Cognitive methods for assessing mental energy

Predictors of Listening-Related Fatigue in Adolescents With Hearing Loss

PURPOSE

Self-reported listening-related fatigue in adolescents with hearing loss (HL) was investigated. Specifically, the extent to which listening-related fatigue is associated with school accommodations, audiologic characteristics, and listening breaks was examined.

METHOD

Participants were 144 adolescents with HL ages 12-19 years. Data were collected online via Qualtrics. The Vanderbilt Fatigue Scale-Child was used to measure listening-related fatigue. Participants also reported on their use of listening breaks and school accommodations, including an Individualized Education Program (IEP) or 504 plan, remote microphone systems, closed captioning, preferential seating, sign language interpreters, live transcriptions, and notetakers.

RESULTS

After controlling for age, HL laterality, and self-perceived listening difficulty, adolescents with an IEP or a 504 plan reported lower listening-related fatigue compared to adolescents without an IEP or a 504 plan. Adolescents who more frequently used remote microphone systems or notetakers reported higher listening-related fatigue compared to adolescents who used these accommodations less frequently, whereas increased use of a sign language interpreter was associated with decreased listening-related fatigue. Among adolescents with unilateral HL, higher age was associated with lower listening-related fatigue; no effect of age was found among adolescents with bilateral HL. Listening-related fatigue did not differ based on hearing device configuration.

CONCLUSIONS

Adolescents with HL should be considered at risk for listening-related fatigue regardless of the type of hearing devices used or the degree of HL. The individualized support provided by an IEP or 504 plan may help alleviate listening-related fatigue, especially by empowering adolescents with HL to be self-advocates in terms of their listening needs and accommodations in school. Additional research is needed to better understand the role of specific school accommodations and listening breaks in addressing listening-related fatigue.

Alignment of Consumers' Expected Brain Benefits from Food and Supplements with Measurable Cognitive Performance Tests

Consumers often cite cognitive improvements as reasons for making dietary changes or using dietary supplements, a motivation that if leveraged could greatly enhance public health. However, rarely is it considered whether standardized cognitive tests that are used in nutrition research are aligned to outcomes of interest to the consumer. This knowledge gap presents a challenge to the scientific substantiation of nutrition-based cognitive health benefits. Here we combined focus group transcript review using reflexive thematic analysis and a multidisciplinary expert panel exercise to evaluate the applicability of cognitive performance tools/tasks for substantiating the specific cognitive benefits articulated by consumers with the objectives to (1) understand how consumers comprehend the potential benefits of nutrition for brain health, and (2) determine the alignment between consumers desired brain benefits and validated tests and tools. We derived a 'Consumer Taxonomy of Cognitive and Affective Health in Nutrition Research' which describes the cognitive and affective structure from the consumers perspective. Experts agreed that validated tests exist for some consumer benefits including focused attention, sustained attention, episodic memory, energy levels, and anxiety. Prospective memory, flow, and presence represented novel benefits that require the development and validation of new tests and tools. Closing the gap between science and consumers and fostering co-creative approaches to nutrition research are critical to the development of products and dietary recommendations that support realizable cognitive benefits that benefit public health.

Multidimensional Model of Energy in Patients With Cancer

OBJECTIVES

Evidence suggests that energy is a distinct symptom from fatigue in patients with cancer. The purpose of this paper is to present the Multidimensional Model of Energy in Patients with Cancer (MMEPC) that is based on emerging evidence and to make recommendations for clinical practice and future research.

METHODS

The literature was reviewed to determine various factors associated with variations in energy in patients with cancer. In addition, some of the emerging evidence in the model is supported by studies of energy in the general population and in patients with other chronic conditions.

RESULTS

Based on a review of the literature, specific concepts in the MMEPC include: person factors, clinical factors, cancer-related factors, biological factors, factors associated with energy balance, and co-occurring symptoms. The evidence to support the association between each of these factors and variations in energy levels in patients with cancer is described and synthesized.

CONCLUSION

This article provides emerging evidence on factors that influence variations in energy levels in patients with cancer. While the fundamental biobehavioral and biologic mechanisms that underlie variations in energy levels are not well understood, the model can be used to design pre-clinical and clinical studies of energy in patients with cancer. In addition, while emerging evidence supports the hypothesis that fatigue and energy are distinct symptoms, additional research on common and distinct risk factors and underlying mechanisms is warranted to be able to develop and test precision interventions for one or both symptoms.

IMPLICATIONS FOR NURSING PRACTICE

The risk factors (eg, being female, sleep quality) associated with variations in energy levels in patients with cancer identified in this paper have important clinical implications. Clinicians can use the identified risk factors to guide their assessments; identify high-risk patients with decrements in energy decrement; and develop targeted energy conservation interventions for the patients.

Developing a novel energy-based approach for measuring mental workload

Minimal research has been conducted to develop non-invasive processes for quantifying and evaluating worker mental workload - a critical concern - at the task level in the construction industry. One reason for this gap in research is the complex and dynamic nature of the construction process, which makes construction work more complicated to measure and predict compared to work in other industries. This paper presents a novel approach and corresponding conceptual model to quantify and evaluate construction worker perception of mental workload at the task level using the energy concept. A conceptual process for assessing mental workload (MWL), i.e., the feeling of stress, pressure, and being overwhelmed due to the task nature, factors, conditions, and resources that accompany the performance of the task, was developed from extant research and interviews. The Delphi method was utilized to characterize the energy-based model and provide initial verification. The results from the literature review, expert insight, and four rounds of the Delphi survey revealed 14 constituents, 51 components, and one metric for each component to measure the level of MWL felt by a worker. These constituents, components, and metrics were used to develop a model for measuring construction worker MWL. This study contributes to knowledge by developing a novel non-invasive method for assessing potential task-level MWL using an energy-based model. The energy-based assessment model contributes to practice by providing a tool that could be used to measure the potential impact of construction tasks on workers perceived mental workload.

The Role of Dietary Ingredients in Mental Energy - A Scoping Review of Randomized Controlled Trials

Low mental energy can contribute to decreased productivity, altered life balance, decreased physical performance, and ultimately affect quality of life. As such, there is a great demand for food and beverage products that positively impact mental energy. Numerous products claim to alter mental energy making continued review of the scientific evidence critical. The objective of this study was to conduct a scoping review of randomized controlled trials to evaluate the effect of 18 dietary ingredients on mental energy outcomes in adults without severe disease. Methods: A literature search, completed using PubMed, resulted in the identification of 2261 articles, 190 of which met eligibility from initial abstract review. Full-text review was completed on the 190 studies which resulted in 101 articles that fully met eligibility for inclusion in this study. The search strategy for two ingredients did not yield any eligible studies, leaving studies for 16 ingredients that were extracted and summarized by reported significantly improved outcomes for cognition, mood and perceived feelings, and sleep assessments. The preliminary results for several dietary ingredients directionally suggested a mental energy benefit (≥20% of outcomes), including ashwagandha, chamomile, dark chocolate, ginseng, green tea, lavender, lion's mane mushroom, maca, tart cherries, turmeric, and valerian root. The results of this scoping review suggest that of the 16 dietary ingredients reviewed, 11 may be promising for further exploration on their potential benefits in supporting mental energy. Given consumer demand and market growth for food and beverage products that positively impact mental energy; continued efforts in assessment method alignment and additional evaluation in well-designed trials is warranted.KEY TEACHING POINTSOf the 16 dietary ingredients reviewed, 11 (ashwagandha, chamomile, dark chocolate, ginseng, green tea, lavender, lion's mane mushroom, maca, melatonin foods, turmeric, and valerian root) may be promising for further exploration on their potential mental energy benefits.Dark chocolate, ginseng, ashwagandha, and lion's mane mushroom were the most promising ingredients for further evaluation in the cognition domain of the ingredients evaluated.Turmeric, maca, lavendar, and ashwagandha were the most promising ingredients for further evaluation in the mood and perceived feelings domain of the ingredients evaluated.Ashwagandha, chamomile, green tea, melatonin foods, valerian root were the most promising ingredients for further evaluation in the sleep domain of the ingredients evaluated.Additional, well-designed, consistent, clinical trials and systematic reviews are warranted as the challenge of heterogeneity in mental energy study design remains.

The Impact of Hearing Aids on Listening Effort and Listening-Related Fatigue - Investigations in a Virtual Realistic Listening Environment

Participation in complex listening situations such as group conversations in noisy environments sets high demands on the auditory system and on cognitive processing. Reports of hearing-impaired people indicate that strenuous listening situations occurring throughout the day lead to feelings of fatigue at the end of the day. The aim of the present study was to develop a suitable test sequence to evoke and measure listening effort (LE) and listening-related fatigue (LRF), and, to evaluate the influence of hearing aid use on both dimensions in mild to moderately hearing-impaired participants. The chosen approach aims to reconstruct a representative acoustic day (Time Compressed Acoustic Day [TCAD]) by means of an eight-part hearing-test sequence with a total duration of approximately 2½ h. For this purpose, the hearing test sequence combined four different listening tasks with five different acoustic scenarios and was presented to the 20 test subjects using virtual acoustics in an open field measurement in aided and unaided conditions. Besides subjective ratings of LE and LRF, behavioral measures (response accuracy, reaction times), and an attention test (d2-R) were performed prior to and after the TCAD. Furthermore, stress hormones were evaluated by taking salivary samples. Subjective ratings of LRF increased throughout the test sequence. This effect was observed to be higher when testing unaided. In three of the eight listening tests, the aided condition led to significantly faster reaction times/response accuracies than in the unaided condition. In the d2-R test, an interaction in processing speed between time (pre- vs. post-TCAD) and provision (unaided vs. aided) was found suggesting an influence of hearing aid provision on LRF. A comparison of the averaged subjective ratings at the beginning and end of the TCAD shows a significant increase in LRF for both conditions. At the end of the TCAD, subjective fatigue was significantly lower when wearing hearing aids. The analysis of stress hormones did not reveal significant effects.

Enhancing work relationships across cultures: The role of energy in cross-cultural work interactions

As culturally different individuals work together, energy may be employed as a resource towards building and sustaining a work relationship. However, current scholarship on energy at work and relational energy fail to take into account cultural considerations. To address this gap, we develop novel theory that distinguishes amongst various forms of energy to explicate how they are differentially interpreted in interactions based on cultural orientation. Integrating theories of interaction rituals and energy at work, our theorizing calls into question common assumptions in prior literature which privilege certain forms of energy expression (such as high intensity) over others (such as calm restraint). We further theorize that energy becomes a resource when culturally-different relationship partners go through a process of discovery as they interact, in which they learn about their partner’s energy contributions and communication preferences. Through adaptation, intercultural partners can then establish an equilibrium, or balanced state, of energy contributions to their interactions. The relational energy gained from reaching this equilibrium replenishes personal resources used in interdependent work with culturally diverse others. We explain how such resource enhancement plays a critical role in sustaining high quality interdependent work in multicultural organizations.

Effects of Low Mental Energy from Long Periods of Work on Brain-Computer Interfaces

Brain-computer interfaces (BCIs) provide novel hands-free interaction strategies. However, the performance of BCIs is affected by the user’s mental energy to some extent. In this study, we aimed to analyze the combined effects of decreased mental energy and lack of sleep on BCI performance and how to reduce these effects. We defined the low-mental-energy (LME) condition as a combined condition of decreased mental energy and lack of sleep. We used a long period of work (>=18 h) to induce the LME condition, and then P300- and SSVEP-based BCI tasks were conducted in LME or normal conditions. Ten subjects were recruited in this study. Each subject participated in the LME- and normal-condition experiments within one week. For the P300-based BCI, we used two decoding algorithms: stepwise linear discriminant (SWLDA) and least square regression (LSR). For the SSVEP-based BCI, we used two decoding algorithms: canonical correlation analysis (CCA) and filter bank canonical correlation analysis (FBCCA). Accuracy and information transfer rate (ITR) were used as performance metrics. The experimental results showed that for the P300-based BCI, the average accuracy was reduced by approximately 35% (with a SWLDA classifier) and approximately 40% (with a LSR classifier); the average ITR was reduced by approximately 6 bits/min (with a SWLDA classifier) and approximately 7 bits/min (with an LSR classifier). For the SSVEP-based BCI, the average accuracy was reduced by approximately 40% (with a CCA classifier) and approximately 40% (with a FBCCA classifier); the average ITR was reduced by approximately 20 bits/min (with a CCA classifier) and approximately 19 bits/min (with a FBCCA classifier). Additionally, the amplitude and signal-to-noise ratio of the evoked electroencephalogram signals were lower in the LME condition, while the degree of fatigue and the task load of each subject were higher. Further experiments suggested that increasing stimulus size, flash duration, and flash number could improve BCI performance in LME conditions to some extent. Our experiments showed that the LME condition reduced BCI performance, the effects of LME on BCI did not rely on specific BCI types and specific decoding algorithms, and optimizing BCI parameters (e.g., stimulus size) can reduce these effects.

A novel brain-controlled wheelchair combined with computer vision and augmented reality

BACKGROUND

Brain-controlled wheelchairs (BCWs) are important applications of brain-computer interfaces (BCIs). Currently, most BCWs are semiautomatic. When users want to reach a target of interest in their immediate environment, this semiautomatic interaction strategy is slow.

METHODS

To this end, we combined computer vision (CV) and augmented reality (AR) with a BCW and proposed the CVAR-BCW: a BCW with a novel automatic interaction strategy. The proposed CVAR-BCW uses a translucent head-mounted display (HMD) as the user interface, uses CV to automatically detect environments, and shows the detected targets through AR technology. Once a user has chosen a target, the CVAR-BCW can automatically navigate to it. For a few scenarios, the semiautomatic strategy might be useful. We integrated a semiautomatic interaction framework into the CVAR-BCW. The user can switch between the automatic and semiautomatic strategies.

RESULTS

We recruited 20 non-disabled subjects for this study and used the accuracy, information transfer rate (ITR), and average time required for the CVAR-BCW to reach each designated target as performance metrics. The experimental results showed that our CVAR-BCW performed well in indoor environments: the average accuracies across all subjects were 83.6% (automatic) and 84.1% (semiautomatic), the average ITRs were 8.2 bits/min (automatic) and 8.3 bits/min (semiautomatic), the average times required to reach a target were 42.4 s (automatic) and 93.4 s (semiautomatic), and the average workloads and degrees of fatigue for the two strategies were both approximately 20.

CONCLUSIONS

Our CVAR-BCW provides a user-centric interaction approach and a good framework for integrating more advanced artificial intelligence technologies, which may be useful in the field of disability assistance.

Reciprocal relationships between time pressure and mental or physical health in Australian mothers of preschool aged children

The associations between time pressure and health are typically conceptualised and examined as unidirectional. This study examined the reciprocal relationships between time pressure and mental and physical health amongst working mothers of preschool children; a high-risk group for feeling time pressured. Using 5 waves of a panel study of Australian mothers when their children were aged 0-4 (n = 3878) and cross-lagged structural equation models, we find strong significant negative reciprocal associations between time pressure and mental and physical health, although these reciprocal associations were stronger and more consistent over time for mental health. Our results indicate that physical health takes a couple of years to deteriorate to a point where the reciprocal effects with time pressure become apparent, but for mental health the reciprocal effects are immediate, present at all time points and consistently strong. Findings suggest there are significant reciprocal health consequences of the time pressure experienced by working mothers and government policy encouraging mothers back into the workforce without adequate supports may be harmful for health.

The burnout construct with reference to healthcare providers: A narrative review

Burnout syndrome is a psychological response to long-term exposure to occupational stressors. It is characterized by emotional exhaustion, cognitive weariness and physical fatigue, and it may occur in association with any occupation, but is most frequently observed among professionals who work directly with people, particularly in institutional settings. Healthcare professionals who work directly with patients and are frequently exposed to work overload and excessive clinical demands, to ethical dilemmas, to pressing occupational schedules and to managerial challenges; who have to make complex judgements and difficult decisions; and who have relatively little autonomy over their job-related tasks are at risk of developing clinical burnout. In turn, clinical burnout among clinicians has a negative impact on the quality and safety of treatment, and on the overall professional performance of healthcare systems. Healthcare workers with burnout are more likely to make mistakes and to be subjected to medical malpractice claims, than do those who are burnout-naïve. Experiencing the emotional values of autonomy, competence and relatedness are essential work-related psychological needs, which have to be satisfied to promote feelings of self-realization and meaningfulness in relation to work activities, thus reducing burnout risk. Importantly, an autonomy-supportive rather than a controlling style of management decreases burnout risk and promotes self-actualization, self-esteem and a general feeling of well-being in both those in charge and in their subordinates. The purpose of this article is to discuss some of the elements constituting the burnout construct with the view of gaining a better understanding of the complex multifactorial nature of burnout. This may facilitate the development and implementation of both personal, behavioural and organizational interventions to deal with the burnout syndrome and its ramifications.

Deriving Mental Energy From Task Completion

Many tasks in everyday life (e.g., making an accurate decision, completing job tasks, and searching for product information) are extrinsically motivated (i.e., the task is performed to gain a benefit) and require mental effort. Prior research shows that the cognitive resources needed to perform an extrinsically motivated task are allocated pre-task. The pre-task allocation of mental resources tends to be conservative, because mental effort is costly. Consequently, there are mental energy deficits when the use of mental resources exceeds the allocated amount. This research provides evidence for post-task mental energy replenishment. The amount of resource replenishment is a function of the size of the mental energy deficit and the favorability of the cost-benefit trade-off experienced at the completion of the task (i.e., the value of the reward given the energy investment). The findings have implications for how cognitive resources management influences the availability of mental energy on a moment-to-moment basis.

The Effect of Hearing-Protection Devices on Auditory Situational Awareness and Listening Effort

OBJECTIVES

Hearing-protection devices (HPDs) are made available, and often are required, for industrial use as well as military training exercises and operational duties. However, these devices often are disliked, and consequently not worn, in part because they compromise situational awareness through reduced sound detection and localization performance as well as degraded speech intelligibility. In this study, we carried out a series of tests, involving normal-hearing subjects and multiple background-noise conditions, designed to evaluate the performance of four HPDs in terms of their modifications of auditory-detection thresholds, sound-localization accuracy, and speech intelligibility. In addition, we assessed their impact on listening effort to understand how the additional effort required to perceive and process auditory signals while wearing an HPD reduces available cognitive resources for other tasks.

DESIGN

Thirteen normal-hearing subjects participated in a protocol, which included auditory tasks designed to measure detection and localization performance, speech intelligibility, and cognitive load. Each participant repeated the battery of tests with unoccluded ears and four hearing protectors, two active (electronic) and two passive. The tasks were performed both in quiet and in background noise.

RESULTS

Our findings indicate that, in variable degrees, all of the tested HPDs induce performance degradation on most of the conducted tasks as compared to the open ear. Of particular note in this study is the finding of increased cognitive load or listening effort, as measured by visual reaction time, for some hearing protectors during a dual-task, which added working-memory demands to the speech-intelligibility task.

CONCLUSIONS

These results indicate that situational awareness can vary greatly across the spectrum of HPDs, and that listening effort is another aspect of performance that should be considered in future studies. The increased listening effort induced by hearing protectors may lead to earlier cognitive fatigue in noisy environments. Further study is required to characterize how auditory performance is limited by the combination of hearing impairment and the use of HPDs, and how the effects of such limitations can be linked to safe and effective use of hearing protection to maximize job performance.

Listen before you drive: the effect of voice familiarity on listening comprehension and driving performance

OBJECTIVE

Voice familiarity has been reported to reduce cognitive load in complex listening environments. The extent to which the reduction in listening effort allows for mental resources to be reallocated to other complex tasks needs further investigation. We sought to answer whether a familiar audiobook narrator provides benefits to (1) listening comprehension and/or (2) driving performance.

DESIGN

A double-blind between-groups design was implemented. Participants were randomly assigned to the Familiar group or the Unfamiliar group.

STUDY SAMPLE

Participants (n = 30) were normal-hearing adults, 18 to 28-years-old (M = 23, SD = 2.6) (n = 18 female). Participants first listened to an audiobook read by either Voice 1 (Familiar condition) or Voice 2 (Unfamiliar condition). Then they completed a virtual reality driving task while listening to a second audiobook, always read by Voice 1. Audiobook comprehension (30-question multiple-choice test) and driving performance (number of driving errors made) were recorded.

RESULTS

Participants in the Familiar group made fewer driving errors than participants in the Unfamiliar group. There were no differences in listening comprehension.

CONCLUSIONS

Increased voice familiarity positively impacts behaviour (i.e. reduced driving errors) in normal-hearing adults. We discuss our findings in the context of effortful listening frameworks.

Autism and Williams syndrome: truly mirror conditions in the socio-cognitive domain?

Autism Spectrum Disorders (ASD) and Williams Syndrome (WS) are frequently characterized as mirror conditions in the socio-cognitive domain, with ASD entailing restrictive social interests and with WS exhibiting hypersociability. In this review paper, we examine in detail the strong points and deficits of people with ASD or WS in the socio-cognitive domain and show that both conditions also share some common features. Moreover, we explore the neurobiological basis of the social profile of ASD and WS and found a similar mixture of common affected areas and condition-specific impaired regions. We discuss these findings under the hypothesis of a continuum of the socio-cognitive abilities in humans.

A randomized, placebo-controlled crossover trial of a decaffeinated energy drink shows no significant acute effect on mental energy

BACKGROUND

"Energy drinks" are heavily marketed to the general public, across the age spectrum. The efficacy of decaffeinated energy drinks in enhancing subjective feelings of energy (s-energy) is controversial.

OBJECTIVE

The authors sought to test the efficacy of the caffeine-free version of a popular energy drink compared with a placebo drink.

METHODS

This study was a randomized, double-blind, placebo-controlled, crossover trial in 223 healthy men and women aged 18-70 y with intention-to-treat and completers analysis. Participants were randomly assigned to consumption of either the decaffeinated energy drink or a placebo drink on testing day 1, and the other drink a week later. A battery of computer-based mood and cognitive tests to assess s-energy was conducted at baseline and at 0.5, 2.5, and 5 h post-ingestion. The main outcome measures were 1) mood, which was assessed by using a General Status Check Scale and the Profile of Mood States 2nd edition brief form, and 2) cognitive measures, including the N-back task (reaction time and accuracy), Reaction Time test, Flanker task (distraction avoidance), and Rapid Visual Information Processing test.

RESULTS

No statistically significant or meaningful benefits were observed for any outcome measure, including mood and cognitive measures. Analyses of mean differences, slopes, and median differences were consistent.

CONCLUSIONS

No differences were detected across a range of mood/cognitive/behavioral/s-energy-level tests after consumption of the energy drink compared with a placebo drink in this diverse sample of adults. Thus, we found strong evidence that the energy drink is not efficacious in enhancing s-energy levels, nor any related cognitive or behavioral variables measured. In light of federal regulations, these findings suggest that labeling and marketing of some products which claim to provide these benefits may be unsubstantiated. This trial was registered at www.clinicaltrials.gov as NCT02727920.

Mental energy: plausible neurological mechanisms and emerging research on the effects of natural dietary compounds

Objective: Lack of mental energy is one of the leading reasons adults turn to dietary supplements, with three out of ten supplement users hoping to improve their energy level; even more consume caffeine-containing products for the same reason. Despite this interest from consumers, there is no consensus scientific definition of mental energy or sole validated instrument for measuring it. We performed this review to summarize main findings from research regarding the influence of natural dietary compounds on three aspects of mental energy: cognition (vigilance), motivation (to do mental work), and mood (feelings of energy and/or absence of feelings of fatigue).Methods: A narrative review of key papers.Results: In addition to caffeine, a number of other compounds, including the polyphenols, which are found in all plant-derived products, and the phytochemicals in culinary herbs and herbal products such as Panax ginseng and Ginkgo biloba, have been shown in animal models to modulate neurotransmitter activity potentially relevant to mental energy. Inadequate intake of B vitamins could also potentially have a negative effect on mental energy due to their role in overall energy production, as precursors of key cofactors in the citric acid cycle, as well as their role in brain function and neurotransmitter synthesis. Consumption of some of these products may have direct or indirect effects on one or more elements of mental energy.Conclusion: Large, prospective clinical trials of these products using appropriate, validated instruments designed to measure mental energy may be worthwhile if sufficient evidence exists to justify such trials.

A Taxonomy of Fatigue Concepts and Their Relation to Hearing Loss

Fatigue is common in individuals with a variety of chronic health conditions and can have significant negative effects on quality of life. Although limited in scope, recent work suggests persons with hearing loss may be at increased risk for fatigue, in part due to effortful listening that is exacerbated by their hearing impairment. However, the mechanisms responsible for hearing loss-related fatigue, and the efficacy of audiologic interventions for reducing fatigue, remain unclear. To improve our understanding of hearing loss-related fatigue, as a field it is important to develop a common conceptual understanding of this construct. In this article, the broader fatigue literature is reviewed to identify and describe core constructs, consequences, and methods for assessing fatigue and related constructs. Finally, the current knowledge linking hearing loss and fatigue is described and may be summarized as follows: Hearing impairment may increase the risk of subjective fatigue and vigor deficits; adults with hearing loss require more time to recover from fatigue after work and have more work absences; sustained, effortful, listening can be fatiguing; optimal methods for eliciting and measuring fatigue in persons with hearing loss remain unclear and may vary with listening condition; and amplification may minimize decrements in cognitive processing speed during sustained effortful listening. Future research is needed to develop reliable measurement methods to quantify hearing loss-related fatigue, explore factors responsible for modulating fatigue in people with hearing loss, and identify and evaluate potential interventions for reducing hearing loss-related fatigue.

Salivary Cortisol Profiles of Children with Hearing Loss

OBJECTIVES

It has long been speculated that effortful listening places children with hearing loss at risk for fatigue. School-age children with hearing loss experiencing cumulative stress and listening fatigue on a daily basis might undergo dysregulation of hypothalamic-pituitary-adrenal (HPA) axis activity resulting in elevated or flattened cortisol profiles. The purpose of this study was to examine whether school-age children with hearing loss show different diurnal salivary cortisol patterns than children with normal hearing.

DESIGN

Participants included 32 children with mild to moderate hearing loss (14 males; 18 females) and 28 children with normal hearing (19 males; 9 females) ranging in age from 6 to 12 years. Saliva samples were obtained six times per day on two separate school days. Cortisol levels were measured by mass spectrometric detection after liquid-liquid extraction. Salivary cortisol levels between children with hearing loss and children with no hearing loss over the course of the day were examined with hierarchical linear modeling using mixed model statistical analysis. Between-group comparisons were also computed for the area under the curve, an analytical approach for calculating overall cortisol secretion throughout the day.

RESULTS

Significant differences in the cortisol awakening response (CAR) were observed between children with hearing loss and children with normal hearing; however, no differences were observed between the two groups subsequent to the cortisol awakening response (60-min postawakening, 10:00 A.M., 2:00 P.M., and 8:00 P.M.). Compared with children with normal hearing, children with hearing loss displayed elevated cortisol levels at awakening and a reduced growth in cortisol secretion from awakening to 30-min postawakening. No significant differences in overall cortisol secretion throughout the day were found between groups (area under the curve). Finally, cortisol levels increased with increasing age for children with hearing loss but not for children with normal hearing.

CONCLUSIONS

Results of this preliminary study indicate a possible dysregulation in HPA axis activity in children with hearing loss characterized by elevated salivary cortisol levels at awakening and a diminished increase in cortisol from awakening to 30-min postawakening. The pattern of elevated cortisol levels at awakening is consistent with some studies on adults with burnout, a condition characterized by fatigue, loss of energy, and poor coping skills. These findings support the idea that children with hearing loss may experience increased vigilance and need to mobilize energy promptly in preparation for the new day.

Subjective Fatigue in Children With Hearing Loss Assessed Using Self- and Parent-Proxy Report

PURPOSE

The primary purposes of this study were to examine the effects of hearing loss and respondent type (self- vs. parent-proxy report) on subjective fatigue in children. We also examined associations between child-specific factors and fatigue ratings.

METHOD

Subjective fatigue was assessed using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL-MFS; Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). We compared self- and parent-proxy ratings from 60 children with hearing loss (CHL) and 43 children with normal hearing (CNH). The children ranged in age from 6 to 12 years.

RESULTS

School-age CHL experienced more overall and cognitive fatigue than CNH, although the differences were smaller than previously reported. Parent-proxy report was not strongly associated with child self-report, and parents tended to underestimate their child's fatigue, particularly sleep/rest fatigue. Language ability was also associated with subjective fatigue. For CHL and CNH, as language abilities increased, cognitive fatigue decreased.

CONCLUSIONS

School-age CHL experience more subjective fatigue than CNH. The poor association between parent-proxy and child reports suggests that the parent-proxy version of the PedsQL-MFS should not be used in isolation when assessing fatigue in school-age children. Future research should examine how language abilities may modulate fatigue and its potential academic consequences in CHL.

Speech-Processing Fatigue in Children: Auditory Event-Related Potential and Behavioral Measures

PURPOSE

Fatigue related to speech processing is an understudied area that may have significant negative effects, especially in children who spend the majority of their school days listening to classroom instruction.

METHOD

This study examined the feasibility of using auditory P300 responses and behavioral indices (lapses of attention and self-report) to measure fatigue resulting from sustained listening demands in 27 children (M = 9.28 years).

RESULTS

Consistent with predictions, increased lapses of attention, longer reaction times, reduced P300 amplitudes to infrequent target stimuli, and self-report of greater fatigue were observed after the completion of a series of demanding listening tasks compared with the baseline values. The event-related potential responses correlated with the behavioral measures of performance.

CONCLUSION

These findings suggest that neural and behavioral responses indexing attention and processing resources show promise as effective markers of fatigue in children.

Commentary: listening can be exhausting--fatigue in children and adults with hearing loss

Anecdotal reports of fatigue after sustained speech-processing demands are common among adults with hearing loss; however, systematic research examining hearing loss-related fatigue is limited, particularly with regard to fatigue among children with hearing loss (CHL). Many audiologists, educators, and parents have long suspected that CHL experience stress and fatigue as a result of the difficult listening demands they encounter throughout the day at school. Recent research in this area provides support for these intuitive suggestions. In this article, the authors provide a framework for understanding the construct of fatigue and its relation to hearing loss, particularly in children. Although empirical evidence is limited, preliminary data from recent studies suggest that some CHL experience significant fatigue-and such fatigue has the potential to compromise a child's performance in the classroom. In this commentary, the authors discuss several aspects of fatigue including its importance, definitions, prevalence, consequences, and potential linkage to increased listening effort in persons with hearing loss. The authors also provide a brief synopsis of subjective and objective methods to quantify listening effort and fatigue. Finally, the authors suggest a common-sense approach for identification of fatigue in CHL; and, the authors briefly comment on the use of amplification as a management strategy for reducing hearing-related fatigue.

Subjective fatigue in children with hearing loss: some preliminary findings

PURPOSE

In this study, the authors examined the effect of hearing loss on subjective reports of fatigue in school-age children using a standardized measure.

METHODS

As part of a larger ongoing study, the authors obtained subjective ratings of fatigue using the Pediatric Quality of Life Inventory (PedsQL) Multidimensional Fatigue Scale ( Varni, Burwinkle, Katz, Meeske, & Dickinson, 2002). This standardized scale provides a measure of general fatigue, sleep/rest fatigue, cognitive fatigue, and an overall composite measure of fatigue. To date, data from 10 children with hearing loss (CHL) and 10 age-matched children with normal hearing (CNH) have been analyzed.

RESULTS

These preliminary results show that subjective fatigue is increased in school-age children with hearing loss (Cohen's d = 0.78-1.90). In addition, the impact of hearing loss on fatigue in school-age children appears pervasive across multiple domains (general, sleep/rest, and cognitive fatigue).

CONCLUSION

School-age CHL reported significantly more fatigue than did CNH. These preliminary data are important given the negative academic and psychosocial consequences associated with fatigue. Further research is needed to determine the underlying mechanisms responsible for this increased fatigue in school-age children with hearing loss, and to identify factors that may modulate (e.g., degree of loss) and mediate (e.g., hearing aid or cochlear implant use) its impact.

The Complexities of Fatigue in Children with Hearing Loss

Fatigue is a common phenomenon in our society, and it can have a major impact on an individual's performance and wellbeing. Parents and teachers have long believed that children with hearing loss (CHL) are at increased risk for fatigue. One could easily speculate that toward the end of a school day, CHL may be “physically and mentally spent” as a result of focusing so intently on a teacher's speech, as well as conversations with other students. Moreover, the increased listening effort, stress, and subsequent fatigue experienced by CHL could jeopardize the ability to learn in a noisy classroom environment, thus increasing the risk for problems in school. Only recently, however, have we begun to see empirical studies supporting the notion that CHL experience more fatigue than children with normal hearing (CNH).

This review was developed to enhance the awareness of fatigue among those audiologists interested in serving CHL. To this end, we have presented an overview on fatigue in CHL, including its importance, definitions, prevalence, consequences, and recent developments. The complexity and multifaceted nature of fatigue has been highlighted and the need for additional research on fatigue in CHL is emphasized.

Approaches to uremia

The development of dialysis was a dramatic step forward in medicine, allowing people who would soon have died because of lack of kidney function to remain alive for years. We have since found, however, that the "artificial kidney" does not live up fully to its name. Dialysis keeps patients alive but not well. Part of the residual illness that dialysis patients experience is caused by retained waste solutes that dialysis does not remove as well as native kidney function does. New means are available to identify these toxic solutes, about which we currently know remarkably little, and knowledge of these solutes would help us to improve therapy. This review summarizes our current knowledge of toxic solutes and highlights methods being explored to identify additional toxic solutes and to enhance the clearance of these solutes to improve patient outcomes.

An evaluation of the cognitive and mood effects of an energy shot over a 6h period in volunteers: a randomized, double-blind, placebo controlled, cross-over study

Energy drinks are widely available mostly containing glucose, and several have been demonstrated to improve alertness and cognitive function; these effects generally being identified 30-60min after administration. The present study assessed whether an energy shot without carbohydrates would affect major aspects of cognitive function and also mood in volunteers over a 6h time period. This randomized, double-blind, placebo-controlled,crossover study compared the acute effects of the energy shot with a matching placebo in 94 healthy volunteers. Cognitive function was assessed with a widely used set of automated tests of attention and memory. Mood was assessed with the Bond-Lader, Beck Anxiety Index, Beck Depression Index, Chalder Fatigue Scales (CFS), and the POMS. The volunteers were requested to limit their sleep to between 3 and 6h the night before each testing day. Compared to the placebo, the energy shot significantly improved 6 validated composite cognitive function measures from the CDR System as well as self-rated alertness; the benefits on 4 of the cognitive measures still remaining at 6h. The overall effect sizes of the performance improvements were in the small to medium range and thus notable in this field. In conclusion, an energy shot can significantly improve important aspects of cognitive function for up to 6h compared to placebo in partially sleep-deprived healthy volunteers.

Occupational health, cognitive disorders and occupational neuropsychology

Work can be an important etiologic factor in the genesis of some mental disorders including cognitive disability. Occupational neuropsychology constitutes an intriguing new but neglected area of research and clinical practice which deals with the neurocognitive consequences of the work environment and work habits. Neuropsychological knowledge is fundamental to understand cognitive requirements of work competence. Work can impact sleep patterns and mental energy, which in turn can cause neuropsychological symptoms. This report presents relevant evidence to illustrate the relationship between work and cognitive dysfunction.

Bodybuilding, energy, and weight-loss supplements are associated with deployment and physical activity in U.S. military personnel

PURPOSE

The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel.

METHODS

Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007-2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities.

RESULTS

Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements.

CONCLUSIONS

The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring.

The effects of a novel histamine-3 receptor inverse agonist on essential tremor in comparison to stable levels of alcohol

Essential tremor (ET) is a common movement disorder. Animal studies show that histaminergic modulation may affect the pathological processes involved in the generation of ET. Histamine-3 receptor inverse agonists (H3RIA) have demonstrated attenuating effects on ET in the harmaline rat model. In this double-blind, three-way cross-over, single-dose, double-dummy study the effects of 25 mg of a novel H3RIA (MK-0249) and a stable alcohol level (0.6 g L(-1)) were compared with placebo, in 18 patients with ET. Tremor was evaluated using laboratory tremorography, portable tremorography and a clinical rating scale. The Leeds Sleep Evaluation Questionnaire (LSEQ) and a choice reaction time (CRT) test were performed to evaluate potential effects on sleep and attention, respectively. A steady state of alcohol significantly diminished tremor as assessed by laboratory tremorography, portable tremorography and clinical ratings compared with placebo. A high single MK-0249 dose was not effective in reducing tremor, but caused significant effects on the LSEQ and the CRT test. These results suggest that treatment with a single dose of MK-0249 does not improve tremor in alcohol-responsive patients with ET, whereas stable levels of alcohol as a positive control reproduced the commonly reported tremor-diminishing effects of alcohol.

Effect of caffeine and taurine on simulated laparoscopy performed following sleep deprivation

Background

Sleep deprivation affects surgical performance and has the potential to endanger patient safety. Pharmacological stimulants may counter this consequence of long working hours. This study aimed to investigate whether commonly available stimulants can counter the effects of fatigue on technical and neurocognitive skill.

Methods

This was a single-blind crossover study of surgical novices trained to proficiency on the Minimally Invasive Surgical Trainer—Virtual Reality laparoscopic simulator. Participants were acutely sleep-deprived three times each, followed by administration of either placebo, 150 mg caffeine, or 150 mg caffeine combined with 2 g taurine before simulated laparoscopy. Outcome measures were: laparoscopic psychomotor skill, cognitive performance and the Stanford Sleepiness Scale (range 1–7). Rested baselines were gathered following completion of test sessions.

Results

Baseline performance was recorded for 18 participants in the rested state. Sleep-deprived participants receiving the placebo took longer (median 41 versus 35 s; P = 0·016), were less economical with movement (3·25 versus 2·95 m; P = 0·016) and made more errors (66 versus 59; P = 0·021) on the laparoscopic task compared with the rested state. Caffeine restored psychomotor skills to baseline for time taken (37 versus 35 s; P = 0·101), although the number of errors remained significantly greater than in the rested state (63 versus 59; P = 0·046). Sleep-deprived subjects receiving placebo had slower reaction times (377 versus 299 ms; P = 0·008) and a higher score on the Stanford Sleepiness Scale (6 versus 2 points; P = 0·001) than rested surgeons. Negative effects of sleep deprivation on reaction time were reversed when caffeine (307 ms versus 299 ms in rested state; P = 0·214) or caffeine plus taurine (326 versus 299 ms; P = 0·110) was administered. Subjective sleepiness was also improved, but not to baseline levels.

Conclusion

Sleep deprivation affects laparoscopic psychomotor skills, reaction time and subjective measures of sleepiness in novice surgical subjects. Caffeine and taurine restore simulated laparoscopic performance to rested levels, but do not reduce errors.

Do specific dietary constituents and supplements affect mental energy? Review of the evidence

The numbers of marketing claims and food, beverage, and drug products claiming to increase mental energy have risen rapidly, thus increasing the need for scientific specificity in marketing and food label claims. Mental energy is a three-dimensional construct consisting of mood (transient feelings about the presence of fatigue or energy), motivation (determination and enthusiasm), and cognition (sustained attention and vigilance). The present review focuses on four dietary constituents/supplements (Ginkgo biloba, ginseng, glucose, and omega-3 polyunsaturated fatty acids) to illustrate the current state of the literature on dietary constituents and mental energy. The strongest evidence suggests effects of Ginkgo biloba on certain aspects of mood and on attention in healthy subjects, as well as associations between omega-3 polyunsaturated fatty acids and reduced risk of age-related cognitive decline. Limitations of the current data and challenges for future research are discussed.