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Purpose We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss. Methods MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai Journals Online Complete databases were searched. A meta-analysis was performed using a random-effects model. Data on the prevalence and types of communication between healthcare professionals and patients with any extent of hearing loss were extracted. Results Twenty studies were included. Using a hearing aid (pooled prevalence, 57.4%; 95% CI, 11.4%-103.4%, N = 3, I 2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I 2 = 99.68) were the most commonly reported modes of communication. Few healthcare professionals could use sign language, and limited access to qualified interpreters was common. Conclusion Communication barriers exist. Qualified sign language interpreters and assistive technology should be used to improve communication. [ABSTRACT FROM AUTHOR]

BackgroundDeaf and hard of hearing (DHH) people are an underserved population and underrepresented among healthcare professionals. A major barrier to success for DHH healthcare professionals is obtaining effective accommodations during education and employment. Our objective: describe DHH individuals' experiences with accommodations in healthcare education.MethodsWe used an online survey and multipronged snowball sampling to recruit participants who identify as DHH and who had applied to a U.S. health professional school (regardless of acceptance status). One hundred forty-eight individuals representing multiple professions responded; 51 had completed their training. Over 80% had been accepted to, were currently enrolled, or had completed health professions schools or residency programs, and/or were employed. The survey included questions addressing experiences applying to health professions programs and employment; satisfaction with accommodations in school and training; having worked with a disability resource professional (DRP); and depression screening.ResultsUse and type of accommodation varied widely. While in school, respondents reported spending a mean of 2.1 h weekly managing their accommodations. Only 50% were highly satisfied with the accommodations provided by their programs. Use of disability resource providers (DRPs) for accommodations was highest during school (56%) and less frequent during post-graduate training (20%) and employment (14%). Respondents who transitioned directly from school to employment (versus via additional training) were more satisfied with their accommodations during school and were more likely to find employment (p = 0.02). Seventeen respondents screened positive for risk of depression; a positive screen was statistically associated with lower school accommodation satisfaction.ConclusionsDHH people study and practice across many health professions. While respondents were mostly successful in entering health professions programs, accommodation experiences and satisfaction varied. Satisfaction with accommodations was related to successful employment and wellness. Low satisfaction was associated with higher likelihood of depression symptoms. To increase representation in the workforce, healthcare professional schools, training programs, and employers should enhance support for the learning and working climates for people with disabilities.

ABSTRACT Purpose: to assess the influence of wearing a mask on auditory-visual speech recognition, in a favorable listening situation, in hearing devices users. Methods: a cross-sectional observational study comprising 52 hearing aid users, whose speech recognition was assessed with six video-recorded lists of sentences with and without masks. The mean test results in the various situations were compared using the Friedman test with Bonferroni post hoc, the significance level being set at 5%. Results: speech recognition assessment results differed between the situations with and without masks and between mask types, with a small effect size. The post hoc, with p-values adjusted with the Bonferroni method, showed a difference between transparent masks and others. The transparent one had a higher mean (77.8%) of auditory-visual sentence recognition between the various situations. There were statistically significant differences, as the transparent mask provided a better performance than the others. Conclusion: the auditory-visual recognition of the hearing-impaired people was better with the transparent mask.

Abstract Background Approximately 235,000 deaf and hard of hearing (DHH) people live in Germany. Due to communication barriers, medical care for this group is difficult in many respects. Especially in the case of acute illnesses, the possibilities of communication, e.g., through sign language interpreters, are limited. This study investigates the satisfaction of DHH patients with medical care in Germany in unplanned medical consultations. The aim of this study is to provide insights into DHH patient's perception of medical care, to identify barriers and avoidance behaviours that stem from fears, miscommunication, and prior experiences. Methods We obtained data from adult DHH participants between February and April 2022 throughout Germany via an online survey in German Sign Language. The responses of N = 383 participants (65% female, M = 44 years, SD = 12.70 years) were included in statistical analyses. Outcomes were convictions of receiving help, satisfaction with healthcare provision, and avoiding healthcare visits; further variables were concerns during healthcare visits, incidences of miscommunication, and a communication score. We calculated t-tests, ANOVAs, correlations, and linear and logistic regression analyses. Results Our main findings show that (1) DHH patients were unsatisfied with provided healthcare (M = 3.88; SD = 2.34; range 0–10); (2) DHH patients reported many concerns primarily about communication and treatment aspects when visiting a doctor; and (3) 57% of participants deliberately avoided doctor visits even though they experienced symptoms. Factors such as concerns during doctor’s visits (B = -0.18; 95%CI: -0.34--0.02; p = .027) or miscommunication with medical staff (B = -0.19; 95%CI: -0.33–0.06; p = .006) were associated with satisfaction with medical care, while we found almost no associations with gender and location, and only few with age and education. Conclusions Overall, our findings suggest that DHH patients are unsatisfied with provided healthcare, they deliberately avoid doctor visits, and they face various communication barriers. This study revealed several communication-related determinants of satisfaction with healthcare in DHH patients, such as incidences of miscommunication and the communication score. Communication-related barriers have high potential to be addressed in collaboration with the DHH community. To improve the medical care and the satisfaction with healthcare in DHH patients, training healthcare professionals, digital technologies, and other communication-enhancing interventions should be explored in future intervention studies.

The prevalence of psychiatric illness among the hearing impaired does not vary from the general population. This case series highlights two different presentations of psychiatric illness in speech and hearing-impaired patients. The first case describes a patient that was diagnosed to have unspecified nonorganic psychosis after a detailed assessment and observation. The second case describes the challenges in diagnosing depression versus organicity. Difficulties in communication act as a barrier to psychiatric assessment, and there are no clear guidelines for the same. Both of these cases summarize the challenges faced in assessment, mental status examination, the lack of knowledge of linguistics hindering assessment, and the paucity of literature on psychiatric problems in speech and hearing impaired, especially in India. We found that these may be overcome by consistent ward observation, assessment of psychomotor activity, affect, functional analysis of aggression, and course and duration of the presenting illness. [ABSTRACT FROM AUTHOR]

Aim: People with hearing impairment (HI) prefer visual learning strategies in daily activities owing to their reliance on vision. The aim of this systematic review is to evaluate the effectiveness of visual learning as a communication strategy in improving oral hygiene and dental care of children and adolescents with HI. Methods and Results: Four electronic databases were searched and complemented by hand searching for original intervention studies published till December 2021. Eligible studies were screened, data was extracted as per priori data collection form and analyzed by thematic content analysis. The quality of studies was assessed as per the validated tools appropriate for study designs including ROB2, ROBINS‐I, and NIH quality assessment tool. Out of 4159 records identified and 1302 duplicates removed, 24 original studies were identified and the visual learning strategies were classified into sign language, visual aids with or without sign language, customized educational demonstrations and the interim role of training the teachers. These strategies helped in improving oral hygiene status, oral health‐related knowledge and attitude as well as dental anxiety during treatment. Participants were found to be satisfied with these strategies, however, significant heterogeneity in the included studies precluded meaningful meta‐analysis. ROB2 and ROBINS were rated as high and serious in all included trials, respectively, and NIH Quality Assessment Tool for Pre‐Post Studies With No Control as fair in five studies and poor in three. Conclusion: Our findings emphasize the significance of visual learning, however, long‐term rigorously designed trials are needed to better understand effective and patient‐centered communication methods for people with HI. [ABSTRACT FROM AUTHOR]

Some deaf men who use American Sign Language (ASL) experience barriers in patient-physician communication which may leave them at disparity for shared decision making compared to hearing men. Transparent communication accessibility is needed between deaf male ASL users and their physicians to maximize the benefit to risk ratio of using the prostate-specific antigen (PSA) as a screening tool for early detection. The objective is to compare shared decision-making outcomes between deaf and hearing males who are (1) age-eligible for PSA screening and (2) younger than 45 years old with a family history of cancer. An accessible health survey including questions about PSA test, PCC, modes of communication, and cancer history was administered in ASL to a nationwide sample of deaf adults from February 2017 to April 2018. Two subsamples were created: (1) 45- to 69-year-old men who were age-eligible for PSA testing and (2) 18- to 44-year-old men with a family history of cancer. Age-eligible and younger deaf men with a family history of cancer are at disparity for shared decision making compared to their hearing peers. Regardless of age and PSA testing status, deaf men felt significantly less engaged in shared decision making with their health care providers compared to hearing men. Participation in shared decision making requires not only accessible communication but also cultural competency in working with deaf patients. This is critical in the shared decision-making era in maximizing the benefit of prostate cancer screening in deaf male patient population.

The prevalence of psychiatric illness among the hearing impaired does not vary from the general population. This case series highlights two different presentations of psychiatric illness in speech and hearing-impaired patients. The first case describes a patient that was diagnosed to have unspecified nonorganic psychosis after a detailed assessment and observation. The second case describes the challenges in diagnosing depression versus organicity. Difficulties in communication act as a barrier to psychiatric assessment, and there are no clear guidelines for the same. Both of these cases summarize the challenges faced in assessment, mental status examination, the lack of knowledge of linguistics hindering assessment, and the paucity of literature on psychiatric problems in speech and hearing impaired, especially in India. We found that these may be overcome by consistent ward observation, assessment of psychomotor activity, affect, functional analysis of aggression, and course and duration of the presenting illness.

Substantial out-of-pocket costs for hearing aids constitute a barrier to hearing health care accessibility for older adults among whom prevalence of hearing loss is high. This study is the first to estimate the proportion of Americans with functional hearing loss for which out-of-pocket expenditures for hearing aids would be unaffordable at current average costs and determine how affordability varies by sociodemographic factors. We utilized data from the 2016 American Community Survey to determine the proportion of adults with functional hearing loss for whom hearing aids would constitute ≥3% of annual income or have post-purchase income below a poverty standard. Chi-square tests were used to identify differences in affordability outcomes by sociodemographic characteristics. Results indicated that an average bundled cost of $2500 would constitute a catastrophic expense for 77% of Americans with functional hearing loss (N = 7,872,292) and would add an additional 4% of the population into poverty for the year (N = 423,548). Affordability outcomes varied significantly by age, race, sex, educational attainment and geographic location. Hearing aids were unaffordable for three-fourths of Americans with functional hearing loss, and their purchase would result in impoverishment for hundreds of thousands of individuals. Reductions in out-of-pocket hearing aid costs to $500 or $1000 would alleviate affordability issues for many Americans with hearing loss. Future federal and state policy should address poor rates of insurance coverage for hearing care, specifically among Medicare and Medicaid, to reduce out-of-pocket costs for hearing care particularly for older adults. An average out-of-pocket hearing care cost of $2500 was unaffordable for over three quarters of Americans with functional hearing loss. Hearing care affordability varied significantly by demographic characteristics such as age, sex, gender, educational attainment and geographic region. Affordability constitutes a significant barrier to hearing care accessibility in the United States, where most costs of hearing aids and rehabilitation are statutorily excluded from insurance coverage, including the largest insurer of Americans, Medicare. [ABSTRACT FROM AUTHOR]

In the past decade, accessible information in American Sign Language (ASL) about cancer and genetic testing is expanding on eHealth platforms, including social network sites, commercial sites, and mobile apps. Primary data on genetic testing awareness and genetic testing for BRCA 1/2 among Deaf women were gathered using HINTS-ASL survey between November 2016 and April 2018, and secondary data for hearing women were drawn from NCI's HINTS 5 Cycle 1 survey in 2017. Deaf women who had heard of DNA testing (63%) were more likely to be young adults, college graduates, and/or have a family history of cancer. Compared to hearing women, Deaf women who had heard of genetic testing were more likely to use social networking sites to read or share information about medical topics and watch health-related videos. Making eHealth platforms accessible in ASL and easy-to-understand text can help reduce knowledge gap in genetic testing, since some Deaf women may not be using genetic testing to help identify whether they are at increased risk for breast and ovarian cancer early on, before they are diagnosed with cancer.

The Deaf community members of this community-campus partnership identified the lack of health information in American Sign Language (ASL) as a significant barrier to increasing the Deaf community's health knowledge. Studies have shown that the delivery of health messages in ASL increased Deaf study participants' cancer knowledge. Once health messages are available on the Internet, strategies are needed to attract viewers to the website and to make repeat visits in order to promote widespread knowledge gains. This feasibility study used the entertainment-education strategy of coupling cancer information with jokes in ASL to increase the appeal and impact of the health messages. ASL-delivered cancer control messages coupled with Deaf-friendly jokes were shown to 62 Deaf participants. Participants completed knowledge questionnaires before, immediately after, and 1 week after viewing the paired videos. Participants' health knowledge statistically significantly increased after viewing the paired videos and the gain was retained 1 week later. Participants also reported sharing the newly acquired information with others. Statistically significant results were demonstrated across nearly all measures, including a sustained increase in cancer-information-seeking behavior and intent to improve health habits. Most participants reported that they would be motivated to return to such a website and refer others to it, provided that it was regularly updated with new jokes.

Introduction. Presbycusis or age-related hearing loss is a physiological elevation of hearing threshold and is one of the leading chronic health problems. A growing number of studies show a correlation between hearing loss in old age and decline in cognitive function. Material and Methods. The Serbian version of the Montreal Cognitive Assessment test was used, and the study included 56 subjects with a confirmed diagnosis of presbycusis of which 29 (51.8%) were hearing aid users. Results. The score of cognitive function in the respondents was lower compared to the results of previous research (mean = 19.07; standard deviation = 5.03). Also, there were significant differences between the scores of cognitive function in persons who used amplification and persons who did not. There was no significant correlation between gender, employment status, and the degree of hearing impairment, while the correlation was significant between the level of education, age, the length of hearing aid use, and the number of hours per day a person used a hearing aid. Regression analysis showed that about 88% of the variance of the dependent variable could be explained by four variables: age, level of education, length of hearing aid use, and daily level of hearing aid use. Conclusion. Persons with presbycusis from the territory of the Autonomous Province of Vojvodina showed poor performance scores on the cognitive ability test compared to the results of other researchers. The results showed that the length of hearing aid use and the daily level of hearing aid use significantly affect the cognitive functions in persons with presbycusis. [ABSTRACT FROM AUTHOR]

PurposeDeaf children are frequently reported to be at risk for difficulties in executive function (EF); however, the literature is divided over whether these difficulties are the result of deafness itself or of delays/deficits in language that often co-occur with deafness. The purpose of this study is to discriminate these hypotheses by assessing EF in populations where the 2 accounts make contrasting predictions.MethodWe use a between-groups design involving 116 children, ages 5-12 years, across 3 groups: (a) participants with normal hearing (n = 45), (b) deaf native signers who had access to American Sign Language from birth (n = 45), and (c) oral cochlear implant users who did not have full access to language prior to cochlear implantation (n = 26). Measures include both parent report and performance-based assessments of EF.ResultsParent report results suggest that early access to language has a stronger impact on EF than early access to sound. Performance-based results trended in a similar direction, but no between-group differences were significant.ConclusionsThese results indicate that healthy EF skills do not require audition and therefore that difficulties in this domain do not result primarily from a lack of auditory experience. Instead, results are consistent with the hypothesis that language proficiency, whether in sign or speech, is crucial for the development of healthy EF. Further research is needed to test whether sign language proficiency also confers benefits to deaf children from hearing families.

OBJECTIVE:To assess whether mode of communication and patient centered communication (PCC) with physicians were associated with the likelihood of deaf smokers inquiring about lung cancer screening. METHODS:An accessible health survey including questions about PCC, modes of communication, smoking status and lung cancer screening was administered in American Sign Language (HINTS-ASL) to a nationwide sample of deaf adults from February to August 2017. Of 703 deaf adults who answered the lung screening question, 188 were 55-80 years old. RESULTS:The odds ratio of asking about a lung cancer screening test was higher for people with lung disease or used ASL (directly or through an interpreter) to communicate with their physicians. PCC was not associated with asking about a lung cancer screening test. CONCLUSION:Current or former smokers who are deaf and use ASL are at greater risk for poorer health outcomes if they do not have accessible communication with their physicians. PRACTICE IMPLICATIONS:Optimal language access through interpreters or directly in ASL is critical when discussing smoking cessation or lung cancer screening tests. Counseling and shared decision-making will help improve high-risk deaf patients' understanding and decision-making about lung cancer screening.

Barriers to obtaining breast cancer prevention knowledge and breast cancer screening have been noted among D/deaf women. A randomized controlled trial (RCT) is described that tested a culturally and linguistically tailored breast cancer education program conducted among a racially/ethnically diverse sample of 209 D/deaf women age 40 years or older. The study focused on D/deaf women with no more than a secondary education, a population at relatively high risk for incomplete breast health knowledge and services. This population's inadequate breast cancer knowledge and screening practices and the value of the education program were confirmed. Knowledge increased from -baseline to 12-month follow-up in the intervention group, and in some instances the control group; increased intention to get a mammogram was observed in the intervention group. Possible reasons for the few significant intervention/control group differences at 12 months were examined. Materials from the RCT are available online.

Background: Little is known about severe maternal morbidity (SMM) among women with disabilities. Objective: We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities. Methods: We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23–42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate‐adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes. Results: Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities). Conclusion: As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities. [ABSTRACT FROM AUTHOR]

For approximately 500,000 Deaf people in the United States who use American Sign Language (ASL), accessing quality health care is challenging.1 Deaf people are more likely to have been admitted to a hospital in the past 12 months and have a history of chronic illness (e.g., cardiovascular disease, arthritis, HIV, obesity) compared with those without hearing impairment.2,3 Contributing factors include lack of cultural competency, few appropriately trained ASL interpreters, insufficient clinician education, and low health literacy levels.4 Deaf is defined here as people who are culturally Deaf (values, traditions, and norms5,6) and use ASL as a primary mode of communication.

Introduction: Healthcare information resources are extremely limited currently in Irish Sign Language and studies of the preferred methods of gaining information in the Deaf and hard of hearing (DHH) community are scarce. This study aims to explore the opinions of DHH people on an information portal designed for a radiology department, taking account of their preferred methods of gaining information and past experiences of participants that may be addressed by a portal of this kind. These opinions inform the overall objective of creating a template for further improvements to the portal., Methods: An information portal containing what to expect before, during and after a chest x-ray examination was created. Ethical approval was granted to interview 11 DHH adults via zoom and in person to explore their opinions of an information portal's value prior to chest x-ray examinations. The preferred media type for obtaining information prior to x-ray examinations was also explored. Interview methods reflected the heterogeneity of DHH people's communication methods. Transcripts of the study were analysed using qualitative thematic analysis., Results: The resultant themes from the study were; positives of the information portal as it stands, feelings, pitfalls of the information portal, accessibility considerations, d/Deaf awareness, previous issues that may be helped by the information portal, improvement suggestions and further developments. The majority of participants preferred the subtitled video over other media types. Participants felt they would have been better prepared for their x-ray if they had used the information portal prior, and it would have increased their ability to give informed consent. Participants highlighted experiences of audism in radiology departments and cited the need for healthcare worker's deaf awareness to be improved. Improvements to the information portal were provided by participants., Conclusion: The idea of this information portal was supported by the participants. Increased deaf awareness particularly in healthcare workers will improve this resource and improve patient experiences in radiology., Implications for Practice: A national policy is needed to implement accessible information in radiology departments to improve the provision of medical autonomy. This policy should be supported by ISL interpreters., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To develop a mobile health application (mHealth) accessible to deaf adolescents, based on their health card, promoting autonomy to the access to the user's health information., Method: This was a methodological study, divided into three stages: a questionnaire to understand the knowledge of deaf adolescents about the health card, and development of the application using videos in Brazilian Sign Language Libras, Android Studio platform with Java language, and evaluation of the application., Results: Most deaf adolescents were not aware of the health card. The application has two interface modes: male and female card, with the particularities of each sex. Furthermore, user's data security is carried out in accordance with the Brazilian General Data Protection Law. The application received a score of 85.5 from experts, being classified as "good" to "excellent" in terms of usability., Conclusion: The application provides information from the health card in text and video in Libras, according to the selected sex, promoting adolescents' autonomy in accessing health information. Future implementations may include expansion to other mobile platforms.

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This paper addresses trade-offs in adaptive feedback cancellation (AFC) for hearing aids. Aggressive AFC for improved added stable gain (ASG) reduces speech quality. In this paper, the hearing-aid speech quality index (HASQI) is used to investigate AFC performance before the system becomes unstable. It is demonstrated that for a desired speech quality, multiple AFC algorithms can be evaluated for their ASG and computational efficiency. An example is presented with HASQI = 0.8, baseline AFC, and two advanced approaches. For the advanced AFCs, ASG gains of 4 and 7 dB were obtained at additional computational complexity of 8% and 11%, respectively.

Voice emotion is a fundamental component of human social interaction and social development. Unfortunately, cochlear implant users are often forced to interface with highly degraded prosodic cues as a result of device constraints in extraction, processing, and transmission. As such, individuals with cochlear implants frequently demonstrate significant difficulty in recognizing voice emotions in comparison to their normal hearing counterparts. Cochlear implant-mediated perception and production of voice emotion is an important but relatively understudied area of research. However, a rich understanding of the voice emotion auditory processing offers opportunities to improve upon CI biomedical design and to develop training programs benefiting CI performance. In this review, we will address the issues, current literature, and future directions for improved voice emotion processing in cochlear implant users.

IntroductionDeaf American Sign Language-users (ASL) have limited access to cancer genetics information they can readily understand, increasing risk for health disparities. We compared effectiveness of online cancer genetics information presented using a bilingual approach (ASL with English closed captioning) and a monolingual approach (English text).HypothesisBilingual modality would increase cancer genetics knowledge and confidence to create a family tree; education would interact with modality.MethodsWe used a parallel 2:1 randomized pre-post study design stratified on education. 150 Deaf ASL-users ≥18 years old with computer and internet access participated online; 100 (70 high, 30 low education) and 50 (35 high, 15 low education) were randomized to the bilingual and monolingual modalities. Modalities provide virtually identical content on creating a family tree, using the family tree to identify inherited cancer risk factors, understanding how cancer predisposition can be inherited, and the role of genetic counseling and testing for prevention or treatment. 25 true/false items assessed knowledge; a Likert scale item assessed confidence. Data were collected within 2 weeks before and after viewing the information.ResultsSignificant interaction of language modality, education, and change in knowledge scores was observed (p = .01). High education group increased knowledge regardless of modality (Bilingual: p

D/deaf cancer patients and survivors, including D/deaf women diagnosed with breast cancer, have been largely overlooked in the research literature. To gain preliminary information we included 29 D/deaf breast cancer survivors in a larger program of community-academic research aimed at evaluating and addressing the breast cancer educational needs of D/deaf women. Seven D/deaf breast cancer survivors completed in-depth signed (American Sign Language) interviews and another 22 survivors completed a written/signed survey. Both studies revealed significant gaps in breast cancer knowledge among these women despite their having multiple contacts with medical providers, communication challenges in clinical settings, and inadequate access to support and advocacy services during diagnosis, treatment, and recovery. Research is needed to develop tailored cancer control programs for this population and to identify strategies for disseminating to health care providers and organizations information about the challenges D/deaf people face in obtaining needed services.

Introdução: Todos os dias, a necessidade de consumo informacional alimenta e instiga, por meio de apelos midiatizados, demandas de consumos diversos. O texto aborda observações acerca de vestígios comunicacionais de consumo informacional sobre a pandemia da Covid 19 vinculada à compreensão das inter-relações comunicativas entre a Associação dos Surdos de Governador Valadares (Asugov - pagina Asugov GV), sujeitos surdos associados e perfis pessoais. O Facebook é a segunda mídia social mais visitada, depois do Google. Possuía em 2019, 2,27 bilhões de perfis em rede mundial. Os perfis brasileiros somam aproximadamente 130 milhões de usuários segundo dados desta rede social disponibilizados em janeiro de 2019. Neste sentido pode-se considerar o Facebook como espaço de constituição de múltiplas articulações, ambiente de configuração de culturas digitais com lógicas incorporadas tanto pelas pessoas com surdez quanto por pessoas ouvintes. Objetivo: Objetivamente abarca-se observar e analisar o consumo de informações por pessoas com surdez, a respeito da pandemia causada pelo vírus Covid 19, em postagens realizadas no Facebook, como direito fundamental à informação, na perspectiva de uma comunicação inclusiva e saúde mental plena. Método: As observações foram respaldadas por uma abordagem netnográfica, as quais por sua vez indicam que os processos comunicacionais desenvolvidos naqueles cenários digitais colaboram para o fortalecimento da cultura surda em perspectiva cidadã, na constituição de vínculos promocionais de ações de consumo sobre prevenções, precauções para com o momento pandemia, cuidados para com a Covid 19. Resultados e conclusões: A iniciativa propulsora do estudo surgiu a partir de uma percepção de que existem poucas fontes de informações acessíveis sobre Covid 19 para as pessoas com surdez. O Facebook vem se mostrando ser uma dessas poucas fontes. Pessoas com surdez são utilizadores de uma comunicação espaço-visual, como principal meio de conhecer o mundo; diferindo do ouvinte, não apenas porque não ouve, pois a privação do sentido da audição não inviabiliza interações linguísticas, participações sociais ou produção cultural. Portanto, a relevância desses usos e apropriações nas práticas comunicativas realizadas foram fomentos que ocorreram para com a edificação dos processos sociocomunicacionais, a partir das relações dialógicas estabelecidas nos comentários imagéticos (uso especifico dos emojis), indicando apropriações em diferentes níveis do conhecimento. Em outras palavras, o registro quantitativo do uso dessas imagens nas manifestações postadas no Facebook nos direcionou a analisá-las e compreendê-las sob a perspectiva de ser um conteúdo imagético que permite a inferência de comunicações relativas às condições de produção/recepção da mensagem, apontando para apropriações comunicacionais daqueles usuários. Dessa forma, justifica-se a relevância do presente resumo, pois informação em tempos de pandemia consolida a democracia através da demanda informacional inerente, independentemente da condição surdez.

ObjectiveSelf-reports of 'hearing handicap' are available, but a comprehensive measure of health-related quality of life (HRQOL) for individuals with adult-onset hearing loss (AOHL) does not exist. Our objective was to develop and evaluate a multidimensional HRQOL instrument for individuals with AOHL.DesignThe Impact of Hearing Loss Inventory Tool (IHEAR-IT) was developed using results of focus groups, a literature review, advisory expert panel input, and cognitive interviews.Study sampleThe 73-item field-test instrument was completed by 409 adults (22-91 years old) with varying degrees of AOHL and from different areas of the USA.ResultsMultitrait scaling analysis supported four multi-item scales and five individual items. Internal consistency reliabilities ranged from 0.93 to 0.96 for the scales. Construct validity was supported by correlations between the IHEAR-IT scales and scores on the 36-item Short Form Health Survey, version 2.0 (SF-36v2) mental composite summary (r = 0.32-0.64) and the Hearing Handicap Inventory for the Elderly/Adults (HHIE/HHIA) (r ≥ -0.70).ConclusionsThe field test provides initial support for the reliability and construct validity of the IHEAR-IT for evaluating HRQOL of individuals with AOHL. Further research is needed to evaluate the responsiveness to change of the IHEAR-IT scales and identify items for a short-form.

Mutations in the OTOF gene encoding otoferlin result in a disrupted function of the ribbon synapses with impairment of the multivesicular glutamate release. Most affected subjects present with congenital hearing loss and abnormal auditory brainstem potentials associated with preserved cochlear hair cell activities (otoacoustic emissions, cochlear microphonics [CMs]). Transtympanic electrocochleography (ECochG) has recently been proposed for defining the details of potentials arising in both the cochlea and auditory nerve in this disorder, and with a view to shedding light on the pathophysiological mechanisms underlying auditory dysfunction. We review the audiological and electrophysiological findings in children with congenital profound deafness carrying two mutant alleles of the OTOF gene. We show that cochlear microphonic (CM) amplitude and summating potential (SP) amplitude and latency are normal, consistently with a preserved outer and inner hair cell function. In the majority of OTOF children, the SP component is followed by a markedly prolonged low-amplitude negative potential replacing the compound action potential (CAP) recorded in normally-hearing children. This potential is identified at intensities as low as 90 dB below the behavioral threshold. In some ears, a synchronized CAP is superimposed on the prolonged responses at high intensity. Stimulation at high rates reduces the amplitude and duration of the prolonged potentials, consistently with their neural generation. In some children, however, the ECochG response only consists of the SP, with no prolonged potential. Cochlear implants restore hearing sensitivity, speech perception and neural CAP by electrically stimulating the auditory nerve fibers. These findings indicate that an impaired multivesicular glutamate release in OTOF-related disorders leads to abnormal auditory nerve fiber activation and a consequent impairment of spike generation. The magnitude of these effects seems to vary, ranging from no auditory nerve fiber activation to an abnormal generation of EPSPs that occasionally trigger a synchronized electrical activity, resulting in high-threshold CAPs.

Introduction: Children who are deaf or hard-of-hearing (DHH) are at risk for speech and language delay. Language outcomes are worse in DHH children from lower socioeconomic backgrounds, due in part to disparities in access to specialised speech-language therapy. Teletherapy may help improve access to this specialised care and close this language gap. Inclusion of diverse DHH children in prospective randomised clinical trials has been challenging but is necessary to address disparities and pursue hearing health equity. Stakeholder input regarding decisions on study design elements, including comparator groups, masking, assessments and compensation, is necessary to design inclusive studies. We have designed an inclusive, equitable comparativeness effectiveness trial to address disparities in paediatric hearing health. The specific aims of the study are to determine the effect of access to and utilisation of speech-language teletherapy in addressing language disparities in low-income children who are DHH., Methods and Analysis: After stakeholder input and pilot data collection, we designed a randomised clinical trial and concurrent longitudinal cohort trial to be conducted at four tertiary children's hospitals in the USA. Participants will include 210 DHH children aged 0-27 months. 140 of these children will be from lower income households, who will be randomised 1:1 to receive usual care versus usual care plus access to supplemental speech-language teletherapy. 70 children from higher income households will be simultaneously recruited as a comparison cohort. Primary outcome measure will be the Preschool Language Scales Auditory Comprehension subscale standard score, with additional speech, language, hearing and quality of life validated measures as secondary outcomes., Ethics and Dissemination: This study was approved by the Institutional Review Boards of the participating sites: the University of California, San Francisco (19-28356), Rady Children's Hospital (804651) and Seattle Children's Hospital (STUDY00003750). Parents of enrolled children will provide written informed consent for their child's participation. Professional and parent stakeholder groups that have been involved throughout the study design will facilitate dissemination and implementation of study findings via publication and through national and regional organisations., Trial Registration Number: NCT04928209., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The matter of raising and educating deaf children has been caught up in percepts of development that are persistently inaccurate and at odds with scientific research. These percepts have negatively impacted the health and quality of life of deaf children and deaf people in general. The all too prevalent advice is to raise the child strictly orally and wait to see what happens. Only when the child is seriously behind is a completely accessible language - a sign language - introduced, and that is far too late for protecting cognitive health. The medical profession, along with others, needs to offer parents better advice and better supports so that neither the children nor their parents wait and watch as the oral-only method fails. All must take responsible action to assure an approach that succeeds., (© 2024. The Author(s).)

Background and Aim: Refractive errors, amblyopia, strabismus, and low vision are more common among children with hearing impairments in comparison with their hearing peers. Neglecting visual disorders can pose educational and social problems for these children. The present study aimed to assess the prevalence of refractive errors, amblyopia, strabismus, and low vision among hearing-impaired and deaf students in Kermanshah., Materials and Methods: A total of 79 deaf and hearing impaired students within the age range of 7-20 years (mean age of 15.01 ± 2.72) underwent optometric examinations, including autorefractometry, retinoscopy, ophthalmoscopy, slit lamp, visual acuity measurement, and cover-uncover test. Those who needed further evaluation were referred to the Ophthalmology Clinic of Imam Khomeini Hospital., Results: Regarding the prevalence of refractive errors, 32 (40.5%) subjects had one or a combination of refractive errors, the most common of which was astigmatism (36.7%), followed by amblyopia (15.1%). The most common type of strabismus was latent strabismus (heterophoria) (88.6%), followed by exophoria (81%). Moreover, 3 (3.7%) cases had nystagmus. A significant difference was observed between the prevalence of amblyopia and the degree of hearing loss (P = 0.026), and no significant difference was detected in other cases., Conclusion: As evidenced by the obtained results, refractive errors, amblyopia, strabismus, and low vision are more prevalent among deaf and hearing-impaired children compared to normal children because deaf and hearing-impaired children are not able to convey their vision problems and need to compensate for their poor hearing with an enhanced sense of sight, inattention to these disorders can present these children with serious educational and social problems. Therefore, eye screening examinations are of paramount importance in deaf and hearing-impaired children., (© 2024. The Author(s).)

In recent years, an increasing number of deaf and hard of hearing (D/HH) undergraduates have chosen to study in STEM fields and pursue careers in research. Yet, very little research has been undertaken on the barriers and inclusive experiences often faced by D/HH undergraduates who prefer to use spoken English in research settings, instead of American Sign Language (ASL). To identify barriers and inclusive strategies, we studied six English speaking D/HH undergraduate students working in research laboratories with their eight hearing mentors, and their three hearing peers sharing their experiences. Three researchers observed the interactions between all three groups and conducted interviews and focus groups, along with utilizing the Communication Assessment Self-Rating Scale (CASS). The main themes identified in the findings were communication and environmental barriers in research laboratories, creating accessible and inclusive laboratory environments, communication strategies, and self-advocating for effective communication. Recommendations for mentors include understanding the key elements of creating an inclusive laboratory environment for English speaking D/HH students and effectively demonstrating cultural competence to engage in inclusive practices., Competing Interests: Conflict of Interest Disclaimer: The authors declare that they have no conflict of interest.

To explore the difficulties and obstacles of hearing-technology users during the coronavirus disease 2019 (COVID-19) pandemic. Descriptive, cross-sectional study. Individuals with permanent hearing loss (n = 278) answered a questionnaire designed to identify potential obstacles caused by using hearing aids during the COVID-19 pandemic, along with the reasons and deleterious effects associated with the devices. Each category reflected challenges in communicating, learning, and working during the pandemic. Different response categories were compared using descriptive and inferential statistics. The duration of daily device usage before the imposed lockdown was significantly higher than that during (Z = −2.01, p < 0.05), potentially attributable to the pandemic-induced difficulties faced by hearing-technology users. Such challenges include the shortage of batteries for hearing devices, limited access to repair or programming services of said devices and accessories, termination of speech therapy sessions, and obstacles to employment and education. Among audiologists, efficiency and professionalism are required to educate the public and private health sectors regarding the prevalent challenges and their harmful impact on hearing-technology users during the COVID-19 pandemic. To overcome these issues, awareness of telepractice and its importance in providing audiological services to hard of hearing individuals should be raised. [ABSTRACT FROM AUTHOR]

ObjectiveSelf-reports of 'hearing handicap' are available, but a comprehensive measure of health-related quality of life (HRQOL) for individuals with adult-onset hearing loss (AOHL) does not exist. Our objective was to develop and evaluate a multidimensional HRQOL instrument for individuals with AOHL.DesignThe Impact of Hearing Loss Inventory Tool (IHEAR-IT) was developed using results of focus groups, a literature review, advisory expert panel input, and cognitive interviews.Study sampleThe 73-item field-test instrument was completed by 409 adults (22-91 years old) with varying degrees of AOHL and from different areas of the USA.ResultsMultitrait scaling analysis supported four multi-item scales and five individual items. Internal consistency reliabilities ranged from 0.93 to 0.96 for the scales. Construct validity was supported by correlations between the IHEAR-IT scales and scores on the 36-item Short Form Health Survey, version 2.0 (SF-36v2) mental composite summary (r = 0.32-0.64) and the Hearing Handicap Inventory for the Elderly/Adults (HHIE/HHIA) (r ≥ -0.70).ConclusionsThe field test provides initial support for the reliability and construct validity of the IHEAR-IT for evaluating HRQOL of individuals with AOHL. Further research is needed to evaluate the responsiveness to change of the IHEAR-IT scales and identify items for a short-form.

Although the cochlear implant has been widely acknowledged as the most successful neural prosthesis, only a fraction of hearing-impaired people who can potentially benefit from a cochlear implant have actually received one due to its limited awareness, accessibility, and affordability. To help overcome these limitations, a 26-electrode cochlear implant has been developed to receive China's Food and Drug Administration (CFDA) approval in 2011 and Conformité Européenne (CE) Marking in 2012. The present article describes design philosophy, system specification, and technical verification of the Nurotron device, which includes advanced digital signal processing and 4 current sources with multiple amplitude resolutions that not only are compatible with perceptual capability but also allow interleaved or simultaneous stimulation. The article also presents 3-year longitudinal evaluation data from 60 human subjects who have received the Nurotron device. The objective measures show that electrode impedance decreased within the first month of device use, but was stable until a slight increase at the end of two years. The subjective loudness measures show that electric stimulation threshold was stable while the maximal comfort level increased over the 3 years. Mandarin sentence recognition increased from the pre-surgical 0%-correct score to a plateau of about 80% correct with 6-month use of the device. Both indirect and direct comparisons indicate indistinguishable performance differences between the Nurotron system and other commercially available devices. The present 26-electrode cochlear implant has already helped to lower the price of cochlear implantation in China and will likely contribute to increased cochlear implant access and success in the rest of the world. This article is part of a Special Issue entitled .

Zinacantec Family Homesign (Z) is a new sign language emerging spontaneously over the past three decades in a single family in a remote Mayan Indian village. Three deaf siblings, their Tzotzil-speaking age-mates, and now their children, who have had contact with no other deaf people, represent the first generation of Z signers. I postulate an augmented grammaticalization path, beginning with the adoption of a Tzotzil cospeech holophrastic gesture-meaning "come!"-into Z, and then its apparent stylization as an attention-getting sign, followed by grammatical regimentation and pragmatic generalization as an utterance initial change of speaker or turn marker.

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Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. [ABSTRACT FROM AUTHOR]

Deaf sport involves the practice of sports performed by deaf athletes, contributing to the development of self-esteem, quality of life and greater social participation of members of the deaf community. Thus, physical therapy performance plays a fundamental role in maintaining and improving the functional capacity of this population. Evidence-Based Practice (EBP) is a process that integrates the best scientific evidence, the physical therapist's clinical experience and the patient's preferences, aiming to offer an adequate and efficient service and treatment, guaranteeing quality of care. Thus, EBP should be used by professionals in clinical practice with the deaf athlete population. However, no studies are found in the literature that highlight its use by professionals working with this population. Evaluate the knowledge and use of EBP by physical therapists who work in deaf sports This is a pilot study, conducted in parallel with a quantitative exploratory cross-sectional study. Brazilian physical therapists participated, female and male, who had been working for at least 3 months in deaf sports and who were associated with state deaf sports federations or the Brazilian Confederation of Deaf Sports (CBDS). A semi-structured questionnaire was used, prepared by the research team, with questions about personal and demographic data, professional training, and the use of EBP. Nominal and/or ordinal variables were described in absolute and relative frequency. Five physical therapists (30.4±3.36 years) participated, mostly male (60%, n=3). 80% of the participants (n=4) had already heard about EBP, with 60% (n=3) indicating that they use EBP partially in their appointments, and 20% (n=1) said that EBP is a determining factor in choosing the best conduct. As resources used for clinical decision-making, 100% (n=5) use clinical experience, 80% (n=4) use clinical practice guidelines and 60% (n=3) use scientific articles, demonstrating a non-homogeneous use of the pillars that support EBP. Regarding the updating of clinical knowledge, 80% (n=4) took courses and participated in scientific events/conferences, 60% (n=3) use scientific articles, 40% (n=2) reported participating in study groups and only 20% (n=1) reported using books, suggesting that knowledge updating may have often been based on sources with high risks of bias. Physical therapists who work in deaf sports are aware of EBP, use resources related to it, but still encounter difficulties and limitations for its applicability in clinical practice. Future studies, with more professionals, are necessary for a national overview of the knowledge of EBP by physical therapists who work in deaf sports. There are still no studies in the literature evaluating the influence of EBP on the performance of the physical therapist in Brazilian deaf sports, despite knowing that this can promote adequate, efficient, and higher quality physical therapy treatment. From the data found, professional education policies to promote greater knowledge and use of EBP by these professionals are necessary for a more qualified service to the deaf athlete population. [ABSTRACT FROM AUTHOR]

ObjectivesSubstantial evidence exists that emergency preparedness and response efforts are not effectively reaching populations with functional and access needs, especially barriers related to literacy, language, culture, or disabilities. More than 36 million Americans are Deaf or hard of hearing (Deaf/HH). These groups experienced higher risks of injury, death, and property loss in recent disasters than the general public. We conducted a participatory research study to examine national recommendations on preparedness communication for the Deaf/HH.MethodsWe assessed whether previous recommendations regarding the Deaf/HH have been incorporated into state- and territorial-level emergency operations plans (EOPs), interviewed state- and territorial-level preparedness directors about capacity to serve the Deaf/HH, and proposed strategies to benefit Deaf/HH populations during emergencies. We analyzed 55 EOPs and 50 key informant (KI) interviews with state directors.ResultsFifty-five percent of EOPs mentioned vulnerable populations; however, only 31% specifically mentioned Deaf/HH populations in their plan. Study findings indicated significant relationships among the following factors: a state-level KI's familiarity with communication issues for the Deaf/HH, making relay calls (i.e., calls to services to relay communication between Deaf and hearing people), and whether the KI's department provides trainings about serving Deaf/HH populations in emergencies. We found significant associations between a state's percentage of Deaf/HH individuals and a KI's familiarity with Deaf/HH communication issues and provision by government of any disability services to Deaf/HH populations in emergencies. Further, we found significant relationships between KIs attending training on serving the Deaf/HH and familiarity with Deaf/HH communication issues, including how to make relay calls.ConclusionThis study provides new knowledge that can help emergency agencies improve their preparedness training, planning, and capacity to serve Deaf/HH populations in emergencies.

Using a prospective, longitudinal study design, this paper addresses the impact of genetic counseling and testing for deafness on deaf adults and the Deaf community. This study specifically evaluated the effect of genetic counseling and Connexin-26 and Connexin-30 genetic test results on participants' deaf identity and understanding of their genetic test results. Connexin-26 and Connexin-30 genetic testing was offered to participants in the context of linguistically and culturally appropriate genetic counseling. Questionnaire data collected from 209 deaf adults at four time points (baseline, immediately following pre-test genetic counseling, 1-month following genetic test result disclosure, and 6-months after result disclosure) were analyzed. Four deaf identity orientations (hearing, marginal, immersion, bicultural) were evaluated using subscales of the Deaf Identity Development Scale-Revised. We found evidence that participants understood their specific genetic test results following genetic counseling, but found no evidence of change in deaf identity based on genetic counseling or their genetic test results. This study demonstrated that culturally and linguistically appropriate genetic counseling can improve deaf clients' understanding of genetic test results, and the formation of deaf identity was not directly related to genetic counseling or Connexin-26 and Connexin-30 genetic test results.

Objective: to build assistive technology, in video format, for deaf and hearing people about sexual health and condom use. Methods: methodological study consisting of the stages of pre-production, production and post-production. In pre-production we built the script, storyboard and scenes, following the principles of Lev Semenovich Vygotsky’s Theory of Learning. In production there was the development of the animation and recording of the scenes by the Libras interpreter. In post-production the final editing of the video took place. Results: the video “Condom: learn to use correctly”,lasting nine minutes and 25 seconds discusses the sexual and reproductive system of man and woman; mode of action, benefits and care with the use of condoms.Given the scarcity of educational materials on the subject, accessibility resources were used to build a video for deaf and hearing people. Conclusion: the construction of the video as an assistive technology directed to the deaf was successfully accomplished.

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ABSTRACT Objective: to analyze YouTube videos with information about COVID-19 in Brazilian sign language. Methods: a cross-sectional study conducted with 402 videos from the YouTube sharing platform. Chi-square, Fisher’s exact, Mann-Whitney and Spearman’s correlation tests were used. Results: the videos mainly covered COVID-19 prevention (20.6%). There was a positive correlation between video length and number of views (p

BackgroundLimited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices.Objective/hypothesisTo assess baseline breast cancer knowledge and practices among a sample of D/deaf women recruited into a randomized controlled trial of a breast cancer education program developed for this population.MethodsA written and signed (American Sign Language) survey was administered to a racially/ethnically diverse sample of 209 D/deaf women, 40+ years old, with lower levels of education, recruited in California between October 2008 and May 2009.ResultsThere were misconceptions about breast cancer risk factors, screening, and treatment; only 64.2% of respondents correctly identified the purpose of mammography. Mammography in the prior 2 years was reported by 57.3% of the sample, by 69.8% of White women, and by 43.5% of women from other racial/ethnic groups. Rates also varied by education, having seen a physician in the prior year, and type of insurance.ConclusionsThis study underscores significant gaps in breast cancer screening knowledge and practices, communication issues in health care settings, and unmet needs for tailored health information and materials in this population. Challenges faced in conducting the research needed to develop and test such programs are noted.

Cochlear Implant (CI) users typically perform poorly on musical tasks, especially those based on pitch ranking and melody recognition. It was hypothesized that CI users would demonstrate deterioration in performance for a pitch ranking and a melody recognition task presented with iterated rippled noise (IRN) in comparison to pure tones (PT). In Addition, it was hypothesized that normal hearing (NH) listeners would show fewer differences in performance between IRN and PT for these two tasks. In this study, the ability of CI users and NH subjects to rank pitches and to identify melodies created with IRN and PT was assessed in free field in a sound-isolated room. CI subjects scored significantly above chance level with PT stimuli in both tasks. With IRN stimuli their performance was around chance level. NH subjects scored significantly above chance level in both tasks and with all stimuli. NH subjects performed significantly better than CI subjects in both tasks. These results illustrate the difficulties of CI subjects to rank pitches and to identify melodies.