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Background/Objectives: Although there is a need for evidence-based physical activity programs in rural communities, evaluating such programs is often challenging due to access-related barriers and measurement tools that are not designed for rural contexts. This study aimed to explore and better understand the day-to-day experiences of rural-dwelling children using wrist-worn PA trackers as part of a study to develop a health promotion program. Methods: Ten caregivers and child dyads were enrolled (n = 20). The children wore accelerometers pre- and post-intervention. Semi-structured interviews were completed post-intervention and were audio recorded, transcribed, and summary reports were generated based on recurring themes. Results: The children had a mean age of 8.7 (SD = 1.4) years and the majority were male (80%). The caregivers were female, white, and had a mean age of 43.6 (SD = 8.5) years, with an annual income of ≥USD 40,000. Factors contributing to device wear times included low caregiver burden, device functioning as a watch, and device interactivity. The children reported that the devices were acceptable, but may have changed their physical activity behaviors, with children regularly checking their step count. The caregivers preferred devices that monitored the children's activity levels without sharing location data. Conclusions: Identifying acceptable and feasible strategies to measure physical activity is vital to developing effective health promotion efforts. The lessons learned may help develop evaluation plans for implementing rural physical activity programming. [ABSTRACT FROM AUTHOR]

During continuous speech perception, endogenous neural activity becomes time-locked to acoustic stimulus features, such as the speech amplitude envelope. This speech–brain coupling can be decoded using non-invasive brain imaging techniques, including electroencephalography (EEG). Neural decoding may provide clinical use as an objective measure of stimulus encoding by the brain—for example during cochlear implant listening, wherein the speech signal is severely spectrally degraded. Yet, interplay between acoustic and linguistic factors may lead to top-down modulation of perception, thereby complicating audiological applications. To address this ambiguity, we assess neural decoding of the speech envelope under spectral degradation with EEG in acoustically hearing listeners (n = 38; 18–35 years old) using vocoded speech. We dissociate sensory encoding from higher-order processing by employing intelligible (English) and non-intelligible (Dutch) stimuli, with auditory attention sustained using a repeated-phrase detection task. Subject-specific and group decoders were trained to reconstruct the speech envelope from held-out EEG data, with decoder significance determined via random permutation testing. Whereas speech envelope reconstruction did not vary by spectral resolution, intelligible speech was associated with better decoding accuracy in general. Results were similar across subject-specific and group analyses, with less consistent effects of spectral degradation in group decoding. Permutation tests revealed possible differences in decoder statistical significance by experimental condition. In general, while robust neural decoding was observed at the individual and group level, variability within participants would most likely prevent the clinical use of such a measure to differentiate levels of spectral degradation and intelligibility on an individual basis. [ABSTRACT FROM AUTHOR]

Introduction: In the search for objective measures of therapeutic outcomes for patients with spinal cord stimulation (SCS) devices, various metrics of cardiac performance have been linked to pain as well as overall health. To track such measures at home, recent studies have incorporated wearables to monitor cardiac activity over months or years. The drawbacks to wearables, such as patient compliance, would be obviated by on-device sensing that incorporates the SCS lead. This study sought to evaluate the feasibility of using SCS leads to record cardiac electrograms. Methods: The quality of signals sensed by externalized, percutaneous leads in the thoracic spine of 10 subjects at the end of their SCS trial were characterized across various electrode configurations and postures by detecting R-peaks and calculating signal-to-noise ratio (SNR). In a subset of 5 subjects, cardiac metrics were then compared to those measured simultaneously with a wearable. Results: The average signal quality was acceptable for R-peak detection (i.e., SNR > 5) for all configurations and positions across all 10 subjects, with higher signal quality achieved when recording in resting positions. Notably, the spinal lead recordings enabled more reliable beat detection compared to the wearable (n = 29 recording pairs; p < 0.001). When excluding wearable recordings with over 35% missed beats, the inter-beat intervals across devices were highly correlated (n = 22 recording pairs; Pearson correlation: R = 0.99, p < 0.001). Further comparisons in these aligned wearable and corresponding spinal-lead recordings revealed significant differences in the frequency domain metrics (i.e., absolute and normalized high and low frequency HRV power, p < 0.05), but not in time domain HRV parameters. Discussion: The ability of an implanted SCS system to record electrocardiograms, as demonstrated here, could provide the basis of automated SCS therapy by tracking potential biomarkers of the patient's overall health state without the need for additional external devices. [ABSTRACT FROM AUTHOR]

Introduction: Optimal cochlear implant (CI) outcomes are due to, at least in part, appropriate device programming. Objective measures, such as electrically evoked stapedial reflex thresholds (ESRTs), can be used to more accurately set programming levels. However, underlying factors that contribute to ESRT levels are not well understood. The objective of the current study was to analyze how demographic variables of patient sex and age, along with CI electrode location, influence ESRTs in adult CI recipients. Methods: A single institution retrospective review was performed. Electronic medical records, CI programming records, and clinic database of postoperative computerized tomography were reviewed to gather information regarding patient demographics, ESRTs, and electrode array metrics including medial-lateral distance and scalar location. Linear mixed models were constructed to determine how demographic variables and electrode position influence ESRTs recorded in 138 adult CI recipients. Results: ESRTs were significantly affected by recipient age, with older listeners demonstrating higher ESRT levels. On average, males had higher ESRT levels when compared to females. In a subset of the study sample, ESRT levels increased with increasing medial-lateral distance; however, there was not a statistically significant effect of electrode type (lateral/straight arrays compared to perimodiolar arrays). ESRTs were not affected by scalar location. Discussion/Conclusions: The results suggest that key demographic and electrode position characteristics influence the level of ESRTs in adult CI recipients. While ESRTs are widely used to assist with CI programming, underlying factors are not well understood. The significant factors of aging and sex could be due to middle ear mechanics or neural health differences. However, further data are needed to better understand these associations. [ABSTRACT FROM AUTHOR]

The articles that compose this special issue of Economic Anthropology represent a sample of the work presented and discussed at the 2023 annual meeting of the Society for Economic Anthropology on the topic of well‐being and the common good. I trace the roots of this conference theme in the midst of the COVID‐19 pandemic and its connections to the literature on the "anthropologies of the good." I then unpack three themes that emerge across the articles in this special issue: the value of tacking between objective measures and subjective meanings, the productive tension produced by investigating across scales, and patterned variation from which we can build an anthropological theory of the good. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the current evidence for surgical sabermetrics: digital methods of assessing surgical nontechnical skills and investigate the implications for enhancing surgical performance. Background: Surgeons need high-quality, objective, and timely feedback to optimize performance and patient safety. Digital tools to assess nontechnical skills have the potential to reduce human bias and aid scalability. However, we do not fully understand which of the myriad of digital metrics of performance assessment have efficacy for surgeons. Methods: A systematic review was conducted by searching PubMed, EMBASE, CINAHL, and PSYCINFO databases following PRISMAScR guidelines. MeSH terms and keywords included “Assessment,” “Surgeons,” and “Technology”. Eligible studies included a digital assessment of nontechnical skills for surgeons, residents, and/or medical students within an operative context. Results: From 19,229 articles screened, 81 articles met the inclusion criteria. The studies varied in surgical specialties, settings, and outcome measurements. A total of 122 distinct objective, digital metrics were utilized. Studies digitally measured at least 1 category of surgical nontechnical skill using a single (n= 54) or multiple objective measures (n= 27). The majority of studies utilized simulation (n=48) over live operative settings (n= 32). Surgical Sabermetrics has been demonstrated to be beneficial in measuring cognitive load (n=57), situation awareness (n= 24), communication (n= 3), teamwork (n= 13), and leadership (n= 2). No studies measured intraoperative decision-making. Conclusions: The literature detailing the intersection between surgical data science and operative nontechnical skills is diverse and growing rapidly. Surgical Sabermetrics may provide a promising modifiable technique to achieve desirable outcomes for both the surgeon and the patient. This study identifies a diverse array of measurements possible with sensor devices and highlights research gaps, including the need for objective assessment of decision-making. Future studies may advance the integration of physiological sensors to provide a holistic assessment of surgical performance. [ABSTRACT FROM AUTHOR]

Introduction: In the search for objective measures of therapeutic outcomes for patients with spinal cord stimulation (SCS) devices, various metrics of cardiac performance have been linked to pain as well as overall health. To track such measures at home, recent studies have incorporated wearables to monitor cardiac activity over months or years. The drawbacks to wearables, such as patient compliance, would be obviated by on-device sensing that incorporates the SCS lead. This study sought to evaluate the feasibility of using SCS leads to record cardiac electrograms.Methods: The quality of signals sensed by externalized, percutaneous leads in the thoracic spine of 10 subjects at the end of their SCS trial were characterized across various electrode configurations and postures by detecting R-peaks and calculating signal-to-noise ratio (SNR). In a subset of 5 subjects, cardiac metrics were then compared to those measured simultaneously with a wearable.Results: The average signal quality was acceptable for R-peak detection (i.e., SNR > 5) for all configurations and positions across all 10 subjects, with higher signal quality achieved when recording in resting positions. Notably, the spinal lead recordings enabled more reliable beat detection compared to the wearable (n = 29 recording pairs; p < 0.001). When excluding wearable recordings with over 35% missed beats, the inter-beat intervals across devices were highly correlated (n = 22 recording pairs; Pearson correlation: R = 0.99, p < 0.001). Further comparisons in these aligned wearable and corresponding spinal-lead recordings revealed significant differences in the frequency domain metrics (i.e., absolute and normalized high and low frequency HRV power, p < 0.05), but not in time domain HRV parameters.Discussion: The ability of an implanted SCS system to record electrocardiograms, as demonstrated here, could provide the basis of automated SCS therapy by tracking potential biomarkers of the patient’s overall health state without the need for additional external devices.

The study evaluates the accuracy of predicting intracochlear pressure during bone conduction stimulation using promontory velocity and ear canal pressure, as less invasive alternatives to intracochlear pressure. Stimulating with a percutaneous bone conduction device implanted in six human cadaveric ears, measurements were taken across various intensities, frequencies, and stimulation positions. Results indicate that intracochlear pressure linearly correlates with ear canal pressure (R2 = 0.43, RMSE = 6.85 dB), and promontory velocity (R2 = 0.47, RMSE = 6.60 dB). Normalizing data to mitigate the influence of stimulation position leads to a substantial improvement in these correlations. R2 values increased substantially to 0.93 for both the ear canal pressure and the promontory velocity, with RMSE reduced considerably to 2.02 (for ear canal pressure) and 1.94 dB (for promontory velocity). Conclusively, both ear canal pressure and promontory velocity showed potential in predicting intracochlear pressure and the prediction accuracy notably enhanced when accounting for stimulation position. Ultimately, these findings advocate for the continued use of intracochlear pressure measurements to evaluate future bone conduction devices and illuminate the role of stimulation position in influencing the dynamics of bone conduction pathways. [ABSTRACT FROM AUTHOR]

Among the inherently interpretable learning algorithms are associative classifiers, which are induced in steps. Regarding the ranking step, it is carried out using objective measures in order to sort the rules. Generally, the CSC method is used based on the two standard measures of association rules (support and confidence). However, several measures are available in the literature, leading to a secondary problem, as there is no measure that is suitable for all explorations. In this context, new proposals have emerged, one of which aims to aggregate a set of measures in order to use them simultaneously. The idea is to reduce the need to choose a single measure, also considering different aspects (semantics) for ranking the rules. Works in this context have been proposed. However, they present problems in relation to the performance and/or interpretability of the generated models. In them it is possible to observe an inverse relationship between performance and interpretability, i.e., when model performance is high, interpretability is low (and vice versa). Therefore, this work presents a rule ranking method via aggregation of objective measures, named $AC.Rank_{A}$ , to be incorporated into associative classifiers induction flows, aiming to obtain models that present a better balance between performance and interpretability. The method was evaluated by comparing several induction flows when ranking takes place via CSC (baseline) and via $AC.Rank_{A}$ . The results demonstrate that $AC.Rank_{A}$ can maintain the performance of the models, but with better interpretability.

Background/Objectives: Although there is a need for evidence-based physical activity programs in rural communities, evaluating such programs is often challenging due to access-related barriers and measurement tools that are not designed for rural contexts. This study aimed to explore and better understand the day-to-day experiences of rural-dwelling children using wrist-worn PA trackers as part of a study to develop a health promotion program. Methods: Ten caregivers and child dyads were enrolled (n = 20). The children wore accelerometers pre- and post-intervention. Semi-structured interviews were completed post-intervention and were audio recorded, transcribed, and summary reports were generated based on recurring themes. Results: The children had a mean age of 8.7 (SD = 1.4) years and the majority were male (80%). The caregivers were female, white, and had a mean age of 43.6 (SD = 8.5) years, with an annual income of ≥USD 40,000. Factors contributing to device wear times included low caregiver burden, device functioning as a watch, and device interactivity. The children reported that the devices were acceptable, but may have changed their physical activity behaviors, with children regularly checking their step count. The caregivers preferred devices that monitored the children’s activity levels without sharing location data. Conclusions: Identifying acceptable and feasible strategies to measure physical activity is vital to developing effective health promotion efforts. The lessons learned may help develop evaluation plans for implementing rural physical activity programming.

The goal of our contribution is the issue of differences in objectively and subjectively measured weight (and consequently Body Mass Index/BMI/) and height in Slovak adolescents. The data obtained are a part of international study Health Behaviour in School Aged Children (HBSC) performed in Slovakia in 2017/2018. Our representative sample consisted of 782 adolescents of the fifth to ninth grades of elementary schools in Slovakia in the target group of 11 to 15 years old. We also obtained objective somatic indicators by measuring and subjective indicators were obtained using 2 item questions of the HBSC questionnaire. The results obtained point to the fact, that adolescents tend to add height and decrease weight (boys on average 0.9 kg and girls 0.6 kg) by self-reported question. However, statistically significant difference was observed in weight difference among boys girls and in total. Overweight boys tend to take almost 3 kilograms of their weight. Moreover, obese boys tend to take 5.14 kilograms and obese girls 2.40 kilograms of their weight. The results of survey show that adolescents self-assessing their height and weight tend to increase their height and decrease their weight, which is more pronounced in boys than in girls. Acknowledgments: The document is also based on the support of the grant task of MS VVS SR: VEGA 1/0460/23: „Postural health in children and adolescents and the possibilities of influencing it ". [ABSTRACT FROM AUTHOR]

Significant advances in virtual reality (VR) technology have called into question the traditional methods of cinema storytelling and dissemination. New VR devices, such as the Meta (Oculus) Quest, have expanded the possibilities for viewing movies. The purpose of this study is to compare the emotional and cognitive impacts of VR and traditional 2D movies. In this study, sixty volunteers were divided into two groups and presented a movie (Gala) in 2D or VR format. We employed a multimodal method to assess the cognitive and emotional effects of the film both during and after watching. Our technique combined self-reports, interviews, questionnaires, and objective heart rate and EEG brain activity data. After quantitative and qualitative evaluation, it was discovered, that regardless of media, there was a substantial influence of the movie on the emotional state of the participant's mood. Moreover, compared to the traditional 2D-movie, the VR movie led to more consistent and robust positive effect on all aspects of self-rated affect. The difference in self-reported mood was corroborated by reduced EEG amplitudes in the beta frequency band, indicating higher levels of positive affectivity, which was only observed for the VR movie. Lastly, the VR movie also leads to overall higher self-rated immersion and engagement than the 2D version. Our results highlight the potential of VR movies to engage and emotionally affect audiences beyond traditional cinema. Moreover, our study highlights the value of using a multidisciplinary method for analysing audience impacts. [ABSTRACT FROM AUTHOR]

Breast cancer is one of the most diagnosed cancers among women. Its effects on the cognitive and wellbeing domains have been widely reported in the literature, although with inconsistent results. The central goal of this review was to identify, in women with breast cancer, the main memory impairments, as measured by objective and subjective tools and their relationship with wellbeing outcomes. The systematic literature search was conducted in the PubMed, Scopus, and ProQuest databases. The selected studies included 9 longitudinal and 10 cross-sectional studies. Although some studies included participants undergoing multimodal cancer therapies, most focused on chemotherapy's effects (57.89%; n = 11). The pattern of results was mixed. However, studies suggested more consistently working memory deficits in breast cancer patients undergoing chemotherapy. In addition, some associations have been identified between objective memory outcomes (verbal memory) and wellbeing indicators, particularly depression and anxiety. The inconsistencies in the results could be justified by the heterogeneity of the research designs, objective and subjective measures, and sample characteristics. This review confirms that more empirical evidence is needed to understand memory impairments in women with breast cancer. An effort to increase the homogeneity of study methods should be made in future studies. [ABSTRACT FROM AUTHOR]

Introduction: Effective teamwork plays a critical role in achieving high- performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach. Methods: A total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question. Results: The findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures. Discussion: The study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research. [ABSTRACT FROM AUTHOR]

The study evaluates the accuracy of predicting intracochlear pressure during bone conduction stimulation using promontory velocity and ear canal pressure, as less invasive alternatives to intracochlear pressure. Stimulating with a percutaneous bone conduction device implanted in six human cadaveric ears, measurements were taken across various intensities, frequencies, and stimulation positions. Results indicate that intracochlear pressure linearly correlates with ear canal pressure (R2 = 0.43, RMSE = 6.85 dB), and promontory velocity (R2 = 0.47, RMSE = 6.60 dB). Normalizing data to mitigate the influence of stimulation position leads to a substantial improvement in these correlations. R2 values increased substantially to 0.93 for both the ear canal pressure and the promontory velocity, with RMSE reduced considerably to 2.02 (for ear canal pressure) and 1.94 dB (for promontory velocity). Conclusively, both ear canal pressure and promontory velocity showed potential in predicting intracochlear pressure and the prediction accuracy notably enhanced when accounting for stimulation position. Ultimately, these findings advocate for the continued use of intracochlear pressure measurements to evaluate future bone conduction devices and illuminate the role of stimulation position in influencing the dynamics of bone conduction pathways.

Research has demonstrated various negative effects of poor sleep on overall health in children. Engaging in physical activity during the day is often recommended to help children sleep better. Limited research has examined this recommendation for preschool children, although physical activity is generally supported as a healthy sleep practice. When measuring physical activity and sleep, objective measures (e.g., accelerometers) are recommended as opposed to subjective measures (e.g., parental reports). The purpose of the current study was to examine the relationship between objectively measured sleep (key variables included sleep efficiency, sleep onset latency, and sleep duration) and physical activity (operationalized as mean daily total physical activity) among preschool-aged children in Nova Scotia, Canada. Children (n = 29) wore a wrist accelerometer to objectively measure sleep and wore an accelerometer on their waist to measure physical activity for nine consecutive days. Overall, linear regression analyses demonstrate physical activity as a predictor of sleep efficiency but not total sleep time or sleep onset latency among preschool-aged children. Future research should examine the causal relationships between sleep efficiency and physical activity by conducting interventions to increase physical activity and determining the impact on sleep efficiency.

Abstract Background Balance impairments, that lead to falls, are one of the main symptoms of Parkinson’s disease (PD). Telerehabilitation is becoming more common for people with PD; however, balance is particularly challenging to assess and treat virtually. The feasibility and efficacy of virtual assessment and virtual treatment of balance in people with PD are unknown. The present study protocol has three aims: I) to determine if a virtual balance and gait assessment (instrumented L-shape mobility test) with wearable sensors can predict a gold-standard, in-person clinical assessment of balance, the Mini Balance Evaluation Systems Test (Mini-BESTest); II) to explore the effects of 12 sessions of balance telerehabilitation and unsupervised home exercises on balance, gait, executive function, and clinical scales; and III) to explore if improvements after balance telerehabilitation transfer to daily-life mobility, as measured by instrumented socks with inertial sensors worn for 7 days. Methods The TelePD Trial is a prospective, single-center, parallel-group, single-blind, pilot, randomized, controlled trial. This trial will enroll 80 eligible people with PD. Participants will be randomized at a 1:1 ratio into receiving home-based balance exercises in either: 1) balance telerehabilitation (experimental group, n = 40) or 2) unsupervised exercises (control group, n = 40). Both groups will perform 12 sessions of exercise at home that are 60 min long. The primary outcome will be Mini-BESTest. The secondary outcomes will be upper and lower body gait metrics from a prescribed task (instrumented L-shape mobility test); daily-life mobility measures over 7 days with wearable sensors in socks, instrumented executive function tests, and clinical scales. Baseline testing and 7 days of daily-life mobility measurement will occur before and after the intervention period. Conclusion The TelePD Trial will be the first to explore the usefulness of using wearable sensor-based measures of balance and gait remotely to assess balance, the feasibility and efficacy of balance telerehabilitation in people with PD, and the translation of balance improvements after telerehabilitation to daily-life mobility. These results will help to develop a more effective home-based balance telerehabilitation and virtual assessment that can be used remotely in people with balance impairments. Trial registration This trial was prospectively registered on ClinicalTrials.gov (NCT05680597).

Within the realm of consciousness research, different methods of measuring the content of visual awareness are used: On the one hand, subjective measures require a report of sensory experiences related to a stimulus. On the other hand, objective measures rely on the observer’s performance to accurately detect or discriminate the stimulus. The most appropriate measure of awareness is currently debated. To contribute to this debate, we review findings on the relation between subjective and objective measures of awareness. Although subjective measures sometimes lag behind objective measures, a substantial number of studies demonstrates a convergence of measures. Based on the reviewed studies, we identify five aspects relevant for achieving a convergence of measures. Future research could then identify and empirically test the boundary conditions, under which a convergence or divergence of subjective and measures of awareness is observed.

Background: Balance impairments, that lead to falls, are one of the main symptoms of Parkinson's disease (PD). Telerehabilitation is becoming more common for people with PD; however, balance is particularly challenging to assess and treat virtually. The feasibility and efficacy of virtual assessment and virtual treatment of balance in people with PD are unknown. The present study protocol has three aims: I) to determine if a virtual balance and gait assessment (instrumented L-shape mobility test) with wearable sensors can predict a gold-standard, in-person clinical assessment of balance, the Mini Balance Evaluation Systems Test (Mini-BESTest); II) to explore the effects of 12 sessions of balance telerehabilitation and unsupervised home exercises on balance, gait, executive function, and clinical scales; and III) to explore if improvements after balance telerehabilitation transfer to daily-life mobility, as measured by instrumented socks with inertial sensors worn for 7 days. Methods: The TelePD Trial is a prospective, single-center, parallel-group, single-blind, pilot, randomized, controlled trial. This trial will enroll 80 eligible people with PD. Participants will be randomized at a 1:1 ratio into receiving home-based balance exercises in either: 1) balance telerehabilitation (experimental group, n = 40) or 2) unsupervised exercises (control group, n = 40). Both groups will perform 12 sessions of exercise at home that are 60 min long. The primary outcome will be Mini-BESTest. The secondary outcomes will be upper and lower body gait metrics from a prescribed task (instrumented L-shape mobility test); daily-life mobility measures over 7 days with wearable sensors in socks, instrumented executive function tests, and clinical scales. Baseline testing and 7 days of daily-life mobility measurement will occur before and after the intervention period. Conclusion: The TelePD Trial will be the first to explore the usefulness of using wearable sensor-based measures of balance and gait remotely to assess balance, the feasibility and efficacy of balance telerehabilitation in people with PD, and the translation of balance improvements after telerehabilitation to daily-life mobility. These results will help to develop a more effective home-based balance telerehabilitation and virtual assessment that can be used remotely in people with balance impairments. Trial registration: This trial was prospectively registered on ClinicalTrials.gov (NCT05680597). [ABSTRACT FROM AUTHOR]

While there are studies connecting everyday physical activity (PA) to mental health, they mostly use self-report measures for PA which are biased in multiple ways. Nevertheless, a realistic assessment of everyday PA is important for the development and implementation of low-threshold public health interventions. Therefore, we want to analyze the relationship between objectively measured daily steps and mental health. We included 1451 subjects from a subsample of the population-based LIFE-Adult-Study (2011–2014) with an average age of 55.0 years, 52.1% were female. We analyzed the effects of PA (step count measured via SenseWear Pro 3) on depression (CES-D), anxiety (GAD-7), and quality of sleep (PSQI). The regression analysis showed a significant negative association between low to moderate PA [Incidence rate ratio: 0.87 (0.77; 0.98)] as well as high to very high PA [0.84 (0.74; 0.95)] and depression and no significant associations between PA and anxiety [l-m: 0.98 (0.81; 1.18)/h-vh: 1.00 (0.82; 1.21)] or quality of sleep [l-m: 0.94 (0.84, 1.06)/h-vh: 0.92 (0.82, 1.03)], controlling for sociodemographic variables and personality. Low-threshold interventions that increase daily step count could be a useful approach for the prevention of depression. The use of objective PA measurement for research is highly encouraged. [ABSTRACT FROM AUTHOR]

Some children experience significant symptoms while doing near work, and accommodative deficits can be a contributory factor. However, studies investigating near work symptoms in children are sparse. To investigate the association between clinical and objective measures of accommodation and near point symptoms. Twelve asymptomatic and 14 symptomatic children (mean age = 11.1 and 11.8 years, respectively) based on their Convergence Insufficiency Symptom Survey scores participated in the study. The clinical measures of accommodation were monocular amplitude of accommodation, monocular accommodative facility, and monocular estimation method. Objective measurements of the accommodative stimulus response function were recorded with a WAM-5500 autorefractor for two consecutive minutes at five viewing distances (0.33, 2, 3, 4, and 5 Dioptres [D]). Accommodative findings were compared between the groups using the Mann–Whitney U-tests. Spearman's rank correlation coefficient was used to assess the association between symptoms and clinical and objective measures of accommodation. The mean CISS scores were 32.8 and 7.3 for the symptomatic and asymptomatic groups, respectively (p = <0.001). The symptomatic group showed a reduced accommodative functions compared to the asymptomatic group (p = 0.002 for accommodative facility, p = 0.04 for accommodative amplitude, p = 0.029 and 0.01 for objective measures of accommodation at 4D and 5D viewing distance, respectively). Clinical tests of accommodative amplitude and facility (correlation coefficient = −0.407 and −0.54, respectively) showed the highest correlation with the CISS scores, compared to the objective measures of accommodation. Clinical tests of accommodation showed a greater association with symptoms than objective measures of accommodation in children aged 8–16 years. In children presenting with visual discomfort symptoms, measurement of accommodative amplitude and facility should be considered. [ABSTRACT FROM AUTHOR]

Background: Researchers use both subjective self‐report and objective measures, such as official records, to investigate the impact of childhood adversity on psychopathology. However, it is unclear whether subjective and objective measures of childhood adversity (a) show agreement, and (b) differentially predict psychopathology. Method: To address this, we conducted a pre‐registered meta‐analysis to examine the agreement between subjective and objective measures of childhood adversity, and their prediction of psychopathology. We searched in PubMed, PsycINFO and Embase for articles with both subjective measures (self‐reports) and objective measures of childhood adversity (comprising official records, or reports from multiple informants unrelated to the target individual), and measures of psychopathology. Results: We identified 22 studies (n = 18,163) with data on agreement between subjective and objective measures of childhood adversities, and 17 studies (n = 14,789) with data on the associations between subjective and objective measures with psychopathology. First, we found that subjective and objective measures of childhood adversities were only moderately correlated (e.g. for maltreatment, r =.32, 95% CI = 0.23–0.41). Second, subjective measures of childhood adversities were associated with psychopathology, independent of objective measures (e.g. for maltreatment, r =.16, 95% CI = 0.09–0.22). In contrast, objective measures of childhood adversities had null or minimal associations with psychopathology, independent of subjective measures (e.g. r for maltreatment =.06, 95% CI = −0.02–0.13). Conclusions: Our findings suggest that the effects of childhood adversity on psychopathology are primarily driven by a person's subjective experience. If this is the case, clinical interventions targeting memories and cognitive processes surrounding childhood adversity may reduce the risk of psychopathology in exposed individuals. [ABSTRACT FROM AUTHOR]

Habit strength for taking medication is associated with medication adherence. However, habit strength is typically measured via self-reports, which have limitations. Objective sensors may provide advantages to self-reports. To evaluate whether habit-strength metrics derived from objective sensor data (MEMS® Caps; AARDEX Group) are associated with self-reported habit strength and adherence (objective and self-reported) and whether objective and self-reported habit strength are independently associated with adherence. Patients (N = 79) on oral medications for type 2 diabetes completed self-reports of habit strength and medication adherence and used MEMS® Caps to take their prescribed medication for one month. MEMS® Caps data were used to create five objective metrics of habit strength (e.g., individual-level variance in pill timing) and quantify medication adherence (% days correct dosing). Consistency in behavior from week to week (versus across each day) had the greatest association with self-reported habit strength (r(78) = 0.29, p = 0.01), self-reported adherence (r(78) = 0.32, p = 0.005), and objective adherence (r(78) = 0.61, p < 0.001). Objective and self-reported habit strength were independently associated with adherence. Weekly pill-timing consistency may be more useful than daily pill-timing consistency for predicting adherence and understanding patients' medication-taking habits. Self-reports and objective metrics of habit strength may be measuring different constructs, warranting further research. [ABSTRACT FROM AUTHOR]

Although clinician-based assessment through standardized clinical rating scales is currently the gold standard for quantifying motor impairment in Parkinson's disease (PD), it is not without limitations, including intra- and inter-rater variability and a degree of approximation. There is increasing evidence supporting the use of objective motion analyses to complement clinician-based assessment. Objective measurement tools hold significant potential for improving the accuracy of clinical and research-based evaluations of patients. The authors provide several examples from the literature demonstrating how different motion measurement tools, including optoelectronics, contactless and wearable systems allow for both the objective quantification and monitoring of key motor symptoms (such as bradykinesia, rigidity, tremor, and gait disturbances), and the identification of motor fluctuations in PD patients. Furthermore, they discuss how, from a clinician's perspective, objective measurements can help in various stages of PD management. In our opinion, sufficient evidence supports the assertion that objective monitoring systems enable accurate evaluation of motor symptoms and complications in PD. A range of devices can be utilized not only to support diagnosis but also to monitor motor symptom during the disease progression and can become relevant in the therapeutic decision-making process. [ABSTRACT FROM AUTHOR]

Abstract Background Prosody is an important acoustic and linguistic component of speech that greatly contributes to speech intelligibility. Speech of hearing-impaired children shows various deviations from their normal-hearing counterparts due to complex physiological mechanisms. Methods Acoustic analysis of the prosodic production of hearing-impaired, cochlear-implanted, Egyptian children, and comparing them to a normal group of normal-hearing peers, using objective measures. Cases group included 30 hearing-impaired verbal children from the age of 6 to 10 years using cochlear implant devices. The controls group included 30 normal-hearing children within the same age range. Recording and analysis of both groups’ speech samples were done using real-time pitch software, generic syllabic rate, and intonation stimulability software. Results Significant differences were found between the two studied groups where decreased pitch range, increased loudness variability, increased pause duration, and decreased syllabic rate were found in hearing-impaired children. Conclusion Prosodic differences between hearing-impaired children with cochlear implants and normal-hearing children could be measured objectively giving a numeric profile that could be used as a measure to monitor the progress of their speech with therapy.

IntroductionEffective teamwork plays a critical role in achieving high-performance outcomes in healthcare. Consequently, conducting a comprehensive assessment of team performance is essential for providing meaningful feedback during team trainings and enabling comparisons in scientific studies. However, traditional methods like self-reports or behavior observations have limitations such as susceptibility to bias or being resource consuming. To overcome these limitations and gain a more comprehensive understanding of team processes and performance, the assessment of objective measures, such as physiological parameters, can be valuable. These objective measures can complement traditional methods and provide a more holistic view of team performance. The aim of this study was to explore the potential of the use of objective measures for evaluating team performance for research and training purposes. For this, experts in the field of research and medical simulation training were interviewed to gather their opinions, ideas, and concerns regarding this novel approach.MethodsA total of 34 medical and research experts participated in this exploratory qualitative study, engaging in semi-structured interviews. During the interview, experts were asked for (a) their opinion on measuring team performance with objective measures, (b) their ideas concerning potential objective measures suitable for measuring team performance of healthcare teams, and (c) their concerns regarding the use of objective measures for evaluating team performance. During data analysis responses were categorized per question.ResultsThe findings from the 34 interviews revealed a predominantly positive reception of the idea of utilizing objective measures for evaluating team performance. However, the experts reported limited experience in actively incorporating objective measures into their training and research. Nevertheless, they identified various potential objective measures, including acoustical, visual, physiological, and endocrinological measures and a time layer. Concerns were raised regarding feasibility, complexity, cost, and privacy issues associated with the use of objective measures.DiscussionThe study highlights the opportunities and challenges associated with employing objective measures to assess healthcare team performance. It particularly emphasizes the concerns expressed by medical simulation experts and team researchers, providing valuable insights for developers, trainers, researchers, and healthcare professionals involved in the design, planning or utilization of objective measures in team training or research.

AimThis study aimed to compare the effectiveness of auditory brainstem response (ABR) and extracochlear electrocochleography (ECochG) in objectively evaluating the coupling efficiency of floating mass transducer (FMT) placement during active middle ear implant (AMEI) surgery.MethodsWe enrolled 15 patients (mean age 58.5 ± 19.4 years) with mixed hearing loss who underwent AMEI implantation (seven ossicular chain and eight round window couplings). Before the surgical procedure, an audiogram was performed. We utilized a clinical measurement system to stimulate and record intraoperative ABR and ECochG recordings. The coupling efficiency of the VSB was evaluated through ECochG and ABR threshold measurements. Postoperatively, we conducted an audiogram and a vibrogram.ResultsIn all 15 patients, ABR threshold testing successfully determined intraoperative coupling efficiency, while ECochG was successful in only eight patients. In our cohort, ABR measurements were more practical, consistent, and robust than ECochG measurements. Coupling efficiency, calculated as the difference between vibrogram thresholds and postoperative bone conduction thresholds, was found to be more accurately predicted by ABR measurements (p = 0.016, R2 = 0.37) than ECochG measurements (p = 0.761, R2 = 0.02). We also found a non-significant trend toward better results with ossicular chain coupling compared to round window coupling.ConclusionOur findings suggest that ABR measurements are more practical, robust, and consistent than ECochG measurements for determining coupling efficiency during FMT placement surgery. The use of ABR measurements can help to identify the optimal FMT placement, especially with round window coupling. Finally, we offer normative data for both techniques, which can aid other clinical centers in using intraoperative monitoring for AMEI placement.

A cochlear implant (CI) is a neurotechnological device that restores total sensorineural hearing loss. It contains a sophisticated speech processor that analyzes and transforms the acoustic input. It distributes its time-enveloped spectral content to the auditory nerve as electrical pulsed stimulation trains of selected frequency channels on a multi-contact electrode that is surgically inserted in the cochlear duct. This remarkable brain interface enables the deaf to regain hearing and understand speech. However, tuning of the large (>50) number of parameters of the speech processor, so-called "device fitting," is a tedious and complex process, which is mainly carried out in the clinic through 'one-size-fits-all' procedures. Current fitting typically relies on limited and often subjective data that must be collected in limited time. Despite the success of the CI as a hearing-restoration device, variability in speech-recognition scores among users is still very large, and mostly unexplained. The major factors that underly this variability incorporate three levels: (i) variability in auditory-system malfunction of CI-users, (ii) variability in the selectivity of electrode-to-auditory nerve (EL-AN) activation, and (iii) lack of objective perceptual measures to optimize the fitting. We argue that variability in speech recognition can only be alleviated by using objective patient-specific data for an individualized fitting procedure, which incorporates knowledge from all three levels. In this paper, we propose a series of experiments, aimed at collecting a large amount of objective (i.e., quantitative, reproducible, and reliable) data that characterize the three processing levels of the user's auditory system. Machine-learning algorithms that process these data will eventually enable the clinician to derive reliable and personalized characteristics of the user's auditory system, the quality of EL-AN signal transfer, and predictions of the perceptual effects of changes in the current fitting. [ABSTRACT FROM AUTHOR]

To investigate electrically evoked auditory cortical responses (eACR) elicited from the stimulation of intracochlear electrodes based on individually fitted stimulation parameters in cochlear implant (CI) users. An eACR setup based on individual fitting parameters is proposed. A 50-ms alternating biphasic pulse train was used to stimulate apical, medial, and basal electrodes and to evoke auditory cortical potentials (N1-P2 complex). The eACR setup proposed was validated with 14 adult CI users. Individual and grand-average eACR waveforms were obtained. The eACR amplitudes were lower in the basal than in the apical and medial regions. Earlier N1 latencies were found in CI users with lower maximum comfortable loudness levels and shorter phase duration in response to apical stimulation, while medial and basal stimulation resulted in earlier N1 latencies and larger N1-P2 amplitudes in users with longer CI experience. eACR could be elicited by direct intracochlear stimulation using individual fitting parameters with a success rate of 71%. The highest cortical peak-to-peak amplitudes were obtained in response to apical stimulation. Unlike the P2, the N1 component appeared to be a consistent cortical potential to determine eACR and gain knowledge of the auditory processing beyond the cochlea in CI users. eACR can be elicited through direct stimulation of intracochlear electrodes. Stimulation of apical and medial regions yielded the highest N1-P2 amplitudes. CI users with lower maximum comfortable loudness levels had shorter N1 latencies during apical stimulation. The present dataset of mainly well-performing CI users suggests better cortical processing, that is, higher amplitudes and shorter latencies of N1. The N1 potential appears a more consistent and reliable potential than the P2 to determine eACR responses in CI users. [ABSTRACT FROM AUTHOR]

Introduction: This study was designed to investigate the use of electrically evoked cortical auditory evoked potentials (eCAEPs) as a tool for cochlear implant (CI) verification, the relationships between the site and intensity of stimulation and the detection rates and morphologies of eCAEPs as well as investigate whether correlations exist between the morphologies of eCAEPs and speech perception in quiet and in noise, duration of hearing loss, age at implantation, whether the hearing loss bilateral or single-sided and the electrode current level required to elicit MCL stimulation. Methods: 32 adult unilateral CI users with postlingual hearing loss were enrolled. The stimuli were 1 kHz biphasic alternating pulses and were presented at either the behaviorally measured MCL or 50% of this value (MCL0.5) via the CI fitting software. Pulses were directed to apical, medial, or basal electrodes. CAEPs were recorded from a scalp electrode placed at the vertex, low forehead, and contralateral mastoid and were evaluated by two electrophysiologists. Results: Overall, eCAEPs could be detected in 31/32 users when stimulating at MCL, and in 29/32 users when stimulating at MCL0.5. The detection rates were 31, 31, and 28/32 for apical, medial, and basal stimulation at MCL, and 29, 29, and 26/32 at MCL0.5. Significant differences in eCAEP amplitudes and latencies were observed across electrodes and stimulation levels. No significant correlations were found between eCAEP latencies and amplitudes and user age, duration of deafness prior to CI surgery, or with bilateral versus single-sided hearing loss, nor with the charge level required to elicit MCL, or with speech perception scores in quiet. Peak latencies correlated with speech perception scores in some configurations of speech-in-noise. Conclusion: eCAEPs can readily be elicited in the majority of adult CI users and show normal waveform characteristics at stimulation levels corresponding to MCL, as well as at basal, medial, and apical electrode stimulation sites. Neither the latencies nor amplitudes of eCAEPs are confounded by variables of age, duration of deafness prior to CI surgery, or the laterality of hearing loss. eCAEPs are a useful, objective method evaluate sound perception in CI users. [ABSTRACT FROM AUTHOR]

Well-established in the field of bioelectronic medicine, Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions. Chronic pain is a widely heterogenous syndrome with regard to both pathophysiology and the resultant phenotype. Despite advances in our understanding of SCS-mediated antinociception, there still exists limited evidence clarifying the pathways recruited when patterned electric pulses are applied to the epidural space. The rapid clinical implementation of novel SCS methods including burst, high frequency and dorsal root ganglion SCS has provided the clinician with multiple options to treat refractory chronic pain. While compelling evidence for safety and efficacy exists in support of these novel paradigms, our understanding of their mechanisms of action (MOA) dramatically lags behind clinical data. In this review, we reconstruct the available basic science and clinical literature that offers support for mechanisms of both paresthesia spinal cord stimulation (P-SCS) and paresthesia-free spinal cord stimulation (PF-SCS). While P-SCS has been heavily examined since its inception, PF-SCS paradigms have recently been clinically approved with the support of limited preclinical research. Thus, wide knowledge gaps exist between their clinical efficacy and MOA. To close this gap, many rich investigative avenues for both P-SCS and PF-SCS are underway, which will further open the door for paradigm optimization, adjunctive therapies and new indications for SCS. As our understanding of these mechanisms evolves, clinicians will be empowered with the possibility of improving patient care using SCS to selectively target specific pathophysiological processes in chronic pain.

A cochlear implant (CI) is a neurotechnological device that restores total sensorineural hearing loss. It contains a sophisticated speech processor that analyzes and transforms the acoustic input. It distributes its time-enveloped spectral content to the auditory nerve as electrical pulsed stimulation trains of selected frequency channels on a multi-contact electrode that is surgically inserted in the cochlear duct. This remarkable brain interface enables the deaf to regain hearing and understand speech. However, tuning of the large (>50) number of parameters of the speech processor, so-called “device fitting,” is a tedious and complex process, which is mainly carried out in the clinic through ‘one-size-fits-all’ procedures. Current fitting typically relies on limited and often subjective data that must be collected in limited time. Despite the success of the CI as a hearing-restoration device, variability in speech-recognition scores among users is still very large, and mostly unexplained. The major factors that underly this variability incorporate three levels: (i) variability in auditory-system malfunction of CI-users, (ii) variability in the selectivity of electrode-to-auditory nerve (EL-AN) activation, and (iii) lack of objective perceptual measures to optimize the fitting. We argue that variability in speech recognition can only be alleviated by using objective patient-specific data for an individualized fitting procedure, which incorporates knowledge from all three levels. In this paper, we propose a series of experiments, aimed at collecting a large amount of objective (i.e., quantitative, reproducible, and reliable) data that characterize the three processing levels of the user’s auditory system. Machine-learning algorithms that process these data will eventually enable the clinician to derive reliable and personalized characteristics of the user’s auditory system, the quality of EL-AN signal transfer, and predictions of the perceptual effects of changes in the current fitting.

BackgroundConcomitant use of cocaine and HIV pre-exposure prophylaxis (PrEP) raises important clinical questions around adherence, retention in care, and renal toxicity.MethodsWe assessed the associations of confirmed cocaine use with PrEP adherence (both ascertained through objective measures), care engagement, and renal function in the iPrEx open-label extension. Cocaine use was measured in scalp hair samples and categorized as light (500-3000 pg/mg) and moderate to heavy (>3000 pg/mg). PrEP adherence in the first 3 months was measured through plasma tenofovir concentrations. Disengagement from PrEP care was defined as a gap in follow-up greater than 4 months. Serum creatinine was assessed at baseline and quarterly visits.ResultsOf the 400 participants included in this analysis, 90% were men who have sex with men, 10% transgender women, 74% Hispanic/Latino; 21% tested positive for cocaine use in the last 3 months. In adjusted analysis, light cocaine use [adjusted odds ratio 2.10 (95% confidence interval: 1.07 to 4.14)] and moderate to heavy use [adjusted odds ratio 2.32 (1.08 to 5.00)] were associated with greater odds of having plasma tenofovir concentrations below the level of quantitation. Participants with moderate to heavy use had a nearly 3-fold higher rate of disengagement from PrEP care compared with nonusers (adjusted hazard ratio 2.90 [1.48 to 5.66]). We found no statistically or clinically significant differences in creatinine clearance and serum creatinine between participants who tested positive for cocaine and those who did not.ConclusionsCocaine use decreases PrEP adherence and care engagement. Comprehensive approaches are needed to reduce cocaine use and enhance engagement along the PrEP care continuum.

O objetivo deste trabalho consiste em analisar a relação entre as medidas subjetivas e objetivas da condição financeira governamental dos municípios do Estado da Paraíba. Entende-se por condição financeira de um governo a capacidade da gestão em cumprir com suas obrigações financeiras de forma tempestiva, presente e futura, além de fornecer bens e serviços públicos demandados pela sociedade em níveis e qualidades desejadas. No entanto, questiona-se a capacidade do gestor em perceber adequadamente a sua condição financeira atual. Diante desse cenário, utilizou-se o modelo de Wang et al. (2007) e o de Arnett (2014) para obtenção da medida objetiva da condição financeira e um questionário direcionado aos gestores públicos municipais, como medida subjetiva autodeclarada pelos mandatários a respeito de sua condição atual. Nessa premissa, analisou-se os dados de 200 municípios do Estado da Paraíba, correspondente ao período de 2017, por meio de análise gráfica e econométrica. Os principais resultados apontam que o gestor consegue ter uma percepção adequada de sua condição financeira a curto prazo (liquidez e endividamento), mas que diante de aspectos de longo prazo (solvência e investimentos), não consegue ter uma leitura adequada, assim como não consegue avaliar corretamente de forma genérica sua condição. Conclui-se, portanto, que os gestores locais precisam melhorar suas percepções acerca da condição financeira de longo prazo (solvência e investimentos) e que os relatórios contábeis precisam abordá-las melhor, contribuindo para avalia-la corretamente de forma genérica, fazendo com que o gestor conduza sua gestão à responsabilidade fiscal.

Background and purpose: Upper limb (UL) function is often affected in people with multiple sclerosis (PwMS) and is typically assessed through objective measures, including the Nine Hole Peg Test (9‐HPT), Box and Block Test (BBT), and Hand Grip Strength (HGS). It is important to include the subjective perspective of PwMS in the assessment. This study aims to evaluate associations between Manual Ability Measure‐36 (MAM‐36) and 9‐HPT, BBT, and HGS in MS. Methods: The cross‐sectional study included five Italian centers. Inclusion criteria were age ≥ 18 years, MS diagnosis, and stable disease course. Exclusion criteria were bilateral UL paralysis, and concomitant orthopedic or neurological diseases. Results: A total of 199 PwMS were included: 128 female, mean age = 50.7 ± 13.0 years, 119 relapsing–remitting MS (RRMS), 31 primary and 49 secondary progressive MS, mean disease duration = 14.0 ± 10.4, years, mean Expanded Disability Status Scale (EDSS) = 4.6 ± 2.0. The MAM‐36 showed small correlations with 9‐HPT, BBT, and HGS. Correlations between MAM‐36 and 9‐HPT and BBT were highest among subjects with EDSS ≥ 6 and progressive MS. MAM‐36 and HGS showed the highest correlations in subjects with EDSS ≤ 5 and RRMS. Combining 9‐HPT and HGS provided the strongest predictive power over the MAM‐36. Conclusions: Correlations between objective measures and MAM‐36 were small to moderate, meaning that objective measures do not match subjects' perception of UL function. The combination of 9‐HPT and HGS measures can help improve the assessment of UL function in activities of daily living. [ABSTRACT FROM AUTHOR]

Despite a rich literature on goals, the notion of successful goal pursuit remains somewhat unclear. Most research on personal goal pursuit relies on subjective measures of goal progress and research that uses objective measures (e.g., grade point average) often ignores individuals' idiosyncratic goals. The present research investigated the relation between diverse measures of goal progress in the context of academic and weight loss goals using four datasets (total sample = 351). Overall, subjective measures were positively related to objective measures. The magnitudes of these associations varied across studies and were generally smaller than would be expected if the measures assessed the same construct (R² = .05-.39). These findings suggest that subjective and objective measures may reflect related but distinct constructs. The present research draws attention to an important topic in the goals literature and highlights the need for additional research on the conceptualization and operationalization of successful goal pursuit. [ABSTRACT FROM AUTHOR]

Purpose - Various recent studies are perplexed with the situation if subjective measures such as perceptions of learning reflect knowledge gains and whether they can be used as a surrogate for evidence of actual learning in an online learning environment. Due to a rising trend in current research studies interpreting perceptions of learning compared to actual learning as a measure of success, this study investigates the dichotomous measures of objective and subjective measures of academic performance in an online learning environment with selected predicted variables. This is followed by an investigation on the effect of online learning on students' academic performance prior to and during the Covid environment. Methodology - This cross-sectional study employed a correlation design for the purpose of data collection among 382 university students. The dependent variable of study comprised objective measures of CGPA scores while the subjective measures was based on a composite score from perceived items in a questionnaire. The predictive independent variables included, i) satisfaction towards online learning, ii) online learning self-efficacy, iii) social interactive engagement in online learning, and iv) online learning environment. Findings - The findings showed an extremely weak and nonsignificant relationship between actual academic performance (GPA) and perceived academic performance in an online learning environment. A statistically significant increase was notable in students' academic performance through GPA scores before and during Covid-19 academic semester and this increase was prevalent among low and intermediate achievers. Apart from environment, all other predictors were significant predictors of perceived academic performance. Engagement was a predictor for the subjective measure of CGPA scores. Significance - Subjective measures data should not be considered as knowledge gain, and it should be used cautiously as a surrogate for evidence of actual learning. Educational research studies should be designed using more objective measures of learning rather than subjective measures in isolation as dependent variable. This should be seen as a caveat by policymakers in decision-making to practise consciousness in terms of judgemental modes employed in measurement and to exercise caution in collecting, analysing, and interpreting subjective data. [ABSTRACT FROM AUTHOR]

Background: The first surgeries with CI532 showed an effect of the proximity of the electrode to the modiolus on the Evoked Compound Action Potentials (ECAPs). Objectives: Objectives of the study were to investigate the effect of the "pullback" procedure on intraoperative ECAP responses in three different electrode array positions and additionally to compare behavioral thresholds with the thresholds obtained in a group of patients using the standard insertion. The hypothesis of this study is that pullback will cause lower ECAPs and behavioral thresholds. Patients: The study included 40 patients, 20 in the pullback insertion group and 20 in the standard insertion group (without pullback). Method: During insertion of the CI532 electrode array, ECAP was performed in three different positions for the pullback group: at initial insertion, at over-insertion, and after pullback. Insertion was monitored by fluoroscopy. In the standard group, ECAP was performed at the initial position, which is also the final position. ECAP thresholds (T-ECAPs) were compared within subjects at the initial and the final position in the pullback group and between groups in the final positions of the pullback and standard groups. Programming levels (C- and T-levels) were compared between the two groups 1 year after switch-on. Results: Intraoperative measurements pullback shows lower average T-ECAPs after pullback compared to thresholds in initial position. Comparison of intraoperative T-ECAPs at the final positions showed no statistically significant difference between the pullback group and the standard insertion group. Furthermore, 1 year after switch-on there was no statistically significant difference in C- and T-levels between the two groups. Conclusion: The pullback maneuver of the CI532 electrode array after an over-insertion gave significantly lower T-ECAPs compared to the thresholds at the initial position. However, the between-groups analysis of pullback and standard insertion showed neither significantly different T-ECAPs nor different programming levels. Because T-ECAPs and programming levels vary considerably between subjects, large groups are required to detect differences between groups. Additionally, the effect pullback technique to preserving the residual hearing is not known yet. [ABSTRACT FROM AUTHOR]

Introduction: Transimpedance measurements from cochlear implant electrodes have the potential to identify anomalous electrode array placement, such as tip fold-over (TFO) or fold-back, basal electrode kinking, or buckling. Analysing transimpedance may thus replace intraoperative or post-operative radiological imaging to detect any potential misplacements. A transimpedance algorithm was previously developed to detect deviations from a normal electrode position with the aim of intraoperatively detecting TFO. The algorithm had been calibrated on 35 forced, tip folded electrode arrays in six temporal bones to determine the threshold criterion required to achieve a sensitivity of 100%. Our primary objective here was to estimate the specificity of this TFO algorithm in patients, in a prospective study, for a series of electrode arrays shown to be normally inserted by post-operative imaging. Methods: Intracochlear voltages were intraoperatively recorded for 157 ears, using Cochlear's Custom Sound™ EP 5 electrophysiological software (Cochlear Ltd., Sydney, NSW, Australia), for both Nucleus® CI512 and CI532 electrode arrays. The algorithm analysed the recorded 22 × 22 transimpedance matrix (TIM) and results were displayed as a heatmap intraoperatively, only visible to the technician in the operating theatre. After all clinical data were collected, the algorithm was evaluated on the bench. The algorithm measures the transimpedance gradients and corresponding phase angles (θ) throughout the TIM and calculates the gradient phase range. If this was greater than the predetermined threshold, the algorithm classified the electrode array insertion as having a TFO. Results: Five ears had no intraoperative TIM and four anomalous matrices were identified from heatmaps and removed from the specificity analysis. Using the 148 remaining data sets (n = 103 CI532 and n = 45 CI512), the algorithm had an average specificity of 98.6% (95.80%–99.75%). Conclusion: The algorithm was found to be an effective screening tool for the identification of TFOs. Its specificity was within acceptable levels and resulted in a positive predictive value of 76%, with an estimated incidence of fold-over of 4% in perimodiolar arrays. This would mean 3 out of 4 cases flagged as a fold-over would be correctly identified by the algorithm, with the other being a false positive. The measurements were applied easily in theatre allowing it to be used as a routine clinical tool for confirming correct electrode placement. [ABSTRACT FROM AUTHOR]

Two of the most used objective measures are electrically evoked action potentials (ECAPs) and electrically evoked stapedius reflex thresholds (ESRTs). Although stimuli used for these measures differ considerably, both measures are influenced by subjective loudness percept. We focus on the subjective maximum acceptable loudness (MAL) to investigate if loudness sensitivity varied along the electrode array during ECAP recordings. In addition, we explored how the MAL reached during an ECAP recording related to the postoperative ESRT. Uni- and bilaterally implanted young CI users (n = 15, average age = 9 y, age range 3–18 y) underwent ECAP and ESR recordings using the clinical software MAESTRO (MED-EL, Innsbruck, Austria) and a commercially available immittance instrument (PATH MEDICAL GmbH, Germering, Germany). Loudness tolerance during ECAP recordings was lowest at the two apical-most electrode contacts (number 1 and 2). There was a moderate correlation between the MAL achieved during ECAP recordings and ESR maximum stimulation amplitudes. (r: 0.44344). ECAP recordings should commence at basal or medial contacts to increase the users' comfort and loudness tolerance, especially in young CI users. A higher maximum stimulation appears to increase the chance of the automatic determination of ECAP thresholds for all electrode contacts. [ABSTRACT FROM AUTHOR]

The task of converting text input into video content is becoming an important topic for synthetic media generation. Several methods have been proposed with some of them reaching close-to-natural performances in constrained tasks. In this paper, we tackle a subissue of the text-to-video generation problem, by converting the text into lip landmarks. However, we do this using a modular, controllable system architecture and evaluate each of its individual components. Our system, entitled FlexLip, is split into two separate modules: text-to-speech and speech-to-lip, both having underlying controllable deep neural network architectures. This modularity enables the easy replacement of each of its components, while also ensuring the fast adaptation to new speaker identities by disentangling or projecting the input features. We show that by using as little as 20 min of data for the audio generation component, and as little as 5 min for the speech-to-lip component, the objective measures of the generated lip landmarks are comparable with those obtained when using a larger set of training samples. We also introduce a series of objective evaluation measures over the complete flow of our system by taking into consideration several aspects of the data and system configuration. These aspects pertain to the quality and amount of training data, the use of pretrained models, and the data contained therein, as well as the identity of the target speaker; with regard to the latter, we show that we can perform zero-shot lip adaptation to an unseen identity by simply updating the shape of the lips in our model. [ABSTRACT FROM AUTHOR]

Background: Parkinson disease (PD) is a chronic degenerative disorder that causes progressive neurological deterioration with profound effects on the affected individual's quality of life. Therefore, there is an urgent need to improve patient empowerment and clinical decision support in PD care. Home-based disease monitoring is an emerging information technology with the potential to transform the care of patients with chronic illnesses. Its acceptance and role in PD care need to be elucidated both among patients and caregivers. Objective: Our main objective was to develop a novel home-based monitoring system (named EMPARK) with patient and clinician interface to improve patient empowerment and clinical care in PD. Methods: We used elements of design science research and user-centered design for requirement elicitation and subsequent information and communications technology (ICT) development. Functionalities of the interfaces were the subject of user-centric multistep evaluation complemented by semantic analysis of the recorded end-user reactions. The ICT structure of EMPARK was evaluated using the ICT for patient empowerment model. Results: Software and hardware system architecture for the collection and calculation of relevant parameters of disease management via home monitoring were established. Here, we describe the patient interface and the functional characteristics and evaluation of a novel clinician interface. In accordance with our previous findings with regard to the patient interface, our current results indicate an overall high utility and user acceptance of the clinician interface. Special characteristics of EMPARK in key areas of interest emerged from end-user evaluations, with clear potential for future system development and deployment in daily clinical practice. Evaluation through the principles of ICT for patient empowerment model, along with prior findings from patient interface evaluation, suggests that EMPARK has the potential to empower patients with PD. Conclusions: The EMPARK system is a novel home monitoring system for providing patients with PD and the care team with feedback on longitudinal disease activities. User-centric development and evaluation of the system indicated high user acceptance and usability. The EMPARK infrastructure would empower patients and could be used for future applications in daily care and research. [ABSTRACT FROM AUTHOR]