Bone-anchored hearing aids for people who are bilaterally deaf: a systematic review and economic evaluation

The 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

A relaxed approach to combinatorial problems in robustness and diagnostics

A range of procedures in both robustness and diagnostics require optimisation of a target functional over all subsamples of given size. Whereas such combinatorial problems are extremely difficult to solve exactly, something less than the global optimum can be ‘good enough’ for many practical purposes, as shown by example. Again, a relaxation strategy embeds these discrete, high-dimensional problems in continuous, low-dimensional ones. Overall, nonlinear optimisation methods can be exploited to provide a single, reasonably fast algorithm to handle a wide variety of problems of this kind, thereby providing a certain unity. Four running examples illustrate the approach. On the robustness side, algorithmic approximations to minimum covariance determinant (MCD) and least trimmed squares (LTS) estimation. And, on the diagnostic side, detection of multiple multivariate outliers and global diagnostic use of the likelihood displacement function. This last is developed here as a global complement to Cook’s (in J. R. Stat. Soc. 48:133–169, 1986) local analysis. Appropriate convergence of each branch of the algorithm is guaranteed for any target functional whose relaxed form is—in a natural generalisation of concavity, introduced here—‘gravitational’. Again, its descent strategy can downweight to zero contaminating cases in the starting position. A simulation study shows that, although not optimised for the LTS problem, our general algorithm holds its own with algorithms that are so optimised. An adapted algorithm relaxes the gravitational condition itself

Socialization of inpatriate managers to the headquarters of global organizations: An application of reference point theory

Understanding the intricacies of managing the life cycle of international personnel is a conundrum that continues to perplex HR managers in the global business arena. Although the notion of adjusting to a socioeconomically and culturally distant environment has been explored extensively from the expatriate perspective, the critical issue to discern is the attention inpatriates need to facilitate successful, long-term integration into a novel setting. With regard to the relatively new staffing option of "inpatriation," the current literature seeks to acquire an understanding of the contextual implications vital for an adjustment process that allows for the successful and lasting incorporation of such individuals in the headquarters of global organizations. As a result of this gap, this article examines the relationship between institutional and individualized socialization tactics and sociocultural and psychological adjustments in conjunction with a proposed moderator effect of cultural distance that inpatriates may undergo. Overall, the article argues that the successful socializing of such individuals will in part depend on their set of psychological reference points during the acculturation stages. © 2010 SAGE Publications

Improving the Evidence Base for Career Development Programs: Making Use of the Evaluation Profession and Positive Psychology Movement

Though much has been written on the topic of career development, the human resource development field has paid little attention to the ways in which career development programs are evaluated.The lack of sound evidence for the effectiveness of career development interventions may be because of the over reliance on Kirkpatrick\u27s ubiquitous evaluation approach or that traditional research methods such as experimental and quasi-experimental designs are not appropriate or feasible in many organizational settings. In this article, we describe the growing profession and practice of evaluation and discuss how the positive psychology movement provides new insights into how career development programs may be evaluated

Cued speech for enhancing speech perception and first language development of children with cochlear implants

Nearly 300 million people worldwide have moderate to profound hearing loss. Hearing impairment, if not adequately managed, has strong socioeconomic and affective impact on individuals. Cochlear implants have become the most effective vehicle for helping profoundly deaf children and adults to understand spoken language, to be sensitive to environmental sounds, and, to some extent, to listen to music. The auditory information delivered by the cochlear implant remains non-optimal for speech perception because it delivers a spectrally degraded signal and lacks some of the fine temporal acoustic structure. In this article, we discuss research revealing the multimodal nature of speech perception in normally-hearing individuals, with important inter-subject variability in the weighting of auditory or visual information. We also discuss how audio-visual training, via Cued Speech, can improve speech perception in cochlear implantees, particularly in noisy contexts. Cued Speech is a system that makes use of visual information from speechreading combined with hand shapes positioned in different places around the face in order to deliver completely unambiguous information about the syllables and the phonemes of spoken language. We support our view that exposure to Cued Speech before or after the implantation could be important in the aural rehabilitation process of cochlear implantees. We describe five lines of research that are converging to support the view that Cued Speech can enhance speech perception in individuals with cochlear implants.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Institutional adaptation: Demands for management reform and university administration

Higher education organizations around the world have always faced environmental changes. However, in the past decade altered societal expectations, new public policies, and technological innovations have created an unprecedented set of challenges for universities. Although the borders of universities have opened in new ways for thei