Exploring Predictors of Outcome in the Psychosis Prodrome: Implications for Early Identification and Intervention

Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth

2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease

The recommendations listed in this document are, whenever possible, evidence based. An extensive evidence review was conducted as the document was compiled through December 2008. Repeated literature searches were performed by the guideline development staff and writing committee members as new issues were considered. New clinical trials published in peer-reviewed journals and articles through December 2011 were also reviewed and incorporated when relevant. Furthermore, because of the extended development time period for this guideline, peer review comments indicated that the sections focused on imaging technologies required additional updating, which occurred during 2011. Therefore, the evidence review for the imaging sections includes published literature through December 2011

A Review of Adult-Onset Hearing Loss: a Primer for Neurologists

Purpose of the Review: The goal of this review is to highlight current approaches to diagnosis and treatment for adult-onset hearing loss in patients likely to present to a neurologist’s office. The review will discuss primary and secondary causes of acute and chronic hearing loss, and will discuss common situations that can be managed by a neurologist as well as situations that require immediate care and referral for further management by an otolaryngologist-head and neck surgeon. Recent Findings: Hearing screening assessments using mobile applications and tablet devices are now available and can be integrated into many clinical practice settings, including in the evaluation of hearing concerns related to various neurological pathologies. For patients presenting with a sudden worsening in hearing, bedside evaluation, including objective measures of hearing, can inform neurologists about diagnosis and subsequent management. For patients who present with gradual worsening in hearing, particularly those related to neurologic disorders, hearing care can be an important adjunct to ongoing neurologic care. More commonly encountered, age-related hearing loss is highly prevalent among older adults and may affect overall neurological assessment, including neurocognitive testing, as well as patient-provider communication, patient satisfaction, and care outcomes. Hearing loss is increasingly recognized as a potentially modifiable risk factor for dementia. Neurologists can support the hearing health of their patients through the routine use of communication strategies and by integrating simple, low-cost technology with their current clinical practices. Summary: Both acute and chronic hearing loss can be a symptom of many conditions managed by neurologists. Few conditions are emergent, requiring immediate referral to and treatment by an otolaryngologist-head and neck surgeon. Despite the range of hearing interventions available, including hearing aids, over-the-counter devices, and aural rehabilitation, hearing loss is a common and under-treated chronic health condition. By promptly addressing a patient’s hearing concerns, neurologists can improve patients’ awareness of the deficit and support the overall importance of maintaining sensory health across the life course

Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators

Objectives: An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique patient population. Design: The study team queried PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, Scopus, and ClinicalTrials.gov on May 1, 2020, for studies in English published from January 2010 to May 2020. Setting and Participants: We conducted a systematic review of articles investigating the use of telemedicine among older adults with Alzheimer\u27s disease and related dementia (ADRD) or mild cognitive impairment (MCI) that focused on the patient and care partner perspectives. Methods: Telemedicine encounter purpose, technological requirements, and findings regarding sensory needs were extracted. The Cochrane Collaboration\u27s Risk of Bias Tool was applied for quality assessment. Results: The search yielded 3551 abstracts, from which 90 articles were reviewed and 17 were included. The purpose of telemedicine encounters included routine care, cognitive assessment, and telerehabilitation. All studies reported successful implementation of telemedicine, supported by patient and care partner satisfaction, similar results on cognitive assessment and diagnosis compared to in-person visits, and improvement in outcome measures following rehabilitation. Sixteen studies relied on staff and care partners to navigate technologies. Six studies reported participants reporting difficulty hearing the provider during the telemedicine visits. Five studies excluded participants with visual or hearing impairment because of the potential difficulty of using telemedicine technology. No studies reported technological adaptations to account for sensory impairment. Conclusions and Implications: Telemedicine is well received among patients and care partners, but successful delivery incorporates support staff and the care partners to navigate technologies. The exclusion of older adults with sensory impairment, especially given that it is highly prevalent, in developing telemedicine systems may further exacerbate access to care in this population. Adapting technologies for sensory needs is critical to the advancement of accessible dementia care through telemedicine

Hearing loss and cognitive decline: Prioritizing equity in a world in which hearing health matters

Abstract Alzheimer's disease and related dementias (ADRDs) and age‐related hearing loss are the intersection of two major public health challenges. With age as the primary risk factor for both disease processes, the burden of ADRDs and age‐related hearing loss is growing, and each field maintains significant barriers to broadscale identification and management that is affordable and accessible. With the disproportionate burden of ADRDs among racial and ethnic minority older adults and existing disparities within hearing care, both areas face challenges in achieving equitable access and outcomes across diverse populations. The publication of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) trial in July 2023 marked a significant moment in the fields of brain and hearing health. The ACHIEVE trial was the first randomized controlled trial to examine whether providing hearing intervention, specifically provision of hearing aids, compared to an education control, would reduce cognitive changes over 3 years. The participants most at risk for cognitive decline, with lower education, lower income, more likely to identify as Black, and have more cardiovascular risk factors, were the participants who benefited most from the hearing intervention and are also the least likely to be represented in research and the least likely to obtain hearing care. With growing evidence of the interconnection between cognitive and sensory health, we have an opportunity to prioritize equity, from purposeful inclusion of diverse participants in trials to influencing the emerging market of over‐the‐counter hearing aids to supporting expanded models of hearing care that reach those who have traditionally gone unserved. No longer can hearing go unrecognized by clinicians, researchers, and advocates for brain health. At the same time, the fields of brain and hearing health must center equity if we are going to meet the needs of diverse older adults in a world in which hearing health matters

Increased Glutathione Biosynthesis Plays a Role in Nickel Tolerance in Thlaspi Nickel Hyperaccumulators

Worldwide more than 400 plant species are now known that hyperaccumulate various trace metals (Cd, Co, Cu, Mn, Ni, and Zn), metalloids (As) and nonmetals (Se) in their shoots. Of these, almost one-quarter are Brassicaceae family members, including numerous Thlaspi species that hyperaccumulate Ni up to 3% of there shoot dry weight. We observed that concentrations of glutathione, Cys, and O-acetyl-l-serine (OAS), in shoot tissue, are strongly correlated with the ability to hyperaccumulate Ni in various Thlaspi hyperaccumulators collected from serpentine soils, including Thlaspi goesingense, T. oxyceras, and T. rosulare, and nonaccumulator relatives, including T. perfoliatum, T. arvense, and Arabidopsis thaliana. Further analysis of the Austrian Ni hyperaccumulator T. goesingense revealed that the high concentrations of OAS, Cys, and GSH observed in this hyperaccumulator coincide with constitutively high activity of both serine acetyltransferase (SAT) and glutathione reductase. SAT catalyzes the acetylation of l-Ser to produce OAS, which acts as both a key positive regulator of sulfur assimilation and forms the carbon skeleton for Cys biosynthesis. These changes in Cys and GSH metabolism also coincide with the ability of T. goesingense to both hyperaccumulate Ni and resist its damaging oxidative effects. Overproduction of T. goesingense SAT in the nonaccumulator Brassicaceae family member Arabidopsis was found to cause accumulation of OAS, Cys, and glutathione, mimicking the biochemical changes observed in the Ni hyperaccumulators. In these transgenic Arabidopsis, glutathione concentrations strongly correlate with increased resistance to both the growth inhibitory and oxidative stress induced effects of Ni. Taken together, such evidence supports our conclusion that elevated GSH concentrations, driven by constitutively elevated SAT activity, are involved in conferring tolerance to Ni-induced oxidative stress in Thlaspi Ni hyperaccumulators

Long?term Impact of Hearing Aid Provision or Cochlear Implantation on Hearing Handicap

Objectives/HypothesisPrevious research has shown hearing handicap to be reduced following hearing aid use or cochlear implantation in short-to-medium follow-up periods, yet the impact of interventions for hearing loss on hearing handicap in the long term remains understudied. This article reports hearing handicap at 6?months, 12?months, and 5?years after either hearing aid provision or cochlear implantation.Study DesignObservational study.MethodsA study of 115 participants from the Studying Multiple Outcomes after Aural Rehabilitative Treatment (SMART) study cohort assessed self-reported hearing handicap using the Hearing Handicap Inventory for the Elderly Screening version (HHIE-S) at baseline, 6?months, 12?months, and 5?years. Generalized estimating equations (GEE) were used to estimate the population mean HHIE-S score over time, accounting for the correlated nature of repeated measures data, and multiple imputation with chained equations was performed to impute missing data.ResultsCompared to baseline, mean HHIE-S scores after hearing aid provision were significantly reduced at 6?months (mean = ?7.96, 95% confidence interval [CI]: ?10.40, ?5.53), 12?months (mean = ?6.58, 95% CI: ?9.26, ?3.90), and 5?years (mean = ?4.58, 95% CI: ?7.87, ?1.30). After cochlear implantation, mean hearing handicap scores were also significantly lower compared to baseline at 6?months (mean = ?8.18, 95% CI: ?11.07, ?5.30), 12?months (mean = ?10.04, 95% CI: ?12.92, ?7.16), and 5?years (mean = ?8.97, 95% CI: ?12.92, ?7.16).ConclusionsThis study found short-term benefits from hearing aids and cochlear implantation on hearing handicap were maintained over 5?years

Prevalence of Eustachian Tube Dysfunction in Adults in the United States

No abstract available

Hearing care across the life course provided in the community

Untreated hearing loss is recognized as a growing global health priority because of its prevalence and harmful effects on health and well-being. Until recently, little progress had been made in expanding hearing care beyond traditional clinic-based models to incorporate public health approaches that increase accessibility to and affordability of hearing care. As demonstrated in numerous countries and for many health conditions, sharing health-care tasks with community health workers (CHWs) offers advantages as a complementary approach to expand health-service delivery and improve public health. This paper explores the possibilities of task shifting to provide hearing care across the life course by reviewing several ongoing projects in a variety of settings - Bangladesh, India, South Africa and the United States of America. The selected programmes train CHWs to provide a range of hearing-care services, from childhood hearing screening to management of age-related hearing loss. We discuss lessons learnt from these examples to inform best practices for task shifting within community-delivered hearing care. Preliminary evidence supports the feasibility, acceptability and effectiveness of hearing care delivered by CHWs in these varied settings. To make further progress, community-delivered hearing care must build on established models of CHWs and ensure adequate training and supervision, delineation of the scope of practice, supportive local and national legislation, incorporation of appropriate technology and analysis of programme costs and cost-effectiveness. In view of the growing evidence, community-delivered hearing care may now be a way forward to improve hearing health equity.United States Department of Health & Human Services National Institutes of Health (NIH) - National Institute on Aging (NIA) [K23AG059900]; United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Deafness & Other Communication Disorders (NIDCD) [R21/R33 DC015062, R21/R33 DC013681]; PCORI Patient-Centered Outcomes Research Institute - PCORI [AD-1602-34571]; Hear the World FoundationOpen access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Prevalence and Population Estimates of Obstructive Eustachian Tube Dysfunction in US Adolescents

This cross-sectional cohort study uses census data to approximate population estimates of obstructive eustachian tube dysfunction among US adolescents