PURPOSE:Cisplatin treats many common tumors but causes permanent and debilitating hearing loss (HL). The objective of this study was to develop and externally validate a predictive model of HL in cisplatin-treated children and adolescent cancer survivors. METHODS:The Pediatric Holistic Evaluation of Auditory Risk (PedsHEAR) model architecture used several machine learning approaches followed by an ensemble predictor. The primary end point was post-treatment communication-affecting HL (International Society of Pediatric Oncology Ototoxicity Scale [SIOP] Grade ≥2). PedsHEAR was developed from a multicenter data set of cisplatin-exposed patients up to 21 years old (1984-2017) and externally validated using data from the Children's Oncology Group ACCL05C1 study (2007-2012) and two combined institutional cohorts (1988-2022). The model predicts post-treatment HL in each patient (probability [%], 95% CI) and classifies patients as low, intermediate, or high risk for HL (probability HL <0.33, 0.33-0.60, >0.60, respectively). RESULTS:In the training data set (n = 1,115, median age 6.3 years, SIOP Grade ≥2 HL 44%), PedsHEAR demonstrated excellent discrimination (AUC, 0.93 [95% CI, 0.92 to 0.95]) and then successfully validated within the internal (testing; AUC, 0.79 [95% CI, 0.74 to 0.85]) and two external validation cohorts (AUC, 0.74 and AUC, 0.67). In an aggregate validation cohort (n = 631), the model predicted the probability of HL (AUC, 0.76 [95% CI, 0.72 to 0.79]) and classified 22% (141/631), 71% (447/631), and 7% (43/631) of patients as low, intermediate, or high risk for HL. CONCLUSION:PedsHEAR predicted SIOP Grade ≥2 HL in pediatric cisplatin-treated patients. This is the first validated model to successfully predict cisplatin-induced HL in a broadly representative population treated with diverse regimens across a range of treatment settings.

Wright, Michael; Hendrix, Ashley MD; Raudat, Madeline MD; Whitaker, Joseph J MD; Fleming, Martin Douglas MD, FACS Author Information

Erratum: After publication of the article,1Cohen-Cutler S Wong K Mena V et al.Hearing Loss Risk in Pediatric Patients Treated with Cranial Irradiation and Cisplatin-Based Chemotherapy.Int J Radiat Oncol Biol Phys. 2021; 110: 1488-1495https://doi.org/10.1016/j.ijrobp.2021.02.050Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar the authors noticed multiple transcriptional errors were introduced into Table 3. These consisted of the values reported for ethnicity within the univariable analysis, the odds ratio for age in the final multivariable model, and several small changes to boundaries of the confidence intervals. The typographical corrections to Table 3 do not alter the significance of any variables reported in the final model nor any of the interpretation or conclusions from the report. The corrected Table 3 is shown below.Table 3Multivariable model of hearing loss SIOP Grade ≥2CovariablesUnivariable AnalysisMultivariable analysis*Stepwise forward selection, retention α < 0.15, and significance P < .05 (see Methods and Materials).OR95% CIp-valueOR95% CIp-valueAge, per 5 years0.430.30-0.61<.0010.760.45-1.30.322Sex FemaleReference--- Male0.960.50-1.82.891---Ethnicity Not Hispanic or Latino†Excludes 1 unknown patient/2 ears.Reference--- Hispanic or Latin1.810.95-3.46.070---Diagnosis Non-CNS tumorReference--- CNS tumor0.650.24-1.79.406---Cisplatin dose, per 100mg/m21.020.77-1.35.9070.850.59-1.22.365RT prior to cisplatin NoReference--- Yes0.390.21-0.76.005---Treatment with aBMT NoReference--- Yes7.253.32-15.85<.00110.473.29-33.34<.001Time to audiology, years1.341.15-1.56<.0011.421.15-1.76.001Minimum RT dose,per +10 Gy1.120.80-1.57.4991.641.02-2.65.043Abbreviations: aBMT = autologous bone marrow transplant; CI = confidence interval; CNS = central nervous system; OR = odds ratio; RT = radiation therapy; SIOP = International Society of Pediatric Oncology. Data are from 161 ears. There were 16 patients without sufficient ear-specific testing to determine the SIOP grade. Stepwise forward selection, retention α < 0.15, and significance P < .05 (see Methods and Materials).† Excludes 1 unknown patient/2 ears. Open table in a new tab Abbreviations: aBMT = autologous bone marrow transplant; CI = confidence interval; CNS = central nervous system; OR = odds ratio; RT = radiation therapy; SIOP = International Society of Pediatric Oncology. Data are from 161 ears. There were 16 patients without sufficient ear-specific testing to determine the SIOP grade. The text associated with Table 3 similarly should have read (changes bolded): "Multivariable analysis (Table 3) showed that after accounting for cisplatin dose and other covariables, the risk for developing moderate/severe hearing loss (SIOP grade ≥2) increased with every 10 Gy of exposure to the cochlea (odds ratio [OR] = 1.64; 95% confidence interval [95% CI], 1.02-2.65; P = .043). In the model, aBMT was also a significant predictor of hearing loss after adjusting for dose of RT (OR = 10.47; 95% CI, 3.29- 33.34; P < .001), as was the time from RT to audiology assessment (OR = 1.42; 95% CI, 1.15-1.76; P = .001)". The authors regret that these errors were introduced into the Table and would like to sincerely apologize for any inconvenience this may have caused. We appreciate the opportunity to make these changes to ensure the correct data is reported in the literature. Hearing Loss Risk in Pediatric Patients Treated with Cranial Irradiation and Cisplatin-Based ChemotherapyInternational Journal of Radiation Oncology, Biology, PhysicsVol. 110Issue 5PreviewCranial radiation therapy (RT) and cisplatin-based chemotherapy are essential to treating many pediatric cancers but cause significant ototoxicity. The objective of this study is to determine the relationship between the RT dose and the risk of subsequent hearing loss in pediatric patients treated with cisplatin. Full-Text PDF

PURPOSE:Cranial radiation therapy (RT) and cisplatin-based chemotherapy are essential to treating many pediatric cancers but cause significant ototoxicity. The objective of this study is to determine the relationship between the RT dose and the risk of subsequent hearing loss in pediatric patients treated with cisplatin.METHODS AND MATERIALS:This retrospective study of cisplatin-treated pediatric patients examined ototoxicity from cranial RT. Ototoxicity was graded for each ear according to the International Society of Pediatric Oncology (SIOP) consensus ototoxicity scale. The RT dose to the cochlea was calculated using the mean, median, maximum, and minimum dose received to determine the most predictive parameter for hearing loss. Multivariable logistic regression models then examined risk factors for hearing loss.RESULTS:In 96 children (161 ears) treated with RT + cisplatin, the minimum cochlear RT dose was most predictive of hearing loss. A higher cochlear RT dose was associated with increased hearing loss (odds ratio per 10 Gy dose increase = 1.64; P = .043), with an added risk in those receiving an autologous bone marrow transplantation (hazard ratio = 10.47; P < .001).CONCLUSIONS:This research supports further testing of the minimum cochlear RT dose as a more predictive dose parameter for risk of ototoxicity. The cochlear RT dose was additive to the risk of hearing loss from underlying cisplatin-based chemotherapy. Exposure to autologous bone marrow transplantation was the strongest predictor of developing hearing loss, placing these children at particularly high risk for hearing loss across all cochlear doses. Future prospective studies are crucial to further inform RT dose thresholds and minimize the risk of hearing loss in childhood cancer survivors.

Background Cisplatin is used to treat a wide range of childhood cancers and cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity. We aimed to address persistent knowledge gaps in CIHL by establishing benchmarks for the prevalence of and risk factors for CIHL. Methods In this multi-institutional cohort study, children (age 0-14 years), adolescents, and young adults (age 15-39 years) diagnosed with a cisplatin-treated tumour from paediatric cancer centres, who had available cisplatin dosing information, and primary audiology data for central review from consortia located in Canada and the USA were eligible for inclusion. Audiology was centrally reviewed and CIHL graded using the consensus International Society of Pediatric Oncology (SIOP) Boston Ototoxicity Scale. We assessed the prevalence of moderate or severe CIHL (SIOP grade >= 2) at latest follow-up and end of therapy, in each demographic, diagnosis, and treatment group and their relative contributions to risk for CIHL. Secondary endpoints explored associations of cisplatin dose reductions and CIHL with survival. We also examined whether cisplatin dose reductions and CIHL were associated with survival outcomes. Findings We included 1481 patients who received cisplatin. Of the 1414 (95.5%) participants who had audiometry at latest follow-up (mean 3.9 years [SD 4.2] since diagnosis), 620 (43.8%) patients developed moderate or severe CIHL. The highest prevalence of CIHL was seen in the youngest patients (aged <5 years; 360 [59.4%] of 606 patients) and those with a CNS tumour (221 [50.9%] of 434 patients), hepatoblastoma (110 [65.9%] of 167 patients), or neuroblastoma (154 [62.1%] of 248 patients). After accounting for cumulative cisplatin dose, higher fractionated doses were associated with risk for CIHL (for each 10 mg/m(2) increase per day, adjusted odds ratio [aOR] 1.15 [95% CI 1.07-1.25]; for each 50 mg/m(2) increase per cycle aOR 2.16 [1.37-3.51]). Vincristine exposure was newly identified as a risk factor for CIHL (aOR 3.55 [2.19-5.84]). Dose reductions and moderate or severe CIHL were not significantly associated with survival differences. Interpretation Using this large, multicentre cohort, benchmarks were established for the prevalence of CIHL in patients treated with cisplatin. Variations in cisplatin dosing confer additive risk for developing CIHL and warrant investigation as a potential approach to decrease the burden of therapy. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

BACKGROUND:Veterans with posttraumatic stress disorder (PTSD) have low employment rates and the job interview presents a critical barrier for them to obtain competitive employment.OBJECTIVE:To evaluate the acceptability and efficacy of virtual reality job interview training (VR-JIT) among veterans with PTSD via a small randomized controlled trial (n=23 VR-JIT trainees, n=10 waitlist treatment-as-usual (TAU) controls).METHODS:VR-JIT trainees completed up to 10 hours of simulated job interviews and reviewed information and tips about job interviewing, while wait-list TAU controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews scored by blinded human resource experts and self-reported interviewing self-confidence.RESULTS:Trainees attended 95% of lab-based VR-JIT sessions and found the intervention easy-to-use, helpful, and prepared them for future interviews. VR-JIT trainees demonstrated significantly greater improvement on role-play interviews compared with wait-list TAU controls (p=0.04) and demonstrated a large effect for within-subject change (Cohen's d=0.76). VR-JIT performance scores increased significantly over time (R-Squared=0.76). Although VR-JIT trainees showed a moderate effect for within-subject change on self-confidence (Cohen's d=0.58), the observed difference between conditions did not reach significance (p=0.09).CONCLUSIONS:Results provide preliminary support that VR-JIT is acceptable to trainees and may be efficacious for improving job interview skills and self-confidence in veterans with PTSD.

Young adults with high-functioning autism spectrum disorder (ASD) have low employment rates and job interviewing presents a critical barrier to employment for them. Results from a prior randomized controlled efficacy trial suggested virtual reality job interview training (VR-JIT) improved interviewing skills among trainees with ASD, but not controls with ASD. We conducted a brief survey with 23 of 26 participants from this study to evaluate their vocational outcomes at 6-month follow-up with a focus on whether or not they attained a competitive position (employment or competitive volunteering). Logistic regression indicated VR-JIT trainees had greater odds of attaining a competitive position than controls (OR 7.82, p < 0.05). Initial evidence suggests VR-JIT is a promising intervention that enhances vocational outcomes among young adults with high-functioning ASD.

Background: Individuals with schizophrenia have low employment rates and the job interview presents a critical barrier for them to obtain employment. Virtual reality training has demonstrated efficacy at improving interview skills and employment outcomes among multiple clinical populations. However, the effects of this training on individuals with schizophrenia are unknown. This study evaluated the efficacy of virtual reality job interview training (VR-JIT) at improving job interview skills and employment outcomes among individuals with schizophrenia in a small randomized controlled trial (n = 21 VR-JIT trainees, n = 11 waitlist controls).Methods: Trainees completed up to 10 h of virtual interviews using VR-JIT, while controls received services as usual. Primary outcome measures included two pre-test and two post-test video-recorded role-play interviews scored by blinded raters with expertise in human resources and self-reported interviewing self-confidence. Six-month follow-up data on employment outcomes were collected.Results: Trainees reported that the intervention was easy-to-use, helpful, and prepared them for future interviews. Trainees demonstrated increased role-play scores between pre-test and post-test while controls did not (p = 0.001), After accounting for neurocognition and months since prior employment, trainees had greater odds of receiving a job offer by 6 month follow-up compared to controls (OR: 8.73, p = 0.04) and more training was associated with fewer weeks until receiving a job offer (r = -0.63, p < 0.001).Conclusions: Results suggest that VR-JIT is acceptable to trainees and may be efficacious for improving job interview skills in individuals with schizophrenia. Moreover, trainees had greater odds of receiving a job offer by 6-month follow-up. Future studies could evaluate the effectiveness of VR-JIT within community-based services. (C) 2015 Elsevier B.V. All tights reserved.

OBJECTIVE:Individuals with severe mental illness have low employment rates, and the job interview presents a critical barrier for them to obtain competitive employment. Prior randomized controlled trials (RCTs) indicated that virtual reality job interview training (VR-JIT) improved job interviewing skills among trainees. This study assessed whether VR-JIT participation was associated with greater odds of receiving job offers in the six-months after completion of training.METHODS:To assess the efficacy of VR-JIT, trainees (N=39) in the method and a comparison group (N=12) completed a brief survey approximately six months after participating in the RCTs. Primary vocational outcome measures included receiving a job offer and number of weeks searching for employment.RESULTS:A larger proportion of trainees than comparison participants received a job offer (51% versus 25%, respectively). Trainees were more likely to receive a job offer than comparison participants (odds ratio=9.64, p=.02) after analyses accounted for cognition, recency of last job, and diagnosis. Trainees had greater odds of receiving a job offer for each completed VR-JIT trial (odds ratio=1.41, p=.04), and a greater number of completed VR-JIT trials predicted fewer weeks of searching for employment (β=-.74, p=.02).CONCLUSIONS:Results provide preliminary support that VR-JIT is a promising intervention associated with enhanced vocational outcomes among individuals with severe mental illness. Given that participants had minimal access to standardized vocational services, future research could evaluate the effectiveness of VR-JIT among individuals with and without access to standardized vocational services as well as evaluate strategies to implement VR-JIT within a large community mental health service provider.

The jews-harp is a distinctive musical instrument of international importance, yet it remains one of those musical instruments, like the ocarina, kazoo or even the art of whistling, that travels beneath the established musical radar. The story of the jews-harp is also part of our musical culture, though it has attracted relatively little academic study. Britain and Ireland played a significant role in the instrument's manufacture and world distribution, particularly during the nineteenth and first half of the twentieth centuries. Drawing upon previously unknown written sources and piecing together thousands of fragments of information spanning hundreds of years, Michael Wright tells the story of the jews-harp's long history in the Britain and Ireland. Beginning with an introductory chapter describing the instrument, Part One looks at the various theories of its ancient origin, how it came to be in Europe, terminology, and its English name. Part Two explores its commercial exploitation and the importance of the export market in the development of manufacturing. Part Three looks the instrument's appearance and use in art, literature and the media, finally considering the many players who have used the instrument throughout its long history.

Services are available to help support existing employment for individuals with psychiatric disabilities; however, there is a gap in services targeting job interview skills that can help obtain employment. We assessed the feasibility and efficacy of Virtual Reality Job Interview Training (VR-JIT) in a randomized controlled trial. Participants were randomized to VR-JIT (n = 25) or treatment-as-usual (TAU) (n = 12) groups. VR-JIT consisted of 10 hours of simulated job interviews with a virtual character and didactic online training. The participants attended 95% of laboratory-based training sessions and found VR-JIT easy to use and felt prepared for future interviews. The VR-JIT group improved their job interview role-play performance (p <= 0.05) and self-confidence (p <= 0.05) between baseline and follow-up as compared with the TAU group. VR-JIT performance scores increased over time (R-2 = 0.65). VR-JIT demonstrated initial feasibility and efficacy at improving job interview skills and self-confidence. Future research may help clarify whether this intervention is efficacious in community-based settings.

Building on literature related to selling and embodied conversational agents (ECA), this research seeks to determine how the use of an ECA might improve users’ perceptions of shopping value (hedonic and utilitarian) and the consequences for their purchase intentions and satisfaction with the website. This analysis focuses specifically on three ECA usage consequences: playfulness, decision quality, and social presence. Hedonic value mediates the effects of playfulness and social presence on satisfaction and behavioral intentions; utilitarian shopping value mediates the effects of decision quality. The results highlight the importance of accounting for both utilitarian and hedonic features to understand ECA outputs in e-commerce sites.

The feasibility and efficacy of virtual reality job interview training (VR-JIT) was assessed in a single-blinded randomized controlled trial. Adults with autism spectrum disorder were randomized to VR-JIT (n = 16) or treatment-as-usual (TAU) (n = 10) groups. VR-JIT consisted of simulated job interviews with a virtual character and didactic training. Participants attended 90 % of laboratory-based training sessions, found VR-JIT easy to use and enjoyable, and they felt prepared for future interviews. VR-JIT participants had greater improvement during live standardized job interview role-play performances than TAU participants (p = 0.046). A similar pattern was observed for self-reported self-confidence at a trend level (p = 0.060). VR-JIT simulation performance scores increased over time (R(2) = 0.83). Results indicate preliminary support for the feasibility and efficacy of VR-JIT, which can be administered using computer software or via the internet.

Prior to the nineteenth century, written references to the Jew's harp are scarce and mention Of named players is extremely rare. One source, however, that describes individuals and their circumstances can be found in criminal trial records. In fact, the first three players of the instrument whom we can definitely identify were tried, convicted, and executed for one crime or another. That the accused were associated with the Jew's harp was coincidental and it had nothing to do with their convictions, but it was considered sufficiently unusual to be noted at their trials. This article considers what we know about the trials and how confident we can be that the information contained in court records and contemporaneous written accounts is correct. It also looks at the historical context in which each of the accused lived and the circumstances of their arrest, and how and why the Jew's harp was mentioned at the trial. It explores what tunes might have been played, how much Jew's harps might have cost and where they could have been purchased, and describes archaeological finds that show the kinds of instruments available. The overall evidence suggests that the Jew's harp was a widely distributed musical instrument throughout the period, hut that exceptional performance skills on it were sufficiently unusual to invite comment.

SUMMARY This article discusses how new or emerging city forms present fresh challenges and opportunities for caregiving agencies and institutions. It describes how tapping the resources and assets of inner cities can revitalize the capacity of the community. The way in which religious institutions, traditional social service agencies, and informal caregivers can work together to provide care is explored.

This edition of the Journal has included a series of articles on the contemporary man in his elder years and the challenges and opportunities he may face. For example, an article by Bullock brings attentions to the increasing number of grandfathers who are becoming responsible for their grandchildren in the absence of fathers. Her study of 26 men age 65 and above who are responsible for the care of at least one grandchild revealed perceptions of powerlessness as grandfathers made this family role transition. Bullock argues that such feelings of powerlessness can be stemmed by programs that provide opportunities for greater self-awareness and support. She also raises questions about the grandfathers' parenting style: Are they interactive care providers or simply passive caretakers? Another issue raised is how schools and agencies involved in kinship care can pay special attention to older men who take on the role of parenting.