Socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017).

OBJECTIVE: To identify socioeconomic factors associated with antimicrobial resistance of Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli in Chilean hospitals (2008-2017). METHODS: We reviewed the scientific literature on socioeconomic factors associated with the emergence and dissemination of antimicrobial resistance. Using multivariate regression, we tested findings from the literature drawing from a longitudinal dataset on antimicrobial resistance from 41 major private and public hospitals and a nationally representative household survey in Chile (2008-2017). We estimated resistance rates for three priority antibiotic-bacterium pairs, as defined by the Organisation for Economic Co-operation and Development; i.e., imipenem and meropenem resistant P. aeruginosa, cloxacillin resistant S. aureus, and cefotaxime and ciprofloxacin resistant E. coli. RESULTS: Evidence from the literature review suggests poverty and material deprivation are important risk factors for the emergence and transmission of antimicrobial resistance. Most studies found that worse socioeconomic indicators were associated with higher rates of antimicrobial resistance. Our analysis showed an overall antimicrobial resistance rate of 32.5%, with the highest rates for S. aureus (40.6%) and the lowest for E. coli (25.7%). We found a small but consistent negative association between socioeconomic factors (income, education, and occupation) and overall antimicrobial resistance in univariate (p < 0.01) and multivariate analyses (p < 0.01), driven by resistant P. aeruginosa and S. aureus. CONCLUSION: Socioeconomic factors beyond health care and hospital settings may affect the emergence and dissemination of antimicrobial resistance. Preventing and controlling antimicrobial resistance requires efforts above and beyond reducing antibiotic consumption

Simultaneous subcortical and cortical electrophysiological recordings of spectro-temporal processing in humans.

Objective assessment of auditory discrimination has often been measured using the Auditory Change Complex (ACC), which is a cortically generated potential elicited by a change occurring within an ongoing, long-duration auditory stimulus. In cochlear implant users, the electrically-evoked ACC has been used to measure electrode discrimination by changing the stimulating electrode during stimulus presentation. In addition to this cortical component, subcortical measures provide further information about early auditory processing in both normal hearing listeners and cochlear implant users. In particular, the frequency-following response (FFR) is thought to reflect the auditory encoding at the level of the brainstem. Interestingly, recent research suggests that it is possible to simultaneously measure both subcortical and cortical physiological activity. The aim of this research was twofold: first, to understand the scope for simultaneously recording both the FFR (subcortical) and ACC (cortical) responses in normal hearing adults. Second, to determine the best recording parameters for optimizing the simultaneous capture of both responses with clinical applications in mind. Electrophysiological responses were recorded in 10 normally-hearing adults while they listened to 16-second-long pure tone sequences. The carrier frequency of these sequences was either steady or alternating periodically throughout the sequence, generating an ACC response to each alternation-the alternating ACC paradigm. In the "alternating" sequences, both the alternating rate and the carrier frequency varied parametrically. We investigated three alternating rates (1, 2.5, and 6.5 Hz) and seven frequency pairs covering the low-, mid-, and high-frequency range, including narrow and wide frequency separations. Our results indicate that both the slowest (1 Hz) and medium (2.5 Hz) alternation rates led to significant FFR and ACC responses in most frequency ranges tested. Low carrier frequencies led to larger FFR amplitudes, larger P1 amplitudes, and N1-P2 amplitude difference at slow alternation rates. No significant relationship was found between subcortical and cortical response amplitudes, in line with different generators and processing levels across the auditory pathway. Overall, the alternating ACC paradigm can be used to measure sub-cortical and cortical responses as indicators of auditory early neural encoding (FFR) and sound discrimination (ACC) in the pathway, and these are best obtained at slow alternation rates (1 Hz) in the low-frequency range (300-1200 Hz)

Neural representation of interaural time differences in humans-an objective measure that matches behavioural performance

Humans, and many other species, exploit small differences in the timing of sounds at the two ears (interaural time difference, ITD) to locate their source and to enhance their detection in background noise. Despite their importance in everyday listening tasks, however, the neural representation of ITDs in human listeners remains poorly understood, and few studies have assessed ITD sensitivity to a similar resolution to that reported perceptually. Here, we report an objective measure of ITD sensitivity in electroencephalography (EEG) signals to abrupt modulations in the interaural phase of amplitude-modulated low-frequency tones. Specifically, we measured following responses to amplitude-modulated sinusoidal signals (520-Hz carrier) in which the stimulus phase at each ear was manipulated to produce discrete interaural phase modulations at minima in the modulation cycle—interaural phase modulation following responses (IPM-FRs). The depth of the interaural phase modulation (IPM) was defined by the sign and the magnitude of the interaural phase difference (IPD) transition which was symmetric around zero. Seven IPM depths were assessed over the range of ±22 ° to ±157 °, corresponding to ITDs largely within the range experienced by human listeners under natural listening conditions (120 to 841 μs). The magnitude of the IPM-FR was maximal for IPM depths in the range of ±67.6 ° to ±112.6 ° and correlated well with performance in a behavioural experiment in which listeners were required to discriminate sounds containing IPMs from those with only static IPDs. The IPM-FR provides a sensitive measure of binaural processing in the human brain and has a potential to assess temporal binaural processing.17 page(s

A Comparison of two objective measures of binaural processing : the interaural phase modulation following response and the binaural interaction component

There has been continued interest in clinical objective measures of binaural processing. One commonly proposed measure is the binaural interaction component (BIC), which is obtained typically by recording auditory brainstem responses (ABRs)—the BIC reflects the difference between the binaural ABR and the sum of the monaural ABRs (i.e., binaural − (left + right)). We have recently developed an alternative, direct measure of sensitivity to interaural time differences, namely, a following response to modulations in interaural phase difference (the interaural phase modulation following response; IPM-FR). To obtain this measure, an ongoing diotically amplitude-modulated signal is presented, and the interaural phase difference of the carrier is switched periodically at minima in the modulation cycle. Such periodic modulations to interaural phase difference can evoke a steady state following response. BIC and IPM-FR measurements were compared from 10 normal-hearing subjects using a 16-channel electroencephalographic system. Both ABRs and IPM-FRs were observed most clearly from similar electrode locations—differential recordings taken from electrodes near the ear (e.g., mastoid) in reference to a vertex electrode (Cz). Although all subjects displayed clear ABRs, the BIC was not reliably observed. In contrast, the IPM-FR typically elicited a robust and significant response. In addition, the IPM-FR measure required a considerably shorter recording session. As the IPM-FR magnitude varied with interaural phase difference modulation depth, it could potentially serve as a correlate of perceptual salience. Overall, the IPM-FR appears a more suitable clinical measure than the BIC.17 page(s

Evaluating the noise in electrically evoked compound action potential measurements in cochlear implants

Electrically evoked compound action potentials (ECAPs) are widely used to study the excitability of the auditory nerve and stimulation properties in cochlear implant (CI) users. However, ECAP detection can be difficult and very subjective at near-threshold stimulation levels or in spread of excitation measurements. In this study, we evaluated the statistical properties of the background noise (BN) and the postaverage residual noise (RN) in ECAP measurements in order to determine an objective detection criterion. For the estimation of the BN and the RN, a method currently used in auditory brainstem response measurements was applied. The potential benefit of using weighted (Bayesian) averages was also examined. All estimations were performed with a set of approximately 360 ECAP measurements recorded from five human CI users of the CII or HiRes90K device (advanced bionics). Results demonstrated that the BN was normally distributed and the RN decreased according to the square root of the number of averages. No additional benefit was observed by using weighted averaging. The noise was not significantly different either at different stimulation intensities or across recording electrodes along the cochlea. The analysis of the statistical properties of the noise indicated that a signal-to-noise ratio of 1.7 dB as a detection criterion corresponds to a false positive detection rate of 1% with the used measurement setup.12 page(s

A Bilateral hearing assistance system and a method of fitting a bilateral hearing assistance system

The application relates to a bilateral hearing assistance system comprising first and second hearing assistance devices, each of the first and second hearing assistance devices being adapted for being located at or in an ear of the user or to be partially or fully implanted in the head at an ear of the user, comprising a processing unit, which in a NORMAL mode of operation is adapted to process an input audio signal based on configurable processing parameters and to provide a processed electric stimulation signal, and comprising an output unit operationally connected to said processing unit in said NORMAL mode of operation and adapted to present an electric stimulation signal input to said user in a form allowing it to be perceived by the user as an auditory signal, the bilateral hearing assistance system further comprising one or more stimulation units for - in a TEST mode of operation of the hearing assistance system - delivering first and second electric TEST stimulation signals to said output units of said first and second hearing assistance devices, respectively. The application further relates to a method of fitting a bilateral hearing assistance system to a particular user. The object of the present application is to provide a measure allowing an improved fitting of bilaterally implanted Cochlear Implant users. The problem is solved in that the bilateral hearing assistance system further comprises an evaluation unit configured to analyze the recorded physiological response of the user and to provide an objective measure of the user's perception of said TEST stimulation signals. This has the advantage of providing an improved speech intelligibility and preservation of spatial cues. The invention may e.g. be used for the fitting of hearing assistance devices comprising cochlear implants

The Polarity sensitivity of the electrically stimulated human auditory nerve measured at the level of the brainstem

Recent behavioral studies have suggested that the human auditory nerve of cochlear implant (CI) users is mainly excited by the positive (anodic) polarity. Those findings were only obtained using asymmetric pseudomonophasic (PS) pulses where the effect of one phase was measured in the presence of a counteracting phase of opposite polarity, longer duration, and lower amplitude than the former phase. It was assumed that only the short high-amplitude phase was responsible for the excitation. Similarly, it has been shown that electrically evoked compound action potentials could only be obtained in response to the anodic phases of asymmetric pulses. Here, experiment 1 measured electrically evoked auditory brainstem responses to standard symmetric, PS, reversed pseudomonophasic, and reversed pseudomonophasic with inter-phase gap (6 ms) pulses presented for both polarities. Responses were time locked to the short high-amplitude phase of asymmetric pulses and were smaller, but still measurable, when that phase was cathodic than when it was anodic. This provides the first evidence that cathodic stimulation can excite the auditory system of human CI listeners and confirms that this stimulation is nevertheless less effective than for the anodic polarity. A second experiment studied the polarity sensitivity at different intensities by means of a loudness balancing task between pseudomonophasic anodic (PSA) and pseudomonophasic cathodic (PSC) stimuli. Previous studies had demonstrated greater sensitivity to anodic stimulation only for stimuli producing loud percepts. The results showed that PSC stimuli required higher amplitudes than PSA stimuli to reach the same loudness and that this held for current levels ranging from 10 to 100 % of the dynamic range.19 page(s

Neural encoding of spectro-temporal cues at slow and near speech-rate in cochlear implant users.

The ability to process rapid modulations in the spectro-temporal structure of sounds is critical for speech comprehension. For users of cochlear implants (CIs), spectral cues in speech are conveyed by differential stimulation of electrode contacts along the cochlea, and temporal cues in terms of the amplitude of stimulating electrical pulses, which track the amplitude-modulated (AM'ed) envelope of speech sounds. Whilst survival of inner-ear neurons and spread of electrical current are known factors that limit the representation of speech information in CI listeners, limitations in the neural representation of dynamic spectro-temporal cues common to speech are also likely to play a role. We assessed the ability of CI listeners to process spectro-temporal cues varying at rates typically present in human speech. Employing an auditory change complex (ACC) paradigm, and a slow (0.5Hz) alternating rate between stimulating electrodes, or different AM frequencies, to evoke a transient cortical ACC, we demonstrate that CI listeners-like normal-hearing listeners-are sensitive to transitions in the spectral- and temporal-domain. However, CI listeners showed impaired cortical responses when either spectral or temporal cues were alternated at faster, speech-like (6-7Hz), rates. Specifically, auditory change following responses-reliably obtained in normal-hearing listeners-were small or absent in CI users, indicating that cortical adaptation to alternating cues at speech-like rates is stronger under electrical stimulation. In CI listeners, temporal processing was also influenced by the polarity-behaviourally-and rate of presentation of electrical pulses-both neurally and behaviorally. Limitations in the ability to process dynamic spectro-temporal cues will likely impact speech comprehension in CI users

Spread of excitation varies for different electrical pulse shapes and stimulation modes in cochlear implants

In Cochlear Implants (CI) Bipolar (BP) electrical stimulation has been suggested as a method to reduce the spread of current along the cochlea. However, behavioral measurements in BP mode have shown either similar or worse performance than in Monopolar (MP) mode. This could be explained by a bimodal excitation pattern, with two main excitation peaks at the sites of the stimulating electrodes. We measured the Spread of Excitation (SOE) by means of the Electrically Evoked Compound Action Potential (ECAP), obtained using the forward-masked paradigm. The aim was to measure the bimodality of the excitation and to determine whether it could be reduced by using asymmetric pulses. Three types of maskers shapes were used: Symmetric (SYM), Pseudomonophasic (PS), and Symmetric with a long Inter-Phase Gap (SYM-IPG) pulses. Maskers were presented in BP + 9 (wide), BP + 3 (narrow) and MP (only SYM) mode on fixed electrodes. The SOE obtained with the MP masker showed a main excitation peak close to the masker electrode. Wide SYM maskers produced bimodal excitation patterns showing two peaks close to the electrodes of the masker channel, whereas SYM-IPG maskers showed a single main peak near the electrode for which the masker's second phase (responsible for most of the masking) was anodic. Narrow SYM maskers showed complex and wider excitation patterns than asymmetric stimuli consistent with the overlap of the patterns produced by each channel's electrodes. The masking produced by narrow SYM-IPG and PS stimuli was more pronounced close to the masker electrode for which the effective phase was anodic. These results showed that the anodic polarity is the most effective one in BP mode and that the bimodal patterns produced by SYM maskers could be partially reduced by using asymmetric pulses.16 page(s