Question asking in active listening scale for early adolescents: Behavioral measure development and initial validation.

Relational theories of human development explain how stereotypes and their underlying ideologies thwart social connections that are fundamental for individuals to thrive, especially in early adolescence. Intervention research to address this crisis of connection is still emergent and active listening is one promising strategy to this end; however, its efficacy has not been examined in part because no validated measures of active listening for this population exist. This validation study is the first to examine whether the behavioral dimensions of one form of active listening can be captured using a coding scheme to assess adolescents' engagement in a live interviewing task (N = 293). Importantly, the measure was developed within the context of a theory-driven intervention to train adolescents in transformative curiosity and listening to enhance connection. Findings indicate that two dimensions underlie the measure as hypothesized, open-ended questions and follow-up questions, with acceptable internal consistency. The measure is sensitive to change in adolescents' questioning skills before and after the intervention. Further, asking follow-up questions was positively related to empathy and also predicted a respondent's perception of their interviewer as a good listener. The effect for asking open-ended questions was moderated by dyad-level tendencies to elicit disclosure from others. The current measure not only examines question asking as a more nuanced behavioral dimension of active listening than previous measures, it is also the first to do so among a sample of early adolescents. The measure will be useful in assessing active listening interventions' efficacy to address the crisis of connection.

Influence of online versus traditional learning on EFL listening skills: A blended mode classroom perspective.

Online learning is becoming more and more popular than traditional learning, and the need to investigate its influence within the framework of instruction and learning domains is - in today's emerging, cutting-edge technology world - an academic trend. The current study's problem intends to explore the impact of virtual versus traditional learning on the academic achievement of EFL students, a subject that has garnered substantial attention from English Language Teaching (ELT) researchers. This study aims to clarify if EFL students' academic progress in a listening skills classroom is influenced by traditional or online learning. The present research compiled information on how EFL students performed when English language teaching took place online as opposed to in a traditional classroom environment. This study, using an experimental research design with (N = 30) pairs of students (both male and female), was held at Najran University, KSA, in the academic year 2022-2023 b y using probability (random sampling). This study used pre-and post-tests to gather data from the subjects of the study, bifurcated into controlled and experimental groups employing the two modes of teaching, viz., online and traditional. The findings of the investigation proved that the experimental group achieved better performance compared to the control group in terms of results and scores. There are no significant differences based on gender. In addition, (N = 20) teachers teaching listening skills to EFL learners participated in semi-structured interviews. The qualitative analysis enlisted flexibility, accessibility, effective communication, collaboration, monitoring of student progress, and the use of a blackboard as constructive elements, followed by maintenance costs, wastage of available resources, long-term engagement, limited face-to-face interaction, and demotivation as critical perspectives. According to the findings of this research, the author recommends further studies with more variables.

Effect of Listening Channels for Sport-Event Theme Songs on Willingness to Share.

Purpose: The sport-event theme songs is a crucial means to evoke consumer enthusiasm and boost the influence of sport event. This research aims to examine the effects of direct and indirect listening channels for sport-event theme songs on consumers' willingness to share. Methods: In this research, three between-subjects experiments were conducted to measure the effect of listening channels for sport-event theme songs on the willingness to share, along with the moderating effects of fans' fanaticism and sport-event type. All participants in the experiments were social populations from China. Results: Study 1 reveals that direct listening is more likely to cause consumers to share cognitive information about sport-event theme songs; indirect listening, meanwhile, makes them more willing to share the emotional value of the songs. Study 2 indicates that fans' fanaticism moderates the relationship between listening type and shared content. In the case of low fanaticism, indirect listening can increase consumers' willingness to share sport-event theme songs compared with direct listening. Study 3 reveals that sport-event type moderates the relationship between listening type and shared content. For public welfare sport events, indirect listening is more likely than direct listening to cause consumers to share the emotional value of sport-event theme songs. For commercial events, compared with indirect listening, direct listening is more likely to cause consumers to share cognitive information about sport-event theme songs. Conclusion: The results of this research unveiled the effect of listening channels for sport-event theme songs on the willingness to share, as well as the theoretical mechanisms behind them. In addition, this research enriches the research on listening channels in the field of psychology and provides an important basis for improving the effectiveness of sport-event theme songs.

Association of quality of nursing care with violence load, burnout, and listening climate.

BACKGROUND: Violence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept. METHODS: We sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected. RESULTS: There were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care. CONCLUSIONS: The results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

Disagreement Gets Mistaken for Bad Listening.

It is important for people to feel listened to in professional and personal communications, and yet they can feel unheard even when others have listened well. We propose that this feeling may arise because speakers conflate agreement with listening quality. In 11 studies (N = 3,396 adults), we held constant or manipulated a listener's objective listening behaviors, manipulating only after the conversation whether the listener agreed with the speaker. Across various topics, mediums (e.g., video, chat), and cues of objective listening quality, speakers consistently perceived disagreeing listeners as worse listeners. This effect persisted after controlling for other positive impressions of the listener (e.g., likability). This effect seemed to emerge because speakers believe their views are correct, leading them to infer that a disagreeing listener must not have been listening very well. Indeed, it may be prohibitively difficult for someone to simultaneously convey that they disagree and that they were listening.

Hearing in categories aids speech streaming at the "cocktail party".

Our perceptual system bins elements of the speech signal into categories to make speech perception manageable. Here, we aimed to test whether hearing speech in categories (as opposed to a continuous/gradient fashion) affords yet another benefit to speech recognition: parsing noisy speech at the "cocktail party." We measured speech recognition in a simulated 3D cocktail party environment. We manipulated task difficulty by varying the number of additional maskers presented at other spatial locations in the horizontal soundfield (1-4 talkers) and via forward vs. time-reversed maskers, promoting more and less informational masking (IM), respectively. In separate tasks, we measured isolated phoneme categorization using two-alternative forced choice (2AFC) and visual analog scaling (VAS) tasks designed to promote more/less categorical hearing and thus test putative links between categorization and real-world speech-in-noise skills. We first show that listeners can only monitor up to ~3 talkers despite up to 5 in the soundscape and streaming is not related to extended high-frequency hearing thresholds (though QuickSIN scores are). We then confirm speech streaming accuracy and speed decline with additional competing talkers and amidst forward compared to reverse maskers with added IM. Dividing listeners into "discrete" vs. "continuous" categorizers based on their VAS labeling (i.e., whether responses were binary or continuous judgments), we then show the degree of IM experienced at the cocktail party is predicted by their degree of categoricity in phoneme labeling; more discrete listeners are less susceptible to IM than their gradient responding peers. Our results establish a link between speech categorization skills and cocktail party processing, with a categorical (rather than gradient) listening strategy benefiting degraded speech perception. These findings imply figure-ground deficits common in many disorders might arise through a surprisingly simple mechanism: a failure to properly bin sounds into categories.

(Why) Do Transparent Hearing Devices Impair Speech Perception in Collocated Noise?

Hearing aids and other hearing devices should provide the user with a benefit, for example, compensate for effects of a hearing loss or cancel undesired sounds. However, wearing hearing devices can also have negative effects on perception, previously demonstrated mostly for spatial hearing, sound quality and the perception of the own voice. When hearing devices are set to transparency, that is, provide no gain and resemble open-ear listening as well as possible, these side effects can be studied in isolation. In the present work, we conducted a series of experiments that are concerned with the effect of transparent hearing devices on speech perception in a collocated speech-in-noise task. In such a situation, listening through a hearing device is not expected to have any negative effect, since both speech and noise undergo identical processing, such that the signal-to-noise ratio at ear is not altered and spatial effects are irrelevant. However, we found a consistent hearing device disadvantage for speech intelligibility and similar trends for rated listening effort. Several hypotheses for the possible origin for this disadvantage were tested by including several different devices, gain settings and stimulus levels. While effects of self-noise and nonlinear distortions were ruled out, the exact reason for a hearing device disadvantage on speech perception is still unclear. However, a significant relation to auditory model predictions demonstrate that the speech intelligibility disadvantage is related to sound quality, and is most probably caused by insufficient equalization, artifacts of frequency-dependent signal processing and processing delays.

Use of person-centred music to manage wound dressing-related pain: a mixed method case study.

OBJECTIVE: To determine whether person-centred music (PCMusic) contributes to reducing pain during painful leg ulcer dressing change procedures indicated by: decreased levels of indicators related to stress; decreased pain scores; and a more favourable treatment climate during the dressing change procedure. METHOD: A case study of a 51-year-old female patient with chronic inherited disease weakening her connective tissues. Quantitative data entailed temporal measurements of stress indicators including: heart pulse rate; oxygen saturation (SpO2); saliva cortisol; and a visual analogue scale (VAS). Qualitative data comprised phenomenological treatment descriptions and patient/licensed practical nurse (LPN) questionnaires. RESULTS: The patient's body temperature remained steady throughout all treatments. Blood pressure was excluded due to missing data. No significant pulse rate differences in relation to music/no music could be observed during treatment. Comparing PCMusic to the patient's own other music (POOM), the pulse rate was greater in both magnitude and variation when the patient listened to POOM. Oxygen saturation showed no significant difference between PCMusic and music/no music. No significant difference was observed pre-/post-debridement with music. Similarly, no significant difference was observed pre-/post-debridement with no music. Treatment with no music showed the highest VAS score; PCMusic treatments had the lowest scores. Qualitative data showed that both patient and LPNs found that PCMusic decreased pain during dressing change. CONCLUSION: The results of this case study indicate that PCMusic is a suitable complementary treatment to decrease patient pain. Patients' general health status is important when using quantitative stress/pain marker measurements. For cohort selection in future studies, we suggest healthy patients undergoing slightly painful or unpleasant treatments, patients in postoperative care and obstetric care.

Psychiatrists' Illustration of Awe in Empathic Listening Assessments: A Pilot Study.

Background "Awe" is typically an inspiring emotional response to perceptually vast stimuli signifying the transcendence beyond all cognitive frames of reference when we encounter the unexpected. Physicians' experience of awe in clinical care interactions has not been studied in an empirical, evidence-based way. We aim to present a focused study of awe in a psychiatrist's empathic listening (EL) assessments and propose an evidence-based framework to study it. Methodology This is an exploratory case series of a psychiatrist's EL interactions (mean duration/x̄ of 46.17 minutes) with six patients (two males and four females) aged 32-72 years (x̄ =54.67, σ = 16.64). Using the method of autoethnography, the verbal and nonverbal aspects of the EL assessments were analyzed and open-coded to generate qualitative data. Results The study revealed that the data in all the case studies could be classed into two thematic groups, namely, mindfulness and transpersonal mindfulness. The emotions of "awe" and "non-agency" were ubiquitous in all six case studies both for the psychiatrist and patients. Conclusions Recognizing the awe and non-agency in EL interaction is essential in conceptualizing the "mindfulness-to-transcendence" framework and the first step toward the evidence-based study of transcendence/metaphysics in phenomenological psychiatry.

Preschoolers benefit from sentential context in familiar- and unfamiliar-accented speech.

To learn the meaning of a new word, or to recognize the meaning of a known one, both children and adults benefit from surrounding words, or the sentential context. Most of the evidence from children is based on their accuracy and efficiency when listening to speech in their familiar native accent: they successfully use the words they know to identify other words' referents. Here, we assess how accurately and efficiently 4-year-old children use sentential context to identify referents of known and novel nouns in unfamiliar-accented speech, as compared to familiar-accented speech. In a looking-while-listening task, children showed considerable success in processing unfamiliar-accented speech. Children robustly mapped known nouns produced in an unfamiliar accent to their target referents rather than novel competitors, and they used informative surrounding verbs (e.g., "You can eat the dax") to identify the referents of both known and novel nouns-although there was a processing cost for unfamiliar-accented speech in some cases. This demonstrates that 4-year-olds successfully and rapidly process unfamiliar-accented speech by recruiting the same strategies available to them in familiar-accented speech, revealing impressive flexibility in word recognition and word learning across diverse linguistic environments. RESEARCH HIGHLIGHTS: We examined 4-year-old children's accuracy and processing efficiency in comprehending known and novel nouns embedded in sentences produced in familiar-accented or unfamiliar-accented speech. Children showed limited processing costs for unfamiliar-accented speech and mapped known words to their referents even when these were produced in unfamiliar-accented speech. Children used known verbs to predict the referents of upcoming nouns in both familiar- and unfamiliar-accented speech, but processing costs were evident for unfamiliar-accented speech. Thus, the strategies that support children's word comprehension and word learning in familiar-accented speech are available to them in unfamiliar accents as well.

Remediation of Perceptual Deficits in Progressive Auditory Neuropathy: A Case Study.

BACKGROUND: Auditory neuropathy (AN) is a hearing disorder that affects neural activity in the VIIIth cranial nerve and central auditory pathways. Progressive forms have been reported in a number of neurodegenerative diseases and may occur as a result of both the deafferentiation and desynchronisation of neuronal processes. The purpose of this study was to describe changes in auditory function over time in a patient with axonal neuropathy and to explore the effect of auditory intervention. METHODS: We tracked auditory function in a child with progressive AN associated with Charcot-Marie-Tooth (Type 2C) disease, evaluating hearing levels, auditory-evoked potentials, and perceptual abilities over a 3-year period. Furthermore, we explored the effect of auditory intervention on everyday listening and neuroplastic development. RESULTS: While sound detection thresholds remained constant throughout, both electrophysiologic and behavioural evidence suggested auditory neural degeneration over the course of the study. Auditory brainstem response amplitudes were reduced, and perception of auditory timing cues worsened over time. Functional hearing ability (speech perception in noise) also deteriorated through the first 1.5 years of study until the child was fitted with a "remote-microphone" listening device, which subsequently improved binaural processing and restored speech perception ability to normal levels. CONCLUSIONS: Despite the deterioration of auditory neural function consistent with peripheral axonopathy, sustained experience with the remote-microphone listening system appeared to produce neuroplastic changes, which improved the patient's everyday listening ability-even when not wearing the device.

Listening effort, fatigue, and streamed voice quality during online university courses.

Understanding the impact of listening effort (LE) and fatigue has become increasingly crucial in optimizing the learning experience with the growing prevalence of online classrooms as a mode of instruction. The purpose of this study was to investigate the LE, fatigue, and voice quality experienced by students during online and face-to-face class sessions. A total of 110 participants with an average age of 20.76 (range 18-28) comprising first year undergraduate students in Speech and Language Therapy and Audiology programs in Turkey, rated their LE during the 2022-2023 spring semester using the Listening Effort Screening Questionnaire (LESQ) and assessed their fatigue with the Multidimensional Fatigue Inventory (MFI-20). Voice quality of lecturers was assessed using smoothed cepstral peak prominence (CPPS) measurements. Data were collected from both online and face-to-face sessions. The results revealed that participants reported increased LE and fatigue during online sessions compared to face-to-face sessions and the differences were statistically significant. Correlation analysis showed significant relationships (p < 0.05) between audio-video streaming quality and LE-related items in the LESQ, as well as MFI sub-scales and total scores. The findings revealed a relationship between an increased preference for face-to-face classrooms and higher levels of LE and fatigue, emphasizing the significance of these factors in shaping the learning experience. CPPS measurements indicated a dysphonic voice quality during online classroom audio streaming. These findings highlight the challenges of online classes in terms of increased LE, fatigue, and voice quality issues. Understanding these factors is crucial for improving online instruction and student experience.

The relationship between Empathy and listening styles is complex: implications for doctors in training.

BACKGROUND: Effective communication is the key to a successful relationship between doctors and their patients. Empathy facilitates effective communication, but physicians vary in their ability to empathize with patients. Listening styles are a potential source of this difference. We aimed to assess empathy and listening styles among medical students and whether students with certain listening styles are more empathetic. METHODS: In this cross-sectional study, 97 medical students completed the Jefferson scale of Empathy (JSE) and the revised version of the Listening Styles Profile (LSP-R). The relationship between empathy and listening styles was assessed by comparing JSE scores across different listening styles using ANOVA in SPSS software. A p-value less than 0.05 was considered significant. RESULTS: Overall, the students showed a mean empathy score of 103 ± 14 on JSE. Empathy scores were lower among clinical students compared to preclinical students. Most of the medical students preferred the analytical listening style. The proportion of students who preferred the relational listening style was lower among clinical students compared to preclinical students. There was no significant relationship between any of the listening styles with empathy. CONCLUSION: Our results do not support an association between any particular listening style with medical students' empathic ability. We propose that students who have better empathetic skills might shift between listening styles flexibly rather than sticking to a specific listening style.

Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives.

BACKGROUND: Despite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops. METHODS: Data collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines. RESULTS: We identified four main themes: "Providers agree on the value of disclosure of a medical error to the patient"; "Emotional challenges of disclosure of medical error to patients"; "The medico-legal discourse challenges transparency"; and "Providers and patients call for a change in the culture regarding disclosure of medical errors". Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties. CONCLUSION: The study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers.

Reading Comprehension in the Arabic Diglossia: The SVR Between the Spoken and Literary Varieties.

This study aimed to examine the validity of the "simple view of reading" (SVR) model in the diglossic Arabic language. Using a longitudinal design, we tested whether decoding and listening comprehension (LC) in kindergarten can later predict reading comprehension (RC) in the first grade and whether the contribution of LC to RC differs between the spoken and literary varieties of Arabic. The participants were 261 kindergartners who were followed to the first grade. Our results from separate SEM analysis for the spoken and literary varieties revealed some similarity between the explained variance in the spoken (52%) and literary (48%) variety models. However, while the contribution of LC to RC was higher than the contribution of decoding in the spoken variety model, an opposite pattern was observed in the literary variety model. The results are discussed in light of the diglossia phenomenon and its impact on comprehension skills in Arabic, with theoretical and pedagogical implications.

Optimising listening skills: Analysing the effectiveness of a blended model with a top-down approach through cognitive load theory.

The ability to listen is critical in the task of language learning. Although listening has the least pedagogical attention, the growing emphasis on communication and language proficiency makes listening skills prominent in the language classroom. This paper aims to analyse the effectiveness of the Blended model to improve teaching listening skills, by instigating a top-down approach through Cognitive Load Theory. The top-down approach aids the students with the background knowledge of the audio with information like context, situation, phrases, etc. The blended model enables the teacher to facilitate students through the technological platform to process their listening input. A questionnaire was adopted for data collection and a semi-structured interview was performed from 60 samples from prefinal year Engineering students selected through purposive sampling techniques and grouped as experimental N = 30 and control N = 30 groups. The experimental group was trained with a top-down approach with the support of LMS. The control group was provided with the same listening material but taught in the conventional method. The purpose of this study is to show the statistically significant impact of employing technology inside the language classroom to teach listening skills. Findings showed that samples in the experimental group could identify the relevant and non-relevant information from the audio, conceptualise the audio content and predict the information beforehand. The difficulties that the students and teachers faced and the remedial measures to overcome them are also discussed. The following objectives were established for the study through mixed methods of enhancing listening skills through Cognitive Load Theory (CLT). •To explore the effect of intervention through a top-down approach with the support of technology (LMS) on enhancing the listening skills of the students.•How the blending of synchronous and asynchronous and a top-down approach develops the predicting skills of the students during the listening comprehension exercises.•To adapt procedures involved in enhancing the self-paced learning efficacy and reducing listening anxiety in ESL learners.

Alpha-Band Dynamics of Hearing Aid Wearers Performing the Repeat-Recall Test (RRT).

This study measured electroencephalographic activity in the alpha band, often associated with task difficulty, to physiologically validate self-reported effort ratings from older hearing-impaired listeners performing the Repeat-Recall Test (RRT)-an integrative multipart assessment of speech-in-noise performance, context use, and auditory working memory. Following a single-blind within-subjects design, 16 older listeners (mean age = 71 years, SD = 13, 9 female) with a moderate-to-severe degree of bilateral sensorineural hearing loss performed the RRT while wearing hearing aids at four fixed signal-to-noise ratios (SNRs) of -5, 0, 5, and 10 dB. Performance and subjective ratings of listening effort were assessed for complementary versions of the RRT materials with high/low availability of semantic context. Listeners were also tested with a version of the RRT that omitted the memory (i.e., recall) component. As expected, results showed alpha power to decrease significantly with increasing SNR from 0 through 10 dB. When tested with high context sentences, alpha was significantly higher in conditions where listeners had to recall the sentence materials compared to conditions where the recall requirement was omitted. When tested with low context sentences, alpha power was relatively high irrespective of the memory component. Within-subjects, alpha power was related to listening effort ratings collected across the different RRT conditions. Overall, these results suggest that the multipart demands of the RRT modulate both neural and behavioral measures of listening effort in directions consistent with the expected/designed difficulty of the RRT conditions.

Combining Cardiovascular and Pupil Features Using k-Nearest Neighbor Classifiers to Assess Task Demand, Social Context, and Sentence Accuracy During Listening.

In daily life, both acoustic factors and social context can affect listening effort investment. In laboratory settings, information about listening effort has been deduced from pupil and cardiovascular responses independently. The extent to which these measures can jointly predict listening-related factors is unknown. Here we combined pupil and cardiovascular features to predict acoustic and contextual aspects of speech perception. Data were collected from 29 adults (mean  =  64.6 years, SD  =  9.2) with hearing loss. Participants performed a speech perception task at two individualized signal-to-noise ratios (corresponding to 50% and 80% of sentences correct) and in two social contexts (the presence and absence of two observers). Seven features were extracted per trial: baseline pupil size, peak pupil dilation, mean pupil dilation, interbeat interval, blood volume pulse amplitude, pre-ejection period and pulse arrival time. These features were used to train k-nearest neighbor classifiers to predict task demand, social context and sentence accuracy. The k-fold cross validation on the group-level data revealed above-chance classification accuracies: task demand, 64.4%; social context, 78.3%; and sentence accuracy, 55.1%. However, classification accuracies diminished when the classifiers were trained and tested on data from different participants. Individually trained classifiers (one per participant) performed better than group-level classifiers: 71.7% (SD  =  10.2) for task demand, 88.0% (SD  =  7.5) for social context, and 60.0% (SD  =  13.1) for sentence accuracy. We demonstrated that classifiers trained on group-level physiological data to predict aspects of speech perception generalized poorly to novel participants. Individually calibrated classifiers hold more promise for future applications.

Mood shapes the impact of reward on perceived fatigue from listening.

Knowledge of the underlying mechanisms of effortful listening could help to reduce cases of social withdrawal and mitigate fatigue, especially in older adults. However, the relationship between transient effort and longer term fatigue is likely to be more complex than originally thought. Here, we manipulated the presence/absence of monetary reward to examine the role of motivation and mood state in governing changes in perceived effort and fatigue from listening. In an online study, 185 participants were randomly assigned to either a "reward" (n = 91) or "no-reward" (n = 94) group and completed a dichotic listening task along with a series of questionnaires assessing changes over time in perceived effort, mood, and fatigue. Effort ratings were higher overall in the reward group, yet fatigue ratings in that group showed a shallower linear increase over time. Mediation analysis revealed an indirect effect of reward on fatigue ratings via perceived mood state; reward induced a more positive mood state which was associated with reduced fatigue. These results suggest that: (1) listening conditions rated as more "effortful" may be less fatiguing if the effort is deemed worthwhile, and (2) alterations to one's mood state represent a potential mechanism by which fatigue may be elicited during unrewarding listening situations.

Patient listening on social media for patient-focused drug development: a synthesis of considerations from patients, industry and regulators.

Patients, life science industry and regulatory authorities are united in their goal to reduce the disease burden of patients by closing remaining unmet needs. Patients have, however, not always been systematically and consistently involved in the drug development process. Recognizing this gap, regulatory bodies worldwide have initiated patient-focused drug development (PFDD) initiatives to foster a more systematic involvement of patients in the drug development process and to ensure that outcomes measured in clinical trials are truly relevant to patients and represent significant improvements to their quality of life. As a source of real-world evidence (RWE), social media has been consistently shown to capture the first-hand, spontaneous and unfiltered disease and treatment experience of patients and is acknowledged as a valid method for generating patient experience data by the Food and Drug Administration (FDA). While social media listening (SML) methods are increasingly applied to many diseases and use cases, a significant piece of uncertainty remains on how evidence derived from social media can be used in the drug development process and how it can impact regulatory decision making, including legal and ethical aspects. In this policy paper, we review the perspectives of three key stakeholder groups on the role of SML in drug development, namely patients, life science companies and regulators. We also carry out a systematic review of current practices and use cases for SML and, in particular, highlight benefits and drawbacks for the use of SML as a way to identify unmet needs of patients. While we find that the stakeholders are strongly aligned regarding the potential of social media for PFDD, we identify key areas in which regulatory guidance is needed to reduce uncertainty regarding the impact of SML as a source of patient experience data that has impact on regulatory decision making.