Chronic renal failure and hemodialysis are common conditions frequently associated with psychological symptoms such as depression, anxiety, and stress, which can significantly impact patients' quality of life and psychosocial adjustment. This quasi-experimental study investigated the effects of listening to Surah Al-Inshirah on depression, anxiety, stress, and mental well-being in hemodialysis patients. A total of 60 eligible patients were allocated to an intervention group (n = 30) and a control group (n = 30) according to dialysis scheduling. Patients in the intervention group listened to Surah Al-Inshirah during dialysis sessions over a 4-week period. Outcomes were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21) and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). The results suggested that listening to Surah Al-Inshirah may be associated with reduced symptoms of depression, anxiety, and stress in hemodialysis patients. Given the cultural context of the study setting, Qur'anic recitation may represent a culturally acceptable complementary intervention.
Successful speech perception requires listeners to bin continuous acoustic information into discrete phonetic categories. However, some people maintain within-category acoustic information (gradient) while others discard category-irrelevant information (discrete) during perception. Listeners also vary in how consistently they label speech sounds and more gradient/consistent labeling has been linked with better speech-in-noise (SIN) perception. Here, we test how neuroanatomical properties of the brain's major speech-language and auditory pathways relate to individual differences in speech categorization and SIN processing. We measured phonetic categorization and SIN comprehension via phoneme labeling and QuickSIN tasks. Diffusion-weighted imaging (DWI) with probabilistic tractography estimated axonal density within the bilateral arcuate fasciculi and brainstem-cortical auditory projections. Anatomical morphology (surface area, gray matter volume, thickness) was also quantified in the adjacent frontotemporal cortical areas and midbrain. Behaviorally, we found more consistent categorizers had better performance on the QuickSIN. DWI showed that more gradient listeners had greater white matter density in the left arcuate fasciculus and brainstem-cortical auditory pathways, while better SIN performance was predicted by denser white matter in the brainstem-cortical auditory pathways. Morphometric results revealed more consistent listening was associated with greater cortical thickness in right superior temporal gyrus and more gradient listening was associated with greater surface area in right pars opercularis. We infer that individual differences in phonetic categorization relate to SIN comprehension and are at least partially explained by neuroanatomical properties of the auditory-linguistic brain.
This randomized clinical trial examines the feasibility, acceptability, and patient-reported outcomes of personalized listening to vocal music during hospitalization for acute stroke.
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Avoidant restrictive food intake disorder (ARFID) was introduced to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 and current guidelines recommend multidisciplinary care, however there are few evaluations of such pathways. This study aims to enhance the study stage of the plan-do-study-act (PDSA) cycle using qualitative methods to improve the development, refinement, and implementation of a novel pilot ARFID pathway in a community eating disorder service. Semi-structured interviews were conducted with 17 participants with experience of the pathway (7 service users:10 staff members) according to an interview schedule. Reflexive, codebook thematic analysis was used to analyse the interview data. Gaps in understanding and treating ARFID were revealed, leading to feelings of uncertainty and frustration. The establishment of a specialist multidisciplinary team (MDT) improved knowledge and efficiency but created challenges related to team integration and resource allocation. Barriers for service user engagement and communication demonstrated the need for service user consultation and pathway co-creation. Service user consultation, treatment adaptations for neurodiversity and cross-service working were identified to improve the pathway as part of the act stage of the PDSA cycle. Future ARFID pathways should prioritise service user agency and access to multidisciplinary care and incorporate consultation from external eating disorder service, as well as lived experience experts. People who have avoidant restrictive food intake disorder (ARFID) have very limited diets and struggle to eat enough or certain kinds of food. This can cause problems with their health and daily life. A new pilot pathway in a community eating disorder service was set up to help adults with these eating difficulties.To help improve this pathway we asked patients and staff what they thought about it. Seven patients and ten staff members were interviewed, and we organized what they said into key messages.Both staff and patients said they were often unsure about what might be most helpful for people with ARFID. Having a team of different professionals made things easier, but it also brought some challenges. Patients said it was important to be involved in planning their care.The study shows that care works best when patients are listened to, teams work together, and support is flexible to fit each person’s needs.
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A recent study found that hearing aids fitted with highly occluding domes had an impact on the perception of externally presented speech, producing sound images that were perceived as too close or even inside the head. The present study examined whether this phenomenon is related to the well-known occlusion effect, which describes changes in ear canal levels and perceived own-voice quality during speaking. Participants were 10 young adults with normal hearing and 10 young adults with sensorineural hearing loss. All participants were fitted with both closed- and open-fit hearing aids, and hearing aid users were also tested with their own devices. Externalization was measured using a numerical scale from 0 (inside the head) to 10 (at the loudspeaker). Participants also rated the naturalness of their own voice while speaking using a subjective scale from 1 (most unnatural) to 10 (most natural). Occlusion was also measured objectively for open and closed fittings using real ear measurements. Externalization ratings were significantly higher for unaided than aided listening and for open versus closed domes. Similarly, own-voice ratings tended to be higher for unaided versus aided listening and for open versus closed domes. Although these broad patterns suggest that reduced ratings are associated with more occlusion, objective measures of occlusion did not account for a significant amount of the variance in either kind of rating. Similarly, individual own-voice ratings did not significantly predict individual externalization ratings. The data obtained with hearing aid users wearing their own devices suggested that regularly worn devices can have positive effects on own-voice perception while disrupting externalization. Overall, compared with unaided listening, hearing aids negatively affected externalization and own-voice perception, with larger effects for closed than open fittings. However, at the individual level, measures of occlusion and sound externalization were not strongly related.
Creativity has traditionally been difficult to measure, partly because it is linked to a diverse set of mental processes that are considered stimulus-independent, like daydreaming and imagining. Music, however, provides a tractable window into these varieties of spontaneous thought. During music listening, people regularly imagine fictional scenarios that feel highly personal, but are actually prompted by features of the music. Here we show that creativity is reliably predicted by music-induced imaginings. Across two studies, participants (total n = 466) listened to a variety of well-validated musical excerpts and gave written descriptions of stories that they imagined. Participants also completed divergent thinking tasks from the Torrance Test of Creative Thinking, a standard measure of domain-general creativity. Using natural language processing tools, we extracted measures of Originality, Appropriateness, and Elaboration from the music-induced imaginings. Measures of Elaboration and Appropriateness were reliably predicted by scores on the Torrance Test of Creative Thinking, suggesting that more creative individuals spontaneously imagine scenarios that are more attuned to the cultural associations of the perceptual environment. Taken together, results show that spontaneous thought during music listening reflects individual differences in human creativity. The ability to predict trait levels of creativity from spontaneous thought paves the way for more naturalistic, accessible measures of creativity that can be readily tailored to samples that share a socio-cultural background.
Music can evoke profound emotions and autobiographical memories. The Bonny Method of Guided Imagery and Music (BMGIM) is a music therapy approach that uses music-evoked imagery to elicit emotions and promote self-exploration. To investigate the neural mechanisms of BMGIM, 22 healthy university students were recruited, of whom 21 were included in the final analysis. Brain activity was measured using functional near-infrared spectroscopy (fNIRS) during a Music Only session and a BMGIM session based on a standardized BMGIM music program. Mood changes were assessed using the Profile of Mood States 2. NIRS data were analyzed using a region-of-interest (ROI)-based approach. Reduced negative mood scores were observed in both sessions, with depression-dejection showing a significant reduction only following BMGIM but not after listening to music alone. In the third piece of music, which was structurally associated with the deepest phase of the BMGIM experience, increased oxygenated hemoglobin responses were observed during BMGIM compared to listening to music alone. After statistical correction, significant condition-dependent effects were observed only in the orbitofrontal cortex, with trends in other regions directionally consistent with the channel-based analyses. The present findings suggest that BMGIM engages the orbitofrontal cortex during emotional processing and specifically reduces depression-dejection. These findings highlight its potential as a clinically meaningful intervention for individuals with depression. Future studies should employ more rigorous experimental designs with larger and more diverse samples to elucidate the mechanisms underlying BMGIM.
Age-related pure-tone hearing loss (HL) frequently co-occurs with central auditory processing deficits and cognitive decline and is commonly associated with speech processing difficulties. To examine how inter-individual differences in central auditory processing and cognitive capacities contribute to speech processing and lexical acquisition, we investigated the neural encoding and acquisition of novel words using phonetic stimuli as a proxy for speech processing abilities. These stimuli were presented at 80 dB SPL to minimize audibility-related confounds and ensure that differences in learning were not primarily driven by peripheral hearing sensitivity. Older adults with mild-to-moderate peripheral HL and signs of cognitive decline (N = 21) completed an attentive listening and associative word learning task with Thai words while EEG was recorded, alongside comprehensive psychometric, audiometric, and auditory assessments. Neural markers of word learning were preserved in this population, as reflected in the N400 and late positive component (LPC) event-related potentials (ERPs), with LPC amplitudes predicting word learning performance. Multiple linear regression models controlling for age and HL examined whether sensory ERPs (P50, N100, P200), behavioral auditory-audiometric measures (OLSA, PTA 4000, d-primes for attentive listening), or cognitive variables (attention, language, memory, perception, executive function, n-back, Stroop) predicted learning outcomes. Age accounted for the largest proportion of variance in word learning performance. Sensory ERPs and cognitive measures also emerged as significant predictors, whereas, as expected given the high stimulus intensity, peripheral HL showed a non-significant effect. Larger N100 amplitudes explained variance in sensory ERP models, while executive functions were the strongest predictors in cognitive models. Superior word learning performance was associated with younger age, enhanced central auditory processing, and stronger executive functions. These findings indicate that central auditory processing and executive functions are key determinants of speech learning in older adults with mild-to-moderate peripheral HL and cognitive decline when audibility is controlled.
Modern cochlear implants (CIs) use pulsatile stimulation to restore hearing for individuals with severe hearing loss. CIs provide robust speech recognition in quiet but poorly represent temporal fine structure (TFS), needed for challenging listening situations. Analog stimulation preserves the acoustic waveform and may better encode TFS, yet it has not been evaluated combined with modern current-focusing strategies. We compared neural responses in the inferior colliculus (IC) evoked by CI stimuli consisting of 100 pulses/s biphasic pulse trains and 100 cycles/s sinusoidal analog stimulation with monopolar, bipolar, and tripolar electrode configurations in urethane-anesthetized guinea pigs. Following cochlear implantation, multiunit activity was recorded from the tonotopic axis of the central nucleus of the IC using 16-channel silicon probes. Detection thresholds, spread of excitation, vector strength, sustained response percentage, and temporal response properties were quantified. Analog stimulation consistently evoked significantly lower activation thresholds than pulsatile stimulation while maintaining comparable or sometimes narrower spatial selectivity across stimulation modes. In contrast, analog stimulation generated lower vector strength, larger tonic response components, and a pronounced level-dependent polarity effect. At low stimulus levels, responses were dominated by the cathodic phase of the sinusoidal waveform, whereas increasing stimulus level responses were elicited by both phases, producing synchronization at twice the stimulus frequency. These findings demonstrate that stimulation waveform strongly influences temporal coding while having relatively little effect on the spatial distribution of neural activation. These results provide a physiological basis for reexamining analog stimulation as an alternative strategy for cochlear implant sound coding.
To explore patients' expressions of emotional distress and subsequent Registered Nurses' (RNs') responses in primary care consultations. This observational study included a consecutive sample of 147 audio recorded RN-led consultations with adult patients seeking primary care for a new health problem. Expressions of emotional distress were analysed using the Verona Coding Definitions of Emotional Sequences. Patients expressed emotional distress in one-third of the recorded consultations. A total of 165 expressions of emotional distress were identified, comprising 140 cues and 25 concerns. The RNs' responses primarily provided space for further disclosure of the emotional expressions (125, 75.8%). No statistically significant differences in RNs' response types, such as providing or reducing space, were found based on patients' sex, age, or native language. RNs demonstrated proficiency in recognising patients' expressions of emotional distress and in facilitating further disclosure in an inclusive manner that aligns with principles of person-centred care. Encouraging recognition of emotional distress through active listening and an engaged communication approach may enhance RN communication and optimise conditions for person-centred care.
Hearing aids (HAs) and cochlear implants (CIs) improve speech perception for individuals with hearing loss (HL), yet their impact on music outcomes remains unclear. We examined music perception, engagement, and reward in a large cohort of individuals across various hearing conditions. Cross-sectional survey. Tertiary academic medical center and community. Adults (≥18 years) including normal hearing (NH) individuals, unaided individuals with HL, HA users, and CI users were assessed using the Barcelona Music Reward Questionnaire (BMRQ), Goldsmiths Musical Sophistication Index perceptual abilities subscale (GMSI-PA), and music engagement items. ANOVA/ANCOVA was used to assess group differences, adjusting for age, gender, race, education, and musical training. Among 201 participants (NH = 30, unaided HL = 23, HA = 84, CI = 64; 55.2% female; mean age 61.3), hearing status was associated with perceptual abilities; in particular, CI users had lower perceptual abilities than other groups (CI adjusted mean = 33.1 vs 38.6-42.9 for NH, unaided HL, HA; all P < .01). However, non-perceptual factors, including musical training and age, were stronger determinants of engagement and reward than hearing condition. A 1-SD increase in musical training (10.1 points) was associated with a 3.1-point increase in GMSI-PA, 21.7 additional listening days/year, 32.3 additional participation days/year, and 3.1-point increase in BMRQ. Poorer hearing status was associated with reduced music perception but not engagement or reward, even among CI users. Non-perceptual factors like musical training and age may play a stronger role in explaining individual differences, highlighting the role of modifiable behavioral factors in enhancing music reward for individuals with HL.
Reported perceptual differences in autism may arise from reduced use of prior context to shape incoming sensory input. Speech perception provides a critical test of this account because stable perception requires listeners to integrate variable acoustic signals with contextual expectations. This study examined context-dependent modulation of speech encoding in autistic and non-autistic adults using the frequency-following response (FFR), a neurophysiological measure of phase-locked auditory encoding. Participants heard English intonational pitch contours presented in repetitive and variable contexts while EEG was recorded. Principal component analysis of FFR metrics yielded components indexing neural encoding fidelity and timing. Non-autistic participants showed enhanced encoding fidelity in more predictable contexts, whereas autistic participants showed reduced context-dependent modulation. Neural encoding timing also showed divergent context effects across groups, suggesting altered balance between feedback-based predictive mechanisms and locally driven adaptation processes. Within the autistic group, greater context-related modulation of encoding fidelity was associated with lower ADOS-2 Social Affect severity but poorer speech-in-noise perception, suggesting that the functional impact of contextual modulation depends on input reliability and task demands. These findings indicate that context-dependent modulation of speech encoding is altered in autism and may contribute to individual differences in auditory and social-communicative function. When we listen to speech, the brain often uses sounds it has recently heard to help make sense of new ones, which is especially useful in noisy, everyday settings. In this study, autistic adults' brains tended to process speech differently, drawing less on recent sound patterns than non-autistic adults, and this difference was related to their autism domain variability and to understanding speech in background noise. These effects were not simply better or worse but depended on the listening conditions, suggesting that natural differences in how the brain uses recent context may shape some of the ways autistic people listen to speech.
Formative assessment can support health professions education; however, reports on electronic 1-min papers as classroom feedback and engagement tools in radiography programmes remain limited. This study explored radiography students' perceptions of an electronic 1-min paper, focusing on in-class reflection, ease of asking questions, and instructor feedback. An electronic 1-min paper was used in a radiotherapy course across 45 class sessions in the 2024 academic year for third-year students enrolled in a 4-year radiography programme. Each 90-min class comprised a 60-min lecture, 10-min completion of the paper, and 20-min instructor feedback. After the course, a de-identified online questionnaire was administered. Eleven 5-point Likert-scale items were analysed using descriptive statistics and Spearman's rank correlations. Free-text responses were analysed using inductive qualitative content analysis. Of the 77 eligible students, 74 responded (96.1%). Ease of use received the highest rating (mean, 4.76; standard deviation [SD], 0.52), followed by ease of asking questions (mean, 4.32), question resolution (mean, 4.16), and usefulness of instructor feedback (mean, 4.08). Motivation to review after class was lowest (mean, 3.04; SD, 1.16). Active participation showed a strong positive association with in-class concentration (rs = 0.815; P < 0.001). Free-text responses indicated reflection and improved understanding, anonymous sharing of questions, active listening and concentration, and suggestions for improvement. The electronic 1-min paper was widely accepted and perceived to support in-class reflection, question expression, and immediate feedback. However, students' perceptions of its influence on out-of-class review motivation were limited. The findings indicate perceived value and engagement rather than demonstrated educational effectiveness. Electronic 1-min papers may help instructors identify students' questions and respond during class, providing a practical approach to in-class feedback.
Parkinson's disease (PD) caregivers face significant emotional, physical, and social challenges that result in poor health outcomes. Despite their critical role, caregivers receive limited support from health care systems. The current study explored the feasibility and acceptability of a student-led virtual support group for PD caregivers. The goal of the support group was to provide a safe space for peer connection, emotional processing, and health education. Feasibility was assessed through participation metrics alongside program surveys measuring loneliness, self-care engagement, satisfaction, and student learning. Results indicated that caregivers reported moderate levels of loneliness and inconsistent self-care but expressed satisfaction and perceived benefit from the group. Students reported gains in empathy, active listening, and confidence in group facilitation. This model provided meaningful caregiver support and valuable experiential student learning. Findings offer a delivery model to address the unmet mental health needs of caregivers and psychiatric-mental health nurse training.
This study aimed to evaluate the differences between unilateral cochlear implant (CI) use and bimodal auditory stimulation regarding speech perception in noise and auditory reaction times. This cross-sectional study included 26 adults (aged 18-53 years) with a unilateral CI and a contralateral hearing aid. Participants underwent free-field audiometry (FFA), Speech Reception Threshold (SRT) testing, the Turkish Matrix Test (TMT) in quiet and noise, and the Auditory Reaction Time Test (ARTT). Measurements were compared between unilateral (CI only) and bimodal (CI plus hearing aid) conditions. Bimodal stimulation yielded significantly better free-field and speech reception thresholds compared to the unilateral condition (p < 0.001). In the TMT, speech perception thresholds improved with bimodal stimulation in both quiet (44.9 ± 8.7 vs. 53.7 ± 9.3 dB SPL) and noise (1.1 ± 3.1 vs. 4.3 ± 3.1 dB SNR) (p < 0.001). Additionally, simple auditory reaction times were significantly shorter in the bimodal condition (518.5 ± 51.9 ms) than in the unilateral condition (559.6 ± 54.6 ms) (p < 0.001). Similar improvements were observed in choice reaction times (p < 0.001). Bimodal auditory stimulation significantly enhances auditory performance and reaction speed compared to unilateral CI use. These findings suggest that bimodal fitting improves binaural integration and processing efficiency, which is beneficial for speech intelligibility in challenging listening environments.
When we produce sounds ourselves, the brain modulates the auditory neural response through an efference copy mechanism, allowing us to distinguish between self-initiated and externally generated auditory inputs. However, the precise level of the auditory pathway at which this attenuation occurs remains unclear. While evidence from animal models suggests that early auditory processing of self-generated sounds may be modulated by corticofugal signaling, localized cortical modulation would preserve the high-fidelity subcortical sound encoding while allowing flexible, context-dependent processing at higher levels. To probe potential motor influences in the early auditory system, we collected scalp-recorded frequency following responses (FFRs) from 33 normal-hearing adults during active (self-initiated) and passive (externally presented) listening conditions using a 170 ms speech stimulus. Data were collected with a vertical montage that emphasizes subcortical generators of the FFR. We observed no significant differences in the FFR between active and passive conditions in spectral power, response amplitude, pitch tracking, onset latency, or phase consistency. In contrast, cortical event-related potentials showed motor-induced suppression (MIS): reduced early peak amplitudes in the active condition after correcting for motor signals, increased phase consistency prior to auditory feedback, and more precise phase consistency at sound offset. In addition to indicating FFRs can be collected during a wider range of behavioral tasks without substantial motor contamination, our observation of the canonical MIS in cortical signals but not in FFRs suggests that MIS of self-initiated sounds primarily affects later stages of auditory processing rather than the early encoding reflected in the FFR.