Hospital Rating Organizations' Quality and Patient Safety Scores: Analysis of Result Discrepancies.

BACKGROUND: In the USA, multiple organizations rate hospitals based on quality and patient safety data, but few studies have analyzed and compared the rating results. OBJECTIVE: Compare the results of different US hospital-rating organizations. DESIGN: Observational data analysis of US acute care hospital ratings. PARTICIPANTS: Four rating organizations: Hospital Compare® (HC), Healthgrades® (HG), The Leapfrog Group® (Leapfrog), and US News and World Report® (USN). MAIN MEASURES: We analyzed the level of concordance (similar ranking), discordance (difference of 1 or more rankings), and severe discordance (difference of two or more rankings), as well as differences and correlations between the scores. KEY RESULTS: From Feb 1 to Oct 3, 2023, we analyzed data from 2,384 hospitals. In Leapfrog, there were 688 hospitals (29%) with Grade A, 652 (27.3%) with B, 885 (37.1%) with C, 153 (6.4%) with D, and 6 (0.3%) with F. For HC, 333 hospitals (14%) had five stars, 676 (28.4%) four, 695 (29.2%) three, 502 (21.4%) two, and 171 (7.2%) one-star. In ratings between HC and Leapfrog, discordance was 70%, and severe discordance was 25.1%. USN ranked 469 hospitals (19.7%). Within the USN-ranked hospital group, there was a 62% discordance and 19.8% severe discordance between HC and Leapfrog. The analysis of orthopedic procedures from HG and USN showed discordance ranging from 48 to 61.2%. CONCLUSION: The rating organizations' reported metrics were highly discordant. A hospital's ranking by one organization frequently did not correspond to a similar ranking by another. The methodology and included timeline and patient population can help explain the differences. However, the discordant ratings may confuse patients and customers.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

BACKGROUND: Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. OBJECTIVE: We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. PARTICIPANTS: Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. DESIGN: A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. MEASURES: Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. RESULTS: Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. CONCLUSIONS: Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Purpose in life and cognitive performance and informant ratings of cognitive decline, affect, and activities.

OBJECTIVE: To examine (1) the association between purpose in life and multiple domains of cognitive function and informant-rated cognitive decline, affect, and activities; (2) whether these associations are moderated by sociodemographic factors, cognitive impairment, or depression; (3) whether the associations are independent of other aspects of well-being and depressive symptoms. METHOD: As part of the 2016 Harmonized Cognitive Assessment Protocol from the Health and Retirement Study, participants completed a battery of cognitive tests and nominated a knowledgeable informant to rate their cognitive decline, affect, and activities. Participants with information available on their purpose in life from the 2014/2016 Leave Behind Questionnaire were included in the analytic sample (N = 2,812). RESULTS: Purpose in life was associated with better performance in every cognitive domain examined (episodic memory, speed-attention, visuospatial skills, language, numeric reasoning; median ß =.10, p <.001; median d =.53). Purpose was likewise associated with informant-rated cognitive decline and informant-rated affective and activity profiles beneficial for cognitive health (median ß =.18, p < .001; median d =.55). There was little evidence of moderation by sociodemographic or other factors (e.g., depression). Life satisfaction, optimism, positive affect, and mastery were generally associated with cognition. When tested simultaneously with each other and depressive symptoms, most dimensions were reduced to non-significance; purpose remained a significant predictor. CONCLUSIONS: Purpose in life is associated with better performance across numerous domains of cognition and with emotional and behavioral patterns beneficial for cognitive health that are observable by knowledgeable others. These associations largely generalize across demographic and clinical groups and are independent of other aspects of well-being.

Validity of chronometric TMS for probing the time-course of word production: a modified replication.

In the present study, we used chronometric TMS to probe the time-course of 3 brain regions during a picture naming task. The left inferior frontal gyrus, left posterior middle temporal gyrus, and left posterior superior temporal gyrus were all separately stimulated in 1 of 5 time-windows (225, 300, 375, 450, and 525 ms) from picture onset. We found posterior temporal areas to be causally involved in picture naming in earlier time-windows, whereas all 3 regions appear to be involved in the later time-windows. However, chronometric TMS produces nonspecific effects that may impact behavior, and furthermore, the time-course of any given process is a product of both the involved processing stages along with individual variation in the duration of each stage. We therefore extend previous work in the field by accounting for both individual variations in naming latencies and directly testing for nonspecific effects of TMS. Our findings reveal that both factors influence behavioral outcomes at the group level, underlining the importance of accounting for individual variations in naming latencies, especially for late processing stages closer to articulation, and recognizing the presence of nonspecific effects of TMS. The paper advances key considerations and avenues for future work using chronometric TMS to study overt production.

Effect of present state bias on minimal important change estimates: a simulation study.

PURPOSE: The minimal important change (MIC) in a patient-reported outcome measure is often estimated using patient-reported transition ratings as anchor. However, transition ratings are often more heavily weighted by the follow-up state than by the baseline state, a phenomenon known as "present state bias" (PSB). It is unknown if and how PSB affects the estimation of MICs using various methods. METHODS: We simulated 3240 samples in which the true MIC was simulated as the mean of individual MICs, and PSB was created by basing transition ratings on a "weighted change", differentially weighting baseline and follow-up states. In each sample we estimated MICs based on the following methods: mean change (MC), receiver operating characteristic (ROC) analysis, predictive modeling (PM), adjusted predictive modeling (APM), longitudinal item response theory (LIRT), and longitudinal confirmatory factor analysis (LCFA). The latter two MICs were estimated with and without constraints on the transition item slope parameters (LIRT) or factor loadings (LCFA). RESULTS: PSB did not affect MIC estimates based on MC, ROC, and PM but these methods were biased by other factors. PSB caused imprecision in the MIC estimates based on APM, LIRT and LCFA with constraints, if the degree of PSB was substantial. However, the unconstrained LIRT- and LCFA-based MICs recovered the true MIC without bias and with high precision, independent of the degree of PSB. CONCLUSION: We recommend the unconstrained LIRT- and LCFA-based MIC methods to estimate anchor-based MICs, irrespective of the degree of PSB. The APM-method is a feasible alternative if PSB is limited.

Estimating anchor-based minimal important change using longitudinal confirmatory factor analysis.

PURPOSE: The minimal important change (MIC) is defined as the smallest within-individual change in a patient-reported outcome measure (PROM) that patients on average perceive as important. We describe a method to estimate this value based on longitudinal confirmatory factor analysis (LCFA). The method is evaluated and compared with a recently published method based on longitudinal item response theory (LIRT) in simulated and real data. We also examined the effect of sample size on bias and precision of the estimate. METHODS: We simulated 108 samples with various characteristics in which the true MIC was simulated as the mean of individual MICs, and estimated MICs based on LCFA and LIRT. Additionally, both MICs were estimated in existing PROMIS Pain Behavior data from 909 patients. In another set of 3888 simulated samples with sample sizes of 125, 250, 500, and 1000, we estimated LCFA-based MICs. RESULTS: The MIC was equally well recovered with the LCFA-method as using the LIRT-method, but the LCFA analyses were more than 50 times faster. In the Pain Behavior data (with higher scores indicating more pain behavior), an LCFA-based MIC for improvement was estimated to be 2.85 points (on a simple sum scale ranging 14-42), whereas the LIRT-based MIC was estimated to be 2.60. The sample size simulations showed that smaller sample sizes decreased the precision of the LCFA-based MIC and increased the risk of model non-convergence. CONCLUSION: The MIC can accurately be estimated using LCFA, but sample sizes need to be preferably greater than 125.

Trends (2014-2018) in the healthiness of packaged food purchases of Australian consumers before and after the introduction of voluntary Health Star Rating nutrition labels.

OBJECTIVE: To evaluate the trends in the healthiness of packaged food purchases of Australian consumers before and after the introduction of the Health Star Rating (HSR) nutrition labels. DESIGN: Panel data analysis and difference-in-differences analysis. SETTING: The Australian Government endorsed HSR nutrition labels for voluntary implementation on packaged foods in June 2014. We analyse the packaged food purchases of households across all major supermarkets before (January 2014 to June 2014) and after (June 2014-Dec 2018) the introduction of HSR. PARTICIPANTS: 6284 members of a panel of households across Australia reporting their grocery purchases to a market research company (Nielsen Homescan panel). RESULTS: The healthiness of household food purchases exhibited a U-shaped trend - decreasing from 2014 to 2017, and then increasing from 2018, corresponding to the time when a higher proportion of products were HSR-labelled. Households that purchased a higher proportion of HSR-labelled products had healthier household purchases overall. Further, the healthiness of households' category-specific food purchases was positively associated with the proportion of HSR-labelled products in categories where HSR was adopted, relative to control categories where HSR was not adopted. CONCLUSIONS: In Australia, once a substantial number of packaged food products adopted the voluntary HSR summary indicator, we observed an increasing trend in the healthiness of household food purchases. Widespread adoption of a nutrition summary indicator, such as HSR, on packaged food is likely to be beneficial for population health.

Benefits of multinomial processing tree models with discrete and continuous variables in memory research: an alternative modeling proposal to Juola et al. (2019).

Signal detection theory (SDT) and two-high threshold models (2HT) are often used to analyze accuracy data in recognition memory paradigms. However, when reaction times (RTs) and/or confidence levels (CLs) are also measured, they usually are analyzed separately or not at all as dependent variables (DVs). We propose a new approach to include these variables based on multinomial processing tree models for discrete and continuous variables (MPT-DC) with the aim to compare fits of SDT and 2HT models. Using Juola et al.'s (2019, Memory & Cognition, 47[4], 855-876) data we have found that including CLs and RTs reduces the standard errors of parameter estimates and accounts for interactions among accuracy, CLs, and RTs that classical versions of SDT and 2HT models do not. In addition, according to the simulations, there is an increase in the proportion of correct model selections when relevant DV are included. We highlight the methodological and substantive advantages of MPT-DC in the disentanglement of contributing processes in recognition memory.

Validity of an expert-based job exposure matrix of hand-wrist physical exposures and their prospective associations with carpal tunnel syndrome.

BACKGROUND: Epidemiological studies of occupational risk factors for rare disorders require large study populations with adequate exposure estimates. Job exposure matrices (JEMs) linked to national information on standardized job titles may enable such large studies. We aimed to establish and validate a JEM for occupational hand-wrist exposures that could be linked to Danish national register data on job titles and hand-wrist disorders. METHODS: We developed a JEM for hand-wrist repetition, force, vibration, and computer work in 96 job groups covering 91% of the 2227 occupational titles in the Danish version of the International Standard Classification of Occupation-88, and examined inter-rater reliability of five expert ratings. Poisson regression models were used to estimate incidence rate ratios for the association of carpal tunnel syndrome (CTS) with the level of repetitive movements, force, vibration, and hours of computer work described by the JEM, adjusted for relevant confounders. RESULTS: The JEM based on expert ratings had fair to good interrater reliability. The incidence of CTS increased with increasing levels of force, hand-wrist repetition, and vibration, Exposure-response patterns for repetition and vibration became less consistent after adjustment for force. The interaction between repetition and force was complex and did not support an overall positive interaction. Computer work was negatively associated with incident CTS. CONCLUSION: The JEM was able to identify known risk factors for CTS consistent with current evidence, and provided further associations on exposure-response patterns, mutual exposure adjustment, and interaction effects between repetition and force. The reliability of expert assessments of hand-wrist physical exposures was fair to good.

The majority of negative online otolaryngology reviews are non-clinical.

OBJECTIVE: To characterize extremely negative online reviews of Otolaryngologists in the United States. METHODS: A search for reviews was performed on Yelp.com using the keyword "Otolaryngologist" in four major urban cities in the United States. On a five-star scale, one-star reviews were isolated, classified as clinical or non-clinical complaints, and further subcategorized. Chi-square analysis was used to determine differences in complaint types between patients reporting surgery and those who did not. RESULTS: From the 7653 reviews that were surveyed, 375 one-star reviews met the inclusion criteria and were used in the analysis. These negative reviews yielded 808 total complaints, 25 % were clinical, and 75 % were non-clinical. The most common clinical complaints were a lack of diagnosis, disagreement with the treatment plan and misdiagnosis, whereas the most common non-clinical complaints included poor physician bedside manner, cost, and unprofessional staff. Fifty-two (14 %) patients reported having surgery. The difference in the number of complaints by patients reporting surgery and patients not reporting surgery was statistically significant (P < .05) for almost all subcategories. CONCLUSION: The most common complaints in negative reviews of Otolaryngologists on Yelp are non-clinical, primarily centered around the professionalism of the physician and staff. This work offers insights into patient satisfaction within Otolaryngology. Considerations should be given to these results as a means for improvement in patient experiences.

Do social media use and patient satisfaction scores correlate with online award recognition among hip and knee arthroplasty specialists?

INTRODUCTION: The physician-patient interaction now begins before patients arrive in the office. Online ratings, social media profiles, and online award status are all components of physician online reputation which contributes to the patient's initial impressions. Therefore, it is important to understand the interplay of these factors and determine if there is a consistent trend indicating the value of this information. METHODS: We Identified all (N â€‹= â€‹160) registered American Association of Hip and Knee Surgeons (AAHKS) in New England using the https://findadoctor.aahks.net/tool for Massachusetts (MA), Connecticut (CT), Rhode Island (RI), Vermont (VT), New Hampshire (NH), and Maine (ME) on 6/26/2023. We collected surgeon age, fellowship graduation year, and practice type (i.e. Academic or Private). The average 5-star rating and number of ratings were collected from four websites. Any professional-use Facebook, Instagram, Twitter, LinkedIn, YouTube Channel, Personal Websites, or Institutional Websites were identified and a modified SMI Score was calculated. Finally, Castle Connolly Top Doctor, Local Magazine (e.g. Boston Magazine) Top Doctor, or the presence of having any award was noted for each surgeon. RESULTS: We identified several significant trends indicating that online awards were associated with higher online ratings. Social media presence, as determined by SMI Score, was also correlated with higher ratings overall and a higher likelihood of having an online award. CONCLUSION: Given the observed trends and reported importance patients place on ratings and awards, surgeons may consider increasing online engagement via social media and encouraging patients to share their experience via online ratings.

Shifting focus from end-of-pipe treatment to source control: ESG ratings' impact on corporate green innovation.

This study actively explores the pivotal role of environment, society, and governance (ESG) ratings in optimizing corporate green innovation activities as a robust response to ongoing ESG investment divestment. It provides empirical support for implementing corporate green transitions, establishing, and refining market-driven green development framework, and attaining "carbon peaking, carbon neutrality" targets. Furthermore, the research represents a groundbreaking effort to assess the influence of ESG ratings on corporate green innovation with a specific focus on pollution disposal. Specifically, examining data from Chinese A-share listed companies spanning 2011 to 2020, this study utilizes various models, including multi-period difference-in-differences (DID), event study, staggered DID, and synthetic DID (SDID). The ensuing analysis reveals that ESG ratings significantly impact the development of corporate green innovation, catalyzing the transformation of green innovation activities from end-of-pipe to source control. Notably, ESG ratings achieve this transformation by mitigating managerial myopia, enhancing the research and development (R&D) staff ratio, and alleviating financial constraints. However, the study also identifies institutional constraints and corporate digitalization as factors leading to heterogeneous effects on green innovation and its direction. These findings not only provide enhanced theoretical support but also offer empirical validation for corporations and governments looking to implement and generalize ESG ratings, facilitating a successful green transition.

A validity study of a work sample test of leadership behavior using supervisor and subordinate ratings as criteria.

Work sample tests gather information about behavior that is consistent with the behavior being predicted. This criterion-related validity study examines whether a work sample test can predict behaviors more than 6 months later among managers (N = 127) in a large municipal organization. Ratings from both the subordinates (SOR) and supervisors (SVR) of the managers were used as criteria for the leadership dimensions of Influencing others, Consideration, and Planning. In total, six hypotheses were tested. The results were corrected for range restriction in the predictors and for unreliability in the criteria. The hypothesis that the work sample test score of Consideration predicted subordinates' ratings of Consideration received full support ( ρ ¯ = 0.33; CI [0.06-0.56]). The Consideration work sample test score also showed a positive relationship with supervisor ratings of Consideration ( ρ ¯ = 0.22; CI [-0.01 to 0.43]), although the confidence interval includes zero. No significant criterion-related validity was found for Influencing others or Planning. Given the results, the work sample test can primarily be used to predict Consideration. The results are discussed, and suggestions for further research are provided.

Utilising raw psycho-physiological data and functional data analysis for estimating mental workload in human drivers.

Recent studies have focused on accurately estimating mental workload using machine learning algorithms and extracting features from physiological measures. However, feature extraction leads to the loss of valuable information and often results in binary classifications that lack specificity in the identification of optimum mental workload. This study investigates the feasibility of using raw physiological data (EEG, facial EMG, ECG, EDA, pupillometry) combined with Functional Data Analysis (FDA) to estimate the mental workload of human drivers. A driving scenario with five tasks was employed, and subjective ratings were collected. Results demonstrate that the FDA applied nine different combinations of raw physiological signals achieving a maximum 90% accuracy, outperforming extracted features by 73%. This study shows that the mental workload of human drivers can be accurately estimated without utilising burdensome feature extraction. The approach proposed in this study offers promise for mental workload assessment in real-world applications.

This study aimed to estimate the mental workload of human drivers using physiological signals and Functional Data Analysis (FDA). By comparing models using raw data and extracted features, the results show that the FDA with raw data achieved a high accuracy of 90%, outperforming the model with extracted features (73%).

Concreteness ratings for 36,000 Estonian words.

We present a collection of concreteness ratings for 35,979 words in Estonian. The data were collected via a web application from 2278 native Estonian speakers. Human ratings of concreteness have not been collected for Estonian beforehand. We compare our results to Aedmaa et al. (2018), who assigned concreteness ratings to 240,000 Estonian words by means of machine learning. We show that while these two datasets show reasonable correlation (R = 0.71), there are considerable differences in the distribution of the ratings, which we discuss in this paper. Furthermore, the results also raise questions about the importance of the type of scale used for collecting ratings. While most other datasets have been compiled based on questionnaires entailing five- or seven-point Likert scales, we used a continuous 0-10 scale. Comparing our rating distribution to those of other studies, we found that it is most similar to the distribution in Lahl et al. (Behavior Research Methods, 41(1), 13-19, 2009), who also used a 0-10 scale. Concreteness ratings for Estonian words are available at OSF .

Normative ratings for the Kitchen and Food Sounds (KFS) database.

Sounds are important sensory cues for food perception and acceptance. We developed and validated a large-scale database of kitchen and food sounds (180 stimuli) capturing different stages of preparing, cooking, serving, and/or consuming foods and beverages and sounds of packaging, kitchen utensils, and appliances. Each sound was evaluated across nine subjective evaluative dimensions (random order), including stimuli-related properties (e.g., valence, arousal) and food-related items (e.g., healthfulness, appetizingness) by a subsample of 51 to 64 participants (Mdn = 54; N = 332; 69.6% women, Mage = 27.46 years, SD = 10.20). Participants also identified each sound and rated how confident they were in such identification. Results show that, overall, participants could correctly identify the sound or at least recognize the general sound categories. The stimuli of the KFS database varied across different levels (low, moderate, high) of the evaluative dimensions under analysis, indicating good adequacy to a broad range of research purposes. The correlation analysis showed a high degree of association between evaluative dimensions. The sociodemographic characteristics of the sample had a limited influence on the stimuli evaluation. Still, some aspects related to food and cooking were associated with how the sounds are evaluated, suggesting that participants' proficiency in the kitchen should be considered when planning studies with food sounds. Given its broad range of stimulus categories and evaluative dimensions, the KFS database (freely available at OSF ) is suitable for different research domains, from fundamental (e.g., cognitive psychology, basic sensory science) to more applied research (e.g., marketing, consumer science).

The standardization of a new Explicit Pornographic Picture Set (EPPS).

Pictures with affective content have been extensively used in scientific studies of emotion and sexuality. However, only a few standardized picture sets have been developed that offer explicit images, with most lacking pornographic pictures depicting diverse sexual practices. This study aimed to fill this gap through developing a standardized affective set of diverse pornographic pictures (masturbation, oral sex, vaginal sex, anal sex, group sex, paraphilia) of same-sex and opposite-sex content, offering dimensional affective ratings of valence, arousal, and dominance, as well as co-elicited discrete emotions (disgust, moral and ethical acceptance). In total, 192 pornographic pictures acquired from online pornography platforms and 24 control IAPS images have been rated by 319 participants (Mage = 22.66, SDage = 4.66) with self-reported same- and opposite-sex sexual attraction. Stimuli were representative of the entire affective space, including positively and negatively perceived pictures. Participants showed differential affective perception of pornographic pictures according to gender and sexual attraction. Differences in affective ratings related to participants' gender and sexual attraction, as well as stimuli content (depicted sexual practices and sexes). From the stimuli set, researchers can select explicit pornographic pictures based on the obtained affective ratings and technical parameters (i.e., pixel size, luminosity, color space, contrast, chromatic complexity, spatial frequency, entropy). The stimuli set may be considered a valid tool of diverse explicit pornographic pictures covering the affective space, in particular, for women and men with same- and opposite-sex sexual attraction. This new explicit pornographic picture set (EPPS) is available to the scientific community for non-commercial use.

Continuous Theta Burst Stimulation to the left anterior medial prefrontal cortex influences metacognitive efficiency.

The contribution of the prefrontal areas to visual awareness is critical for the Global Neuronal Workspace Theory and higher-order theories of consciousness. The goal of the present study was to test the potential engagement of the anterior medial prefrontal cortex (aMPFC) in visual awareness judgements. We aimed to temporarily influence the neuronal dynamics of the left aMPFC via neuroplasticity-like mechanisms. We used different Theta Burst Stimulation (TBS) protocols in combination with a visual identification task and visual awareness ratings. Either continuous TBS (cTBS), intermittent TBS (iTBS), or sham TBS was applied prior to the experimental paradigm in a within-participant design. Compared with sham TBS, we observed an increase in participants' ability to judge their perception adequately (metacognitive efficiency) following cTBS but not iTBS. The effect was accompanied by lower visual awareness ratings in incorrect responses. No significant differences in the identification task performance were observed. We interpret these results as evidence of the involvement of PFC in the brain network that underlies metacognition. Further, we discuss whether the results of TMS studies on perceptual metacognition can be taken as evidence for PFC involvement in awareness itself.

Proxy ratings of psychological well-being in patients with primary brain tumors: A systematic review.

OBJECTIVE: This systematic review examined the agreement of proxy ratings of depression and anxiety in neuro-oncology patients. METHODS: Searches were conducted across 4 databases (MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science) to identify studies that compared proxy ratings (non-health care providers) of anxiety and depression in patients with brain cancer. Methodological quality and potential risk of bias were evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS: Out of the 936 studies that were screened for inclusion, 6 were included for review. The findings were mixed in terms of whether patient and proxy ratings were accurate (e.g., deemed equivalent), with many of the selected studies suggesting moderate level of agreement for several of the selected studies and, when both depression and anxiety were included, depression ratings from proxy raters were more accurate than for anxiety. We identified important limitations across the selected articles, such as low sample size, clarity on defining proxy raters and the different instructions that proxy raters are given when asked to assess patients' mood symptoms. CONCLUSIONS: Our findings suggest that proxy ratings of depression and anxiety should be interpreted with caution. While there is some agreement in proxy and patients with brain cancer ratings of depression and anxiety (greater agreement for depression), future work should recruit larger samples, while also remaining mindful of defining proxy raters and the instructions given in collecting these ratings.

Sound Level Changes the Auditory Cortical Activation Detected with Functional Near-Infrared Spectroscopy.

BACKGROUND: Functional near-infrared spectroscopy (fNIRS) is a viable non-invasive technique for functional neuroimaging in the cochlear implant (CI) population; however, the effects of acoustic stimulus features on the fNIRS signal have not been thoroughly examined. This study examined the effect of stimulus level on fNIRS responses in adults with normal hearing or bilateral CIs. We hypothesized that fNIRS responses would correlate with both stimulus level and subjective loudness ratings, but that the correlation would be weaker with CIs due to the compression of acoustic input to electric output. METHODS: Thirteen adults with bilateral CIs and 16 with normal hearing (NH) completed the study. Signal-correlated noise, a speech-shaped noise modulated by the temporal envelope of speech stimuli, was used to determine the effect of stimulus level in an unintelligible speech-like stimulus between the range of soft to loud speech. Cortical activity in the left hemisphere was recorded. RESULTS: Results indicated a positive correlation of cortical activation in the left superior temporal gyrus with stimulus level in both NH and CI listeners with an additional correlation between cortical activity and perceived loudness for the CI group. The results are consistent with the literature and our hypothesis. CONCLUSIONS: These results support the potential of fNIRS to examine auditory stimulus level effects at a group level and the importance of controlling for stimulus level and loudness in speech recognition studies. Further research is needed to better understand cortical activation patterns for speech recognition as a function of both stimulus presentation level and perceived loudness.