Hearing Aids Reduce Self-Perceived Difficulties in Noise for Listeners With Normal Audiograms

OBJECTIVES

This study assessed hearing aid benefits for people with a normal audiogram but hearing-in-noise problems in everyday listening situations.

DESIGN

Exploratory double-blinded case-control study whereby participants completed retrospective questionnaires, ecological momentary assessments, speech-in-noise testing, and mental effort testing with and without hearing aids. Twenty-seven adults reporting speech-in-noise problems but normal air conduction pure-tone audiometry took part in the study. They were randomly separated into an experimental group that trialed mild-gain hearing aids with advanced directional processing and a control group fitted with hearing aids with no gain or directionality.

RESULTS

Self-reports showed mild-gain hearing aids reduce hearing-in-noise difficulties and provide a better hearing experience (i.e., improved understanding, participation, and mood). Despite the self-reported benefits, the laboratory tests did not reveal a benefit from the mild-gain hearing aids, with no group differences on speech-in-noise tests or mental effort measures. Further, participants found the elevated cost of hearing aids to be a barrier for their adoption.

CONCLUSIONS

Hearing aids benefit the listening experience in some listening situations for people with normal audiogram who report hearing difficulties in noise. Decreasing the price of hearing aids may lead to greater accessibility to those seeking remediation for their communication needs.

Wolbachia interferes with Zika virus replication by hijacking cholesterol metabolism in mosquito cells

IMPORTANCE

Arthropod-borne viruses are emerging pathogens that are spread widely by mosquitos. Zika virus is an arbovirus that can infect humans and be transmitted from an infected mother to the fetus, potentially leading to microcephaly in infants. One promising strategy to prevent disease caused by arboviruses is to target the insect vector population. Recent field studies have shown that mosquito populations infected with Wolbachia bacteria suppress arbovirus replication and transmission. Here, we describe how intracellular bacteria redirect resources within their host cells and suppress Zika virus replication at the cellular level. Understanding the mechanism behind Wolbachia-induced interference of arbovirus replication could help advance strategies to control arbovirus pathogens in insect vectors and human populations.

Scoping Review for a Global Hearing Care Framework: Matching Theory with Practice

The hearing healthcare industry is evolving rapidly. A framework addressing provision options in contemporary hearing care could assist clinician and client navigate their options to find the most appropriate solution for each individual. A PRISMA approach was used followed by mapping, validation, and thematic analysis to produce a framework to better describe and discuss service and product delivery options in contemporary hearing care. No frameworks were identified to advise matching needs with current provision options in audiological care. Charting, mapping, and thematic analysis of the validation criteria and hearing care literature produced three core domains: Service, Channel, and Technology/Device. The framework developed in this review allows for an understanding of where innovation is occurring in hearing healthcare and differentiates between changes to technology, channel, and service. New questions open up such as whether one model is more effective than another or which model of hearing help is best for which type of person. This framework allows for the disambiguation of hearing health services, hearing loss technology, and the channel in which services and technology are delivered. It has potential to be a versatile and valuable addition to the industry of hearing healthcare.

The value of headphone accommodations in Apple Airpods Pro for managing speech-in-noise hearing difficulties of individuals with normal audiograms

OBJECTIVE

To investigate the extent to which Headphone Accommodations in Apple AirPods Pro attend to the hearing needs of individuals with normal audiograms who experience hearing difficulties in noisy environments.

DESIGN

Single-arm interventional study using acoustic measures, speech-in-noise laboratory testing, and real-world measures via questionnaires and ecological momentary assessment.

STUDY SAMPLE

Seventeen normal-hearing individuals (9 female, 21-59 years) with self-reported hearing-in-noise difficulties.

RESULTS

Acoustic measures showed that, relative to unaided, AirPods Pro provided a SNR advantage of +5.4 dB. Speech intelligibility performance in laboratory testing increased 11.8% with AirPods Pro, relative to unaided. On average, participants trialling AirPods Pro in real-world noisy venues reported that their overall hearing experience was a bit better than without them. Five participants (29%) reported that they would continue using AirPods Pro in the future. The most relevant barriers that would discourage their future use were limited hearing benefit, discomfort, and stigma.

CONCLUSIONS

Occasional use of AirPods Pro may help some individuals with normal audiograms ameliorate their speech-in-noise hearing difficulties. The identified barriers may inspire the development of new technological solutions aimed at providing an optimal management strategy for the hearing difficulties of this segment of the population.

Giant valley-Zeeman coupling in the surface layer of an intercalated transition metal dichalcogenide

Spin-valley locking is ubiquitous among transition metal dichalcogenides with local or global inversion asymmetry, in turn stabilizing properties such as Ising superconductivity, and opening routes towards 'valleytronics'. The underlying valley-spin splitting is set by spin-orbit coupling but can be tuned via the application of external magnetic fields or through proximity coupling. However, only modest changes have been realized to date. Here, we investigate the electronic structure of the V-intercalated transition metal dichalcogenide V_1/3NbS₂ using microscopic-area spatially resolved and angle-resolved photoemission spectroscopy. Our measurements and corresponding density functional theory calculations reveal that the bulk magnetic order induces a giant valley-selective Ising coupling exceeding 50 meV in the surface NbS₂ layer, equivalent to application of a ~250 T magnetic field. This energy scale is of comparable magnitude to the intrinsic spin-orbit splittings, and indicates how coupling of local magnetic moments to itinerant states of a transition metal dichalcogenide monolayer provides a powerful route to controlling their valley-spin splittings.

1271 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA

Introduction

Pressure injury (PI) management is a challenge in dependent patients in acute care wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition).

Method

A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long Term Care (LTC) wards and thus may improve outcomes. The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD. After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (19(60 %) were female). All had stage 2-4 PIs (present in 25(83%) on admission to ACW). On transfer to LTC wards, all patients had severe physical dependency with a mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.

Results

PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.

Conclusion

These results suggest that an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation has been planned.

199 A NOVEL PRESSURE INJURY CARE BUNDLE FOR DEPENDENT PATIENTS WITH PRESSURE INJURIES IN BERMUDA

Background

Pressure Injury (PI) management is challenging for dependent patients in Acute Care Wards (ACW) despite standard care (regular pressure relief measures, incontinence management, debridement, optimisation of hydration and nutrition). A Pressure Injury Care Bundle (PICB), introduced by the Department of Geriatrics, enhanced standard care by diligent and regular interdisciplinary team monitoring of patients with PIs following transfer to Long-Term Care (LTC) wards and thus may improve outcomes.

Methods

The PICB was delivered by multiple PI Nurse Champions with education of all nurse assistants and medical staff into PI aetiology/management. Progress was monitored with weekly PI measurements/photography and Nurse Champion-lead team review of all PIs. Data are presented as mean+/-1SD.

After 96+/-103 days in the ACW, the PICB was applied to 30 consecutive patients aged 80+/-14 years, (60 % female; 19/30). All had stage 2-4 PIs (present in 83% on admission to ACW). On transfer to LTC wards, all had severe physical dependency with mean Charlson Comorbidity Index of 7+/-3, 27(90%) had palliative needs and 24(80%) were bedfast. Cognitive impairment was present in 22(68%) patients with 12(37%) dying due to advanced dementia. Patients were followed for 116+/-274 days.

Results

PI improvement by >2 stages occurred in 11(36%) patients after a mean of 103 days. Ulcers closed fully after 154+/-48 days in a further 15(50 %) patients. However, new ulcers emerged or preterminal (<21 days prior to death) deterioration occurred in 5(17%) patients, related to severe contractures, preterminal poor nutrition and sarcopenia with 16(54%) patients dying.

Conclusion

These results suggest an intensive multimodal intervention involving best practice enhanced by PI Nurse Champions and delivered by educated staff with regular PI team progress reviews results in significant improvement/healing of PIs in severely dependent patients with palliative needs. Expansion of the PICB to other wards with prospective evaluation is planned.

376 Prognosis in Patients Presenting with Non-Reactive Pupils with a Chronic Subdural Haematoma

Introduction

Chronic subdural haematoma (CSDH) is a common neurosurgical pathology which is increasing in prevalence due to the ageing population. Predicting neurological outcome from defined metrics following surgery for CSDH is key to defining a neuroprognostic tool. Non-reactive pupils, due to coma, is recognised as an indicator of raised intracranial pressure (ICP) and poorer neurological outcome. There remains limited evidence defining its exact effect on outcome in patients with CSDH.

Method

Data from 1278 patients surgically managed for CSDH between 2009 and 2019 were retrospectively reviewed. Those with a GCS of 8 or less pre-operatively were identified (n = 77). These patient’s pupillary response at presentation, inpatient mortality, and Glasgow Outcome Score (GOS) on discharge were recorded from electronic and paper notes.

Results

8 patients (10.3%) had a non-reactive pupil at presentation. 4 patients with an unreactive pupil died as inpatients (50% mortality) versus 2 with bilaterally reactive pupils (2.8%) (p<0.01). Overall, only 1 survivor with non-reactive pupils had a good neurological outcome (GOS 4 or 5) meaning 7 or 87.5% had a poor neurological outcome (GOS 1-3) (p = 0.03). This compares to 35 patients or 50.7% having a poor neurological outcome in the bilaterally reactive pupil group. There is a statistically significant difference in mortality and morbidity in patients with a non-reactive pupil.

Conclusions

An unreactive pupil is a poor prognostic indicator of morbidity and mortality in patients presenting with CSDH.

381 Is Risk of Postoperative Seizures Higher in Patients with Blood Type a in Chronic Subdural Haematoma?

Introduction

Seizure is a recognised complication of Chronic Subdural Haematoma (CSDH). Blood Type A has been indicated as a risk factor for developing postoperative seizures in Acute Subdural Haematoma (ASDH). However, to our knowledge there has not been a similar study to see if there is an association between blood type and seizure risk in CSDH.

Method

699 patients who had a CSDH surgically evacuated with burr holes between 2013 and 2019 were identified and their electronic and paper notes were retrospectively reviewed. Clinical information including their blood type and occurrence of postoperative seizure were recorded.

Results

26/699 patients overall had a postoperative seizure (3.7%). Blood type A had a higher overall number of seizures (4.3%, 13/301) than other blood types (3.4%,13/379) however this difference was not statistically significant (p = 0.22).

Conclusions

There is no convincing evidence that patients with blood type A have a higher risk of seizures after CSDH than patients with other blood types. Therefore, there is no reason to manage patients with blood type A differently regarding seizure prophylaxis.

362 Neurological Outcomes in Patients Presenting with a Low GCS Due to CSDH

Introduction

Chronic Subdural Haematoma (CSDH) is a common neurosurgical pathology. Neuroprognostication remains a challenge and evidence remain limited, particularly in patients presenting with a low GCS (8 or lower). Further clarification on neuroprognostication is important to inform surgical decision making.

Method

1278 patients who had CSDH surgically evacuated were retrospectively reviewed for GCS at presentation. 77 patients with GCS of 8 or less were detected. Mortality at discharge and 6 months, GCS, Glasgow Outcome Score (GOS) on discharge, discharge destination and other relevant clinical information were recorded from their paper and electronic notes.

Results

35 patients (45.4%) had a good neurological outcome (GOS 4 or 5). Inpatient mortality was 7.8% (n = 6). 6-month all-cause mortality was 20.7% (n = 16). Only 21.1% were discharged directly to their usual place of residence, with the remainder being discharged to local hospitals or rehabilitation units. Overall GCS (p = 0.003) and motor score (p = 0.013) at presentation was significantly associated with neurological outcome. Only overall GCS was associated with inpatient mortality (p = 0.037) but there was no association with mortality at 6 months (p = 0.603).

Conclusions

GCS of 8 or less in patients with CSDH is an important finding, with significant subsequent neurological morbidity and mortality. Although it is not the only prognostic indicator, a large number of patients had a good outcome despite this, indicating that intervention is not futile in all.

385 Improving Neurosurgical Handover: A Quality Improvement Project

Aim

Efficient, succinct, and salient handover of current issues of surgical inpatients between doctors is an essential process which, if done ineffectively can contribute to patient harm. It was recognised that existing junior neurosurgical handover could be improved and using the Royal College of Surgeons’ and NICE guidelines for clinical handover we aimed to improve the existing handover system, improving doctor’s satisfaction with handover and patient safety.

Method

19 junior doctors on the SHO rota were surveyed to establish their perspective on the existing handover process. Based on this feedback, we redesigned handover combining national bodies’ guidance and local ideas. We resurveyed following these changes to measure improvement.

Results

Initial results showed only 36 % of junior doctors were satisfied with the existing handover procedure and only 50.5% felt the existing handover was safe. After these changes there was a 44% improvement in satisfaction with handover and a 24% improvement in the perceived safety of the handover process.

Conclusions

Handovers should be optimised to improve patient care and doctors working environment. We have improved our existing handover procedure increasing the perceived safety and doctor’s satisfaction of the handover process.

P057 Virus aerosol propagation by CPAP is proportional to mask leak and can be prevented by use of a hood and air filtration system

Introduction

Nosocomial transmission of SARS-CoV-2 has caused significant morbidity/mortality in the COVID-19 pandemic. Because patients auto-emit aerosols containing viable virus, these aerosols can be further propagated when patients undergo certain treatments including continuous positive airway pressure (PAP) therapy. This study aimed to assess the degree of viable virus propagated from mask leak in a PAP circuit.

Methods

Bacteriophage PhiX174 (108copies/mL) was nebulised into a custom PAP circuit. Mask leak was systematically varied to 0, 7, 21, 28 and 42 L/min at the mask interface. Plates containing Escherichia coli assessed the degree of viable virus settling on surfaces around the room. In order to contain virus spread a ventilated headboard and high efficiency particulate air (HEPA) filter was tested.

Results

Increasing mask leak was associated with virus contamination in a dose response manner (χ2= 58.24, df=4, p<0.001). Clinically relevant levels of leak (≥21 L/min) were associated with virus counts equivalent to using PAP with a standard vented mask. Viable viruses were recorded on all plates (up to 3.86m from source). A plastic hood with HEPA filtration significantly reduced viable viruses on all plates. HEPA exchange rates of 170 and 470m3/hr eradicated all evidence of virus contamination.

Discussion

Mask leak from PAP circuits may be a major source of environmental contamination and nosocomial spread of infectious respiratory diseases. Subclinical levels of leak should be treated as an infectious risk. Cheap and low-cost patient hoods with HEPA filtration are an effective countermeasure.

757 Does Increased Sampling of Cerebrospinal Fluid from External Ventricular Drains Lead to Increased Rates of Infection?

Introduction

External ventricular drains (EVDs) are commonly used in the management of acute hydrocephalus after subarachnoid haemorrhage (SAH). Infection is the most common complication. There remains controversy over whether frequent sampling is associated with increased risk of infection.

Method

Two cohorts of patients requiring EVD after SAH were retrospectively analysed for suspected and proven CSF infection. The first clinical cohort was of 50 consecutive patients with twice weekly sampling. The second group had alternate daily sampling as part of a prospective research study.

Results

Female to male ratio were (32:18) and (29:15) in clinical vs research group respectively. Average age of both groups was 59. Average length of treatment with EVD in both groups was 10 days. 16/50 (32%) patients had a suspected infection vs 13/44 (30%) and 8/50 (16%) had a proven infection compared to 6/44 (14%) in clinical and research groups, respectively. There was no statistically significant difference between the two groups (suspected infections p = 0.7 and proven infections p = 0.7)

Conclusions

Increased rates in CSF sampling in the research cohort did not result in higher rates of CSF infection. This suggests that rate of sampling, if done following a strict protocol, is not associated with increased risk of infection.

Patterns and trends in lake concentrations of dissolved organic carbon in a landscape recovering from environmental degradation and widespread acidification

Concentrations of dissolved organic carbon (DOC) have increased in lakes throughout North America and Europe over the last three decades. Recovery from acid deposition and climate change have both been postulated as the primary mechanisms for the increase in DOC. To provide a clearer insight into the mechanisms responsible for increasing DOC we evaluated changes in lake and peat porewater chemistry collected in an area of approximately 33,000 km² surrounding Sudbury, Ontario, a region undergoing dramatic recovery from acidic deposition. DOC concentrations varied considerably among the 44 lakes and over time (samples annually from 1981 to 2018), but the Sens Slope value showed a strong increase in lake DOC concentration over time, at 0.05 mg/ L y^-1 (p < 0.001) that was related to increasing pH [0.03 units y^-1, p < 0.001] and decreasing lake SO₄ concentration [-0.24 mg/ L y^-1; p < 0.001], but showed no relationship with temperature or precipitation. Similar strong relationships between DOC and pH (positive) and SO₄ (negative) were observed in 18 peatlands sampled in the region. In a spatial analysis of 82 lakes sampled in 2018, concentrations of DOC in lakes were highest in flatter catchments with a greater wetland area, suggesting that wetlands are a major source of DOC in lakes. Optical properties of DOC obtained from extracts of wetland and upland soils at 6 catchments could be distinguished, primarily due to upland litter extracts having distinct optical properties from mineral soils or wetland soils. Optical properties of DOC in lakes however were inconsistent with those measured in soil extracts indicating that they are not useful for distinguishing DOC sources in these lakes. A predictive model was developed to explain DOC trends within Sudbury lakes using a stepwise linear regression combined with hierarchical partitioning to confirm the most influential processes on DOC. Almost 50% of the variability in DOC change in the 44 lakes was explained by the magnitude in lake pH change, catchment size and catchment sparse tree cover showing that recovery from acidic deposition is overwhelmingly responsible for increasing DOC in Sudbury lakes.

Cancer patients with fractures are rarely assessed or treated for osteoporosis: a population-based study

Among 4238 cancer and 16,418 cancer-free individuals with incident major non-traumatic fractures (hip, clinical vertebral, forearm, humerus), post-fracture osteoporosis care was equally poor for both groups, whether assessed from bone mineral density (BMD) testing, initiation of osteoporosis therapy or either intervention (BMD testing and/or osteoporosis therapy).

INTRODUCTION

Most individuals sustaining a fracture do not undergo evaluation and/or treatment for osteoporosis. Cancer survivors are at increased risk for osteoporosis and fracture. Whether cancer survivors experience a similar post-fracture "care gap" is unclear. Using population-based databases, we assessed whether cancer patients are evaluated and/or treated for osteoporosis after a major fracture.

METHODS

From the Manitoba Cancer Registry, we identified cancer cases (first cancer diagnosis between 1987 and 2013) and cancer-free controls with incident major non-traumatic fractures (from provincial physician billing claims and hospitalization databases). The outcomes were performance of BMD testing (from the BMD Registry), initiation of osteoporosis therapy (from drug dispensation database) or either intervention (BMD testing and/or osteoporosis therapy) in the 12 months post-fracture.

RESULTS

There were 4238 cancer and 16,418 cancer-free individuals who sustained a fracture after the index date (cancer diagnosis) and were followed for at least 1 year post-fracture. Subsequent BMD testing was performed in 11.0% of cancer cases versus 11.5% non-cancer controls (P = 0.43), osteoporosis treatment in 22.9% cancer cases versus 21.8% non-cancer controls (P = 0.15), and either testing or treatment in 28.9% cancer cases versus 28.4% non-cancer controls (P = 0.53). Predictors of BMD testing and/or initiation of therapy were similar for non-cancer and cancer patients. Post-fracture interventions were consistently used more frequently among women, older patients (age 50 years or older), those who sustained fractures in a later calendar period, and (for treatment) after vertebral fracture. Cancer-specific variables (cancer type, years from cancer diagnosis to fracture, specialty of care provider) showed only weak and inconsistent effects.

CONCLUSIONS

A large care gap exists among cancer patients who sustain a fracture, similar to the general population, whereby the evaluation or treatment for osteoporosis is seldom conducted. Care maps may need to be developed for cancer populations to improve post-fracture care.

Human-Technology Interaction Considerations in Hearing Health Care: An Introduction for Audiologists

Purpose Innovations in user-driven hearing technology and services have placed greater control in the hands of the patient. While these advances could address issues of hearing health care accessibility, their success rests on the assumption that patients possess sufficient technological competence to self-manage these products and services successfully. The purpose of this tutorial is to highlight the importance of focusing on usability, rather than just performance outcomes, during the design, development, and evaluation of user-driven hearing technology and services. Method This tutorial explores human-technology interaction and usability and discusses practical methods for applying these concepts in hearing health care research and development. Two case studies illustrate how usability can inform the design and development of interactive educational materials for patients and the evaluation of a commercially available mHealth app. Conclusions In order to derive benefit from innovations in hearing health care, products and services must be intuitively usable in addition to being accessible and affordable. The discipline of human-technology interaction provides a relevant and useful framework to guide future research and development efforts in user-driven hearing health care.

0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes

Introduction

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes.

Methods

Sixty five patients with OSA (AHI&gt;10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI&gt;10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT).

Results

Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs.

Conclusion

Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear.

Support

R01HL085188-05A1 (U.S. NIH Grant/Contract)

Emerging Technologies, Market Segments, and MarkeTrak 10 Insights in Hearing Health Technology

Hearing health care is rapidly changing through innovation in technology, services, business models, and product categories. The introduction of hearables and over-the-counter (OTC) hearing aids in particular will change the market for hearing help and the role of the hearing care professionals (HCPs). This article focuses on how these products will be differentiated from HCP-fit hearing aids through their ability to address the unmet needs of different consumer segments within the population of people with hearing dysfunction. The unmet hearing needs of each segment are discussed, and the size of each segment estimated, demonstrating a large potential market for hearables and a smaller potential market for hearing aids than has been previously mentioned in the literature. The results from MarkeTrak 10's survey of consumers' attitudes toward an OTC model are reviewed, showing that approximately half of both hearing aid owners and nonowners are uncomfortable doing hearing- and hearing aid-related tasks on their own without the assistance of an HCP and would be unlikely to purchase OTC hearing aids if available today. MarkeTrak data are also shown that demonstrate that the majority of hearing aid and personal sound amplification product owners believe that the HCP helped or would have helped with their hearing devices. Finally, challenges to OTC hearing aids becoming successful are discussed.

Predictors of Hearing-Aid Outcomes

Over 360 million people worldwide suffer from disabling hearing loss. Most of them can be treated with hearing aids. Unfortunately, performance with hearing aids and the benefit obtained from using them vary widely across users. Here, we investigate the reasons for such variability. Sixty-eight hearing-aid users or candidates were fitted bilaterally with nonlinear hearing aids using standard procedures. Treatment outcome was assessed by measuring aided speech intelligibility in a time-reversed two-talker background and self-reported improvement in hearing ability. Statistical predictive models of these outcomes were obtained using linear combinations of 19 predictors, including demographic and audiological data, indicators of cochlear mechanical dysfunction and auditory temporal processing skills, hearing-aid settings, working memory capacity, and pretreatment self-perceived hearing ability. Aided intelligibility tended to be better for younger hearing-aid users with good unaided intelligibility in quiet and with good temporal processing abilities. Intelligibility tended to improve by increasing amplification for low-intensity sounds and by using more linear amplification for high-intensity sounds. Self-reported improvement in hearing ability was hard to predict but tended to be smaller for users with better working memory capacity. Indicators of cochlear mechanical dysfunction, alone or in combination with hearing settings, did not affect outcome predictions. The results may be useful for improving hearing aids and setting patients’ expectations.

Factors associated with delayed infant immunization in a nationally representative cohort study

BACKGROUND

Many children in developed countries do not receive recommended vaccines on time. However, knowledge about factors related to timeliness remains limited. Quantifying the relative impact of parental attitudes compared with socio-demographic factors for delayed immunization would inform policy responses.

METHODS

Participants in the nationally representative Longitudinal Study of Australian Children were matched with their vaccination histories in the Australian Childhood Immunisation Register (N = 4,121). Information about the children and their families were collected in face-to-face interviews in 2003-2004. We considered whether children had completed the primary course for each recommended antigen due by 6 months old. Children were categorized as either fully immunized, delayed, or totally non-immunized. The outcome was examined using logistic regression. Population attributable fractions were estimated for key predictors.

RESULTS

Delayed immunization was significantly associated with indicators of social disadvantage as well as parental disagreement with immunization. Attributable fractions for delayed immunization included lone motherhood (3.8%; 95% confidence interval CI [0.8, 6.7]), larger family size (39.5%; 95% CI [31.2, 46.8]), residential mobility (3.3%; 95% CI [0.1, 6.5]), lack of private hospital insurance (9.4%; 95% CI [0.7, 17.3]), a medical condition in the child (2.0%; 95% CI [0.2, 3.9]), and parental disagreement with immunization (2.1%; 95% CI [0.3, 3.9]).

CONCLUSIONS

Parental attitudes accounted for a relatively small percentage of delayed infant immunization. In contrast, many children who did not receive vaccines on time were characterized by social disadvantage, especially larger family size. Researchers and policy-makers should consider how to make timely immunization easier for busy parents.