Looking through a new lens, exploring the interdependent relationship between interprofessional education and collaborative practice with Polarity ThinkingTM.

The context of interprofessional education (IPE) and collaborative practice (IPCP) has led to calls for greater alignment, coordination, and coalitions among education and healthcare delivery systems. One method to evaluate and improve these coalitions is the Polarity ThinkingTM framework. Polarities, such as IPE and IPCP, can represent interdependent pairs of different but complementary values or perspectives. This project investigates the IPE and IPCP polarity as perceived by educators and practitioners using survey research and an in-person summit to examine how the interdependent relationship between IPE and IPCP can support efficient, effective, and integrated care. Eighteen participants registered to attend the Association of Schools Advancing Health Professions (ASAHP) Summit on Healthcare Workforce Readiness for IPCP were surveyed in July 2018. Fifteen of the registered participants responded to the survey, which consisted of demographic questions and 16 items specific to the respondents' experiences with IPE and IPCP. The resulting Polarity Map®, generated based on responses to the pre-conference survey, showed that neither the IPE or IPCP poles were strongly supported. However, survey respondents did indicate more frequent positive outcomes with IPCP than experienced with IPE. Additionally, using the Polarity Map® as a guide, Summit participants generated action steps and early warning signs to support IPE and IPCP values. While the sample size was limited, the study can be used as an example of managing the IPE-IPCP polarity through broad engagement of stakeholders to better leverage IPE and IPCP to achieve efficient, effective, and integrated healthcare.

Effect of rate-alteration on speech perception in noise in older adults with normal hearing and hearing impairment.

PURPOSE: The purpose of this study was to evaluate the effect of using slow and fast speaking rates in competing noise on older adults with normal hearing (NH) and those with hearing impairment (HI). METHOD: Thirty-four older adults (56-85 years) were grouped based on hearing ability-NH (N = 15) and HI (N = 19). Rate-altered Quick Speech-in-Noise Test (QuickSIN; Etymotic Research, 2001) stimuli were presented at 3 speech rates (slow, average, and fast), and the signal-to-noise ratio (SNR) loss was calculated for each. RESULTS: The older participants with HI had significantly higher SNR loss than the NH participants at all 3 speech rates. The NH participants showed improved speech perception in noise when a slow rate of speech was used. This benefit was not observed for the participants with HI. Both groups performed poorly with the fastest speech rate. CONCLUSION: Results suggest that older adults with HI who are not wearing hearing aids are not able to take advantage of additional processing time afforded by the use of slow speaking rates when speech (70-75 dB HL) is presented in competing noise. Additionally, the use of a fast speaking rate significantly reduces an individual's ability to perceive speech in noise, regardless of hearing status. Decreasing from a fast speaking rate to an average rate is beneficial and should be recommended by audiologists to increase the likelihood of older adults understanding speech in noise.

Effects of reverberation on acceptable noise level measurements in younger and older adults.

Acceptable noise level (ANL) test materials were digitally modified to create five reverberant conditions by applying different values of reverberation time (RT) to a non-reverberant condition (RT = 0, 0.4, 0.7, 1.2, and 2 s). Two groups of 12 subjects participated: younger individuals (22­29 years, M = 24.3) and older adults (50­69 years, M = 57.5). Mean hearing threshold levels (250 to 8000 Hz) for both groups were 30 dB HL or better. Most comfortable listening level (MCL) and background noise level (BNL) measurements were completed in each reverberant condition, and from these measurements, ANLs were calculated. Significant main effects for age and reverberation were not found for ANL or MCL. These results suggest that reverberation does not affect the amount of background noise individuals are willing to accept, or the level of speech individuals choose as the MCL. These results can be used by clinical audiologists to counsel patients regarding the use of communication strategies. Additionally, these results can be used to support previous findings that ANL is not related to the intelligibility of the speech signal.

Safety and immunogenicity study of Multiclade HIV-1 adenoviral vector vaccine alone or as boost following a multiclade HIV-1 DNA vaccine in Africa.

BACKGROUND: We conducted a double-blind, randomized, placebo-controlled Phase I study of a recombinant replication-defective adenovirus type 5 (rAd5) vector expressing HIV-1 Gag and Pol from subtype B and Env from subtypes A, B and C, given alone or as boost following a DNA plasmid vaccine expressing the same HIV-1 proteins plus Nef, in 114 healthy HIV-uninfected African adults. METHODOLOGY/PRINCIPAL FINDINGS: Volunteers were randomized to 4 groups receiving the rAd5 vaccine intramuscularly at dosage levels of 1×10(10) or 1×10(11) particle units (PU) either alone or as boost following 3 injections of the DNA vaccine given at 4 mg/dose intramuscularly by needle-free injection using Biojector® 2000. Safety and immunogenicity were evaluated for 12 months. Both vaccines were well-tolerated. Overall, 62% and 86% of vaccine recipients in the rAd5 alone and DNA prime - rAd5 boost groups, respectively, responded to the HIV-1 proteins by an interferon-gamma (IFN-γ) ELISPOT. The frequency of immune responses was independent of rAd5 dosage levels. The highest frequency of responses after rAd5 alone was detected at 6 weeks; after DNA prime - rAd5 boost, at 6 months (end of study). At baseline, neutralizing antibodies against Ad5 were present in 81% of volunteers; the distribution was similar across the 4 groups. Pre-existing immunity to Ad5 did not appear to have a significant impact on reactogenicity or immune response rates to HIV antigens by IFN-γ ELISPOT. Binding antibodies against Env were detected in up to 100% recipients of DNA prime - rAd5 boost. One volunteer acquired HIV infection after the study ended, two years after receipt of rAd5 alone. CONCLUSIONS/SIGNIFICANCE: The HIV-1 rAd5 vaccine, either alone or as a boost following HIV-1 DNA vaccine, was well-tolerated and immunogenic in African adults. DNA priming increased the frequency and magnitude of cellular and humoral immune responses, but there was no effect of rAd5 dosage on immunogenicity endpoints. TRIAL REGISTRATION: ClinicalTrials.gov NCT00124007.

Effects of speech rate, background noise, and simulated hearing loss on speech rate judgment and speech intelligibility in young listeners.

PURPOSE: To study the effect of noise on speech rate judgment and signal-to-noise ratio threshold (SNR50) at different speech rates (slow, preferred, and fast). RESEARCH DESIGN: Speech rate judgment and SNR50 tasks were completed in a normal-hearing condition and a simulated hearing-loss condition. STUDY SAMPLE: Twenty-four female and six male young, normal-hearing participants. RESULTS: Speech rate judgment was not affected by background noise regardless of hearing condition. Results of the SNR50 task indicated that, as speech rate increased, performance decreased for both hearing conditions. There was a moderate correlation between speech rate judgment and SNR50 with the various speech rates, such that as judgment of speech rate increased from too slow to too fast, performance deteriorated. CONCLUSIONS: These findings can be used to support the need for counseling patients and their families about the potential advantages to using average speech rates or rates that are slightly slowed while conversing in the presence of background noise.

Effects of reverberation and filtering on speech rate judgment.

This study investigated the effects of listening condition on speech rate judgment. Four listening conditions, in which a single sentence was presented at 21 speech rates ranging from 90 WPM to 250 WPM, were incorporated. These conditions included non-degraded, reverberation, band-pass filtered, and low-pass filtered conditions, each of which was selected to simulate listening conditions one might encounter in daily life. The participants were 20 young adults (20 to 40 years) with normal hearing. They were asked to make judgments of the rates of speech randomly presented in the four listening conditions using an equal-interval 5-step scale from too slow through too fast. Overall, speech rate was judged to be faster in the reverberant condition than in the other three conditions. These findings may have implications for auditory rehabilitation and counseling.

Safety and immunogenicity of a polyvalent peptide C4-V3 HIV vaccine in conjunction with IL-12.

We examined the safety and immunogenicity of a human leukocyte antigen-based HIV envelope polyvalent synthetic peptide vaccine, C4-V3, alone and in combination with subcutaneous IL-12 in nine HIV-infected patients. Lymphocyte proliferative responses increased threefold or more to all four peptides at two consecutive post-immunization timepoints for four individuals. Three responders had received IL-12, suggesting a possible adjuvant effect of Il-12. Transient mild injection site reactions (7.9) and systemic symptoms (3/9) occurred.

Older adult performance on an altered version of the SSI test.

The Synthetic Sentence Identification (SSI) test has been used extensively in investigations of reduced speech understanding skills in older adults. In this study the SSI test was altered by adding noise to the competing message and by administering practice lists and equivalent test lists, as well as versions of the test that have 4- and 12-s interstimulus intervals (ISIs), along with the standard 8-s ISI. The purpose was to determine the effect of these alterations on performance in a group of older adults with average pure-tone average 2 values less than 33 dB HL. Performance changed as a function of the ISI, with less rollover occurring for the 4-s ISI condition than the other 2 ISIs.