Factors Related to Self-Identification of Candidacy, Device Selection, and Self-Fitting of Over-The-Counter Hearing Aids

Purpose: The Over-The-Counter (OTC) Hearing Aid Act was introduced in an effort to make hearing aids more accessible and affordable. Implementation of this law will go into effect in 2020. It is assumed that the average consumer will be able to self-navigate an OTC hearing aid fitting. In the OTC hearing aid model consumers are expected to self-diagnose, self-treat, and self manage their hearing loss. The purpose of the present study was to assess how well the average consumer can perform each step in the OTC hearing aid model, and identify factors related to self-identification of candidacy, device selection, and self-fitting of an OTC hearing aid. Method: Participants included 52 adults who were 40 years of age and older, self-reported having trouble hearing and were interested in trying an OTC hearing aid. They had to have owned a smartphone and had no prior hearing aid experience. Data was collected over two tests sessions. During the first session all participants were asked to report their degree of hearing loss, identify if they thought they were at risk for having ear disease, and completed questionnaires related to demographics, health literacy, hearing aid self-efficacy, health locus of control, and technology commitment and usage. Also, participants completed three cognitive tasks and were given a hearing test and administered three cognitive measures: the Reading-SPAN, Digit Symbol Substitution Task, and the Simon task. During the second test session participants were asked to browse three different OTC hearing aids online and select the device they preferred. They were asked to complete a questionnaire regarding potential reasons for why they selected a particular device. The OTC hearing aid they selected was given in its original packaging, and participants were asked to set the device up without any assistance. The Practical Hearing Aid Skills Test- Revised (PHAST-R) along with three questions related to Bluetooth connectivity was used to evaluate the participants’ hearing aid handling skills. Real-ear verification was performed to assess how closely the participant’s settings were to NAL-NL2 prescriptive targets. Last, participants completed the Consumer Ear Disease Risk Assessment (CEDRA) to determine if participants correctly self-identified the risk for ear-disease. Results: Only 38% of participants were able to correctly classify their hearing status in both ears, with pure tone average being a significant predictor of correct hearing status classification. A majority of the participants who misclassified their hearing status had normal hearing, but self-reported they had a hearing loss. Eighty-eight percent of the participants who were identified for being at risk for ear disease misclassified their risk for ear disease. Years of education was inversely related to correctly self-identifying risk for ear disease. Sixty percent of the participants who were flagged by the CEDRA and 30% of normal-hearing participants indicated that they would purchase an OTC hearing aid at the end of the study. Participants’ scores ranged from 45-100% on the PHAST-R and Bluetooth connectivity assessment. The type of the manufacturer’s instructional material was significantly associated with participants’ hearing aid and Bluetooth connectivity skills. For the normal-hearing participants all of the OTC devices attenuated speech, and none of the devices met NAL-NL2 targets in the high frequencies for the hearing-impaired participants. Income status and technology commitment was not predictive of OTC hearing aid device selection and all participants ranked ‘easy to read descriptions’ and ‘website appearance’ as the main factors that influenced their decision to select a device. Conclusions: Most participants were unable to successfully navigate all of the steps in the OTC hearing aid model. Some of the participants who had normal hearing but self-reported a hearing loss and the participants who were at risk for ear disease said they would purchase an OTC hearing aid as a treatment option. Unfortunately, both groups are not the intended user of an OTC hearing aid. Manufacturer instructional material can impact set up and programming of an OTC device. However, users may still run into fitting and programming challenges that will require the assistance of a hearing health care professional

A study regarding the availability and utilization of water supply and sanitation practices in rural Amritsar, Punjab, India

Background: Access to safe water and sanitation practices is an important issue of health and development at local, regional and national levels. The government has come up with various facilities regarding the water supply and sanitation but there are various factors which curtail their utilization. The present study deals with the extent of utilization and factors impeding the utilization of such services at the village level.Methods: The present impeding cross-sectional study was carried out in village Nagkalan, Amritsar, where the eldest adult member present in the house at the time of the visit was interviewed. Every house of the village was visited during the period of January 2017 to December 2017, and a total of 1123 families were included in the final analysis. Thereafter, data was compiled and analyzed.Results: Out of total 1123 families, only 31.4% were using government water supply (tap water); while 42.7% had no government connection at all and used submersible as their sole source of water supply. 20.2% did not have a toilet at their house and therefore practiced open defecation; out of which majority families belonged to lower socio-economic status (statistically significant). Out of total 896 families having a toilet at their house, there were only 30 families (3.4%) who responded that some of the family members practice open defecation. Also, only 6.1% of the respondents were aware about the functions of Village Health Sanitation and Nutrition Committee (VHSNC).Conclusions: More number of families (42.7%) were dependent on submersible pump as sole source of water supply. 20.2% lacked separate toilet facility, mostly belonging to lower socio- economic status. Only 6.1% were aware regarding the VHSNC. All the families disposed of their household waste on the roads

Impact on quality-of-life: before and after topical combinational treatment in patients of acne vulgaris

Background: The objective was to study quality-of-life in patients of acne vulgaris before and after treatment by benzoyl peroxide 2.5% gel and clindamycin 1% gel or benzoyl peroxide 2.5% gel and nadifloxacin 1% cream or tretinoin 0.025% and clindamycin 1% gel.Methods: This was a prospective, open, randomized, parallel comparative study of 60 patients of acne vulgaris attending the Department of Dermatology and Venereal Diseases, Government Medical College, Rajindra Hospital, Patiala. Three groups were made 20 in each group, one group received benzoyl peroxide 2.5% gel and clindamycin 1% gel, the second group received benzoyl peroxide 2.5% gel, and nadifloxacin 1% cream and the third group received tretinoin 0.025% and clindamycin 1% gel. Cardiff acne disability index questionnaire was filled before starting and after the treatment.Results: In these three groups, it was found that the group on benzoyl peroxide 2.5% gel and clindamycin 1% gel, mean score, before starting treatment was 8.35±3.48 and after treatment was 2.95±2.09 (p<0.001), group on benzoyl peroxide 2.5% gel and nadifloxacin 1% cream, mean score, before starting treatment was 7.60±3.75 and after treatment was 5.80±2.98 (p<0.001) and group on tretinoin 0.025% and clindamycin 1% gel mean score is 8.00±3.06 and after treatment was 5.40±2.93 (p<0.001).Conclusion: Quality-of-life improves more in patients taking benzoyl peroxide 2.5% gel and clindamycin 1% gel, and then, tretinoin 0.025% and clindamycin 1% gel and then benzoyl peroxide 2.5% gel and nadifloxacin 1% cream

Progress in the performance of HIV early infant diagnosis services in Zambia using routinely collected data from 2006 to 2016.

BACKGROUND: Early diagnosis and treatment initiation of HIV-infected infants can greatly reduce the risk of infant mortality. The WHO recommends testing HIV-exposed infants at 6 weeks of age and immediate initiation of antiretroviral therapy if positive. This study aimed to determine the feasibility of using an electronic health records system to evaluate the performance of Zambia's HIV Early Infant Diagnosis services. METHODS: A retrospective analysis of routinely collected data from the Zambian SmartCare database was performed for the period January 2006 to December 2016. The study population includes all HIV-infected infants (n = 32,593) registered during this period on treatment for HIV. Univariable logistic regression was conducted to identify factors associated with later infant testing and treatment initiation. RESULTS: The mean age at infant HIV test decreased from 10.10 months in 2006 to 3.49 months in 2016. Infants born in 2015 were almost 4 times more likely to be tested under 2 months of age compared to infants born in 2006 (OR: 3.72, p-value: < 0.001). The mean time from diagnosis to treatment initiation decreased from 220 days in 2006 to 9 days in 2015. There was substantial regional variability with infants in the provinces of Copperbelt, Luapula and Southern performing best in outcomes and Eastern, Lusaka and Western performing the worst. CONCLUSIONS: HIV-exposed infants born more recently have significantly better outcomes than infants born a decade ago in Zambia, which could be as a result of increased attention and funding for HIV programmes

Microperimetry reliability assessed from fixation performance

Purpose: Microperimetry provides an accurate assessment of central retinal sensitivity due to its fundus-tracking capability, but it has limited reliability indicators. One method currently employed, fixation loss, samples the optic nerve blind spot for positive responses; however, it is unclear if these responses arise from unintentional button presses or from tracking failure leading to stimuli misplacement. We investigated the relationship between blind spot scotoma positive responses (termed scotoma responses) and fixation. Methods: Part 1 of the study involved a custom grid of 181 points centered on the optic nerve that was constructed to map physiological blind spots in primary and simulated eccentric fixation positions. Scotoma responses and the 63% and 95% fixation bivariate contour ellipse areas (BCEA63 and BCEA95) were analyzed. In Part 2, fixation data from controls and patients with retinal diseases (234 eyes from 118 patients) were collected. Results: Part 1, a linear mixed model of 32 control participants, demonstrated significant (P < 0.001) correlation between scotoma responses and BCEA95. In Part 2, the upper 95% confidence intervals for BCEA95 were 3.7 deg2 for controls, 27.6 deg2 for choroideremia, 23.1 deg2 for typical rod–cone dystrophies, 21.4 deg2 for Stargardt disease, and 111.3 deg2 for age-related macular degeneration. Incorporating all pathology groups into an overall statistic resulted in an upper limit BCEA95 = 29.6 deg2. Conclusions: Microperimetry reliability is significantly correlated to fixation performance, and BCEA95 provides a surrogate marker for test accuracy. Examinations of healthy individuals and patients with retinal disease are deemed unreliable if BCEA95 > 4 deg2 and BCEA95 > 30 deg2, respectively. Translational Relevance: Microperimetry reliability should be assessed using fixation performance as summarized by BCEA95 rather than the level of fixation losses

Microperimetry hill of vision and volumetric measures of retinal sensitivity

Purpose: Mean retinal sensitivity is the main output measure used in microperimetry. It is, however, of limited use in patients with poor vision because averaging is weighted toward zero in those with significant scotomas creating an artificial floor effect. In contrast, volumetric measures avoid these issues and are displayed graphically as a hill of vision. Methods: An open-source program was created to manipulate raw sensitivity threshold data files obtained from MAIA microperimetry. Thin plate spline interpolated heat maps and three-dimensional hill of vision plots with an associated volume were generated. Retrospective analyses of microperimetry volumes were undertaken in patients with a range of retinal diseases to assess the qualitative benefits of three-dimensional visualization and volumetric measures. Simulated pathology was applied to radial grid patterns to investigate the performance of volumetric sensitivity in nonuniform grids. Results: Volumetric analyses from microperimetry in RPGR-related retinitis pigmentosa, choroideremia, Stargardt disease, and age-related macular degeneration were analyzed. In simulated nonuniform testing grids, volumetric sensitivity was able to detect differences in retinal sensitivity where mean sensitivity could not. Conclusions: Volumetric measures do not suffer from averaging issues and demonstrate superior performance in nonuniform testing grids. Additionally, volume measures enable detection of localized retinal sensitivity changes that might otherwise be undetectable in a mean change. Translational Relevance: As microperimetry has become an outcome measure in several gene-therapy clinical trials, three-dimensional visualization and volumetric sensitivity enables a complementary analysis of baseline disease characteristics and subsequent response to treatment, both as a signal of safety and efficacy

Characterizing visual fields in RPGR related retinitis pigmentosa using octopus static-automated perimetry

Purpose: Peripheral visual fields have not been as well defined by static automated perimetry as kinetic perimetry in RPGR-related retinitis pigmentosa. This study explores the pattern and sensitivities of peripheral visual fields, which may provide an important end point when assessing interventional clinical trials. Methods: A retrospective observational cross-sectional study of 10 genetically confirmed RPGR subjects was performed. Visual fields were obtained using the Octopus 900 perimeter. Interocular symmetry and repeatability were quantified. Visual fields were subdivided into central and peripheral subfields for analysis. Results: Mean patient age was 32 years old (20 to 49 years old). Average mean sensitivity was 7 dB (SD = 3.67 dB) and 6.8 dB (SD = 3.4 dB) for the right and left eyes, respectively, demonstrating interocular symmetry. Coefficient of repeatability for overall mean sensitivity: <2 dB. Nine out of 10 subjects had a preserved inferotemporal subfield, whose mean sensitivity was highly correlated to the central field (r2 = 0.78, P = 0.002 and r2 = 0.72, P = 0.002 for the right and left eyes, respectively). Within the central field, sensitivities were greater in the temporal than the nasal half (t-test, P = 0.01 and P = 0.03 for the right and left eyes, respectively). Conclusions: Octopus static-automated perimeter demonstrates good repeatability. Interocular symmetry permits use of the noninterventional eye as an internal control. In this cohort, the inferotemporal and central visual fields are preserved into later disease stages likely mapping to populations of surviving cones. Translational Relevance: A consistently preserved inferotemporal island of vision highly correlated to that of the central visual field may have significance as a possible future therapeutic site

Highlights from the 16th International Society for Computational Biology Student Council Symposium 2020.

In this meeting overview, we summarise the scientific program and organisation of the 16th International Society for Computational Biology Student Council Symposium in 2020 (ISCB SCS2020). This symposium was the first virtual edition in an uninterrupted series of symposia that has been going on for 15 years, aiming to unite computational biology students and early career researchers across the globe. [Abstract copyright: Copyright: © 2021 Cuypers WL et al.

The NRPD1 N-terminus contains a Pol IV-specific motif that is critical for genome surveillance in Arabidopsis

RNA-guided surveillance systems constrain the activity of transposable elements (TEs) in host genomes. In plants, RNA polymerase IV (Pol IV) transcribes TEs into primary transcripts from which RDR2 synthesizes double-stranded RNA precursors for small interfering RNAs (siRNAs) that guide TE methylation and silencing. How the core subunits of Pol IV, homologs of RNA polymerase II subunits, diverged to support siRNA biogenesis in a TE-rich, repressive chromatin context is not well understood. Here we studied the N-terminus of Pol IV’s largest subunit, NRPD1. Arabidopsis lines harboring missense mutations in this N-terminus produce wild-type (WT) levels of NRPD1, which co-purifies with other Pol IV subunits and RDR2. Our in vitro transcription and genomic analyses reveal that the NRPD1 N-terminus is critical for robust Pol IV-dependent transcription, siRNA production and DNA methylation. However, residual RNA-directed DNA methylation observed in one mutant genotype indicates that Pol IV can operate uncoupled from the high siRNA levels typically observed in WT plants. This mutation disrupts a motif uniquely conserved in Pol IV, crippling the enzyme's ability to inhibit retrotransposon mobilization. We propose that the NRPD1 N-terminus motif evolved to regulate Pol IV function in genome surveillance