Framework to Guide Health Professions Faculty Towards Increased Scholarship: Recommendations from the ASAHP Research, Discovery & Innovation Committee.

The Research, Discovery, and Innovation Publications (RDI-P) Task Force met from October 2020 to March 2022 to discuss ways in which the Association of Schools Advancing Health Professions (ASAHP) can help to guide institutional leaders to assign faculty effort and resources to enable success with the scholarship mission. The purpose of this White Paper is to propose a guiding framework for institutional leaders to determine their faculty's individual or team scholarly goals, assign appropriate percent efforts (funded/unfunded), and guide an overall faculty mix that balances required teaching loads with scholarly activities. The Task Force identified seven modifiable factors that can influence workload allocation for scholarship: 1. Limited range of the spectrum for effort distribution; 2. Matching expectations with reality; 3. Clinical training undervalued as adequate prep for translational or implementation research; 4. Limited support for mentorship availability; 5. Richer collaborations needed; 6. Finding resources and matching them to individual faculty needs; and 7. Further time for training needed. We then provide a set of recommendations to address the seven issues described. Finally, we describe four foci of scholarly activity (evidence-based educator; evidence-based clinical application; evidence-based collaborator; and evidence-based principal leader) with which a leader can develop strategies to align faculty interests and growth opportunities towards advancing scholarship.

The Impact of Transducer Selection on the Acceptable Noise Level.

PURPOSE: The aim of this study was to assess the impact of transducer (loudspeaker, supra-aural headphones, and insert earphones) selection on the acceptable noise level (ANL). STUDY SAMPLE: Thirty young adults with normal hearing who reported difficulty with background noise served as participants. RESEARCH DESIGN: A repeated-measures experimental design was employed. DATA COLLECTION AND ANALYSIS: Most comfortable listening level (MCL) and background noise level (BNL) were measured for all participants using three transducers (loudspeaker, supra-aural headphones, and insert earphones). ANL was computed as the difference between the mean MCL and the mean BNL. RESULTS: Analytical statistics revealed that ANL did not differ due to the transducer used. However, there were statistically significant differences found for MCL and BNL across transducers. CONCLUSIONS: Results of this study indicate that ANL is not vulnerable to the selection of transducer and that ANLs can be compared across transducer types. Researchers should cautiously interpret findings across studies when discussing the base measures of MCL and BNL as these may be influenced slightly by transducer selection.

The Effect of Music Genre and Music-Preference Dimension on Acceptable Noise Levels in Listeners with 'Normal' Hearing.

BACKGROUND: The acceptable noise level (ANL) is the maximum level of background noise that an individual is willing to accept while listening to speech. The type of background noise does not affect ANL results except for music. PURPOSE: The purpose of this study was to determine if ANL differed due to music genre or music genre preference. RESEARCH DESIGN: A repeated-measures experimental design was employed. STUDY SAMPLE: Thirty-three young adults with normal hearing served as listeners. DATA COLLECTION AND ANALYSIS: Most comfortable listening level and background noise level were measured to twelve-talker babble and five music samples from different genres: blues, classical, country, jazz, and rock. Additionally, music preference was evaluated via rank ordering of genre and by completion of the Short Test of Music Preference (STOMP) questionnaire. RESULTS: The ANL for music differed based on music genre; however, the difference was unrelated to music genre preference. Also, those with low ANLs tended to prefer the intense and rebellious music-preference dimension compared with those with high ANLs. CONCLUSIONS: For instrumental music, ANL was lower for blues and rock music compared with classical, country, and jazz. The differences identified were not related to music genre preference; however, this finding may be related to the music-preference dimension of intense and rebellious music. Future work should evaluate the psychological variables that make up music-preference dimension to determine if these relate to our ANL.

Interprofessional Collaborative Practice Trends Between Speech-Language Pathologists and Audiologists.

PURPOSE: This study investigated interprofessional practice (IPP) trends and attitudes between speech-language pathologists (SLP) and audiologists (AUD). METHODS: Clinical SLPs and AUDs completed an online survey, consisting of demographics, caseload trends, collaborative practice trends, and barriers to collaborative practice. RESULTS: A total of 237 participants (131 SLPs, 106 AUDs) completed an online survey. Survey results indicated that IPP is important or very important to both professions. A smaller proportion of SLPs reported collaborating with AUDs than AUDs reported collaborating with SLPs. The most frequently identified barrier to collaboration experienced by the two professions was "access." Based on their beliefs, however, the top barriers differed between the professions. Specifically, SLPs believed that "access" was the top barrier to collaboration with AUDs whereas AUDs believed that "attitudes and perceptions" was the top barrier to collaboration with SLPs. Findings from the revised Attitudes Towards Health Care Teams Scale indicated that SLPs had a significantly more positive attitude toward IPP than AUDs. CONCLUSIONS: This study indicated that although IPP is valued by SLPs and AUDs, barriers continue to limit the percentage of practitioners engaging in IPP. Although both professions experienced common barriers, their beliefs about barriers to collaboration differed.

Improving Acceptance of Background Noise with Sound Enrichment.

BACKGROUND: Acceptance of background noise serves as a means to predict likelihood of hearing aid success. Individuals that are able to accept background noise are more likely to be successful with hearing aids. PURPOSE: The aim of the study was to assess the impact of sound enrichment on the acceptable noise level (ANL). STUDY SAMPLE: Nineteen young adult participants served as listeners. Participants were randomly assigned to the experimental or control group. RESEARCH DESIGN: An experimental design with random assignment to experimental or control group was used. DATA COLLECTION AND ANALYSIS: One group used sound enrichment procedures for 2 weeks, whereas the other group served as a control group. Sound enrichment procedures required that participants add low-level background sound to any quiet environment encountered during the study. Most comfortable listening level (MCL) and background noise level (BNL) were measured at three sessions, each 1 week apart (baseline, after 1 week of treatment, and after 2 weeks of treatment). RESULTS: Analytical statistics revealed that ANL improved for the sound enrichment group but remained the same for the control group. For both groups, there was no significant change in MCL across sessions. However, for the experimental group, BNL improved (increased) over the 2-week period while using sound enrichment. CONCLUSIONS: Results of this study indicate that ANL can be improved with the use of sound enrichment procedures over a 2-week period. Future work should examine the use of sound enrichment procedures for older adults with hearing loss.

Acceptable Noise Level Stability Over a One-Year Period of Time.

BACKGROUND: The acceptable noise level (ANL) is a measure of willingness to listen to speech in the presence of background noise and is thought to be related to success with amplification. To date, ANLs have only been assessed over short periods of time, including within a session and over a 3-week and 3-month time period. ANL stability over longer periods of time has not been assessed. PURPOSE: The purpose was to examine the stability of ANL over a 1-year time period. RESEARCH DESIGN: A repeated-measures, longitudinal study was completed. STUDY SAMPLE: Thirty young adults with normal hearing served as participants. The participants were tested at two different sites. DATA COLLECTION AND ANALYSIS: Two trials of most comfortable listening levels (MCLs), background noise levels (BNLs), and ANLs were assessed for each participant during three experimental sessions: at 0 months, 6 months, and 1 year. RESULTS: Two-way repeated-measures analysis of variances revealed no significant change in MCLs, BNLs, or ANLs within a session or over a 1-year time period. These results indicate that ANLs remain stable for 1 year in listeners with normal hearing. CONCLUSIONS: The finding that the ANL is stable over a longer period of time supports the theory that the ANL is an inherent trait of the listener and mediated at in the central auditory nervous system.

Safe Medication Administration in Patients with Communication Disorders: A Simulation-Enhanced Interprofessional Education Approach.

Medications and their associated side effects impact systems treated by speech-language pathologists and audiologists, such as speech, language, voice, swallowing, hearing, tinnitus, and balance. However, students in these disciplines receive limited training in pharmacology, while nursing students receive training in pharmacology but limited training in communication disorders. In this interprofessional simulation experience to increase understanding of the impact of medications on communication, swallowing, and balance, audiology, nursing, and speech-language pathology students worked together to interview standardized patients (SPs) about their medications and symptoms in a simulated clinical setting. Goals were for students to understand professional roles, identify high-risk medications with potential communication implications, provide patient education, and evaluate interdisciplinary collaboration. The SPs demonstrated symptoms patients may have as they take high-risk medications. Students (n = 101) completed a knowledge pretest, online training, simulation, debriefing facilitated by faculty experts, and posttest and impressions survey. Results indicated high satisfaction with teamwork and interprofessional interactions. Student knowledge of high-risk medications was improved as a result of this exercise, with nursing and speech-language pathology students demonstrating statistically significant improvements in posttest results. While knowledge deficits of some high-risk medications were evident across student groups, the overall effects demonstrated benefits of the simulation-enhanced interprofessional education experience.

The Influence of Speech Rate on Acceptable Noise Levels.

BACKGROUND: Older adults often struggle with accurate perception of rate-altered speech and have difficulty understanding speech in noise. The acceptable noise level (ANL) quantifies a listener's willingness to listen to speech in background noise and has been found to accurately predict hearing aid success. Based on the difficulty older adults experience with rapid speech, we were interested in how older adults may change the amount of background noise they willingly accept in a variety of speech rate conditions. PURPOSE: To determine the effects of age and speech rate on the ANL. RESEARCH DESIGN: A quasi-experimental mixed design was employed. STUDY SAMPLE: Fifteen young adults (19-27 yr) and fifteen older adults (55-73 yr) with audiometrically normal hearing or hearing loss within age-normed limits served as participants. DATA COLLECTION AND ANALYSIS: Most comfortable listening levels (MCLs) and background noise levels (BNLs) were measured using three different speech rates (slow, normal, and fast). The ANL was calculated by subtracting BNL from MCL. Repeated measures analysis of variances were used to analyze the effects of age and speech rate on ANL. RESULTS: A significant main effect of speech rate was observed; however, a significant main effect of age was not found. Results indicated that as speech rate increased the ANLs increased. This suggests that participants became less accepting of background noise as speech rates increased. CONCLUSIONS: The findings of the present study provide support for communication strategies that recommend slowing an individual's speaking rate and/or reducing background noise, if possible. Participants in the present study were better able to cope with background noise when the primary stimulus was presented at slow and normal speaking rates.

P300 Event-Related Potentials Differentiate Better Performing Individuals With Traumatic Brain Injury: A Preliminary Study of Semantic Processing.

OBJECTIVE: To measure the effect of traumatic brain injury on the cognitive processing of words, as measured by the P300, in a semantic categorization task. PARTICIPANTS: Eight adults with a history of moderate to severe traumatic brain injury and 8 age- and gender-matched controls. DESIGN: A pilot study measuring cognitive event-related potentials in response to word pairs that were either in same or different semantic categories. MAIN MEASURES: The P300 (P3b) component of the auditory event-related potential and neuropsychological assessment. RESULTS: Two patterns of P300 amplitude related to brain injury were observed. Participants with poorer performance on neuropsychological tests exhibited reduced P300 amplitude as compared to controls but showed the typical P300 parietal scalp distribution. In contrast, better performing participants demonstrated robust P300 amplitude but a substantially altered scalp distribution, characterized by the recruitment of anterior brain regions in addition to parietal activation. CONCLUSIONS: The recruitment of frontal areas after traumatic brain injury may represent compensatory neural mechanisms utilized to successfully maximize task performance. The P300 in a semantic processing paradigm may be a sensitive marker of neural plasticity that could be used to improve functional outcomes in cognitive remediation paradigms.

Speech Recognition at the Acceptable Noise Level.

BACKGROUND: The acceptable noise level (ANL) has been proposed as a prehearing aid fitting measure that could be used for hearing aid selection and counseling purposes. Previous work has demonstrated that a listener's ANL is unrelated to their speech recognition in noise abilities. It is unknown what criteria a listener uses when they select their ANL. To date, no research has explored the amount of speech recognized at the listener's ANL. PURPOSE: To examine the amount of speech recognized at the listener's ANL to determine whether speech recognition in noise is utilized as a factor for setting ANL. RESEARCH DESIGN: A descriptive quasi-experimental study was completed. For all listeners, ANL was measured and speech recognition in noise was tested at ANL and at two additional signal-to-noise ratio (SNR) conditions based on the listener's ANL (ANL + 5 and ANL - 5). STUDY SAMPLE: Forty-four older adults served as participants. Twenty-seven participants had normal hearing and seventeen participants had mild to moderately-severe, symmetrical, sensorineural hearing loss. DATA COLLECTION AND ANALYSIS: Acceptance of noise was calculated from the measures of most comfortable listening level and background noise level. Additionally, speech recognition in noise was assessed at three SNRs using the quick speech-in-noise test materials. RESULTS: A significant interaction effect of SNR condition and ANL group occurred for speech recognition. At ANL, a significant difference in speech recognition in noise was found across groups. Those in the mid and high ANL groups had excellent speech recognition at their ANL. Speech recognition in noise at ANL decreased with ANL category. CONCLUSIONS: For listeners with mid and high ANLs, speech recognition appears to play a primary role in setting their ANL. For those with low ANLs, speech recognition may contribute to setting their ANL; however, it does not appear to be the primary determiner of ANL. For those with very low ANLs, speech recognition does not appear to be significant variable for setting their ANL.

Intertester reliability of the acceptable noise level.

BACKGROUND: The acceptable noise level (ANL) serves to accurately predict the listener's likelihood of success with amplification. It has been proposed as a pre-hearing aid fitting protocol for hearing aid selection and counseling purposes. The ANL is a subjective measure of the listener's ability to accept background noise. Measurement of ANL relies on the tester and listener to follow the instructions set forth. To date, no research has explored the reliability of ANL as measured across clinicians or testers. PURPOSE: To examine the intertester reliability of ANL. RESEARCH DESIGN: A descriptive quasi-experimental reliability study was completed. ANL was measured for one group of listeners by three testers. STUDY SAMPLE: Three participants served as testers. Each tester was familiar with basic audiometry. Twenty-five young adults with normal hearing served as listeners. DATA COLLECTION/ANALYSIS: Each tester was stationed in a laboratory with the needed equipment. Listeners were instructed to report to these laboratories in a random order provided by the experimenters. The testers assessed most comfortable listening level (MCL) and background noise level (BNL) for all 25 listeners. RESULTS: Intraclass correlation coefficients were significant and revealed that MCL, BNL, and ANLs are reliable across testers. Additionally, one-way ANOVAs for MCL, BNL, and ANL were not significant. These findings indicate that MCL, BNL, and ANL do not differ significantly when measured by different testers. CONCLUSIONS: If the ANL instruction set is accurately followed, ANL can be reliably measured across testers, laboratories, and clinics. Intertester reliability of ANL allows for comparison across ANLs measured by different individuals. Findings of the present study indicate that tester reliability can be ruled out as a factor contributing to the disparity of mean ANLs reported in the literature.

The impact of listening condition on background noise acceptance for young adults with normal hearing.

PURPOSE: To evaluate the effect of different speech conditions on background noise acceptance. A total of 23 stimulus pairings, differing in primary talker gender (female, male, conventional), number of background talkers (1, 4, 12), and gender composition of the background noise (female, male, mixed) were used to evaluate background noise acceptance. METHOD: A repeated measures research design was used. Participants were 15 female and 15 male young adults with normal hearing. Background noise acceptance was evaluated with the acceptable noise level (ANL). RESULTS: The results revealed main effects of primary talker gender, number of background talkers, and listener gender. ANL was lower for conditions of a female primary talker and for conditions with multitalker backgrounds. Male listeners had significantly lower ANLs than female listeners. An interaction occurred between primary talker and background noise composition. For female primary talker conditions, the male talker backgrounds produced the lowest ANLs. For male primary talker conditions, the lowest ANLs were obtained with the female and male background talker conditions. CONCLUSIONS: Background noise acceptance depends on the listener and the stimulus condition. Stimulus selection can influence the measurement of ANL. The results support the use of the commercially available ANL materials.

The relationship of locus of control, self-control, and acceptable noise levels for young listeners with normal hearing.

OBJECTIVE: Background noise acceptance while listening to speech, assessed via the acceptable noise level (ANL) measure, has been shown to be an accurate predictor of hearing-aid success. No specific listener characteristics have been identified as being related to a listener's ability to accept background noise. The purpose of this study was to determine whether or not locus of control and self-control are related to ANL. DESIGN: Correlational design. STUDY SAMPLE: Participants were seventy young adults (21 male, 49 female; aged 19 to 39 years) with normal hearing. Participants completed psychological profiles that evaluated locus of control and self-control and their ANLs were measured. RESULTS: Results revealed correlations between ANL and self-control. Listeners with higher levels of self-control accepted more background noise than listeners with lower levels of self-control. CONCLUSIONS: This research suggests that exercises aimed at strengthening a listener's auditory self-control may lead to improved background noise acceptance. Improvement in background noise acceptance could lead to improved hearing-aid success. Future research should explore these possibilities.

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.

Most comfortable listening levels, background noise levels, and acceptable noise levels for children and adults with normal hearing.

BACKGROUND: For adults the acceptable noise level (ANL) has been shown to be a strong predictor of hearing aid success. ANL is calculated as the difference between most comfortable listening level (MCL) and background noise level (BNL). No studies have made direct comparisons of these measures between adults and children. PURPOSE: To evaluate and compare MCLs, BNLs, and ANLs in children and young adults. RESEARCH DESIGN: A cross-sectional design was used in this study. Two groups (children and adults) were tested for each dependent variable. MCLs and BNLs were measured for each participant, and ANLs were computed from these two measurements. STUDY SAMPLE: The participants were 34 children (8-10 yr) and 34 young adults (19-29 yr) with normal hearing. RESULTS: Significant main effects were found for MCLs and BNLs. There was no main effect for ANLs. MCLs and BNLs were significantly lower for the children than for the adults. CONCLUSIONS: These results suggest that while ANLs are unchanged from childhood to adulthood, there appears to be a developmental change in MCLs and BNLs. These findings have implications for the use of ANLs in the pediatric population.

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.

Acceptance of noise with intelligible, reversed, and unfamiliar primary discourse.

PURPOSE: The purpose of this study was to investigate the effects of intelligible and unintelligible primary discourse on acceptance of noise. Of particular interest was the effect of intelligibility on the most comfortable loudness (MCL) component of acceptable noise level (ANL). METHOD: ANLs were measured for 30 participants using an intelligible discourse, a reversed discourse, and an unfamiliar primary discourse. For each discourse, MCL and background noise level (BNL) were found. The ANL was then computed by subtracting the mean BNL from the MCL. RESULTS: The intelligibility of the primary discourse did not affect MCL. The ANL was significantly different for the intelligible versus reversed condition and the intelligible versus unfamiliar (Chinese) condition. CONCLUSION: Results indicate that ANL may change as speech intelligibility changes and/or speech recognition ability decreases in adults with normal hearing.

Pitch discrimination and pitch matching abilities with vocal and nonvocal stimuli.

Various stimulus types have been investigated in pitch discrimination and pitch matching tasks. However, previous studies have not explored the use of recorded samples of an individual's own voice in performing these two tasks. The purpose of this study was to investigate pitch discrimination and pitch matching abilities using three stimuli conditions (participant's own voice, a neutral female voice, and nonvocal complex tones) to determine if pitch discrimination and/or pitch matching abilities are influenced by the type of stimuli presented. Results of the pitch discrimination tasks yielded no significant difference in discrimination ability for the three stimuli. For the pitch matching tasks, a significant difference was found for the participants' voice versus neutral female voice and the participants' voice versus tonal stimuli. There was no significant difference in pitch matching ability between the neutral female voice and the tonal stimuli. There was no significant correlation between pitch discrimination and pitch matching abilities for any of the three stimuli types. These results suggest that it is easier to match the pitch of one's own voice than to match the pitch of a neutral female voice and nonvocal complex tones, although no difference was found for pitch discrimination abilities. One possible implication of this study is that differences in matching the pitch of one's own voice compared to matching other stimuli types may help to differentiate the source of singing inaccuracy (motor vs discrimination skills).

Influence of music and music preference on acceptable noise levels in listeners with normal hearing.

Acceptable noise level (ANL) is defined as the maximum level of background noise that an individual is willing to accept while listening to speech. The type of background noise does not affect ANL results with the possible exception of music. The purpose of this study was to determine if ANL for music was different from ANL for twelve-talker babble and investigate if there was a correlation between ANL for music samples and preference for those music samples. Results demonstrated that ANL for music tended to be better than ANL for twelve-talker babble, indicating listeners were more willing to accept music as a background noise than speech babble. The results further demonstrated that ANL for the music samples were not correlated with preference for the music samples, indicating that ANL for music was not related to music preference. Therefore, music appeared to be processed differently as a background noise than twelve-talker babble.