Nevin Manimala

Ear Hear. 2021 Apr 8. doi: 10.1097/AUD.0000000000001048. Online ahead of print.

ABSTRACT

OBJECTIVES: Speech understanding in noise is difficult for patients with a cochlear implant. One common and disruptive type of noise is transient noise. We have tested transient noise reduction (TNR) algorithms in cochlear implant users to investigate the merits of personalizing the noise reduction settings based on a subject’s own preference.

DESIGN: The effect of personalizing two parameters of a broadband and a multiband TNR algorithm (TNRbb and TNRmb, respectively) on speech recognition was tested in a group of 15 unilaterally implanted subjects in cafeteria noise. The noise consisted of a combination of clattering dishes and babble noise. Each participant could individually vary two parameters, namely the scaling factor of the attenuation and the release time (τ). The parameter τ represents the duration of the attenuation applied after a transient is detected. As a reference, the current clinical standard TNR “SoundRelax” from Advanced Bionics was tested (TNRbb-std). Effectiveness of the algorithms on speech recognition was evaluated adaptively by determining the speech reception threshold (SRT). Possible subjective benefits of the algorithms were assessed using a rating task at a fixed signal-to-noise ratio (SNR) of SRT + 3 dB. Rating was performed on four items, namely speech intelligibility, speech naturalness, listening effort, and annoyance of the noise. Word correct scores were determined at these fixed speech levels as well.

RESULTS: The personalized TNRmb improved the SRT statistically significantly with 1.3 dB, while the personalized TNRbb degraded it significantly by 1.7 dB. For TNRmb, we attempted to further optimize its settings by determining a group-based setting, leaving out those subjects that did not experience a benefit from it. Using these group-based settings, however, TNRmb did not have a significant effect on the SRT any longer. TNRbb-std did not affect speech recognition significantly. No significant effects on subjective ratings were found for any of the items investigated. In addition, at a constant speech level of SRT + 3 dB, no effect of any of the algorithms was found on word correct scores, including TNRmb with personalized settings.

CONCLUSIONS: Our study results indicate that personalizing noise reduction settings of a multiband TNR algorithm can significantly improve speech intelligibility in transient noise, but only under challenging listening conditions around the SRT. At more favorable SNRs (SRT + 3 dB), this benefit was lost. We hypothesize that TNRmb was beneficial at lower SNRs, because of more effective artifact detection under those conditions. Group-averaged settings of the multiband algorithm did not significantly affect speech recognition. TNRbb decreased speech recognition significantly using personalized parameter settings. Rating scores were not significantly affected by the algorithms under any condition tested. The currently available TNR algorithm for Advanced Bionics systems (SoundRelax) is a broadband filter that does not support personalization of its settings. Future iterations of this algorithm might benefit from upgrading it to a multiband variant with the option to personalize its parameter settings.

PMID:33974780 | DOI:10.1097/AUD.0000000000001048

WMJ. 2021 Apr;120(1):45-50.

ABSTRACT

OBJECTIVE: The American College of Obstetrics and Gynecology (ACOG) has recommended every hospital disclose their level of maternal care (LOMC) to categorize the capabilities of their birthing center and regionalize perinatal care. Of the 98 birthing centers in Wisconsin, 44% have self-disclosed their LOMC. In many states, disclosing LOMC is mandated but, despite evidence and professional association recommendations, Wisconsin relies on voluntary self-reporting. We surveyed all birthing centers in Wisconsin to better understand the barriers to disclosing their LOMC.

STUDY DESIGN: An anonymous survey was sent to all 98 birthing centers in Wisconsin. Survey recipients were hospital administrators, nursing supervisors, or physician directors of obstetric units. The survey sought information on perceived barriers to completing self-assessments and disclosing their hospital’s LOMC. Quantitative descriptive statistics were used for data analysis.

RESULTS: Of 98 birth centers in Wisconsin, 40 (40.8%) responded. Fifteen of the 40 responses were from birthing centers that have not yet disclosed their LOMC. Of these, 93% were unsure how to disclose, 73% found the paperwork confusing, and 80% did not have the time or staff to complete the paperwork. Respondents did not report lack of departmental support, concerns about losing business or reputation, or future physician recruitment as barriers. Of all respondents, 77.5% were aware of ACOG’s LOMC recommendations, but only 35% thought disclosing their LOMC would be beneficial to maternal care.

CONCLUSIONS: Birthing centers in Wisconsin need further guidance on how to complete a self-assessment of their LOMC. In order to increase self-disclosure of LOMC, statewide perinatal organizations will need to continue to emphasize the benefits of releasing this information. Organizations should also provide additional support to level 1 and 2 birthing centers and improve maternal and neonatal care overall.

PMID:33974765

WMJ. 2021 Apr;120(1):34-40.

ABSTRACT

PROBLEM CONSIDERED: Obstructive sleep apnea (OSA) is underdiagnosed during pregnancy, but there is strong theoretical and some empiric evidence that treatment may improve obstetric outcomes. Barriers to screening, testing, and treatment are common during pregnancy. The goal of this described intervention was to reduce these barriers and improve detection of OSA in pregnancy.

METHODS: Representatives from sleep medicine and perinatology established a cross-disciplinary, collaborative Sleep Pregnancy Clinic offering a streamlined referral process for multimodal screening, testing, and treatment of OSA during pregnancy. This is a retrospective analysis of data from the clinic’s first 19 months.

RESULTS: Between June 2017 and December 2018, 134 pregnant women were referred for OSA testing. Sixty-three (47.0%) completed objective sleep testing, and 38 (60.3%) of the women who completed testing met diagnostic criteria for OSA. This intervention resulted in a statistically significant increase in the number of diagnostic sleep apnea tests performed (average 22.4 tests per year pre-intervention, 77 per year post-intervention [P = 0.0012]).

DISCUSSION AND CONCLUSIONS: Despite a streamlined referral pipeline, completion rates of OSA testing in pregnant women remained below 50%. However, the overall number of women referred and who completed testing increased significantly during this time period. Of those who completed testing, the majority were diagnosed with OSA. Since starting this clinic, we have created resources to familiarize patients with the equipment and worked to reduce other barriers. Assessment of these interventions and the impact of treatment on obstetric outcomes is ongoing, as is assessment of reasons women do not complete diagnostic testing.

PMID:33974763

WMJ. 2021 Apr;120(1):17-22.

ABSTRACT

BACKGROUND: Studies suggest widespread advantages to peer mentoring programs; however, there is minimal data pertaining to medical students mentoring undergraduate students.

OBJECTIVES: To determine the feasibility and perceived effectiveness of a medical student-undergraduate student peer mentorship program.

METHODS: A needs assessment guided the development of Pre-Med Pair Up, a program connecting medical student mentors from the Medical College of Wisconsin and other US medical schools to undergraduates at Marquette University and the University of Wisconsin-Oshkosh to provide peer mentorship, premedical resources, and global health information. After 6 months, surveys were distributed to 43 premedical and 26 medical students to evaluate the program. Descriptive statistics and Pearson correlations (r) were used to assess the relational strength between program components and student confidence and knowledge.

RESULTS: Eleven undergraduate and 26 medical students completed surveys. Most undergraduates expressed increased confidence in abilities as premedical students associated with program involvement (18.2% great, 27.3% moderate, 45.5% minimal, 9.1% no improvement). Increased confidence was strongly correlated with knowledge of volunteer opportunities (r = 0.887, P < 0.001) and feelings of preparedness for the medical school application process (r = 0.854, P = 0.001) and curriculum (r = 0.871, P < 0.001).

CONCLUSION: While self-reported confidence improved and overall positive program outcomes were statistically significant, the number of participants was low and the number who completed mid-year surveys was even lower. Therefore, no conclusions about program effectiveness were made. Instead, a lessons-learned approach was used to discuss the pilot development, implementation, and suggestions for future program installment.

PMID:33974760

WMJ. 2021 Apr;120(1):8-16.

ABSTRACT

PROBLEM CONSIDERED: Medical schools historically have utilized instructor-centered lectures to teach medical students the basic sciences. Several commercial electronic-based resources are now available to enhance lecture-based content. This study examines perceptions between students and faculty regarding the efficacy of lecture-based teaching and learning strategies used by students overall.

RESEARCH METHODS: The authors distributed surveys to medical students and basic science teaching faculty at the Medical College of Wisconsin. Survey items used categorical and 10-point scales and open-ended text response. Mean scores were compared with independent t tests and Cohen d effect sizes. Pearson (r) and Spearman rho (ρ) correlations were used for relational analysis. IBM SPSS 24.0 was used for statistical analysis, NVivo 11 was used for qualitative analysis.

RESULTS: Faculty’s perception of meeting students’ learning needs was rated significantly higher (mean [SD] = 7.3 [1.3]) than students (5.9 [2.0]) (Cohen d = 1.0/P < .001). There was a significant negative correlation between lectures meeting students’ learning needs and time students spent outside of lecture seeking supplemental learning resources (ρ = -0.4/P < .001). Students highlighted their use of personal learning strategies, desire for equitable access to resources, and preparation for national board examinations. Faculty emphasized their perceptions of learning resources, recognition of learning styles, time restrictions, and desire to utilize diverse teaching methods.

CONCLUSIONS: Student and faculty perceptions regarding student learning needs were significantly different. Students use lectures extensively, but additionally add to the financial burden of medical school by personally funding supplemental resources. This study helps bridge the gap between medical students and faculty regarding what educational tools are best suited to support a student population with increasingly diverse learning needs.

PMID:33974759

Catheter Cardiovasc Interv. 2021 May 1;97(6):1139-1140. doi: 10.1002/ccd.29726.

NO ABSTRACT

PMID:33974740 | DOI:10.1002/ccd.29726

J Infect Dis. 2021 May 11:jiab253. doi: 10.1093/infdis/jiab253. Online ahead of print.

ABSTRACT

BACKGROUND: Understanding the genetic interplay between human hosts and infectious pathogens is crucial for how we interpret virulence factors. Here, we tested for associations between HIV and host genetics, and interactive genetic effects on viral load (VL) in HIV+ ART-naive clinical trial participants.

METHODS: HIV genomes were sequenced and the encoded amino acid (AA) variants were associated with VL, human single nucleotide polymorphisms (SNPs) and imputed HLA alleles, using generalized linear models with Bonferroni correction.

RESULTS: Human (388,501 SNPs) and HIV (3,010 variants) genetic data was available for 2,122 persons. Four HIV variants were associated with VL (p-values<1.66×10 -5). Twelve HIV variants were associated with a range of 1-512 human SNPs (p-value<4.28×10 -11). We found 46 associations between HLA alleles and HIV variants (p-values<1.29×10 -7). We found HIV variants and immunotypes when analyzed separately, were associated with lower VL, whereas the opposite was true when analyzed in concert. Epitope binding prediction showed HLA alleles to be weaker binders of associated HIV AA variants relative to alternative variants on the same position.

CONCLUSIONS: Our results show the importance of immunotype specificity on viral antigenic determinants, and the identified genetic interplay puts emphasis that viral and human genetics should be studied in the context of each other.

PMID:33974707 | DOI:10.1093/infdis/jiab253

Int Health. 2021 May 11:ihab024. doi: 10.1093/inthealth/ihab024. Online ahead of print.

ABSTRACT

The emotional impact of the coronavirus disease 2019 (COVID-19) pandemic on populations at large is emerging in the literature. However, the emotional response of persons with diabetes to the pandemic is only now beginning to emerge. Therefore this study aimed to identify factors contributing to emotional reactions towards this pandemic among persons with diabetes. A total of 205 persons with diabetes participated in this cross-sectional online survey between 14 May and 22 June 2020. Participants completed measures of emotional reactions towards COVID-19, perceived diabetes status, perceived susceptibility, knowledge about COVID-19, sense of mastery and sociodemographic questionnaires. Statistical analyses included Pearson correlations and regression analysis. According to the results, the mean score of negative emotional reactions towards COVID-19 was 3.45 (standard deviation 1.11, range 1-5), meaning that the score was relatively high. Higher levels of negative emotional reactions towards COVID-19 were associated with higher perceived susceptibility, greater knowledge about COVID-19 and a lower sense of mastery. The study’s findings emphasize the need to communicate ongoing knowledge regarding COVID-19 and diabetes as well as to provide persons with diabetes with the necessary emotional support related to coping with diabetes and COVID-19.

PMID:33974703 | DOI:10.1093/inthealth/ihab024

Eur Heart J Acute Cardiovasc Care. 2021 May 11;10(3):329-334. doi: 10.1177/2048872619848661.

ABSTRACT

BACKGROUND: Infectious endocarditis is often complicated by conduction abnormalities at the time of presentation. Cardiac surgery is the treatment of choice for many infectious endocarditis patients, but carries an additional risk of persistent postoperative conduction abnormality. We sought to define the incidence and clinical predictors of significant postoperative conduction abnormalities necessitating permanent pacemaker implantation after cardiac surgery for infectious endocarditis.

METHODS: All consecutive patients with infectious endocarditis who were surgically treated at Cleveland Clinic from 2007 to 2013 were identified using the Cleveland Clinic Infective Endocarditis Registry and the Cardiovascular Information Registry. Patients with a pre-existing cardiac implantable electronic device were excluded. The primary outcome was the need for permanent pacemaker placement postoperatively for atrioventricular block. Regression analysis was performed to identify risk factors for permanent pacemaker requirement.

RESULTS: Among 444 infectious endocarditis patients who underwent cardiac surgery for infectious endocarditis, 57 (13%) required postoperative permanent pacemaker for atrioventricular block. Multivariable analysis identified that prolongation in preoperative PR and QRS intervals, Staphylococcus aureus as the infectious endocarditis organism, the presence of intracardiac abscess, tricuspid valve involvement, and prior valvular surgery independently predicted postoperative permanent pacemaker placement. The developed model exhibited excellent predictive ability (c-statistic 0.88) and calibration.

CONCLUSION: Infectious endocarditis cardiac surgery patients often require a postoperative permanent pacemaker. Preoperative conduction abnormality, S. aureus infection, abscess, tricuspid valve involvement, and prior valvular surgery are strong predictors of postoperative permanent pacemaker placement.

PMID:33974691 | DOI:10.1177/2048872619848661

PLoS One. 2021 May 11;16(5):e0251436. doi: 10.1371/journal.pone.0251436. eCollection 2021.

ABSTRACT

BACKGROUND: In recent years, the price of pork in China continues to fluctuate at a high level. The forecast of pork price becomes more important. Single prediction models are often used for this work, but they are not accurate enough. This paper proposes a new method based on Census X12-GM(1,1) combination model.

METHODS: Monthly pork price data from January 2014 to December 2020 were obtained from the State Statistics Bureau(Mainland China). Census X12 model was adopted to get the long-term trend factor, business cycle change factor and seasonal factor of pork price data before September 2020. GM (1,1) model was used to fit and predict the long-term trend factor and business cycle change factor. The fitting and forecasting values of GM(1,1) were multiplied by the seasonal factor and empirical seasonal factor individually to obtain the fitting and forecasting values of the original monthly pork price series.

RESULTS: The expression of GM(1,1) model for fitting and forecasting long-term trend factor and and business cycle change factor was X(1)(k) = -1704.80e-0.022(k-1) + 1742.36. Empirical seasonal factor of predicted values was 1.002 Using Census X12-GM(1,1) method, the final forecast values of pork price from July 2020 to December 2020 were 34.75, 33.98, 33.23, 32.50, 31.78 and 31.08 respectively. Compared with ARIMA, GM(1,1) and Holt-Winters models, Root mean square error (RMSE), mean absolute percentage error (MAPE) and mean absolute error (MAE) of Census X12-GM(1,1) method was the lowest on forecasting part.

CONCLUSIONS: Compared with other single model, Census X12-GM(1,1) method has better prediction accuracy for monthly pork price series. The monthly pork price predicted by Census X12-GM(1,1) method can be used as an important reference for stakeholders.

PMID:33974663 | DOI:10.1371/journal.pone.0251436