| 1. |
- Bergström, Martin, et al.
(author)
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Interventions in Foster Family Care: A Systematic Review
- 2020
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In: Research on social work practice. - : SAGE Publications. - 1049-7315 .- 1552-7581. ; 30:1, s. 3-18
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Journal article (peer-reviewed)abstract
- Objective: Foster family care is associated with adverse short- and long-term consequences for the child. A systematic review was conducted on interventions for foster children and foster careers. Method: A comprehensive search process was used to find eligible interventions evaluated in randomized controlled trials or quasi-experimental studies. The quality of studies was assessed with GRADE, and effects were synthesized using meta-analytic methods. Results: In all, 28 publications of 18 interventions, including 5,357 children, were identified. Only three specific interventions had sufficient confidence of evidence. No study had examined tools for foster parent selection nor had evaluated preservice programs related to outcomes. Discussion: These analyses provide new insights and hope into the field of systematic interventions in foster care. The overall results indicate that it is possible to improve eight outcomes but cannot point out which programs are superior. Ethically, social care organizations should systematically collect knowledge about effects and side effects.
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| 2. |
- Fredén Jansson, Karl-Johan, 1988, et al.
(author)
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Bone Conduction Stimulated VEMP Using the B250 Transducer
- 2021
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In: Medical Devices: Evidence and Research. - 1179-1470. ; 14, s. 225-237
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Journal article (peer-reviewed)abstract
- Objective: Bone conduction (BC) stimulation is rarely used for clinical testing of vestibular evoked myogenic potentials (VEMPs) due to the limitations of conventional stimulation alternatives. The aim of this study is to compare VEMP using the new B250 transducer with the Minishaker and air conduction (AC) stimulation. Methods: Thirty normal subjects between 20 and 37 years old and equal gender distribution were recruited, 15 for ocular VEMP and 15 for cervical VEMP. Four stimulation conditions were compared: B250 on the mastoid (FM); Minishaker and B250 on the forehead (FZ); and AC stimulation using an insert earphone. Results: It was found that B250 at FM required a statistically significant lower hearing level than with AC stimulation, in average 41 dB and 35 dB lower for ocular VEMP and cervical VEMP, respectively, but gave longer n10 (1.1 ms) and n23 (1.6 ms). No statistical difference was found between B250 at FM and Minishaker at FZ. Conclusion: VEMP stimulated with B250 at FM gave similar response as the Minishaker at FZ and for a much lower hearing level than AC stimulation using insert earphones.
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| 3. |
- Fredén Jansson, Karl-Johan, 1988, et al.
(author)
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Electroacoustic evaluation of the bone conduction transducer B250 for vestibular and hearing diagnostics in comparison with Radioear B71 and B81
- 2024
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In: International Journal of Audiology. - 1499-2027 .- 1708-8186. ; In Press
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Journal article (peer-reviewed)abstract
- Objective: The objective is to evaluate the electroacoustic performance of the B250 transducer and to compare it with the two most widely used audiometric transducers B71 and B81. Design: The electroacoustic performance was evaluated in terms of sensitivity level, distortion, maximum hearing level and electrical impedance. Study sample: Six B250 prototype transducers were evaluated and compared with published data of B71 and B81 together with complementary measurements of maximum hearing level at 125 Hz and phase of electrical impedance. Differences in reference equivalent threshold vibratory force levels were estimated by comparing hearing threshold measurements of 60 healthy ears using B81 and B250. Results: B250 has approximately 27 dB higher sensitivity levels than both B71 and B81 at 250 Hz and can generate higher maximum hearing level at low frequencies: 11.8 to 35.8 dB (125–1000 Hz) higher than B71, and 1.4 to 18.6 dB (125–750 Hz) higher than B81. The maximum average difference in reference threshold force levels was 13.5 ± 8.7 dB higher for B250 at 250 Hz compared to B81. Conclusions: B250 can produce higher output force with less distortion than B71 and B81, especially at 125 and 250 Hz, which could possibly improve low frequency investigations of the audio-vestibular system.
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| 4. |
- Fredén Jansson, Karl-Johan, 1988, et al.
(author)
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Electroacoustic evaluation of the bone conduction transducer B250 for vestibular and hearing diagnostics in comparison with Radioear B71 and B81
- 2024
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In: INTERNATIONAL JOURNAL OF AUDIOLOGY. - 1499-2027 .- 1708-8186.
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Journal article (peer-reviewed)abstract
- ObjectiveThe objective is to evaluate the electroacoustic performance of the B250 transducer and to compare it with the two most widely used audiometric transducers B71 and B81.DesignThe electroacoustic performance was evaluated in terms of sensitivity level, distortion, maximum hearing level and electrical impedance.Study sampleSix B250 prototype transducers were evaluated and compared with published data of B71 and B81 together with complementary measurements of maximum hearing level at 125 Hz and phase of electrical impedance. Differences in reference equivalent threshold vibratory force levels were estimated by comparing hearing threshold measurements of 60 healthy ears using B81 and B250.ResultsB250 has approximately 27 dB higher sensitivity levels than both B71 and B81 at 250 Hz and can generate higher maximum hearing level at low frequencies: 11.8 to 35.8 dB (125-1000 Hz) higher than B71, and 1.4 to 18.6 dB (125-750 Hz) higher than B81. The maximum average difference in reference threshold force levels was 13.5 +/- 8.7 dB higher for B250 at 250 Hz compared to B81.ConclusionsB250 can produce higher output force with less distortion than B71 and B81, especially at 125 and 250 Hz, which could possibly improve low frequency investigations of the audio-vestibular system.
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| 5. |
- Håkansson, Bo, 1953, et al.
(author)
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The mechanical impedance of the human skull via direct bone conduction implants
- 2020
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In: Medical Devices: Evidence and Research. - 1179-1470. ; 13, s. 293-313
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Journal article (peer-reviewed)abstract
- Purpose: The mechanical skull impedance is used in the design of direct bone drive hearing systems. This impedance is also important for the design of skull simulators used in manufacturing, service, and fitting procedures of such devices. Patients and Methods: The skull impedance was measured in 45 patients (25 female and 20 male) who were using percutaneous bone conduction implants (Ponto system or Baha system). Patients were recruited as a consecutive prospective case series and having an average age of 55.4 years (range 18–80 years). Seven patients were treated in Gothenburg, Sweden, and 38 patients in Edmonton, Canada. An impedance head (B&K 8001), driven by an excitation transducer with emphasized low-frequency response, was used to measure the mechanical point impedance with a swept sine from 100 to 10k Hz. Results and Discussion: The skull impedance was found to have an anti-resonance of approximately 150 Hz, with a median maximum magnitude of 4500 mechanical ohms. Below this anti-resonance, the mechanical impedance was mainly mass-controlled corresponding to an effective skull mass of 2.5 kg at 100 Hz with substantial damping from neck and shoulder. Above the anti-resonance and up to 4 kHz, the impedance was stiffness-controlled, with a total compliance of approximately 450n m/N with a small amount of damping. At frequencies above 4 kHz, the skull impedance becomes gradually mass-controlled originating from the mass of the osseointegrated implant and adjacent bone. No significant differences related to gender or skull abnormalities were seen, just a slight dependence on age and major ear surgeries. The variability of the mechanical impedance among patients was not found to have any clinical importance. Conclusion: The mechanical skull impedance of percutaneous implants was found to confirm previous studies and can be used for optimizing the design and test procedures of direct bone drive hearing implants. © 2020 Håkansson et al.
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| 6. |
- Maier, Hannes, et al.
(author)
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Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss
- 2022
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In: Otology and Neurotology. - : Lippincott, Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 43:5, s. 513-529
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Journal article (peer-reviewed)abstract
- Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
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| 7. |
- Mastinu, Enzo, 1987, et al.
(author)
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Neural feedback strategies to improve grasping coordination in neuromusculoskeletal prostheses
- 2020
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322 .- 2045-2322. ; 10:1
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Journal article (peer-reviewed)abstract
- Conventional prosthetic arms suffer from poor controllability and lack of sensory feedback. Owing to the absence of tactile sensory information, prosthetic users must rely on incidental visual and auditory cues. In this study, we investigated the effect of providing tactile perception on motor coordination during routine grasping and grasping under uncertainty. Three transhumeral amputees were implanted with an osseointegrated percutaneous implant system for direct skeletal attachment and bidirectional communication with implanted neuromuscular electrodes. This neuromusculoskeletal prosthesis is a novel concept of artificial limb replacement that allows to extract control signals from electrodes implanted on viable muscle tissue, and to stimulate severed afferent nerve fibers to provide somatosensory feedback. Subjects received tactile feedback using three biologically inspired stimulation paradigms while performing a pick and lift test. The grasped object was instrumented to record grasping and lifting forces and its weight was either constant or unexpectedly changed in between trials. The results were also compared to the no-feedback control condition. Our findings confirm, in line with the neuroscientific literature, that somatosensory feedback is necessary for motor coordination during grasping. Our results also indicate that feedback is more relevant under uncertainty, and its effectiveness can be influenced by the selected neuromodulation paradigm and arguably also the prior experience of the prosthesis user.
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| 8. |
- Persson, Ann-Charlotte, 1970, et al.
(author)
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A novel method for objective in-situ measurement of audibility in bone conduction hearing devices - a pilot study using a skin drive BCD
- 2023
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In: International Journal of Audiology. - : Informa UK Limited. - 1499-2027 .- 1708-8186. ; 62:4, s. 357-361
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Journal article (peer-reviewed)abstract
- Objective Objective measurement of audibility (verification) using bone conduction devices (BCDs) has long remained an elusive problem for BCDs. For air conduction hearing aids there are well-defined and often used objective methods, and the aim of this study is to develop an objective method for BCDs. Design In a novel setup for audibility measurements of bone-anchored hearing aid (BAHA) attached via a soft band, we used a skin microphone (SM) on the forehead measuring in-situ sound field thresholds, maximum power output (MPO) and international speech test signal (ISTS) responses. Study sample Five normal-hearing persons. Result Using the electrical output of SM it was possible to objectively measure the audibility of a skin drive BCD, presented as an eSPL-o-gram showing thresholds, MPO and ISTS response. Normalised eSPL-o-gram was verified against corresponding FL-o-grams (corresponding force levels from skull simulator and artificial mastoid (AM)). Conclusion The proposed method with the SM can be used for objective measurements of the audibility of any BCDs based on thresholds, MPO and speech response allowing for direct comparisons of hearing and BCD output on the same graph using an eSPL-o-gram. After normalisation to hearing thresholds, the audibility can be assessed without the need for complicated calibration procedures.
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| 9. |
- Persson, Ann-Charlotte, 1970, et al.
(author)
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Objective verification of audibility in bone conduction devices
- 2024
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In: International Journal of Audiology. - 1499-2027 .- 1708-8186.
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Journal article (peer-reviewed)abstract
- Objective: To objectively measure audibility in patients wearing bone conduction devices (BCDs) with a new approach using a skin microphone at the patient’s forehead. Design: The skin microphone was attached by a softband and shielded by an earmuff. This set-up was confirmed not to be influenced by neither noise floor nor sound bypassing the BCD. Sound field warble tones were used for measuring aided hearing thresholds and maximum power output (MPO) whereas an international speech test signal (ISTS) was presented at different speech levels. Study sample: 29 patients were tested (two were bilateral), 19 used percutaneous, eight used active transcutaneous and two used passive transcutaneous devices. Results: The skin microphone responses at ISTS levels, hearing threshold and MPO, could be obtained in all patients. Two patients with poor audibility are highlighted in this article as examples. After adjusting the gain of the BCD, they were retested with the skin microphone (for verification) and with speech-in-noise tests (for validation). Both tests confirmed an improved audibility after the adjustments. Conclusion: In summary, the proposed measurement of audibility of speech using a skin microphone is a promising method that can be used in a clinical setting for all types of BCDs.
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| 10. |
- Persson, Ann-Charlotte, 1970, et al.
(author)
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Three-Year Follow-Up with the Bone Conduction Implant
- 2020
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In: Audiology and Neuro-Otology. - : S. Karger AG. - 1421-9700 .- 1420-3030. ; 25:5, s. 263-275
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Journal article (peer-reviewed)abstract
- Background: The bone conduction implant (BCI) is an active transcutaneous bone conduction device where the transducer has direct contact to the bone, and the skin is intact. Sixteen patients have been implanted with the BCI with a planned follow-up of 5 years. This study reports on hearing, quality of life, and objective measures up to 36 months of follow-up in 10 patients. Method: Repeated measures were performed at fitting and after 1, 3, 6, 12, and 36 months including sound field warble tone thresholds, speech recognition thresholds in quiet, speech recognition score in noise, and speech-to-noise thresholds for 50% correct words with adaptive noise. Three quality of life questionnaires were used to capture the benefit from the intervention, appreciation from different listening situations, and the ability to interact with other people when using the BCI. The results were compared to the unaided situation and a Ponto Pro Power on a soft band. The implant functionality was measured by nasal sound pressure, and the retention force from the audio processor against the skin was measured using a specially designed audio processor and a force gauge. Results: Audiometry and quality of life questionnaires using the BCI or the Ponto Pro Power on a soft band were significantly improved compared to the unaided situation and the results were statistically supported. There was generally no significant difference between the two devices. The nasal sound pressure remained stable over the study period and the force on the skin from the audio processor was 0.71 ± 0.22 N (mean ± 1 SD). Conclusion: The BCI improves the hearing ability for tones and speech perception in quiet and in noise for the indicated patients. The results are stable over a 3-year period, and the patients subjectively report a beneficial experience from using the BCI. The transducer performance and contact to the bone is unchanged over time, and the skin area under the audio processor remains without complications during the 3-year follow-up.
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