The successful implementation of pediatric audiology services depends on parental engagement and support. It is essential to analyze the gaps in knowledge level and attitude of the parents in United Arab Emirates (UAE), towards pediatric hearing loss and pediatric audiology services. The present study aimed to assess the knowledge and attitude of parents in Sharjah, UAE.A cross-sectional survey was administered to 295 parents in a tertiary care hospital setting. The self-reported questionnaire consisted of 26 items. 34.2% of the parents ascertaining good knowledge and 65.8% reported poor knowledge regarding the various factors related to the childhood hearing loss. Further, 86.2% of parents reported positive attitudes regarding accessing pediatric audiology services. A significant association was found between age groups, educational status, and knowledge levels. The study highlights the poor knowledge demonstrated by parents in the UAE regarding hearing loss and its associated risk factors. Findings outline the critical need in the region to enhance parental awareness. More health promotion activities and community outreach campaigns are necessary to increase the uptake of pediatric audiology services in the region.  The development and implementation of successful pediatric audiological services relies on active participation and support from parents within the community . Such deHere is a general negative attitude reported among parents towards hearing screening and hearing loss ,7. Usualp = 0.031), Otitis Media (OM) (p = 0.038), and noise exposure (p = 0.007) [Studies have been conducted to assess the knowledge and attitude of parents towards hearing loss in many countries. In the middle east, particularly in Saudi Arabia, a recent study revealed that less than 50% of parents have adequate knowledge about hearing loss, whereas approximately 93% of parents showed a positive attitude towards audiology related services . Additio= 0.007) .Studies report that parents showed a positive attitude and favored seeking audiological services . Most paTo the best of our knowledge, there are limited or no published data available on parental knowledge and attitudes towards hearing loss in the United Arab Emirates (UAE). Thus, the present study attempts to explore the parental knowledge and attitude towards childhood hearing loss and pediatric hearing services in Sharjah, UAE, through a cross-sectional survey of the parents.The study was in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). Ethical approval was obtained for the current study from the Institutional Ethics and Research Committee of University Hospital Sharjah (UHS-HERC-041-01092020).A cross-sectional survey study was conducted. The study was carried out from September 2020 to January 2021 at a tertiary care university hospital in Sharjah, UAE. The survey was administered to 295 parents of children without an hearing impairment diagnosis, who visited the well-baby clinic and an audiology clinic for a pediatric hearing assessment. We targeted both fathers and mothers of the newborns, regardless of them being first-time or subsequent parents. Due to the cultural sensitivities in the region, we targeted both parents to measure and compare their responses. To be included in the study, parents should be aged 20 years and above. Parents with below-elementary level of education and who could not comprehend the language were excluded from the study. Both parents were given a thorough explanation regarding the purpose of the study. Written consent was obtained before the paper-based questionnaire was handed and answeredanonymously by the parentsThe questionnaire consisted of 26 items . Twenty After the translation, the Arabic version of the questionnaire was shared with two audiologists, two otolaryngologists, and two neonatologists, who were asked to assess the questionnaire and rule out any ambiguities in the regional context. Their suggestions were incorporated, and a pilot study was conducted on 20 parents  to ensure the clarity of the questions and to estimate the duration needed to complete the questionnaire. The pilot study questions were to be rated on a three-point rating scale: yes, no, or unsure. Parental demographic information, including age and level of education, was also collected.p-value of 0.05. The internal consistency of the questionnaire was assessed via Cronbach’s alpha coefficient.The data were entered and analyzed using the Statistical Package for Social Sciences . Descriptive statistics were utilized to describe the frequency of the responses and analyzed in percentages. Twenty questions evaluated knowledge levels and six questions assessed attitudes. For ease of interpretation, responses were further coded as “Yes” = 1, “No” and “Unsure” = 0. Knowledge and attitude levels were computed based on a total of 20 points and 6 points, respectively. Knowledge responses were further grouped into: “poor knowledge” = 0–10 points and “good knowledge” = 11–20 points. Attitude was scored based on the range: “negative” for 0–3 points and “positive” for 4–6 points. Furthermore, the chi-square test was utilized to measure the association between socio-demographic details and the knowledge and attitude responses. The significant level was kept at a A total of 295 parents participated in the study. The overall response rate was 91.2% (269). Ninety-four (34.9%) fathers and 175 (65.1%) mothers completed the questionnaire. The mean age of the participants was 30.7 years (standard deviation: 5.5) and ranged from 21–49 years. One-hundred and eighty-eight (69.9%) parents were university graduates and 81(30.1%) were educated at secondary levels or below.Questions addressing maternal rubella  and low birth weight as risk factors , showed extremely poor awareness among fathers and mothers, respectively. In addition, their knowledge related to risk factors, such as OM and conductive hearing loss, was rated high. Both fathers (55.1%) and mothers (47.2%) reported that were aware that “Ear discharge and OM cause hearing loss.”Regarding identification and intervention, both fathers (77.1%) and mothers (56.5%) claimed that were fully aware that “children with hearing loss can attend schools.” Interestingly, they showed a great degree of understanding regarding “speech and language problems can be a sign of hearing loss” . Moreover, both fathers and mothers showed positive and agreeable attitudes towards availing childhood audiology services.Overall responses to parental knowledge and attitudes are illustrated in p = 0.001). However, no significance was found between attitude factors and education levels. Further, there was a significant association between age group and knowledge level (p = 0.020).The association between knowledge, attitudes, and socio-demographic characteristics  revealedThe internal consistency of the questionnaire was assessed with the Cronbach’s alpha coefficient (α) and there was an excellent consistency for knowledge (0.86) and attitudes (0.90); an α closer to 1 is an indication of high reliability .The current study attempted to explore the knowledge and attitudes of parents towards childhood hearing loss and hearing services. The results from the study revealed that both fathers and mothers reported relatively poor knowledge of childhood hearing loss and its risk factors.Around 58% of fathers reported a good degree of knowledge regarding consanguineous marriages causing hearing loss. More than half 59%) of mothers were aware that family history can cause hearing loss. These findings are consistent with the study reported by Kasper et al. . Both pa% of mothThe current study also noted poor levels of knowledge for the risk factors of “high fever,” “measles”, “and “neonatal jaundice,” and the lowest knowledge level regarding “maternal rubella can cause hearing loss.” Both parents reported that they were unsure and had limited knowledge regarding whether drugs or medication cause hearing loss. This concurred with the study reported from Saudi Arabia  and IndiWhen probed about their knowledge level of OM and its risk factors, fathers (55%) reported a higher level of knowledge than mothers. However, this contrasted with findings from other regions where mothers were more aware of OM leading to hearing loss . SeveralReported knowledge levels regarding identification and intervention of hearing loss revealed comparatively higher percentages than parental awareness of risk factors leading to hearing loss. The parents’ knowledge about children with hearing loss attending school was excellent, rating beyond 65%. This was consistent with previous study findings ,12. In aRegarding the parents’ attitude towards utilizing pediatric audiology services, most parents were overwhelmingly positive and were in favor of newborn hearing screening immediately after birth (fathers: 90.4% and mothers: 89.1%). Furthermore, parents displayed a positive attitude towards testing their child for hearing loss at school. These are interesting findings, given the fact that successful implementation of newborn hearing screening (NHS) and other hearing screening methods in school were highly dependent on parents’ acceptance ,21,22. OThe current study also compared the association between knowledge and attitudes between age groups, revealing that parents aged 31–40 years (53%) share greater knowledge levels compared to other age groups. However, contradictory findings were reported from Saudi Arabia where parents aged more than 40 years showed better knowledge levels than those below . FurtherIt was surprising to note that 86.2% of parents showed a positive and favorable attitude towards hearing screening. However, a vast majority of them (65.8%) noted poor knowledge and comprehension regarding hearing loss and the associated risk factors. These findings are the first to be reported in the UAE. It highlights the need for formulating robust public awareness campaigns among expectant parents regarding childhood hearing loss. The current study findings highlight the dire need for initiating community outreach programs on hearing loss in children amongst parents in the UAE. Given the dearth of information from the region, these findings will help in tailoring the health awareness and promotional activities for the community in the UAE. Maternal and antenatal classes for expectant parents may be utilized to educate parents on breastfeeding initiatives as a preventable cause of hearing loss and OM. Further they can be educated on early intervention with NHS and school hearing screening. Digital pamphlets and social media could be utilized to disseminate information on identifying childhood hearing loss early and its associated risk factors for expectant fathers and mothers.All participants were from the same hospital setting, where their child was treated. Selection bias does exist as the parents who were willing to take part in the study were approached. In addition, parents who had reading or writing difficulties opted out of the study. Further assessment of the current findings is warranted; other parents from the adjacent emirates in the region should be studied.Future studies could focus on understanding the implementation of an NHS program and assess the knowledge and attitudes of mothers during follow-up visits. Furthermore, a larger cohort of parents is to be recruited within the adjacent emirates allowing us to better profile the gap in knowledge levels among parents pertaining to childhood hearing loss and its prevention. In addition, focused groups or interviews with the parents to explore their beliefs shall help in tailoring the awareness campaigns.The current study provides data on parental knowledge and attitudes towards childhood hearing loss and pediatric audiology services in the UAE. The findings outline the gap present in the region regarding parental awareness. Health promotional activities and community awareness campaigns are necessary to reduce the knowledge gap and to enhance parental engagement. Such a systematic approach would allow for the optimal implementation of an NHS program and to increase uptake for pediatric audiology services in the region.


The adjusted associations between vision impairment and ADL disability were significant among males  and females . Similarly, significant adjusted associations were found between hearing impairment and ADL disability among males  and females . Vision and hearing impairments were significantly associated with ADL disability, with no gender differences identified. Early detection and effective management of vision and hearing impairments are important to prevent ADL disability and improve older adults’ level of independence.Vision and hearing impairments are common among older adults and can cause undesirable health effects. There are limited studies from low- and middle-income countries exploring gender differences between vision and hearing impairment with Activities of Daily Living (ADL) disability. Therefore, this study aimed to investigate gender differences between vision and hearing impairments with ADL disability among older adults in Malaysia. Cross-sectional data from 3977 respondents aged 60 and above from the Malaysian National Health and Morbidity Survey 2018 were used. We used logistic regression analysis to measure associations between vision and hearing impairments with ADL disability, adjusted for covariates. The prevalence of ADL disability was higher among females than males ( Vision and hearing impairments are common and prevalent among older adults ,2,3. TheA study conducted among older adults residing in a long-term care facility in four countries  reported older adults with both vision and hearing impairments were more likely to have highly compromised independence of ADL . SingapoIn a study evaluating the association of hearing and vision impairments with negative well-being among community-dwelling older adults, vision impairment was related to reduced functional activity in both genders, but hearing impairment was not . EvidencTo date, there are limited studies from low- and middle-income countries exploring gender differences in the association between vision and hearing impairments, and ADL disability. Considering the differences between males and females in proportion to disabled years to be lived, this study aimed to investigate gender differences in the association between vision and hearing impairments with ADL disability among older adults in Malaysia.The NHMS 2018 was a nationally representative health survey in Malaysia for older adults aged 60 years and above. Sample size was calculated using the sample size calculation formula for a prevalence study and was adjusted for the total number of the target population based on the estimated 2017 population, design effect and non-response. Sample size was calculated for each specific objective based on the identified scopes, using a single proportion formula and previous literature estimates. The largest sample size was based on the prevalence of living alone . This sample size was chosen to ensure the sample in this study covered all the objectives of NHMS 2018. This ensured the minimum required sample size to meet the desired precision with a 95% confidence interval. Precision was determined based on the 95% confidence interval and the relative standard error. To ensure optimum sample size, the sample was further adjusted for the total number of the target population using 2018 estimates, the design effect of 1.5–4.0 from previous surveys and complex sampling analysis with a 30% non-response rate [A bilingual  structured questionnaire was designed, pre-tested and piloted prior to data collection. Data were collected from July 2018 to September 2018 via a face-to-face data collection method. Data collection was conducted by trained research assistants using mobile devices. For respondents with communication problems, for instance post-stroke, cognitive impairment, speech disabilities or language barrier, proxies assisted in the interview process. Proxies mainly were the family members who knew the respondent best. We obtained written consent form all eligible respondents prior to interviews. For illiterate respondents, verbal consent with thumb prints were obtained in front of a literate witness. Ethical approval for the study was obtained from the Medical Research and Ethics Committee (MREC), Ministry of Health (NMRR-17-2655-39047).Dependent variable, ADL disability was measured using the Barthel index of activities of daily living . The BarThe Washington Group Extended Questions Set on Functioning was used to measure the independent variables, hearing and vision impairments . Level oA total of ten covariates were included in this study. Socio-demographic variables included were sex, ethnicity, marital status, education level, individual monthly income and employment status. Ethnicity was classified into ‘Malay’, ‘Chinese’, ‘Indian’, ‘Bumiputra Sabah’, ‘Bumiputra Sarawak’ and ‘Others’. Marital status was grouped into ‘unmarried/separated/divorced/widowed’ or ‘married’. Education level was divided into ‘no formal education’, ‘primary education’, ‘secondary education’ or ‘tertiary education’. Individual monthly income had three categories: ‘<RM1000′, ‘RM1000-RM1999′ or ‘≥RM2000′. Employment status was categorized into ‘yes’ or ‘no’. The presence of chronic diseases was based on self-reported medically diagnosed diabetes mellitus, hypertension and hypercholesterolemia. Self-reported diabetes, hypertension or hypercholesterolemia were defined as being told they have the diseases by a doctor or assistant medical officer. Fall was described based on the question ‘In the last 12 months, have you had a fall?’. The responses were ‘yes’ or ‘no’. Social support was assessed by using the Duke Social Support Index (DSSI) and was categorized into ‘low to fair’, ‘high’ and ‘very high’. Living status was categorized into ‘living alone’ and ‘not living alone’.The prevalence of vision impairment, hearing impairment, ADL disability and covariates was described as frequencies and percentages according to gender for categorical data. In addition, we used logistic regression to investigate differences between male and female groups. Subsequently, logistic regression analysis was used to measure the association between vision and hearing impairments with ADL disability. First, results from an unadjusted model (Model 1) were reported, followed by results from a set of hierarchical models adjusting for the covariates . Socio-demographic covariates included in Model 2 were for ethnicity, marital status, education level, employment status and individual monthly income. Health-related covariates included in Model 3 were presence of chronic diseases and falls. Social-related covariates included in Model 4 were living status and social support. Data analyses were conducted using SPSS Statistics 25.0  taking into consideration the complex survey design.p < 0.001). Both males and females had similar prevalence of vision and hearing impairments. More than 80% of male respondents were married, and only half of female respondents were married. A majority of the respondents were Malays and received primary education. More than one-third of male respondents were employed, and only 10% of female respondents were employed. Male respondents had a higher individual monthly income level compared to female respondents. Female respondents reported higher prevalence of hypertension and hypercholesterolemia compared to male counterparts. The prevalence of falls was similar between both genders. A majority of the respondents were not living alone.Respondents with higher educational levels, employment and a higher level of social support were associated with lower odds of having ADL disability, in both genders. Married women were associated with lower odds of having ADL disability. On the other hand, falls were associated with higher odds of ADL disability among males.The aim of this study was to determine whether the association between vision and hearing impairments with ADL disability differs by gender, considering the differences between males and females in proportion years to be lived, medical conditions and illnesses.This study found higher prevalence of ADL disability among female respondents than male respondents. This finding is consistent with previous studies ,21,22,23In this study, vision impairment was significantly associated with ADL disability after adjusting for covariates, in both genders. This is in line with a study conducted among older adults from two welfare homes in Malaysia that reported that older adults with vision impairment experienced more difficulties in ADL . Harada Hearing impairment had significant associations with ADL disability in both genders in this study. However, there are contradicting findings in previous studies. A study reported older adults with hearing impairment were more likely to have difficulty in walking, getting outside, getting in and out of a bed or chair, and managing medication compared to older adults without sensory problems . HoweverRespondents with a higher education level were associated with lower odds of having ADL disability, in both genders. This finding is in line with prior studies. A study conducted among older rural Malaysians reported a low educational level as one of the risk factors of ADL disability . A natioThis study also found that employed respondents had lower odds of having ADL disability, in both genders. Among Singaporean older adults, a lower likelihood of being employed was associated with higher disability rates . In ruraIn both male and female respondents, a higher level of social support was associated with lower odds of ADL disability. In Poland, older adults who did not maintain social contact were twice as likely to have at least one ADL limitation . ExtensiThis study has several strengths. First, the present study recruited national representative respondents of Malaysian older adults using a proper sampling method whereby a stratified two-stage sampling was carried out to ensure that the sample size was representative of the national population. Secondly, this study included a variety of factors, for instance socio-demographic characteristics, health-related variables and social-related variables in the multivariable analysis, which made the final model robust.It is important to consider the limitations of this study. First, vision and hearing impairment data were collected using a self-reported method. The data collected using a self-reported method may differ from data collected using objective measurement. Secondly, this study collected cross-sectional data. Hence, we were not able to establish the causal relationship due to the cross-sectional study design.In conclusion, both vision and hearing impairments had significant associations with ADL disability among older adults. Both genders appear to show significant associations between vision and hearing impairments with ADL disability. In addition, older adults who were employed and had higher social support and educational levels were shown to have lower odds of having an ADL disability. Early detection and effective management of vision and hearing impairments are important among older adults to prevent ADL disability and improve their level of independence. Hearing and visual screening programs at the primary-care level could help with early detection. Primary healthcare providers should also be empowered with the knowledge and skills to screen, detect and manage vision and hearing impairments. Older adults with hearing and vision impairments could benefit from interventions and rehabilitation programs, such as vision and audiological rehabilitation, which have the potential to reduce the occurrence of ADL disability and lead to a longer disability-free life.


Colorectal and perianal surgery encompasses a broad range of procedures to address various pathologies arising from the colon and anorectum. Data regarding the pattern and outcome of colorectal and perianal disorders requiring surgery remains largely unknown in Ethiopia.A descriptive cross sectional one-year review was made and all patients who were admitted and operated for colorectal and perianal disorders were included in the study. Data was collected by chart review and analyzed by SPSS version 23.Colorectal and perianal surgeries accounted for 14.6% of the procedures in the study period. Males constituted the major share of the study population. The mean age for perianal and colorectal pathologies were 39.6±13.7 and 44.8± 16.2 years respectively. Among the colorectal disorders redundant sigmoid was the most common indication for admission 41(34.4%) followed by colorectal neoplasms 38(31.9%) while among the perianal conditions, fistula in ano was the most common pathology accounting for 69(43.4%) of admissions followed by hemorrhoids 35(22%). The overall incidence of post-operative complications in the colorectal and perianal procedure groups was found to be 29(24.4%) and 4(2.5%) respectively. There was no mortality in the perianal group whereas there were 11(9.2%) deaths in the colorectal procedure group.Colorectal surgeries accounted for a fair share of procedures among the other specialty units. The morbidity and mortality associated with colorectal procedures is fairly high and warrants attention. Colorectal and perianal surgery encompasses a broad range of procedures to address various pathologies arising from the colon and anorectum including congenital disorders, inflammatory conditions of the colon, diverticular disease, trauma, malignancy and perianal conditions.Colorectal and perianal surgery has its roots in the early civilization starting from the ancient Egyptians. The first surgical treatments for colorectal and perianal diseases were limited to rectal prolapse and hemorrhoids but later its evolution progressed through time to include other pathologies related to trauma and malignancy. The last century was a time of marked progress with the introduction of minimally invasive approaches namely laparoscopic and robotic procedures to the practice of colorectal and perianal surgery .Historically, colorectal surgery was associated with a high risk of morbidity and mortality compared to other surgeries which is in the range of 13–28%. This high rate of complication has been decreasing over the decades due to betterment in the availability of broad-spectrum antibiotics, development of improved surgical techniques and advances in critical care and perioperative management of patients  grade, malnutrition, anemia, intraoperative blood transfusion, use of steroids, albumin <3.5 g/L and creatinine >1.4 mmol/L, longer operative time (> 120 minutes), and peritoneal contamination . The burThe objective of this study is to describe sociodemographic characteristics, admission diagnosis, the types of procedures and patient outcome of colorectal and perianal surgeries in Menelik II referral hospital. This will provide a vital input to improve the level of surgical care to patients and lay foundation for further research.This study was conducted in Menelik II Referral Hospital which serves patients from the metropolis and surrounding towns. The surgical department of the hospital consists of one colorectal surgeon, one cardiothoracic surgeon, four general surgeons, one urology surgeon, one neuro surgeon and surgical residents from Addis Ababa University.Retrospective review of charts of patients operated for colorectal disorders in the time period of January 1, 2018 to December 31, 2018 was done to determine the pattern and outcome of colorectal surgery at Menelik II referral Hospital. As the number of retrieved charts in the one year of the study period was equal to the calculated sample size  all patients admitted and operated to surgical wards in the given period were included in the study. The colorectal surgeries which are included in this paper were performed by the colorectal surgeon, general surgeons and surgical residents. Data was collected by the principal investigators using a structured questionnaire and was analyzed by statistical package for social science (SPSS) version 23. Ethical clearance was obtained from the research review and ethical committee of the college.A total of 2025 surgical procedures were performed in the surgical department of our institution over a period of one-year out of which colorectal and perianal procedures accounted for 14.6%. Among the total emergency and elective procedures, the share of colorectal and perianal procedures was 7.9% and 19.9% respectively. Colorectal and perianal surgeries were the second most common elective procedures next to urology surgeries in the study period. A total of 296 colorectal and perianal surgeries were performed in the study period out of which the medical records of 9 Patients could not be accessed from the medical record room making the chart retrieval rate 96.4%.Socio-demographic data: Males constituted the major share of the study population in both colorectal and perianal procedure groups with 91(76.5%) and 125(80.5%) of the study subjects being male respectively. The mean age of the study population was 41.67±15.23 years with a range of 17–80 years. Patients who were operated for perianal conditions were relatively younger compared to those operated for colorectal pathologies with a mean age of 39.6±13.7 years and 44.8± 16.2 years respectively. Regarding the place of residence, only 41(17%) patients were from rural areas of the country.Pattern of colorectal and perianal surgeries: Elective procedures took the major share of colorectal and perianal surgeries performed in the study period accounting for 75(63%) and 123(77.4%) of the procedures respectively. Among the colorectal disorders, redundant sigmoid was the most common indication for admission 41(34.4%) followed by colorectal neoplasms 38(31.9%) while among the perianal conditions, fistula in ano was the most common accounting for 69(43.4%) of admissions followed by hemorrhoids 35(22%) ( 35(22%) .Overall, fistulotomy was the most common procedure accounting for 57(24.1%) followed by hemorrhoidectomy 35(12.6%) and incision and drainage for anorectal abscess 32(11.9%) Among the colorectal procedures, colostomy was the most common procedure accounting for 31(10.8%) of the total procedures .The pre-operative diagnosis was the same with the intra operative finding in 265 (95.7%) of the procedures. Majority of the procedures were done by residents, 106 (38.1%) followed by colorectal/GI surgeon 94(33.9%). Residents handled more emergency procedures than elective procedures (80% Vs 21%).Outcome of colorectal and perianal surgeries: The post-operative hospital stay in the colorectal surgery group was between 6–10 days in 51(42.9%) patients whereas in the perianal surgery group majority 135(84.9%) of the patients had a post-operative stay of less than 3 days  and 4(2.5%) respectively. There were 68 procedures, all in the colorectal disorders group, in which bowel anastomosis was done. Out of these, 4 developed anastomotic leak making the leak rate 5.9%. Among these 68 anastomoses, 8 were done during emergency procedures with 1 subsequent anastomotic leak and the rest 60 during elective procedures with 3 leaks making the leak rate of emergency and elective anastomosis 12.5% and 5% respectively.Over all, surgical site infection (4.3%) was the most common post-operative complication. The incidence of surgical site infection among the colorectal procedures was 9(7.6%) while it was 3(1.9%) in the perianal procedure group. Among the study population, 7.7% underwent relaparotomy with the most common indication being anastomotic leak (35%).There was no mortality in the perianal surgery group whereas there were 11(9.2%) deaths in the colorectal procedure group. Among these deaths, 5 occurred following elective procedures making the mortality rate 2.5% while the rest 6 were after emergency procedures with a mortality rate of 7.5%. Sepsis with multiorgan failure was responsible for 9(7.6%) of the deaths while bleeding 1(0.8) and respiratory failure 1(0.8%) were the other causes of death.Colorectal and perianal surgery commands a considerable proportion of surgeon's attention in clinical practice as surgical disorders affecting the colon, rectum and the anus are quite frequently encountered ,11. ThisBenign perianal conditions  collectively accounted for more than half of the colorectal and perianal disorders in this study. Although there are no populationbased reports regarding the prevalence of these disorders in a national or international literature, they were mentioned as growing health problems in the tropics ,14. In oThe mean age of patients with perianal condition in our study was lower compared to the study from St. Paul's Hospital Millenium Medical college and Nepal ,15. The In our study the most common colorectal pathology was redundant sigmoid. This is expected as this pathology has been described to be common in areas where high dietary fiber is consumed and Ethiopia and generally Africa are considered to be endemic areas –25. The Colorectal surgeries are associated with higher rate of postoperative morbidity compared to other surgical subspecialities with up to one-third of patients developing these complications . In our In this study anastomotic leak occurred in 5.4% of the colorectal procedures which involved bowel anastomosis. This figure compares well to another study from Ethiopia (5.2%) but higher when compared to other reports from USA (3.8%) and France (4.4%) –35. NoneSurgical site infection was documented in 7.6% of patients who underwent colorectal procedures in this study which was comparable to a study from Australia 7.2%) and USA (8.4%) while it was lower when compared to an earlier report from USA (11.3%) ,2,37. Ou% and USARelaparotomy was required in 7.7% of patients after colorectal procedures for various indications. This figure was lower when compared to a study from Netherland 12.5%) while it was higher than reports from Australia (5.7%) and France (2%) ,12,33. A.5% whileThere was no mortality in patients after perianal procedures in this study which was also true in other reports from India and Turkey ,20. The This study has tried to provide baseline information regarding the pattern and outcome of colorectal and perianal surgeries in the setup of a referral hospital in the capital city. We believe that this study can serve as a stepping stone for further population based prospective studies in the future to define the status of colorectal and perianal pathologies in Ethiopia better.


Objectives: Age-related hearing loss (ARHL) is highly prevalent among older adults, but the potential mechanisms and predictive markers for ARHL are lacking. Epigenetic age acceleration has been shown to be predictive of many age-associated diseases and mortality. However, the association between epigenetic age acceleration and hearing remains unknown. Our study aims to investigate the relationship between epigenetic age acceleration and audiometric hearing in the Baltimore Longitudinal Study of Aging (BLSA).Methods: Participants with both DNA methylation and audiometric hearing measurements were included. The main independent variables are epigenetic age acceleration measures, including intrinsic epigenetic age acceleration—“IEAA,” Hannum age acceleration—“AgeAccelerationResidualHannum,” PhenoAge acceleration—“AgeAccelPheno,” GrimAge acceleration—“AgeAccelGrim,” and methylation-based pace of aging estimation—“DunedinPoAm.” The main dependent variable is speech-frequency pure tone average. Linear regression was used to assess the association between epigenetic age acceleration and hearing.Results: Among the 236 participants , after adjusting for age, sex, race, time difference between measurements, cardiovascular factors, and smoking history, the effect sizes were 0.11 995% CI: , p = 0.054] for Hannum’s clock, 0.08  for Horvath’s clock, 0.10  for PhenoAge, 0.20  for GrimAge, and 0.21  for DunedinPoAm.Discussion: The present study suggests that some epigenetic age acceleration measurements are associated with hearing. Future research is needed to study the potential subclinical cardiovascular causes of hearing and to investigate the longitudinal relationship between DNA methylation and hearing. Age is one of the strongest risk factors for hearing loss which is prevalent in nearly two-thirds of adults over 70 years . AccordiWe have previously hypothesized that there is a hierarchical and temporal relationship between biological aging, phenotypic aging, and functional aging . Thus, bAlthough the relationship between these epigenetic measures and many early life exposures as well as age-related functional decline  have been widely studied , the relThe BLSA is a study of healthy aging conducted by the National Institute on Aging Intramural Research Program. Established in 1958 and comprehensively revised in 2003, the BLSA includes extensive domain-based phenotypic measurements and molecular biomarkers . All par1 or ‘‘projector’’ package.2 As to the construction of PhenoAge, DNA methylation was assayed using DNA extracted from blood samples collected at visits between November 1993 and March 2010. CpG methylation status of 485,577 CpG sites was determined using the Illumina Infinium HumanMethylation450 BeadChip  per the manufacturer’s protocol. Data processing included NOOB and BMIQ normalization using R package “minfi” . Multi-dAudiometric testing was conducted using a sound-attenuating booth and an Interacoustics AD629 audiometer with ER3A insert earphones by trained technicians. Air-conduction thresholds were assessed in each ear at octave frequencies from 0.5 to 8 kHz. The speech-frequency pure tone average (PTA) defined by thresholds at 0.5, 1, 2, and 4 kHz in the better ear was used in the main analyses . Higher Age, sex, race, smoking history, and history of hypertension, diabetes, congestive heart failure, peripheral arterial disease were obtained from health history interviews and examinations conducted by the trained health professionals. As to detailed smoking history, participants were asked about their history of using pipe tobacco, cigarette, and cigar.Linear regression was used to estimate the association between epigenetic measurements (independent variable) and audiometric hearing (dependent variable). In model 1, we adjusted for sex, black race, age, and time difference between epigenetic measurement and hearing measurement. In model 2, to account for potential confounding by cardiovascular diseases, we further adjusted for hypertension, diabetes, congestive heart failure, and peripheral arterial disease. Because smoking history was used as an intermediate step to create GrimAge, in model 3, to account for the potential confounding by smoking, we further adjusted for smoking history . Since not all epigenetic clocks were developed using populations with wide age ranges, we performed a subgroup analysis limiting to those aged 60 and above. Additional sensitivity analysis evaluating smoking using pack-years including pipe tobacco, cigarette, and cigar history were also conducted. Further, we also conducted the other sensitivity analysis using the PTA at worse ear as dependent variable. All standardized estimates were reported with 95% confidence interval (CI). The analysis was conducted using R 3.6.Baseline characteristics of the analytic population are shown in p = 0.001), and pace of aging estimate (“POAm_38_Dunedin”) with effect size of 0.19 (p < 0.001)  , Model 1< 0.001) .p = 0.005), and pace of aging estimate (“POAm_38_Dunedin”) 0.21 (p = 0.001) in the fully adjusted model  0.20  were associated with hearing. One potential explanation is that these two epigenetic clocks contain richer information than the other three clocks. The construction of GrimAge uses more biomarkers and smoking history in comparison to the other three epigenetic clocks , and mortality information was directly used for training in the last step . Pace ofAlternatively, our findings may be an indication of the impact of cardiovascular factors on hearing loss. The absence of association between hearing and several epigenetic clocks suggests both that the meaning of epigenetic clocks is highly dependent on the ways they are constructed  and thatWe acknowledge several limitations to our study. First, the hearing and DNA methylation were not measured at the same time. Second, the DNA methylation was sampled from blood, which may not reflect the DNA methylation in cells of the inner ear or other tissues that are involved in the pathogenesis of hearing loss. Third, although DNA methylation was measured before hearing, since this is cross-sectional study, the results may be driven by unmeasured confounders, such as environmental/occupational noise exposure, and detailed medication history. Although the relationship between noise exposure and epigenetic age acceleration remains unclear, the observed association between epigenetic age acceleration and hearing is expected to be weakened if there is a strong association between noise exposure and epigenetic age acceleration. Fourth, because BLSA aims to study healthy aging, the participants in BLSA are healthier than the general population. Future studies are needed to understand whether the association between epigenetic age acceleration and hearing is stronger in the population with higher proportion of participants experiencing accelerated epigenetic aging. However, despite these limitations, the BLSA is one of the very few studies collecting both DNA methylation data and performing audiometric hearing testing. We believe these measurements analyzed in the context of a deeply phenotyped cohort represent an important first step in understanding biological aging processes and hearing loss.In conclusion, our findings demonstrate that not all epigenetic clocks were strongly correlated with hearing. Only those epigenetic clocks established using many cardiovascular measurements with longitudinal information were associated with hearing. Future research is needed to study the potential subclinical cardiovascular causes of hearing and to investigate the relationship between DNA methylation and hearing longitudinally.via website portal (https://www.blsa.nih.gov/how-apply). Requests to access these datasets should be directed to https://www.blsa.nih.gov/how-apply.The data analyzed in this study is subject to the following licenses/restrictions: BLSA data are available upon request The studies involving human participants were reviewed and approved by the Internal Review Board of the Intramural Research Program of the National Institutes of Health. The patients/participants provided their written informed consent to participate in this study.P-LK, AM, FL, and LF contributed to conception, design of the study, collected and organized the data, designed the analysis, interpreted the results of the statistical analysis, contributed to manuscript revision, read, and approved the submitted version. P-LK wrote the first draft of the manuscript. All authors contributed to the article and approved the submitted version.FL reports being a consultant to Frequency Therapeutics, receiving speaker honoraria from Caption Call, and being the director of a public health research center funded in part by a philanthropic donation from Cochlear Ltd., to the Johns Hopkins Bloomberg School of Public Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with one of the authors LF.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


REFLECTIONS B538–02 is a randomized, double-blind comparative study of the adalimumab (ADL) biosimilar PF-06410293, (ADL-PF), and reference ADL sourced from the European Union (ADL-EU) in patients with active RA. Therapeutic equivalence was demonstrated based on ACR20 responses at week 12 (primary endpoint). We report long-term safety, immunogenicity, and efficacy of ADL-PF in patients who continued ADL-PF treatment throughout 78 weeks or who switched from ADL-EU to ADL-PF at week 26 or week 52.Eligible patients , stratified by geographic regions were initially randomized (1:1) in treatment period 1 (TP1) to ADL-PF or ADL-EU , both with MTX (10–25 mg/week). At week 26 (start of TP2), patients receiving ADL-EU were re-randomized to remain on ADL-EU or transition to ADL-PF for 26 weeks. At week 52 (start of TP3), all patients received open-label treatment with ADL-PF for 26 weeks and were followed after last treatment dose to week 92. To evaluate maintenance of response after switching or remaining on ADL-PF, ACR20, DAS28-4(CRP), and other measures of clinical response/remission were assessed through week 78 as secondary endpoints. Three groups were evaluated: biosimilar, week 26 switch, and week 52 switch.Overall, 507 patients participated in TP3. ACR20 response rates at week 52 were 88.4%, 88.2%, and 87.6% for the biosimilar, week 26, and week 52 switch groups, respectively. ACR20 response rates and DAS28-4(CRP) scores were sustained and comparable across groups in TP3. Incidence of treatment-emergent adverse events (AEs) during TP3 and follow-up was 42.6% (biosimilar), 37.0% (week 26 switch), and 50.8% (week 52 switch); 3 (0.6%) patients  reported treatment-related serious AEs. ADL-PF was generally well tolerated, with a comparable safety profile across groups. Overall, incidences of patients with anti-drug antibodies in TP3 and follow-up were comparable among groups .There were no clinically meaningful differences in safety, immunogenicity, and efficacy for patients who were maintained on ADL-PF for 78 weeks and those who had switched from ADL-EU at week 26 or week 52.ClinicalTrials.gov, NCT02480153. First posted on June 24, 2015; EU Clinical Trials Register; EudraCT number: 2014-000352-29. Start date, October 27, 2014The online version contains supplementary material available at 10.1186/s13075-021-02626-4. Rheumatoid arthritis (RA) is a lifelong chronic disease, which, although not curable, can be brought into remission or low disease activity in many patients by appropriate treatment . DiseaseADL is a recombinant, fully human, immunoglobulin G1 monoclonal antibody that specifically binds to human tumor necrosis factor-α (TNF-α), inhibiting its interaction with surface TNF receptors. Inhibition of TNF-α results in the down-regulation of the abnormal inflammatory pathways implicated in the pathogenesis and progression of immune-mediated inflammatory diseases , 3. In cPF-06410293 (ADL-PF) is an ADL biosimilar DMARD (bsDMARD), approved in the US  and the EU  for all eligible indications of reference ADL, the boDMARD  . PreclinObtaining clinical evidence concerning switching of patients from boDMARDs to bsDMARDs, as well as following longer-term treatment, is key to instilling patient and clinician confidence. Here, we report findings from REFLECTIONS B538–02 on the long-term safety, immunogenicity, and efficacy of ADL-PF in patients who continued ADL-PF treatment throughout 78 weeks, or who switched from ADL-EU to ADL-PF at week 26 or week 52.The methodology for this comparative study has been described previously and is summarized briefly here .Inclusion and exclusion criteria have been described in detail elsewhere . EligiblThis was a multinational, two-arm, randomized, double-blind, parallel-group, 78-week study, comprising three 26-week treatment periods and a 14-week follow-up period  has been reported elsewhere . We repoSafety endpoints evaluated throughout TP3 and follow-up period included type, incidence, severity, seriousness, and investigator-determined relatedness of adverse events (AEs) and laboratory abnormalities. AEs were classified using the MedDRA (version 20.1) classification system. The severity of AEs was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.03). Treatment-emergent AEs (TEAEs) were defined as those with onset on or after the first dose of study drug during TP3 as well as ongoing AEs at the start of TP3 that worsened on or after the first dose of study drug in TP3.Immunogenicity endpoints, assessed as a secondary objective of the study, were the number and percentage of patients in TP3 and follow-up period who had positive anti-drug antibodies (ADAs), positive neutralizing antibodies (NAbs) , ADA and NAb titers, and incidence of transient ADA response.PK serum samples were analyzed for ADL-PF and ADL-EU using a validated analytical assay QPS, LLC , with a lower limit of quantification of 250 ng/mL. The PD endpoint was serum hs-CRP concentration.Three groups were evaluated corresponding to the treatment sequence during the study: biosimilar group; week 26 switch group; and week 52 switch group Fig. . Efficacn = 297) or ADL-EU (n = 300) in TP1 [As previously reported, 597 patients were initially randomized to ADL-PF  in TP1 . A totalAs previously reported, therapeutic equivalence of ADL-PF and ADL-EU was demonstrated based on the two-sided 95% confidence interval (CI) for the treatment difference in the primary endpoint (week-12 ACR20) being entirely contained within ± 14% symmetric margin, as well as by the two-sided 90% CI being entirely contained within asymmetric margin of − 12 to 15% as specified by the FDA. ACR20, ACR50, and ACR70 response rates for all patients were 88.2%, 68.4%, and 40.0%, respectively, at week 52, and 84.2%, 68.2%, and 48.3%, respectively, at 78 weeks. For the biosimilar, week 26 switch, and week 52 switch groups, the ACR20 response rates prior to the first injection of study drug (week 52) were 88.4%, 88.2%, and 87.6%, respectively, and were 83.4%, 85.8%, and 84.3%, respectively, at week 78 Fig. . ACR20 rMean DAS28-4CRP score for all patients was 3.0 at week 52 reflecting a mean change from study baseline of − 3.0 and at week 78 was 2.8 reflecting a mean change from study baseline of − 3.2. The mean DAS28-4CRP scores and the mean change from study baseline on DAS28-4CRP were comparable between the three treatment groups at all TP3 visits Fig. .Overall, a good EULAR response was reached by 61.9% of patients at week 52 and by 63.7% of patients at week 78. Overall, the EULAR response rates at week 52 persisted in TP3 across the three treatment groups Fig. . NumericA total of 218 (43.2%) patients reported 446 all-causality TEAEs during TP3 and follow-up period; 21 (4.2%) patients reported serious AEs (SAEs) and 28 (5.5%) patients reported grade 3 or higher TEAEs. Eleven (2.2%) patients discontinued treatment due to TEAEs in TP3 , 35.6% (week 26 switch), and 46.2% (week 52 switch) also tested positive for NAb. The incidences of patients with ADAs and NAbs at pre-dose (TP3) week 52, overall during TP3 and the follow-up period, and overall during the study were comparable between the three groups  were determined based on data from all three treatment periods and the follow-up period. Transient ADA response in the ADA-positive population was comparable in the biosimilar (15.8%), week 26 switch (10.3%), and week 52 switch (10.5%) groups. Among the patients who developed ADAs overall during the study, 10/290 (3.4%) had a hypersensitivity TEAE Table  and 1/29Mean serum drug concentrations were generally comparable across all three treatment groups at each TP3 visit and during the follow-up period Fig. . As expeMean hs-CRP concentrations at week 52 pre-dose were 9.7, 9.8, and 10.4 mg/L in the biosimilar, week 26 switch, and week 52 switch groups, respectively, and at week 78 were 10.5, 8.2, and 9.4 mg/L, respectively. The mean change from study baseline in hs-CRP concentrations were − 10.7, − 12.9, and − 11.9 mg/L at week 52 pre-dose, and − 9.7, − 13.3, and − 11.9 mg/L at week 52 in the biosimilar, week 26 switch, and week 52 switch groups, respectively.Acquiring data on switching and longer-term efficacy and safety of biosimilars in the clinical setting, beyond the data required for support of regulatory approval, is valuable in informing payor and clinician decision-making. Here, we report data from TP3 and the long-term safety follow-up period of REFLECTIONS B538–02, a double-blind, comparative study of ADL-PF and ADL-EU in patients with active RA. Therapeutic equivalence between the ADL-PF (a bsDMARD) and ADL-EU (the boDMARD) was established based on the primary endpoint of ACR20 response at week 12 . The effDuring TP3 (from week 52 to 78), all patients received open-label treatment with ADL-PF. The efficacy of ADL-PF, as determined by the ACR response rates, was comparable between the three treatment groups during TP3, which were based on the treatment sequence the patients received during the study Fig. . ACR50 aADL-PF was generally well tolerated during TP3 and the safety profile of ADL-PF was consistent with the long-term profile established for ADL in patients with RA . There wResults from TP3 of this study, in which all patients received open-label treatment with ADL-PF, showed that there were no clinically meaningful differences in safety, immunogenicity, or efficacy between patients who had been maintained on ADL-PF for 78 weeks and those who had switched from ADL-EU at week 26 or week 52. These data, demonstrating response maintenance after switching, together with results from the previously reported primary analysis establishing therapeutic equivalence of ADL-PF with ADL-EU at week 12, support the similarity of ADL-PF to reference ADL.Additional file 1: Figure S1 Serum drug concentration–time profile for ADA-positive patients in the biosimilar, week 26 switch, and week 52 switch treatment groups, by neutralizing antibody status during TP3 A NAb positive, B NAb negative.Additional file 2: Table S1. Hypersensitivity TEAEs (PT) on or after the date of subject first ADA-positive test .


A previous investigation demonstrated differences between younger adult normal-hearing listeners and older adult hearing-impaired listeners in the perceived emotion of clear and conversational speech. Specifically, clear speech sounded angry more often than conversational speech for both groups, but the effect was smaller for the older listeners. These listener groups differed by two confounding factors, age (younger vs. older adults) and hearing status . The objective of the present study was to evaluate the contributions of aging and hearing loss to the reduced perception of anger in older adults with hearing loss. We investigated perceived anger in clear and conversational speech in younger adults with and without a simulated age-related hearing loss, and in older adults with normal hearing. Younger adults with simulated hearing loss performed similarly to normal-hearing peers, while normal-hearing older adults performed similarly to hearing-impaired peers, suggesting that aging was the primary contributor to the decreased anger perception seen in previous work. These findings confirm reduced anger perception for older adults compared to younger adults, though the significant speaking style effect—regardless of age and hearing status—highlights the need to identify methods of producing clear speech that is emotionally neutral or positive. Talkers may adopt a more clear speaking style to overcome perceived barriers to communication . This clear speaking style serves to improve the communicative experience by affording the listener a speech-understanding benefit compared to when a more conversational style is used e.g., ,2). Clea. Clea2])While adopting these segmental and suprasegmental modifications makes speech easier to understand for many different listener groups, there has been some speculation recently about other, unintended consequences of clear speech, such as the increased perception of anger . Indeed,Directly investigating perceived anger in clear and conversational speech, Morgan and Ferguson  found thIn psychological sciences, emotion is generally described using one of three models: discrete , dimensiAging differences have been observed in the emotional perception of both visual and acoustic stimuli ,16, suggA recent study on auditory emotion recognition across the lifespan suggests that emotion recognition performance improves and approaches adult-like levels in early adolescence . Early aThe effect of hearing loss on auditory emotion recognition is an expanding area of research interest. Recent studies have shown conflicting reports, with some suggesting no relationship between hearing loss and emotion recognition ability , while In this manuscript we present two experiments that, when compared with previously published data from our research group , provideThe objective of this experiment was to determine the extent to which the reduced audibility of high frequencies, independent of age, affects the perceived emotion of clear and conversational speech by simulating hearing loss in young adults with normal hearing.Speech stimuli used in this experiment came from the Ferguson Clear Speech Database (described in ). The dafft function in MATLAB). Similarly, according to Moore and Glasberg, the degree of envelope expansion was directly determined by the attenuation level of each band. The simulation of envelope expansion accounts for loss of cochlear compression; however, such expansion may also occur within the central auditory system due to increased central gain [We processed the stimuli used in Morgan and Ferguson  to simulral gain . Our simral gain ) are notIn addition to processing the stimuli to simulate hearing loss, we included a control set of stimuli, which underwent the same processing  as the experimental stimuli, except no attenuation was applied to the frequency bands (effectively simulating hearing thresholds at 0 dB HL). The stimuli were scaled to the same average root-mean-square amplitude in Cool Edit 2000 to limit the use of amplitude differences as an emotional cue between the speaking styles; this procedure is common in clear speech perception research .A total of 44 younger adults  with normal hearing were recruited for this experiment. Normal hearing was established via a pure tone screening at the time of testing, with all participants demonstrating thresholds better than or equal to 20 dB HL at octave intervals from 250 to 8000 Hz. These participants were divided into two groups (22 listeners per group) that were similar in their average age and hearing thresholds. One group rated the processed control stimuli  and the other group rated the processed experimental stimuli . All listeners in this experiment passed the Montreal Cognitive Assessment . All lisAll subject recruitment and other procedures were in accordance with a protocol approved by the University of Utah Institutional Review Board. Participants sat in a sound-treated room in front of a computer monitor, mouse, and keyboard. Test methods were similar to those used in Morgan and Ferguson . A custoStimuli were presented through a Tucker-Davis Technologies (TDT) RP2.1 real-time processor and then attenuated by a TDT programmable attenuator (PA-5) to a comfortable listening level . The stimuli were then routed via a headphone buffer (TDT HB7) to Sennheiser HD 515 headphones for monaural presentation to the participant’s test ear, which was selected by the participant as their perceived better ear. Monaural presentation was chosen to mimic procedures used for the older adult group with hearing loss (OHL) in Morgan and Ferguson . Task falme4 [lmerTest [R . In eacp-values . In contp-values .p > 0.26). This confirmed that any effects related to the simulated hearing loss are a result of the attenuation and recruitment simulation and not the other aspects of the processing.A data integrity check comparing data obtained from YNH listeners in Morgan and Ferguson  and the F = 17.4, p < 0.001), a significant interaction between talker and speaking style  = 129.5, p < 0.001), and a significant three-way interaction between speaking style, talker group, and listener group  = 6.9, p < 0.001). In general, clear speech was rated as sounding angry more often than conversational speech, and that effect was more pronounced for “good” clear speakers than for the “poor” clear speakers in this study. The nature of the three-way interaction can be seen in Experiment I showed no significant effect of simulated hearing loss on the perception of anger in clear and conversational speech in a group of young adult listeners. This finding suggests that the reduced perception of anger in clear and conversational speech in older adults with hearing loss is driven by the effects of age, rather than the effects of hearing sensitivity. To confirm this, in Experiment II we repeated the study/task of auditory emotion perception for unprocessed clear and conversational speech materials with a sample of older adults with normal or borderline normal hearing .Stimuli for Experiment II were the same as Experiment I, except the stimuli were not processed to simulate hearing loss or produce control stimuli. These unprocessed stimuli were the same as those used in Morgan and Ferguson .A total of 17 older adult listeners  were recruited from the Utah Senior Ears database. This database recruits community members who are interested in participating in hearing-related research in exchange for periodic hearing tests at no charge. The listeners in this study had pure tone thresholds less than or equal to 25 dB HL for 250–3000 Hz and no greater than 40 dB HL for 4000 Hz.n = 1) or visuospatial processing (n = 1). However, data from these participants were included in the data analysis, as there was no significant difference found when their data were excluded. All listeners denied any history of speech or language disorders or therapy and were native speakers of American English. Participants were either compensated for their time (n = 6) or opted to participate as volunteers (n = 11).In addition to these hearing status criteria, all listeners in this experiment were administered the Montreal Cognitive Assessment . Two parThe experimental methods and procedures for Experiment II were the same as those used for Experiment I, except the stimuli used in this experiment were not processed to simulate hearing loss.n = 6). The data were analyzed in the same manner detailed for Experiment I, but comparing YNH and OHL data with ONH participants rather than YSIM participants from Experiment I.In total, 17 listeners judged 224 sentences, resulting in 3808 data points for ONH listeners. A total of 121 missing data points occurred due to an experiment software error encountered by some participants which resulted in the premature termination of the experiment  = 17.4, p < 0.001), a significant interaction between talker and speaking style  = 98.1, p < 0.001), and a significant three-way interaction between speaking style, talker group, and listener group  = 10.4, p < 0.01). The nature of this three-way interaction can be seen in In addition to the three listener groups from Experiment I, F = 4.2, p < 0.05), where YSIM participants . This aThe two experiments detailed in this manuscript confirm that the differences in perceived anger in clear and conversational speech between YNH and OHL listeners are primarily an effect of aging rather than decreased peripheral sensitivity to emotional acoustic cues. Listeners continued to perceive clear speech as angry more often than conversational speech. This finding is consistent with previous research in the emotional perception of clear speech, as well as clinical patient reports. In addition, anger was perceived more often in the clear speaking style with talkers with good clear speech, compared to talkers who had poor clear speech. YNH and YSIM listeners had a larger perception of anger in clear speech when compared to OHL and ONH listeners. These findings support aging as the primary mechanism in reduced perception of anger in clear speech.Future research could target other listener populations, such as adolescents and middle-aged adults. This research would provide information to help support or refute the sociocognitive theories surrounding emotional perception of speech. Another direction to be explored could examine the acoustic features of clear speech. By examining the Group A talkers, we could potentially identify speaking strategies that make speech clearer without perceived anger. When these acoustic strategies are found, informational materials could be created that educate audiologists and aural rehabilitation specialists to modify their counseling and training of frequent communication partners.


While prior research has explored various physiological consequences associated with assistive device use for ambulation, limited research has specifically explored the impact of mobility dog partnership on human kinematics. This descriptive study examined the impact of mobility dog partnership on kinematics of individuals in the normal young adult population. Sixteen participants were video recorded while walking in a straight line for 3.7 m (12 feet) under three different conditions . Differences between joint angles under each of the conditions were analyzed. Statistically significant differences were found in left elbow flexion when comparing ambulating with a cane versus ambulating with no device; left shoulder abduction when comparing ambulating with a cane versus ambulating with a mobility dog, ambulating with a mobility dog versus no device, and ambulating with a cane versus no device; and left hip extension when comparing ambulating with a mobility dog versus no device, and when ambulating with a mobility dog versus a cane. These findings suggest that providers should evaluate and monitor potential negative impacts of assistive devices such as mobility dogs on human kinematics. According to a report published by the World Health Organization in 2018  to enhanWhile mobility devices including canes, walkers, and wheelchairs are commonly used to provide assistance with functional mobility, some individuals with mobility disabilities may choose to partner with a specific type of assistance dog called a mobility dog. Mobility dogs can assist wheelchair users with propulsion assistance. They can also assist ambulatory individuals with their balance and gait while walking by acting as a brace or counterbalance for individuals with limitations in balance and strength. Mobility dogs performing this type of work typically wear a special harness that allows them to provide balance assistance in a manner that is safe for both the handler and the dog . For thePrior research has explored the impacts of mobility dog partnership on various aspects of mobility of the human partner, including speed, joint loading, and muscular demand. Wheelchair users partnered with a mobility dog trained to assist them in ascending ramps have demonstrated decreases in mechanical load and muscular demands of the upper extremity ,12. BlanHowever, research has also indicated that mobility dog partnership can have potentially harmful impacts on the kinematics of their human partners. For example, in their study examining the effects of mobility dog partnership on the kinematics of individuals using wheelchairs, Coppinger et al. found that completion of mobility dog tasks  placed significant physical strain on both the mobility dog and the wheelchair user . More reTogether these findings suggest that, similar to other types of mobility devices, mobility dog partnership has the ability to impact the human partner positively, or negatively, during ambulation. As mobility with or without devices involves sustained posturing and positioning of joints, it is important to understand how use of mobility aids or mobility dog partnerships impact joint angles. Therefore, the purpose of this descriptive study was to examine the impact of mobility dog partnership on kinematics of individuals within the normal adult population. Specifically, this study examined the differences, if any, between individuals’ joint angles when walking with no mobility device, versus walking with a standard cane, versus walking with a trained mobility dog wearing a mobility harness. It was hypothesized that there would be a statistically significant difference between mean joint angle measurements when comparing the joint angles under each of the three conditions for each joint measured. Separate comparisons were completed for each joint on both the left side and the right side.Participants were recruited by word of mouth and flyers posted at the researchers’ university. Participants had to be between the ages of 18–30 years old and enrolled at the researchers’ university at the time of the study. This age range was selected in order to improve consistency of the data collection results, as participants who were closer in age were more likely to have physical similarities. In addition, participants must have been able to grasp an assistive device handle with their left hand when ambulating and be able to walk without assistance from a mobility device such as a walker, cane, or brace for a distance of 3.7 m (12 feet). People with a history of a condition impacting range of motion in the shoulder, elbow, wrist, hip, knee, and/or ankle joints were excluded from the study. The authors aimed to recruit a total of 15–20 participants. This decision was based off three previously conducted gait analysis studies which utilized 16, 20 and 20 participants respectively ,22.Written informed consent was obtained from all participants prior to the start of the study. The study was approved in advance by the Saginaw Valley State University Institutional Review Board  and the Saginaw Valley State University Institutional Animal Care and Use Committee . Seventeen people (15 women and 2 men) were recruited for the study; a total of 16 participants completed all portions of the study. One person  who enrolled did not complete all portions of data collection and was thus excluded from the final results. The mean age of the study participants was 22.5 + 1.83 (SD) years old, with their mean height being 163 + 9.50 (SD) centimeters.Data was collected in a private room at the researchers’ university. The room was approximately 9 m wide and 12 m long, and contained a hard, flat, even walking surface with no obstacles, and adequate lighting. Tape marks were placed along the walking path (a straight line) at the 0.9, 1.8, 2.7, and 3.7 m  marks to provide consistent, equidistant points of reference for obtaining multiple joint angle measurements to establish a mean measurement for each joint. The distance of 3.7 m was selected for the walking distance based on recommendations by Pirker and Katzenschlager stating that clinical examination of gait should involve observation while ambulating at least several meters without obstacles . FurtherParticipation in the study involved a single session that lasted approximately 15–20 min . This process was then repeated, with the participants ambulating the same distance, utilizing the standard cane on their left side. Finally, the above process was repeated for the third condition, while the participants ambulated with the mobility dog on their left side . Thus, the researchers rejected the null hypotheses for these three differences.Separate comparisons were completed for each joint on both the left side and the right side. Descriptive statistics and Friedman’s tests were completed for each side for each joint under each condition. Refer to p = 0.001). There were also statistically significant differences in left shoulder abduction when comparing ambulating with a mobility dog versus ambulating with a cane, ambulating with a mobility dog versus no device, and ambulating with a cane versus no device . Finally, there were also statistically significant differences in left hip extension when comparing ambulating with a mobility dog versus a cane, as well as when ambulating with a mobility dog versus no device . The researchers rejected the null hypotheses that corresponded to these six joint angles and conditions. However, they failed to reject the remaining null hypotheses that were related to all other joint angles when compared under other conditions.Post hoc testing with the Wilcoxon Signed-Rank test was utilized to determine the specific conditions under which statistically significant differences in joint angles existed. Refer to The results of the present study suggest that ambulating with an assistive device, including a mobility dog, may impact kinematics  of select joints. Statistically significant differences were found in left shoulder abduction joint angles across all conditions, in left elbow flexion joint angles when comparing the use of a cane to no device during ambulation, and in left hip extension when comparing ambulating with a dog to no device and to a cane.The statistically significant difference found in left elbow flexion when comparing ambulating with a cane to no device could imply that left elbow flexion is impacted due to the nature of ambulating with a cane. When walking with a cane, the individual must lift the cane off the ground and place it ahead of them, leading to increased elbow flexion when lifting the cane while ambulating, when compared to ambulating with no device. The results of the testing indicated there was no statistical significance in left elbow flexion when ambulating with no device versus with the mobility dog.It is also logical that there was no statistically significant difference found when comparing measurements obtained when comparing walking with no device versus walking with a mobility dog. When walking with a mobility dog in heel position, the individual does not move or lift the arm to reposition the device when moving through the environment; rather, the arm stays in constant contact with a stable “surface”  as the dog moves through the environment. This is consistent with prior research suggesting that mobility dogs require fewer movements for use when compared to traditional mobility devices such as canes, which may make them preferable for people with disabilities that impact their ability to produce coordinated, controlled movements ,16.It appears that left shoulder abduction was impacted by both cane use and mobility dog use, as the users may have had to position the arm in slight abduction to accommodate for the added width of the device (cane/dog with harness). These findings regarding the potential impact of ambulation with a mobility dog on the shoulder makes sense in context with the results of prior research focused specifically on guide dog users, which highlighted negative musculoskeletal effects (most notably at the shoulder) associated with the use of standard guide harnesses ,19. HoweInterestingly, in the present study, significantly decreased hip extension was found when participants ambulated with the dog versus ambulating with no device or with a cane. It is possible that this is due to the modulating effect of the dog’s speed on the participants’ pace and stride length (and therefore joint angle). This is in contrast to prior findings supporting the positive impacts of mobility dog partnership on walking speed and gait patterns in persons with disabilities ,15. In tLimitations to the study include the mobility dog’s trainer/owner walking with the participants and the mobility dog during testing. In addition to affecting pace and stride length, it is possible that, in the absence of this trainer/owner, a mobility dog-human team may not consistently maintain proper positioning when working in real life, which could result in different outcomes being observed. Another limitation to this study is the participants’ inexperience ambulating with mobility devices. The participants could have potentially been focusing more on utilizing the mobility devices correctly when ambulating, instead of walking with their typical movement patterns (Hawthorne effect ). Thus, Future research should continue to explore the impact of mobility dogs on human kinematics during ambulation. Specifically, future research should include participants with disabilities who are partnered with mobility dogs and experienced with the use of mobility aids/devices. This will allow a better understanding of how mobility dog partnership may impact the kinematics of individuals with disabilities. Additionally, a longitudinal study would provide information regarding if and how these kinematics may change over time. This knowledge could be used to develop guidelines for dog/harness fit and handler training and education to reduce potential negative impacts on human user’s kinematics. Additionally, future research should be carried out involving different types of mobility harnesses, to explore if different styles of harnesses impact human kinematics differently and if so, how they impact them differently.The results of this study are consistent with prior research concluding that mobility device use can impact human kinematics in select joints during ambulation. Specifically, the findings suggest that mobility dog partnership may differentially impact kinematics as compared to cane use or no device use. Based upon these findings, it is suggested that individuals involved in the assessment, training, and placement of human-mobility dog teams carefully monitor human kinematics, particularly within the shoulder and hip of the side on which the dog works, to ensure that partnership does not have negative impacts on the human’s biomechanics. The use of carefully-fitted harnesses customized to the human user’s height may also decrease the potential for long-term negative impacts of mobility dog partnership on human kinematics. Furthermore, it may be beneficial to involve professionals with advanced knowledge and training in human kinematics throughout the process, to decrease the risk of short- and long-term injuries due to poor harness fit and use. However, because this study involved healthy young adults, it is important that this study be replicated with a population of individuals with disabilities.


Hearing loss is one of the most common disabilities affecting both children and adults worldwide. However, traditional treatment of hearing loss has some limitations, particularly in terms of drug delivery system as well as diagnosis of ear imaging. The blood–labyrinth barrier (BLB), the barrier between the vasculature and fluids of the inner ear, restricts entry of most blood-borne compounds into inner ear tissues. Nanoparticles (NPs) have been demonstrated to have high biocompatibility, good degradation, and simple synthesis in the process of diagnosis and treatment, which are promising for medical applications in hearing loss. Although previous studies have shown that NPs have promising applications in the field of inner ear diseases, there is still a gap between biological research and clinical application. In this paper, we aim to summarize developments and challenges of NPs in diagnostics and treatment of hearing loss in recent years. This review may be useful to raise otology researchers’ awareness of effect of NPs on hearing diagnosis and treatment. Hearing loss is one of the most common disabilities affecting the quality of life. Nowadays, people’s lifestyle has been changed with longer life expectancy, and the prevalence and the severity of hearing loss have increased . AccordiAttention to the treatment of hearing loss has varied, which is influenced by social status, education, and race. For example, nearly two-thirds of United States adults aged 70 years and older are affected by hearing loss, and only 15% of older people use hearing aids . At presin vivo, but also carry drugs to specific parts of the cochlea  to guinea pig round window, which provides sustained release of drugs, increases the total concentration of peripheral blood lymphocytes by about 1.6-fold, and increases the residence time of drugs by about 24-fold. The initial peak concentration of dexamethasone injection before clearance from the lymphatic vessels was within 12 h, while the mDex hydrogel sustained release for 10 days . This stAs a new medical application of nanomaterials, the nano drug delivery system not only has a wide application in drug transportation of inner ear hearing loss, but also plays a role in clinical diagnosis and treatment of inner ear hearing loss diseases because of its specific penetration, good biocompatibility, and editability . Due to 3O4) or magnetite (γ-Fe2O3) nucleus, with a molecular diameter of 100–300 nm and with a certain biocompatibility (in vivo (3) NPs and lipid NPs that are designed to combine with traditional contrast agents to form chelates that can reflect the distribution of these contrast agents in the cochlea and form visual images (Superparamagnetic nanoparticles (SPIONs) with good physical properties are characterized by nanocrystalline iron oxide (Fetibility . Therefo(in vivo . Besidesl images ,b. Some l images . Interesl images . These fThere are more than 324,000 CI users in the world. CI has greatly improved the quality of hearing life of patients with hearing loss. The mechanism of CI in the treatment of hearing loss is related to the connection between the CI electrode array and auditory neurons . CI direThe application of nanomaterials, such as graphene and MXene, can also promote the proliferation and differentiation of neural stem cells in the inner ear, and many ultrastructures can be produced by 3D printing technology or other novel methods, so as to obtain more satisfactory biological characteristics that can be applied in hair cells . These nWhat is more exciting is that there are also nanomaterials in the cochlea that can be used for a longer time by spontaneous power supply. Some studies have investigated the silver NP microcoil with the micro size by aerosol jet printing. It has been demonstrated that the electromagnetic field generated by this material is not affected by cochlear environment . The eddThese studies may have paved the way for the development of self-powered nanofibrous implantable auditory sensors, which suggests that more and more nanomaterials may be used in the construction of cochlear materials and cochlear signal transduction technology in the future.in vivo. These substances act on the cells or tissues of the inner ear, which may also have ototoxicity, thus affecting the biological activity of hair cells and the activity of auditory neurons. Although some studies have found that NPs may have ototoxicity in vivo, there is no clear report on the ototoxicity of nanomaterials to humans (Nanomaterials and related technology products may not only provide diagnosis and treatment strategies for specific and efficient treatment of hearing loss, but also other inner ear diseases, such as otology tumors and ear inflammation. Furthermore, we can foresee that some types of nanomaterials or nanoproducts may be routinely used in the treatment of hearing loss and other inner ear diseases in the future . Among to humans .Previous studies have reported that positively charged NPs can enter the inner ear more easily through RWM, as drug carriers for inner ear diseases or CI materials, but they will produce certain ototoxicity in the process of biodegradation with cell membrane damage, production of reactive oxygen species, hair cell apoptosis, etc. . The timMoreover, the cost of developing and manufacturing NPs for clinical application in the field of inner ear diseases is significantly higher than traditional treatments . Many pain vivo with nanomaterials, and promising results have also been reported. However, we do not know the specific effect of nanomaterials applied in human inner ear. There is still a big gap between basic research and clinical application of nanomaterials, so it is necessary to study the safety and effectiveness of nanomaterials. With the emergence of new biomaterials and the realization of a deeper understanding of inner ear physiology, nanomaterials will have a clearer understanding of the diagnosis and treatment of hearing loss.The application of nanomaterials in the diagnosis and treatment of hearing loss diseases is novel and promising. In the future, ideal nanomaterials should be more universal, able to load more therapeutic drugs with various functions, such as preventing rapid degradation, retaining targeting effects, and prolonging the action time in the inner ear. This kind of materials should not only have better efficacy in various diseases of inner ear hearing loss, but also have stronger ear permeability, and ensure no impact or side effects on the human body. Many studies have attempted to deliver drugs, genes, and growth factors to the inner ear ZLH, SL, and QX wrote the first draft of the manuscript. YZ and ZHH polished the language. KL searched the literatures. XC, PS, and MLY conceived the idea and revised the manuscript. All authors read and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Over 1.1 billion individuals are at risk for noise induced hearing loss yet there is no accepted therapy. A long history of research has demonstrated that excessive noise exposure will kill outer hair cells (OHCs). Such observations have fueled the notion that dead OHCs underlie hearing loss. Therefore, previous and current therapeutic approaches are based on preventing the loss of OHCs. However, the relationship between OHC loss and hearing loss is at best a modest correlation. This suggests that in addition to the death of OHCs, other mechanisms may regulate the type and degree of hearing loss. In the current study, we tested the hypothesis that permanent noise-induced-hearing loss is consequent to additional mechanisms beyond the noise dose and the death of OHCs. Hooded male rats were randomly divided into noise and control groups. Morphological and physiological assessments were conducted on both groups. The combined results suggest that beyond OHC loss, the surviving cochlear elements shape sensorineural outcomes, which can be nondeterministic. These findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead OHCs. Summary: The current findings provide the basis for individualized ototherapeutics that manipulate surviving cellular elements in order to bias cochlear function towards normal hearing even in the presence of dead cells. A fundamental concept in occupational and environmental medicine is the notion that excessive exposure to loud noise will kill outer hair cells (OHCs) in the cochlea which manifest as permanent noise induced hearing loss (NIHL) . HistoloCurrently there is no ototherapeutic approach that has achieved enough success to be widely accepted. The persistent failure to produce a widely-accepted ototherapy is likely the result of a variety of factors . HoweverIn the current study, we attempt to interrogate the hypothesis that permanent NIHL is consequent to additional mechanisms beyond the noise dose and the death of OHCs. As a first-approximation, we expect to observe normal cochlear functions even in the presence of noise induced dead/missing OHCs; a surrogate indication that the loss of OHCs does not consistently result in permanent thresholds shifts. Furthermore, we expect that individual subjects who experience the same noise trauma and exhibit similar threshold loss would nonetheless possess cochleae that are functioning in independent ways; an indication that no two post-injury cochlea can be the same. This suggests that a single ototherapy may not be appropriate for individuals who experienced similar noise exposure and present with similar threshold loss. Indeed, this study provides the theoretical basis for the development of future individualized ototherapeutics that manipulate the surviving cellular elements in order to bias the injured cochlea towards normal  threshold sensitivity.t (16)=1.676, P<0.05].The working hypothesis is that permanent NIHL is consequent to additional mechanisms beyond the noise dose and the death of OHCs. If this is correct, then sensorineural outcomes will not be predictable from OHC loss and a given loss of OHCs will result in disparate functional outcomes. Sensorineural outcomes mean the test results from sensory testing [e.g. the use of distortion product otoacoustic emission (DPOAE) to test the function of sensory cells] and the results from both sensory and neural testing [e.g. the use of compound action potential (CAP) to test the function of both sensory cells and their neural elements]. Disparate functional outcomes refer to the various patterns of results (e.g. degrees of severity and loss configurations) from all functional tests. Therefore, we reasoned that a group of subjects exposed to the same traumatic noise dose should yield functional outcomes (DPOAE and CAP) that would manifest a wide variety of severity  and configurations. Important to this line of thinking is the notion that all functional outcomes will be nondeterministic (unpredictable from the noise dose or OHC loss) and are expected to produce a variety of patterns . Fig. 3 F=5.095, P<0.05) between DPOAE recordings made before and after noise exposure. The control group exhibited no loss of DPOAE and there were no significant differences in DPOAE recordings overtime.The DPOAE recordings in In other biological systems it is known that distinct structural alterations can nonetheless yield what appears to be similar functional outcomes , 2008a,bCorrelation analyses yielded results that were consistent with the findings described above. Excessive exposure to noise is often considered a major determinant of hearing loss . The aveWhen demographic variables are held constant, there is some evidence that genetics might be a determining factor. Indeed, both human and animal studies have concluded that genotype is predictive of NIHL . HoweverIn the present study, animals exposed at the same time, to the same noise dose exhibited functional outcomes that were specific to each animal's cochlea. For instance, a given animal that presented with dead OHCs, may yield normal DPOAE with pathological CAP thresholds. Similarly, another animal may present with dead OHCs yet yield normal CAP thresholds and pathological DPOAE recordings. These examples of within subject incongruence in DPOAE and CAP profiles suggest that functional outcomes are not predictable from the noise exposure but instead specific to each cochlea. Between subject variability also provides some support for cochlear individualism. For instance, animals exposed to the same noise dose exhibited CAP thresholds that could be normal, moderately impaired, or severely impaired. Similarly, CAP threshold configuration exhibited a range of patterns within the noise exposed group. These results were confirmed by DPOAE recordings from the same animals. Here the DPOAE recordings also exhibited variable degrees of dysfunction and loss configuration.The combined results from the current study suggest that sensorineural outcomes following noise exposure is nondeterministic and therefore does not support the equal-energy-hypothesis. This conclusion is directly orthogonal to that of previous research in the literature showing a deterministic relationship between hair cells loss and permanent threshold shifts. For instance, in noise-exposed chinchillas, threshold shifts that are greater than 5 dB has been linked to OHC loss . Howeverad libitum access to food and water in environmentally enriched cages. Temperature was maintained at 21°C±1°C and a 12-h light/dark cycle was followed. Each subject was randomly assigned to a control (N=9) or experimental  group. Each group received baseline otoacoustic emission recordings under general anesthesia. Then the experimental group was exposed to noise. Four weeks after the noise exposure otoacoustic emission recordings were obtained again from both the experimental and the control groups. After these recordings, both groups underwent non-survival surgery in order to obtain action potential recordings and cytocochleograms. Subjects from both groups started and ended the study together. Before survival and non-survival procedures, the subjects received general anesthesia . Atipamezole hydrochloride  was used to facilitate quick recovery from the anesthesia following all survival procedures. All protocols regarding the use and handling of Long-Evans rats were evaluated and approved by the IACUC.A total of 18 subjects  were used in the current study . EpidemiThe noise generation apparatus and procedure has been reported in detail previously . BrieflyThe animals were conscious throughout the noise exposure epoch. They were staged in a wire-cloth enclosure (15×13×11 cm) that was placed within a 40 L reverberant cylindrical chamber. The noise was raised to 90-dB SPL; then, the animals were visually monitored for physical signs of stress . After 1 or 2 min, the noise was slowly raised in 5-dB steps  until the desired noise level was reached. The desired SPL was 105 dB (linear settings), and this was measured with the OB-300Quest Type-1 meter at a level that approximated the rats’ pinnae. This particular sound pressure is known to induce dead outer hair cells along the basilar membrane of Long-Evans rats . The rat1F and 2F) and record the 1-f22f DPOAE. The 2/F1F frequency ratio was 1.25 and the corresponding level ratios was 1.18 (1/L2L), where 1L=65 dB SPL and 2L=55 dB SPL. A customized script written in LabVIEW  was used for presenting the primaries and acquire DPOAE recordings. A 0.2 cm2 hard-walled cavity that approximates the rat's external auditory meatus was used to calibrate the DPOAE recordings. These calibrations were free of artifacts and did not produce DPOAE SPLs that exceeded the noise floor.The DPOAE apparatus and protocol have been reported previously . BrieflyThe CAP procedure is terminal  and therefore deployed at the end of the study (4 weeks post-noise exposure). The procedure and apparatus are consistent with that of our previous work . Brieflyin toto then washed with 0.1 M phosphate buffered saline and stained with 2% Osmium. Cytocochleograms of missing OHCs were constructed for each animal as described in detail from our previous work , 2015. Bt-testing to determine statistically significant differences in thresholds between groups. The DPOAE data were treated with a repeated-measures ANOVA to determine significant differences in responses before and after noise exposure. Spearman correlation coefficient was computed to assess how well hair cell loss (cytocochleograms) correlated with CAP thresholds and DPOAE recordings. Furthermore, Spearman correlation coefficient was also used to assess correlation between CAP thresholds and DPOAE responses. A P-value <0.05 was accepted as statistically significant for all computations.Prism 5 version 5.03  was used for statistical computations. The CAP threshold data were treated with


While hearing loss is highly prevalent among patients with dementia, it frequently goes unidentified and unmanaged. It has been a commonly-held belief that older adults with dementia are unable to benefit from hearing rehabilitation, but recent evidence shows that many individuals with dementia can successfully use amplification, helping to improve communication, social interaction and quality of life for these individuals and their caregivers. This presentation will describe how modifications to practice led to successful outcomes for the majority of patients of a geriatric audiology clinic with co-morbid hearing loss and cognitive impairment. In a study of hearing aid use in 67 patients with these comorbidities, over 90% used hearing aids successfully with measurable benefit for both patients and caregivers. Furthermore, we will discuss approaches to improving communication for LTC residents with dementia and hearing loss through the support of audiologists during remote visits with physicians and families during the pandemic.