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It is our pleasure to announce the first issue of Audiology Research. This new journal was designed to be a place where the readers will quickly and clearly find up-to-date and highquality information related to the audiology field in a broad sense, ranging from the medical/clinical perspective to the basic and experimental research...

Increasing evidence indicates that screening and early treatment of hearing disability have the potential to significantly improve the quality of life and extend the functional status of adult population. Hearing disability is indeed one of the most common chronic health conditions in older adults, and has important implications for the quality of life, such as functional decline, depression and social isolation. According to the 2004 report from the World Health Organization, released in 2008, hearing loss is the first among the 20 leading causes of moderate- to-severe disability. The diminished ability to hear and to communicate is frustrating in and of itself, but the strong association of hearing disability with depression and functional decline adds further to the burden on individuals who are hearing impaired...

A series of pilot initiatives of adult hearing screening programs were organized in eight large and small-size cities in Italy in the past two years. The screening initiatives were held in public places, supermarkets, drugstores, and in some universities of the third age, and involved an overall population of 2,278 screened subjects with age ranging from 13 to 93 years. Three different screening tests were used to assess hearing ability in the participants, i.e.: screening pure tone audiometry (PTA), an automated speech-in-noise screening test (the SUN-test), and a screening questionnaire of self-perceived hearing handicap (the HHIE-S). This paper describes the organization and management of these screening initiatives and reviews the main results obtained in the screened population, using the three different screening tests. Results obtained in these pilot initiatives showed that screening adults for hearing problems might be feasible, on a local level, in non clinical settings and can be performed quite easily with the support of local coordinators and partners, such as associations or local authorities. It is recognized that further initiatives and studies will have to be performed to better define the key aspects related to the organization and management of adult hearing screening programs, either at a local, regional, or national level.

The SUN-test (Speech Understanding in Noise) is a speech-innoise test to screen adults and older adults for hearing disability. The SUN-test consists in a short list of intervocalic consonants (VCV, vowel-consonant-vowel) in noise that are presented in a three-alternatives forced choice (3AFC) paradigm by means of a touch-screen interface. Based on the number of stimuli correctly identified, the tested subject gets one of three possible test outcomes: no listening difficulties, a hearing check would be advisable, or a hearing check is recommended. This paper reviews the main results obtained with the SUNtest in the Italian language in a population of nearly 1,300 adults and older adults with varying degrees of audiometric thresholds and audiometric configurations, tested both in low and in high ambient noise settings. Results obtained in the tested population revealed that the outcomes of the SUN-test were in line with the outcomes of pure-tone testing, and that the test performance was similar both in low and in high ambient noise (up to 65 dB A). Results obtained with the SUNtest were not biased by the age of the subject because the performance of younger and older subjects in the test was similar. The mean duration of the SUN-test was nearly 40 s/ear, and was lower than 1 minute per ear even in subjects older than 80 years so that both ears could be tested, on average, in 2 minutes. The SUN-test was considered easy or slightly difficult by nearly 90% of subjects; test duration was judged short or fair by nearly 95% of subjects, and the overall evaluation of the test was pleasant, or neutral, in more than 90% of subjects. Overall, results of this study indicated that the SUN-test might be feasible for application in adult hearing screening. The test is fast, easy, self convincing, and reflects differences in hearing sensitivity between the tested subjects. The outcomes of the SUN-test were not influenced by the noise level in the test room (up to 65 dB A) indicating that the test, as such, might be feasible to screen adults and older adults both in clinical and in non clinical settings, such as convenient care clinics, hearing aid providers, or pharmacies, where the ambient noise is, typically, not controlled.

This paper assessed the variability of radiofrequency exposure among road users in urban settings due to vehicle-to-vehicle (V2V) communication operating at 5.9 GHz. The study evaluated the absorbed dose of radiofrequencies using whole-body specific absorption rate (SAR) in human models spanning different age groups, from children to adults. To overcome limitations of previous studies, we developed a novel hybrid procedure that combines deterministic and stochastic approaches, enabling assessment across multiple urban layouts. Real urban conditions and varying propagation scenarios were considered in SAR calculations. By varying the road user's position within 1.5-300 m from transmitting cars, the SAR distribution was determined. Median SAR remained consistently low, around 0.70 mW/kg, even with multiple transmitting cars and multiple emitting antennas, using maximum power allowed in US (44.8 dBm). The 99th percentile of SAR distribution varied based on body mass, decreasing for heavier models (typically adults) and increasing with the number of transmitting cars and antennas. The highest absorbed dose (73 mW/kg) occurred in a child model. The SAR consistently remained below the 80 mW/kg limit for whole-body exposure to electromagnetic fields in the 100 kHz-300 GHz range.

This study investigates the radio-frequency electromagnetic field exposure (RF-EMF) levels in pedestrians generated by vehicular communication technology. We specifically investigated exposure levels in children of different ages and both genders. This study also compares the children's exposure levels generated by such technology with those of an adult investigated in our previous study. The exposure scenario consisted of a 3D-CAD model of a vehicle equipped with two vehicular antennas operating at 5.9 GHz, each fed with 1 W power. Four child models were analyzed near the front and back of the car. The RF-EMF exposure levels were expressed as the Specific Absorption Rate (SAR) calculated over the whole body and 10 g mass (SAR 10g ) of the skin and 1 g mass (SAR 1g ) of the eyes. The maximum SAR 10g value of 9 mW/kg was found in the skin of the head of the tallest child. The maximum whole-body SAR was 0.18 mW/kg and was found in the tallest child. As a general result, it was found that children's exposure levels are lower than those of adults. All the SAR values are well below the limits recommended by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) in the general population.

(1) Background: This work aims to assess human exposure to EMF due to two different wearable antennas tuned to two 5G bands. (2) Methods: The first one was centered in the lower 5G band, around f = 3.5 GHz, whereas the second one was tuned to the upper 5G band, at 26.5 GHz. Both antennas were positioned on the trunk of four simulated human models. The exposure assessment was performed by electromagnetic numerical simulations. Exposure levels were assessed by quantifying the specific absorption rate averaged on 10 g of tissue (SAR 10g ) and the absorbed power density (S ab ), depending on the frequency of the wearable antenna. (3) Results: the higher exposure values that resulted were always mainly concentrated in a superficial area just below the antenna itself. In addition, these resulting distributions were narrowed around their peak values and tended to flatten toward lower values in farther anatomical body regions. All the exposure levels complied with ICNIRP guidelines when considering realistic input power. (4) Conclusions: This work highlights the importance of performing an exposure assessment when the antenna is placed on the human wearer, considering the growth of wearable technology and its wide variety of application, particularly regarding future 5G networks.

This study addressed an important but not yet thoroughly investigated topic regarding human exposure to radio-frequency electromagnetic fields (RF-EMF) generated by vehicular connectivity. In particular, the study assessed, by means of computational dosimetry, the RF-EMF exposure in road users near a car equipped with vehicle-to-vehicle (V2V) communication antennas. The exposure scenario consisted of a 3D numerical model of a car with two V2V antennas, each fed with 1 W, operating at 5.9 GHz and an adult human model to simulate the road user near the car. The RF-EMF dose absorbed by the human model was calculated as the specific absorption rate (SAR), that is, the RF-EMF power absorbed per unit of mass. The highest SAR was observed in the skin of the head (34.7 mW/kg) and in the eyes (15 mW/kg); the SAR at the torso (including the genitals) and limbs was negligible or much lower than in the head and eyes. The SAR over the whole body was 0.19 mW/kg. The SAR was always well below the limits of human exposure in the 100 kHz-6 GHz band established by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The proposed approach can be generalized to assess RF-EMF exposure in different conditions by varying the montage/number of V2V antennas and considering human models of different ages.

(1) Background: Cooperative Intelligent Transportation Systems (C-ITS) will soon operate using 5G New-Radio (NR) wireless communication, overcoming the limitations of the current V2X (Vehicle-to-Everything) wireless communication technologies and increasing road-safety and driving efficiency. These innovations will also change the RF exposure levels of pedestrians and road-users in general. These people, in fact, will be exposed to additional RF sources coming from nearby cars and from the infrastructure. Therefore, an exposure assessment of people in the proximity of a connected car is necessary and urgent. (2) Methods: Two array antennas for 5G-V2X communication at 3.5 GHz were modelled and mounted on a realistic 3D car model for evaluating the exposure levels of a human model representing people on the road near the car. Computational simulations were conducted using the FDTD solver implemented in the Sim4Life platform; different positions and orientations between the car and the human model were assessed. The analyzed quantities were the Specific Absorption Rate on the whole body (SAR wb ), averaged over 10 g (SAR 10g ) in specific tissues, as indicated in the ICNIRP guidelines. (3) Results: the data showed that the highest exposure levels were obtained mostly in the head area of the human model, with the highest peak obtained in the configuration where the main beam of the 5G-V2X antennas was more direct towards the human model. Moreover, in all configurations, the dose absorbed by a pedestrian was well below the ICNIRP guidelines to avoid harmful effects. (4) Conclusions: This work is the first study on human exposure assessment in a 5G-V2X scenario, and it expands the knowledge about the exposure levels for the forthcoming use of 5G in connected vehicles.

This study is based on the quantification of the influence of the presence of gold nanoparticles (Au NPs), of their geometry and their distance from cell membrane during time-varying electromagnetic fields cell membrane permeabilization on the pores opening dynamics. Results showed that the combined use of Au NPs and time-varying magnetic field can improve significantly the permeabilization of cell membrane. The presence of Au NPs allowed to reach transmembrane potential values enabling the cell membrane permeabilization only when placed at very short distance, equal to 20 nm. Both geometry and variability of the positioning in proximity of the cell membrane showed a strong influence on the probability of enabling pores opening. Clinical Relevance- This study provides a better comprehension about the mechanisms, still not completely understood, underlying cell membrane permeabilization by combining Au NPs and time-varying magnetic fields.

(1) Background: This work aims to assess the human exposure to the RF-EMFs emitted by a wearable antenna. (2) Methods: a wearable antenna tuned at f = 2.45 GHz was tested by placing it in six realistic configurations relative to a male and female human model. The exposure assessment was performed by means of computational methods to estimate the SAR 10g distributions at 1W of input power. (3) Results: (i) for all the configurations the SAR 10g distributions resulted always mainly concentrated on a superficial area immediately below the antenna itself; (ii) the obtained values have shown that the configuration with the highest exposure value was when the antenna was posed on the arm; (iii) the exposure tends to be higher for male model. (4) Discussion and Conclusions: This work highlights the importance of performing an exposure assessment when the antenna is placed on the human wearer considering the growth of the wearable technology and its wide variety of fields of application, e.g., medical and military.

The recent deployment of 5G networks is bringing benefits to the population but it is also raising public concern about human RF-EMF exposure levels. This is particularly relevant considering the next 5G mobile devices, which are placed in close proximity to the subjects. Therefore, the aim of the following paper is focused on expanding the knowledge of the exposure levels in 5G exposure scenarios, specifically for mobile applications, using computational methods. The mobile antenna was designed considering the 5G technology innovations (i.e., mm-wave spectrum, beamforming capability, high gain and wide coverage), resulting in a phased-array antenna with eight elements at the working frequency of 27 GHz. To assess the exposure levels, different types of skin models with different grades of details and layers were considered. Furthermore, not only was the presence of a mobile phone user simulated, but also that of a person in their proximity, who could be hit by the main beam of the phased-array antenna. All the simulations were conducted in Sim4Life platform, where the exposure levels were assessed in terms of absorbed power density averaged over 4 cm 2 and 1 cm 2 , following the ICNIRP guidelines. The results highlighted that the use of the homogeneous skin model led to the absorbed power density peaks being greatly underestimated, with respect to those obtained in multilayer skin models. Furthermore, interestingly, we found that the exposure levels obtained for the person passing nearby were slightly higher than those experienced by the mobile phone user himself. Finally, using the allowed input power for real mobile applications, all the values remained below the limits indicated by the ICNIRP guidelines.

(1) Background: Radiofrequency radiations are used in most devices in current use and, consequently, the assessment of the human exposure to the radiofrequency radiations has become an issue of strong interest. Even if in the military field there is wide use of radiofrequency devices, a clear picture on the exposure assessment to the electromagnetic field of the human beings in the military scenario is still missing. (2) Methods: a review of the scientific literature regarding the assessment of the exposure of the military personnel to the RF specific to the military environment, was performed. (3) Results: the review has been performed grouping the scientific literature by the typology of military devices to which the military personnel can be exposed to. The military devices have been classified in four main classes, according to their intended use: communication devices, localization/surveillance devices, jammers and EM directed-energy weapons. (4) Discussion and Conclusions: The review showed that in the exposure conditions here evaluated, there were only occasional situations of overexposure, whereas in the majority of the conditions the exposure was below the worker exposure limits. Nevertheless, the limited number of studies and the lack of exposure assessment studies for some devices prevent us to draw definitive conclusions and encourage further studies on military exposure assessment.

In recent years the introduction of 5G networks is causing a drastically change of human exposure levels in the radio frequency range. The aim of this paper is on expanding the knowledge on this issue, assessing the exposure levels for a particular case of indoor 5G scenario, where the presence of an Access Point (AP) was simulated. Coupling the traditional deterministic computational method with an innovative stochastic approach, called Polynomial Chaos Kriging, allowed to evaluate the exposure variability of an user considering the 3D beamforming capability of the antenna. The exposure levels, expressed in terms of specific absorption rate (SAR) in specific tissues, showed low values compared to ICNIRP guidelines.

The feasibility of using time-varying magnetic field as a contactless cells permeabilization method was demonstrated by experimental results, but the underlying mechanism is still poorly understood. In this study a numerical analysis of the transmembrane potential (TMP) at cell membranes during permeabilization by time-varying magnetic fields was proposed, and a first quantification of mechanical stress induced by the magnetic and electric fields and hypothesized to play an important role in the permeabilization mechanism was carried out. TMP values induced by typical in-vitro experimental conditions were far below the values needed for membrane permeabilization, with a strong dependence on distance of the cell from the coil. The preliminary assessment of the mechanical pressure and potential deformation of cells showed that stress values evaluated in conditions in which TMP values were too low to cause membrane permeabilization were comparable to those known to influence the pore opening mechanisms.Clinical Relevance- Results represent a significant step towards a better comprehension of the mechanism underlying cell membrane permeabilization by time-varying magnetic fields.

A novel Machine Learning (ML) method based on Neural Networks (NN) is proposed to assess radio-frequency (RF) exposure generated by WiFi sources in indoor scenarios. The aim was to build an NN capable of addressing the complexity and variability of real-life exposure setups, including the effects of not only down-link transmission access points (APs) but also up-link transmission by different sources (e.g. laptop, printers, tablets, and smartphones). The NN was fed with easy to be found data, such as the position and type of WiFi sources (APs, clients, and other users) and the position and material characteristics (e.g. penetration loss) of walls. The NN model was assessed using an additional new layout, distinct from that one used to build and optimize the NN coefficients. The NN model achieved a remarkable field prediction accuracy across exposure conditions in both layouts, with a median prediction error of -0.4 to 0.6 dB and a root mean square error of 2.5-5.1 dB, compared with the target electric field estimated by a deterministic indoor network planner. The proposed approach performs well for the different layouts and is thus generally used to assess RF exposure in indoor scenarios. © 2021 The Authors. Bioelectromagnetics published by Wiley Periodicals LLC on behalf of Bioelectromagnetics Society., (© 2021 The Authors. Bioelectromagnetics published by Wiley Periodicals LLC on behalf of Bioelectromagnetics Society.)

Personal exposure to Extremely Low Frequency Magnetic Fields (ELF MF) in children is a very timely topic. We applied cluster analysis to 24 h indoor personal exposures of 884 children in France to identify possible common patterns of exposures. We investigated how electric networks near child home and other variables potentially affecting residential exposure, such as indoor sources of ELF MF, the age and type of the residence and family size, characterized the magnetic field exposure patterns. We identified three indoor personal exposure patterns: children living near overhead lines of high (63-150 kV), extra-high (225 kV) and ultra-high voltage (400 kV) were characterized by the highest exposures; children living near underground networks of low (400 V) and mid voltage (20 kV) and substations (20 kV/400 V) were characterized by mid exposures; children living far from electric networks had the lowest level of exposure. The harmonic component was not relevant in discriminating the exposure patterns, unlike the 50 Hz or broadband (40-800 Hz) component. Children using electric heating appliances, or living in big buildings or in larger families had generally a higher level of personal indoor exposure. Instead, the age of the residence was not relevant in differentiating the exposure patterns.

Purpose Despite the current legislative indications toward the digitization of patient health records, 80% of health data are unstructured and in a format that cannot be used in electronic archives or in registries of diseases. An innovative automated system is here proposed to efficiently retrieve and digitize clinical information from original unstructured ear, nose, and throat (ENT) medical records, in order to reduce the manual workload in the retrieval and digitization process. Method The system, based on an eHealth technology named cognitive computing , interprets medical reports to transform unstructured clinical data (e.g., narrative text) into a structured digital format. The system has been tailored to handle the reports of aged cochlear implant (CI) patients by digitizing the information typically requested in electronic CI registries and by the current ENT/audiology guidelines. Results were obtained from the reports generated by an outpatient ENT care service from 52 older adult CI patients. Results The system allowed a quick and automated interpretation and retrieval of all the information required, such as the patient's medical history, risk factors, examination outcomes, communicative performances before and after CI implantation, and CI settings. The accuracy of the system in correctly interpreting and retrieving the above information from the original unstructured medical reports was very good (recall = 0.78; precision = 0.95). The system allowed to reduce the time needed to manually digitize the information from 20-30 min/report to only 20 s/report. Conclusion The proposed system is a viable solution for the automated digitization of unstructured health data as recommended by the ENT/audiology clinical best practices.

[Figure: see text].

In this paper, the exposure of a child to a hairdryer model is evaluated. Nowadays, the assessment of children exposure to near-field sources has become in fact a topic of high interest, because it was found that even domestic appliances could be relevant for children exposure level. Therefore, the aim of the present work is to use a method based on stochastic dosimetry to assess the exposure variability due to near-field sources, not limiting it only on some worst-case exposure scenario. In particular, electric field amplitudes induced in specific tissues composing the central nervous system and the peripheral nervous system (following the ICNIRP guidelines) were analyzed. The results highlight a high exposure variability depending on the hairdryer position in respect with the child.

In the last few years, the use of nanoparticles for therapeutic applications has attracted the interest of many scientists, who are looking for effective methods to target nanoparticles linked to drugs directly to the diseased organs. Among them, magnetic targeting consists of magnetic systems (magnets or coils) which can impress high gradient magnetic fields and then magnetic forces on the magnetic nanoparticles. Despite some studies have reported an effective improvement in drug delivery by using this technique, there is still a paucity of studies able to quantify and explain the experimental results. In this scenario, "in silico" models allow to analyze and compare different magnetic targeting systems in their ability to generate the required magnetic field gradient for specific human targets.In this paper we then evaluated, by means of computational electromagnetics techniques, the attitude of various ad-hoc designed magnetic systems in targeting the heart tissues of differently aged human anatomical models.

Characterization of children exposure to extremely low frequency (ELF) magnetic fields is an important issue because of the possible correlation of leukemia onset with ELF exposure. Cluster analysis-a Machine Learning approach-was applied on personal exposure measurements from 977 children in France to characterize real-life ELF exposure scenarios. Electric networks near the child's home or school were considered as environmental factors characterizing the exposure scenarios. The following clusters were identified: children with the highest exposure living 120⁻200 m from 225 kV/400 kV overhead lines; children with mid-to-high exposure living 70⁻100 m from 63 kV/150 kV overhead lines; children with mid-to-low exposure living 40 m from 400 V/20 kV substations and underground networks; children with the lowest exposure and the lowest number of electric networks in the vicinity. 63⁻225 kV underground networks within 20 m and 400 V/20 kV overhead lines within 40 m played a marginal role in differentiating exposure clusters. Cluster analysis is a viable approach to discovering variables best characterizing the exposure scenarios and thus it might be potentially useful to better tailor epidemiological studies. The present study did not assess the impact of indoor sources of exposure, which should be addressed in a further study.

Exposure to radiofrequency (RF) electromagnetic fields (EMFs) in indoor environments depends on both outdoor sources such as radio, television and mobile phone antennas and indoor sources, such as mobile phones and wireless communications applications. Establishing the levels of exposure could be challenging due to differences in the approaches used in different studies. The goal of this study is to present an overview of the last ten years research efforts about RF EMF exposure in indoor environments, considering different RF-EMF sources found to cause exposure in indoor environments, different indoor environments and different approaches used to assess the exposure. The highest maximum mean levels of the exposure considering the whole RF-EMF frequency band was found in offices (1.14 V/m) and in public transports (0.97 V/m), while the lowest levels of exposure were observed in homes and apartments, with mean values in the range 0.13⁻0.43 V/m. The contribution of different RF-EMF sources to the total level of exposure was found to show slightly different patterns among the indoor environments, but this finding has to be considered as a time-dependent picture of the continuous evolving exposure to RF-EMF.

Mutations in GJB2, the gene that encodes connexin 26 (Cx26), are the most common cause of sensorineural hearing impairment. The truncating variant 35delG, which determines a complete loss of Cx26 protein function, is the prevalent GJB2 mutation in several populations. Here, we generated and analyzed Gjb2 +/- mice as a model of heterozygous human carriers of 35delG. Compared to control mice, auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAEs) worsened over time more rapidly in Gjb2 +/- mice, indicating they were affected by accelerated age-related hearing loss (ARHL), or presbycusis. We linked causally the auditory phenotype of Gjb2 +/- mice to apoptosis and oxidative damage in the cochlear duct, reduced release of glutathione from connexin hemichannels, decreased nutrient delivery to the sensory epithelium via cochlear gap junctions and deregulated expression of genes that are under transcriptional control of the nuclear factor erythroid 2-related factor 2 (Nrf2), a pivotal regulator of tolerance to redox stress. Moreover, a statistically significant genome-wide association with two genes (PRKCE and TGFB1) related to the Nrf2 pathway (p-value < 4 × 10 -2 ) was detected in a very large cohort of 4091 individuals, originating from Europe, Caucasus and Central Asia, with hearing phenotype (including 1076 presbycusis patients and 1290 healthy matched controls). We conclude that (i) elements of the Nrf2 pathway are essential for hearing maintenance and (ii) their dysfunction may play an important role in the etiopathogenesis of human presbycusis., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: This introduction overviews this special issue on the Hearing Across the Lifespan (HEAL) conference, which was held in Cernobbio, Italy, June 2-4, 2016.

Purpose: The aim of the study was to analyze, by using the ALFA4Hearing model (At-a-Glance Labeling for Features of Apps for Hearing Health Care), a sample of apps over a wide range of services in the hearing health care (HHC) domain in order to take a first picture of the current scenario of apps for HHC., Method: We tested 120 apps, and we characterized them by using the ALFA4Hearing model, which includes 29 features in 5 components (Promoters, Services, Implementation, Users, and Descriptive Information). We analyzed (a) the distribution of the 29 features in the sample, (b) the relationship between the Implementation features and the Services provided by the apps, and (c) the distribution of the 29 features in apps for professional use., Results: The analysis of our sample of apps by means of the ALFA4Hearing model highlighted interesting trends and emerging challenges. Also, results suggested many potential opportunities for research and clinical practice, such as greater involvement of stakeholders, improved evidence base, higher technical quality, and usability., Conclusions: The ALFA4Hearing model is able to represent, at a glance, a large amount of information about apps for HHC, highlighting trends and challenges. It might be useful to HHC professionals as a basis for app characterization and informed decision making.

Objective: To perform a review of recent research in clinical data reuse or secondary use, and envision future advances in this field. Methods: The review is based on a large literature search in MEDLINE (through PubMed), conference proceedings, and the ACM Digital Library, focusing only on research published between 2005 and early 2016. Each selected publication was reviewed by the authors, and a structured analysis and summarization of its content was developed. Results: The initial search produced 359 publications, reduced after a manual examination of abstracts and full publications. The following aspects of clinical data reuse are discussed: motivations and challenges, privacy and ethical concerns, data integration and interoperability, data models and terminologies, unstructured data reuse, structured data mining, clinical practice and research integration, and examples of clinical data reuse (quality measurement and learning healthcare systems). Conclusion: Reuse of clinical data is a fast-growing field recognized as essential to realize the potentials for high quality healthcare, improved healthcare management, reduced healthcare costs, population health management, and effective clinical research., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart.)

Background: The aim of this study was to evaluate the state of implementation of the Universal Newborn Hearing Screening Programs in Italy and to determine the effect that an ad hoc legislation may have on the percentage of infants screened for detection of hearing impairment in nurseries., Material and Methods: Italian Newborn Hearing Screening data were obtained during four national surveys (years 2003, 2006, 2008, and 2011). The screening rates obtained by the Regions which adopted or did not adopt a legislation to increase the newborns' coverage were compared., Results: In 2011, the average coverage rate was 78.3%, but in 12 out of 20 Regions it exceeded 95%. Coverage rate was greater in Regions that implemented an ad hoc legislation compared to Regions that did not. As a matter of fact, Regions which passed the legislation screened more than 95% of infants, whereas Regions without legislation reported a mean screening rate of nearly 67% of newborns., Conclusion: Current results seem to confirm that a specific legislation might have a decisive effect on the increase of rate of coverage of newborn hearing screenings.

Information extraction from narrative clinical notes is useful for patient care, as well as for secondary use of medical data, for research or clinical purposes. Many studies focused on information extraction from English clinical texts, but less dealt with clinical notes in languages other than English. This study tested the feasibility of using "off the shelf" information extraction algorithms to identify medical concepts from Italian clinical notes. Among all the available and well-established information extraction algorithms, we used MetaMap to map medical concepts to the Unified Medical Language System (UMLS). The study addressed two questions: (Q1) to understand if it would be possible to properly map medical terms found in clinical notes and related to the semantic group of "Disorders" to the Italian UMLS resources; (Q2) to investigate if it would be feasible to use MetaMap as it is to extract these medical concepts from Italian clinical notes. We performed three experiments: in EXP1, we investigated how many medical concepts of the "Disorders" semantic group found in a set of clinical notes written in Italian could be mapped to the UMLS Italian medical sources; in EXP2 we assessed how the different processing steps used by MetaMap, which are English dependent, could be used in Italian texts to map the original clinical notes on the Italian UMLS sources; in EXP3 we automatically translated the clinical notes from Italian to English using Google Translator, and then we used MetaMap to map the translated texts. Results in EXP1 showed that the Italian UMLS Metathesaurus sources covered 91% of the medical terms of the "Disorders" semantic group, as found in the studied dataset. We observed that even if MetaMap was built to analyze texts written in English, most of its processing steps worked properly also with texts written in Italian. MetaMap identified correctly about half of the concepts in the Italian clinical notes. Using MetaMap's annotation on Italian clinical notes instead of a simple text search improved our results of about 15 percentage points. MetaMap's annotation of Italian clinical notes showed recall, precision and F-measure equal to 0.53, 0.98 and 0.69, respectively. Most of the failures were due to the impossibility for MetaMap to generate meaningful variants for the Italian language, suggesting that modifying MetaMap to allow generating Italian variants could improve the performance. MetaMap's performance in annotating automatically translated English clinical notes was in line with findings in the literature, with similar recall (0.75), F-measure (0.83) and even higher precision (0.95). Most of the failures were due to a bad Italian to English translation of medical terms, suggesting that using an automatic translation tool specialized in translating medical concepts might be useful to obtain better performances. In conclusion, performances obtained using MetaMap on the fully automatic translation of the Italian text are good enough to allow to use MetaMap "as it is" in clinical practice., (Copyright © 2016 Elsevier Inc. All rights reserved.)