 Hi everyone thanks for joining us for our inaugural webinar series. What I'd like to do today is give an overview of the research that we do at the National Acoustic Laboratories. But before I get into that I want to talk a little bit about this seminar series that we are just kicking off with this presentation. What we plan on doing over the next three months is presenting around 30 or so webinars detailing different aspects of research at NAL. We want to make this widely available around the world so we're focusing on three different time zones for these presentations in Australia, in the US, and in Europe. So it's convenient for people around the world. These will be high impact 50 to 20 minute long presentations detailing different aspects of research that we think are important for people who are in hearing healthcare business. You'll get a chance to meet researchers across the organization in different fields talking about the work that they do. Now one of the reasons that we're doing this is with the current COVID situation there has been some fairly dramatic changes in hearing healthcare. A lot of innovation happening but a lot of transformation in how hearing healthcare services are provided and a lot of this relates to research that has been done at NAL over the past several years. So we want to share the insights of what we have found and so the technology that we've developed in this area that we think could be beneficial for people who are changing the services that they provide or the technology that they're developing. But we also want to share other insights that we've gathered with research at NAL over the past many years because we think that this can also help with the treatment of hearing healthcare worldwide. So that's the goal of the seminar series. We hope you really find what we're presenting valuable for you and by participating you also get a chance to ask questions of us and hopefully we can build a relationship as well over time. So these are the people that you'll be seeing give presentations over the next three months and you'll get a chance to really to know NAL as well as the people there. So I want to start by talking about who is the National Acoustic Laboratories. So you know I've known about NAL almost my whole career when I joined NAL two and a half years ago. I really didn't understand a lot about it except of course for the fitting prescription and Harvey Dillon and some of the other researchers who I've met at conferences. What I was astounded by when I joined NAL was the breadth of research that they've done and really the incredible work that has gone on for many years at this center. So NAL is a government-funded research center funded by the Department of Health and has been around for a very long time over 70 years. And in the U.S. it'd be very similar to a research center in Bethesda that was funded by the National Institute of Health for example. We are made up of over 50 career scientists of variety disciplines, audiology, engineering, neuroscience, psychology, speech pathology, all areas that we think are important to understand the needs of those with hearing loss and the solutions that are necessary in order to help them. We are located at the building that you see here which is really a beautiful center in Sydney, Australia, five-story building filled with organizations that are all focused on hearing health care, helping people with hearing loss. So it's really a great building to be, great organizations for us to collaborate with. And most importantly we are a part of Hearing Australia Services which is the largest hearing health care provider in Australia, also a government organization. And why this is so critical for the success of NAL is it allows us to work with hundreds of audiologists across the country, well over a hundred clinics providing hearing health care services. So it allows us to really understand deeply the needs of people with hearing loss, the needs of clinicians who are treating those clients, and for us to test ideas, test protocols, test technology and develop our ideas. So this is really I think a unique relationship in the world that is valuable for developing new ideas and innovation in the hearing health care area. So why, why do we exist? What is that we're focused on doing? Well our goal is basically in everything that we do to transform the lives of people who have hearing difficulties, whatever those difficulties have. And the way that we do this is not just through research, research is a very important part of what we do, but also with innovation which for me innovation is the creation of things that helps bring value to someone. So here we have created a lot of technology solutions that have helped clinicians treat clients and helped bring technical solutions to hearing health care as well. So it's really as much of an innovation center as it is a research center. And we are a little bit different than research centers that also exist around the world focused on hearing loss and hearing health care. There are a lot of great departments at universities around the world that do research in this area. We're a little bit different in a variety of ways. One is our main focus for the projects that we do is on the impact the results of our projects have. So we publish quite a bit, the publications are important, but they're really not the end goal. The end goal is that we're somehow changing the lives of people who have health care in a variety of ways. We also, all of our projects are done by career scientists. We don't, we're not a university, we don't have students. And so we've got people who have been doing this for a very long time are very confident in the plans that they make and our capabilities and in the goals that we set for the for the projects that we develop. We work a lot with people who are developing solutions for people with hearing loss. So we work a lot with the major hearing aid companies, with the cochlear implant companies, with a lot of hearing startups. We really want to help anyone out there who was trying to help people who have hearing loss. And over the past couple years, we have embraced a lot of innovation methodologies that I probably brought with me from Silicon Valley, things like design thinking, lean startup, minimum mobile products, the agile approaches that's really sort of transformed our approach to, to the projects that we do, I think making them more effective and more targeted at having that impact that is so important for our mission. So most of the projects that we have can be categorized in one of these four areas. So in order to give you an overview of the kind of research that we do, I'm going to just highlight a couple projects in each of these areas. And I think you'll get a very good sense of the kind of work that we do and, you know, the impact that we have with the research that we conduct. So one of the things that we want to make sure we're on top of, that's all the sort of the current trends that are happening in hearing healthcare. We want to be leaders in understanding the benefits of these trends and understanding what the barriers are, what are the facilitators of success in order to help continue to grow and transform hearing healthcare. So one of the most prominent changes in hearing healthcare over the past few years has been the emergence of self-fitting hearing aids, direct to consumer hearing aids and hearables. So we have had a lot of projects in this area over many years. In fact, in self-fitting hearing aids, we've been focused on this for over seven years. And the results of a lot of this research, which you'll hear about more in, in future webinars in this series, is there are a lot of barriers for getting someone to be successful with the self-fitting hearing aid. In other words, there are a lot of ways that people can get it wrong and that people can be unsuccessful. So it's not as simple as just giving someone a hearing aid, giving them an instruction manual, and then they're going to be happy. There are a lot of ways that they can be unsuccessful. And these are outlined here. If we look at the top part, just getting the form factor right, getting the user control interface right for the unique needs of the demographic that we target is critical. Figuring out how are you going to test your hearing? How are you going to incorporate that in the signal processing of the device? How do you instruct people on something as simple as how it fits on the ear or how a tube goes in the canal? All of these are critical for success and are ways that people can fail. You'll hear in a future webinar about an experiment that we did where only about 25% of the people that we tested with the self-fitting hearing were actually able to fit themselves. But we did understand what were the factors that made them successful and we'll talk in more detail about that in the future. We've also tested some self-hearing tests that are available. We tested one app in particular that's on smartphones. We brought in some normal hearing people and people with hearing loss and we tested their ability to self-test their audiogram compared to an audiologist conducted Houston Westlake audiogram. What we found was a very high correlation between the self-test with the app and the proper in a soundproof booth with an audiologist with an audiometer threshold at the four frequencies that you see here 500 through 4k with correlation coefficients ranging from 0.89 to 0.99. What we're seeing is that it's not that the limitations for self-fitting and direct to consumer technology is not the technology itself. It's really the understanding of how to help the client, how to get them motivated. Everything that audiologists do so well and practitioners do so well. We have a lot of evidence that demonstrates the value of the clinician to a lot of clients out there. It's less about the technology and more about the understanding of the unique needs and the unique treatment strategies for that person. I'll talk a little bit more about that data in a bit. Tele-ideology of course has been an emerging technology for a long time and it's in our face now. Everyone is scrambling to embrace it. We've done a lot of research in this area. Two years ago we did some investigation into the barriers for success for tele-ideology which included the attitudes and beliefs that people had. What you're seeing here is just one small bit of the data that we gathered two years ago in this where we asked audiologists what their opinion was on the use of tele-ideology for a variety of treatment steps for hearing health care. What you can see here is the blue bars are the levels of willingness to use tele-ideology. If there's an assistant at the far end with the client, the red bars are the level of willingness to use tele-ideology if the client is on their own. There's no one there to help them. The first thing you notice the blue bars are taller than the red bars meaning that audiologists are happier to use tele-ideology if there's an assistant or less willing to use it if there's no assistant at the other end. You also see that there are some cases where some aspects of tele-ideology where audiologists are quite comfortable in using it as a tool such as when there's information transfer but when there are things like diagnostics tests involved there's a very low level of comfort with the use of tele-ideology and we have a lot of more data on the barriers and attitudes towards tele-ideology that we'll share with you in a future webinar but we're really starting to see these at play in the treatment of health care today using remote services. We did a fairly extensive test of the Resound Remote Assist tele-ideology system and what we did with a treatment group and a control group is we had a control group go through a standard of fitting with the device with the fitting and several follow-ups and with the test group we replaced one of the follow-up visits with the remote programming only and we looked at a variety of aspects of how well was that client treated. We'll get into a lot more of that data in a future webinar but sort of the headline here you can see on the screen is most if not all of the people who experienced remote care in that follow-up were very very happy with that and in other data we saw that they actually preferred that over that face-to-face visit for a variety of reasons. Now there were a lot of care that was necessary for face-to-face and we'll get into those different nuances of using tele-ideology again at a future webinar but we're seeing this at play right now and we've spent many years trying to develop insight into how best to apply tele-ideology and hearing health care. We also spent a lot of time understanding why people make the decisions that they do and what is the best way to treat individuals what their unique needs are and what unique treatment strategies should be. One of the ways that every field is doing this right now in hearing health care and other fields is with the use of big data and machine learning. We're seeing it transform health care in a very dramatic way and transforming other fields as well and so we are starting to invest quite heavily into using big data to understand the unique needs of people with hearing loss. One of the ways that we've done this is we've implemented an online assessment system where people answer a variety of questions about their hearing about what they're experiencing with their hearing and what their beliefs on hearing and hearing devices are in conjunction with an online hearing test that gives us greater insight to that person which we can then correlate with success with treatment strategies and with that big data analysis that allows us to more specifically target the unique needs of people who have hearing difficulty. In another big data project that we had we looked at people we gathered data during the fitting process and three months after they were fit with the hearing device in order to understand what are the most important factors to make someone successful with the hearing aid. Here are on the screen are some of the factors that were most important for people believing that they are having success with their hearing devices several months after obtaining them. What's most important interesting for me is the high loading on clinician interest in terms of what's important in making someone successful with their devices and this is really shown strongly with this figure where on the Y axis we see the benefit that the client is reporting with their hearing aid and the Y axis we see the level of perceived interest or care that they believe they got from their audiologist when they were fit and here you can see the stronger the level of interest and care that they got so the happier they are and the more benefit they're getting from their hearing aids months down the road. So clinicians are really really important in making people successful with their devices but also in getting benefit from their devices in stark contrast to some of the trends happening now with the direct to consumer hearing aids and the belief that you can just give devices to people on their own and they'll do just fine. There's a lot of evidence that's coming out of this research and others showing the value that audiologists bring to making people with hearing loss successful with their devices and we'll be talking more about this in future webinars. We've gotten pretty involved in the field of behavioral economics over the last two years. This is an emerging field that is transforming a lot of areas. Now behavioral economics is the field of understanding why people make the decisions that they do when they seem either illogical, unnatural, irrational or just unexpected but there's actually a deep-seated reason that people make these decisions and a simple example is sometimes too much choice is a bad thing. If you're looking to buy something you might think the best thing you could do for someone is give them as many options as possible and this will actually sometimes freeze people to a point where they won't make a decision at all. They'll just back away say it's too complicated I'm actually choosing not to get anything. So sometimes simplifying the decisions help people make a choice and there are dozens and dozens and dozens of these factors that go in that are at play when people make choices. So behavioral economics is the field of understanding why people choose the things that they do and then developing nudges, ways that we can get people to make choices that are in their better interest so that they're not influenced by biases, by some inherent thinking that they have by outside influences in those choices and if you think about hearing health care there are a variety of places in the patient journey where people are making choices about their hearing health whether it's to go see a healthcare practitioner, whether it's to get a hearing test, whether it's to actually get a hearing aid if it's recommended, which hearing aid to get, whether to actually wear the hearing aid once you've obtained a hearing aid. There's a lot of places where people are not making the best decisions for themselves so we want to understand how can we apply behavioral economics in order to understand these decisions that are being made and help people make better decisions in hearing health care. One area where we've been successful with this is in the at the point where people are deciding what hearing aid to get. As we all know in this field a lot of people often simply choose the cheapest hearing aid that's available to them and it's not necessarily because that's the only one they can afford but sometimes it's because that's the default choice. They have a hard time making a decision for a higher level and better technology that can produce better hearing outcomes for them. So our goal was how could we apply behavioral economics to allow people to make better choices for the hearing health care to get better technology and get better hearing outcomes from those decisions that they're making. So we applied concept from behavioral economics. We spent months understanding the issue, identifying the heuristics that are involved, the biases. We developed nudges that can help people make better decisions for the hearing health care and then we developed a protocol that clinics can use in order to get people to get better hearing care. What we were able to do is to get more than twice as many people make that choice to get better hearing technology and get better hearing for the when they're seeking to get hearing health. So I think that behavioral economics can be applied in a lot of positive ways and we're heavily involved in this. You'll hear a lot more about this and our work in helping hearing health care through behavioral insights in future webinars. NAL also develops a lot of technology that we make available to clinicians and people and to manufacturers of technology in order to help with hearing. One of the most successful technologies that we developed is an EEG system called Hear Lab and this was developed in order to solve the problem of how do you tell how a baby is doing when they're fit with a hearing aid or cochlear implant. They can't tell you if they're hearing well or not, they can't do speech tests. So the solution that NAL developed was an EEG system that measures the auditory cortex and is able to tell which speech materials are actually getting to the auditory cortex through the hearing aid or through the cochlear implant that would allow the clinician to make decisions on the amount of gain that the baby is getting or whether they should actually switch from a hearing aid to a cochlear implant if they're in that level of hearing loss where it's a little bit ambiguous. So this has been used very successfully with clinics across Australia and around the world and we have continued to innovate in this area and in areas such as being able to identify whether babies can differentiate between the different speech sounds. So this is one of the better examples of technologies that we've developed. We've licensed this to a diagnostic company called Inventus that will be releasing this in the future. We have developed some automated visual reinforcement audiology systems that is going to be released very soon by Metarex. We've developed apps. We've developed remote hearing tests and hearing systems. All things where we're identifying unmet needs of either people with hearing loss or clinicians and developing tools that can help get better outcomes for people with hearing loss. Then finally NAL spends a lot of time understanding the how to measure outcomes of people who get hearing devices. You know we historically in research spent a lot of time using very artificial tests whether it's the quicksand or the hint very simple sentences and very simple noise. We all know that these are not representative of the real world and we want to understand better how people are are doing with their devices. Where are there still gaps? Where do they still have unmet needs even though they've been fit with very good products? The only way to do that is to be able to test them in the most realistic way possible and in all aspects of outcomes not just speech reception but effort and comfort and a variety of ways. Social participation. One project that's been very important for us in terms of outcomes is a longstanding study. It's a longitudinal study on outcomes of children fit with devices. We have been following people, babies who have been born with hearing loss, over 400 babies who were then subsequently fit with either hearing aids or cochlear implants and we have been following them throughout their whole lives. They have reached the age of 10 and older now and we're tracking things like how they're doing in school, how their speech is developing, how they're socializing, basically any and all aspects of their lives that have been impacted by the provision of hearing devices and seeing what the impact of the devices are compared to children who aren't wearing device or have normal hearing but also seeing what the impact is on the timeliness of the fitting of devices because as we know some people delay in fitting cochlear implants or hearing aids we wanted to see if that had an impact on how people are living their lives years years later and so we're hoping that this data can be used by policymakers in changing policy on fitting babies with devices on healthcare professionals and the decisions that they make in the clinician in the clinic for the provision of devices for babies but also for the public awareness for parents and helping them make decisions on whether or not they should treat their children their children's identified hearing loss. So here's the example of the data that we've found and you'll see a lot more about this in an upcoming webinar. Here we see on the y-axis is a is a speech score for how this cohort is doing at the age of five and what the x-axis is the age of the baby when they were fit with their hearing aid. So this is a group of babies who had severe hearing loss, 70 dB, HL, or greater and you can see with the red line the trend of the population that orange area in the middle is the norm for their speech production scores sorry their language scores and the red line shows you the trend for how they're doing as a function of when the hearing aid was first fit and you can see if they've been fit beyond the first six months of age as on average they are doing worse than the normative group shown here. So the age at which someone is fit with a hearing aid is very important from a developmental perspective in terms of language acquisition and their ability to use language years down the road. So well this is again one of the more important projects we've done at NAL you'll hear more about this at a later webinar. We spent a lot of time figuring out how can we get most realistic measures of how people are performing with their devices. One way that we're doing this is getting out of the real world and developing technology that people can use for us to assess how they're doing when they're at restaurants, when they're at social functions, when they're at home, whether these are apps on iPhones or other technology we are getting out into the real world and trying to get out of the lab to see how people are functioning in their everyday lives with the treatments that they've received or even to understand the needs of people with untreated hearing loss. We also have very sophisticated laboratory technology that allows us to use ambisonics with this 42-speaker system that you see here on the screen that will perfectly provide an acoustic representation of any environment that we've recorded whether that's a restaurant, whether that's a train station, whether that's a store, environments where people might have difficulty communicating, we're able to replicate in the laboratory to get a better understanding of how they're doing with their technology, how they're doing with untreated hearing loss and again understand the unmet needs of the population so we can develop solutions for them. One example is we're currently using this technology to allow us to measure EEG in this laboratory using realistic acoustic situations. So see how the brain is responding when people are wearing hearing devices in a very natural, very normal acoustic environment. So this again gives us better insight into the needs of people and also how well technology is doing today in overcoming those needs and meeting the needs that people have. So that's just a glimpse at the kind of research that we do at NAL. You'll be hearing about each of these projects and a lot more over the rest of this webinar series from the NAL scientists at NAL. So thank you.