Hearing aids are a major tool for individuals with hearing loss — especially age-related hearing loss, which currently affects approximately 226 million adults over the age of 65 worldwide (and is projected to affect 900 million by 2050). However, hearing aid adoption remains relatively low among adults: fewer than 3 percent of adults in low-and-middle-income countries (LMIC) use hearing aids, versus around 20 percent of adults in non-LMIC countries. Though various reasons contribute to this poor uptake, cost is a significant factor. While the price to manufacture hearing aids has decreased over time, the retail price for a pair of hearing aids ranges from $1,000 to $8,000 USD, with the average pair costing $4,700 in the US.

In this study, Sinha and colleagues used mass-produced open source electronics to engineer a durable, affordable, self-serviceable hearing aid that meets most of the targets set by the WHO for mild-to-moderate age-related hearing loss: “LoCHAid.” When mass-produced at 10,000 units including earphones, a coin-cell battery, and holder, LoCHAid costs $0.98 (this doesn’t include labor costs) and is designed to be marketed over-the-counter — or even as a DIY project. LoCHAid doesn’t require specialty parts, and repairs can be completed by a minimally skilled user with access to a soldering iron and solder. Though it’s not currently programmable, simulations show that the LoCHAid is well fitted to a range of age-related hearing loss profiles for men and women between the ages of 60-79 years.

Potential limitations include the device lifetime (currently 1.5 years), as well as its relatively large size, which may not appeal to all consumers. The authors are currently working on a smaller prototype, but this costs more money to produce and would likely require third-party assemblers.

Despite these limitations, LoCHAid shows great potential to benefit individuals impacted by age-related hearing loss, especially those consumers challenged by the affordability and accessibility of current hearing aids available on the market.

The authors add: “In this work, we describe the development and rigorous audiological testing a minimal, 3d-printed and ultra low-cost ($1 in parts) hearing aid. The vision of the device is to make hearing aid accessible and affordable for elderly individuals with age related hearing loss in low- and middle-income countries.”

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Rheumatoid arthritis is the most common type of autoimmune arthritis, caused when the immune system attacks healthy cells in the linings of joints. Over the last decade it has become clear that there are differences in RA patients with and without RA-associated autoantibodies detectable in their blood. In the new study, researchers followed 1,285 RA patients between 1993 and 2016 through the Leiden Early Arthritis Clinic cohort. Data on patients’ symptoms, treatments, autoantibody status, disability and mortality was collected annually.

In total, 823 patients had autoantibody-positive RA and 462 patients had autoantibody-negative RA. In both groups, disease activity decreased significantly over time. Sustained drug-free remission rates increased, as a new treat-to-target treatment strategy became common in 2006 to 2010, in patients with autoantibody-positive, but not autoantibody-negative, RA. Moreover, mortality and functional disability rates decreased with treat-to-target adjustments only in autoantibody-positive patients.

“The disconnection between improvement in disease activity and subsequent improvement in long-term outcomes in RA without autoantibodies suggests that the underlying pathogenesis of RA with and without autoantibodies is different,” the authors say. “We propose that it is time to formally divide RA into type 1, with autoantibodies, and type 2, without autoantibodies, in the hope that it leads to stratified treatment in autoantibody-positive and autoantibody-negative RA.”

Dr. Matthijssen notes “In the last decennia research in RA has largely focused on the autoantibody-positive subset. More research on autoantibody-negative RA is urgently needed to identify methods to also improve their long-term outcomes.”

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Previous research suggests that people from racial and ethnic minority backgrounds are at greater risk of severe or deadly cases of COVID-19. However, most studies of these disparities have only investigated patients who had already tested positive or who were hospitalized. Understanding disparities in who was tested and whether they tested positive could help inform efforts to reduce the burden of COVID-19 in minority communities.

To improve understanding of testing disparities, Rentsch and colleagues investigated statistical associations between 5.8 million VA patients’ race/ethnicity and their detailed medical records (the VA comprises more than 1,200 points-of-care nationally including hospitals, medical centers, and community outpatient clinics, with around nine million individuals accessing VA care each year), including COVID-19 testing records from February 8 through July 22, 2020. 91% of participants were male; 7% were of Hispanic ethnicity, 19% were Black and 74% were White.

Over 250,000 of the patients studied received a COVID-19 test during the study period, 16,317 tested positive, and 1,057 died within 30 days of testing. Black and Hispanic patients were more likely to receive a test and were more likely to test positive than White patients, even when accounting for other demographics underlying medical conditions and geographic location (Black vs White adjusted Odds Ratio 1.93, 95% CI 1.85-2.01, p<0.001; Hispanic vs White 1.84, 1.74-1.94, p<0.001).

For positive test rates, the disparity between White and Black patients was greatest in the Midwest and decreased slightly overall during the study. The positive-test disparity between Hispanic and White patients was consistent across regions and over time. Among the cohort of 5.8 million people, although those from minority backgrounds appeared to have a higher burden of COVID-19, for those who tested positive, no racial or ethnic disparities in 30-day death rates were seen.

These findings suggest that Black and Hispanic individuals experience a disproportionate risk of COVID-19 infection, even when accounting for where they live and underlying medical conditions. The authors call for urgent state- and local-level strategies to reduce COVID-19 spread in minority communities.

Dr. Rentsch says: “Minority individuals who received a positive COVID-19 test did not appear to have worse outcomes. However, Black and Hispanic individuals were still twice as likely to testing positive for COVID-19, even after accounting for underlying health conditions, other demographics, and geographic location. Taken together, these findings suggest a substantial excess burden of COVID-19 infection in US minority communities.” He adds: “Understanding what is driving these disparities is vital so that strategies can be tailored to curb the disproportionate epidemics in minority communities…going forward, we are exploring whether racial and ethnic disparities exist at other key stages in the clinical course of COVID-19, from hospitalization to intubation. We appeal to other researchers who have the necessary testing data to investigate disparities in testing and testing positive. This will provide essential information to design effective interventions.”

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The international team of researchers analyzed the results of 173 peer-reviewed studies investigating antipredator traits (behavioral and physiological) in 102 species of domesticated, captive, and urbanized mammals, birds, reptiles, fish and molluscs, while taking into account their position in the Tree of Life.

The scientists found that contact with humans led to a rapid loss of animals antipredator traits, but simultaneously the variability between individuals initially increases and then gradually decreases over the generations in contact with human. The authors suppose that this two-step process is caused by reduced pressure from natural selection as a result of living in a safer environment, followed by artificial selection by humans for docility in the case of domestication.

Animals showed immediate changes in antipredator responses in the first generation after contact with humans, suggesting that the initial response is a result of behavioral flexibility, which may later be accompanied by genetic changes if contact continues over many generations. The researchers also found that domestication altered animal antipredator responses three times faster than urbanization, while captivity resulted in the slowest changes. The results also showed that herbivores changed behavior more rapidly than carnivores and that solitary species tended to change quicker that group-living animals.

The study demonstrates that domestication and urbanization exert similar pressures on animals and can result in rapid behavioral changes. The loss of anti-predator behaviors can cause problems when those domesticated or urbanized species encounter predators or when captive animals are released back into the wild. Understanding how animals respond to contact with humans has important implications for conservation and urban planning, captive breed programs, and livestock management.

Dr. Geffroy adds “While it is well known that the fact of being protected by humans decreases antipredator capacities in animals, we did not know how fast this occurs and to what extent this is comparable between contexts! We also integrated physiological traits in the study but they were much less numerous that behavioral traits. We believe they should be systematically investigated to draw a global pattern of what is happening at the individual level. We need more data to understand whether this occurs also with the mere presence of tourists.”

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