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Denham MW, Arnold ML, Sanchez VA, Lin FR, Tucker LH, Gomez MC, Fernandez K, Arpi P, Neil H, Boyle S, Selevan S, Sussman TJ, Fine I, Glynn NW, Teresi J, Noble JM, Goldberg T, Luchsinger JA, Golub JS. Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial. Otol Neurotol 2024; 45:594-601. [PMID: 38728564 PMCID: PMC11093050 DOI: 10.1097/mao.0000000000004093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment. STUDY DESIGN Randomized, controlled, single-site, early phase II, superiority trial. SETTING Tertiary academic medical center. PARTICIPANTS One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included. INTERVENTIONS Participants will be randomized 1:1 to a best practice hearing intervention or a health education control. MAIN OUTCOME MEASURES The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity. RESULTS Trial enrollment will begin in early 2024. CONCLUSIONS After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.
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Affiliation(s)
- Michael W. Denham
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Michelle L. Arnold
- Department of Communication Sciences & Disorders, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Victoria A. Sanchez
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Frank R. Lin
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Otolaryngology, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lauren H. Tucker
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Michael C. Gomez
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Karla Fernandez
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Pamela Arpi
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
| | - Haley Neil
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Suzannah Boyle
- Department of Otolaryngology—Head and Neck Surgery, University of South Florida, Tampa, FL
| | - Sally Selevan
- Department of Communication Sciences & Disorders, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Tamara J. Sussman
- Center for Intergenerational Psychiatry, Division of Child Psychiatry, New York State Psychiatric Institute/Columbia University Irving Medical Center, New York, NY
| | - Ione Fine
- Department of Psychology/Center for Human Neuroscience University of Washington, Seattle, WA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Jeanne Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute and Department of Medicine, New York, NY
| | - James M. Noble
- Department of Neurology, GH Sergievsky Center, and Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University, New York, NY
| | - Terry Goldberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY
| | - Jose A. Luchsinger
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
| | - Justin S. Golub
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY
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Arnold ML, Heslin BJ, Dowdy M, Kershner SP, Phillips S, Lipton B, Pesko MF. Longitudinal Policy Surveillance of Private Insurance Hearing Aid Mandates in the United States: 1997-2022. Am J Public Health 2024; 114:407-414. [PMID: 38478867 PMCID: PMC10937611 DOI: 10.2105/ajph.2023.307551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate. Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey-Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022. Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19-64 years) increased from 0.3% to 4.6%. Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults. Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. (Am J Public Health. 2024;114(4):407-414. https://doi.org/10.2105/AJPH.2023.307551).
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Affiliation(s)
- Michelle L Arnold
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Brianna J Heslin
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Madison Dowdy
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Stacie P Kershner
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Serena Phillips
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Brandy Lipton
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
| | - Michael F Pesko
- Michelle L. Arnold and Madison Dowdy are with the Department of Communication Sciences & Disorders, University of South Florida, Tampa. Brianna J. Heslin and Stacie P. Kershner are with the Center for Law, Health & Society, Georgia State University College of Law, Atlanta. Serena Phillips and Michael F. Pesko are with the Department of Economics, College of Arts and Science, University of Missouri, Columbia. Brandy Lipton is with the Program in Public Health, University of California, Irvine
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Kolberg ER, Morales EEG, Thallmayer TW, Arnold ML, Burgard S, Chisolm TH, Coresh J, Couper D, Hayden KM, Huang AR, Lin FR, Mitchell CM, Mosley TH, Gravens‐Mueller L, Owens TA, Pankow JS, Pike JR, Reed NS, Sanchez V, Schrack JA, Deal JA, Goman AM. Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment. Alzheimers Dement 2024; 20:1671-1681. [PMID: 38081140 PMCID: PMC10947954 DOI: 10.1002/alz.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Many neurocognitive evaluations involve auditory stimuli, yet there are no standard testing guidelines for individuals with hearing loss. The ensuring speech understanding (ESU) test was developed to confirm speech understanding and determine whether hearing accommodations are necessary for neurocognitive testing. METHODS Hearing was assessed using audiometry. The probability of ESU test failure by hearing status was estimated in 2679 participants (mean age: 81.4 ± 4.6 years) using multivariate logistic regression. RESULTS Only 2.2% (N = 58) of participants failed the ESU test. The probability of failure increased with hearing loss severity; similar results were observed for those with and without mild cognitive impairment or dementia. DISCUSSION The ESU test is appropriate for individuals who have variable degrees of hearing loss and cognitive function. This test can be used prior to neurocognitive testing to help reduce the risk of hearing loss and compromised auditory access to speech stimuli causing poorer performance on neurocognitive evaluation.
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Affiliation(s)
- Elizabeth R. Kolberg
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Emmanuel E. Garcia Morales
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Tara W. Thallmayer
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michelle L. Arnold
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Sheila Burgard
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Theresa H. Chisolm
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
- Department of General Internal MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - David Couper
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Alison R. Huang
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Christine M. Mitchell
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Thomas H. Mosley
- Memory Impairment and Neurodegenerative Dementia CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Lisa Gravens‐Mueller
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Tiffany A. Owens
- Memory Impairment and Neurodegenerative Dementia CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - James S. Pankow
- Division of EpidemiologyUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - James Russell Pike
- Collaborative Studies Coordinating CenterUniversity of North CarolinaChapel HillNorth CarolinaUSA
- Department of BiostatisticsGillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Nicholas S. Reed
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Victoria Sanchez
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Jennifer A. Deal
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adele M. Goman
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
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Sanchez VA, Arnold ML, Betz JF, Reed NS, Faucette S, Anderson E, Burgard S, Coresh J, Deal JA, Eddins AC, Goman AM, Glynn NW, Gravens-Mueller L, Hampton J, Hayden KM, Huang AR, Liou K, Mitchell CM, Mosley TH, Neil HN, Pankow JS, Pike JR, Schrack JA, Sherry L, Teece KH, Witherell K, Lin FR, Chisolm TH. Description of the Baseline Audiologic Characteristics of the Participants Enrolled in the Aging and Cognitive Health Evaluation in Elders Study. Am J Audiol 2024; 33:1-17. [PMID: 38166200 PMCID: PMC11001432 DOI: 10.1044/2023_aja-23-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/01/2023] [Accepted: 10/04/2023] [Indexed: 01/04/2024] Open
Abstract
PURPOSE The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a randomized clinical trial designed to determine the effects of a best-practice hearing intervention versus a successful aging health education control intervention on cognitive decline among community-dwelling older adults with untreated mild-to-moderate hearing loss. We describe the baseline audiologic characteristics of the ACHIEVE participants. METHOD Participants aged 70-84 years (N = 977; Mage = 76.8) were enrolled at four U.S. sites through two recruitment routes: (a) an ongoing longitudinal study and (b) de novo through the community. Participants underwent diagnostic evaluation including otoscopy, tympanometry, pure-tone and speech audiometry, speech-in-noise testing, and provided self-reported hearing abilities. Baseline characteristics are reported as frequencies (percentages) for categorical variables or medians (interquartiles, Q1-Q3) for continuous variables. Between-groups comparisons were conducted using chi-square tests for categorical variables or Kruskal-Wallis test for continuous variables. Spearman correlations assessed relationships between measured hearing function and self-reported hearing handicap. RESULTS The median four-frequency pure-tone average of the better ear was 39 dB HL, and the median speech-in-noise performance was a 6-dB SNR loss, indicating mild speech-in-noise difficulty. No clinically meaningful differences were found across sites. Significant differences in subjective measures were found for recruitment route. Expected correlations between hearing measurements and self-reported handicap were found. CONCLUSIONS The extensive baseline audiologic characteristics reported here will inform future analyses examining associations between hearing loss and cognitive decline. The final ACHIEVE data set will be publicly available for use among the scientific community. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24756948.
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Affiliation(s)
- Victoria A. Sanchez
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Joshua F. Betz
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nicholas S. Reed
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sarah Faucette
- The MIND Center, The University of Mississippi Medical Center, Jackson
- Department of Otolaryngology–Head and Neck Surgery, The University of Mississippi Medical Center, Jackson
| | | | - Sheila Burgard
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Josef Coresh
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer A. Deal
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ann Clock Eddins
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Adele M. Goman
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA
| | | | - Jaime Hampton
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Alison R. Huang
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kaila Liou
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Christine M. Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas H. Mosley
- The MIND Center, The University of Mississippi Medical Center, Jackson
| | - Haley N. Neil
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida, Tampa
| | - James S. Pankow
- Minneapolis Field Center, University of Minnesota
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - James R. Pike
- Department of Biostatistics, The University of North Carolina at Chapel Hill
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Center on Aging and Health, Johns Hopkins University, Baltimore, MD
| | - Laura Sherry
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Theresa H. Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
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Reed NS, Gravens‐Mueller L, Huang AR, Goman AM, Mitchell CM, Arnold ML, Bolton S, Burgard S, Chisolm TH, Couper D, Deal JA, Evans J, Faucette S, Glynn NW, Gmelin T, Hayden KM, Miller E, Minotti M, Mosley T, Naylor S, Pankow JS, Pike JR, Sanchez VA, Schrack JA, Coresh J, Lin FR. Recruitment and baseline data of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study: A randomized trial of a hearing loss intervention for reducing cognitive decline. Alzheimers Dement (N Y) 2024; 10:e12453. [PMID: 38356470 PMCID: PMC10865776 DOI: 10.1002/trc2.12453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Hearing loss is highly prevalent among older adults and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a multicenter randomized control trial (partially nested within the infrastructure of an observational cohort study, the Atherosclerosis Risk in Communities [ARIC] study) to determine the efficacy of best-practice hearing treatment to reduce cognitive decline over 3 years. The goal of this paper is to describe the recruitment process and baseline results. METHODS Multiple strategies were used to recruit community-dwelling 70-84-year-old participants with adult-onset hearing loss who were free of substantial cognitive impairment from the parent ARIC study and de novo from the surrounding communities into the trial. Participants completed telephone screening, an in-person hearing, vision, and cognitive screening, and a comprehensive hearing assessment to determine eligibility. RESULTS Over a 24-month period, 3004 telephone screenings resulted in 2344 in-person hearing, vision, and cognition screenings and 1294 comprehensive hearing screenings. Among 1102 eligible, 977 were randomized into the trial (median age = 76.4 years; 53.5% female; 87.8% White; 53.3% held a Bachelor's degree or higher). Participants recruited through the ARIC study were recruited much earlier and were less likely to report hearing loss interfered with their quality of life relative to participants recruited de novo from the community. Minor differences in baseline hearing or health characteristics were found by recruitment route (i.e., ARIC study or de novo) and by study site. DISCUSSION The ACHIEVE study successfully completed enrollment over 2 years that met originally projected rates of recruitment. Substantial operational and scientific efficiencies during study startup were achieved through embedding this trial within the infrastructure of a longstanding and well-established observational study. Highlights The ACHIEVE study tests the effect of hearing intervention on cognitive decline.The study is partially nested within an existing cohort study.Over 2 years, 977 participants recruited and enrolled.Eligibility assessed by telephone and in-person for hearing, vision, and cognitive screening.The ACHIEVE study findings will have significant public health implications.
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Affiliation(s)
- Nicholas S. Reed
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Lisa Gravens‐Mueller
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Alison R. Huang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adele M. Goman
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Christine M. Mitchell
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michelle L. Arnold
- College of Science and MathematicsUniversity of South Florida Sarasota ‐ ManateeSarasotaFloridaUSA
| | - Spencer Bolton
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Sheila Burgard
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Theresa H. Chisolm
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - David Couper
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joshua Evans
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sarah Faucette
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Nancy W. Glynn
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Theresa Gmelin
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Elizabeth Miller
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Melissa Minotti
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Thomas Mosley
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Stacee Naylor
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - James S. Pankow
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - James Russell Pike
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Victoria A. Sanchez
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of South FloridaTampaFloridaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Arnold ML, Sanchez VA, Carrasco DN, Martinez D, Dhar S, Stickel A, Perreira KM, Athanasios T, Lee DJ. Risk factors associated with occupational noise-induced hearing loss in the Hispanic community health study/study of Latinos: A cross-sectional epidemiologic investigation. J Occup Environ Hyg 2023; 20:586-597. [PMID: 37615410 DOI: 10.1080/15459624.2023.2250403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
The purpose of this study was to estimate the prevalence of occupational noise exposure and risk factors of occupational noise-induced hearing loss (NIHL) in Hispanic/Latino adults included in the baseline wave of the Hispanic Community Health Study/Study of Latinos collected from 2008 to 2011. Sequential multiple linear regression modeled the relationship between occupational NIHL (defined as a 3-, 4-, 6-kHz pure-tone average [PTA]) and occupation type, self-reported noise exposure, cardiovascular disease (CVD) risk score, and hearing protective device (HPD) use. The final model controlled for sex, age, and recreational noise exposure. Among 12,851 included participants, approximately 40% (n = 5036) reported occupational noise exposure "Sometimes" (up to 50% of the time) or "Frequently" (75-100% of the time). In the final fitted model, longest-held occupation and CVD risk were associated with poorer hearing. Specifically, those in non-skilled, service, skilled, and military/police/other job categories had between 2.07- and 3.29-dB worse PTA than professional/office workers. Additionally, a shift in the CVD risk score category from low to medium was associated with a 2.25- and 8.20-dB worse PTA for medium and high CVD risk, respectively. Age and sex were also significantly associated with poorer hearing, such that men presented with 6.08 dB worse PTA than women, and for every one-year increase in age, PTA increased by 0.62 dB (ps < .001). No interactions were seen between noise*sometimes or frequent exposure to other ototoxic agents and PTA (ps = .33 & .92, respectively). The prevalence of occupational noise exposure was high in this cross-sectional investigation of adults from Hispanic/Latino backgrounds. Findings contribute to the extant literature by demonstrating that risk factors for occupational NIHL in adults from varying Hispanic/Latino backgrounds are consistent with those of other previously studied groups.
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Affiliation(s)
- Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida
| | - Victoria A Sanchez
- Department of Otolaryngology - Head and Neck Surgery, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | | | - Diane Martinez
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida
| | - Sumitrajit Dhar
- School of Communication, Northwestern University, Evanston, Illinois
| | - Ariana Stickel
- Department of Psychology, San Diego State University, San Diego, California
| | - Krista M Perreira
- Department of Health Policy, and Management, University of North Carolina, Chapel Hill, North Carolina
| | - Tsalatsanis Athanasios
- Biostatistics Core, University of South Florida - Morsani College of Medicine, Tampa, Florida
| | - David J Lee
- Miller School of Medicine, University of Miami, Coral Gables, Florida
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Reed NS, Garcia-Morales EE, Myers C, Huang AR, Ehrlich JR, Killeen OJ, Hoover-Fong JE, Lin FR, Arnold ML, Oh ES, Schrack JA, Deal JA. Prevalence of Hearing Loss and Hearing Aid Use Among US Medicare Beneficiaries Aged 71 Years and Older. JAMA Netw Open 2023; 6:e2326320. [PMID: 37505496 PMCID: PMC10383002 DOI: 10.1001/jamanetworkopen.2023.26320] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Importance National prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss. Objective To estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older. Design, Setting, and Participants In this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022. Main Outcomes and Measures Criterion-standard audiometric measures of hearing loss and self-reported hearing aid use. Results In this nationally representative sample of 2803 participants (weighted estimate, 33.1 million individuals) aged 71 years or older, 38.3% (95% CI, 35.5%-41.1%) were aged 71 to 74 years, 36.0% (95% CI, 33.1%-38.8%) were aged 75 to 79 years, 13.8% (95% CI, 12.6%-14.9%) were aged 80 to 84 years, 7.9% (95% CI, 7.2%-8.6%) were aged 85 to 89 years, and 4.0% (95% CI, 3.5%-4.6%) were aged 90 years or older; 53.5% (95% CI, 50.9%-56.1%) were female and 46.5% (95% CI, 43.9%-49.1%) were male; and 7.5% (95% CI, 6.2%-8.7%) were Black, 6.5% (95% CI, 4.4%-8.7%) were Hispanic, and 82.7% (95% CI, 79.7%-85.6%) were White. An estimated 65.3% of adults 71 years and older (weighted estimate, 21.5 million individuals) had at least some degree of hearing loss (mild, 37.0% [95% CI, 34.7%-39.4%]; moderate, 24.1% [95% CI, 21.9%-26.4%]; and severe, 4.2% [95% CI, 3.3%-5.3%]). The prevalence was higher among White, male, lower-income, and lower education attainment subpopulations and increased with age, such that 96.2% (95% CI, 93.9%-98.6%) of adults aged 90 years and older had hearing loss. Among those with hearing loss, only 29.2% (weighted estimate, 6.4 million individuals) used hearing aids, with lower estimates among Black and Hispanic individuals and low-income individuals. Conclusions and Relevance These findings suggest that bilateral hearing loss is nearly ubiquitous among older US individuals, prevalence and severity increase with age, and hearing aid use is low. Deeper consideration of discrete severity measures of hearing loss in this population, rather than binary hearing loss terminology, is warranted.
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Affiliation(s)
- Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Emmanuel E Garcia-Morales
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clarice Myers
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Olivia J Killeen
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Julie E Hoover-Fong
- Department of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Esther S Oh
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Sanchez VA, Arnold ML, Moore DR, Clavier O, Abrams HB. Speech-in-noise testing: Innovative applications for pediatric patients, underrepresented populations, fitness for duty, clinical trials, and remote services. J Acoust Soc Am 2022; 152:2336. [PMID: 36319253 PMCID: PMC9722269 DOI: 10.1121/10.0014418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/24/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Speech perception testing, defined as providing standardized speech stimuli and requiring a listener to provide a behavioral and scored response, has been an integral part of the audiologic test battery since the beginning of the audiology profession. Over the past several decades, limitations in the diagnostic and prognostic validity of standard speech perception testing as routinely administered in the clinic have been noted, and the promotion of speech-in-noise testing has been highlighted. This review will summarize emerging and innovative approaches to speech-in-noise testing with a focus on five applications: (1) pediatric considerations promoting the measurement of sensory and cognitive components separately; (2) appropriately serving underrepresented populations with special attention to racial, ethnic, and linguistic minorities, as well as considering biological sex and/or gender differences as variables of interest; (3) binaural fitness for duty assessments of functional hearing for occupational settings that demand the ability to detect, recognize, and localize sounds; (4) utilization of speech-in-noise tests in pharmacotherapeutic clinical trials with considerations to the drug mechanistic action, the patient populations, and the study design; and (5) online and mobile applications of hearing assessment that increase accessibility and the direct-to-consumer market.
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Affiliation(s)
- Victoria A Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, Florida 33612, USA
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital, Cincinnati, Ohio 45229, USA
| | | | - Harvey B Abrams
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida 33612, USA
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Arnold ML, Schwartz B, Neil H, Chisolm TH, Sanchez VA. Feasibility and Assessment of a Hybrid Audiology Service Delivery Model for Older Adult Hearing Aid Users: A Pilot Study. Am J Audiol 2022; 31:892-904. [PMID: 35503960 PMCID: PMC9886165 DOI: 10.1044/2022_aja-21-00200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The aim of this study was to provide insight for the feasibility and outcomes of hybrid (combination of in-person office and Internet-based appointments) audiology services. METHOD This pilot included two phases. First, we surveyed audiologists regarding what elements of a best-practice, in-person delivery of a hearing intervention could be delivered via Internet-based appointments. Next, we piloted the feasibility and assessed outcomes of the procedures identified. Ten first-time hearing aid users aged 70 years and older were fit with Phonak Audeo M90-312T hearing aids. Two Internet-based follow-up appointments were completed using the myPhonak app. We administered the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), the Client Oriented Scale of Improvement (COSI), the Quick Speech-in-Noise Test (QuickSIN), and real-ear aided responses (REARs) to determine whether participants experienced improvements on hearing-related outcomes. The Telehealth Acceptance Questionnaire (TAQ) and the Visit-Specific Satisfaction Questionnaire (VSQ-9) were administered to gauge comfort with telehealth and satisfaction with Internet-based appointments. RESULTS Survey results revealed that after an initial in-person appointment, nearly all follow-up hearing intervention components could be delivered remotely. We performed Wilcoxon signed-ranks tests to determine if the baseline and outcome results differed for outcomes. Baseline scores improved after 6 weeks (ps = .02 and. 005 for QuickSIN and HHIE-S) for speech-in-noise performance and self-perceived hearing difficulties. REARs from 500 to 4000 Hz measured after 6 weeks did not differ from baseline (ps = .612 and .398 for the right and left ears), suggesting no significant deviation from prescriptive targets because of remote fitting adjustments. All participants reported improvement in COSI goals after the intervention. TAQ results suggested that comfort with telehealth improved after attending Internet-based appointments (p = .005). VSQ-9 results revealed no differences in reported patient satisfaction between in-person and Internet-based appointments. CONCLUSIONS We were able to develop a feasible hybrid audiology service delivery model for older adults. Our results enhance the evidence base for the implementation of telehealth audiology services.
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Affiliation(s)
- Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Breanne Schwartz
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Haley Neil
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa
| | - Theresa H. Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Victoria A. Sanchez
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
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Arnold ML, Haley W, Lin FR, Faucette S, Sherry L, Higuchi K, Witherell K, Anderson E, Reed NS, Chisolm TH, Sanchez VA. Development, assessment, and monitoring of audiologic treatment fidelity in the aging and cognitive health evaluation in elders (ACHIEVE) randomised controlled trial. Int J Audiol 2022; 61:720-730. [PMID: 34533430 DOI: 10.1080/14992027.2021.1973126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Studies investigating hearing interventions under-utilise and under-report treatment fidelity planning, implementation, and assessment. This represents a critical gap in the field that has the potential to impede advancements in the successful dissemination and implementation of interventions. Thus, our objective was to describe treatment fidelity planning and implementation for hearing intervention in the multi-site Ageing and Cognitive Health Evaluation in Elders (ACHIEVE) randomised controlled trial. DESIGN Our treatment fidelity plan was based on a framework defined by the National Institutes of Health Behaviour Change Consortium (NIH BCC), and included strategies to enhance study design, provider training, and treatment delivery, receipt, and enactment. STUDY SAMPLE To assess the fidelity of the ACHIEVE hearing intervention, we distributed a checklist containing criteria from each NIH BCC core treatment fidelity category to nine raters. RESULTS The ACHIEVE hearing intervention fidelity plan satisfied 96% of NIH BCC criteria. Our assessment suggested a need for including clear, objective definitions of provider characteristics and non-treatment aspects of intervention delivery in future fidelity plans. CONCLUSIONS The ACHIEVE hearing intervention fidelity plan can serve as a framework for the application of NIH BCC fidelity strategies for future studies and enhance the ability of researchers to reliably implement evidence-based interventions.
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Affiliation(s)
- Michelle L Arnold
- Department of Communication Sciences & Disorders, University of South Florida, Florida, FL, USA
| | - William Haley
- School of Aging Studies, University of South Florida, Florida, FL, USA
| | - Frank R Lin
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah Faucette
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura Sherry
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kerry Witherell
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Elizabeth Anderson
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas S Reed
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Theresa H Chisolm
- Department of Communication Sciences & Disorders, University of South Florida, Florida, FL, USA
| | - Victoria A Sanchez
- Department of Communication Sciences & Disorders, University of South Florida, Florida, FL, USA
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, FL, USA
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Arnold ML, Sanchez VA. APSO Standards: Implementing Hearing Aid Needs Assessments and Measuring Related Outcomes. Semin Hear 2022; 43:110-120. [PMID: 35903071 PMCID: PMC9325087 DOI: 10.1055/s-0042-1748835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The proportion of individuals who pose to benefit from the use of hearing aids is much smaller than those who adopt them. Likewise, many adults who try hearing devices abandon using them after a short period of time. Most factors related to hearing aid use are unrelated to a patient's hearing loss severity. Hearing loss treatment requires more than the provision of hearing aids as a sole intervention. Adoption rates could be improved through the implementation of evidence-based clinical protocols which maximize patients' success. Recently, the Audiology Practice Standards Organization (APSO) released evidence-based, formal standards of practice addressing hearing aid selection, fitting, and rehabilitation for adult and geriatric patients. Notably, the standards acknowledge the importance of an amplification needs assessment, including hearing aid outcomes measurement. In this brief narrative, we describe Standards 3 and 14 ( Needs Assessment and Hearing Aid Outcomes Measurement ) and offer an example of the clinical implementation of a comprehensive needs assessment and hearing aid outcomes measurement currently being used in a multisite, longitudinal clinical trial.
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Affiliation(s)
- Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, Florida
| | - Victoria A Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Morsani College of Medicine, Tampa, Florida
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Arnold ML, Dhar S, Lee DJ, Perreira KM, Pupo D, Tsalatsanis A, Sanchez VA. Sex-Specific Prevalence, Demographic Characteristics, and Risk Factors of Tinnitus in the Hispanic Community Health Study/Study of Latinos. Am J Audiol 2022; 31:78-90. [PMID: 34990560 DOI: 10.1044/2021_aja-21-00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to determine the prevalence of any and chronic tinnitus among female and male individuals from varied Hispanic/Latino backgrounds and to estimate associations between risk factors for chronic tinnitus. METHOD Our analysis used cross-sectional baseline data collected from 2008 to 2011 from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Prevalence estimates and multivariable logistic regression were conducted using survey methodology. Participants included 15,768 adults (8,229 women and 7,539 men) aged 18-76 years. The primary outcome of interest was chronic tinnitus, defined as self-reported tinnitus lasting ≥ 5 min at a time and at least once per week. We hypothesized that after adjusting for covariates, the risk factors of depressed and anxious symptoms, smoking history, hypertension, and noise exposure history would be associated with higher odds of chronic tinnitus. RESULTS Unstratified prevalence for any tinnitus was 32.9%, and for chronic tinnitus, it was 12.1%. Sex-stratified results demonstrated that 2,995 female individuals (36.4%) and 2,187 male individuals (29.0%) reported any tinnitus, and of these, 1,043 female individuals (12.7%) and 870 male individuals (11.5%) reported chronic tinnitus. In the fully adjusted model, depressed and anxious symptoms as well as recreational noise exposure were associated with higher odds of chronic tinnitus in female individuals (odds ratios [ORs] = 1.06, confidence interval [CI; 1.04, 1.07]; 1.02, CI [1.01, 1.04]; and 1.40, CI [1.20, 1.62]) and in male individuals (ORs = 1.06, CI [1.03, 1.08]; 1.05, CI [1.02, 1.08]; and 1.30, CI [1.05, 1.65]). Current smoking was a risk factor for chronic tinnitus in male individuals (OR = 1.53, CI [1.16, 2.02]). CONCLUSIONS Prevalence of any and chronic tinnitus in the HCHS/SOL baseline cohort is higher than that reported in previous studies, particularly among female individuals. Understanding risk factors associated with tinnitus is important for the development of culturally and linguistically appropriate public health programs that consider sex differences and promote lifestyle modifications known to lower the odds of experiencing tinnitus.
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Affiliation(s)
- Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa
| | - Sumitrajit Dhar
- School of Communication, Northwestern University, Evanston, IL
| | - David J. Lee
- Department of Health Sciences, University of Miami Miller School of Medicine, FL
| | - Krista M. Perreira
- Department of Social Medicine, School of Medicine, University of North Carolina at Chapel Hill
| | - Daniel Pupo
- School of Aging Studies, University of South Florida, Tampa
| | - Athanasios Tsalatsanis
- Department of Otolaryngology–Head and Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
| | - Victoria A. Sanchez
- Department of Otolaryngology–Head and Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
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Miller EL, Jilla AM, Arnold ML. Defining Audiology through Occupational and Health Policy Action. Semin Hear 2022; 43:3-12. [PMID: 35719744 DOI: 10.1055/s-0042-1743123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Many barriers to accessibility exist for Medicare beneficiaries seeking hearing and balance care such as availability of providers, coverage for services, and ability to pay. Other statutory and administrative barriers exist including the need for physician orders to have audiology services covered, the classification of audiologists as suppliers of "other diagnostic tests" under Medicare payer policy, and non-coverage of certain audiologic management and treatment services. Nearly two decades of legislative efforts have not resulted in any substantial changes to U.S. health policy, while the need for audiology services has increased due to a growing demographic of older adults. The Medicare Audiologist Access and Services Act (MAASA) has been introduced in the 116th and 117th Congress and proposes amendments to the Social Security Act that would address statutory barriers to accessing hearing and balance care among Medicare beneficiaries and would recognize audiologists for their scope of practice within the Medicare program. Objectives of the present review are to provide a summary of statutes in the Social Security Act and Standard Occupational Classification system which affect audiologists, audiology services, and Medicare beneficiaries and to discuss previous and current legislative health policy efforts to address these statutory barriers to hearing and balance care access.
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Affiliation(s)
- Erin L Miller
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio
| | - Anna Marie Jilla
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida Sarasota - Manatee Campus, Sarasota, Florida
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Sanchez VA, Arnold ML, Reed NS, Oree PH, Matthews CR, Eddins AC, Lin FR, Chisolm TH. The Hearing Intervention for the Aging and Cognitive Health Evaluation in Elders Randomized Control Trial: Manualization and Feasibility Study. Ear Hear 2021; 41:1333-1348. [PMID: 32251012 PMCID: PMC10436703 DOI: 10.1097/aud.0000000000000858] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This work describes the development of a manualized best-practice hearing intervention for older adults participating in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled clinical trial. Manualization of interventions for clinical trials is critical for assuring intervention fidelity and quality, especially in large multisite studies. The multisite ACHIEVE randomized controlled trial is designed to assess the efficacy of a hearing intervention on rates of cognitive decline in older adults. We describe the development of the manualized hearing intervention through an iterative process that included addressing implementation questions through the completion of a feasibility study (ACHIEVE-Feasibility). DESIGN Following published recommendations for manualized intervention development, an iterative process was used to define the ACHIEVE-hearing intervention elements and create an initial manual. The intervention was then delivered within the ACHIEVE-Feasibility study using one-group pre-post design appropriate for assessing questions related to implementation. Participants were recruited from the Tampa, Florida area between May 2015 and April 2016. Inclusion criteria were cognitively healthy adults aged 70 to 89 with symmetrical mild-to-moderately severe sensorineural hearing loss. The ACHIEVE-Feasibility study sought to assess the implementation of the manualized hearing intervention by: (1) confirming improvement in expected outcomes were achieved including aided speech-in-noise performance and perception of disease-specific self-report measures; (2) determining whether the participants would comply with the intervention including session attendance and use of hearing aids; and (3) determining whether the intervention sessions could be delivered within a reasonable timeframe. RESULTS The initial manualized intervention that incorporated the identified best-practice elements was evaluated for feasibility among 21 eligible participants and 9 communication partners. Post-intervention expected outcomes were obtained with speech-in-noise performance results demonstrating a significant improvement under the aided condition and self-reported measures showing a significant reduction in self-perceived hearing handicap. Compliance was excellent, with 20 of the 21 participants (95.2%) completing all intervention sessions and 19 (90.4%) returning for the 6-month post-intervention visit. Furthermore, self-reported hearing aid compliance was >8 hr/day, and the average daily hearing aid use from datalogging was 7.8 hr. Study completion was delivered in a reasonable timeframe with visits ranging from 27 to 85 min per visit. Through an iterative process, the intervention elements were refined, and the accompanying manual was revised based on the ACHIEVE-Feasibility study activities, results, and clinician and participant informal feedback. CONCLUSION The processes for the development of a manualized intervention described here provide guidance for future researchers who aim to examine the efficacy of approaches for the treatment of hearing loss in a clinical trial. The manualized ACHIEVE-Hearing Intervention provides a patient-centered, yet standardized, step-by-step process for comprehensive audiological assessment, goal setting, and treatment through the use of hearing aids, other hearing assistive technologies, counseling, and education aimed at supporting self-management of hearing loss. The ACHIEVE-Hearing Intervention is feasible in terms of implementation with respect to verified expected outcomes, compliance, and reasonable timeframe delivery. Our processes assure intervention fidelity and quality for use in the ACHIEVE randomized controlled trial (ClinicalTrials.gov Identifier: NCT03243422).
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Affiliation(s)
- Victoria A. Sanchez
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida
| | | | - Nicholas S. Reed
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine
| | - Preyanca H. Oree
- Department of Communication Sciences & Disorder, University of South Florida
| | | | - Ann Clock Eddins
- Department of Communication Sciences & Disorder, University of South Florida
| | - Frank R. Lin
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine
| | - Theresa H. Chisolm
- Department of Communication Sciences & Disorder, University of South Florida
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Abstract
The demand for telehealth services will continue to grow alongside an increased need for audiology services among both children and adults. Insurance coverage policies for audiologic services are specific to each payer and vary widely in the level of coverage provided for both in-person and telehealth-based audiology services. While benefits for children are fairly comprehensive, coverage for audiology services for adults is generally poor. Traditional Medicare does not cover hearing aids or other rehabilitative audiologic services, and other payer policies vary widely. Lack of benefits for hearing and balance services is inconsistent with the evidence base and leaves many beneficiaries without access to meaningful care for hearing and balance disorders, which are highly prevalent among and disproportionately affect Medicare beneficiaries. The purpose of this article is to discuss regulatory and reimbursement considerations for telehealth provision in audiology and elucidate opportunities to influence related health policy at both state and federal levels.
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Affiliation(s)
- Anna Marie Jilla
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee Campus, Sarasota, Florida
| | - Erin L. Miller
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio
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Arnold ML, Reichard A, Gutman K, Westermann L, Sanchez V. Cross-Cultural Adaptation of Hearing Loss Self-Management Patient Education Materials: Development of the Caja de Instrumentos de Pérdida Auditiva. Am J Audiol 2020; 29:691-700. [PMID: 32976032 DOI: 10.1044/2020_aja-19-00120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The lack of culturally and linguistically appropriate interventions contributes to unsatisfactory hearing health care service delivery and outcomes for Spanish-speaking persons from Hispanic/Latino background. To address this issue, our objective was to cross-culturally adapt a "Hearing Loss Toolkit for Self-Management" for use with Spanish-speaking adults seen in a clinical setting. In this clinical focus article, we describe a process for translation and cross-cultural adaptation of patient education materials based on current best practices guidelines. Method We utilized guidelines from the International Society for Pharmoeconomics Outcomes Research Task Force for Translation and Cultural Adaptation, the World Health Organization, and the International Collegium of Rehabilitative Audiology to complete a comprehensive, systematic, cross-cultural adaptation process of the source materials. The adaptation stages included forward translation and reconciliation, back translation and review, field testing with representative end users from the target population, and finalization. Results We successfully cross-culturally adapted the source materials following best practice guidelines. The Spanish-language adaptation was deemed understandable, actionable, aesthetically pleasing, and culturally appropriate by a group of native Spanish speakers. Conclusions There is an unmet need for the development of hearing loss self-management materials that incorporate cultural and linguistic competence with best health literacy practices. High-quality cross-cultural adaptations that consider the intersection of culture, language, and health literacy are a positive step toward reducing barriers to hearing health care related to language access for U.S. Hispanic/Latino adults with hearing loss.
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Affiliation(s)
- Michelle L. Arnold
- College of Science & Mathematics, University of South Florida Sarasota–Manatee
| | - Alexandra Reichard
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Kalene Gutman
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Laura Westermann
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD
| | - Victoria Sanchez
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
- Department of Otolaryngology – Head & Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa
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Goman AM, Deal JA, Arnold ML, Chisolm T, Coresh J, Hayden KM, Owens TA, Pankow J, Reed NS, Sanchez VA, Lin FR, Mosley TH. Hearing loss and cognition: A protocol for ensuring speech understanding in neuropsychological assessment. Alzheimers Dement 2020. [DOI: 10.1002/alz.042883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Jennifer A Deal
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA
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Arnold ML, Hyer K, Small BJ, Chisolm T, Saunders GH, McEvoy CL, Lee DJ, Dhar S, Bainbridge KE. Hearing Aid Prevalence and Factors Related to Use Among Older Adults From the Hispanic Community Health Study/Study of Latinos. JAMA Otolaryngol Head Neck Surg 2020; 145:501-508. [PMID: 30998816 DOI: 10.1001/jamaoto.2019.0433] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hearing loss is highly prevalent in the rapidly growing and aging Hispanic/Latino population in the United States. However, little is known or understood about hearing aid use among US adults from Hispanic/Latino backgrounds. Objective To describe hearing aid prevalence and factors associated with hearing aid use among US adults of Hispanic/Latino backgrounds. Design, Setting, and Participants Cross-sectional data were collected between 2008 and 2011 from 4 field centers (Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California) as part of the multisite Hispanic Community Health Study/Study of Latinos. Included individuals were adults aged 45 to 76 years with hearing loss (pure-tone average ≥25 dB HL) from randomly selected households in the 4 field centers and were from self-reported Hispanic/Latino backgrounds, including Central American, Cuban, Dominican, Mexican, Puerto Rican, South American, and mixed or other backgrounds. Analysis, including age- and background-weighted prevalence estimates and multivariate logistic regression using survey methodology, was conducted from 2017 to 2018. Main Outcomes and Measures The primary outcome of interest was self-reported hearing aid use. The a priori hypothesis was that hearing aid prevalence estimates among included Hispanic/Latino adults would be less than recently published estimates of the general US population, and that poorer hearing, higher perceived need, older age, and higher acculturation would be associated with hearing aid use. Results Of 1898 individuals with hearing loss, 1064 (56.1%) were men, and the mean (SE) age was 60.3 (0.3) years. A total of 87 (4.6%) included individuals reported hearing aid use. Increased odds of self-reported use was associated with poorer measured hearing (odds ratio [OR], 1.06; 95% CI, 1.03-1.09), higher Hearing Handicap Inventory-Screening scores (OR, 1.06; 95% CI, 1.03-1.08), access to health insurance coverage (OR, 2.30; 95% CI, 1.20-4.37), and place of residence (OR, 2.42; 95% CI, 1.17-5.02) in an adjusted logistic regression model. Conclusions and Relevance Findings revealed underuse of hearing aids among adults from Hispanic/Latino backgrounds. A primary factor related to use was lack of health insurance, which suggests that access influenced hearing aid use. Changes to policy and clinical service provision are needed to increase hearing aid use among aging Hispanic/Latino adults in the United States.
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Affiliation(s)
- Michelle L Arnold
- College of Science & Mathematics, University of South Florida Sarasota-Manatee, Sarasota.,School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Kathryn Hyer
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Brent J Small
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - Theresa Chisolm
- Department of Communication Sciences & Disorders, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | | | - Cathy L McEvoy
- School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa
| | - David J Lee
- University of Miami Health System, University of Miami, Miami, Florida
| | | | - Kathleen E Bainbridge
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
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Affiliation(s)
- Michelle L. Arnold
- Western Michigan University, Department of Psychology, Kalamazoo, Michigan, USA
| | - Ron VanHouten
- Western Michigan University, Department of Psychology, Kalamazoo, Michigan, USA
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Saunders GH, Frederick MT, Arnold ML, Silverman SC, Chisolm TH, Myers PJ. A Randomized Controlled Trial to Evaluate Approaches to Auditory Rehabilitation for Blast-Exposed Veterans with Normal or Near-Normal Hearing Who Report Hearing Problems in Difficult Listening Situations. J Am Acad Audiol 2019; 29:44-62. [PMID: 29309023 DOI: 10.3766/jaaa.16143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Blast exposure is a major source of injury among Service members in the Iraq and Afghanistan conflicts. Many of these blast-exposed veterans report hearing-related problems such as difficulties understanding speech in noise and rapid speech, and following instructions and long conversations that are disproportionate to their measured peripheral hearing sensitivity. Evidence is mounting that these complaints result from damage to the central auditory processing system. PURPOSE To evaluate the effectiveness of audiological rehabilitative interventions for blast-exposed veterans with normal or near-normal peripheral hearing and functional hearing difficulties. RESEARCH DESIGN A randomized controlled trial with four intervention arms. STUDY SAMPLE Ninety-nine blast-exposed veterans with normal or near-normal peripheral hearing who reported functional hearing difficulties. INTERVENTION Four interventions were compared: compensatory communication strategies (CCS) education, CCS and use of a personal frequency modulation system (FM + CCS), CCS and use of an auditory training program (AT + CCS), and use of all three interventions combined (FM + AT + CCS). DATA COLLECTION AND ANALYSIS All participants tested before, and immediately following an 8-week intervention period. The primary outcome measures upon which the study was powered assessed speech understanding in noise and self-reported psychosocial impacts of the intervention. In addition, auditory temporal processing, auditory working memory, allocation of attention, and hearing and cognitive self-report outcomes were assessed. RESULTS Use of FM + CCS resulted in significant benefit for speech understanding in noise and self-reported hearing benefits, and FM + AT + CCS provided more self-reported cognitive benefits than FM + CCS, AT + CCS, or CCS. Further, individuals liked and reported using the FM system, but there was poor adherence to and high attrition among individuals assigned to receive AT. CONCLUSIONS It is concluded that a FM system (or remote microphone via Bluetooth system) is an effective intervention for blast-exposed veterans with normal or near-normal hearing and functional hearing difficulties and should be routinely considered as an intervention approach for this population when possible.
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Affiliation(s)
- Gabrielle H Saunders
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR.,Department of Otolaryngology, Oregon Health and Science University, Portland, OR
| | - Melissa T Frederick
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - ShienPei C Silverman
- National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR
| | - Theresa H Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
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Abstract
Hearing aids are a demonstrated efficacious intervention for age-related hearing loss, and research suggests that good hearing loss self-management skills improve amplification satisfaction and outcomes. One way to foster self-management skills is through the provision of patient education materials. However, many of the available resources related to the management of hearing loss do not account for health literacy and are not suitable for use with adults from varying health literacy backgrounds. To address this issue, we developed the Hearing Loss Toolkit for Self-Management as part of a manualized, best practices hearing intervention used in large clinical trial. We incorporated health literacy recommendations from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality in a series of modules that address a variety of common problem areas reported by adults with hearing loss. A formative assessment consisting of feedback questionnaires, semistructured interviews, and a focus group session with representatives from the target audience was conducted. Findings from the development assessment process demonstrate that the Hearing Loss Toolkit for Self-Management is suitable for use with adults with age-related hearing loss who have varying health literacy backgrounds and abilities.
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Affiliation(s)
- Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee, Sarasota, Florida.,School of Aging Studies, University of South Florida, Tampa, Florida
| | - Preyanca Oree
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee, Sarasota, Florida
| | - Victoria Sanchez
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee, Sarasota, Florida
| | - Nicholas Reed
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland
| | - Theresa Chisolm
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee, Sarasota, Florida
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Deal JA, Goman AM, Albert MS, Arnold ML, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Hayden KM, Mosley T, Pankow JS, Reed N, Sanchez VA, Richey Sharrett A, Thomas SD, Coresh J, Lin FR. Hearing treatment for reducing cognitive decline: Design and methods of the Aging and Cognitive Health Evaluation in Elders randomized controlled trial. Alzheimers Dement (N Y) 2018; 4:499-507. [PMID: 30364572 PMCID: PMC6197326 DOI: 10.1016/j.trci.2018.08.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hearing impairment is highly prevalent and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders study is a multicenter randomized controlled trial to determine efficacy of hearing treatment in reducing cognitive decline in older adults. Clinicaltrials.gov Identifier: NCT03243422. METHODS Eight hundred fifty participants without dementia aged 70 to 84 years with mild-to-moderate hearing impairment recruited from four United States field sites and randomized 1:1 to a best-practices hearing intervention or health education control. Primary study outcome is 3-year change in global cognitive function. Secondary outcomes include domain-specific cognitive decline, incident dementia, brain structural changes on magnetic resonance imaging, health-related quality of life, physical and social function, and physical activity. RESULTS Trial enrollment began January 4, 2018 and is ongoing. DISCUSSION When completed in 2022, Aging and Cognitive Health Evaluation in Elders study should provide definitive evidence of the effect of hearing treatment versus education control on cognitive decline in community-dwelling older adults with mild-to-moderate hearing impairment.
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Affiliation(s)
- Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adele M. Goman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle L. Arnold
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicholas Reed
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria A. Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, FL, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- George W. Comstock Center for Public Health Research and Prevention, Johns Hopkins Bloomberg School of Public Health, Hagerstown, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Arnold ML, Kainz A, Hidalgo LG, Eskandary F, Kozakowski N, Wahrmann M, Haslacher H, Oberbauer R, Heilos A, Spriewald BM, Halloran PF, Böhmig GA. Functional Fc gamma receptor gene polymorphisms and donor-specific antibody-triggered microcirculation inflammation. Am J Transplant 2018; 18:2261-2273. [PMID: 29478298 DOI: 10.1111/ajt.14710] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 01/25/2023]
Abstract
Fc-dependent effector mechanisms may contribute to antibody-mediated rejection (ABMR), and distinct gene polymorphisms modifying the function of Fc gamma receptors (FcγRs) may influence the capability of donor-specific antibodies (DSAs) to trigger inflammation. To evaluate the relevance of functional FcγR variants in late ABMR, 85 DSA-positive kidney allograft recipients, who were recruited upon antibody screening of 741 prevalent patients, were genotyped for polymorphisms in FcγRIIA (FCGR2A-H/R131 ; rs1801274), FcγRIIIA (FCGR3A-V/F158 ; rs396991), and FcγRIIIB (FCGR3B-neutrophil antigen 1 ([NA1]/NA2; rs35139848). Individuals with high-affinity FCGR3A-V158 alleles (V/V158 or V/F158 ) showed a higher rate (and extent) of peritubular capillaritis (ptc) in protocol biopsies than homozygous carriers of the lower-affinity allele (ptc score ≥1: 53.6% vs 25.9%; P = .018). Associations were independent of C1q-binding to DSA or capillary C4d. In parallel, there was a trend toward increased macrophage- and injury-repair response-associated transcript subsets. Kidney function over 24 months, however, was not different. In support of a functional role of FcγRIIIA polymorphism, NK92 cells expressing FCGR3A-V158 produced >2 times as much interferon gamma upon incubation with HLA antibody-coated cells as those expressing FCGR3A-F158 . FcγRIIA and FcγRIIIB polymorphisms were not associated with allograft morphology. Our data suggest that the presence of high-affinity FcγRIIIA variants may favor DSA-triggered microcirculation inflammation.
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Affiliation(s)
- M L Arnold
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany
| | - A Kainz
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - L G Hidalgo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - F Eskandary
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - N Kozakowski
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - M Wahrmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - H Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - R Oberbauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - A Heilos
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - B M Spriewald
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany
| | - P F Halloran
- Alberta Transplant Applied Genomics Centre, ATAGC, University of Alberta, Edmonton, AB, Canada
| | - G A Böhmig
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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Fausto BA, Badana ANS, Arnold ML, Lister JJ, Edwards JD. Comparison of Subjective and Objective Measures of Hearing, Auditory Processing, and Cognition Among Older Adults With and Without Mild Cognitive Impairment. J Speech Lang Hear Res 2018; 61:945-956. [PMID: 29594311 DOI: 10.1044/2017_jslhr-h-17-0263] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/01/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The aims of the study were to compare the Cognitive Self-Report Questionnaire (CSRQ; Spina, Ruff, & Mahncke, 2006) Hearing and Cognitive subscale ratings among older adults with and without probable mild cognitive impairment (MCI) and to examine whether self-report, as measured by the CSRQ, is associated with objective measures of hearing, auditory processing, and cognition. METHOD Data analyses included 97 older adults of ages 61-91 years. Participants completed the CSRQ self-report measure as well as a battery of objective measures, including pure-tone audiometry, degraded speech understanding, temporal processing, and memory. RESULTS Older adults with probable MCI rated their cognitive abilities more poorly than those without MCI (p = .002), but ratings of hearing and auditory abilities did not differ between the two groups (p = .912). Age and CSRQ Hearing subscale ratings explained a significant proportion of variance in objective measures of hearing and degraded speech understanding (R2 = .39, p < .001). Age, sex, mental status, and CSRQ Cognition subscale ratings explained a significant proportion of variance in objective memory performance (R2 = .55, p < .001). CONCLUSIONS Taken together, these results suggest that the CSRQ is an appropriate self-report measure of hearing, cognition, and some aspects of auditory processing for older adults with and without probable MCI.
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Affiliation(s)
| | | | - Michelle L Arnold
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Jennifer J Lister
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
| | - Jerri D Edwards
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa
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Saunders GH, Frederick MT, Silverman SC, Penman T, Gardner A, Chisolm TH, Escabi CD, Oree PH, Westermann LC, Sanchez VA, Arnold ML. Hearing Screening in the Community. J Am Acad Audiol 2018; 30:145-152. [PMID: 30461404 DOI: 10.3766/jaaa.17103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults typically wait 7-10 yr after noticing hearing problems before seeking help, possibly because they are unaware of the extent of their impairment. Hearing screenings, frequently conducted at health fairs, community events, and retirement centers can increase this awareness. To our knowledge, there are no published studies in which testing conditions and outcomes have been examined for multiple "typical screening events." PURPOSE The purpose of this article is to report hearing screening outcomes for pure tones and self-report screening tests and to examine their relationship with ambient noise levels in various screening environments. STUDY SAMPLE One thousand nine hundred fifty-four individuals who completed a hearing screening at one of 191 community-based screening events that took place in the Portland, OR, and Tampa, FL, metro areas. DATA COLLECTION AND ANALYSIS The data were collected during the recruitment phase of a large multisite study. All participants received a hearing screening that consisted of otoscopy, pure-tone screening, and completion of the Hearing Handicap Inventory-Screening Version (HHI-S). In addition, ambient sound pressure levels were measured just before pure-tone testing. RESULTS Many more individuals failed the pure-tone screening (n = 1,238) and then failed the HHI-S (n = 796). The percentage of individuals who failed the pure-tone screening increased linearly with age from <20% for ages <45 yr to almost 100% for individuals aged ≥85 yr. On the other hand, the percentage of individuals who failed the HHI-S remained unchanged at approximately 40% for individuals aged ≥55 yr. Ambient noise levels varied considerably across the hearing screening locations. They impacted the pure-tone screen failure rate but not the HHI-S failure rate. CONCLUSIONS It is important to select screening locations with a quiet space for pure-tone screening, use headphones with good passive attenuation, measure sound levels regularly during hearing screening events, halt testing if ambient noise levels are high, and/or alert individuals to the possibility of a false-positive screening failure. The data substantiate prior findings that the relationship between pure-tone sensitivity and reported hearing loss changes with age. Although it might be possible to develop age-specific HHI-S failure criteria to adjust for this, such an endeavor is not recommended because perceived difficulties are the best predictor of hearing health behaviors. Instead, it is proposed that a public health focus on education about hearing and hearing loss would be more effective.
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Affiliation(s)
- Gabrielle H Saunders
- VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR.,Department of Otolaryngology, Oregon Health and Sciences University, Portland, OR
| | - Melissa T Frederick
- VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
| | - ShienPei C Silverman
- VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
| | - Tina Penman
- VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
| | - Austin Gardner
- VA RR&D National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, OR
| | - Theresa H Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Celia D Escabi
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Preyanca H Oree
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Laura C Westermann
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Victoria A Sanchez
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
| | - Michelle L Arnold
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL
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Affiliation(s)
- Michelle L. Arnold
- Michelle L. Arnold ( ) is a research audiologist in the Department of Communication Sciences and Disorders, University of South Florida, in Tampa
| | - Kathryn Hyer
- Kathryn Hyer is a professor in the School of Aging Studies, University of South Florida, and director of the Florida Policy Exchange Center on Aging
| | - Theresa Chisolm
- Theresa Chisolm is a professor in the Department of Communication Sciences and Disorders and vice provost for strategic planning, performance, and accountability, both at the University of South Florida
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Antwi SO, Eckel-Passow JE, Diehl ND, Serie DJ, Custer KM, Arnold ML, Wu KJ, Cheville JC, Thiel DD, Leibovich BC, Parker AS. Coffee consumption and risk of renal cell carcinoma. Cancer Causes Control 2017. [PMID: 28647866 DOI: 10.1007/s10552-017-0913-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies have suggested an inverse association between coffee consumption and risk of renal cell carcinoma (RCC); however, data regarding decaffeinated coffee are limited. METHODS We conducted a case-control study of 669 incident RCC cases and 1,001 frequency-matched controls. Participants completed identical risk factor questionnaires that solicited information about usual coffee consumption habits. The study participants were categorized as non-coffee, caffeinated coffee, decaffeinated coffee, or both caffeinated and decaffeinated coffee drinkers. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using logistic regression, adjusting for multiple risk factors for RCC. RESULTS Compared with no coffee consumption, we found an inverse association between caffeinated coffee consumption and RCC risk (OR 0.74; 95% CI 0.57-0.99), whereas we observed a trend toward increased risk of RCC for consumption of decaffeinated coffee (OR 1.47; 95% CI 0.98-2.19). Decaffeinated coffee consumption was associated also with increased risk of the clear cell RCC (ccRCC) subtype, particularly the aggressive form of ccRCC (OR 1.80; 95% CI 1.01-3.22). CONCLUSIONS Consumption of caffeinated coffee is associated with reduced risk of RCC, while decaffeinated coffee consumption is associated with an increase in risk of aggressive ccRCC. Further inquiry is warranted in large prospective studies and should include assessment of dose-response associations.
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Affiliation(s)
- Samuel O Antwi
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Jeanette E Eckel-Passow
- Department of Health Sciences Research, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Nancy D Diehl
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Daniel J Serie
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kaitlynn M Custer
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michelle L Arnold
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Kevin J Wu
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Bradley C Leibovich
- Department of Urology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Alexander S Parker
- Department of Health Sciences Research, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Parker AS, Arnold ML, Diehl ND, Hassan L, Thiel DD. Evaluation of awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Scand J Urol 2013; 48:239-44. [PMID: 24328689 DOI: 10.3109/21681805.2013.863803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE This study aimed to evaluate awareness of risk factors for kidney cancer among patients presenting to a urology clinic. Smoking, obesity and hypertension are widely accepted as risk factors for kidney cancer; however, there are limited data regarding awareness of these risk factors. MATERIAL AND METHODS The researchers prospectively identified 172 patients presenting to a urology clinic between 1 May 2009 and 31 August 2009. Each patient completed a questionnaire that requested responses to whether certain lifestyle factors increased the risk of a variety of cancers. Information on demographics and other covariates was collected via questionnaires and medical chart abstraction. To estimate and compare risk factor awareness levels for different cancers, 95% confidence intervals (95% CIs) were constructed and Fisher's exact tests performed. Logistic regression analysis was used to evaluate covariates associated with risk factor awareness. RESULTS The percentage reporting that smoking increases the risk of kidney cancer (36%, 95% CI 29-44%) was lower than for lung cancer (96%, 95% CI 92-99%). Similarly, the percentage reporting that obesity increases the risk of kidney cancer (32%, 95% CI 25-40%) was lower than for colon cancer (45%, 95% CI 37-53% CI). Only 18% (95% CI 13-25%) identified hypertension as a risk factor for kidney cancer. Female gender and younger age were associated with increased levels of awareness of the association with smoking and obesity, respectively. CONCLUSION The data support a low level of awareness of kidney cancer risk factors and underscore an opportunity for urologists to engage in education efforts.
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Affiliation(s)
- Alexander S Parker
- Departments of Health Sciences Research, Mayo Clinic , Jacksonville, Florida , USA
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Parker AS, Diehl N, Arnold ML, Rivera S, Cannon A, Custer K, Leibovich B. Abstract A62: Alcohol consumption, genetic variation in alcohol dehydrogenase genes, and risk of clear cell renal cell carcinoma. Cancer Prev Res (Phila) 2013. [DOI: 10.1158/1940-6215.prev-13-a62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: An inverse association between alcohol consumption and risk of renal cell carcinoma (RCC) is well reported in the literature. Despite this, no investigators have explored the potential for effect modification of this association by genetic variations in enzymes that metabolize alcohol. Motivated by this, we conducted a pilot investigation of the role of genetic variation in the alcohol dehydrogenase genes (ADH) as an effect modifier of the association of alcohol and RCC risk.
Methods: We analyzed data on 121 RCC cases and 121 controls. Cases were prospectively collected as part of our Renal Registry in the Department of Urology. Controls were recruited through the Family Medicine and frequency matched to cases on age, gender and state of residence. We collected detailed risk factor data (self-report questionnaire) as well as a DNA sample on cases and controls. We utilized Sequenome analysis to determine presence of published SNPs in the ADH gene cluster (ADH1-7). We employed logistic regression with interaction terms as well as stratified analyses to evaluate effect modification by genetic variants in the ADH gene cluster on the association of alcohol consumption and RCC risk.
Results: Compared to non-drinkers, those that consumed alcohol above the median experienced a lowering in RCC risk (OR=0.80; 95% CI 0.5 to 1.43). We observed evidence of interactions with 6 SNPs in the ADH gene (p-values from 0.05-0.2). As an example, in stratified analysis, the inverse association strengthened in those without the minor allele present at rs1154454 in ADH7 (OR=0.56; 95% CI 0.3 to 1.0; p=0.08) while evidence of an increased in RCC risk was noted among those with the minor allele (OR=2.14; 95CI 0.8 – 5.7; p=0.1). Adjustment for age and gender did not alter our results.
Conclusion: Our pilot data suggest that specific variants in the ADH gene cluster may modify the reported protective effect of alcohol consumption on RCC risk. Given the possible implications for improving our understanding of the biology of this association and informing prevention, future investigations that analyze a larger sample size and examine additional variants are warranted.
Citation Format: Alexander Scott Parker, Nancy Diehl, Michelle L. Arnold, Shauna Rivera, Ashley Cannon, Kaitlynn Custer, Bradley Leibovich. Alcohol consumption, genetic variation in alcohol dehydrogenase genes, and risk of clear cell renal cell carcinoma. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr A62.
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Arnold ML, Thiel DD, Diehl N, Wu KJ, Ames S, Parker AS. Comparison of baseline quality of life measures between renal cell carcinoma patients undergoing partial versus radical nephrectomy. BMC Urol 2013; 13:52. [PMID: 24148752 PMCID: PMC3816591 DOI: 10.1186/1471-2490-13-52] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background To compare demographics, pathologic features, performance scores, comorbidities, symptoms and responses to quality of life (QoL) surveys between nephron-sparing surgery (NSS) and radical nephrectomy (RN) patients prior to surgical intervention. Previous investigators have compared QoL outcomes for patients undergoing RN and NSS; however, there are limited data comparing QoL-related characteristics at baseline between these groups. Methods We identified 144 patients with localized RCC who underwent either NSS (n = 71) or RN (n = 73) between May ‘07-November ‘12. We abstracted baseline data on demographic and clinic-pathologic variables as well as responses to the SF-36 and FACT-G surveys from our prospective registry. We amended the FACT-G with 8 additional questions designed to address RCC-specific QoL. For comparisons between the two groups, we employed Wilcoxon rank-sum and Fisher's Exact tests where appropriate. Results We observed RN patients to have more aggressive pathology. We noted no difference in performance scores between the two groups; however, RN patients were more likely to have higher Charlson scores (p = 0.022) and various symptoms at presentation (all p <0.001). For the QoL surveys, we did not observe differences on the FACT-G; however, we noted evidence of differential scores between the two groups on specific domains of the SF-36 (e.g. Mental Health; p 0.022) and the RCC-specific QoL questions added to the FACT-G. Conclusions We report baseline differences between RN and NSS patients on clinico-pathologic as well as QoL-related metrics. As issues of survivorship become increasingly important, our results underscore the need to consider baseline status in evaluations of QoL-related outcomes for patients undergoing surgery for RCC.
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Affiliation(s)
| | | | | | | | | | - Alexander S Parker
- Department of Health Sciences Research, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Thiel DD, Lohse CM, Arnold ML, Cheville JC, Leibovich BC, Parker AS. Does left side renal cell carcinoma (RCC) with renal vein/vena cava thrombus predict worse prognosis than equivalent right side RCC tumor thrombus? Int Urol Nephrol 2012; 44:1005-12. [DOI: 10.1007/s11255-012-0168-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/22/2012] [Indexed: 11/29/2022]
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Jorns J, Thiel DD, Lohse CM, Williams A, Arnold ML, Cheville JC, Leibovich BC, Parker AS. Three-dimensional tumour volume and cancer-specific survival for patients undergoing nephrectomy to treat pT1 clear-cell renal cell carcinoma. BJU Int 2012; 110:956-60. [PMID: 22300498 DOI: 10.1111/j.1464-410x.2012.10937.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Study Type - Prognosis (case series) Level of Evidence 4. What's known on the subject? and What does the study add? The positive association of tumour size (largest tumour dimension on pathology review) and risk of RCC progression and survival following nephrectomy is well documented. Moreover, several clinicopathological scoring systems (i.e. nomograms and algorithms) have been developed to predict outcomes for surgically treated RCC patients and each of these includes tumour size as an independent predictor of RCC outcome. There is still the question of whether information on three-dimensional tumour volume (cm(3) ) can provide additional prognostic information, particularly among patients with small pT1 tumours where the range of tumour size is more limited. Our study demonstrates that increasing tumour volume is associated with a greater risk of RCC-specific death in patients with pT1 ccRCC, with a more pronounced association in pT1a tumours specifically. In addition, we observed evidence that tumour volume may provide more accurate prognostic information than tumour size alone in pT1a patients. Tumour volume may add prognostic information specifically in pT1a RCC. OBJECTIVE To address whether information on three-dimensional tumour volume can provide additional prognostic information for patients with small, localized renal cell carcinoma (RCC) superior to tumour size alone. PATIENTS AND METHODS We identified 955 patients treated with radical nephrectomy or nephron-sparing surgery for unilateral, sporadic, pT1, pN0/NX, M0, non-cystic clear-cell RCC (ccRCC) between 1980 and 2004, including 515 pT1a patients and 440 pT1b patients. • We estimated tumour volume using three tumour dimensions recorded on pathological analysis and the equation for the volume of an ellipsoid [π/6 (length × width × height)]. For tumour size alone, we used the maximum tumour diameter recorded on pathological analysis. • Univariate and multivariable associations with RCC-specific death were evaluated using Cox proportional hazards regression models summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among pT1a patients, the risk of RCC death associated with having a tumour volume above the median (HR = 4.55; 95% CI, 1.30-15.83; P= 0.018) was markedly higher than having a tumour size above the median (HR = 2.55; 95% CI 0.83-7.85; P= 0.10). Comparison of concordance (c) index values further supported the idea that additional prognostic information was provided by tumour volume (c= 0.659) compared with tumour size (c= 0.600) for pT1a patients. • Among pT1b patients, we noted that associations of tumour volume and tumour size with RCC-specific death were similar. • Multivariable adjustment did not alter our findings. CONCLUSIONS Tumour volume could provide valuable prognostic information for patients with pT1a ccRCC but not pT1b ccRCC. • Future investigations are needed to confirm this finding, explore other RCC subtypes and evaluate accuracy of tumour volume determination on radiographic imaging for potential patient management before surgery.
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Affiliation(s)
- Jacob Jorns
- Department of Urology, Mayo Medical School and Mayo Clinic, Jacksonville, Florida 32224, USA
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Arnold ML, Van Houten R. Increasing following headway with prompts, goal setting, and feedback in a driving simulator. J Appl Behav Anal 2011; 44:245-54. [PMID: 21709782 DOI: 10.1901/jaba.2011.44-245] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 09/13/2010] [Indexed: 11/22/2022]
Abstract
We evaluated the effects of prompting, goal setting, and feedback on following headway of young drivers in a simulated driving environment and assessed whether changes produced in following headway were associated with reductions in hard braking when drivers were and were not using cell phones. Participants were 4 university students. During baseline, drivers spent half of the time talking on cell phones while driving. At the start of the intervention, drivers were prompted to increase following headway while on the cell phones and were provided a specific target for following headway. Drivers were given feedback on increasing following headway when on cell phones at the end of each session. The intervention package was associated with an increase in following headway and a decrease in hard braking when participants were on and off the cell phones. Cell phone use did not affect any of the measures.
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Arnold ML, Shaw DD, Contreras N. Ribosomal RNA-encoding DNA introgression across a narrow hybrid zone between two subspecies of grasshopper. Proc Natl Acad Sci U S A 2010; 84:3946-50. [PMID: 16593840 PMCID: PMC304993 DOI: 10.1073/pnas.84.11.3946] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A ribosomal RNA-encoding DNA (rDNA) cloned sequence, consisting of a 0.8-kilobase fragment from the 26S/nontranscribed spacer region, was used to identify diagnostic restriction enzyme fragments that distinguish the Moreton and Torresian subspecies of the grasshopper Caledia captiva. These restriction fragments were then used to study patterns of rDNA variation across a narrow geographical hybrid zone between the two subspecies. The pattern of rDNA variation that emerged after the analysis of over 250 individuals clearly demonstrates the asymmetrical introgression of the Moreton ribosomal RNA genes into the Torresian subspecies. This asymmetric movement of genetic material occurs even though there exists extreme postmating F(2) and backcross inviability between the two subspecies. From our data, as well as those of previous chromosomal and allozymic studies, we are able to support the occurrence of nonrandom processes such as biased gene conversion and/or natural selection. Because the rDNA loci in the Moreton and Torresian individuals are located in different regions on chromosomes 10 and 11, it should be possible to determine the relative contributions of conversion, natural selection, and these sorts of processes to the pattern of introgression of the Moreton rDNA into the Torresian subspecies.
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Affiliation(s)
- M L Arnold
- Population Genetics Group, Research School of Biological Sciences, The Australian National University, Canberra, ACT 2601 Australia
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Parker AS, Leroy TJ, McNeil RB, Bot BM, Diehl N, Arnold ML, Kreinest PA, Hilton TW, Wu KJ, Igel TC. LOSS OF EXPRESSION OF THE VITAMIN D RECEPTOR IN CLEAR CELL RENAL CELL CARCINOMA. J Urol 2009. [DOI: 10.1016/s0022-5347(09)60703-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lehmann J, Stern RL, Daly TP, Rocke DM, Schwietert CW, Jones GE, Arnold ML, Siantar CLH, Goldberg Z. Dosimetry for Quantitative Analysis of the Effects of Low-Dose Ionizing Radiation in Radiation Therapy Patients. Radiat Res 2006; 165:240-7. [PMID: 16435922 DOI: 10.1667/rr3480.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We have developed and validated a practical approach to identifying the location on the skin surface that will receive a prespecified biopsy dose (ranging down to 1 cGy) in support of in vivo biological dosimetry in humans. This represents a significant technical challenge since the sites lie on the patient's surface outside the radiation fields. The PEREGRINE Monte Carlo simulation system was used to model radiation dose delivery, and TLDs were used for validation on phantoms and for confirmation during patient treatment. In the developmental studies, the Monte Carlo simulations consistently underestimated the dose at the biopsy site by approximately 15% (of the local dose) for a realistic treatment configuration, most likely due to lack of detail in the simulation of the linear accelerator outside the main beam line. Using a single, thickness-independent correction factor for the clinical calculations, the average of 36 measurements for the predicted 1-cGy point was 0.985 cGy (standard deviation: 0.110 cGy) despite patient breathing motion and other real-world challenges. Since the 10-cGy point is situated in the region of high-dose gradient at the edge of the field, patient motion had a greater effect, and the six measured points averaged 5.90 cGy (standard deviation: 1.01 cGy), a difference that is equivalent to approximately a 6-mm shift on the patient's surface.
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Affiliation(s)
- Joerg Lehmann
- Glenn T. Seaborg Institute, University of California-Lawrence Livermore National Laboratory, Livermore, California, USA.
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Chettle DR, Arnold ML, Aro ACA, Fleming DEB, Kondrashov VS, McNeill FE, Moshier EL, Nie H, Rothenberg SJ, Stronach IM, Todd AC. An agreed statement on calculating lead concentration and uncertainty in XRF in vivo bone lead analysis. Appl Radiat Isot 2003; 58:603-5. [PMID: 12735978 DOI: 10.1016/s0969-8043(03)00060-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Arnold ML, McNeill FE, Stronach IM, Pejovic-Milic A, Chettle DR, Waker A. An accelerator based system for in vivo neutron activation analysis measurements of manganese in human hand bones. Med Phys 2002; 29:2718-24. [PMID: 12462740 DOI: 10.1118/1.1517613] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Manganese (Mn) is an essential nutrient for growth and development. Unfortunately, overexposure can lead to neurological damage, which is manifested as a movement disorder marked by tremors. Preclinical symptoms have been found in populations occupationally exposed to the element, and it is suggested that in late stages of the disorder, removing the Mn exposure will not prevent symptoms from progressing. Hence, it is desirable to have a means of monitoring Mn body burden. In vivo neutron activation analysis (IVNAA) is a technique which allows the concentration of some elements to be determined within sites of the body without invasive procedures. Data in the literature suggests that the Mn concentration in bone is greater than other tissues, and that it may be a long term storage site following exposure. Therefore, using the McMaster KN-accelerator to produce neutrons through the 7Li(p,n)7Be reaction, the feasibility of IVNAA for measuring Mn levels in the human hand bone was investigated. Mn is activated through the 55Mn(n,gamma)56Mn reaction, and the 847 keV gamma rays emitted when 56Mn decays are measured outside the body using NaI(Tl) detectors. An optimal incident proton energy of 2.00 MeV was determined from indium foil and microdosimetry measurements. Hand phantom data suggest a minimum detectable limit of approximately 1.8 ppm could be achieved with a reasonably low dose of 50 mSv to the hand (normal manganese levels in the human hand are approximately 1 ppm). It is recommended the technique be developed further to make human in vivo measurements.
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Affiliation(s)
- M L Arnold
- Medical Physics and Radiation Sciences Unit, McMaster University, Hamilton, Ontario L8S 4K1, Canada
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Abstract
Over the years, the evolutionary importance of natural hybridization has been a contentious issue. At one extreme is the relatively common view of hybridization as an evolutionarily unimportant process. A less common perspective, but one that has gained support over the past decade, is that of hybridization as a relatively widespread and potentially creative evolutionary process. Indeed, studies documenting the production of hybrid genotypes exhibiting a wide range of fitnesses have become increasingly common. In this review, we examine the genetic basis of such variation in hybrid fitness. In particular, we assess the genetic architecture of hybrid inferiority (both sterility and inviability). We then extend our discussion to the genetic basis of increased fitness in certain hybrid genotypes. The available evidence argues that hybrid inferiority is the result of widespread negative epistasis in a hybrid genetic background. In contrast, increased hybrid fitness can be most readily explained through the segregation of additive genetic factors, with epistasis playing a more limited role.
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Affiliation(s)
- J M Burke
- Department of Biology, Indiana University, Bloomington, Indiana 47405, USA.
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Wassmuth R, Hauser IA, Schuler K, Erxleben H, Arnold ML, Koelman CA, Claas FH, Kalden JR. Differential inhibitory effects of intravenous immunoglobulin preparations on HLA-alloantibodies in vitro. Transplantation 2001; 71:1436-42. [PMID: 11391232 DOI: 10.1097/00007890-200105270-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatment of allosensitized patients with intravenously administered pooled immunoglobulin preparations (IVIG) may lead to a long-lasting reduction of anti-HLA alloantibody titers. An inhibitory response of IVIG preparations on lymphocytotoxicity is suggested to depend on IgG and to predict a successful reduction of anti-HLA alloantibodies upon the administration of high-dose IVIG in vivo. METHODS In this study, we evaluated different IVIG preparations for their in vitro inhibitory capacity on lymphocytotoxicity and binding of anti-HLA alloantibodies to purified HLA antigens. For that purpose sera from 24 highly sensitized patients awaiting kidney transplantation and serological HLA testing reagents were used. Panel-reactive antibody (PRA) determinations using standard complement-dependent cytotoxicity testing and anti-HLA alloantibody determination by ELISA were carried out in the presence and absence of 50% (v/v) IVIG. RESULTS The addition of IgG-containing IVIG preparations gave only a moderate inhibitory response judging from the average decrease of PRA levels (absolute DeltaPRA range: -2% to 16%), whereas the largest inhibition of lymphocytotoxicity was seen after the addition of IgM/IgA-containing IVIG preparations (absolute DeltaPRA range: 19% to 44%). For both IgG and IgM/IgA-containing IVIG preparations, the reduction of lymphocytotoxicity occurred in a dose-dependent fashion without a preference for particular anti-HLA class I antibody specificities. Significantly lower inhibitory effects on anti-HLA antibody reactivity were observed when the effects of IVIG preparations were monitored by ELISA (absolute DeltaPRA range: 7% to 22%). CONCLUSIONS Our data suggest that the immunomodulatory capacity is largely caused by the IgM/IgA fraction of IVIG when analyzed by lymphocytotoxicity. The different effect on ELISA versus complement-dependent cytotoxicity testing suggests that interactions of IVIG with complement rather than anti-idiotypic antibodies may contribute to the inhibitory effects of IVIG in vitro.
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Affiliation(s)
- R Wassmuth
- Department of Medicine III, University of Erlangen-Nürnberg, Erlangen, Germany.
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Johnston JA, Wesselingh RA, Bouck AC, Donovan LA, Arnold ML. Intimately linked or hardly speaking? The relationship between genotype and environmental gradients in a Louisiana Iris hybrid population. Mol Ecol 2001; 10:673-81. [PMID: 11298978 DOI: 10.1046/j.1365-294x.2001.01217.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several models of hybrid zone evolution predict the same spatial patterns of genotypic distribution whether or not structuring is due to environment-dependent or -independent selection. In this study, we tested for evidence of environment-dependent selection in an Iris fulva x Iris brevicaulis hybrid population by examining the distribution of genotypes in relation to environmental gradients. We selected 201 Louisiana Iris plants from within a known hybrid population (80 m x 80 m) and placed them in four different genotypic classes (I. fulva, I. fulva-like hybrid, I. brevicaulis-like hybrid and I. brevicaulis) based on seven species-specific random amplified polymorphic DNA (RAPD) markers and two chloroplast DNA haplotypes. Environmental variables were then measured. These variables included percentage cover by tree canopy, elevation from the high water mark, soil pH and percentage soil organic matter. Each variable was sampled for all 201 plants. Canonical discriminant analysis (CDA) was used to infer the environmental factors most strongly associated with the different genotypic groups. Slight differences in elevation (-0.5 m to +0.4 m) were important for distinguishing habitat distributions described by CDA, even though there were no statistical differences between mean elevations alone. I. brevicaulis occurred in a broad range of habitats, while I. fulva had a narrower distribution. Of all the possible combinations, I. fulva-like hybrids and I. brevicaulis-like hybrids occurred in the most distinct habitat types relative to one another. Each hybrid class was not significantly different from its closest parent with regard to habitat occupied, but was statistically unique from its more distant parental species. Within the hybrid genotypes, most, but not all, RAPD loci were individually correlated with environmental variables. This study suggests that, at a very fine spatial scale, environment-dependent selection contributed to the genetic structuring of this hybrid zone.
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Affiliation(s)
- J A Johnston
- Department of Botany, University of Georgia, Athens, GA 30602, USA
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Pratt MW, Danso HA, Arnold ML, Norris JE, Filyer R. Adult generativity and the socialization of adolescents: relations to mothers' and fathers' parenting beliefs, styles, and practices. J Pers 2001; 69:89-120. [PMID: 11294343 DOI: 10.1111/1467-6494.00137] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mothers, fathers, and their adolescent children participated in two studies investigating the relations between Erikson's concept of generativityin adulthood and patterns of parenting. Study 1 involved 77 mothers and 48 fathers of 1st-year university students; Study 2 was part of an investigation of socialization processes in 35 families with an adolescent, aged 14-18. Parental generative concern was assessed by the Loyola Generativity Scale (LGS) of McAdams and de St. Aubin (1992) in each study. In both studies, mothers demonstrated positive relations between scores on the LGS and an authoritative style of parenting, as well as between generativity and more positive, optimistic views of adolescent development. In Study 2, these more positive views in turn mediated some aspects of autonomy-fostering practices used with the adolescent. Variations in fathers' levels of generative concern were less consistently related to these indices of parenting, however.
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Affiliation(s)
- M W Pratt
- Psychology Department, Wilfrid Laurier University, Waterloo, Ontario, Canada.
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Abstract
Most models of hybridization assume that hybrids are less fit than their parental taxa. In contrast, some researchers have explored the possibility that hybrid individuals may actually have higher fitness and so play an important role in the generation of new species or adaptations. By estimating age-specific fitness components, we can determine not only how hybrid fitness differs from parental taxa, but also whether the fitness of hybrids relative to parental taxa changes with age. Here we describe an analysis of age-specific fitness traits in two species of Drosophila, D. pseudoobscura and D. persimilis, and their F1 hybrids. At early ages, hybrid females lay as many eggs as parental individuals, on average, but produce far fewer offspring. By late ages, in contrast, parental taxa show a steep decline in production not seen in hybrids, such that hybrids produce more offspring, on average, than parental taxa. Furthermore, egg-adult survival in hybrids is negatively correlated with egg density, whereas these traits are only weakly correlated in parental taxa. The results are limited somewhat by the fact that we analyze only two strains, and that these may be partially inbred. Nonetheless, the results are certainly illustrative, pointing out not only that at least some hybrid individuals may be as fit or fitter than parental taxa, but also that the difference between hybrids and parental taxa varies with age.
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Affiliation(s)
- D E Promislow
- Department of Genetics, University of Georgia, Athens 30602-7223, USA.
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Affiliation(s)
- M L Arnold
- Department of Genetics, University of Georgia, Athens, GA 30602, USA.
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Pejović-Milić A, Arnold ML, McNeill FE, Chettle DR. Monte Carlo design study for in vivo bone aluminum measurement using a low energy accelerator beam. Appl Radiat Isot 2000; 53:657-64. [PMID: 11003504 DOI: 10.1016/s0969-8043(00)00200-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The need for aluminum monitoring exists in occupational medicine, as well as for the clinical monitoring of patients with renal dysfunction. After the development of an appropriate neutron source card, Monte Carlo simulations were made to design moderator/reflector assembly consisting of a polyethylene moderator (2 cm) and graphite reflector (30 cm), surrounded by a boronated (5%) wax (20 cm) and lead (1 cm) shield. This design should allow for the bone aluminum measurement of healthy subjects, but prior to that detailed microdosimetry is necessary to address a noticed disagreement between theoretical and experimental dose data.
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Affiliation(s)
- A Pejović-Milić
- Department of Physics and Astronomy, McMaster University, Hamilton, ON, Canada.
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Arnold ML, McNeill FE, Prestwich WV, Chettle DR. System design for in vivo neutron activation analysis measurements of manganese in the human brain: based on Monte Carlo modeling. Appl Radiat Isot 2000; 53:651-6. [PMID: 11003503 DOI: 10.1016/s0969-8043(00)00199-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Manganese is an essential nutrient required by the human body, but conversely, over exposure to the element may cause central nervous system damage. The technique of in vivo neutron activation analysis, using the McMaster KN-accelerator, is being investigated as a possible method of noninvasively determining manganese concentrations within the human body. Since the brain is the primary target of damage from exposure it would be the ideal site for measurements. Thus, Monte Carlo simulations have been undertaken to define the optimum experimental parameters for such a measurement, examining the use of possible moderator, reflector and collimator materials.
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Affiliation(s)
- M L Arnold
- Department of Physics and Astronomy, McMaster University, Hamilton, ON, Canada.
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Wesselingh RA, Arnold ML. Nectar Production in Louisiana Iris Hybrids. Int J Plant Sci 2000; 161:245-251. [PMID: 10777448 DOI: 10.1086/314252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/1999] [Revised: 11/01/1999] [Indexed: 05/23/2023]
Abstract
Nectar is an important attractant for pollinators, and a plant's success in sexual reproduction can be influenced by the amount and concentration of nectar produced by its flowers. We studied nectar production over flower lifetime in Iris fulva, Iris brevicaulis, and four classes of hybrids-reciprocal F1's and backcrosses-between these species. Iris fulva produced less concentrated nectar than did I. brevicaulis, whereas I. brevicaulis flowers had a shorter life span. Hybrids were not intermediate, but they had the high nectar concentration of I. brevicaulis combined with the long life span of I. fulva flowers. Nectar production and concentration declined after the first day in all classes, but flowers continued to produce nectar until they were completely wilted. Backcrosses did not show a shift in mean or increased variation for the characters that distinguished the parental species; backcrosses toward I. fulva retained the high nectar concentration of I. brevicaulis, and backcrosses toward I. brevicaulis did not have a reduced flower life span. Overall, F1 hybrid flowers produced the highest amounts of nectar and nectar sugar over their life spans. These results, together with previously obtained data on pollinator choice in mixed arrays of the same flower classes, show that F1 hybrids between these species do not suffer from reduced attractiveness to pollinators. F1 individuals produced more nectar and nectar sugar than did their parents, and thus, they are possibly even more attractive to pollinators that forage for nectar.
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Abstract
The plant genera in which natural hybridization is most prevalent tend to be outcrossing perennials with some mechanism for clonal (i.e., asexual) reproduction. Although clonal reproduction in fertile, sexually reproducing hybrid populations could have important evolutionary consequences, little attention has been paid to quantifying this parameter in such populations. In the present study, we examined the frequency and spatial patterning of clonal reproduction in two Louisiana iris hybrid populations. Allozyme analysis of both populations revealed relatively high levels of genotypic diversity. However, a considerable amount of clonality was apparent. Nearly half of all genets (47%) in one population and more than half (61%) in the other had multiple ramets. Furthermore, both populations exhibited relatively high levels of genetic structuring, a pattern that resulted from the aggregation of clonal ramets. The occurrence of clonal reproduction in hybrid populations could not only facilitate introgression through an increase in the number of flowering ramets per genet and/or the survivorship of early generation hybrids, but might also influence the mating system of such populations. Any potential increase in the selfing rate due to cross-pollination among ramets of the same genet may, in turn, increase the likelihood of homoploid hybrid speciation.
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Affiliation(s)
- J M Burke
- Department of Genetics, University of Georgia, Athens 30602-7223, USA.
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