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Purpose: Due to the elevated vocal risks of university professors and the possible relationship between auditory-motor integration and voice disorders, the current study was designed to explore the effects of altered auditory feedback via bone conduction on voice production measures in university professors., Methods: A total of 43 hours of voice recordings across 32 university classes were collected from two vocally healthy college professors through voice dosimetry. During their classes, the professors experienced either the real-time altered auditory feedback or a condition without altered auditory feedback. The voice dosimetry recordings from all classes were processed to calculate the sound pressure level values, fundamental frequency values, and the time dose. The effects of the altered auditory feedback conditions on these voice acoustic parameters were analyzed and compared with the conditions without altered auditory feedback., Results: The altered auditory feedback conditions resulted in significantly decreased sound pressure level values and time dose for both professors when comparing the altered auditory feedback conditions to the conditions without altered auditory feedback. The altered auditory feedback effects were larger for the male professor compared with the female professor. Additionally, the male professor demonstrated significantly decreased fundamental frequency values when comparing the altered auditory feedback conditions to the conditions without altered auditory feedback, while the female professor did not., Conclusions: This study provides evidence that altered auditory feedback provided via bone conduction through an altered auditory feedback device resulted in statistically significant improvements in the voices of two college professors., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships that may be considered as potential competing interests: Pasquale Bottalico reports equipment, drugs, or supplies were provided by SOUND FOR LIFE. In particular, the device Forbrain was provided free of charge by SOUND FOR LIFE. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Single-cell genomics is a powerful tool for studying heterogeneous tissues such as the brain. Yet little is understood about how genetic variants influence cell-level gene expression. Addressing this, we uniformly processed single-nuclei, multiomics datasets into a resource comprising >2.8 million nuclei from the prefrontal cortex across 388 individuals. For 28 cell types, we assessed population-level variation in expression and chromatin across gene families and drug targets. We identified >550,000 cell type-specific regulatory elements and >1.4 million single-cell expression quantitative trait loci, which we used to build cell-type regulatory and cell-to-cell communication networks. These networks manifest cellular changes in aging and neuropsychiatric disorders. We further constructed an integrative model accurately imputing single-cell expression and simulating perturbations; the model prioritized ~250 disease-risk genes and drug targets with associated cell types.

Objectives: This study investigated the influence of long-term talker familiarity on speech-in-speech recognition in school-age children, with a specific emphasis on the role of familiarity with the mother's voice as either the target or masker speech., Design: Open-set sentence recognition was measured adaptively in a two-talker masker. Target and masker sentences were recorded by the adult mothers of the child participants. Each child heard sentences spoken by three adult female voices during testing; their own mother's voice (familiar voice) and two unfamiliar adult female voices., Study Sample: Twenty-four school age children (8-13 years) with normal hearing., Results: When the target speech was spoken by a familiar talker (the mother), speech recognition was significantly better compared to when the target was unfamiliar. When the masker was spoken by the familiar talker, there was no difference in performance relative to the unfamiliar masker condition. Across all conditions, younger children required a more favorable signal-to-noise ratio than older children., Conclusion: Implicit long-term familiarity with a talker consistently improves children's speech-in-speech recognition across the age range tested, specifically when the target talker is familiar. However, performance remains unaffected by masker talker familiarity. Additionally, while target familiarity is advantageous, it does not entirely eliminate children's increased susceptibility to competing speech., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Flaherty.)

Introduction: Pulsed electric field (PEF) ablation relies on the intersection of a critical voltage gradient with tissue to cause cell death. Field-based lesion formation with PEF technologies may still depend on catheter-tissue contact (CTC). The purpose of this study was to assess the impact of CTC on PEF lesion formation with an investigational large area focal (LAF) catheter in a preclinical model., Methods: PEF ablation via a 10-spline LAF catheter was used to create discrete right ventricle (RV) lesions and atrial lesion sets in 10 swine (eight acute, two chronic). Local impedance (LI) was used to assess CTC. Lesions were assigned to three cohorts using LI above baseline: no tissue contact (NTC: ≤∆10 Ω, close proximity to tissue), low tissue contact (LTC: ∆11-29 Ω), and high tissue contact (HTC: ≥∆30 Ω). Acute animals were infused with triphenyl tetrazolium chloride (TTC) and killed ≥2 h post-treatment. Chronic animals were remapped 30 days post-index procedure and stained with infused TTC., Results: Mean (± SD) RV treatment sizes between LTC (n = 14) and HTC (n = 17) lesions were not significantly different (depth: 5.65 ± 1.96 vs. 5.68 ± 2.05 mm, p = .999; width: 15.68 ± 5.22 vs. 16.98 ± 4.45 mm, p = .737), while mean treatment size for NTC lesions (n = 6) was significantly smaller (1.67 ± 1.16 mm depth, 5.97 ± 4.48 mm width, p < .05). For atrial lesion sets, acute and chronic conduction block were achieved with both LTC (N = 7) and HTC (N = 6), and NTC resulted in gaps., Conclusions: PEF ablation with a specialized LAF catheter in a swine model is dependent on CTC. LI as an indicator of CTC may aid in the creation of consistent transmural lesions in PEF ablation., (© 2024 CardioFocus. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.)

Purpose: The goal was to evaluate whether implicit talker familiarization via an interactive computer game, designed for this study, could improve children's word recognition in classroom noise. It was hypothesized that, regardless of age, children would perform better when recognizing words spoken by the talker who was heard during the game they played., Method: Using a one-group pretest-posttest experimental design, this study examined the impact of short-term implicit voice exposure on children's word recognition in classroom noise. Implicit voice familiarization occurred via an interactive computer game, played at home for 10 min a day for 5 days. In the game, children (8-12 years) heard one voice, intended to become the "familiar talker." Pre- and postfamiliarization, children identified words in prerecorded classroom noise. Four conditions were tested to evaluate talker familiarity and generalization effects., Results: Results demonstrated an 11% improvement when recognizing words spoken by the voice heard in the game ("familiar talker"). This was observed only for words that were heard in the game and did not generalize to unfamiliarized words. Before familiarization, younger children had poorer recognition than older children in all conditions; however, after familiarization, there was no effect of age on performance for familiarized stimuli., Conclusions: Implicit short-term exposure to a talker has the potential to improve children's speech recognition. Therefore, leveraging talker familiarity through gameplay shows promise as a viable method for improving children's speech-in-noise recognition. However, given that improvements did not generalize to unfamiliarized words, careful consideration of exposure stimuli is necessary to optimize this approach.

Objectives: This study explored the effects of different face masks on school-age children's and young adults' word recognition., Design: Speech recognition thresholds were measured adaptively in a two-talker speech masker using a closed-set picture pointing task. Target words were recorded by a female talker in five conditions: no mask, transparent mask, face shield, N95 mask and surgical mask., Study Samples: Thirty children (8-12 years) and 25 adults (18-25 years) with normal hearing., Results: Both children's and adults' word recognition was most negatively impacted by the face shield. Children's recognition was also impaired by the transparent mask. No negative effects were observed for the N95 or surgical mask for either age group., Conclusion: School-age children, like young adults, are negatively affected by face masks when recognising speech in a two-talker speech masker, but the effects depend on the type of face mask being worn. Acoustic analyses suggest that the reflective materials used for masks impact speech signal quality and impair word recognition.

Purpose: The purpose of this project is to assess the acoustical conditions in which optimal intelligibility and low listening difficulty can be achieved in real classrooms for elementary students, taking into consideration the effects of dysphonic voice and typical classroom noise., Method: Speech intelligibility tests were performed in six elementary classrooms with 80 normal-hearing students aged 7-11 years. The speech material was produced by a female actor using a normal voice quality and simulating a dysphonic voice. The stimuli were played by a Head and Torso Simulator. Child babble noise and classrooms with different reverberation times were used to obtain a Speech Transmission Index (STI) range from 0.2 to 0.7, corresponding to the categories bad, poor, fair, and good., Results: The results showed a statistically significant decrease in intelligibility when the speaker was dysphonic, in STI higher than 0.33. The rating of listening difficulty showed a significantly greater difficulty in perceiving the dysphonic voice. In addition, younger children showed poorer performance and greater listening difficulty compared with older children when listening to the normal voice quality. Both groups were equally impacted when the voice was dysphonic., Conclusions: The results suggested that better acoustic conditions are needed for children to reach a good level of intelligibility and to reduce listening difficulty if the teacher is suffering from voice problems. This was true for children regardless of grade level, highlighting the importance of ensuring more favorable acoustic conditions for children throughout all elementary schools., Supplemental Material: https://doi.org/10.23641/asha.23504487.

Purpose: Maturation of the ability to recognize target speech in the presence of a two-talker speech masker extends into early adolescence. This study evaluated whether children benefit from differences in fundamental frequency ( f o ) contour depth between the target and masker speech, a cue that has been shown to improve recognition in adults., Method: Speech stimuli were recorded from talkers using three speaking styles, with f o contour depths that were Flat, Normal, or Exaggerated. Targets were open-set, declarative sentences produced by a female talker, and maskers were two streams of concatenated sentences produced by a second female talker. Listeners were children (ages 5-17 years) and adults (ages 18-24 years) with normal hearing. Each listener was tested in one of the three masker styles paired with all three target styles. Speech recognition thresholds (SRTs) corresponding to 50% correct were estimated by fitting psychometric functions to adaptive track data., Results: For adults, performance did not differ significantly across conditions with matched speaking styles. A mismatch benefit was observed when combining Flat targets with the Exaggerated masker and Exaggerated targets with the Flat masker, and for both Flat and Exaggerated targets paired with the Normal masker. For children, there was a significant effect of age in all conditions. Flat targets in the Flat masker were associated with lower SRTs than the other two matched conditions, and a mismatch benefit was observed for young children only when the target f o contour was less variable than the masker f o contour., Conclusions: Whereas child-directed speech often has exaggerated pitch contours, young children were better able to recognize speech with less variable f o . Age effects were observed in the benefit of mismatched speaking styles for some conditions, which could be related to differences in baseline SRTs rather than differences in segregation abilities.

While the audible frequency range for humans spans approximately 20 Hz to 20 kHz, children display enhanced sensitivity relative to adults when detecting extended high frequencies (frequencies above 8 kHz; EHFs), as indicated by better pure tone thresholds. The impact that this increased hearing sensitivity to EHFs may have on children's speech recognition has not been established. One context in which EHF hearing may be particularly important for children is when recognizing speech in the presence of competing talkers. In the present study, we examined the extent to which school-age children (ages 5-17 years) with normal hearing were able to benefit from EHF cues when recognizing sentences in a two-talker speech masker. Two filtering conditions were tested: all stimuli were either full band or were low-pass filtered at 8 kHz to remove EHFs. Given that EHF energy emission in speech is highly dependent on head orientation of the talker (i.e., radiation becomes more directional with increasing frequency), two masker head angle conditions were tested: both co-located maskers were facing 45°, or both were facing 60° relative to the listener. The results demonstrated that regardless of age, children performed better when EHFs were present. In addition, a small change in masker head orientation also impacted performance, with better recognition at 60° compared to 45°. These findings suggest that EHF energy in the speech signal above 8 kHz is beneficial for children in complex listening situations. The magnitude of benefit from EHF cues and talker head orientation cues did not differ between children and adults. Therefore, while EHFs were beneficial for children as young as 5 years of age, children's generally better EHF hearing relative to adults did not provide any additional benefit., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: The objectives of the study were to (1) evaluate the impact of hearing loss on children's ability to benefit from F0 differences between target/masker speech in the context of aided speech-in-speech recognition and (2) to determine whether compromised F0 discrimination associated with hearing loss predicts F0 benefit in individual children. We hypothesized that children wearing appropriately fitted amplification would benefit from F0 differences, but they would not show the same magnitude of benefit as children with normal hearing. Reduced audibility and poor suprathreshold encoding that degrades frequency discrimination were expected to impair children's ability to segregate talkers based on F0., Design: Listeners were 9 to 17 year olds with bilateral, symmetrical, sensorineural hearing loss ranging in degree from mild to severe. A four-alternative, forced-choice procedure was used to estimate thresholds for disyllabic word recognition in a 60-dB-SPL two-talker masker. The same male talker produced target and masker speech. Target words had either the same mean F0 as the masker or were digitally shifted higher than the masker by three, six, or nine semitones. The F0 benefit was defined as the difference in thresholds between the shifted-F0 conditions and the unshifted-F0 condition. Thresholds for discriminating F0 were also measured, using a three-alternative, three-interval forced choice procedure, to determine whether compromised sensitivity to F0 differences due to hearing loss would predict children's ability to benefit from F0. Testing was performed in the sound field, and all children wore their personal hearing aids at user settings., Results: Children with hearing loss benefited from an F0 difference of nine semitones between target words and masker speech, with older children generally benefitting more than younger children. Some children benefitted from an F0 difference of six semitones, but this was not consistent across listeners. Thresholds for discriminating F0 improved with increasing age and predicted F0 benefit in the nine-semitone condition. An exploratory analysis indicated that F0 benefit was not significantly correlated with the four-frequency pure-tone average (0.5, 1, 2, and 4 kHz), aided audibility, or consistency of daily hearing aid use, although there was a trend for an association with the low-frequency pure-tone average (0.25 and 0.5 kHz). Comparisons of the present data to our previous study of children with normal hearing demonstrated that children with hearing loss benefitted less than children with normal hearing for the F0 differences tested., Conclusions: The results demonstrate that children with mild-to-severe hearing loss who wear hearing aids benefit from relatively large F0 differences between target and masker speech during aided speech-in-speech recognition. The size of the benefit increases with increasing age, consistent with previously reported age effects for children with normal hearing. However, hearing loss reduces children's ability to capitalize on F0 differences between talkers. Audibility alone does not appear to be responsible for this effect; aided audibility and degree of loss were not primary predictors of performance. The ability to benefit from F0 differences may be limited by immature central processing or aspects of peripheral encoding that are not characterized in standard clinical assessments., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose The purpose of this study was to examine the independent and combined contributions of fundamental frequency (F0) and vocal tract length (VTL) differences on children's speech-in-speech recognition in the presence of a competing two-talker masker. Method Participants were 64 children (5-17 years old) and 25 adults (18-39 years old). Sentence recognition thresholds were measured in a two-talker masker. Target sentences had either the same mean F0 and VTL of the masker or were digitally altered so that the target and masker differed in F0 (Experiment 1), differed in VTL (Experiment 2), or differed in both F0 and VTL (Experiment 3). To determine the benefit, masking release was computed by subtracting thresholds in each shifted condition from the threshold in the unshifted condition. Results Results demonstrate that children's ability to benefit from either F0 or VTL differences (Experiments 1 and 2) depended on listener age, with younger children showing less improvement in speech reception thresholds compared to older children and adults. Age effects were also evident in the combined-cue conditions (Experiment 3), but children showed greater improvements compared to F0-only or VTL-only manipulations. Conclusions There was a prolonged pattern of development in children's ability to benefit from F0 or VTL differences between target and masker speech. Young children failed to capitalize on F0 and VTL differences to the same extent as older children and adults but did show a robust benefit when the cues were combined, supporting the hypothesis that younger children rely more heavily on redundant cues compared to older children and adults.

Complementary and integrative therapies are used by people to address many conditions, including pain-related conditions. There has been concern about the quality of online health information, including information pertaining to complementary and integrative health (CIH). In this qualitative interview study, we sought to investigate how individuals interact with CIH-related information online and how this might affect their subsequent behavior. We conducted semi-structured interviews with 14 individuals with chronic pain conditions. We report findings based on three main themes: individuals' beliefs about CIH; approach to CIH, including how people view provider information and personalize their CIH use strategy; and factors that affect trust in the information encountered. Overall, study participants believed there was value in CIH therapies and that treatments were effective. Many described experiences that had influenced their views of complementary therapies over time. We also found that individuals form impressions of CIH providers based on structural and personal characteristics, particularly cost and proximity, that are conveyed in information to which they are exposed. These findings have various implications. First, over time individuals with chronic pain conditions develop their own beliefs and attitudes, which play a role in their selection of providers and modalities relating to CIH. Health care providers should consider how people view information relating to, and make decisions about, CIH therapies and work collaboratively with patients to develop effective health management strategies. Information services should also consider patients' perspectives in developing websites and other informational materials., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Alpha-gal food allergy is a life-threatening, newly discovered condition with limited presence in authoritative information sources. Sufferers seeking diagnosis are likely to encounter clinicians unfamiliar with the condition., Objective: To understand information practices of individuals diagnosed with alpha-gal allergy, how they obtained diagnosis, and their perceptions of health-care providers' awareness of the condition., Methods: Semistructured interviews with open- and closed-ended questions were completed with a chronological systematic sample of 28 adults (11% of alpha-gal clinic patients at the time) diagnosed with alpha-gal allergy and treated at University of North Carolina Allergy and Immunology Clinic., Results: The majority of patients determined they had alpha-gal allergy through nontraditional health information channels. Three-quarters of patients rated their primary care provider as having little to no knowledge. In 25 specialists' encounters, 23 were rated as having little to no knowledge., Conclusion: With new conditions, information is often available through informal networks before appearing in the vetted medical literature. In this study, social connections were the primary pathway to successful diagnosis. Health practitioners need to develop mechanisms to understand that process., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2018.)

Objectives: The objectives of this study were to (1) evaluate the extent to which school-age children benefit from fundamental frequency (F0) differences between target words and competing two-talker speech, and (2) assess whether this benefit changes with age. It was predicted that while children would be more susceptible to speech-in-speech masking compared to adults, they would benefit from differences in F0 between target and masker speech. A second experiment was conducted to evaluate the relationship between frequency discrimination thresholds and the ability to benefit from target/masker differences in F0., Design: Listeners were children (5 to 15 years) and adults (20 to 36 years) with normal hearing. In the first experiment, speech reception thresholds (SRTs) for disyllabic words were measured in a continuous, 60-dB SPL two-talker speech masker. The same male talker produced both the target and masker speech (average F0 = 120 Hz). The level of the target words was adaptively varied to estimate the level associated with 71% correct identification. The procedure was a four-alternative forced-choice with a picture-pointing response. Target words either had the same mean F0 as the masker or it was shifted up by 3, 6, or 9 semitones. To determine the benefit of target/masker F0 separation on word recognition, masking release was computed by subtracting thresholds in each shifted-F0 condition from the threshold in the unshifted-F0 condition. In the second experiment, frequency discrimination thresholds were collected for a subset of listeners to determine whether sensitivity to F0 differences would be predictive of SRTs. The standard was the syllable /ba/ with an F0 of 250 Hz; the target stimuli had a higher F0. Discrimination thresholds were measured using a three-alternative, three-interval forced choice procedure., Results: Younger children (5 to 12 years) had significantly poorer SRTs than older children (13 to 15 years) and adults in the unshifted-F0 condition. The benefit of F0 separations generally increased with increasing child age and magnitude of target/masker F0 separation. For 5- to 7-year-olds, there was a small benefit of F0 separation in the 9-semitone condition only. For 8- to 12-year-olds, there was a benefit from both 6- and 9-semitone separations, but to a lesser degree than what was observed for older children (13 to 15 years) and adults, who showed a substantial benefit in the 6- and 9-semitone conditions. Examination of individual data found that children younger than 7 years of age did not benefit from any of the F0 separations tested. Results for the frequency discrimination task indicated that, while there was a trend for improved thresholds with increasing age, these thresholds were not predictive of the ability to use F0 differences in the speech-in-speech recognition task after controlling for age., Conclusions: The overall pattern of results suggests that children's ability to benefit from F0 differences in speech-in-speech recognition follows a prolonged developmental trajectory. Younger children are less able to capitalize on differences in F0 between target and masker speech. The extent to which individual children benefitted from target/masker F0 differences was not associated with their frequency discrimination thresholds.

Purpose The purpose of this study was to evaluate speech-in-noise and speech-in-speech recognition associated with activation of a fully adaptive directional hearing aid algorithm in children with mild to severe bilateral sensory/neural hearing loss. Method Fourteen children (5-14 years old) who are hard of hearing participated in this study. Participants wore laboratory hearing aids. Open-set word recognition thresholds were measured adaptively for 2 hearing aid settings: (a) omnidirectional (OMNI) and (b) fully adaptive directionality. Each hearing aid setting was evaluated in 3 listening conditions. Fourteen children with normal hearing served as age-matched controls. Results Children who are hard of hearing required a more advantageous signal-to-noise ratio than children with normal hearing to achieve comparable performance in all 3 conditions. For children who are hard of hearing, the average improvement in signal-to-noise ratio when comparing fully adaptive directionality to OMNI was 4.0 dB in noise, regardless of target location. Children performed similarly with fully adaptive directionality and OMNI settings in the presence of the speech maskers. Conclusions Compared to OMNI, fully adaptive directionality improved speech recognition in steady noise for children who are hard of hearing, even when they were not facing the target source. This algorithm did not affect speech recognition when the background noise was speech. Although the use of hearing aids with fully adaptive directionality is not proposed as a substitute for remote microphone systems, it appears to offer several advantages over fixed directionality, because it does not depend on children facing the target talker and provides access to multiple talkers within the environment. Additional experiments are required to further evaluate children's performance under a variety of spatial configurations in the presence of both noise and speech maskers.

Management of healthcare waste in low- and middle-income countries lacks a straightforward solution, especially where rural health services are provided. The purpose of our case study was to explore the knowledge and practices of health surveillance assistants operating at rural village health clinics in Ntcheu District, Malawi, with regard to the collection, segregation, transportion, treatment, and disposal of healthcare waste. Data were collected from 81 clinics. The results indicated that while general gaps in both knowledge and practice were observed, sharps (e.g., needles) management was generally being done well. An opportunity for scale-up was found in one clinic, in which local materials had been used to construct a low-cost innovative sharps disposal receptacle that had been modified from a pit latrine design. This study recommends waste management training suitable for rural settings, the promotion of low-cost sharps disposal receptacles using local materials, further opportunities for low-cost incinerators, central waste collection, and encouraging grassroots innovation in healthcare waste management.

Donor and agency priorities are influenced by a variety of political, social, and media-related forces that can have a profound impact on response and resource provision. We have attempted to assess how well internet searches articulate the span of violent death rates for five current "crisis" settings. In three graduate classes (2 public health, 1 information science) at US universities, during a four month period in 2017-2018, we asked approximately 60 graduate students to conduct an internet search to determine which of five countries had the highest and lowest "violence specific mortality rate": Venezuela, Syria, Yemen, Central African Republic (CAR), or Mali. Students were divided into groups of three, and within each group explored this question by three approaches. Many graduate students in all groups could not determine the relative rates, especially which country had the lowest violence specific mortality rate. Of the 34 searches that identified a highest violent death rate country, 27.5 (81%) concluded it was Venezuela, followed by Syria (4.5; 13%), Mali (1; 3%) and CAR (1; 3%). Of the 26 searches that identified a least violent death rate 21.5 (83%) reported either CAR or Mali, followed by Yemen (2.5; 10%) and Syria (2; 8%). Aside from lack of data on CAR and Mali, students were perplexed about whether to include suicides or executions in the measure. This resulted in almost half of all inquiries unable to estimate a highest and lowest rate among these five countries. Where conclusions were drawn, it is likely the internet drew students to the opposite conclusion from reality. There are several reasons for this discordance, such as differing categories of violent deaths as defined by the World Health Organization, and search engine algorithms. It is probable, however, that larger issues of connectivity of individual societies with each other and the outside world are playing a profound role in the deceptive results found in this exercise. This insight emphasizes the internet's under-reporting in the world's most poor and remote locations, and highlights the importance of primary data collection and reporting in such settings., Competing Interests: Not applicable. According to the University of North Carolina at Chapel Hill Institutional Review Board, this exercise did not fall under human subjects research (Flaherty, personal communication, April 9, 2018).Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Policy makers and public health practitioners rarely consider public libraries to be part of the health system, even though they possess several characteristics that suggest unrealized potential to advance population health. This scoping review uses an adapted social determinants framework to categorize current health-related work conducted by public libraries in the United States and to discuss libraries' potential as 'meso-level' community resources to improve population health. Our discussion of libraries contributes to scholarship on place-based health disparities, by emphasizing the potential impact of institutions that are modifiable through social policy-e.g., parks, community centers, schools-and which have a conceptually clear or empirically documented relationship to health.

Purpose: Published data indicate nearly adultlike frequency discrimination in infants but large child-adult differences for school-age children. This study evaluated the role that differences in measurement procedures and stimuli may have played in the apparent nonmonotonicity. Frequency discrimination was assessed in preschoolers, young school-age children, and adults using stimuli and procedures that have previously been used to test infants., Method: Listeners were preschoolers (3-4 years), young school-age children (5-6 years), and adults (19-38 years). Performance was assessed using a single-interval, observer-based method and a continuous train of stimuli, similar to that previously used to evaluate infants. Testing was completed using 500- and 5000-Hz standard tones, fixed within a set of trials. Thresholds for frequency discrimination were obtained using an adaptive, two-down one-up procedure. Adults and most school-age children responded by raising their hands. An observer-based, conditioned-play response was used to test preschoolers and those school-age children for whom the hand-raise procedure was not effective for conditioning., Results: Results suggest an effect of age and frequency on thresholds but no interaction between these 2 factors. A lower proportion of preschoolers completed training compared with young school-age children. For those children who completed training, however, thresholds did not improve significantly with age; both groups of children performed more poorly than adults. Performance was better for the 500-Hz standard frequency compared with the 5000-Hz standard frequency., Conclusions: Thresholds for school-age children were broadly similar to those previously observed using a forced-choice procedure. Although there was a trend for improved performance with increasing age, no significant age effect was observed between preschoolers and school-age children. The practice of excluding participants based on failure to meet conditioning criteria in an observer-based task could contribute to the relatively good performance observed for preschoolers in this study and the adultlike performance previously observed in infants.

[This corrects the article DOI: 10.1371/journal.pone.0177676.].

Objective: Patients exhibiting life-threatening symptoms associated with the alpha-gal food allergy (delayed urticaria or anaphylaxis due to mammalian meat) are frequently undiagnosed, causing unnecessary emergency department (ED) and health care visits, and extensive pain and suffering. This study aimed to determine the path to diagnosis experienced by alpha-gal patients., Methods: Semistructured interviews were conducted from March to June 2016 with a chronological systematic sample of approximately 10% of patients diagnosed with alpha-gal and treated by the University of North Carolina Allergy and Immunology Clinic (n = 28). Main outcome measures included average length of time between first symptoms' appearance and diagnosis, number and type of health care encounters en route to diagnosis, and typical symptom severity., Results: Six interviewees (21%) were diagnosed within a year of experiencing symptoms, of the remaining 22, mean time to diagnosis was 7.1 years. In over 100 medical encounters (including 28 ED visits and 2 urgent care) the correct diagnosis or effective diagnosing referral occurred less than 10% of the time. Seventy-one percent (20/28) described their first symptoms as severe. More patients found the allergist specializing in this condition on their own (n = 12; 43%) than those who were formally diagnosed or received referrals (n = 10; 36%) through the health care system., Conclusions: The medical community is challenged to stay abreast of emerging and newly uncovered illnesses through traditional medical literature communication channels. Presently, patients more often discover a diagnosis of alpha-gal allergy by using information resources on their own than by presenting to the ED with anaphylaxis.

Frequency discrimination was measured in 5- to 11-year-olds and adults with normal hearing. The standard stimulus was either a 250-Hz tone or the syllable /ba/ with a fundamental frequency (F0) of 250 Hz. Target stimuli were higher in frequency than the standard, and the threshold for frequency discrimination was determined adaptively for each of the two stimulus types separately. For both the tone and /ba/ stimuli, thresholds improved approximately linearly with the log of child age, reaching adult levels by 11.5 years of age. There was no evidence of an effect of stimulus type.

The influence of experience with human speech sounds on speech perception in budgerigars, vocal mimics whose speech exposure can be tightly controlled in a laboratory setting, was measured. Budgerigars were divided into groups that differed in auditory exposure and then tested on a cue-trading identification paradigm with synthetic speech. Phonetic cue trading is a perceptual phenomenon observed when changes on one cue dimension are offset by changes in another cue dimension while still maintaining the same phonetic percept. The current study examined whether budgerigars would trade the cues of voice onset time (VOT) and the first formant onset frequency when identifying syllable initial stop consonants and if this would be influenced by exposure to speech sounds. There were a total of four different exposure groups: No speech exposure (completely isolated), Passive speech exposure (regular exposure to human speech), and two Speech-trained groups. After the exposure period, all budgerigars were tested for phonetic cue trading using operant conditioning procedures. Birds were trained to peck keys in response to different synthetic speech sounds that began with "d" or "t" and varied in VOT and frequency of the first formant at voicing onset. Once training performance criteria were met, budgerigars were presented with the entire intermediate series, including ambiguous sounds. Responses on these trials were used to determine which speech cues were used, if a trading relation between VOT and the onset frequency of the first formant was present, and whether speech exposure had an influence on perception. Cue trading was found in all birds and these results were largely similar to those of a group of humans. Results indicated that prior speech experience was not a requirement for cue trading by budgerigars. The results are consistent with theories that explain phonetic cue trading in terms of a rich auditory encoding of the speech signal.

Aim: To evaluate the prevalence of organ system disorders and describe healthcare utilization among adults with spina bifida at a regional clinic., Method: This study was a structured chart review using the Rochester Health Status Survey-IV. 65 males, 57 females aged 16 to 59 years were seen at the Spina Bifida Center of Central New York between January 2007 and December 2008 (annual hospitalization rate was 15 out of 100)., Results: Hospitalizations and acute outpatient visits were associated with having shunted hydrocephalus, whereas visits to the emergency department were associated with having a decubitus ulcer. Logistic regression models revealed that older adults made proportionately fewer visits to primary care providers than younger adults (odds ratio 0.919; p=0.02). Yet for every 1-year increase in age, the odds of being hospitalized increased by 5% (odds ratio 1.051; p=0.03)., Interpretation: Adults with spina bifida have multiple organ-system disorders. They have greater difficulty accessing services, and utilize emergency and inpatient healthcare at higher rates than the general population. In the future, adults with spina bifida will require access to more medical care and preventive services if they are to have optimal health, well-being, and functioning., (© 2015 Mac Keith Press.)

Deciphering the auditory scene is a problem faced by many organisms. However, when faced with numerous overlapping sounds from multiple locations, listeners are still able to attribute the individual sound objects to their individual sound-producing sources. Here, the characteristics of sounds important for integrating versus segregating in birds were determined. Budgerigars and zebra finches were trained using operant conditioning procedures on an identification task to peck one key when they heard a whole zebra finch song and to peck another when they heard a zebra finch song missing a middle syllable. Once the birds were trained to a criterion performance level on those stimuli, probe trials were introduced on a small proportion of trials. The probe songs contained modifications of the incomplete training song's missing syllable. When the bird responded as if the probe was a whole song, it suggests they streamed together the altered syllable and the rest of the song. When the bird responded as if the probe was a non-whole song, it suggests they segregated the altered probe from the rest of the song. Results show that some features, such as location and intensity, are more important for segregating than other features, such as timing and frequency.

The aim of this study was to examine the influence of yoga practice on body image satisfaction in men. Male Figure Drawings were used to explore body image satisfaction in yoga beginners (n = 26, M age = 40.3 yr., SD = 11.6), experienced yoga practitioners (n = 22, M age = 46.4 yr., SD = 11.6), and non-yoga practicing aerobic and weight training exercisers (n = 34, M age = 41.2 yr., SD = 11.9). Satisfaction was significantly higher among the yoga groups than the exercisers. There was no statistical difference between the body satisfaction scores of the experienced yoga group and the beginner yoga students. This may suggest that individuals drawn to yoga have greater body satisfaction than exercisers, and that regular yoga practice possibly further increases body satisfaction.

Advanced practice nurses have increased in number and public acceptance. Students preparing for these roles require quality clinical education so they are prepared to assume collaborative roles in healthcare settings. Although graduate clinical preceptors have a vitally important role in the clinical education and professional socialization of advanced practice students, there is a paucity of evidence about factors that influence their role commitment. In this article, the authors review the literature related to graduate-level, clinical-preceptor experiences; describe their study of 91 graduate clinical preceptors that identified factors influencing graduate clinical preceptors' role commitment; report and discuss their findings; as well as the limitations of this study. They conclude that the graduate clinical preceptor role needs to be more visible and better integrated into schools of nursing and healthcare organizational structures, and identify the need for intra-professional collaboration among nursing faculty, administrators, and clinicians to facilitate the recruitment, cultivation, and retention of graduate clinical preceptors.

Background: Tactile acuity in the back relates to voluntary lumbo-pelvic control and is lower in chronic low back pain (CLBP) patients. Two-point discrimination (TPD) thresholds are higher, indicating decreased tactile acuity in patients with CLBP. Yoga has been shown to help relieve CLBP., Objectives: This study investigated the hypothesis that regular practitioners of yoga have increased tactile acuity (i.e., lower TPD thresholds) when compared to matched controls who regularly perform gym-based (resistance training or aerobic-type) exercise., Method: Tactile acuity in the low back was assessed using TPD in 16 long-term practitioners of yoga (5 Ashtanga, 5 Bikram, and 6 Iyengar practitioners) and 16 age- and gender-matched healthy controls who exercise (with weights and aerobic exercise)., Results: The yoga practitioners' TPD was lower than that of the exercisers, indicating greater tactile acuity in the low back. While there was no difference between the TPD of the practitioners of different yoga styles, the TPD of the Ashtanga yoga participants were significantly lower than those of the exercisers. The yogis whose main reasons to practice yoga were for "meditation or increased mindfulness" and for "well-being" showed a nonsignificant trend of higher tactile acuity than those who did yoga for "physical exercise." There was no association between TPD threshold and cumulative amount of yoga practice in terms of hours per week and years of experience. However, increased hours of exercise per week correlated with higher TPD., Conclusion: The findings suggest that there may be a relationship between yoga practice and enhanced tactile acuity in the low back.

Background: Accurate quantification of mitral regurgitation (MR) is important for patient treatment and prognosis. Three-dimensional echocardiography allows for the direct measure of the regurgitant orifice area (ROA) by 3D-guided planimetry of the vena contracta area (VCA). We aimed to (1) establish 3D VCA ranges and cutoff values for MR grading, using the American Society of Echocardiography-recommended 2D integrative method as a reference, and (2) compare 2D and 3D methods of ROA to establish a common calibration for MR grading., Methods and Results: Eighty-three patients with at least mild MR underwent 2D and 3D echocardiography. Direct planimetry of VCA was performed by 3D echocardiography. Two-dimensional quantification of MR included 2D ROA by proximal isovelocity surface area (PISA) method, vena contracta width, and ratio of jet area to left atrial area. There were significant differences in 3D VCA among patients with different MR grades. As assessed by receiver operating characteristic analysis, 3D VCA at a best cutoff value of 0.41 cm(2) yielded 97% of sensitivity and 82% of specificity to differentiate moderate from severe MR. There was significant difference between 2D ROA and 3D VCA in patients with functional MR, resulting in an underestimation of ROA by 2D PISA method by 27% as compared with 3D VCA. Multivariable regression analysis showed functional MR as etiology was the only predictor of underestimation of ROA by the 2D PISA method., Conclusions: Three-dimensional VCA provides a single, directly visualized, and reliable measurement of ROA, which classifies MR severity comparable to current clinical practice using the American Society of Echocardiography-recommended 2D integrative method. The 3D VCA method improves accuracy of MR grading compared with the 2D PISA method by eliminating geometric and flow assumptions, allowing for uniform clinical grading cutoffs and ranges that apply regardless of etiology and orifice shape.

Aims: Two-dimensional echocardiographic (2DE) continuity-equation derived aortic valve area (AVA) in aortic stenosis (AS) relies on non-simultaneous measurement of left ventricular outflow tract (LVOT) velocity and geometric assumptions of LVOT area, which can amplify error, especially in upper septal hypertrophy (USH). We hypothesized that real-time three-dimensional echocardiography (RT3DE) can improve accuracy of AVA by directly measuring LVOT stroke volume (SV) in one window., Methods and Results: RT3DE colour Doppler and 2DE were acquired in 68 AS patients (74 +/- 12 yrs) prospectively. SV was derived from flow obtained from a sampling curve placed orthogonal to LVOT (Tomtec Imaging). Agreement between continuity-equation derived AVA by RT3DE (AVA(3D-SV)) and 2DE (AVA(2D)) and predictors of discrepancies were analysed. Validation of LVOT SV was performed by aortic flow probe in a sheep model with balloon inflation of septum to mimic USH. There was only modest correlation between AVA(2D) and AVA(3D-SV) (r = 0.71, difference 0.11 +/- 0.23 cm(2)). The degree of USH was significantly associated with difference in AVA calculation (r = 0.4, P = 0.005). In experimentally distorted LVOT geometry in sheep, RT3DE correlated better with flow probe assessment (r = 0.96, P < 0.001) than 2DE (r = 0.71, P = 0.006)., Conclusion: RT3DE colour Doppler-derived LVOT SV in the calculation of AVA by continuity equation is more accurate than 2D, including in situations such as USH, common in the elderly, which modify LVOT geometry.

Most studies on the Stroop effect (unintentional automatic word processing) have been restricted to English speakers using vocal responses. Little is known about this effect with deaf signers. The study compared Stroop task responses among four different samples: deaf participants from a Japanese-language environment and from an English-language environment; and hearing individuals from Japan and from Australia. Color words were prepared in both English and Japanese and were presented in three conditions: congruent (e.g., the word red printed in red), incongruent (e.g., red printed in blue), and neutral. The magnitude of the effect was greater with the deaf participants than with the hearing participants. The deaf individuals experienced more interference in English than in Japanese.

We investigated the effect of familiarity on people's perception of facial likeness by asking participants to choose which of two mirror-symmetric chimeric images (made from the left or right half of a photograph of a face) looked more like an original image. In separate trials the participants made this judgment for their own face and for the face of a close friend; half of them matched to a true image of the original and half matched to a mirror image of the original. In the case of matching to a friend's face presented in the familiar orientation, over 80% of participants chose the left-left composite to be a better likeness to the original, whereas only 62% showed the same left-side bias when matching to a mirror image. The difference is significant, and the result contrasts markedly with a second experiment where participants who were unfamiliar with the faces showed comparable left-side biases when matching to true or mirror reversed images. The result suggests that perceptual asymmetries are retained in our long-term memory for highly familiar faces. While matching to images of self also showed an effect of familiarity, the data in this condition show less evidence of perceptual asymmetry and are discussed in relation to recent research on the representation of one's own face.

Deaf people have difficulty reading and remembering English script because of its sound-based orthography. Logographs (e.g., kanji, Arabic numerals) should not pose the same challenge because they are based on meaning, not sound. Little research has been conducted to test this theory's validity cross-culturally. The present study was an attempt to do just that. The first of two experiments tested immediate memory spans for word sequences of 20 hearing Irish, 20 prelingually deaf Americans, 20 hearing Japanese, and 20 prelingually deaf Japanese. For English words, deaf participants showed shorter memory spans than hearing participants, but memory spans were similar for deaf and hearing participants for words in kanji, the logographic system for Japanese writing. The second experiment tested memory span for Arabic numerals, with the same participants. Deaf English-readers showed shorter memory spans than their hearing counterparts, but deaf and hearing Japanese performed similarly.

We investigated hemispheric asymmetries in face processing using a task in which participants judged the likeness of chimeric faces to their own face and to the face of a close friend based on their memory for those faces. When asked to choose which of two mirror-symmetric images (one made from the left half and one from the right half of a photograph of their face) looked more like themselves as remembered, participants showed a significant bias for the composite corresponding to the half face that lies in their right visual field when they look at themselves in the mirror. They showed the opposite bias when asked to make the same choice for images of a close friend, that is, they showed a significant bias for the composite corresponding to the half face that lies in their left visual field when they look at their friend. This result shows that in the case of these highly familiar faces--self and friend--the perceptual asymmetry is preserved in the memory representation. Assuming that people remember their own face as a mirror-image, the data also suggest a dissociation in face processing such that the left brain is dominant for the recognition of self and the right brain is dominant for the recognition of others.

Long-term use of a sign language may enhance visual abilities. Deaf signers consistently outscore their hearing nonsigning counterparts on visual memory tests. In a similar vein, the long-term use of a logographic script, Chinese characters appears to boost visual memory. Both learning a sign language and mastering Chinese characters involve a relatively complex task of visual recognition and memory. This review of the literature suggests that daily use of either a sign language, one not based on sound, or Chinese characters, a script which maps language at the word level rather than at the phonemic level, may facilitate recall of visual forms.

This article presents arguments in support of the ANA's first position on education for nurses written in 1965 and discusses the effect of this statement on nursing education and practice over the past four decades. The similarity of the issues discussed at policy tables in 1965 and 2002 are addressed. The article ends with a challenge for nurses to advocate for better educated nurses with stakeholders, their patients and clients, in public and private sectors.