Communicating Auditory Impairments Using Electroacoustic Composition

Changes in human sensory perception can occur for a variety of reasons. In the case of distortions or transformations in the human auditory system, the aetiology may include factors such as medical conditions affecting cognition or physiology, interaction of the ears with mechanical waves, or stem from chemically induced sources, such the consumption of alcohol. These changes may be permanent, intermittent, or temporary. In order to communicate such effects to an audience in an accessible, and easily understood manner, a series of electroacoustic compositions were produced. This concept follows on from previous work on the theme of representing auditory hallucinations. Specifically, these compositions relate to auditory impairments that humans can experience due to tinnitus or through the consumption of alcohol. In the case of tinnitus, whilst much is known about the causes and symptoms, the experience of what it is like to live with tinnitus is less explored and those who have acquired the condition may often feel frustration when trying to convey the experience of ‘what it is like’ for them. In terms of impairment from alcohol consumption, whilst there is much hearsay, little research exists on the immediate and short-term effects of alcohol consumption on the human auditory system, despite over half of the UK population reported as consuming alcohol in 2017. The methodology employed to design these compositions draws upon scientific research findings, including experimental and explorative studies involving human participants, coupled with electroacoustic composition techniques. The pieces are typically constructed by mixing field recordings with synthesised materials and incorporating a range of temporal and frequency domain manipulations to the elements therein. In this way, the listener is able to experience the phenomenon in a recognisable context, where distortions of reality can be emulated to varying degrees. It is intended that these compositions can serve as easily accessible and understood examples of auditory impairments and that they might find utility in the communication of symptoms to those who have never experienced the underlying causes or conditions. This presents opportunities for pieces like these to be used in scenarios such as education and public health awareness campaigns

Tinnitus referral pathways within the National Health Service in England: a survey of their perceived effectiveness among audiology staff

<p>Abstract</p> <p>Background</p> <p>In the UK, audiology services deliver the majority of tinnitus patient care, but not all patients experience the same level of service. In 2009, the Department of Health released a Good Practice Guide to inform commissioners about key aspects of a quality tinnitus service in order to promote equity of tinnitus patient care in UK primary care, audiology, and in specialist multi-disciplinary centres. The purpose of the present research was to evaluate utilisation and opinions on pathways for the referral of tinnitus patients to and from English Audiology Departments.</p> <p>Methods</p> <p>We surveyed all audiology staff engaged in providing tinnitus services across England. A 36-item questionnaire was mailed to 351 clinicians in all 163 National Health Service (NHS) Trusts identified as having a tinnitus service. 138 clinicians responded. The results presented here describe experiences and opinions of the current patient pathways to and from the audiology tinnitus service.</p> <p>Results</p> <p>The most common referral pathway was from general practice to a hospital-based Ear, Nose & Throat department and from there to a hospital-based audiology department (64%). Respondents considered the NHS tinnitus referral process to be generally effective (67%), but expressed needs for improving GP referral and patients' access to services. 'Open access' to the audiology clinic was rarely an option for patients (9%), nor was the opportunity to access specialist counselling provided by clinical psychology (35%). To decrease the number of inappropriate referrals, 40% of respondents called for greater awareness by referrers about the audiology tinnitus service.</p> <p>Conclusions</p> <p>Respondents in the present survey were generally satisfied with the tinnitus referral system. However, they highlighted some potential targets for service improvement including 1] faster and more appropriate referral from GPs, to be achieved through education on tinnitus referral criteria, 2] improved access to psychological services through audiologist training, and 3] ongoing support from tinnitus support groups, national charities, or open access to the tinnitus clinic for existing patients.</p

Gameplay as a source of intrinsic motivation in a randomized controlled trial of auditory training

Background: Previous studies of frequency discrimination training (FDT) for tinnitus used repetitive task-based training programmes relying on extrinsic factors to motivate participation. Studies reported limited improvement in tinnitus symptoms. Purpose: To evaluate FDT exploiting intrinsic motivations by integrating training with computer-gameplay. Methods: Sixty participants were randomly assigned to train on a conventional taskbased training, or one of two interactive game-based training platforms over six weeks. Outcomes included assessment of motivation, tinnitus handicap, and performance on tests of attention. Results: Participants reported greater intrinsic motivation to train on the interactive game-based platforms, yet compliance of all three groups was similar (~70%) and changes in self-reported tinnitus severity were not significant. There was no difference between groups in terms of change in tinnitus severity or performance on measures of attention. Conclusion: FDT can be integrated within an intrinsically motivating game. Whilst this may improve participant experience, in this instance it did not translate to additional compliance or therapeutic benefit

Delivering affordable cancer care in high-income countries

The burden of cancer is growing, and the disease is becoming a major economic expenditure for all developed countries. In 2008, the worldwide cost of cancer due to premature death and disability (not including direct medical costs) was estimated to be US$895 billion. This is not simply due to an increase in absolute numbers, but also the rate of increase of expenditure on cancer. What are the drivers and solutions to the so-called cancer-cost curve in developed countries? How are we going to afford to deliver high quality and equitable care? Here, expert opinion from health-care professionals, policy makers, and cancer survivors has been gathered to address the barriers and solutions to delivering affordable cancer care. Although many of the drivers and themes are specific to a particular field-eg, the huge development costs for cancer medicines-there is strong concordance running through each contribution. Several drivers of cost, such as over-use, rapid expansion, and shortening life cycles of cancer technologies (such as medicines and imaging modalities), and the lack of suitable clinical research and integrated health economic studies, have converged with more defensive medical practice, a less informed regulatory system, a lack of evidence-based sociopolitical debate, and a declining degree of fairness for all patients with cancer. Urgent solutions range from re-engineering of the macroeconomic basis of cancer costs (eg, value-based approaches to bend the cost curve and allow cost-saving technologies), greater education of policy makers, and an informed and transparent regulatory system. A radical shift in cancer policy is also required. Political toleration of unfairness in access to affordable cancer treatment is unacceptable. The cancer profession and industry should take responsibility and not accept a substandard evidence base and an ethos of very small benefit at whatever cost; rather, we need delivery of fair prices and real value from new technologies