Speech understanding in noise for cochlear implant recipients using a spatial noise reduction setting in an off the ear sound processor with directional microphones.

PURPOSE: Cochlear implant (CI) recipients struggle to hear in competing background noise. ForwardFocus is a spatial noise reduction setting from Cochlear Ltd. (Sydney) that can simultaneously attenuate noise from multiple sources behind the listener. This study assessed hearing performance with ForwardFocus in an off-the-ear (OTE) sound processor. METHOD: Twenty-two experienced adult CI recipients participated. Speech reception data was collected in fixed noise acutely in the clinic. After three to five weeks take home experience, subjective impressions were recorded, and evaluations were conducted for speech reception in quiet and roving noise. RESULTS: Group mean speech reception thresholds (SRT) were below 0 dB in two spatially-separated noise test conditions when using ForwardFocus in the OTE sound processor. SRT were -8.5 dB (SD 2.9) in 4-talker babble roving in a rear hemi-field (S0Nrearhemi) and -3.9 dB (SD 3.3) in 12-talker babble presented laterally and behind (S0N3). Results in S0N3 were significantly better with ForwardFocus On (p = 0.0018). Subjective ratings with the OTE were comparable to, or better than, with their walk-in BTE or OTE sound processor. CONCLUSIONS: ForwardFocus provides significant benefits for speech recognition in competing background noise in an OTE sound processor. These results support clinicians in counselling CI recipients on potential sound processor options to consider.

The Eighteen of 1918-1919: Black Nurses and the Great Flu Pandemic in the United States.

This article examines the role of Black American nurses during the 1918-1919 influenza pandemic and the aftermath of World War I. The pandemic caused at least 50 million deaths worldwide and 675 000 in the United States. It occurred during a period of pervasive segregation and racial violence, in which Black Americans were routinely denied access to health, educational, and political institutions. We discuss how an unsuccessful campaign by Black leaders for admission of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during World War I eventually created opportunities for 18 Black nurses to serve in the army during the pandemic and the war's aftermath. Analyzing archival sources, news reports, and published materials, we examine these events in the context of nursing and early civil rights history. This analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity.

Placing Health Trajectories in Family and Historical Context: A Proposed Enrichment of the Life Course Health and Development Model.

Purpose This article offers constructive commentary on The Life Course Health and Development Model (LCHD) as an organizing framework for MCH research. Description The LCHD has recently been proposed as an organizing framework for MCH research. This model integrates biomedical, biopsychosocial, and life course frameworks, to explain how "individual health trajectories" develop over time. In this article, we propose that the LCHD can improve its relevance to MCH policy and practice by: (1) placing individual health trajectories within the context of family health trajectories, which unfold within communities and societies, over historical and generational time; and (2) placing greater weight on the social determinants that shape health development trajectories of individuals and families to produce greater or lesser health equity. Assessment We argue that emphasizing these nested, historically specific social contexts in life course models will enrich study design and data analysis for future developmental science research, will make the LCHD model more relevant in shaping MCH policy and interventions, and will guard against its application as a deterministic framework. Specific ways to measure these and examples of how they can be integrated into the LCHD model are articulated. Conclusion Research applying the LCHD should incorporate the specific family and socio-historical contexts in which development occurs to serve as a useful basis for policy and interventions. Future longitudinal studies of maternal and child health should include collection of time-dependent data related to family environment and other social determinants of health, and analyze the impact of historical events and trends on specific cohorts.

Gestational Weight Gain: Historical Evolution of a Contested Health Outcome.

The history of research on gestational weight gain (GWG) in the United States and United Kingdom provides a context for current clinical practice. We trace the evolution of research on GWG in scientific literature from the 19th century to the present and examine its implications for contemporary clinical and public health practice. Obstetricians, beginning in the late 1800s, recommended dieting during pregnancy in order to limit GWG to 20 lb or less, driven by a belief that excessive weight gain was a cause of toxemia. Beginning in the 1930s, a burgeoning focus on nutrition and health allowed a better understanding of the effect of GWG on the health of the fetus and the newborn. Increased awareness of disparities in infant mortality in the 1960s, followed by systematic review of the literature, produced further refinements in GWG recommendations in the 1970s, which continue today. Current research focuses on epigenetic influences over the life course and has emphasized individualized recommendations. The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted. IMPORTANCE: Gestational weight gain and its relationship to maternal, fetal, and infant health are areas of active inquiry. OBJECTIVE: We critically review evolution of scientific understanding of GWG from the 19th century to the present, and examine its implications for contemporary obstetric practice. EVIDENCE ACQUISITION: We reviewed all English-language medical studies related to GWG published through 1930s as well as widely cited influential works from 1940s through present time. RESULTS: During the past century, recommendations for GWG have reversed from emphasizing dieting during pregnancy to the importance of proper nutrition during pregnancy. Obstetricians' focus has also evolved from being exclusively on the newborn to include the health of mothers. Contemporary obstetric practice seeks to achieve a balance between mothers' and infants' risk of adverse outcomes. CONCLUSIONS: Historical and social contexts of the United States and the United Kingdom led to distinct GWG policies in the 2 countries. Changes in GWG recommendations over the past century reflect developments in the allied fields, such as epidemiology and nutrition, as much as progress in obstetrics and gynecology. RELEVANCE: The complex historical perspective that this article provides serves as a reminder of both the interplay and the gaps between research and practice. These gaps result from the fact that clinical guidelines often reflect a specific point in a perpetually evolving state of knowledge that is influenced not only by advances in bench research, but also by refinements in statistical and epidemiologic methods, as well as by the political realities of the time in which they are drafted.

Clinical outcomes with the Kanso™ off-the-ear cochlear implant sound processor.

OBJECTIVE: To investigate clinical outcomes and subjective ratings of the Kanso™ off-the-ear (OTE) cochlear implant sound processor. DESIGN: Prospective, within-subject design investigating outcomes with a range of single and dual-microphone programmes for Kanso compared to conventional behind-the-ear (BTE) sound processors. STUDY SAMPLE: Twenty post-lingually hearing-impaired cochlear implant recipients who were experienced Nucleus® 5 or Nucleus® 6 BTE users. RESULTS: No significant difference in performance was found for words in quiet or sentences in co-located noise between the Kanso and Nucleus 6 devices. For the moderately directional Standard programme, no significant difference was found for sentences in spatially separated noise between the Kanso and Nucleus 6 devices, but a performance decrement between 1.4 and 2.0 dB was found in highly directional and adaptive directional programmes. The default Kanso programme, SCAN, provided improvements of 6.9 dB over a single-microphone programme and 2.3 dB over the Standard programme in spatially separated noise. Participants rated Kanso significantly better than their own BTE processor on measures of comfort, look and feel, ease of use, music and overall hearing performance. CONCLUSION: Dual-microphone directional processing provides significant benefit over a single microphone for OTE processors. This study demonstrates clinical outcomes and acceptance of the Kanso OTE sound processor.

Does Race Matter in Addressing Homelessness? A Review of the Literature.

Since the 1980s, black persons have been overrepresented in the United States homeless population. Given that morbidity and mortality is elevated among both the black population and the homeless population in comparison to the general U.S. population, this overrepresentation has important implications for health policy. However, the racial demographics of homelessness have received little attention from policymakers. This article reviews published social and behavioral science literature that addresses the relationship between race and contemporary homelessness in the United States. This literature points to substantial differences between racial subgroups of the U.S. homeless population in vulnerabilities, health risks, behaviors, and service outcomes. Such observed differences suggest that policies and programs to prevent and end homelessness must explicitly consider race as a factor in order to be of maximum effectiveness. The limited scope of these findings also suggests that more research is needed to better understand these differences and their implications.

Benefits of Adaptive Signal Processing in a Commercially Available Cochlear Implant Sound Processor.

OBJECTIVE: Cochlear implant recipients often experience difficulty understanding speech in noise. The primary objective of this study was to evaluate the potential improvement in speech recognition in noise provided by an adaptive, commercially available sound processor that performs acoustic scene classification and automatically adjusts input signal processing to maximize performance in noise. RESEARCH DESIGN: Within-subjects, repeated-measures design. SETTING: This multicenter study was conducted across five sites in the U.S.A. and Australia. PATIENTS: Ninety-three adults and children with Nucleus Freedom, CI422, and CI512 cochlear implants. INTERVENTION: Subjects (previous users of the Nucleus 5 sound processor) were fitted with the Nucleus 6 sound processor. Performance was assessed while these subjects used each sound processor in the manufacturer's recommended default program (standard directionality, ASC + ADRO for the Nucleus 5 processor and ASC + ADRO and SNR-NR with SCAN for the Nucleus 6 sound processor). The subjects were also evaluated with the Nucleus 6 with standard directionality, ASC + ADRO and SNR-NR enabled but SCAN disabled. MAIN OUTCOME MEASURES: Speech recognition in noise was assessed with AzBio sentences. RESULTS: Sentence recognition in noise was significantly better with the Nucleus 6 sound processor when used with the default input processing (ASC + ADRO, SNR-NR, and SCAN) compared to performance with the Nucleus 5 sound processor and default input processing (standard directionality, ASC + ADRO). Specifically, use of the Nucleus 6 at default settings resulted in a mean improvement in sentence recognition in noise of 27 percentage points relative to performance with the Nucleus 5 sound processor. Use of the Nucleus 6 sound processor using standard directionality, ASC + ADRO and SNR-NR (SCAN disabled) resulted in a mean improvement of 9 percentage points in sentence recognition in noise compared to performance with the Nucleus 5. CONCLUSION: The results of this study suggest that the Nucleus 6 sound processor with acoustic scene classification, automatic, adaptive directionality, and speech enhancement in noise processing provides significantly better speech recognition in noise when compared to performance with the Nucleus 5 processor.

Creating a science of homelessness during the Reagan era.

UNLABELLED: POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.

Poison politics: a contentious history of consumer protection against dangerous household chemicals in the United States.

The history of consumer protection against household poisons presents a key case study of the uniquely American struggle to balance public health and safety with the interests of business. By the late 19th century, package designs, warning labels, and state statutes had formed an uneven patchwork of protective mechanisms against accidental poisonings. As household chemicals proliferated in the early 20th century, physicians concerned with childhood poisonings pressured the federal government to enact legislation mandating warning labels on packaging for these substances. Manufacturers of household chemicals agreed to labeling requirements for caustic poisons but resisted broader regulation. Accidental poisonings of children continued to increase until the enactment of broad labeling and packaging legislation in the 1960s and 1970s. This history suggests that voluntary agreements between government agencies and manufacturers are inadequate to protect consumers against household poisonings and that, in the United States, protective household chemical regulation proceeds in a reactive rather than a precautionary manner.

The American Red Cross and local response to the 1918 influenza pandemic: a four-city case study.

The role of the American Red Cross in the U.S. response to the 1918-1919 influenza pandemic holds important lessons for current-day pandemic response. This article, which examines local ARC responses in Boston, Pittsburgh, St. Louis, and Richmond, Virginia, demonstrates how the ARC coordinated nursing for military and civilian cases; produced and procured medical supplies and food; transported patients, health workers, and bodies; and aided influenza victims' families. But the organization's effectiveness varied widely among localities. These findings illustrate the persistently local character of pandemic response, and demonstrate the importance of close, timely, and sustained coordination among local and state public health authorities and voluntary organizations before and during public health emergencies. They further illustrate the persistently local character of these emergencies, while underscoring the centrality and limits of voluntarism in American public health.

Paternalism and its discontents: motorcycle helmet laws, libertarian values, and public health.

The history of motorcycle helmet legislation in the United States reflects the extent to which concerns about individual liberties have shaped the public health debate. Despite overwhelming epidemiological evidence that motorcycle helmet laws reduce fatalities and serious injuries, only 20 states currently require all riders to wear helmets. During the past 3 decades, federal government efforts to push states toward enactment of universal helmet laws have faltered, and motorcyclists' advocacy groups have been successful at repealing state helmet laws. This history raises questions about the possibilities for articulating an ethics of public health that would call upon government to protect citizens from their own choices that result in needless morbidity and suffering.

The challenge of mandatory evacuation: providing for and deciding for.

Insufficient attention has been given to the ethical and legal questions surrounding mandatory evacuation in disasters and emergencies. We argue that mandatory evacuation orders entail a governmental duty both to provide for people and to decide for people: Government must trigger the provision of critical resources as well as vigorous and persistent efforts to persuade reluctant citizens to leave. Public health professionals, with their experience in weighing costs and risks in the face of uncertainty and balancing individual liberties with the need to protect the common welfare, offer a unique perspective that should be brought to bear in emergencies and disasters.