Strengthening COVID-19 vaccine confidence & demand during the US COVID-19 emergency response.

In October 2020, the CDC's Vaccinate with Confidence strategy specific to COVID-19 vaccines rollout was published. Adapted from an existing vaccine confidence framework for childhood immunization, the Vaccinate with Confidence strategy for COVID-19 aimed to improve vaccine confidence, demand, and uptake of COVID-19 vaccines in the US. The objectives for COVID-19 were to 1. build trust, 2. empower healthcare personnel, and 3. engage communities and individuals. This strategy was implemented through a dedicated unit, the Vaccine Confidence and Demand (VCD) team, which collected behavioral insights; developed and disseminated toolkits and best practices in collaboration with partners; and collaborated with health departments and community-based organizations to engage communities and individuals in behavioral interventions to strengthen vaccine demand and increase COVID-19 vaccine uptake. The VCD team collected and used social and behavioral data through establishing the Insights Unit, implementing rapid community assessments, and conducting national surveys. To strengthen capacity at state and local levels, the VCD utilized "Bootcamps," a rapid training of trainers on vaccine confidence and demand, "Confidence Consults", where local leaders could request tailored advice to address local vaccine confidence challenges from subject matter experts, and utilized surge staffing to embed "Vaccine Demand Strategists" in state and local public health agencies. In addition, collaborations with Prevention Research Centers, the Institute of Museum and Library Services, and the American Psychological Association furthered work in behavioral science, community engagement, and health equity. The VCD team operationalized CDC's COVID-19 Vaccine with Confidence strategy through behavioral insights, capacity building opportunities, and collaborations to improve COVID-19 vaccine confidence, demand, and uptake in the US. The inclusion of applied behavioral science approaches were a critical component of the COVID-19 vaccination program and provides lessons learned for how behavioral science can be integrated in future emergency responses.

Adaptation of the electrically evoked compound action potential (ECAP) recorded from nucleus CI24 cochlear implant users.

OBJECTIVE: This study had three main goals. The first goal was to assess the extent to which neural adaptation varied across cochlear implant users. The second goal was to determine whether adaptation at the level of the auditory nerve was correlated with word recognition ability. The third goal was to determine whether peripheral neural adaptation had an impact on the relationship between the electrically evoked compound action potential (ECAP) thresholds and MAP levels. DESIGN: Neural response telemetry software was used to record the ECAP in 21 Nucleus cochlear implant users. A series of 110 ECAP recordings were made over a 5-min period at three different stimulation rates: 15, 80, and 300 Hz. The stimulation levels used to record this series of responses were held constant at or near the level the subject identified as his or her maximum comfort level (C-level) for the 300-Hz stimulation rate. Consistent decreases in ECAP amplitude as measured from the beginning to the end of the 5-min stimulation interval were interpreted as evidence of neural adaptation. Regression analysis procedures were then used to assess the relationship between neural adaptation and word recognition. RESULTS: Significant levels of adaptation were observed for all 21 subjects at stimulation rates of 80 and 300 Hz. Little or no adaptation was observed over the 5-min recording period when the 15-Hz rate was used. The amount of adaptation was greatest at the 300-Hz rate and varied substantially across cochlear implant users. No relationship between the amount of adaptation and word recognition was found. Neither was the degree of adaptation shown to influence the relationship between ECAP thresholds recorded at low rates and the levels used to program the speech processor. CONCLUSIONS: Cochlear implant users experienced varying degrees of long-term adaptation in response to continuous electrical stimulation. The effects of adaptation on the ECAP were apparent even at stimulation rates as low as 80 Hz. Although variations in the amount of adaptation are likely to reflect cross-subject differences in the status of the auditory nerve, no predictable relationship was found between these physiologic measures of peripheral neural function and either word recognition or the relationship between ECAP thresholds and MAP levels.

Comparison of electrically evoked whole-nerve action potential and electrically evoked auditory brainstem response thresholds in nucleus CI24R cochlear implant recipients.

In this study, differences between electrically evoked whole-nerve action potential (EAP) and electrically evoked auditory brainstem response (EABR) measurements within Nucleus CI24R cochlear implant recipients were evaluated. Precurved modiolus-hugging internal electrode arrays, such as the CI24R, are designed to provide more direct stimulation of neural elements of the modiolus. If the electrode array is closer to the modiolus, electrically evoked and behavioral levels might be lower than were previously recorded for the straight electrode array, the CI24M. EAP and EABR growth functions and behavioral levels were obtained for 10 postlingually deafened adults. Results revealed no significant differences between EAP and EABR threshold levels, and these levels were not significantly lower than those obtained using the CI24M.

Comparison of auditory steady-state response and auditory brainstem response thresholds in children.

Recently, auditory steady-state responses (ASSRs) have been proposed as an alternative to the auditory brainstem response (ABR) for threshold estimation. The goal of this study was to investigate the degree to which ASSR thresholds correlate with ABR thresholds for a group of sedated children with a range of hearing losses. Thirty-two children from the University of Iowa Hospitals and Clinics ranging in age from 2 months to 3 years and presenting with a range of ABR thresholds participated. Strong correlations were found between the 2000-Hz ASSR thresholds and click ABR thresholds (r = .96), the average of the 2000- and 4000-Hz ASSR thresholds and click ABR thresholds (r = .97), and the 500-Hz ASSR and 500-Hz toneburst ABR thresholds (r = .86). Additionally, it was possible to measure ASSR thresholds for several children with hearing loss that was great enough to result in no ABR at the limits of the equipment. The results of this study indicate that the ASSR may provide a reasonable alternative to the ABR for estimating audiometric thresholds in very young children.