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Objective During early childhood, the development of communication skills, such as language and speech perception, relies in part on auditory system maturation. Because auditory behavioral tests engage cognition, mapping auditory maturation in the absence of cognitive influence remains a challenge. Furthermore, longitudinal investigations that capture auditory maturation within and between individuals in this age group are scarce. The goal of this study is to longitudinally measure auditory system maturation in early childhood using an objective approach. Methods We collected frequency-following responses (FFR) to speech in 175 children, ages 3–8 years, annually for up to five years. The FFR is an objective measure of sound encoding that predominantly reflects auditory midbrain activity. Eliciting FFRs to speech provides rich details of various aspects of sound processing, namely, neural timing, spectral coding, and response stability. We used growth curve modeling to answer three questions: 1) does sound encoding change across childhood? 2) are there individual differences in sound encoding? and 3) are there individual differences in the development of sound encoding? Results Subcortical auditory maturation develops linearly from 3-8 years. With age, FFRs became faster, more robust, and more consistent. Individual differences were evident in each aspect of sound processing, while individual differences in rates of change were observed for spectral coding alone. Conclusions By using an objective measure and a longitudinal approach, these results suggest subcortical auditory development continues throughout childhood, and that different facets of auditory processing follow distinct developmental trajectories. Significance The present findings improve our understanding of auditory system development in typically-developing children, opening the door for future investigations of disordered sound processing in clinical populations.

Aim: Neurosensory tests have emerged as components of sport-related concussion management. Limited normative data are available in healthy, nonconcussed youth athletes. Patients & methods/results: In 2017 and 2018, we tested 108 youth tackle football players immediately before their seasons on the frequency-following response, Balance Error Scoring System, and King-Devick test. We compared results with published data in older and/or and nonathlete populations. Performance on all tests improved with age. Frequency-following response and Balance Error Scoring System results aligned with socioeconomic status. Performance was not correlated across neurosensory domains. Conclusion: Baseline neurosensory functions in seven 14-year-old male tackle football players are consistent with previously published data. Results reinforce the need for individual baselines or demographic-specific norms and the use of multiple neurosensory measures in sport-related concussion management., Lay abstract Previous studies have shown that tests of neurosensory function, including hearing, balance, and vision, tend to be abnormal in children and adults with a sports-related concussion. Little data are available on how youth athletes perform on these tests when they are healthy. Here we report male youth football players’ preseason performance on three tests of neurosensory function. Performance at baseline is generally consistent with previous reports in older children and/or nonathlete populations, supporting the use of these assessments when evaluating an athlete for a sports-related concussion. However, performance varies with age and socioeconomic status, reinforcing the need for an individual preinjury baseline or careful, demographic-specific norms for comparison. Performance was not correlated across neurosensory domains, supporting the use of multiple measures in concussion evaluation and management.

Objective: Few studies have tracked neurologic function in youth football players longitudinally. This study aimed to determine whether changes in tests of auditory, vestibular, and/or visual funct...

Concussions can result in auditory processing deficits even in the absence of hearing loss. In children and adolescents, the extent to which these impairments have functional consequences for everyday listening, such as the ability to understand speech in noisy environments, is unknown.Case-control study.Forty youth comprised the participants: 20 had sustained a concussion and were recovering from their injury, and 20 controls had sustained non-concussive orthopaedic (e.g. musculoskeletal) injuries. All were evaluated on the Hearing in Noise Test, an audiologic index of the ability to hear sentences in adverse listening conditions.Children and adolescents recovering from concussions demonstrated an overall impaired ability to perceive speech in noisy backgrounds compared to a peer control group. This deficit also emerged across trials in the most taxing listening condition, and with respect to published, age-normative values.Functional listening skills-such as the ability to understand speech in noise, and the ability to sustain performance over time in taxing auditory conditions-may be compromised in children with concussions. These impairments may exacerbate cognitive and academic challenges associated with concussion injuries, and should be considered in return-to-learn and return-to-play decisions.

Numerous investigations have definitively shown amygdalar involvement in delay and contextual fear conditioning. However, much less is known about amygdala contributions to trace fear conditioning, and what little evidence exists is conflicting as noted in previous studies. This discrepancy may result from selective targeting of individual nuclei within the amygdala. The present experiments further examine the contributions of amygdalar subnuclei to trace, delay, and contextual fear conditioning. Rats were trained using a 10-trial trace, delay, or unpaired fear conditioning procedure. Pretraining lesions targeting the entire basolateral amygdala (BLA) resulted in a deficit in trace, delay, and contextual fear conditioning. Immediate post-training infusions of the protein synthesis inhibitor, cycloheximide, targeting the basal nucleus of the amygdala (BA) attenuated trace and contextual fear memory expression, but had no effect on delay fear conditioning. However, infusions targeting the lateral nucleus of the amygdala (LA) immediately following conditioning attenuated contextual fear memory expression, but had no effect on delay or trace fear conditioning. In follow-up experiments, rats were trained using a three-trial delay conditioning procedure. Immediate post-training infusions targeting the LA produced deficits in both delay tone and context fear, while infusions targeting the BA produced deficits in context but not delay tone fear. These data fully support a role for the BLA in trace, delay, and contextual fear memories. Specifically, these data suggest that the BA may be more critical for trace fear conditioning, whereas the LA may be more critical for delay fear memories.

It has been hypothesized that concussions impart lasting brain damage, even after a patient has ostensibly recovered. This hypothesis is based largely upon neuropathological studies in deceased athletes, however, leaving open the question of whether it can be detected in vivo. We measured neural responses to speech in collegiate student-athletes with a history of a single concussion from which they had recovered. These student-athletes had weaker responses to speech than age- and position-matched peers. This group difference suggests that concussions engender small, but detectable, changes in brain function prior to the emergence of frank behavioral indications.

Rapid, disruptive change is today's normal. It comes in all forms and frequencies. To cope and survive, healthcare executives need to build a culture of agility and resilience at all levels and across all domains of the hospital or health system. Lakeland Regional Health Systems Inc. has been transforming its culture in order to manage resilience by creating purpose. To adapt and sustain itself, Lakeland Regional has launched a transformation from a culture characterized by a collection of single values to one whose core is caring relationships through human interaction; human experience; and community values, beliefs, and attitudes. With a clear purpose of caring for ourselves, caring for our patients and families, caring for each other, and caring for our community, Lakeland Regional is creating resilience by building a purpose that sets the stage for a resilient culture defined by purpose; passion; and a healthy work, spiritual, and life balance.

Concussions carry devastating potential for cognitive, neurologic, and socio-emotional disease, but no objective test reliably identifies a concussion and its severity. A variety of neurological insults compromise sound processing, particularly in complex listening environments that place high demands on brain processing. The frequency-following response captures the high computational demands of sound processing with extreme granularity and reliably reveals individual differences. We hypothesize that concussions disrupt these auditory processes, and that the frequency-following response indicates concussion occurrence and severity. Specifically, we hypothesize that concussions disrupt the processing of the fundamental frequency, a key acoustic cue for identifying and tracking sounds and talkers, and, consequently, understanding speech in noise. Here we show that children who sustained a concussion exhibit a signature neural profile. They have worse representation of the fundamental frequency, and smaller and more sluggish neural responses. Neurophysiological responses to the fundamental frequency partially recover to control levels as concussion symptoms abate, suggesting a gain in biological processing following partial recovery. Neural processing of sound correctly identifies 90% of concussion cases and clears 95% of control cases, suggesting this approach has practical potential as a scalable biological marker for sports-related concussion and other types of mild traumatic brain injuries.

Speech signals contain information in hierarchical time scales, ranging from short-duration (e.g., phonemes) to long-duration cues (e.g., syllables, prosody). A theoretical framework to understand how the brain processes this hierarchy suggests that hemispheric lateralization enables specialized tracking of acoustic cues at different time scales, with the left and right hemispheres sampling at short (25 ms; 40 Hz) and long (200 ms; 5 Hz) periods, respectively. In adults, both speech-evoked and endogenous cortical rhythms are asymmetrical: low-frequency rhythms predominate in right auditory cortex and high-frequency rhythms in left auditory cortex. It is unknown, however, whether endogenous resting state oscillations are similarly lateralized in children. We investigated cortical oscillations in children (3–5 years; N = 65) at rest and tested our hypotheses that this temporal asymmetry is evident early in life and facilitates recognition of speech in noise. We found a systematic pattern of increasing leftward asymmetry for higher frequency oscillations; this pattern was more pronounced in children who better perceived words in noise. The observed connection between left-biased cortical oscillations in phoneme-relevant frequencies and speech-in-noise perception suggests hemispheric specialization of endogenous oscillatory activity may support speech processing in challenging listening environments and that this infrastructure is present during early childhood.

Learning to read is a fundamental developmental milestone, and achieving reading competency has lifelong consequences. Although literacy development proceeds smoothly for many children, a subset struggle with this learning process, creating a need to identify reliable biomarkers of a child’s future literacy that could facilitate early diagnosis and access to crucial early interventions. Neural markers of reading skills have been identified in school-aged children and adults; many pertain to the precision of information processing in noise, but it is unknown whether these markers are present in pre-reading children. Here, in a series of experiments in 112 children (ages 3–14 y), we show brain–behavior relationships between the integrity of the neural coding of speech in noise and phonology. We harness these findings into a predictive model of preliteracy, revealing that a 30-min neurophysiological assessment predicts performance on multiple pre-reading tests and, one year later, predicts preschoolers’ performance across multiple domains of emergent literacy. This same neural coding model predicts literacy and diagnosis of a learning disability in school-aged children. These findings offer new insight into the biological constraints on preliteracy during early childhood, suggesting that neural processing of consonants in noise is fundamental for language and reading development. Pragmatically, these findings open doors to early identification of children at risk for language learning problems; this early identification may in turn facilitate access to early interventions that could prevent a life spent struggling to read., The neural coding of consonants in noise predicts early literacy skills in pre-reading children, providing a biological marker that may help to target early intervention., Author Summary Learning to read is a chief developmental milestone with lifelong consequences; although there are effective interventions for struggling readers, an ongoing challenge has been to identify candidates for intervention at a young-enough age. We measured the precision of the neural coding of consonants in noise, and found that pre-reading children (4 y old) with stronger neural processing had superior early literacy skills; one year later they were also stronger emerging readers. We applied the same neural coding measure to a cohort of older children: in addition to predicting these children’s literacy achievement, we could reliably predict which of the children had received a diagnosis of a reading impairment. Taken together, these results suggest that the neural coding of speech in noise plays a fundamental role in language development. Children who struggle to listen in noisy environments may struggle to make meaning of the language they hear on a daily basis, which can in turn set them at risk for literacy challenges. Evaluating the neural coding of speech in noise may provide an objective neurophysiological marker for these at-risk children, opening a door to early and specific interventions that may stave off a life spent struggling to read.

Early childhood is a critical period of auditory learning, during which children are constantly mapping sounds to meaning. But this auditory learning rarely occurs in ideal listening conditions—children are forced to listen against a relentless din. This background noise degrades the neural coding of these critical sounds, in turn interfering with auditory learning. Despite the importance of robust and reliable auditory processing during early childhood, little is known about the neurophysiology underlying speech processing in children so young. To better understand the physiological constraints these adverse listening scenarios impose on speech sound coding during early childhood, auditory-neurophysiological responses were elicited to a consonant-vowel syllable in quiet and background noise in a cohort of typically-developing preschoolers (ages 3–5 yr). Overall, responses were degraded in noise: they were smaller, less stable across trials, slower, and there was poorer coding of spectral content and the temporal envelope. These effects were exacerbated in response to the consonant transition relative to the vowel, suggesting that the neural coding of spectrotemporally-dynamic speech features is more tenuous in noise than the coding of static features—even in children this young. Neural coding of speech temporal fine structure, however, was more resilient to the addition of background noise than coding of temporal envelope information. Taken together, these results demonstrate that noise places a neurophysiological constraint on speech processing during early childhood by causing a breakdown in neural processing of speech acoustics. These results may explain why some listeners have inordinate difficulties understanding speech in noise. Speech-elicited auditory-neurophysiological responses offer objective insight into listening skills during early childhood by reflecting the integrity of neural coding in quiet and noise; this paper documents typical response properties in this age group. These normative metrics may be useful clinically to evaluate auditory processing difficulties during early childhood.

The purpose of this study was to evaluate the reliability of three separate isometric strength testing devices. Seventeen (10 female, 7 male) adult volunteers with no known shoulder dysfunction participated. Each subject's internal rotation, external rotation and abduction strength was measured with the Nicholas Manual Muscle Tester (MMT), Biodex Isokinetic Dynamometer, and Isobex 2.0. Two investigators administered the test to each subject with each device. Data were analyzed with intraclass correlation coefficients (ICCs). Ranges of the intrarater intraclass correlation coefficient (3,1) values for each muscle group with each device for both testers were as follows: Nicholas MMT = .84 to .97, Biodex = .97 to .99, and Isobex 2.0 = .95 to .98. Ranges of interrater intraclass correlation coefficient values for each device and muscle group were as follows: Nicholas MMT = .79 to .94, Biodex = .93 to .96, and Isobex 2.0 = .90 to .97. Time to complete testing was shortest for Nicholas MMT, followed by Isobex 2.0, then Biodex. Measurements taken on the same day by the same therapist appear to be highly reliable for all three devices. Measurements taken over a 3-day period by two therapists appear to be highly reliable for all devices and muscle groups with the exception of Nicholas MMT abduction (.79), which was moderately reliable.

Regadenoson (Reg) is being administered with increasing frequency either at peak exercise (ExPeak-Reg) or during a slow-down/walking recovery state (ExRec-Reg) rather than at rest (Rest-Reg). The aim of this study was to compare the clinical response of ExPeak-Reg, ExRec-Reg, and Rest-Reg.We compared 531 patients divided equally between Rest-Reg, ExPeak-Reg, and ExRec-Reg matched for age, sex, and BMI.The average systolic blood pressure (SBP) rise following Reg was modest, but there was considerable heterogeneity and the ExPeak-Reg group had a higher percentage of patients who had a SBP rise of 40 mm Hg or a fall of 20 mm Hg than either the ExRec-Reg or the Rest-Reg groups (≥40 mm Hg rise 6.8%, 1.7%, and 1.7%, respectively) (P .02) (≥20 mm Hg fall 15.8%, 13.0%, and 7.3%, respectively) (P .05). Chest discomfort, nausea, dizziness, and interfering abdominal radiotracer activity were less common in both exercise Reg groups compared to Rest-Reg (P .05).Regadenoson injected at peak of symptom-limited exercise was generally well tolerated, but some patients had a significant rise or drop in SBP. There is no apparent advantage of administering regadenoson at peak exercise rather than during walk recovery, and the latter approach may have a greater safety margin.