Modeling the Intelligibility Benefit of Active Noise Cancelation in Hearing Devices That Improve Signal-to-Noise Ratio.

The extent to which active noise cancelation (ANC), when combined with hearing assistance, can improve speech intelligibility in noise is not well understood. One possible source of benefit is ANC's ability to reduce the sound level of the direct (i.e.

Clinical evaluation of a Borrelia modified two-tiered testing (MTTT) shows increased early sensitivity for Borrelia burgdorferi but not other endemic Borrelia species in a high incidence region for Lyme disease in Wisconsin.

A modified two-tiered testing algorithm (MTTT; ZEUS Scientific) for Borrelia burgdorferi was recently FDA-cleared. We evaluated the MTTT algorithm to confirm Lyme disease and compared the findings in parallel with those obtained using standard two-tiered testing (STTT). Medical records from patients who submitted sera for laboratory confirmation of Lyme-like disease were reviewed.

Optimized infection control practices augment the robust protective effect of vaccination for ESRD patients during a hemodialysis facility SARS-CoV-2 outbreak.

Background: While dialysis patients are at greater risk of serious SARS-CoV-2 complications, stringent infection prevention measures can help mitigate infection and transmission risks within dialysis facilities. We describe an outbreak of 14 cases diagnosed in a hospital-based outpatient ESRD facility over 13 days in the second quarter of 2021, and our coordinated use of epidemiology, viral genome sequencing, and infection control practices to quickly end the transmission cycle.

Methods: Symptomatic patients and staff members were diagnosed by RT-PCR.

Emergence and onward transmission of a SARS-CoV-2 E484K variant among household contacts of a bamlanivimab-treated patient.

The implementation of monoclonal antibody therapeutics during the COVID-19 pandemic altered the selective pressures encountered by SARS-CoV-2, raising the possibility of selection for resistant variants. Within-host viral evolution was reported in treated immunocompromised individuals but whether this signifies a real risk of onward transmission is unclear. We used a regional SARS-CoV-2 sequencing program to monitor lineages with clinically relevant variants in identified patients, which facilitated analysis of parameters potentially relevant to new variant emergence.

Correlation Between Early Endpoints and Overall Survival in Non-Small-Cell Lung Cancer: A Trial-Level Meta-Analysis.

Early endpoints, such as progression-free survival (PFS), are increasingly used as surrogates for overall survival (OS) to accelerate approval of novel oncology agents. Compiling trial-level data from randomized controlled trials (RCTs) could help to develop a predictive framework to ascertain correlation trends between treatment effects for early and late endpoints. Through trial-level correlation and random-effects meta-regression analysis, we assessed the relationship between hazard ratio (HR) OS and (1) HR PFS and (2) odds ratio (OR) PFS at 4 and 6 months, stratified according to the mechanism of action of the investigational product.

Outbreak or pseudo-outbreak? Integrating SARS-CoV-2 sequencing to validate infection control practices in a dialysis facility.

Background: The COVID-19 pandemic poses a particularly high risk for End Stage Renal Disease (ESRD) patients so rapid identification of case clusters in ESRD facilities is essential. Nevertheless, with high community prevalence, a series of ESRD patients may test positive contemporaneously for reasons unrelated to their shared ESRD facility. Here we describe a series of 5 cases detected within 11 days in November 2020 in a hospital-based 32-station ESRD facility in Southwest Wisconsin, the subsequent facility-wide testing, and the use of genetic sequence analysis to evaluate links between cases.

Systemic versus free antibiotic delivery in preventing acute exogenous implant related infection in a rat model.

We studied systemic ceftriaxone, and free/local tobramycin and doxycycline in a controlled rat model representing a generic acute exogenous joint infection. We hypothesized that evidence of infection (quantitative colony forming units [CFU], qualitative scanning electron microscopy [SEM], histopathology) (1a) would be reduced with local versus systemic antibiotic, (1b) any antibiotic would be superior to control, (2) there would be a difference among antibiotics, and (3) antibiotic would not be detectable in serum at 4-week euthanasia. Study groups included infected and noninfected (1) control (no treatment), (2) systemic ceftriaxone (daily), (3) local tobramycin, and (4) local doxycycline (10 rats/group; power = 0.

Validation of a Self-Fitting Method for Over-the-Counter Hearing Aids.

In common practice, hearing aids are fitted by a clinician who measures an audiogram and uses it to generate prescriptive gain and output targets. This report describes an alternative method where users select their own signal processing parameters using an interface consisting of two wheels that optimally map to simultaneous control of gain and compression in each frequency band. The real-world performance of this approach was evaluated via a take-home field trial.

A note on the determination of non-inferiority margins with application in oncology clinical trials.

The goal of a non-inferiority trial is to evaluate whether the effect of an experimental treatment is not inferior to that of the active control. Determination of an appropriate non-inferiority margin is critical to the demonstration of non-inferiority. A commonly used method is called the fixed-margin approach recommended by the FDA.

Perceptual-learning evidence for inter-onset-interval- and frequency-specific processing of fast rhythms.

Rhythm is fundamental to music and speech, yet little is known about how even simple rhythmic patterns are processed. Here we investigated the processing of isochronous rhythms in the short inter-onset-interval (IOI) range (IOIs < 250-400 ms) using a perceptual-learning paradigm. Trained listeners (n=8) practiced anisochrony detection with a 100-ms IOI marked by 1-kHz tones, 720 trials per day for 7 days.

Exaggeration of PFS by blinded, independent, central review (BICR).

Background: Recent published studies have shown meaningful discrepancies between local investigator and blinded, independent, central review (BICR) assessed median progression-free survival (PFS). When the local review but not BICR shows progression, generally, no further assessments are carried out and patients are censored in the BICR analysis, leading to violation of the statistical assumptions of independence between censoring and outcome used in survival analysis methods.

Methods: We carried out a simulation study to assess methodological reasons behind these discrepancies and corroborated our findings in a case study of three BRCA-mutated ovarian cancer trials.

Widespread Lichtheimia Infection in a Patient with Extensive Burns: Opportunities for Novel Antifungal Agents.

The Mucorales fungi-formerly classified as the zygomycetes-are environmentally ubiquitous fungi, but generally rare causes of clinical infections. In the immunocompromised host, however, they can cause invasive, rapidly spreading infections that confer a high risk of morbidity and mortality, often despite surgical and antifungal therapy. Patients with extensive burn injuries are particularly susceptible to skin and soft-tissue infections with these organisms.

Biomimetic hydrogels direct spinal progenitor cell differentiation and promote functional recovery after spinal cord injury.

Objective: Demyelination that results from disease or traumatic injury, such as spinal cord injury (SCI), can have a devastating effect on neural function and recovery. Many researchers are examining treatments to minimize demyelination by improving oligodendrocyte availability in vivo. Transplantation of stem and oligodendrocyte progenitor cells is a promising option, however, trials are plagued by undirected differentiation.

Exclusive breastfeeding practices in working women of Pakistan: A cross sectional study.

Objective: To determine the prevalence of exclusive breast feeding in working women and to identify the factors effecting exclusive breast feeding in working women.

Methods: This cross-sectional survey was conducted in Faisalabad city within a period of six months from June 2016 to December 2016. Working women of age 18 to 45 years, working as doctors, teachers, nurses and bankers in public (government) setup were included.

Mycobacterium abscessus Complex Infections in Children: A Review.

Purpose Of Review: Infections in children with Mycobacterium abscessus complex represent a particular challenge for clinicians. Increasing incidence of these infections worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. Published medical literature was reviewed, with emphasis on material published in the past 5 years.

The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study.

The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

TRAIL receptor agonist conatumumab with modified FOLFOX6 plus bevacizumab for first-line treatment of metastatic colorectal cancer: A randomized phase 1b/2 trial.

Background: In patients with previously untreated metastatic colorectal cancer (mCRC), we conducted a phase 1b/randomized phase 2 trial to define the safety, tolerability, and efficacy of mFOLFOX6 plus bevacizumab (mFOLFOX6/bev) with conatumumab, an investigational, fully human monoclonal IgG1 antibody that specifically activates death receptor 5 (DR5).

Methods: Twelve patients were enrolled in a phase 1b open-label dose-escalation trial of conatumumab with mFOLFOX6/bev; thereafter, 190 patients were randomized 1:1:1 to receive mFOLFOX6/bev in combination with 2 mg/kg conatumumab, 10 mg/kg conatumumab, or placebo. Therapy cycles were repeated every 2 weeks until disease progression or the occurrence of unacceptable toxicity.

Vertical-plane sound localization with distorted spectral cues.

For human listeners, the primary cues for localization in the vertical plane are provided by the direction-dependent filtering of the pinnae, head, and upper body. Vertical-plane localization generally is accurate for broadband sounds, but when such sounds are presented at near-threshold levels or at high levels with short durations (<20 ms), the apparent location is biased toward the horizontal plane (i.e.

Initial development of a temporal-envelope-preserving nonlinear hearing aid prescription using a genetic algorithm.

Most hearing aid prescriptions focus on the optimization of a metric derived from the long-term average spectrum of speech, and do not consider how the prescribed values might distort the temporal envelope shape. A growing body of evidence suggests that such distortions can lead to systematic errors in speech perception, and therefore hearing aid prescriptions might benefit by including preservation of the temporal envelope shape in their rationale. To begin to explore this possibility, we designed a genetic algorithm (GA) to find the multiband compression settings that preserve the shape of the original temporal envelope while placing that envelope in the listener's audiometric dynamic range.

Acoustical correlates of performance on a dynamic range compression discrimination task.

Dynamic range compression is widely used to reduce the difference between the most and least intense portions of a signal. Such compression distorts the shape of the amplitude envelope of a signal, but it is unclear to what extent such distortions are actually perceivable by listeners. Here, the ability to distinguish between compressed and uncompressed versions of a noise vocoded sentence was initially measured in listeners with normal hearing while varying the threshold, ratio, attack, and release parameters.

Sound localization in noise and sensitivity to spectral shape.

Individual differences exist in sound localization performance even for normal-hearing listeners. Some of these differences might be related to acoustical differences in localization cues carried by the head related transfer functions (HRTF). Recent data suggest that individual differences in sound localization performance could also have a perceptual origin.

Sound localization in unilateral deafness with the Baha or TransEar device.

Objective: To evaluate the sound localization capabilities of patients with unilateral, profound sensorineural hearing loss who had been treated with either a bone-anchored hearing device (Baha BP100) or a TransEar 380-HF bone-conduction hearing device.

Study Design: Nonrandomized, prospective study. SETTING Tertiary referral private practice.

Different patterns of perceptual learning on spectral modulation detection between older hearing-impaired and younger normal-hearing adults.

Young adults with normal hearing (YNH) can improve their sensitivity to basic acoustic features with practice. However, it is not known to what extent the influence of the same training regimen differs between YNH listeners and older listeners with hearing impairment (OHI)--the largest population seeking treatment in audiology clinics. To examine this issue, we trained OHI listeners on a basic auditory task (spectral modulation detection) using a training regimen previously administered to YNH listeners (≈ 1 h/session for seven sessions on a single condition).

Hearing outcomes in stapes surgery: a comparison of fat, fascia, and vein tissue seals.

Objective: To compare short- and long-term hearing results following stapedectomy using 3 different oval window grafting materials with the same stapes prosthesis.

Study Design: Database review.

Setting: Tertiary referral private practice.