Testing a computational model for aural detection of aircraft in ambient noise.

Computational models are used to predict the performance of human listeners for carefully specified signal and noise conditions. However, there may be substantial discrepancies between the conditions under which listeners are tested and those used for model predictions. Thus, models may predict better performance than exhibited by the listeners, or they may "fail" to capture the ability of the listener to respond to subtle stimulus conditions. This study tested a computational model devised to predict a listener's ability to detect an aircraft in various soundscapes. The model and listeners processed the same sound recordings under carefully specified testing conditions. Details of signal and masker calibration were carefully matched, and the model was tested using the same adaptive tracking paradigm. Perhaps most importantly, the behavioral results were not available to the modeler before the model predictions were presented. Recordings from three different aircraft were used as the target signals. Maskers were derived from recordings obtained at nine locations ranging from very quiet rural environments to suburban and urban settings. Overall, with a few exceptions, model predictions matched the performance of the listeners very well. Discussion focuses on those differences and possible reasons for their occurrence.

COVID-19 Vaccination Of People Experiencing Homelessness And Incarceration In Minnesota.

We used data from a statewide public health-health system collaboration to describe trends in COVID-19 vaccination rates by racial and ethnic groups among people experiencing homelessness or incarceration in Minnesota. Vaccination completion rates among the general population and people incarcerated in state prisons were substantially higher than those among people experiencing homelessness or jail incarceration.

Trends in COVID-19 Vaccine Administration and Effectiveness Through October 2021.

Importance: COVID-19 vaccines are effective, but inequities in vaccine administration and waning immunity may limit vaccine effectiveness. Objectives: To report statewide trends in vaccine administration and vaccine effectiveness in Minnesota. Design, Setting, and Participants: This cohort study used COVID-19 vaccine data from the Minnesota Immunization Information Connection from October 25, 2020, through October 30, 2021 that were linked with electronic health record (EHR) data from health systems collaborating as part of the Minnesota EHR Consortium (MNEHRC). Participants included individuals who were seen at a participating health system in Minnesota. Exposures: Individuals were considered fully vaccinated in the second week after receipt of a second dose of a BNT162b2 or mRNA-1273 vaccine or a single dose of an Ad26.COV.2.S vaccine. Main Outcomes and Measures: A completed vaccination series and vaccine breakthrough, defined as either a positive SARS-CoV-2 polymerase chain reaction (PCR) test or a hospital admission the same week or within the 3 weeks following a positive SARS-CoV-2 PCR test. A test-negative design and incident rate ratio were used to evaluate COVID-19 vaccine effectiveness separately for the BNT162b2, mRNA-1273, and Ad26.COV.2.S vaccines. Rurality and social vulnerability index were assessed at the area level. Results: This study included 4 431 190 unique individuals at participating health systems, and 3 013 704 (68%) of the individuals were fully vaccinated. Vaccination rates were lowest among Minnesotans who identified as Hispanic (116 422 of 217 019 [54%]), multiracial (30 066 of 57 412 [52%]), American Indian or Alaska Native (22 190 of 41 437 [54%]), and Black or African American (158 860 of 326 595 [49%]) compared with Minnesotans who identified as Asian or Pacific Islander (159 999 of 210 994 [76%]) or White (2 402 928 of 3 391 747 [71%]). Among individuals aged 19 to 64 years, vaccination rates were lower in rural areas (196 479 of 308 047 [64%]) compared with urban areas (151 541 of 1 951 265 [77%]) and areas with high social vulnerability (544 433 of 774 952 [70%]) compared with areas with low social vulnerability (571 613 of 724 369 [79%]). In the 9 weeks ending October 30, 2021, vaccine effectiveness as assessed by a test-negative design was 33% (95% CI, 30%-37%) for Ad26.COV.2.S; 53% (95% CI, 52%-54%) for BNT162b2; and 66% (95% CI, 65%-67%) for mRNA-1273. For SARS-CoV-2-related hospitalizations, vaccine effectiveness in the 9 weeks ending October 30, 2021, was 78% (95% CI, 75%-81%) for Ad26.COV.2.S; 81% (95% CI, 79%-82%) for BNT162b2; and 81% (95% CI, 79%-82%) for mRNA-1273. Conclusions and Relevance: This cohort study of data from a Minnesota statewide consortium suggests disparities in vaccine administration and effectiveness. Vaccine effectiveness against infection was lower for Ad26.COV.2.S and BNT162b2 but was associated with protection against SARS-CoV-2-related hospitalizations despite the increased prevalence of the Delta variant in Minnesota.

Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19.

OBJECTIVE: Ensuring an efficient response to COVID-19 requires a degree of inter-system coordination and capacity management coupled with an accurate assessment of hospital utilization including length of stay (LOS). We aimed to establish optimal practices in inter-system data sharing and LOS modeling to support patient care and regional hospital operations. MATERIALS AND METHODS: We completed a retrospective observational study of patients admitted with COVID-19 followed by 12-week prospective validation, involving 36 hospitals covering the upper Midwest. We developed a method for sharing de-identified patient data across systems for analysis. From this, we compared 3 approaches, generalized linear model (GLM) and random forest (RF), and aggregated system level averages to identify features associated with LOS. We compared model performance by area under the ROC curve (AUROC). RESULTS: A total of 2068 patients were included and used for model derivation and 597 patients for validation. LOS overall had a median of 5.0 days and mean of 8.2 days. Consistent predictors of LOS included age, critical illness, oxygen requirement, weight loss, and nursing home admission. In the validation cohort, the RF model (AUROC 0.890) and GLM model (AUROC 0.864) achieved good to excellent prediction of LOS, but only marginally better than system averages in practice. CONCLUSION: Regional sharing of patient data allowed for effective prediction of LOS across systems; however, this only provided marginal improvement over hospital averages at the aggregate level. A federated approach of sharing aggregated system capacity and average LOS will likely allow for effective capacity management at the regional level.

Interpretability of the audiogram by audiologists and physician non-specialists.

OBJECTIVE: The audiogram is frequently used by hearing specialists communicate test results to non-specialists, such as physicians. However, it relies on uncommon terminology and interpreting unusual graphical elements to extract information. In this study, we examine whether the audiogram can be accurately interpreted by specialists and non-specialists. DESIGN: We used an online questionnaire to assess the interpretability of an audiogram by audiologists and primary-care physicians. Participants viewed a sample audiogram and submitted their answers via an online survey system. STUDY SAMPLE: We recruited actively practicing primary care physicians (n = 100) and actively practicing audiologists (n = 67). We only accepted respondents from the United States. RESULTS: The audiogram was not easily interpreted by physicians, with a median score of 4/9. Fewer than 25% could accurately report a threshold correctly. Audiologists were more accurate than physicians (median score 7/9, Wilcoxon two-sample p < 0.001, r = 0.648). CONCLUSIONS: The audiogram is difficult for non-specialists to interpret. Clinicians are advised to supplement or supplant the audiogram in interprofessional communication. The development of tools to facilitate interprofessional communication between audiologists and physicians could have positive effects on physician awareness of hearing loss, and even downstream influences on patient behaviour and outcomes.

Health Literacy and Self-Reported Hearing Aid Use in the Health and Retirement Study.

OBJECTIVES: Understanding the determinants of hearing aid use is important to improve the provision of hearing healthcare. Prior research has indicated that materials in the clinic and online, as well as audiologists' language during appointments, require a higher literacy level than most patients possess. We hypothesized that low health literacy is a barrier to entry in hearing healthcare, and therefore that health literacy would be positively correlated with the probability of hearing aid use. DESIGN: We performed retrospective analyses of the Health and Retirement Study, a longitudinal survey of American adults of retirement age. Objective health literacy was measured in different but overlapping subsamples using subsets of the Test of Functional Health Literacy in Adults and the Rapid Estimate of Adult Literacy in Medicine (n = 1240, n = 1586, and n = 2412). Subjective health literacy was assessed using a single-question screener in a larger sample (n = 8362). Separate discrete time models including common covariates of hearing aid use were constructed for each subsample. RESULTS: Objective health literacy measures did not correlate significantly with hearing aid use when age, gender, race/ethnicity, self-assessed hearing ability, and net income were included in the models. Subjective health literacy did correlate significantly with hearing aid use in the complete model, with lower subjective health literacy correlated with lower odds of reporting hearing aid use. CONCLUSIONS: Taken at face value, the results provide mixed evidence for a link between health literacy and hearing aid use. The results from the analysis of the largest sample, using the subjective health literacy measure, were consistent with the hypothesis that low health literacy is a barrier to hearing aid use. However, this was not supported by the analysis of the objective health literacy measures in these samples. Further research using full health literacy measurement tools and capturing other relevant variables would offer clarification on this conflict. The literacy level of clinical materials and conversation is a modifiable potential factor in hearing aid uptake, so further clinical and research consideration is warranted.

CEDRA: A Tool to Help Consumers Assess Risk for Ear Disease.

This article introduces the Consumer Ear Disease Risk Assessment (CEDRA) tool. CEDRA is a brief questionnaire designed to screen for targeted ear diseases. It offers an opportunity for consumers to self-screen for disease before seeking a hearing device and may be used by clinicians to help their patients decide the appropriate path to follow in hearing healthcare. Here we provide highlights of previously published validation in the context of a more thorough description of CEDRA's development and implementation. CEDRA's sensitivity and specificity, using a cut-off score of 4 or higher, was 90% and 72%, respectively, relative to neurotologist diagnoses in the initial training sample used to create the scoring algorithm (n = 246). On a smaller independent test sample (n = 61), CEDRA's sensitivity and specificity were 76% and 80%, respectively. CEDRA has readability levels similar to many other patient-oriented questionnaires in hearing healthcare, and informal reports from pilot CEDRA-providers indicate that the majority of patients can complete it in less than 10 min. As the hearing healthcare landscape changes and provider intercession is no longer mandated, CEDRA provides a measure of safety without creating a barrier to access.

A Retrospective Estimate of Ear Disease Detection Using the "Red Flags" in a Clinical Sample.

OBJECTIVES: The purpose of this study was to evaluate the specificity and sensitivity of two red flag protocols in detecting ear diseases associated with changes in hearing. DESIGN: The presence of red-flag symptoms was determined in a chart review of 307 adult patients from the Mayo Clinic Florida Departments of Otorhinolaryngology and Audiology. Participants formed a convenience sample recruited for a separate study. Neurotologist diagnosis was the criterion for comparisons. RESULTS: Of the 251 patient files retained for analysis, 191 had one or more targeted diseases and 60 had age- or noise-related hearing loss. Food and Drug Administration red flags sensitivity was 91% (confidence interval [CI], 86 to 95%) and specificity was 72% (CI, 59 to 83%). American Academy of Otolaryngology-Head and Neck Surgery red flags sensitivity was 98% (CI, 95 to 99%) and specificity was 20% (CI, 11 to 32%). CONCLUSIONS: Stakeholders must determine which diseases are meaningful contraindications for hearing aid use and whether these red-flag protocols have acceptable levels of sensitivity and specificity. As direct-to-consumer models of hearing devices increase, a disease detection method that does not require provider intercession would be useful.

Differential short-term memorisation for vocal and instrumental rhythms.

This study explores differential processing of vocal and instrumental rhythms in short-term memory with three decision (same/different judgments) and one reproduction experiment. In the first experiment, memory performance declined for delayed versus immediate recall, with accuracy for the two rhythms being affected differently: Musicians performed better than non-musicians on clapstick but not on vocal rhythms, and musicians were better on vocal rhythms in the same than in the different condition. Results for the second experiment showed that concurrent sub-vocal articulation and finger-tapping differentially affected the two rhythms and same/different decisions, but produced no evidence for articulatory loop involvement in delayed decision tasks. In a third experiment, which tested rhythm reproduction, concurrent sub-vocal articulation decreased memory performance, with a stronger deleterious effect on the reproduction of vocal than of clapstick rhythms. This suggests that the articulatory loop may only be involved in delayed reproduction not in decision tasks. The fourth experiment tested whether differences between filled and empty rhythms (continuous vs. discontinuous sounds) can explain the different memorisation of vocal and clapstick rhythms. Though significant differences were found for empty and filled instrumental rhythms, the differences between vocal and clapstick can only be explained by considering additional voice specific features.