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A printed electronics technology has the advantage of additive and extremely low-cost fabrication compared with the conventional silicon technology. Specifically, printed electrolyte-gated field-effect transistors (EGFETs) are attractive for low-cost applications in the Internet-of-Things domain as they can operate at low supply voltages. In this paper, we propose an empirical dc model for EGFETs, which can describe the behavior of the EGFETs smoothly and accurately over all regimes. The proposed model, built by extending the Enz-Krummenacher-Vittoz model, can also be used to model process variations, which was not possible previously due to fixed parameters for near threshold regime. It offers a single model for all the operating regions of the transistors with only one equation for the drain current. Additionally, it models the transistors with a less number of parameters but higher accuracy compared with existing techniques. Measurement results from several fabricated EGFETs confirm that the proposed model can predict the I-V more accurately compared with the state-of-the-art models in all operating regions. Additionally, the measurements on the frequency of a fabricated ring oscillator are only 4.7% different from the simulation results based on the proposed model using values for the switching capacitances extracted from measurement data, which shows more than 2× improvement compared with the state-of-the-art model.
Chronic insomnia is defined by difficulties in falling asleep, maintaining sleep, and early morning awakening, and is coupled with daytime consequences such as fatigue, attention deficits, and mood instability. These symptoms persist over a period of at least 3 months (Diagnostic and Statistical Manual 5 criteria). Chronic insomnia can be a symptom of many medical, neurological, and mental disorders. As a disorder, it incurs substantial health-care and occupational costs, and poses substantial risks for the development of cardiovascular and mental disorders, including cognitive deficits. Family and twin studies confirm that chronic insomnia can have a genetic component (heritability coefficients between 42% and 57%), whereas the investigation of autonomous and central nervous system parameters has identified hyperarousal as a final common pathway of the pathophysiology, implicating an imbalance of sleep–wake regulation consisting of either overactivity of the arousal systems, hypoactivity of the sleep-inducing systems, or both. Insomnia treatments include benzodiazepines, benzodiazepine-receptor agonists, and cognitive behavioural therapy. Treatments currently under investigation include transcranial magnetic or electrical brain stimulation, and novel methods to deliver psychological interventions.
Energy management in distribution grids is one of the key challenges that needs to be overcome to increase the share of fluctuating renewable energies. Current control systems for energy management mainly demonstrate centralized- or decentralized-hierarchical control structures. Very few systems manifest a fully decentralized multiagent-based control structure. Multiagent-based control systems promise to be an advantageous approach for the future distributed energy supply system because no central control entity is necessary, which eases parameterization in case of grid topology changes, and the agents are more stable against failures and changes of control topologies. Research is necessary to prove these benefits. In this study, we introduce a design of a multiagent-based voltage control system for low-voltage grids. In detail we introduce cooperative decision-making processes and software solutions that allow the agents to perceive and control their environment, the agent-discovery and localization in different types of communication networks, agent-to-agent communication, and the integration of the multiagent system in existing grid-control infrastructures. Furthermore, the study proposes how different existing technologies can be combined into an applicable multiagent-based voltage control system: the Java/OSGi-based OpenMUC framework allows a generic field–device interaction; peer-to-peer discovery and session establishment functionalities are combined with the agent communication defined by the Foundation for Intelligent Physical Agents (FIPA). The ripple control-signal technology is applied as a fallback communication between the agent and a central grid-control center.
Cardiac contractility modulation (CCM) is a device-based therapy for the treatment of systolic left ventricular chronic heart failure. Unlike other device-based therapies for heart failure, CCM delivers non-excitatory pacing signals to the myocardium. This leads to an extension of the action potential and to an improved contractility of the heart. The modeling and simulation was done with the electromagnetic simulation software CST. Three CCM electrodes were inserted into the Offenburg heart rhythm model and subsequently simulated the electric field propagation in CCM therapy.
In addition, simulations of CCM have been performed with electrodes from other device-based therapies, such as cardiac resynchronization therapy (CRT) and implantable cardioverter / defibrillator (ICD) therapy. At the same distance to the simulation electrode, the electric field is slightly stronger in CCM therapy than in CCM therapy with additionally implanted CRT or ICD electrodes. In addition, there is a change in the electric field propagation at the electrodes of the CRT and the shock electrode of the ICD.
By simulating several different therapy procedures on the heart, it is possible to check how they affect their behavior during normal operation. CCM heart rhythm model simulation allows the evaluation the individual electrical pacing and sensing field during CCM.
Energy consumption for cooling is growing dramatically. In the last years, electricity peak consumption grew significantly, switching from winter to summer in many EU countries. This is endangering the stability of electricity grids. This article outlines a comprehensive analysis of an office building performances in terms of energy consumption and thermal comfort (in accordance with static – ISO 7730:2005 – and adaptive thermal comfort criteria – EN 15251:2007 –) related to different cooling concepts in six different European climate zones. The work is based on a series of dynamic simulations carried out in the Trnsys 17 environment for a typical office building. The simulation study was accomplished for five cooling technologies: natural ventilation (NV), mechanical night ventilation (MV), fan-coils (FC), suspended ceiling panels (SCP), and concrete core conditioning (CCC) applied in Stockholm, Hamburg, Stuttgart, Milan, Rome, and Palermo. Under this premise, the authors propose a methodology for the evaluation of the cooling concepts taking into account both, thermal comfort and energy consumption.
Formal verification (FV) is considered by many to be complicated and to require considerable mathematical knowledge for successful application. We have developed a methodology in which we have added formal verification to the verification process without requiring any knowledge of formal verification languages. We use only finite-state machine notation, which is familiar and intuitive to designers. Another problem associated with formal verification is state-space explosion. If that occurs, no result is returned; our method switches to random simulation after one hour without results, and no effort is lost. We have compared FV against random simulation with respect to development time, and our results indicate that FV is at least as fast as random simulation. FV is superior in terms of verification quality, however, because it is exhaustive.
Eine Regelung zur optimalen Kraftschlußausnutzung von Lokomotiven setzt das Erreichen folgender Ziele voraus: Frühzeitiges Erkennen der Schleudergrenze zur Vermeidung von Gleitvorgängen; Fahren eines optimalen Kraftschlusses vom Fahr- und Bremsbetrieb ohne Überschreitung des Kraftschlußmaximums und schnelle Anpassung an wechselnde Arbeitspunkte, zum Beispiel an wechselnde Schienenzustände. Die vorgestellte optimale Regelung der Kraftschlußausnutzung erfaßt Schleuder- und Gleitzustände, die mit bisher eingesetzten Verfahren nicht erkannt werden können und ist Basis für ein Konzept, das ein quasi permanentes Fahren in der Nähe des Kraftschlußmaximums ermöglicht.
Der Beitrag beschreibt wichtige Eckdaten und Ergebnisse der Kraftschlußregelung, die in der Lokomotive 12X auf internationalen Strecken erprobt wurde, und mit der auch zukünftige Projekte ausgestattet werden. Diese werden nicht nur von weiteren technischen Verbesserungen profitieren, sondern auch von geringerem Aufwand für die Inbetriebsetzung.
High-precision signal processing algorithm to evaluate SAW properties as a function of temperature
(2013)
This paper presents a signal processing algorithm which accurately evaluates the SAW properties of a substrate as functions of temperature. The investigated acoustic properties are group velocity, phase velocity, propagation loss, and coupling coefficient. With several measurements carried out at different temperatures, we obtain the temperature dependency of the SAW properties. The analysis algorithm starts by reading the transfer functions of short and long delay lines. The analysis algorithm determines the center frequency of the delay lines and obtains the delay time difference between the short and long delay lines. The extracted parameters are then used to calculate the acoustic properties of the SAW material. To validate the algorithm, its accuracy is studied by determining the error in the calculating delay time difference, center frequency, and group velocity.
Die Kommunikationstechnik für die Zählerfernauslesung (Smart Metering) und für die Energieerzeugungs- und -verteilnetze (Smart Grid) hat das Potenzial, zu einer der ersten hoch skalierten M2M-Anwendungen zu werden. In den vergangenen Jahren konnten zwei vielversprechende Entwicklungen im Umfeld der drahtlosen Kommunikation für die Smart-Grid-Kommunikation vorbereitet werden, die das Marktgeschehen über Deutschland und über die Versorgungstechnik hinaus beeinflussen könnten. Neben der Spezifikation der OMS-Gruppe ist die Erarbeitung eines Schutzprofils (Protection Profile, PP) sowie einer Technischen Richtlinie (TR) für die Kommunikationseinheit eines intelligenten Messsystems (Smart Meter Gateway) durch das Bundesamt für Sicherheit in der Informationstechnik (BSI) zu nennen. Diese greifen, wie der Beitrag beschreibt, den Stand der Technik auf und geben praxisorientierte Umsetzungen vor.
The increasing number of transistors being clocked at high frequencies of modern microprocessors lead to an increasing power consumption, which calls for an active dynamic thermal management. In a research project a system environment has been developed, which includes thermal modeling of the microprocessor in the board system, a software environment to control the characteristics of the system’s timing behavior, and a modified Linux scheduler, which is enhanced with a prediction controller. Measurement results are shown for this development for a Freescale i.MX6Q quad-core microprocessor.
Transcatheter aortic valve implantation is a therapy for patients with reduced left ventricular ejection fraction and symptomatic aortic stenosis. The aim of the study was to compare the pre-and post- transcatheter aortic valve implantation procedures to determine the QRS and QT ventricular conduction times as a potential predictor of permanent pacemaker therapy requirement after transcatheter aortic valve implantation. QRS and QT ventricular conduction times were prolonged after transcatheter aortic valve implantation in heart failure patients with permanent dual chamber pacemaker therapy after transcatheter aortic valve implantation. QRS and QT ventricular conduction times may be useful parameters to evaluate the risk of post-procedural ventricular conduction block and permanent pacemaker therapy in transcatheter aortic valve implantation.
Seit den ersten Projekten der 90er Jahre arbeiten Hochschulen daran, geeignete Servicestrukturen für E-Learning zu etablieren, die die erforderliche technische, didaktische und organisatorische Unterstützung hochschulweit zur Verfügung stellen. Ging es zunächst darum, Services überhaupt dauerhaft zu sichern, steht heute die Frage des „wie“ im Vordergrund. Dabei wird am Bereich E-Learning ein eigentlich viel allgemeineres Problem deutlich: Die bisher überwiegende Organisation der Hochschule nach funktionellen Einheiten stößt an ihre Grenzen. Wir schlagen eine stärker prozessorientierte Sichtweise vor, analog zu Entwicklungen bei der Organisation von Unternehmen.
Cardiac resynchronization therapy (CRT) is an established therapy for heart failure patients and improves quality of life in patients with sinus rhythm, reduced left ventricular ejection fraction (LVEF), left bundle branch block and wide QRS duration. Since approximately sixty percent of heart failure patients have a normal QRS duration they do not benefit or respond to the CRT. Cardiac contractility modulation (CCM) releases nonexcitatoy impulses during the absolute refractory period in order to enhance the strength of the left ventricular contraction. The aim of the investigation was to evaluate differences in cardiac index between optimized and nonoptimized CRT and CCM devices versus standard values. Impedance cardiography, a noninvasive method was used to measure cardiac index (CI), a useful parameter which describes the blood volume during one minutes heart pumps related to the body surface. CRT patients indicate an increase of 39.74 percent and CCM patients an improvement of 21.89 percent more cardiac index with an optimized device.
There is an increasing demand by an ever-growing number of mobile customers for transfer of rich media content. This requires very high bandwidth which either cannot be provided by the current cellular systems or puts pressure on the wireless networks, affecting customer service quality. This study introduces COARSE – a novel cluster-based quality-oriented adaptive radio resource allocation scheme, which dynamically and adaptively manages the radio resources in a cluster-based two-hop multi-cellular network, having a frequency reuse of one. COARSE is a cross-layer approach across physical layer, link layer and the application layer. COARSE gathers data delivery-related information from both physical and link layers and uses it to adjust bandwidth resources among the video streaming end-users. Extensive analysis and simulations show that COARSE enables a controlled trade-off between the physical layer data rate per user and the number of users communicating using a given resource. Significantly, COARSE provides 25–75% improvement in the computed user-perceived video quality compared with that obtained from an equivalent single-hop network.
Exploiting Dissent: Towards Fuzzing-based Differential Black Box Testing of TLS Implementations
(2017)
The Transport Layer Security (TLS) protocol is one of the most widely used security protocols on the internet. Yet do implementations of TLS keep on suffering from bugs and security vulnerabilities. In large part is this due to the protocol's complexity which makes implementing and testing TLS notoriously difficult. In this paper, we present our work on using differential testing as effective means to detect issues in black-box implementations of the TLS handshake protocol. We introduce a novel fuzzing algorithm for generating large and diverse corpuses of mostly-valid TLS handshake messages. Stimulating TLS servers when expecting a ClientHello message, we find messages generated with our algorithm to induce more response discrepancies and to achieve a higher code coverage than those generated with American Fuzzy Lop, TLS-Attacker, or NEZHA. In particular, we apply our approach to OpenssL, BoringSSL, WolfSSL, mbedTLS, and MatrixSSL, and find several real implementation bugs; among them a serious vulnerability in MatrixSSL 3.8.4. Besides do our findings point to imprecision in the TLS specification. We see our approach as present in this paper as the first step towards fully interactive differential testing of black-box TLS protocol implementations. Our software tools are publicly available as open source projects.
The automatic classification of the modulation format of a detected signal is the intermediate step between signal detection and demodulation. If neither the transmitted data nor other signal parameters such as the frequency offset, phase offset and timing information are known, then automatic modulation classification (AMC) is a challenging task in radio monitoring systems. The approach of clustering algorithms is a new trend in AMC for digital modulations. A novel algorithm called `highest constellation pattern matching' is introduced to identify quadrature amplitude modulation and phase shift keying signals. The obtained simulation and measurement results outperform the existing algorithms for AMC based on clustering. Finally, it is shown that the proposed algorithm works in a real monitoring environment.
Im Jahr 1504 verlor der deutsche Ritter Gottfried („Götz“) von Berlichingen seine
rechte Hand. Schon während seiner Genesung dachte er daran, die Hand zu ersetzen,
und beauftragte bald darauf die erste Handprothese, die sogenannte „Eiserne Hand“.
Jahre später wurde die aufwändigere zweite „Eiserne Hand“ gebaut. Wir haben die erste
Prothese auf der Basis früherer Literaturdaten von
Quasigroch (1982) mit Hilfe von 3-D
Computer-Aided Design (CAD) rekonstruiert. Dazu mussten einige Abmessungen angepasst
und ein paar Annahmen für das CAD-Modell gemacht werden. Die historische passive
Prothese des Götz von Berlichingen ist für die moderne Neuroprothetik interessant, da sie
eine Alternative zu komplexen invasiven Brain-Machine-Interface-Konzepten darstellen
könnte, wo diese Konzepte nicht notwendig, möglich oder vom Patienten gewünscht sind.
Auf Grundlage der Computer-Aided-Design (CAD)-rekonstruierten ersten „Eisernen Hand“ des Götz von Berlichingen wird ein umgebautes, controllergesteuertes sensomotorisches Fingersystem auf seine Funktionalität beim Greifen von unterschiedlichen Gegenständen beschrieben und geprüft. Die elektronischen Finger, die den „Pinzettengriff“ nachahmen und automatisch bei dem zuvor eingestellten Anpressdruck abschalten, bewiesen eine bemerkenswerte Alltagstauglichkeit. Das vorgestellte Grundkonzept könnte eine Alternative bei der Entwicklung einfacher und kostengünstiger, aber dennoch gut einsatzfähiger bionischer Hände sein und zeigt einmal mehr, wie historische Ideen in die Gegenwart transferiert werden können.
Im Rahmen der Cochleaimplantat (CI)-Versorgung werden sowohl intraoperativ als auch postoperativ verschiedene elektrische und elektrophysiologische Diagnostikverfahren eingesetzt, bei denen elektrische Messgrößen vom CI erfasst und elektrophysiologische Messungen bei CI-Patienten durchgeführt werden. Zu den elektrophysiologischen Diagnostikverfahren zählen die Messung der elektrisch evozierten Summenaktionspotenziale des Hörnervs, die Registrierung der elektrisch evozierten auditorischen Hirnstammpotenziale und die Erfassung der elektrisch evozierten auditorischen kortikalen Potenziale. Diese Potenziale widerspiegeln die Erregung des Hörnervs und die Reizverarbeitung in verschiedenen Stationen der aufsteigenden Hörbahn bei intracochleärer elektrischer Stimulation mittels eines CI. Bei den aktuellen CI sind die Beurteilung der Elektrodenlage sowie die Prüfung der Ankopplung des Implantats an den Hörnerv wichtige Anwendungsgebiete der elektrophysiologischen Diagnostikverfahren. Ein weiteres bedeutendes Einsatzfeld stellt die Prüfung der Reizverarbeitung in der Hörbahn dar. Das Hauptanwendungsgebiet dieser Verfahren bildet jedoch die Unterstützung der Anpassung der CI-Sprachprozessoren bei Säuglingen und Kleinkindern auf der Basis elektrophysiologischer Schwellen.
The interaural time difference (ITD) is an important cue for the localization of sounds. ITD changes as little as 10 μs can be detected by the human auditory system. By provision of one ear with a cochlear implant (CI) ITD are altered due to the partial replacement of the peripheral auditory system. A hearing aid (HA), in contrast, does not replace but adds a processing delay component to the peripheral auditory system extending ITD. The aim of the present study was to quantify interaural stimulation timing between these different modalities to estimate the need for central auditory temporal compensation in single sided deaf CI users or bimodal CI/HA users. For this purpose, wave V latencies of auditory brainstem responses evoked either acoustically (ABR) or electrically via the CI (EABR) have been measured. The sum of delays consisting of CI signal processing measured in the MED-EL OPUS2 audio processor and EABR wave V latencies evoked on different intracochlear sites allowed an estimation of the entire CI channel-specific delay for MED-EL MAESTRO CI systems. We compared these values with ABR wave V latencies measured in the contralateral normal hearing or HA provided ear in different frequency bands. The results showed that EABR wave V latencies were consistently shorter than those evoked acoustically in the unaided normal hearing ear. Thus, artificial delays within the audio processor can be implemented to adjust interaural stimulation timing. The currently implemented group delays in the MED-EL CI system turned out to be reasonably similar to those of the unaided ear. For adjustment of CI and contralateral HA, in contrast, an adjustable additional across-frequency delay in the range of 1–11 ms implemented in the CI would be required. Especially for bimodal CI/HA users the adjustment of interaural stimulation timing may induce improved binaural hearing, reduced need for central auditory temporal compensation and increased acceptance of the CI/HA provision.
Serendipities in der Medizin
(2016)
Zufälle begleiten unser Leben. Auch bei wichtigen Entdeckungen und Entwicklungen in der Medizin spielt der „Zufall“ (engl. „serendipity“) eine Rolle. Hierzu gehören u. a. die Mendelschen Gesetze, die Ermittlung der menschlichen Chromosomenzahl, die Entdeckung der DNS durch Watson und Crick, der PAP-Test oder die Entdeckung der Röntgenstrahlung und der Radioaktivität. Aber auch und gerade in der Pharmakologie gibt es viele Beispiele für Serendipitäten. Einige gehen eng mit Zufällen bei der Entdeckung der Bakteriologie einher.
A wide range catalyst screening with noble metal and oxide catalysts for a metal–air battery with an aqueous alkaline electrolyte was carried out. Suitable catalysts reduce overpotentials during the charge and discharge process, and therefore improve the round-trip efficiency of the battery. In this case, the electrodes will be used as optimized cathodes for a future lithium–air battery with an aqueous alkaline electrolyte. Oxide catalysts were synthesized via atmospheric plasma spraying. The screening showed that IrO2, RuO2, La0.6Ca0.4Co3, Mn3O4, and Co3O4 are promising bi-functional catalysts. Considering the high price for the noble metal catalysts further investigations of the oxide catalysts were carried out to analyze their electrochemical behavior at varied temperatures, molarities, and in case of La1−x Ca x CoO3 a varying calcium content. Additionally all catalysts were tested in a longterm test to proof cyclability at varied molarities. Further investigations showed that Co3O4 seems to be the most promising bi-functional catalyst of the tested oxide catalysts. Furthermore, it was shown that a calcium content of x = 0.4 in LCCO has the best performance.
Impedance of the Surface Double Layer of LSCF/CGO Composite Cathodes: An Elementary Kinetic Model
(2014)
Modeling and Simulation the Influence of Solid Carbon Formation on SOFC Performance and Degradation
(2013)
The flow field-flow fractionation (FIFFF) technique is a promising method for separating and analysing particles and large size macromolecules from a few nanometers to approximately 50 μm. A new fractionation channel is described featuring well defined flow conditions even for low channel heights with convenient assembling and operations features. The application of the new flow field-flow fractionation channel is proved by the analysis of pigments and other small particles of technical interest in the submicrometer range. The experimental results including multimodal size distributions are presented and discussed.
Objectives: Speech recognition on the telephone poses a challenge for patients with cochlear implants (CIs) due to a reduced bandwidth of transmission. This trial evaluates a home-based auditory training with telephone-specific filtered speech material to improve sentence recognition. Design: Randomised controlled parallel double-blind. Setting: One tertiary referral centre. Participants: A total of 20 postlingually deafened patients with CIs. Main outcome measures: Primary outcome measure was sentence recognition assessed by a modified version of the Oldenburg Sentence Test filtered to the telephone bandwidth of 0.3-3.4 kHz. Additionally, pure tone thresholds, recognition of monosyllables and subjective hearing benefit were acquired at two separate visits before and after a home-based training period of 10-14 weeks. For training, patients received a CD with speech material, either unmodified for the unfiltered training group or filtered to the telephone bandwidth in the filtered group. Results: Patients in the unfiltered training group achieved an average sentence recognition score of 70.0%±13.6% (mean±SD) before and 73.6%±16.5% after training. Patients in the filtered training group achieved 70.7%±13.8% and 78.9%±7.0%, a statistically significant difference (P=.034, t10 =2.292; two-way RM ANOVA/Bonferroni). An increase in the recognition of monosyllabic words was noted in both groups. The subjective benefit was positive for filtered and negative for unfiltered training. Conclusions: Auditory training with specifically filtered speech material provided an improvement in sentence recognition on the telephone compared to training with unfiltered material.
The ability to detect a target signal masked by noise is improved in normal-hearing listeners when interaural phase differences (IPDs) between the ear signals exist either in the masker or in the signal. To improve binaural hearing in bilaterally implanted cochlear implant (BiCI) users, a coding strategy providing the best possible access to IPD is highly desirable. In this study, we compared two coding strategies in BiCI users provided with CI systems from MED-EL (Innsbruck, Austria). The CI systems were bilaterally programmed either with the fine structure processing strategy FS4 or with the constant rate strategy high definition continuous interleaved sampling (HDCIS). Familiarization periods between 6 and 12 weeks were considered. The effect of IPD was measured in two types of experiments: (a) IPD detection thresholds with tonal signals addressing mainly one apical interaural electrode pair and (b) with speech in noise in terms of binaural speech intelligibility level differences (BILD) addressing multiple electrodes bilaterally. The results in (a) showed improved IPD detection thresholds with FS4 compared with HDCIS in four out of the seven BiCI users. In contrast, 12 BiCI users in (b) showed similar BILD with FS4 (0.6 ± 1.9 dB) and HDCIS (0.5 ± 2.0 dB). However, no correlation between results in (a) and (b) both obtained with FS4 was found. In conclusion, the degree of IPD sensitivity determined on an apical interaural electrode pair was not an indicator for BILD based on bilateral multielectrode stimulation.
The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users
(2016)
Objective: The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release. Design: This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR). Study sample: A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems. Results: The mean SRT of CI users in continuous noise was −3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached −5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to −1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to −18.9 ± 3.8 dB SNR. Conclusions: The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.
Die Hersteller von Cochlea-Implantat (CI)-Systemen sehen für klinische Audiologen die Möglichkeit vor, die Mikrofonleistung der meisten aktuellen CI-Sprachprozessoren mittels anschließbarer Monitorkopfhörer zu prüfen. Nähere Angaben dazu, nach welchem Prozedere diese Prüfung stattfinden soll, z. B. welche Stimuli mit welchen Pegeln verwendet werden sollen, sind nach Wissen der Autoren seitens der CI-Hersteller nicht verfügbar. Auf der Basis dieser subjektiven Prüfung entscheidet dann der Audiologe, ob der betreffende Sprachprozessor an den Hersteller eingeschickt wird oder nicht. Wir haben eine Messbox entwickelt, mit der die Mikrofonleistung aller abhörbaren CI-Sprachprozessoren der Hersteller Advanced Bionics, Cochlear und MED-EL objektiv geprüft werden kann. Die Box wurde im 3-D-Druckverfahren hergestellt. Der zu prüfende Sprachprozessor wird in die Messbox eingehängt und über einen verbauten Lautsprecher mit definierten Prüfsignalen (Sinustönen unterschiedlicher Frequenz) beschallt. Das Signal des Mikronfons bzw. der Mikrofone wird über das in der Audio-/Abhörbuchse des Prozessors eingesteckte Kabel der Monitorkopfhörer herausgeführt und mit einer Shifting and Scaling-Schaltung in einen Spannungsbereich transformiert, der für die A/D-Wandlung mit einem Mikrokontroller (ATmega1280 verbaut auf einem Arduino Mega) geeignet ist. Derselbe Mikrokontroller übernimmt über einen eigens gebauten D/AWandler die Ausgabe der Prüfsignale über den Lautsprecher. Signalaufnahme und –wiedergabe erfolgt jeweils mit einer Samplingrate von 38,5 kHz. Der frequenzspezifische Effektivwert des abgegriffenen Mikrofonsignals wird mit einem Referenzwert verglichen. Die (frequenzspezifischen) Referenzwerte wurden mit einem neuwertigen Sprachprozessor gleichen Typs ermittelt und im Speicher des Mikrokontrollers abgelegt. Das Ergebnis wird nach Abschluss der Messung grafisch auf einem Touchscreen ausgegeben. Derzeit läuft eine erste Datenerhebung mit in der Klinik subjektiv auffällig gewordenen CI-Sprachprozessoren, die anschließend in der Messbox untersucht werden. Längerfristiges Ziel ist es, die hit und false alarm Raten der subjektiven Prüfung zu ermitteln.
BACKGROUND:
While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL.
METHODS:
This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada.
RESULTS:
A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable.
CONCLUSION:
A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.