Fit for the frontline? A focus group exploration of auditory tasks carried out by infantry and combat support personnel

In order to preserve their operational effectiveness and ultimately their survival, military personnel must be able to detect important acoustic signals and maintain situational awareness. The possession of sufficient hearing ability to perform job-specific auditory tasks is defined as auditory fitness for duty (AFFD). Pure tone audiometry (PTA) is used to assess AFFD in the UK military; however, it is unclear whether PTA is able to accurately predict performance on job-specific auditory tasks. The aim of the current study was to gather information about auditory tasks carried out by infantry personnel on the frontline and the environment these tasks are performed in. The study consisted of 16 focus group interviews with an average of five participants per group. Eighty British army personnel were recruited from five infantry regiments. The focus group guideline included seven open-ended questions designed to elicit information about the auditory tasks performed on operational duty. Content analysis of the data resulted in two main themes: (1)the auditory tasks personnel are expected to perform and (2) situations where personnel felt their hearing ability was reduced. Auditory tasks were divided into subthemes of sound detection, speech communication and sound localization. Reasons for reduced performance included background noise, hearing protection and attention difficulties. The current study provided an important and novel insight to the complex auditory environment experienced by British infantry personnel and identified 17 auditory tasks carried out by personnel on operational duties. These auditory tasks will be used to inform the development of a functional AFFD test for infantry personnel

Incidence and management of early postoperative complications in lamellar corneal transplantation.

PurposeTo provide a comprehensive review of the incidence, risk factors, and management of early complications after deep anterior lamellar keratoplasty (DALK), Descemet stripping automated keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK).MethodsA literature review of complications, that can occur from the time of the transplant up to 1 month after the transplant procedure, was conducted. Case reports and case series were included in the review.ResultsComplications in the earliest postoperative days following anterior and posterior lamellar keratoplasty have shown to affect graft survival. These complications include, but are not limited to, double anterior chamber, sclerokeratitis endothelial graft detachment, acute glaucoma, fluid misdirection syndrome, donor-transmitted and recurrent infection, and Uretts-Zavalia syndrome.ConclusionIt is essential for surgeons and clinicians to not only be aware of these complications but also know how to manage them to minimize their impact on long-term transplant survival and visual outcomes

Update on Suture Techniques in Corneal Transplantation: A Systematic Review

Effective suturing remains key to achieving successful outcomes in corneal surgery, especially anterior lamellar keratoplasty and full thickness transplantation. Limitations in the technique may result in complications such as wound leak, infection, or high astigmatism post corneal graft. By using a systematic approach, this study reviews articles and conducts content analysis based on update 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria). The aim of this paper is to summarize the state of the art of corneal suturing techniques for every type of corneal transplant and patient age and also their outcomes regarding astigmatism and complications. Future developments for corneal transplantation will be also discussed. This is important because especially the young surgeon must have knowledge of the implications of every suture performed in order to achieve consistent and predictable post-operative outcomes and also be aware of all the possible complications

Developing a measure of auditory fitness for duty for military personnel

The ability to listen to and understand commands in noisy environments, whilst maintaining situational awareness, is an important skill for military personnel, and can be critical for mission success. Due to the nature of their work, military personnel are regularly exposed to damaging noise exposures, which could lead to hearing loss and therefore the inability to understand commands. Accurately measuring auditory fitness for duty (AFFD) is important for ensuring that personnel have sufficient hearing ability to be effective in operational scenarios. Pure-tone audiometry (PTA) is the hearing test currently used by the UK military but it is not known whether it is able to accurately predict AFFD. The aims of this thesis were to: 1) better understand AFFD, focusing on the infantry; and 2) undertake the initial development of a credible alternative to PTA and a simulation of an AFFD task, ahead of future research to determine which test(s) best predict AFFD.Using focus groups, followed by a questionnaire, 17 mission-critical auditory tasks (MCATs) carried out by infantry personnel were identified. Nine of these tasks were prioritised for evaluating AFFD and seven were speech communication tasks (SC-MCATs). It was anticipated that a speech-in-noise test might be a better tool than PTA for predicting performance on the SC-MCATs. Following a review of existing speech-in-noise tests, including a consultation with military subject-matter experts, the Coordinate Response Measure (CRM) was selected for this purpose, partly due to the high face validity when compared to typical infantry command structure. The CRM speech material was re-recorded in British English using NATO call-signs, was equalised in terms of intelligibility, and was implemented into an adaptive procedure with stationary speech-spectrum noise and evaluated using normal hearing civilians and hearing impaired military personnel. An AFFD task simulation of the SC-MCATs was developed. It simulated the environment of listening to commands over a military radio in a moving armoured vehicle. A final study found that while both the AFFD task simulation and the CRM were adversely affected by simulated hearing loss, only the task simulation appeared to be affected by experience of military commands. Further work is now required to determine whether PTA or the CRM, when combined with additional information such as previous military experience, best predict performance on the AFFD task simulation

Fit for the frontline? Identification of mission-critical auditory tasks (MCATs) carried out by infantry and combat-support personnel

The ability to listen to commands in noisy environments and understand acoustic signals, whilst maintaining situational awareness, is an important skill for military personnel, and can be critical for mission success. Seventeen auditory tasks carried out by British infantry and combat-support personnel were identified through a series of focus groups conducted by Bevis et al.1. For military personnel these auditory tasks are termed mission-critical auditory tasks (MCATs) if they are carried in out in a military specific environment and have a negative consequence when performed below a specified level. A questionnaire study was conducted to find out which of the auditory tasks identified by Bevis et al.1 satisfy the characteristics of an MCAT. Seventy-nine British infantry and combat-support personnel from four regiments across the South of England participated. For each auditory task participants indicated: 1) the consequences of poor performance on the task, 2) who performs the task and 3) how frequently the task is carried out. The data were analysed to determine which tasks are carried out by all personnel, have the most negative consequences when performed poorly and are performed the most frequently. This resulted in a list of nine MCATs (seven speech communication tasks, one sound localisation task and one sound detection task) that should be prioritised for representation in a measure of auditory fitness for duty (AFFD) for these personnel. Incorporating MCATs in AFFD measures will help to ensure that personnel have the necessary auditory skills for safe and effective deployment on operational duties

Development of the Arabic Commands in Noise Test for studying auditory fitness for duty

Military employees often work in challenging auditory environments and are required to have appropriate auditory fitness for duty (AFFD). In this project we present the newly developed ‘Arabic Commands in Noise Test’ (ACINT) to study AFFD. Many factors affect auditory performance, including the personality trait conscientiousness, which has not yet been investigated in the context of hearing task performance.The aim of our study is to assess the ability of the ACINT to discriminate between normal-hearing and hearing-impaired individuals. A secondary aim is to explore differences in performance under different listening conditions and performer characteristics, including conscientiousness. The objectives are 1. To assess the test’s ability to distinguish between normal-hearing and hearing-impaired individuals by assessing the sensitivity and specificity of the SIN test to detect mild sensorineural hearing loss (SNHL) and 2. To explore differences in performance under standard and challenging listening conditions between individuals with high and low conscientiousness. Study sample: 54 normal-hearing individuals (low C=17 ,High C=37) and 19 (data collection ongoing) hearing impaired individuals. Results: pending detailed analysis and will be available for discussion in the conference Conclusion: Preliminary data analysis shows that ACINT appears to discriminate between normal hearing individuals and those with mild sensorineural hearing loss documented by audiogram with high specificity

Hearing healthcare for workers with hearing loss: audiologists' experiences and views

Purpose: This study explored audiologists’ perspectives regarding their interactions with workers with hearing loss (WHL). Materials and methods: Semi-structured interviews were conducted with twenty-five audiologists working in the National Health Service (NHS) and independent companies (IC) in the UK and were thematically analysed. Results: The developed themes and sub-themes (shown in parenthesis) are (1) Current practices and routines (Same approach for most patients; Variations between hearing care services; Audiologists’ personal experience of hearing loss) (2) Perceived challenges (Non-routine and challenging cases; The role of hearing technology; Concerns about lack of awareness and knowledge; Communication difficulties between services, Limited funding and resources) (3) Scope for better support (Would like to be informed; Other potential service improvements). Conclusions: This study revealed that audiologists’ perceived deficiencies in the hearing rehabilitation for WHL and identified ways to improve it. Key priorities for improvement were found to include addressing audiologists’ informational and training needs, facilitating WHLs’ access to appointments, improving communication between services, raising awareness in the workplace, developing relevant resources and extending funding for provision of longer appointments and hearing technologies. This is the first time this information has been reported in the literature. Opportunities for conducting further research in this area are suggested.Implications for rehabilitation Workers with hearing loss face many challenges in work life and have the option of audiologic rehabilitation to alleviate their difficulties and improve their wellbeing; however, this study suggests that workers' audiological care needs improvements. Audiologists should assess and consider patients' work needs and psychosocial concerns in consultations to provide personalised care. Audiology educational programmes, services, and the healthcare system can assist audiologists in helping workers with hearing loss by providing updated knowledge, continuous training and improved interprofessional communication and patients’ access to useful resources.</p

Development of an Arabic “command in noise” hearing test to assess fitness for duty

Objective: the goal is to implement the developed speech material in a hearing test to assess auditory fitness for duty (AFFD), specifically in areas where the intelligibility of spoken commands is essential. Design: in study 1, a speech corpus with equal intelligibility was constructed using constant stimuli to test each target word’s psychometric functions. Study 2 used an adaptive interleaving procedure to maximize equalized terms. Study 3 used Monte Carlo simulations to determine speech test accuracy. Study sample: Study 1 (n = 24) and study 2 (n = 20) were completed by civilians with normal hearing. Study 3 ran 10,000 simulations per condition across various conditions varying in slopes and speech recognition thresholds (SRTs). Results: studies 1 and 2 produced three 8-word wordlists. The mean, standard deviation in dB SNR is −13.1 1.2 for wordlist 1, −13.7 1.6 for wordlist 2, and −13.7 1.3 for wordlist 3, with word SRTs within 3.4 dB SNR. Study 3 revealed that a 6 dB SNR range is appropriate for equally understandable speech using a closed-set adaptive technique. Conclusion: the developed speech corpus may be used in an AFFD measure. Concerning the homogeneity of the speech in noise test material, care should be taken when generalizing and using ranges and standard deviations from multiple tests

Development and evaluation of the British English Coordinate Response Measure Speech-In-Noise Test as an occupational hearing assessment tool

Objective: The studies described in this paper outline the design and development of a British English version of the coordinate response measure (CRM) speech-in-noise (SiN) test. Our interest in the CRM is as a SiN test with high face validity for occupational auditory fitness for duty (AFFD) assessment. Design: Study 1 used the method of constant stimuli to measure and adjusted the psychometric functions of each target word, producing a speech corpus with equal intelligibility. After ensuring all the target words had similar intelligibility, for studies 2 and 3 the CRM was presented in an adaptive procedure in stationary speech-spectrum noise to measure speech reception thresholds and evaluate the test-retest reliability of the CRM SiN test.Study sample: Studies 1 (n=20) and 2 (n=30) were completed by normal-hearing civilians. Study 3 (n=22) was completed by hearing impaired military personnel.Results: The results display good test-retest reliability (95% confidence interval &lt; 2.1 dB) and concurrent validity when compared to the triple-digit test (r = &lt; 0.65) and the CRM is sensitive to hearing impairment.Conclusion: The British English CRM using stationary speech-spectrum noise is a ‘ready to use’ SiN test, suitable for investigation as an AFFD assessment tool for military personnel. </p

Measuring speech recognition and quality of life in Arabic children with OME using the PAAST SiQ and Arabic OM-6 questionnaire

Background: otitis media with effusion (OME) is the most common cause for conductive hearing loss in children and is associated with poor quality of life (QoL). The Paediatric Arabic Auditory Speech Test in Quiet (PAAST SiQ) and Arabic OM-6 (AOM-6) are investigated in this study as tools to measure speech recognition threshold (SRT) and QoL, respectively, in Arabic children with OME.Aims and objectives: (1) to investigate the relationship between SRTs, OME condition and PTA Threshold, and (2) to investigate the relationship between the AOM-6 scores and SRTs. Study design: 50 children between the ages 3 and 5.9 years with confirmed OME (unilateral or bilateral) were tested using PAAST SiQ to measure their SRTs for each ear. The child’s main care giver filled the AOM-6 questionnaire.Results and conclusion: preliminary results show a significant positive relationship between PTA threshold and SRT, which may indicates the PAAST SiQ’s potential for predicting hearing threshold. Further analysis will be discussed in the conference