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.

Early parenting behaviour is associated with complex attention outcomes in middle to late childhood in children born very preterm.

Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born <30 weeks' gestation and/or with a birth weight <1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.

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.

Facilitating the Voice of Adolescents in Hospitals Through Art: A Case Report.

Adolescence can be a challenging time, but even more so when diagnosed with a serious or chronic illness. Starlight Children's Foundation established the Livewire program after recognizing the unique needs of adolescents in hospitals. This article describes our experience of implementing an art-based project within the Livewire program, designed to facilitate the voice of adolescents with a serious or chronic illness and their siblings. We invited young people across Australia to contribute their artwork which would be used as the design for a deck of playing cards. The final 54 cards were a creative reflection of the unique interests, personalities, and experiences of 45 young people. In this article, we also share the experiences of two young people who contributed to this project. We conclude with our learnings in delivering an art-based project for young people that is not presented directly as "therapy".

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.

Effect of eccentric exercise on quality of life and function in people with chronic heart failure: a pilot randomised controlled trial.

PURPOSE: To determine if eccentric exercise was effective, safe and feasible in increasing function and quality of life in people with heart failure compared to usual care and a waitlist control group. METHODS: A prospective, three-armed, parallel-design, assessor-blind, pilot randomised controlled trial with 1:1:1 allocation. Forty-seven participants (16 female; mean age 66 years) with mild to moderate heart failure were randomly allocated to either eccentric exercise, concentric exercise or a waitlist control group. Participants in the exercise groups completed twice-weekly exercise for eight weeks. Primary outcome was walking capacity. Secondary outcomes were quality of life, leg strength and fatigue. Outcomes were assessed at baseline, post intervention and three-month follow-up. Attendance, tolerability and adverse events were used to determine safety and feasibility. RESULTS: Intention-to-treat analysis showed no differences between eccentric exercise and either concentric exercise or waitlist for any outcome. Per-protocol analysis found improvements identified by the Minnesota living with heart failure questionnaire were significantly greater post-intervention for eccentric exercise compared to concentric exercise (-17.99 units, 95% confidence interval -35.96 to -0.01). No major adverse events were reported. CONCLUSION: In this small trial, eccentric exercise did not demonstrate superior outcomes to concentric exercise or a waitlist control group. CLINICAL TRIAL REGISTRATION: The protocol for this trial was registered at clinicaltrials.gov, registration number: NCT02223624, registration date: 22 August 2014.IMPLICATIONS FOR REHABILITATIONRegular physical activity and referral to rehabilitation is recommended for people with chronic heart failure, however exercise can be challenging for this group.Eccentric exercise was safe and tolerable for participants with heart failure.Documentation of exercise progression is important to demonstrate a dose-response relationship.In this study there were no differences between groups who received eccentric exercise, concentric exercise or no exercise.

Coincidental splenic irradiation and risk of functional hyposplenism in oesophageal cancer treatment.

INTRODUCTION: Definitive chemoradiotherapy (dCRT) and radical radiotherapy are central to the management of distal oesophageal carcinoma. This study sought to establish whether the spleen receives a significant incidental radiation dose when treating distal oesophageal carcinoma with the standardised dCRT or radical radiotherapy doses. METHODS: In this single-centre retrospective study, all patients (n = 34) with distal oesophageal cancer, treated with either dCRT or radical radiotherapy over an 18-month period using a volumetric modulated arc therapy (VMAT) planning technique, were included. The median age was 74 years old: 56% were male; 50% (n = 17) had adenocarcinoma and 41% (n = 14) had squamous carcinoma. The majority (79%) received dCRT with a prescribed dose of 50 Gy in 25 fractions while the other 21% of patients were treated with radical radiotherapy alone (55 Gy in 20 fractions). The spleen was retrospectively contoured by one physician, and the V10 Gy and mean splenic dose (MSD) were calculated using Eclipse planning software. RESULTS: The median MSD was 14.4 Gy with a range of 0.75-28.3 Gy. The median V10 Gy was 62.7%. Of the cohort, 67.6% received an MSD of more than 10 Gy. CONCLUSIONS: Two-thirds of the patients received a dose of more than the 10 Gy. A review of the literature suggests that higher splenic radiation doses may increase the long-term risk of infection and impact on other outcomes. This study provides important evidence that the spleen receives a significant dose of radiation when treating distal oesophageal cancer and should be considered as an organ at risk.

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.

Comparison of Expressive Spoken Language Skills in Children With Cochlear Implants and Children With Typical Hearing.

When children start formal education, they are expected to be able to express complex thoughts. However, in order to do so, they need to be able to use both complex grammatical structures and a variety of words. One group that is at risk of having a delay in terms of their expressive language ability is children with cochlear implants (CI). In this study, we evaluated whether children with CI perform comparably to children with typical hearing (TH) on a standard expressive spoken grammar and a standard expressive spoken vocabulary task when the groups were matched on non-verbal intelligence and working memory capacity. It was found that the children with CI in this study performed more poorly on a standard expressive spoken vocabulary task but not on a standard expressive spoken grammar task when compared to the children with TH. Differences in terms of expressive spoken vocabulary do not seem to be explained by differences in cognitive ability. In addition, the variation in terms of expressive spoken language ability was larger in the children with CI compared to the children with TH. This might be explained by additional confounding factors, like the time of language deprivation or by a greater influence of cognitive differences for the acquisition of spoken language for children with CI.

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.

GOT SHINGLES? TEST FOR HIV. Severe shingles as first presenting infection in HIV/AIDS patient.

Late diagnosis of HIV is associated with increased morbidity and mortality. Infected individuals need to be identified early and started on antiretroviral therapy to increase their survival and to limit transmission to the community. Historically speaking, late diagnosis has been a common occurrence in the United States, despite the majority of those patients having had a medical encounter in the year prior to their diagnosis. These visits represent missed opportunities for HIV testing and therefore delays in initiation of appropriate antiretroviral therapy. Herpes zoster is a common infection that may indicate a weakened immune system, and as such should prompt consideration for HIV testing, even in patients who lack or deny classic risk factors such as "risky sexual behavior" or drug use. Here, we present a case of severe herpes zoster in a middle aged woman with no other HIV risk factors, who was tested and found to be HIV positive. Her CD4 count at diagnosis was <200 cells/mcL, consistent with AIDS.

Pragmatic Language Skills: A Comparison of Children With Cochlear Implants and Children Without Hearing Loss.

Pragmatic language ability refers to the ability to use language in a social context. It has been found to be correlated with success in general education for deaf and hard of hearing children. It is therefore of great importance to study why deaf and hard of hearing children often perform more poorly than their hearing peers on tests measuring pragmatic language ability. In the current study the Pragmatics Profile questionnaire from the CELF-IV battery was used to measure pragmatic language ability in children using cochlear implants (N = 14) and children without a hearing loss (N = 34). No significant difference was found between the children with cochlear implants (CI) and the children without hearing loss (HL) for the sum score of the pragmatics language measure. However, 35.71% of the children with CI performed below age norm, while only 5.89% of the children without HL performed below age norm. In addition, when dividing the sum score into three sub-measures: Rituals and Conversational skills (RCS), Asking for, Giving, and Responding to Information (AGRI), and Nonverbal Communication skills (NCS), significant differences between the groups were found for the NCS measure and a tendency for a difference was found for the RCS measure. In addition, all three sub-measures (NCS, AGRI, RCS) were correlated to verbal fluency in the children with CI, but not the children without HL.

Relationships between adrenarcheal hormones, hippocampal volumes and depressive symptoms in children.

Early timing of puberty (i.e., advanced pubertal maturation relative to same-age peers) has been associated with depressive symptoms during adolescence. To date, research on this relationship has focused on gonadarche, the second phase of puberty, while less is known about the first phase of puberty, adrenarche. Increasing evidence suggests that androgens that rise during adrenarche, most notably dehyrdoepiandrosterone (DHEA) and testosterone, may be involved both in the development of the hippocampus, and risk for depression. The current study investigated whether hippocampal volumes mediated the relationship between adrenarcheal timing (based on relative levels of adrenarcheal hormones) and depressive symptoms in children. Data were collected from a cross-sectional sample of 88 children (46 female) selected to have relatively increased variance in these androgens. Participants completed brain MRI structural scans, provided saliva samples for hormones, and completed the Children's Depression Inventory (CDI). Contrary to predictions, larger right hippocampi significantly partially mediated the positive relationship between early timing of testosterone exposure (i.e., relatively high levels of testosterone for one's age) and depressive symptoms in girls. No other evidence of significant mediation effects was obtained, however DHEA and testosterone exposure showed unique effects on hippocampal volumes in males and females, and larger hippocampal volumes predicted higher depressive symptoms in the entire sample. These results suggest that adrenarcheal timing may be related to hippocampal development and depressive symptoms, extending current knowledge of pubertal risk processes.

Reliability of one-repetition maximum performance in people with chronic heart failure.

PURPOSE: Evaluate intra-rater and inter-rater reliability of the one-repetition maximum strength test in people with chronic heart failure. DESIGN: Intra-rater and inter-rater reliability study. SETTING: A public tertiary hospital in northern metropolitan Melbourne. PARTICIPANTS: Twenty-four participants (nine female, mean age 71.8 ± 13.1 years) with mild to moderate heart failure of any aetiology. METHODS: Lower limb strength was assessed by determining the maximum weight that could be lifted using a leg press. Intra-rater reliability was tested by one assessor on two separate occasions . Inter-rater reliability was tested by two assessors in random order. STATISTICAL ANALYSES: Intra-class correlation coefficients and 95% confidence intervals were calculated. Bland and Altman analyses were also conducted, including calculation of mean differences between measures ( ¯d ) and limits of agreement . RESULTS: Ten intra-rater and 21 inter-rater assessments were completed. Excellent intra-rater (intra-class correlation coefficient2,1 0.96) and inter-rater (intra-class correlation coefficient2,1 0.93) reliability was found. Intra-rater assessment showed less variability (mean difference 4.5 kg, limits of agreement -8.11 to 17.11 kg) than inter-rater agreement (mean difference -3.81 kg, limits of agreement -23.39 to 15.77 kg). CONCLUSION: One-repetition maximum determined using a leg press is a reliable measure in people with heart failure. Given its smaller limits of agreement, intra-rater testing is recommended. Implications for Rehabilitation Using a leg press to determine a one-repetition maximum we were able to demonstrate excellent inter-rater and intra-rater reliability using an intra-class correlation coefficient. The Bland and Altman levels of agreement were wide for inter-rater reliability and so we recommend using one assessor if measuring change in strength within an individual over time.

Developmental Trajectory of Language From 2 to 13 Years in Children Born Very Preterm.

OBJECTIVES: The objective of this study was to describe language functioning at 13 years of age and examine its developmental trajectory from 2 to 13 years of age in children born very preterm (VP) compared with term controls. METHODS: Two hundred and twenty-four children born VP (<30 weeks' gestation) and 77 term controls had language skills assessed by using performance-based and/or parent-report measures at 2, 5, 7, and 13 years of age. Regression models were used to compare verbal memory, grammar, semantics, and pragmatic skills between the VP and term groups at 13 years of age. Linear mixed effects regression models were used to assess language trajectories from 2 to 13 years of age. RESULTS: Compared with term controls, children born VP had poorer functioning across all components of language (mean group differences ranged from -0.5 SD to -1 SD; all P < .05) at 13 years of age. At each follow-up age, the VP group displayed poorer language functioning than the term controls, with the groups exhibiting similar developmental trajectories (slope difference = -0.01 SD per year; P = .55). CONCLUSIONS: Children born VP continue to display language difficulties compared with term controls at 13 years of age, with no evidence of developmental "catch-up." Given the functional implications associated with language deficits, early language-based interventions should be considered for children born VP.