32 research outputs found
Bone-anchored hearing aids for people with bilateral hearing impairment: a systematic review
Get PDFBACKGROUND: Bone-anchored hearing aids (BAHAs) are indicated for people with conductive or mixed hearing loss who can benefit from amplification of sound. In resource limited health care systems, it is important that evidence regarding the benefit of BAHAs is critically appraised to aid decision-making.OBJECTIVE OF REVIEW: To assess the clinical effectiveness of BAHAs for people with bilateral hearing impairment.TYPE OF REVIEW: Systematic review.SEARCH STRATEGY: Nineteen electronic resources were searched from inception to November 2009. Additional studies were sought from reference lists, clinical experts and BAHA manufacturers.EVALUATION METHOD: Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment of full papers were undertaken by one reviewer and checked by a second. Studies were synthesised through narrative review with tabulation of results.RESULTS: Twelve studies were included. Studies suggested audiological benefits of BAHAs when compared with bone-conduction hearing aids or no aiding. A mixed pattern of results was seen when BAHAs were compared to air-conduction hearing aids. Improvements in quality of life with BAHAs were found by a hearing-specific instrument but not generic quality of life measures. Issues such as improvement of discharging ears and length of time the aid can be worn were not adequately addressed by the studies. Studies demonstrated some benefits of bilateral BAHAs. Adverse events data were limited. The quality of the studies was low.CONCLUSIONS: The available evidence is weak. As such, caution is indicated in the interpretation of presently available data. However, based on the available evidence, BAHAs appear to be a reasonable treatment option for people with bilateral conductive or mixed hearing loss. Further research into the benefits of BAHAs, including quality of life, is required to reduce the uncertainty.<br/
Bone-anchored hearing aids for people who are bilaterally deaf: systematic review and economic evaluation
No full textReplies to Critics of the Fiery Test of Critique
Get PDFA set of replies to critics of my 2021 book 'The Fiery Test of Critique: A Reading of Kant's Dialectic' (OUP).
The criticisms are based on talks given at an Author-meets-critics symposium at Princeton University on April 22nd, 2023. The critics are: Beatrice Longuenesse, Patricia Kitcher, Allen Wood, Des Hogan, and Anja Jauernig
Bone-anchored hearing aids for people who are bilaterally deaf: a systematic review and economic evaluation
No full textThe aim of this systematic review, using standard methodology,was to assess the clinical and cost-effectiveness of bone-anchored hearing aids (BAHAs) for people who are bilaterally deaf. Prospective studies comparing BAHAs versus conventional hearing aids [air conduction hearing aid (ACHA) or bone conduction hearing aid (BCHA)], unaided hearing or ear surgery; and unilateral versus bilateral BAHAs were eligible. Twelve clinical effectiveness studies were included. No eligible comparisons with ear surgery were identified. Overall quality was rated as weak for all included studies.There appeared to be some audiological benefits of BAHAs compared with BCHAs and improvements in speech understanding in noise compared with ACHAs, however ACHAs may produce better audiological results for other outcomes; the limited evidence reduces certainty. Hearing is improved with BAHAs compared with unaided hearing. Improvements in QoL with BAHAs were identified by a hearing-specific instrument but not generic QoL measures. Studies comparing unilateral with bilateral BAHAs suggested benefits of bilateral BAHAs in many, but not all, situations.A decision analytic model was developed to estimate the costs and benefits of unilateral BAHAs over a ten year time horizon. The incremental cost per user receiving BAHA, compared with BCHA, was £16,344 for children and £13,281 for adults. In an exploratory analysis the incremental cost per QALY gained was between £118,898 and £55,424 for children and between £98,790 to £46,051 for adults for BAHAs compared with BCHA, depending on the assumed QoL gain and proportion of each modelled cohort using their hearing aid for eight or more hours per day. Deterministic sensitivity analysis suggested results were highly sensitive to the assumed proportion of people using BCHA for eight or more hours per day.Exploratory cost effectiveness analysis suggests that BAHAs are unlikely to be a cost effective option where the benefi ts are similar for BAHAs and their comparators. The greater the benefit from aided hearing and the greater the difference in the proportion of people using the hearing aid for eight hours or more per day, the more likely BAHAs are to be a cost effective option. The inclusion of other dimensions of QoL may also increase the likelihood of BAHAs being a cost effective option.A national audit of BAHAs is needed to provide clarity on the many areas of uncertainty surrounding BAHAs
Sifting through the glamorization of the Tiny House Movement – Perceptions among affordable housing stakeholders in Lüneburg, Germany
Get PDFabstract: How we divide space in ever growing urban areas in an equitable, efficient and aesthetic fashion is one of the big questions of our time. In Lüneburg, Germany, citizens think more alternative forms of housing will be an important element of a sustainable future (Lüneburg 2030, 2018). Tiny Houses, dwellings that downsize an entire household to its minimum, are currently gaining attention in the country, but legal barriers make their implementation difficult. It has to be decided if legislations should be changed to allow these structures in the housing mix of Lüneburg. It is a difficult task to sift through the glamorization of Tiny Houses past the ideological utopia to see their value for the individual (Ansons, 2015). Therefore, it is of interest to fully understand what Tiny Houses offer for affordable housing stakeholders. Twenty-five evaluations of criticism and praise of the Tiny House Movement are collected by applying Q method, a tool to gather subjective viewpoints (Barry & Proops, 1999). Results indicate, four salient perceptions on that matter. Each viewpoint identifies different opportunities and risks when evaluating Tiny Houses for Lüneburg. This research demonstrates the potential of Tiny Houses to trigger participation by bringing people with diverse backgrounds together
The role of bone anchored hearing aids in children with Down syndrome
No full textObjectives: To evaluate complication rates and outcomes of children with Down syndrome fitted with a Bone Anchored Hearing Aid (Baha®). To evaluate whether the Bone Anchored Hearing Aid is a successful form of aural rehabilitation in children with Down syndrome from a patients' perspective. Study design: Retrospective case analysis and postal questionnaire study. Setting: The Birmingham Children's Hospital, UK. Methods: A total of 15 children were fitted with a Baha® between February 1992 and February 2007. The age range was 2-15 years. A postal questionnaire was sent to each family. The Glasgow Children's Benefit Inventory (GCBI) was used in this study. Outcome measures: Implantation results, skin reactions and other complications were recorded. Quality of life after receiving a Baha® was assessed with the GCBI. Results: All 15 patients are using their Baha® 7 days a week for more than 8 h a day after a follow-up of 14 months with continuing audiological benefit. No fixtures were lost, and skin problems were encountered in 3 (20%). Regarding quality of life, all 15 patients had improved social and physical functioning as a result of better hearing. Conclusions: Baha® has an important role in the overall management of individuals with Down syndrome after conventional hearing aids and/or ventilation tubes have been considered or already failed. This study has shown a 20% rate of soft tissue reaction and there were no fixture losses in this group. No significant increase in complication rates was identified in children with Down syndrome. Finally, there was a significantly improved quality of life in children with Down syndrome after receiving their Baha®. There was a high patient/carer satisfaction with Baha®. Two of our series had bilateral two stage fixture procedures without any complications. More consideration should be given to bilateral bone anchored hearing aids in this group. © 2008 Elsevier Ireland Ltd. All rights reserved
Author Correction: Domestic horses (Equus caballus) prefer to approach humans displaying a submissive body posture rather than a dominant body posture
No full textThe bone-anchored hearing aid in the rehabilitation of single-sided deafness: experience with 58 patients
No full textObjectives: To assess the efficacy of the bone-anchored hearing aid (BAHA) in the rehabilitation of single-sided deafness (SSD). Study design: Retrospective case-control series review. Setting: Tertiary referral unit. Patients: Fifty-eight consecutive patients that had a bone-anchored hearing aid for single-sided deafness completed outcome questionnaires, building upon earlier audiological assessment of 19 patients. Single-sided deafness controls (n = 49) were mainly acoustic neuroma patients. Main outcome measurements: speech discrimination testing in directional noise, speech and spatial qualities of hearing questionnaire and the Glasgow Benefit Inventory (GBI). Results: The mean follow-up time was 28.4 months. Five (13%) of the bone-anchored hearing aid patients were non-users because of lack of benefit. The audiometric testing confirmed that when noise was on the bone-anchored hearing aid side speech perception was reduced but benefited when noise was on the side of the hearing ear. There was no difference between the Speech and Spatial Qualities of Hearing Scores in bone-anchored hearing aid users and controls. In particular there was no difference in the spatial subscores. In the bone-anchored hearing aid users the median Glasgow Benefit Inventory score was 11. If the non-users are included then 13 (22%) patients had no or detrimental (negative) Benefit scores. No or negative benefit scores were more frequent in those deaf for <10 years. In open-field questions, patients felt the bone-anchored hearing aid was most useful in small groups or in 'one-to-one' conversation. Conclusions: Bone-anchored hearing aid rehabilitation for single-sided deafness is less successful than for other indications, reflected here by relatively low median Glasgow Benefit Inventory scores. There was also no significant difference between controls and bone-anchored hearing aid users in the Speech and Spatial Qualities of Hearing Questionnaire. Patients with a longer duration of deafness report greater subjective benefit than those more recently deafened, perhaps due to differing expectations
Impact Analysis and Extraction Method: Applications on water resources in Andalusia
Get PDFThe objective of this work is to deepen in the relationships between the andalusian productive system and the water consumption. We will use an Impact Analysis and the Extraction Method. The first one allows us to study how it would affect to the regional water consumption a change in the sectorial demand. The second one allows us to simulate how it would affect to the water consumption the hypothetical extraction of a certain sector of the economic system. This study allows us to conclude that a reduction in the exports of some sectors would affect positively on the water saving; and that the extraction, fundamentally of the agro-alimentary industry, would considerably reduce the consumption of this resource. Before this reality we raised the possibility of considering a structural change in the region that consists of a productive specialization less water consumer.Input-Output analysis, Water consumption, Andalusian
