Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers

<b><i>Background:</i></b> Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population. <b><i>Summary:</i></b> A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. <b><i>Key Messages:</i></b> As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.

Pupillometry and the vigilance decrement: Task-evoked but not baseline pupil measures reflect declining performance in visual vigilance tasks

Baseline and task-evoked pupil measures are known to reflect the activity of the nervous system's central arousal mechanisms. With the increasing availability, affordability and flexibility of video-based eye tracking hardware, these measures may one day find practical application in real-time biobehavioral monitoring systems to assess performance or fitness for duty in tasks requiring vigilant attention. But real-world vigilance tasks are predominantly visual in their nature and most research in this area has taken place in the auditory domain. Here we explore the relationship between pupil size—both baseline and task-evoked—and behavioral performance measures in two novel vigilance tasks requiring visual target detection: 1) a traditional vigilance task involving prolonged, continuous, and uninterrupted performance (n = 28), and 2) a psychomotor vigilance task (n = 25). In both tasks, behavioral performance and task-evoked pupil responses declined as time spent on task increased, corroborating previous reports in the literature of a vigilance decrement with a corresponding reduction in task-evoked pupil measures. Also in line with previous findings, baseline pupil size did not show a consistent relationship with performance measures. We discuss our findings considering the adaptive gain theory of locus coeruleus function and question the validity of the assumption that baseline (prestimulus) pupil size and task-evoked (poststimulus) pupil measures correspond to the tonic and phasic firing modes of the LC.

Reliability and Validity of a 3-minute Psychomotor Vigilance Task (PVT) in Assessing Sensitivity to Sleep Loss and Alcohol: Fitness for Duty in Aviation and Transportation

Study Objectives The psychomotor vigilance task (PVT) is a widely used objective method to measure sustained attention, but the standard 10-min version is often impractical in operational settings. We investigated the reliability and validity of a 3-min PVT administered on a portable handheld device assessing sensitivity to sleep loss and alcohol in relation to a 10-min PVT and to applied tasks. Methods Forty-seven healthy volunteers underwent a 12 consecutive days sleep lab protocol. A cross-over design was adopted including total sleep deprivation (TSD, 38 hours awake), sleep restriction (SR, 4 h sleep opportunity), acute alcohol consumption, and SR after alcohol intake (SR/Alc 4 h sleep opportunity). Participants performed a 10-min and 3-min PVT and operationally-relevant tasks related to demands in aviation and transportation. Results Sleep loss resulted in significant performance impairments compared to baseline measurements detected by both PVT versions – particularly for mean speed (both p &lt; .001) - and the operationally-relevant tasks. Similar effects were observed due to alcohol intake (speed: both p &lt; .001). The 3-min and 10-min PVT results were highly correlated (speed: between r = .72 and r = .89). Three of four aviation related tasks showed robust correlations with the 3-min PVT. Correlations with the parameters of the task related to transportation were lower, but mainly significant. Conclusion The 3-min PVT showed a high reliability and validity in assessing sleep loss and alcohol induced impairments in cognitive performance. Thus, our results underline its usefulness as potential fitness for duty self-monitoring tool in applied settings.

Neuropsychological Assessment of the Aging Physician: A Review & Commentary

Late-career physicians (LCPs) are at risk for cognitive changes that may affect their ability to practice medicine. This review aggregates and discusses research that has examined cognitive functioning among physicians, typically when clinically referred for various medical and psychological reasons that may interfere with their ability to practice medicine. Special consideration is devoted to the role of approaches for examining cognitive functioning (e.g., cognitive screening, cognitive testing, & neuropsychological assessment), normative challenges, and cultural factors that should be considered when evaluating a physician. Based on published studies, there is evidence supportive of the use of cognitive testing and neuropsychological assessment among physicians in a fitness for duty setting. However, prospective studies designed to identify physicians at-risk (i.e., to prevent medical error) are lacking. Additional research is warranted to establish physician-based normative reference groups and aid in test interpretation and prognostication. Moreover, given limitations associated with cognitive testing in isolation, there is a potential role for comprehensive neuropsychological assessment to identify cognitive changes in physicians and provide a supportive pathway to preserve physicians’ ability to practice medicine.

Patient Rights and Practitioner Duties

In military medicine, the goals of war transform patient rights and practitioner duties. Attention to conserving mission readiness and maintaining one’s fitness for duty limits soldiers’ rights to refuse standard medical care, initiate DNR (Do Not Resuscitate) orders, maintain privacy, and demand confidentiality. At the same time, however, military medical practitioners are expected to maintain impartiality and neutrality. In wartime, both are problematic. The imperative of military necessity may override impartiality while medical staff members tending compatriot warfighters are not neutral. Special, associative duties of care, moreover, may demand preferential treatment for compatriots at the expense of the medical needs of others. Citing dual loyalty, some observers call on military medical personnel to choose between their medical and military obligations. Dual loyalty, however, is a false dichotomy that obscures the moral tension between collective and individual interests coloring all aspects of political and military ethics.

Vitamin D Status in Adolescents during COVID-19 Pandemic: A Cross-Sectional Comparative Study

Vitamin D has been claimed to be effective in the response to infections, including the respiratory syndrome coronavirus 2 (SARS-CoV-2). It is supposed that lockdown measures and fear of SARS-CoV-2 infection might reduce vitamin D levels through the modification of lifestyle. However, very few data exist on the association between lockdown measures and vitamin D status in humans. For this cross-sectional comparative study, adolescents (n = 298) aged 18 to 19 years were enrolled during the compulsory military fitness-for-duty evaluation between July and December 2020 in Southern Switzerland. Beyond anthropometric measurements, participants filled in a structured questionnaire about their lifestyle and a blood specimen was sampled for the determination of total 25-hydroxy-vitamin D. The obtained data were compared with those of 437 adolescents enrolled at the military fitness-for-duty evaluation during the same period of the year in the context of the CENERI study (2014–2016). The anthropometric measures were similar between the two study groups. The levels of vitamin D were also comparable (77 (64–91) vs. 74 (60–92) nmol/L, p = 0.50; median and interquartile range). A total of 38 (13%) and 43 (9.8%) subjects presented insufficient (<50 nmol/L) levels of vitamin D (p = 0.42) during the current pandemic and in the CENERI study, respectively. These data do not support the hypothesis that during the SARS-CoV-2 pandemic, late adolescents are at higher risk of vitamin insufficiency.