High and Wide: An In Silico Investigation of Frequency, Intensity, and Vibrato Effects on Widely Applied Acoustic Voice Perturbation and Noise Measures.

OBJECTIVES: This in silico study explored the effects of a wide range of fundamental frequency (fo), source-spectrum tilt (SST), and vibrato extent (VE) on commonly used frequency and amplitude perturbation and noise measures. METHOD: Using 53 synthesized tones produced in Madde, the effects of stepwise increases in fo, intensity (modeled by decreasing SST), and VE on the PRAAT parameters jitter % (local), relative average perturbation (RAP) %, shimmer % (local), amplitude perturbation quotient 3 (APQ3) %, and harmonics-to-noise ratio (HNR) dB were investigated. A secondary experiment was conducted to determine whether any fo effects on jitter, RAP, shimmer, APQ3, and HNR were stable. A total of 10 sinewaves were synthesized in Sopran from 100 to 1000 Hz using formant frequencies for /a/, /i/, and /u/-like vowels, respectively. All effects were statistically assessed with Kendall's tau-b and partial correlation. RESULTS: Increasing fo resulted in an overall increase in jitter, RAP, shimmer, and APQ3 values, respectively (P < 0.01). Oscillations of the data across the explored fo range were observed in all measurement outputs. In the Sopran tests, the oscillatory pattern seen in the Madde fo condition remained and showed differences between vowel conditions. Increasing intensity (decreasing SST) led to reduced pitch and amplitude perturbation and HNR (P < 0.05). Increasing VE led to lower HNR and an almost linear increase of all other measures (P < 0.05). CONCLUSION: These novel data offer a controlled demonstration for the behavior of jitter (local) %, RAP %, shimmer (local) %, APQ3 %, and HNR (dB) when varying fo, SST, and VE in synthesized tones. Since humans will vary in all of these aspects in spoken language and vowel phonation, researchers should take potential resonance-harmonics type effects into account when comparing intersubject or preintervention and postintervention data using these measures.

It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers.

To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers' perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/PSub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants' composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users.

Aided Cortical Auditory Evoked Potentials in Infants With Frequency-Specific Synthetic Speech Stimuli: Sensitivity, Repeatability, and Feasibility.

OBJECTIVES: The cortical auditory evoked potential (CAEP) test is a candidate for supplementing clinical practice for infant hearing aid users and others who are not developmentally ready for behavioral testing. Sensitivity of the test for given sensation levels (SLs) has been reported to some degree, but further data are needed from large numbers of infants within the target age range, including repeat data where CAEPs were not detected initially. This study aims to assess sensitivity, repeatability, acceptability, and feasibility of CAEPs as a clinical measure of aided audibility in infants. DESIGN: One hundred and three infant hearing aid users were recruited from 53 pediatric audiology centers across the UK. Infants underwent aided CAEP testing at age 3 to 7 months to a mid-frequency (MF) and (mid-)high-frequency (HF) synthetic speech stimulus. CAEP testing was repeated within 7 days. When developmentally ready (aged 7-21 months), the infants underwent aided behavioral hearing testing using the same stimuli, to estimate the decibel (dB) SL (i.e., level above threshold) of those stimuli when presented at the CAEP test sessions. Percentage of CAEP detections for different dB SLs are reported using an objective detection method (Hotellings T 2 ). Acceptability was assessed using caregiver interviews and a questionnaire, and feasibility by recording test duration and completion rate. RESULTS: The overall sensitivity for a single CAEP test when the stimuli were ≥0 dB SL (i.e., audible) was 70% for the MF stimulus and 54% for the HF stimulus. After repeat testing, this increased to 84% and 72%, respectively. For SL >10 dB, the respective MF and HF test sensitivities were 80% and 60% for a single test, increasing to 94% and 79% for the two tests combined. Clinical feasibility was demonstrated by an excellent >99% completion rate, and acceptable median test duration of 24 minutes, including preparation time. Caregivers reported overall positive experiences of the test. CONCLUSIONS: By addressing the clinical need to provide data in the target age group at different SLs, we have demonstrated that aided CAEP testing can supplement existing clinical practice when infants with hearing loss are not developmentally ready for traditional behavioral assessment. Repeat testing is valuable to increase test sensitivity. For clinical application, it is important to be aware of CAEP response variability in this age group.

Functional topography of the neocortex predicts covariation in complex cognitive and basic motor abilities.

Although higher-order cognitive and lower-order sensorimotor abilities are generally regarded as distinct and studied separately, there is evidence that they not only covary but also that this covariation increases across the lifespan. This pattern has been leveraged in clinical settings where a simple assessment of sensory or motor ability (e.g. hearing, gait speed) can forecast age-related cognitive decline and risk for dementia. However, the brain mechanisms underlying cognitive, sensory, and motor covariation are largely unknown. Here, we examined whether such covariation in midlife reflects variability in common versus distinct neocortical networks using individualized maps of functional topography derived from BOLD fMRI data collected in 769 45-year-old members of a population-representative cohort. Analyses revealed that variability in basic motor but not hearing ability reflected individual differences in the functional topography of neocortical networks typically supporting cognitive ability. These patterns suggest that covariation in motor and cognitive abilities in midlife reflects convergence of function in higher-order neocortical networks and that gait speed may not be simply a measure of physical function but rather an integrative index of nervous system health.

Altered structural connectome of children with auditory processing disorder: a diffusion MRI study.

Auditory processing disorder (APD) is a listening impairment that some school-aged children may experience despite having normal peripheral hearing. Recent resting-state functional magnetic resonance imaging (MRI) has revealed an alteration in regional functional brain topology in children with APD. However, little is known about the structural organization in APD. We used diffusion MRI data to investigate the structural connectome of 58 children from 8 to 14 years old diagnosed with APD (n = 29) and children without hearing complaints (healthy controls, HC; n = 29). We investigated the rich-club organization and structural connection differences between groups. The APD group showed similar rich-club organization and edge-wise connection compared with the HC group. However, at the regional level, we observed increased average path length (APL) and betweenness centrality in the right inferior parietal lobule and inferior precentral gyrus, respectively, in the APD group. Only HCs demonstrated a positive association between APL and the listening-in-spatialized-noise-sentences task in the left orbital gyrus. In line with previous findings, the current results provide evidence for altered structural networks at the regional level in the APD group, suggesting the involvement of multimodal deficits and a role for structure-function alteration in the listening difficulties of children with APD.

The mismatch response in normal hearing adults: a performance comparison with stimuli relevant for objective validation of hearing aid fittings.

OBJECTIVE: A long-standing observation is that the Mismatch Response (MMR) has the potential to offer a clinically feasible index of sound discrimination. However, findings that positively identify MMRs at the individual level have been mixed, even for those who are normally hearing and who can discriminate sounds behaviourally. This complicates interpretation when an MMR is not observed. The objective of this study was to determine the reliability of the MMR using an optimised paradigm and a range of stimuli relevant to audiological applications in relation to objective verification of hearing aid fittings. DESIGN: MMRs were measured using an optimised 3-deviant paradigm in response to a range of sounds designed for aided and unaided sound field assessments, including complex tones (CTs) and speech-like signals. STUDY SAMPLE: Seventeen normally hearing adults (18-56 years). RESULTS: The most robust MMRs were recorded in response to CTs; responses were positively identified in 50 out of 51 instances (98%), assessed via objective Hotelling's T2 bias-free statistical analyses. CONCLUSIONS: The results indicate that CTs in conjunction with optimised recording and analysis parameters offer the potential to elicit robust MMRs, supporting future utilisation of MMRs for clinical audiological applications.

Functional Topography of the Neocortex Predicts Covariation in Complex Cognitive and Basic Motor Abilities.

Although higher-order cognitive and lower-order sensorimotor abilities are generally regarded as distinct and studied separately, there is evidence that they not only covary but also that this covariation increases across the lifespan. This pattern has been leveraged in clinical settings where a simple assessment of sensory or motor ability (e.g., hearing, gait speed) can forecast age-related cognitive decline and risk for dementia. However, the brain mechanisms underlying cognitive, sensory, and motor covariation are largely unknown. Here, we examined whether such covariation in midlife reflects variability in common versus distinct neocortical networks using individualized maps of functional topography derived from BOLD fMRI data collected in 769 45-year old members of a population-representative cohort. Analyses revealed that variability in basic motor but not hearing ability reflected individual differences in the functional topography of neocortical networks typically supporting cognitive ability. These patterns suggest that covariation in motor and cognitive abilities in midlife reflects convergence of function in higher-order neocortical networks and that gait speed may not be simply a measure of physical function but rather an integrative index of nervous system health.

Resources and Attitudes Influence Acculturation of Deaf Children with Cochlear Implants.

Early detection of hearing loss leads to early intervention-related decisions. Most children with cochlear implants (CIs) are born to hearing parents. Prior evidence suggests that this increased access to oral communication and the "hearing" world means oral communication is prioritized by hearing parents. Language plays a key role within culture and these communication decisions are likely to be associated with children's level of d/Deaf acculturation. This study was based on qualitative interviews. Thirty-two people associated with 14 children were interviewed; these were parents of children with CIs, four children over age 11 years, and teachers of 13 of the children. The study aimed to investigate parental communication decisions on child/family d/Deaf acculturation and the role of access to resources on children's d/Deaf acculturation development. Findings indicate two profiles of family acculturation-oral and bicultural and point to a possible relationship between access to resources and parents' decision-making process.

Female adolescent singing voice characteristics: an exploratory study using LTAS and inverse filtering.

Background and Aim: To date, little research is available that objectively quantifies female adolescent singing-voice characteristics in light of the physiological and functional developments that occur from puberty to adulthood. This exploratory study sought to augment the pool of data available that offers objective voice analysis of female singers in late adolescence.Methods: Using long-term average spectra (LTAS) and inverse filtering techniques, dynamic range and voice-source characteristics were determined in a cohort of vocally healthy cis-gender female adolescent singers (17 to 19 years) from high-school choirs in Aotearoa New Zealand. Non-parametric statistics were used to determine associations and significant differences.Results: Wide intersubject variation was seen between dynamic range, spectral measures of harmonic organisation (formant cluster prominence, FCP), noise components in the spectrum (high-frequency energy ratio, HFER), and the normalised amplitude quotient (NAQ) suggesting great variability in ability to control phonatory mechanisms such as subglottal pressure (Psub), glottal configuration and adduction, and vocal tract shaping. A strong association between the HFER and NAQ suggest that these non-invasive measures may offer complimentary insights into vocal function, specifically with regard to glottal adduction and turbulent noise in the voice signal.Conclusion: Knowledge of the range of variation within healthy adolescent singers is necessary for the development of effective and inclusive pedagogical practices, and for vocal-health professionals working with singers of this age. LTAS and inverse filtering are useful non-invasive tools for determining such characteristics.

Life-Course Persistent Antisocial Behavior and Accelerated Biological Aging in a Longitudinal Birth Cohort.

Prior research shows that individuals who have exhibited antisocial behavior are in poorer health than their same-aged peers. A major driver of poor health is aging itself, yet research has not investigated relationships between offending trajectories and biological aging. We tested the hypothesis that individuals following a life-course persistent (LCP) antisocial trajectory show accelerated aging in midlife. Trajectories of antisocial behavior from age 7 to 26 years were studied in the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort (N = 1037). Signs of aging were assessed at age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports. First, we tested whether the association between antisocial behavior trajectories and midlife signs of faster aging represented a decline from initial childhood health. We then tested whether decline was attributable to tobacco smoking, antipsychotic medication use, debilitating illnesses in adulthood, adverse exposures in childhood (maltreatment, socioeconomic disadvantage) and adulthood (incarceration), and to childhood self-control difficulties. Study members with a history of antisocial behavior had a significantly faster pace of biological aging by midlife, and this was most evident among individuals following the LCP trajectory (ß, 0.22, 95%CI, 0.14, 0.28, p ≤ 0.001). This amounted to 4.3 extra years of biological aging between ages 25-45 years for Study members following the LCP trajectory compared to low-antisocial trajectory individuals. LCP offenders also experienced more midlife difficulties with hearing (ß, -0.14, 95%CI, -0.21, -0.08, p ≤ 0.001), balance (ß, -0.13, 95%CI, -0.18, -0.06, p ≤ 0.001), gait speed (ß, -0.18, 95%CI, -0.24, -0.10, p ≤ 0.001), and cognitive functioning (ß, -0.25, 95%CI, -0.31, -0.18, p ≤ 0.001). Associations represented a decline from childhood health. Associations persisted after controlling individually for tobacco smoking, antipsychotic medication use, midlife illnesses, maltreatment, socioeconomic status, incarceration, and childhood self-control difficulties. However, the cumulative effect of these lifestyle characteristics together explained why LCP offenders have a faster Pace of Aging than their peers. While older adults typically age-out of crime, LCP offenders will likely age-into the healthcare system earlier than their chronologically same-aged peers. Preventing young people from offending is likely to have substantial benefits for health, and people engaging in a LCP trajectory of antisocial behaviors might be the most in need of health promotion programs. We offer prevention and intervention strategies to reduce the financial burden of offenders on healthcare systems and improve their wellbeing.

Improving risk indexes for Alzheimer's disease and related dementias for use in midlife.

Knowledge of a person's risk for Alzheimer's disease and related dementias (ADRDs) is required to triage candidates for preventive interventions, surveillance, and treatment trials. ADRD risk indexes exist for this purpose, but each includes only a subset of known risk factors. Information missing from published indexes could improve risk prediction. In the Dunedin Study of a population-representative New Zealand-based birth cohort followed to midlife (N = 938, 49.5% female), we compared associations of four leading risk indexes with midlife antecedents of ADRD against a novel benchmark index comprised of nearly all known ADRD risk factors, the Dunedin ADRD Risk Benchmark (DunedinARB). Existing indexes included the Cardiovascular Risk Factors, Aging, and Dementia index (CAIDE), LIfestyle for BRAin health index (LIBRA), Australian National University Alzheimer's Disease Risk Index (ANU-ADRI), and risks selected by the Lancet Commission on Dementia. The Dunedin benchmark was comprised of 48 separate indicators of risk organized into 10 conceptually distinct risk domains. Midlife antecedents of ADRD treated as outcome measures included age-45 measures of brain structural integrity [magnetic resonance imaging-assessed: (i) machine-learning-algorithm-estimated brain age, (ii) log-transformed volume of white matter hyperintensities, and (iii) mean grey matter volume of the hippocampus] and measures of brain functional integrity [(i) objective cognitive function assessed via the Wechsler Adult Intelligence Scale-IV, (ii) subjective problems in everyday cognitive function, and (iii) objective cognitive decline measured as residualized change in cognitive scores from childhood to midlife on matched Weschler Intelligence scales]. All indexes were quantitatively distributed and proved informative about midlife antecedents of ADRD, including algorithm-estimated brain age (ß's from 0.16 to 0.22), white matter hyperintensities volume (ß's from 0.16 to 0.19), hippocampal volume (ß's from -0.08 to -0.11), tested cognitive deficits (ß's from -0.36 to -0.49), everyday cognitive problems (ß's from 0.14 to 0.38), and longitudinal cognitive decline (ß's from -0.18 to -0.26). Existing indexes compared favourably to the comprehensive benchmark in their association with the brain structural integrity measures but were outperformed in their association with the functional integrity measures, particularly subjective cognitive problems and tested cognitive decline. Results indicated that existing indexes could be improved with targeted additions, particularly of measures assessing socioeconomic status, physical and sensory function, epigenetic aging, and subjective overall health. Existing premorbid ADRD risk indexes perform well in identifying linear gradients of risk among members of the general population at midlife, even when they include only a small subset of potential risk factors. They could be improved, however, with targeted additions to more holistically capture the different facets of risk for this multiply determined, age-related disease.

Effects of aging on neural processing during an active listening task.

Factors affecting successful listening in older adults and the corresponding electrophysiological signatures are not well understood. The present study investigated age-related differences in attention and temporal processing, as well as differences in the neural activity related to signal degradation during a number comparison task. Participants listened to digits presented in background babble and were tested at two levels of signal clarity, clear and degraded. Behavioral and electrophysiological measures were examined in 30 older and 20 younger neurologically-healthy adults. Relationships between performance on the number comparison task, behavioral measures, and neural activity were used to determine correlates of listening deficits associated with aging. While older participants showed poorer performance overall on all behavioral measures, their scores on the number comparison task were largely predicted (based on regression analyses) by their sensitivity to temporal fine structure cues. Compared to younger participants, older participants required higher signal-to-noise ratios (SNRs) to achieve equivalent performance on the number comparison task. With increasing listening demands, age-related changes were observed in neural processing represented by the early-N1 and later-P3 time windows. Source localization analyses revealed age differences in source activity for the degraded listening condition that was located in the left prefrontal cortex. In addition, this source activity negatively correlated with task performance in the older group. Together, these results suggest that older adults exhibit reallocation of processing resources to complete a demanding listening task. However, this effect was evident only for poorer performing older adults who showed greater posterior to anterior shift in P3 response amplitudes than older adults who were good performers and younger adults. These findings might reflect less efficient recruitment of neural resources that is associated with aging during effortful listening performance.

Altered brain network topology in children with auditory processing disorder: A resting-state multi-echo fMRI study.

Children with auditory processing disorder (APD) experience hearing difficulties, particularly in the presence of competing sounds, despite having normal audiograms. There is considerable debate on whether APD symptoms originate from bottom-up (e.g., auditory sensory processing) and/or top-down processing (e.g., cognitive, language, memory). A related issue is that little is known about whether functional brain network topology is altered in APD. Therefore, we used resting-state functional magnetic resonance imaging data to investigate the functional brain network organization of 57 children from 8 to 14 years old, diagnosed with APD (n = 28) and without hearing difficulties (healthy control, HC; n = 29). We applied complex network analysis using graph theory to assess the whole-brain integration and segregation of functional networks and brain hub architecture. Our results showed children with APD and HC have similar global network properties -i.e., an average of all brain regions- and modular organization. Still, the APD group showed different hub architecture in default mode-ventral attention, somatomotor and frontoparietal-dorsal attention modules. At the nodal level -i.e., single-brain regions-, we observed decreased participation coefficient (PC - a measure quantifying the diversity of between-network connectivity) in auditory cortical regions in APD, including bilateral superior temporal gyrus and left middle temporal gyrus. Beyond auditory regions, PC was also decreased in APD in bilateral posterior temporo-occipital cortices, left intraparietal sulcus, and right posterior insular cortex. Correlation analysis suggested a positive association between PC in the left parahippocampal gyrus and the listening-in-spatialized-noise -sentences task where APD children were engaged in auditory perception. In conclusion, our findings provide evidence of altered brain network organization in children with APD, specific to auditory networks, and shed new light on the neural systems underlying children's listening difficulties.

Persisting variance in middle ear ventilation tube insertion in Auckland children: why ethnic disparity continues.

AIM: Insertion of ventilation tubes (VTs) is a common surgical treatment for recurrent and persistent otitis media, but surgical practice varies internationally. The current study explored variations in practice within New Zealand by examining VT insertion rates. The aim of the study was to determine time trends and current variations in VT insertion rates by ethnicity and district health board (DHB), with a focus on comparison of two DHBs in Auckland (Counties Manukau and Auckland DHB) to national average data. METHOD: Data for surgical procedures were analysed in the Atlas of Healthcare Variation domain, available via the Health Quality & Safety Commission website. Publicly funded events for New Zealand residents over a 10-year period (2009-2018) were examined for 0-4-year-olds. Individuals were assigned to their DHB of residence. VT rates for each DHB are presented per 1,000 population, with upper and lower confidence intervals calculated to the 95% level. RESULTS: There was a general decline in the rates of VT insertions for the 0-4-year-olds over the 2009-2018 decade. Analysis of the 2018 year showed variation by ethnicity and DHB. In CMDHB, ADHB and nationally, Asian and Pacific ethnic groups had the lowest rates of VT insertions compared to other ethnic groups. In CMDHB, the VT rates for Maori, Pacific and Asian children were less than half that of their respective groups in ADHB. The NZ European/Other ethnic group had the highest rates of VT insertions in CMDHB and nationally, but in ADHB, the rate for the NZ European/Other group was similar to that for Maori. CONCLUSION: These results are incongruent with evidence that Maori and Pacific children in New Zealand experience a greater burden of middle ear disease than NZ European children. The finding of persisting inequities in VT treatment for middle ear disease in 0-4-year-olds, with greatest impact on Pacific children, suggests that there may be a need for targeted middle ear screening for preschool children to detect pre-schoolers with ear disease, earlier than the 4-year-old B4 School Check.

CPPS and Voice-Source Parameters: Objective Analysis of the Singing Voice.

INTRODUCTION: In recent years cepstral analysis and specific cepstrum-based measures such as smoothed cepstral peak prominence (CPPS) has become increasingly researched and utilized in attempts to determine the extent of overall dysphonia in voice signals. Yet, few studies have extensively examined how specific voice-source parameters affect CPPS values. OBJECTIVE: Using a range of synthesized tones, this exploratory study sought to systematically analyze the effect of fundamental frequency (fo), vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental on CPPS values. MATERIALS AND METHODS: A series of scales were synthesised using the freeware Madde. Fundamental frequency, vibrato extent, source-spectrum tilt, and the amplitude of the voice-source fundamental were systematically and independently varied. The tones were analysed in PRAAT, and statistical analyses were conducted in SPSS. RESULTS: CPPS was significantly affected by both fo and source-spectrum tilt, independently. A nonlinear association was seen between vibrato extent and CPPS, where CPPS values increased from 0 to 0.6 semitones (ST), then rapidly decreased approaching 1.0 ST. No relationship was seen between the amplitude of the voice-source fundamental and CPPS. CONCLUSION: The large effect of fo should be taken into account when analyzing the voice, particularly in singing-voice research, when comparing pre and posttreatment data, and when comparing inter-subject CPPS data.

The Spanish 12-item version of the Speech, Spatial and Qualities of Hearing scale (Sp-SSQ12): adaptation, reliability, and discriminant validity for people with and without hearing loss.

PURPOSE: Because of the limited number of Spanish validated questionnaires available to assess auditory functionality in daily life situations in adults, the purpose of this study was to investigate the validity and the reliability of the Spanish version of the Speech, Spatial and Qualities of Hearing 12 items scale (sp-SSQ12), adapted from the published Spanish SSQ49, and to provide reference data for normal and hearing-impaired populations. METHODS: The SSQ12 is a self-report questionnaire, consisting of 12 items assessing a range of daily life listening situations. One hundred fifty adults (101 female) with a mean age of 53.9 years (SD 20.3; range 20-88 years) took part in the study. Internal consistency, test-retest reliability, validity, and floor and ceiling effects were investigated. RESULTS: The sp-SSQ12 questionnaire had high internal consistency (Cronbach's alpha = 0.95) and test-retest scores were highly correlated (ICC = 0.79). There was minimal evidence of floor and ceiling effects in our sample. Significant differences were observed overall and for the three subscales between normal and hearing-impaired groups. Although some significant differences in SSQ12 scores between groups of participants from different countries, these differences were minimal. CONCLUSIONS: The sp-SSQ12 questionnaire is a valid and reliable tool that is easy to administer and requires a short time to answer. We recommend the use of this tool for the assessment of functional hearing in the Spanish-speaking population.Implication for rehabilitationHearing loss impacts people's lives in a number of ways that are captured in the SSQ.The sp-SSQ12 is a valid and reliable tool for assessing everyday listening abilities and limitations experienced by Spanish-speaking adults with hearing loss.The sp-SSQ12 can be incorporated in the hearing rehabilitation process as a tool for evaluating and improving hearing assessment and rehabilitation programs.The sp-SSQ12 can help to identify adults who require a comprehensive hearing assessment.

Visual impairment and its correction among Pacific youth in Aotearoa: findings from the Pacific Islands Families Study.

AIM: Childhood visual impairment has a life-long impact that, with early access to eyecare, is largely avoidable. We aimed to understand visual impairment and its correction among Pacific youth in Aotearoa New Zealand. METHOD: The Pacific Islands Families Study is a birth cohort study that tracks an original sample of 1,398 Pacific children born at Middlemore Hospital (Auckland). This analysis focuses on assessed visual acuity (at 9- and 18-years, using 0.3logMAR or 6/12 as the cut-off for visual impairment) and participants' self-reports about accessing eyecare services. RESULTS: Less than a fifth of children (111/729, 15.2%) and teens (86/457, 18.8%) reported having sought eyecare. The percentage of participants with refractive correction was 3.6% (32/887) at 9-years and 14.3% (66/463) at 18-years. At 9-years, 1.9% of children (16/853) had visual impairment in one eye only, and 0.9% (8/853) had visual impairment impacting both eyes. By 18-years these values increased to 7.9% (36/456) and 4.2% (19/456), respectively. Among those with visual impairment, most children (15/24, 62.5%) and teens (32/55, 58.2%) reported they did not have refractive correction. CONCLUSION: Although prevalence of visual impairment is relatively low compared to non-Pacific youth, much of the reported impairment appears to be avoidable with improved eyecare.

The electrophysiology of aphasia: A scoping review.

OBJECTIVE: To systematically assess the body of literature using N400 and P600 as they relate to people with aphasia. The primary aim was to reveal patterns in the literature which could be used to direct future research in the development of clinically relevant Event-Related Potentials (ERPs) for language assessment, while also identifying gaps in existing knowledge and highlight areas of further inquiry. METHODS: A literature search was performed on studies published before May 2021. Relevant studies on aphasia and the two ERPs of interest were assessed for quality, and the relationship between aphasia and these ERPs was explored. RESULTS: A total of 721 articles were identified, with 30 meeting inclusion criteria. Although there is significant variation in the literature, this scoping review revealed people with aphasia show reduced amplitude, delayed latency and different distribution compared to controls, and that ERPs are modulated by severity of aphasia. CONCLUSIONS: To develop a relevant clinical tool for the management of aphasia, future research must strive to improve consistency within ERP methodology, with a greater number of diverse aphasia subtypes included in research. SIGNIFICANCE: This scoping review reveals N400 and P600 represent promising potential biomarkers for the diagnosis and ongoing management of aphasia.

Voice Behavior in Healthcare: A Scoping Review of the Study of Voice Behavior in Healthcare Workers.

BACKGROUND: Patient safety and quality care require learning organizations. For organizations to pivot and progress they need a workforce skilled and confident in voicing ideas and errors. Expressing issues related to patient safety and quality improvement can be defined as voice behavior. METHODS: This scoping review aimed to answer two questions: 1) What is the scope of the study of voice behavior in healthcare? 2) How do new graduates in allied health use their voice? The Joanna Briggs guidelines were used to identify 76 articles that were explored using a descriptive and evaluative approach to map the depth and breadth of this topic and identify research gaps. FINDINGS: The review revealed that nursing and medicine feature in voice behavior studies, but few studies focus on allied health. An exploration of the concepts emerging from these studies revealed eight topics: power, risk, tenure, leadership, intervention, self, climate, and strategies. CONCLUSION: Synthesis of the reviewed studies highlights that we know little about allied health new graduates' voice behavior in healthcare. Exploration of voice behaviors with this group will inform education and workplace settings about ways to grow professionals who are confident and competent in speaking up for patient safety and quality improvement.