposing them to a different narrative condition: positive, negative, or neutral. the appointment was designed to look and feel like a "traditional" hearing aid fitting appointment, during which the experimenter introduced (i.e., the narrative condition) and fit a pair of hearing aids, the participant was asked to provide their initial feedback about the hearing aids, and the participant performed speech-in-noise testing. Unbeknownst to the research participant, the hearing aids fitted at all three appointments were the same, and the only difference between the three appointments was the way the hearing aids were described to the participants. RESULTS: The results of this study showed that communication of a positive narrative about hearing aids before a hearing aid fitting led to better speech-in-noise performance on the QuickSIN as compared with performance following the negative or neutral narrative conditions. Also, the positive narrative led to the perception that acclimatization to the hearing aids would occur faster than the negative or neutral narrative conditions. Notably, the effect of communication of a positive narrative was stronger for individuals who scored higher on agreeableness, and susceptibility to positive and negative messaging was stronger for individuals low in neuroticism. CONCLUSIONS: The study suggests that short-term evaluations of hearing aids can be strongly influenced by narratives as provided by the hearing healthcare provider at the time of a hearing aid fitting.

COVID-19 risk index (CRI): a simple and validated emergency department risk score that predicts mortality and the need for mechanical ventilation.

Although certain risk factors have been associated with morbidity and mortality, validated emergency department (ED) derived risk prediction models specific to coronavirus disease 2019 (COVID-19) are lacking. The objective of this study is to describe and externally validate the COVID-19 risk index (CRI). A large retrospective longitudinal cohort study was performed to analyze consecutively hospitalized patients with COVID-19. Multivariate regression using clinical data elements from the ED was used to create the CRI. The results were validated with an external cohort of 1799 patients from the MI-COVID19 database. The primary outcome was the composite of the need for mechanical ventilation or inpatient mortality, and the secondary outcome was inpatient mortality. A total of 1020 patients were included in the derivation cohort. A total of 236 (23%) patients in the derivation cohort required mechanical ventilation or died. Variables independently associated with the primary outcome were age ≥ 65 years, chronic obstructive pulmonary disease, chronic kidney disease, cerebrovascular disease, initial D-dimer > 1.1 µg/mL, platelet count < 150 K/µL, and severity of SpO2:FiO2 ratio. The derivation cohort had an area under the receiver operator characteristic curve (AUC) of 0.83, and 0.74 in the external validation cohort Calibration shows close adherence between the observed and expected primary outcomes within the validation cohort. The CRI is a novel disease-specific tool that assesses the risk for mechanical ventilation or death in hospitalized patients with COVID-19. Discrimination of the score may change given continuous updates in contemporary COVID-19 management and outcomes.

Regulation of the cell cycle under anoxia stress in tail muscle and hepatopancreas of the freshwater crayfish, Orconectes virilis.

Regulation of the cell cycle is an understudied response to oxygen deprivation among crustaceans. The virile crayfish, Orconectes virilis, is a freshwater crustacean that when challenged by environmental oxygen limitation undergoes metabolic rate depression (to ~30% of normal levels) and switches to anaerobic metabolism to generate energy. To understand how crayfish regulate the cell cycle in response to anoxia, key proteins involved in cell cycle control were analyzed in muscle and hepatopancreas. At the G1/S barrier, an overall upregulation of positive regulators of cell cycle progression was indicated by the responses of G1 cyclins (cyclin D and cyclin E) and Cyclin dependent kinases (CDK4, CDK6 and CDK2) under anoxia. Although the levels of Cyclin kinase inhibitors (CKIs) at this juncture were also upregulated (P15/16 and P21 (T145) in muscle and P16 (S152) in hepatopancreas), levels of a major regulator of this phase and driver to S-phase, E2F1, were significantly higher in both tissues in conjunction with deactivation of its inhibitor, Retinoblastoma (Rb) protein. At the G2/M barrier, expression profiles of the G2 cyclin B suggested cell cycle progression despite overall trend of higher activities of checkpoint kinases, (Chk1 (S317) and Chk2 (S19)), that also negatively regulate the cyclin B-CDK1 complex via CdC25C (cell division cycle 25) whose levels remained unchanged. Overall, the present study suggests continued cell cycle progression, albeit with potential deceleration, as indicated by checkpoint kinases and kinase inhibitor profiles that might play a role in protecting tissues from apoptotic damage under chronic anoxic stress.

Pacemaker following transcatheter aortic valve replacement and tricuspid regurgitation: A single-center experience.

BACKGROUND: As transcatheter aortic valve replacement (TAVR) procedures increase, more data is available on the development of conduction abnormalities requiring permanent pacemaker (PPM) implantation post-TAVR. Mechanistically, new pacemaker implantation and incidence of associated tricuspid regurgitation (TR) post-TAVR is not well understood. Studies have evaluated the predictability of patient anatomy towards risk for needing permanent pacemaker (PPM) post-TAVR; however, little has been reported on new PPM and TR in patients post-TAVR. METHODS: This retrospective study identified patients at our health system who underwent PPM following TAVR from January 2014 to June 2018. Data from both TAVR and PPM procedures as well as patient demographics were collected. Echocardiographic data before TAVR, between TAVR and PPM placement, and the most recent echocardiogram at the time of chart review were analyzed. RESULTS: Of 796 patients who underwent TAVR between January 2014 and June 2018, 89 patients (11%) subsequently required PPM. Out of the 89 patients who required PPM implantation, 82 patients had pre-TAVR and 2-year post-TAVR echocardiographic imaging data. At baseline, 22% (18/82) of patients had at least moderate TR. At 2-year post-TAVR echocardiographic imaging follow-up; 27% (22/82) of patients had at least moderate TR. Subgroup analysis was performed according to the TAVR valve size implanted. In patients who received a TAVR device < 29 mm in diameter in size, 25% (11/44) had worsening TR. In patients who received a TAVR device ≥ 29 mm in diameter, 37% (14/38) had worsening TR. CONCLUSION: We have demonstrated a patient population that may be predisposed to developing worsening TR and right heart function after TAVR and Pacemaker implantation.

A Comparison between a remote testing and a laboratory test setting for evaluating emotional responses to non-speech sounds.

OBJECTIVE: To evaluate remote testing as a tool for measuring emotional responses to non-speech sounds. DESIGN: Participants self-reported their hearing status and rated valence and arousal in response to non-speech sounds on an Internet crowdsourcing platform. These ratings were compared to data obtained in a laboratory setting with participants who had confirmed normal or impaired hearing. STUDY SAMPLE: Adults with normal and impaired hearing. RESULTS: In both settings, participants with hearing loss rated pleasant sounds as less pleasant than did their peers with normal hearing. The difference in valence ratings between groups was generally smaller when measured in the remote setting than in the laboratory setting. This difference was the result of participants with normal hearing rating sounds as less extreme (less pleasant, less unpleasant) in the remote setting than did their peers in the laboratory setting, whereas no such difference was noted for participants with hearing loss. Ratings of arousal were similar from participants with normal and impaired hearing; the similarity persisted in both settings. CONCLUSIONS: In both test settings, participants with hearing loss rated pleasant sounds as less pleasant than did their normal hearing counterparts. Future work is warranted to explain the ratings of participants with normal hearing.

Sensory Neuron-Specific Deletion of Tropomyosin Receptor Kinase A (TrkA) in Mice Abolishes Osteoarthritis (OA) Pain via NGF/TrkA Intervention of Peripheral Sensitization.

Tropomyosin receptor kinase A (TrkA/NTRK1) is a high-affinity receptor for nerve growth factor (NGF), a potent pain mediator. NGF/TrkA signaling elevates synovial sensory neuronal distributions in the joints and causes osteoarthritis (OA) pain. We investigated the mechanisms of pain transmission as to whether peripheral sensory neurons are linked to the cellular plasticity in the dorsal root ganglia (DRG) and are critical for OA hyperalgesia. Sensory neuron-specific deletion of TrkA was achieved by tamoxifen injection in 4-week-old TrkAfl/fl;NaV1.8CreERT2 (Ntrk1 fl/fl;Scn10aCreERT2) mice. OA was induced by partial medial meniscectomy (PMM) in 12-week-old mice, and OA-pain-related behavior was analyzed for 12 weeks followed by comprehensive histopathological examinations. OA-associated joint pain was markedly improved without cartilage protection in sensory-neuron-specific conditional TrkA knock-out (cKO) mice. Alleviated hyperalgesia was associated with suppression of the NGF/TrkA pathway and reduced angiogenesis in fibroblast-like synovial cells. Elevated pain transmitters in the DRG of OA-induced mice were significantly diminished in sensory-neuron-specific TrkA cKO and global TrkA cKO mice. Spinal glial activity and brain-derived neurotropic factor (BDNF) were significantly increased in OA-induced mice but were substantially eliminated by sensory-neuron-specific deletion. Our results suggest that augmentation of NGF/TrkA signaling in the joint synovium and the peripheral sensory neurons facilitate pro-nociception and centralized pain sensitization.

MultiPole pacing in non-responders to cardiac resynchronization therapy: Results from the QP ExCELs/MPP sub-study.

BACKGROUND: Multisite LV stimulation therapy allows for stimulation of two different left ventricular pacing vectors within a single LV lead and may improve responsiveness to cardiac resynchronization therapy (CRT). This study prospectively evaluated the safety and efficacy of the MultiPole Pacing (MPP) feature in CRT non-responder patients. METHODS AND RESULTS: CRT non-responders with a standard CRT-D indication were eligible for enrollment into the MPP Sub-Study. Patient status, NYHA classification, Patient Global Assessment (PGA), and adverse events were collected at follow-up. A clinical composite score (CCS) was determined at the 6 month follow-up visit. The primary objective was defined as the proportion of patients with an improved CCS. Safety was evaluated as freedom from MPP system related adverse events requiring additional invasive intervention to resolve. A total of 53 patients were enrolled across 26 U.S. centers. The cumulative follow-up duration was 24.1 years. CCS was improved in 35.6% of patients (p < .0001 when compared to a performance goal of 3%) after 6 months of MPP therapy. When incorporating patient feedback into a modified CCS, 60.0% of patients showed an improvement. Three patients (5.7%) experienced hospitalization for heart failure, and three patient deaths occurred over the follow-up period. No MPP system-related events were reported for an AE-free rate of 100% (95% CI 93.28% to 100.0%). CONCLUSIONS: The results of this small, non-randomized study suggest that the MPP feature is safe, and may be effective at converting a percentage of CRT non-responders to responders. Larger, randomized studies are needed to confirm this result.

1H-1,2,3-triazole grafted tacrine-chalcone conjugates as potential cholinesterase inhibitors with the evaluation of their behavioral tests and oxidative stress in mice brain cells.

The present paper explicates the synthesis of 1H-1,2,3-triazole tethered tacrine-chalcone conjugates and evaluation of their AChE and BuChE inhibitory activity. In-vitroAChE inhibition assay revealed three compounds, 9h, 9i, and 11f, being more potent than the standard drug tacrine and further evaluated against butyrylcholinesterase. The present study was extended to investigate the anti-amnestic effect of promising compoundson scopolamine-induced behavioral and neurochemical changes in mice. Inclined plane model and Elevated plus-maze model were performed to assess general limb motor activity and anxiety-like behavior, respectively, in mice pre-treated with scopolamine. Oxidative stress parameters reduced glutathione contents (GSH) and lipid peroxidation products (TBARS) in the brain homogenates as estimated using ex-vivo studies. Furthermore, molecular docking studies were performed for the potent compounds to decipher the mechanism of observed activities.

Be Part of the Conversation: Audiology Messaging During a Hearing Screening.

OBJECTIVES: The moment patients learn the results from a hearing assessment can be a critical juncture on their journey to rehabilitation. Message framing (e.g., the positive or negative manner in which information is presented) has been explored in a wide range of health contexts as a method for shaping patients' decision-making. This study investigated whether attitudes toward hearing loss treatment varied as a function of how messages about treatment were framed, and whether such attitudes differed as a function of participants being led to believe they had failed a hearing screening. METHODS: Sixty-four participants (18 to 39 years of age) took the Hearing in Noise Test. In the sound booth, participants saw a poster bearing either a gain-framed or loss-framed message about hearing loss treatment. During the test, half the participants were interrupted by the researcher who stated that their performance appeared to suggest a hearing loss, with the caveat that it might be due to an equipment malfunction. While the researcher investigated the problem, the participants completed an 11-item questionnaire asking about their attitudes toward help seeking for hearing loss. Participants in the control group completed the same questionnaire with no interruption. RESULTS: Statistical analyses revealed no significant interaction effect between message type and experimenter feedback condition, though a significant main effect was present for message type. Post hoc testing showed medium to large effect sizes as a function of message type on five of the 11-questionnaire items. These data indicated that participants were more likely to endorse health-positive responses (i.e., greater interest in hearing treatment) when exposed to the gain-framed message than the loss-framed message. CONCLUSIONS: The greater likelihood of health-positive responses in the presence of the gain-framed message suggests that this framing strategy may have a positive influence on attitudes toward hearing health behaviors among individuals under 40 years of age with no history of hearing loss.

Ecological Momentary Assessment: A Field Evaluation of Subjective Ratings of Speech in Noise.

PURPOSE: As hearing rehabilitation research evolves to include both retrospective and momentary assessment outcome measures, it is important to understand how in-the-moment contextual factors influence subjective ratings. We aimed to determine, over a 4-week period of participants responding to ecological momentary assessments (EMAs) in their own environments, whether: (1) participants will complete surveys in speech-in-noise listening situations; (2) ratings of speech in noise change in a predictable manner as the acoustic conditions change; and (3) EMAs provide patient insights beyond those provided from retrospective ratings. DESIGN: Fourteen adults aged 26 to 86 years with at least 6 months of hearing aid experience were recruited for an 8-week crossover field trial (4 weeks wearing hearing aids with no EMA; 4 weeks wearing hearing aids with EMA). Participants were fitted with hearing aids and provided with a streamer and a smartphone with an app that analyzed the acoustic signal from the hearing aids and alerted the participant to respond to a survey when predetermined acoustic conditions were detected. Participants were prompted to complete brief surveys up to 9 times/day that contained establishing questions, quality ratings, and items assessing perceived benefit, residual activity limitation, and satisfaction. Participants also completed retrospective questionnaires at intake and after each 4-week field trial. RESULTS: Participants completed an average of 4.4 surveys per day. The quality ratings changed as the acoustics changed: Ratings of intelligibility were lower for 10 dB signal-to-noise ratio (SNR) than 20 dB SNR (p = 0.006); ratings of noisiness were higher for 10 dB SNR than 20 dB SNR (p = 0.001) and higher for 65 dB SPL than 50 dB SPL (p < 0.001); ratings of effort were higher for 65 dB SPL than 50 dB SPL (p = 0.004); ratings of loudness were higher for 65 dB SPL than 50 dB SPL (p = 0.001). Descriptive analysis of satisfaction, benefit, and residual activity limitation responses showed that the momentary surveys provided more detail about individual variability across acoustic conditions than the retrospective questions. CONCLUSIONS: Participants completed more than 99% of the triggered surveys, demonstrating high compliance. Because the quality ratings generally changed in the hypothesized direction, it is concluded that the participants provided valid responses. The greater variability in responses with EMA than retrospective questionnaires demonstrates its potential utility as a clinical tool for exploring hearing aid outcomes in real-world environments.

Changing the narrative for hearing health in the broader context of healthy living: a call to action.

OBJECTIVE: To discuss the steps necessary to facilitate hearing health care in the context of well-being and healthy living. DESIGN: Common themes among the articles in this special supplement of the International Journal of Audiology were used to identify issues that must be addressed if audiology is to move from being hearing-focussed to taking a holistic perspective of hearing care in the context of healthy aging. These are discussed within the context of other published literature. RESULTS AND CONCLUSIONS: Three needs were identified: (i) Increased interdisciplinary education to raise awareness of the interplay between hearing and health. (ii) Increased emphasis on counselling education in audiology programs so that audiologists are equipped with the knowledge, competence and confidence to provide counselling and emotional support to their patients, beyond care. (iii) Redefinition of therapeutic goal setting and hearing outcomes to include aspects of well-being, so that audiologists can capture and patients realise that that good hearing outcomes can have a direct positive impact on a person's quality of life that extends beyond their improved ability to hear. It was emphasised that each of these needs to be considered within the context of the audiologists' scope of practice and audiologists' well-being.

Identifying the approaches used by audiologists to address the psychosocial needs of their adult clients.

OBJECTIVE: To identify the approaches taken by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: A participatory mixed methods design. Participants generated statements describing the ways in which the psychosocial needs of their adult clients with hearing loss are addressed, and then grouped the statements into themes. Data were obtained using face-to-face and online structured questions. Concept mapping techniques were used to identify key concepts and to map each of the concepts relative to each other. STUDY SAMPLE: An international sample of 65 audiologists. RESULTS: Ninety-three statements were generated and grouped into seven conceptual clusters: Client Empowerment; Use of Strategies and Training to Personalise the Rehabilitation Program; Facilitating Peer and Other Professional Support; Providing Emotional Support; Improving Social Engagement with Technology; Including Communication Partners; and Promoting Client Responsibility. CONCLUSIONS: Audiologists employ a wide range of approaches in their attempt to address the psychosocial needs associated with hearing loss experienced by their adult clients. The approaches described were mostly informal and provided in a non-standardised way. The majority of approaches described were not evidence-based, despite the availability of several options that are evidence-based, thus highlighting the implementation gap between research and clinical practice.

Audiological approaches to address the psychosocial needs of adults with hearing loss: perceived benefit and likelihood of use.

OBJECTIVE: To explore the perceived benefit and likely implementation of approaches used by audiologists to address their adult clients' psychosocial needs related to hearing loss. DESIGN: Adults with hearing loss and audiologists completed separate, but related, surveys to rate their perceived benefit and also their likely use of 66 clinical approaches (divided over seven themes) that aim to address psychosocial needs related to hearing loss. STUDY SAMPLE: A sample of 52 Australian adults with hearing loss, and an international sample of 19 audiologists. RESULTS: Overall, participants rated all of the approaches highly on both benefit and likelihood of use; the highest ranked theme was Providing Emotional Support. Cohort comparisons showed that audiologists ranked the approaches significantly higher than did adults with hearing loss. Overall, participants ranked the themes higher on benefit than on the likelihood to use scales. CONCLUSIONS: Adults with hearing loss and audiologists recognise the importance of approaches that address the psychosocial impacts of hearing loss in audiological rehabilitation. However, both groups placed slightly greater value on the internal-based approaches (the clients own emotional response, empowerment, and responsibility), and slightly less emphasis on the external-based approaches (being supported by communication partners, support groups or other health professionals).

MondoA:MLX complex regulates glucose-dependent gene expression and links to circadian rhythm in liver and brain of the freeze-tolerant wood frog, Rana sylvatica.

The wood frog, Rana sylvatica, is one of only a few vertebrate species that display natural freeze tolerance. Frogs survive the freezing of about two-thirds of their body water as extracellular ice over the winter months. Multiple adaptations support freeze tolerance including metabolic rate depression and the production of huge amounts of glucose (often 200 mM or more) as a cryoprotectant that protects cells from freeze damage. To understand how high glucose levels affect gene expression, we studied MondoA, a glucose sensing transcription factor, and its partner MLX (Max-like protein) to assess their ability to modulate the expression of genes involved in glucose metabolism and circadian rhythm. Wood frog liver and brain tissues were analyzed, assessing protein levels, nuclear distribution, and DNA binding activity of MondoA:MLX during freezing (24 h at - 2.5 °C) and subsequent thawing (8 h returned to 5 °C), as compared with 5 °C controls. Downstream targets of MondoA:MLX were also evaluated: TXNIP (thioredoxin interacting protein), ARRDC4 (arrestin domain containing 4), HK-2 (hexokinase-2), PFKFB-3 (6-phosphofructo-2-kinase isozyme 3) and KLF-10 (Kruppel-like factor-10). Both KLF-10 and PFKFB-3 are also involved in circadian dependant regulation which was also explored in the current study via analysis of BMAL-1 (aryl hydrocarbon receptor nuclear translocator-like protein 1) and CLOCK (circadian locomotor output cycles kaput) proteins. Our data establish the MondoA-MLX complex as active under the hyperglycemic conditions in liver to regulate glucose metabolism and may also link to circadian rhythm in liver via KLF-10 and PFKFB-3 but not in brain.

Biopsychosocial Classification of Hearing Health Seeking in Adults Aged Over 50 Years in England.

OBJECTIVES: Approximately 10 to 35% of people with a hearing impairment own a hearing aid. The present study aims to identify barriers to obtaining a hearing aid and inform future interventions by examining the biopsychosocial characteristics of adults aged 50+ according to 7 categories: (i) Did not report hearing difficulties, (ii) Reported hearing difficulties, (iii) Told a healthcare professional about experiencing hearing difficulties, (iv) Referred for a hearing assessment, (v) Offered a hearing aid, (vi) Accepted a hearing aid, and (vii) Reported using a hearing aid regularly. DESIGN: The research was conducted using the English Longitudinal Study of Aging wave 7 with data obtained from 9666 adults living in England from June 2014 to May 2015. Cross-sectional data were obtained from a subset of 2845 participants aged 50 to 89 years of age with a probable hearing impairment measured by hearing screening (indicating a hearing threshold of >20 dB HL at 1 kHz or >35 dB HL at 3 kHz in the better ear). Classification according to hearing health-seeking category was via participants' self-report. Participants in each category were compared with people in all subsequent categories to examine the associations between each category and biopsychosocial correlates (sex, age, ethnicity, educational level, wealth, audiometric hearing level, self-reported health status, cognitive performance, attitudes to aging, living alone, and engagement in social activities) using multiple logistic regression. RESULTS: The proportions of individuals (N = 2845) in categories i to vii were 40.0% (n = 1139), 14.0% (n = 396), 4.5% (n = 129), 4.0% (n = 114), 1.2% (n = 34), 7.7% (n = 220), and 28.6% (n = 813), respectively. Severity of hearing impairment was the only factor predictive of all the categories of hearing health-seeking that could be modeled. Other correlates predictive of at least one category of hearing health-seeking included sex, age, self-reported heath, participation in social activities, and cognitive function. CONCLUSIONS: For the first time, it was shown that 40.0% of people with an audiometrically identified probable hearing impairment did not report hearing difficulties. Each of the five categories of hearing health-seeking that could be modeled had different drivers and consequently, interventions likely should vary depending on the category of hearing health-seeking.

Anti-nociceptive and anti-inflammatory effect of imperatorin: evidences for involvement of COX-2, iNOS, NFκB and inflammatory cytokines.

Aim: The objective of the current investigation was to explore the analgesic effect of naturally occurring furanocoumarin, imperatorin and the involvement of inducible cyclooxygenase (COX-2), inducible nitric oxide synthase (iNOS), NFκB and cytokines in the observed effect.Materials and methods: Anti-nociceptive effect was explored by inducing chemical hyperalgesia using acetic acid and formalin in mice. ED50 of imperatorin was calculated in acetic acid model. Modulation of cyclooxygenase and nitric oxide pathway by imperatorin was examined by stimulator/precursor challenge with substance P and L-arginine, respectively and quantification of COX-2, iNOS and NFκB expression by immunohistochemical analysis in spinal tissues. Involvement of inflammatory cytokines TNF-α and IL-1ß was investigated using LPS challenge and subsequent ELISA analysis of these inflammatory mediators in serum. Carrageenan inflicted paw edema was employed to explore the anti-inflammatory activity of imperatorin.Results: A significant reduction in the nociceptive behaviour was observed with imperatorin treatment in acetic acid and formalin test. ED50 of imperatorin was found to be 4.53 mg/kg. Pre-treatment with substance P and L-arginine significantly attenuated the anti-nociceptive activity of imperatorin in formalin test. Immunohistochemical findings revealed marked decrease in spinal COX-2, iNOS and NFκB expression. Imperatorin administration significantly reduced LPS induced rise in level of TNF-α and IL-1ß dose dependently. In carrageenan-induced paw edema test, maximum possible anti-inflammatory effect of imperatorin was evident after 240 min of carrageenan administration.Conclusion: Current investigation revealed that anti-nociceptive and anti-inflammatory potential of imperatorin is probably mediated through the attenuation of COX-2, iNOS, NFκB activity and reduction in circulatory cytokines.