Apr 142012
 

Car hoist is a device that is used to lift a car up into the air. It is serves the one who needs to work on car or check something on it that is underneath it. A car lift hoist is usually seen in car servicing and repairing workshops. This is a car lifting instrument which lifts cars to certain heights for making repair and car wash more easy and convenient. Commercial workshops usually possess a number of them, which are either with 2 post or 4. Many car hoists works with the help of hydraulics. They are huge aid in providing the cars a smooth lift with high assurance of security and safety. Modern car hoist work with the help of electricity as well.

A hydraulic car hoist is the most commonly used car hoists in the world. It aids in lifting cars during repairs or maintenance. The basis purpose is to guarantee that the car is well supported and secured.

A four post car hoist is normally used to lift heavy vehicles. It has a four pillar column and they also have drive on and park the car. This lift gives you an opportunity to work freely under the car. They are very popular among the users who are not professionals and just use this lift in a very curious way. It is always very expensive. It is also used for parking.

When the car reaches the required level, switch off the car lift or lock it. Hydraulic auto lifts are in high demand these days. The increased demand led companies to come up with innovative features and designs of hydraulic auto lifts.

By using this professional tool, the user can himself have a close observation of the components of the car. The buying of such a tool can be beneficial for all the car problems which can be fixed at home and you can become expert by doing it yourself. Along with the car hoists, wheelchair lifts are also available for the disabled people. These chairs are also used to accommodate the disabled people in the car.

Some people like to buy a four post car lift as they feel safer. Some people prefer a two post car lift, as they cost less and save time in setting up the lifting of a vehicle. A two-post also require less maintenance than four post. Some people, who have large space in their work shed or garage, also prefer the one with two posts. One can also purchase that is complemented with ramps. Some people prefer this type of hoist, as they experience safety to know that the vehicle is supported by the lift machine and the ramps.

It is one of the essential requirements of car mechanic. It is used for car storage areas and an in auto repair center. It helps to lift vehicles from the ground and it eases this process. it also saves a lot of time and effort for an individual. One can also keep car hoist in their garage for their own use as well. A car lift hoist is also available with a warranty on parts and structure. A purchaser is provided the facility to upgrade the lift warranty for an extended interval. Undoubtedly, a car hoist is a great device when safe lifting of cars is required.

You can now get Car Hoist and other equipment for sale online at our side, as we are the famous name in Equipment industry to deals with Garage Equipment and tools online.

Feb 232012
 

Most people who have a car would love for it to run as smoothly as possible for as long as possible. However, since engine malfunctions are inevitable, this also means that they have to be willing to fix some of the complex problems that usually manifest as dashboard warning lights. There are many benefits of making sure that such problems are always attended to, such as through the use of a car MD device.

There are many reasons why one should always keep tabs on the performance of their vehicle. For starters, it ensures that you do not spend much on maintenance. When you know what is going on with your car at each point in time, you can easily fix problems before they become more complex, which is usually much cheaper than waiting for them to evolve into bigger problems.

When you make sure that your car is running optimally, you also find that it is cheaper to maintain it as well. For instance, when you always maintain your engine in a certain state, you will be sure that it will not consume more fuel than necessary. This way, you can reduce the cost of running the car, something that most car owners would love to do these days.

These are just some of the things you can benefit from when you keep engine problems fixed at all times. This means that it is always prudent for any car owner to have a method of checking what is wrong with the car every time the engine fault light comes on. The typical way to do it would be to take your car to the garage, but this may be too expensive for some people.

In fact, the fact that such problems are often not very complex is part of the reason why most people ignore them. You may spend loads of money trying to have your car fixed by a mechanic, only to find that it was not such a major problem in the first place and you could have fixed it on your own. For this reason, most people would prefer to have an idea of what is wrong with the car before seeking further advice.

There are a few tools that one can use to do this. In a nutshell, all you have to do is access your car’s engine control unit, which normally contains fault data. You can then use one of these gadgets to decipher this information and find out what is wrong with the car, and then plan a way forward keeping this information in mind.

One of such devices is car MD. This is an electronic device which can interface with a data port which is found on most modern cars. It can then provide a brief diagnostic report on the engine based on information saved in the car’s ECU.

You can find a brief summary of the features of Car MD vehicle health system and details about the CarMDScam on our site, right now.

Nov 132011
 

November 2011 – In short, highly successful patients required fewer visits to the clinic. What could explain this difference in number of visits? It is hypothesized that a lack of verification (real-ear measurement) and validation (confirmation of a patient’s performance with their hearing aids) during the hearing aid fitting increased the number of patient visits. For some patients the result was a less-than-optimum fit, reduced hearing aid utility, and mediocre benefit-each of which accrues to result in rejection and/or the return of the hearing aids for credit.

In this study, we will explore the relationship between verification, validation, and patient visits. Future studies will explore the impact of verification and validation on hearing aid returns.

Methods

We queried the MarkeTrak VIII database for patients fit with hearing aids between January 2008 and January 2009. The reader is referred to earlier publications describing methodology and description of the MarkeTrak VIII database. Before we explore the relationship between verification, validation, and patient visits, it is important that we rule out extraneous variables explaining above-average patient visits during the hearing aid fitting process; to this point, neither degree of hearing loss in deciles nor age explained significant variance in patient visits.

Shows the use of verification and validation for 788 subjects fit with hearing aids between 2008 and early 2009. About one-third of patients reported they were fit with hearing aids using verification and validation (either subjective or objective), another third had their hearing aid fit validated but not verified, 9% were fit using real-ear measurement (REM) without validation, and 22% reported they received neither verification nor validation during the hearing aid fitting process.

Average patient visits as a function of whether they were fit with real-ear measurement, validation procedures, or neither (patients who were “not sure” if verification and/or validation was used are excluded). The analysis completed from 533 patient responses indicates that the combined usage of verification and validation results in an average of 1.2 fewer visits. The interaction of verification and validation was marginally significant. The beta weights in this model indicate that validation may possibly reduce patient visits more than REM.

The previous observation confirms that the use of verification and validation in fitting hearing aids decreases the number of visits per hearing aid fitting. As an extension to this analysis, the impact of including these best practices on the US hearing healthcare market was estimated.

In 2010, nearly 2.7 million hearing aids were fit in the US hearing aid market, representing over 1.5 million patients (binaural fitting rate of 74.3% in 2008). Assuming the same distribution of best practices as noted by patients and the estimate of reduced patient visits, it is suggested that the systematic utilization of both verification and validation procedures while fitting hearing aids will reduce patient visits by a total of 521,779 visits. This is an opportunity available for every one of the 64% of US practices not utilizing both verification and validation.

Assuming 45 minutes a visit, inclusion of these best practices could reduce the time spent with patients in fitting hearing aids by 391,334 hours in a single year. This additional time frees the hearing healthcare professional for additional counseling, marketing, community outreach, or fitting new patients with hearing aids. It also represents a significant convenience savings for patients who often have multiple disabilities that can include challenges in mobility, danger from falls, and other potential problems.

Conclusions

The utilization of verification and validation during the hearing aid fitting process was shown to significantly reduce patient visits (1.2 fewer visits), with evidence that utilizing both verification and validation may compound to yield the best results. According to patients, one-third of hearing care professionals in the United States utilize both verification and validation during hearing aid fitting. The MarkeTrak VIII data suggest that wide-scale adoption of verification and validation in the US hearing care market will increase patient satisfaction and reduce patient visits by more than a half million. Given the profound implications for the hearing care field, systematic study and verification of these findings in a more robust clinical study is warranted.

If your practice is among the 64% highlighted in this study, there is opportunity for growth that could begin today. Simple modification to routine clinical protocol can result in significantly improved patient outcomes. Real-ear measurement is a quick and easy step that should be included in every hearing aid fitting. Validation with a standardized outcome measure is just as easy. While an objective pre-post measure is preferred, if this is not possible, a brief questionnaire such as the International Outcome Inventory for Hearing Aids (IOI-HA)-available for free in 21 languages- can provide valuable insight into patient satisfaction and real-world benefit.

It can be argued that time wasted during unnecessary patient visits could be better utilized in improving quality care for existing patients or in the treatment of new patients. After all, time is money!

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Nov 122011
 

2011 – Of the approximately 6,400 languages spoken in the world, only about 4% of them are spoken by the vast majority (96%) of people. In an ever increasing multicultural and multilingual environment, it is necessary to investigate the similarities and differences among the various commonly spoken languages and how this may affect hearing aid specifications.

The phonetic inventory is a listing of those possible sounds spoken in a language-one language may have more vowels or different vowels than another. This has ramifications for setting the frequency response of a hearing aid.
The phonology is the sound patterns of a language and refers to which of the sounds carry meaning. For example, in English, most of the higher frequency phonemes carry much of the clarity. This also has ramifications for setting the frequency response of a hearing aid and unlike the first element, phonetic inventory, will be observed on the speech intelligibility index (SII) for a particular language.

The third element, syntax, as far as hearing aid fittings are concerned, refers to the word order and whether the ends of sentences in certain languages are quieter (eg, compared to English). This has ramifications for whether more gain may be required in these languages than for English when it comes to the setting of gain for soft level inputs.

The study detailed in this article focuses on those linguistic parameters that cannot be found on an SII. The SII is a very important tool, but is only part of the answer regarding setting hearing aids differently for different languages. Some manufacturers offer different program formulae for different languages, but these are generally based on the SII of the language in question and typically will only result in frequency response changes.

Many of the languages that are encountered in our clinical practices are Subject-Verb-Object (SVO) word order languages. These include English, Russian, German, Chinese, French, Spanish, and Portuguese, to name a few. In contrast, there are many clients whose first (or second) language is Hindi, Urdu, Japanese, Korean, Iranian, or Turkish. In these languages (and many others, such as in the Altaic language family and the Indo-Iranian sub-branch of Indo-European), the word order in a sentence is Subject-Object-Verb (SOV).

Sentence final verbs are not nearly as intense as sentence final nouns (objects), and as such, the research hypothesis is that more gain would be required for SOV languages for soft level inputs (ie, sentence final sounds) than for SVO languages, for sufficient audibility. It is hypothesized that, for languages with a SOV word order, hearing aid changes should be increased in gain for soft level inputs (or equivalently a decrease in the threshold kneepoint or TK setting of the hearing aid).

Method

A clinical study was undertaken to analyze this phenomenon in detail. Digital recordings were made of cold running speech for four languages with a SOV word order. This included recordings for Hindi-Urdu (considered linguistically to be the same language but differing writing systems), Turkish, Japanese, and Korean.

In all cases, the client with hearing impairment, who was about to be fit with hearing aids in a clinical practice, had one of these four languages as their first language but spoke English as a second (or third) language. Once fit with appropriate amplification based on English, the clients listened to cold running speech of their other language and self-adjusted the amount of gain for soft level inputs. In this way, each client served as their own control.

The clients were then asked to redo this same task for English and then again for their SOV language. If there was greater than a 3 dB difference for their adjustment for the English language, then that second setting was chosen for comparison over that which was initially set. The amount of selected gain at 2000 Hz was recorded for each client and was calculated as the difference between the amount of gain for soft level inputs between Program 1 and Program 2.

In total, 68 people were assessed using this paradigm, with the majority having mild sloping to moderate or mild to moderately severe sloping sensorineural hearing losses. Preliminary (pilot) unpublished data suggests that the language was not a factor as long as they shared the same syntactic SOV structure. As such, all data were collapsed and treated together.

Results

Figure 3 shows the data for the 68 clients exhibiting the differences for the amount of gain desired for soft level inputs between English (SVO) and their other SOV language. Since each client served as their own control and only differences were analyzed, factors such as amount of gain, as well as many individual and hearing aid-related factors, were minimized. The data achieved statistical significance at the 0.01 level with a 95% confidence interval of 3.62-4.75. Statistically, a paired comparison was utilized with appropriate standard deviations.

Taken together for all 68 clients, at the 0.01 level of significance, there was a preference for 4.2 dB more amplification for soft level inputs in the SOV language than for English (a SVO language). This is significant evidence that the null hypothesis of “no differences between language syntactic type” is rejected.

Discussion

This experiment shows only preliminary results, but indicates that clients appear to prefer slightly more gain for soft level inputs while listening to those languages that have a lower intensity at the end of a sentence. This is consistent with the hypothesis that sentence-final audibility is a factor and should be taken into account during a non-English hearing aid fitting for those languages that do not have nouns (or equivalently intense elements such as pronouns) in or near a sentence final position.

The difference in desired gain for soft level inputs is not a hearing aid fitting parameter that would show up on an SII measure or even those non-English fitting formulae supported by many manufacturers, assuming that they are based only on a language-specific SII.
It should be pointed out that this study has some inherent limitations. Ideally, each client should have been allowed to make more adjustments while listening to cold running speech, but this experiment was performed in conjunction with a routine clinical hearing aid fitting. In addition, there may be interactions between other hearing aid settings or even as a function of type or configuration of hearing loss. Another drawback that limits the utility of this experiment is that the available hearing aids had slightly differing amounts of adjustment for the gain for soft-level inputs, as well as to which frequency range(s) these adjustments would apply.

If, indeed, it is shown that people who listen to languages with a SOV word order require more gain for soft level inputs-which is an issue of audibility-hearing aids should be made available to have an extended ability to provide gain for soft level speech over a wider range than is typically commercially available.

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Nov 122011
 

November 2011 – This brash assertion opens an article from the late 1980s that reviews methods of coupling hearing instruments to ears with minimal occlusion of the ear canal. In fairness, it was indeed the case that much had been investigated on the topic of open fittings in the previous two decades. Although primarily dealing with the acoustics of open fittings, issues such as candidacy and benefit were also studied. A common thread in this early literature was that acoustic feedback constituted the main limitation of open fittings and was a key reason that they were relegated to special cases.

Early in the 21st century, two hearing instruments designed specifically for open fittings became commercially available. One of these was the ReSoundAIR from GN ReSound (2003), which was a small BTE-style device coupled to the ear with thin acoustic tubing and non-occluding eartips. The other was the Vivatone (2004), also a small BTE, but with the receiver encased in a protective sheath and placed in the ear of the wearer with a wire connection to the device. While there had been a few marketed devices intended for open fittings prior to these, no others had such a major impact on the hearing industry.

Virtually all hearing aid manufacturers offered products based on one of these concepts; today, the open-fit hearing aid appears to be here to stay. The proliferation of open-fit devices has also upset the balance of hearing aid styles sold away from custom in-the-ear models-respondents to a recent US survey stated that 41.6% of all hearing aids they dispensed the previous year were open-fit mini-BTEs.

We hypothesize that a main reason for the surge in popularity of open fitting is that current open-fit products offer solutions to the “side effects” of hearing aids for those with mild-to-moderate high frequency hearing losses, which tip their cost/benefit analyses in favor of amplification. In addition to their cosmetic appeal, open-fit hearing aids are generally physically comfortable to wear, eliminate occlusion-related complaints, and reduce the occurrence of feedback.

In our clinical experience, patients with high frequency hearing losses typically did not perceive the benefits of conventionally fitted amplification as outweighing the drawbacks, and we considered them to be “hard-to-fit.”
Mecklenburger and Joergensen explored whether candidates for open-fit hearing aids exhibit less potential for benefit of amplification than a normative group encompassing a broader range of hearing losses as determined by a typical outcome measure. They compared the Abbreviated Profile of Hearing Aid Benefit (APHAB) results for 85 individuals with mild-to- severe high frequency hearing losses who participated in clinical trials with various open-fit devices to normative data from Cox and Alexander.

The results clearly indicated that individuals who meet audiometric open-fit candidacy criteria generally have less to gain in terms of benefit of amplification, as the percentage of problems experienced was significantly less on all of the communication-related subscales. This finding implies that these candidates are less likely to put up with much inconvenience, bother, or discomfort to get those benefits.

This paper takes the opportunity to review a couple of important “dos” and “don’ts” in selecting and fitting this game-changing style of hearing device.
What is an open fitting? Because the new generation of open-fit products has been so strongly associated with thin-tube and receiver-in-the-ear styles, many consider any device falling into either of these categories to be “open fit.” However, either of these types of hearing aids can also be fit with either a custom micro mold or occluding plastic dome, thereby making them anything but open. A more useful way to define open fitting is in terms of low frequency acoustics: If low frequency energy can pass freely in and out of the ear canal when the hearing aid is worn, then it is an open fitting. Defined in this way, any style of existing or not-yet-invented hearing aid can be an open fitting as long as it meets the criterion of allowing low frequencies to enter and leave the ear canal unhindered.

Open fitting impacts the sound pressure levels achieved in the ear canal in two important ways. For one thing, real-ear low frequency gain will be negligible, and this is discussed in further detail below. Another significant effect of open fitting is an enhancement of real-ear gain in the region of the unaided ear canal resonance.

An in-house study with 20 adult participants sought to quantify this effect in order to tune factory settings for open-fit hearing aids, and to more accurately simulate real-ear gain in fitting software for this type of fitting.

In this investigation, a device was programmed to provide a fixed amount of amplifier gain, but was coupled to the participants’ ears with different types of open domes and a fully occluding ear tip. The real-ear gain of the open domes compared to the occluded condition showed an increase of 6 to 7 dB around the frequency of the open ear canal resonance. This is consistent with results reported by Mueller and Ricketts, who found an enhancement ranging 5 to 10 dB in the 2 to 4 kHz frequency range with hearing aids fit as open relative to occluded with the same amplifier gain.

What does all this mean for the dispensing professional? For one thing, it is important to understand and follow the manufacturer’s guidelines for telling the fitting software module that the fitting is open. For some manufacturers, this means defining acoustic parameters at the start of the fitting. Other manufacturers, including ReSound, ask the fitter to “reconfigure” the hearing aid as either open fit or closed fit. Once the fitting software has this information, it will adjust the amplifier gain behind the scenes to account for both the extra high frequency gain that is afforded by the open fit, as well as the inability of the device to provide low frequency gain for the open condition.

As mentioned, the manufacturer may account for the change in acoustics by the gain prescription, as well as the frequency response of the device. For example, the ReSound philosophy is that the sound pressure level required at the tympanic membrane to achieve audibility does not depend on how the sound gets there. This means that the proprietary gain prescription for our hearing aids is not dependent on the device or the way the device is coupled to the ear.

For conventional hearing aids that can be fit open with large venting, these effects might not be compensated at all. Add to that the individual variation of how hearing aids perform in ears, and the fact that simulated real-ear gains in manufacturers’ fitting software may overestimate actual real-ear gains, and it would seem to be in the best interest of patients to perform verification measures.

Verification is the most straightforward way of finding out whether prescribed targets are met, and how amplified sounds fit into the patient’s residual dynamic range without having to delve into each manufacturer’s specific approach to open fittings. Output measures using live or recorded speech are particularly helpful in demonstrating for the patient what the hearing aid is doing, as the perceptual effects of an open-fit product can be subtle.

As representatives of a manufacturer of open-fit hearing aids, the authors have often been asked by clinicians how they should change verification protocols for this type of fitting. In our clinic, the only accommodation we make to verification of open fittings is to use the equipment manufacturer’s “open” feature. When enabled, this feature will use a “modified substitution method” to adjust the signal presentation level, and disable the reference microphone on the probe during the actual measurement.

The rationale for this is that, because there is less damping of the amplified sound leaking from the ear canal when it is not occluded, there is a danger of elevated sound pressure level present at the measurement equipment’s reference microphone. This will cause the automatic gain control of the probe microphone equipment to decrease the signal level, resulting in erroneous calculation of actual gain by the equipment-and misleading representation of output.

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Nov 122011
 

2011 – As much and as little as we know about the development of language, each child’s journey toward communication still seems nothing short of miraculous. More so for the hearing-impaired (HI) child. The multitude of factors involved in ensuring successful oral communication for the HI child is overwhelming for parents and perhaps also for the diagnosing pediatric audiologist.

What are the primary factors for ensuring language success for the HI child? Methodical and continued research has indicated age of intervention as one of the most important. But, with so many additional elements-such as type of amplification and intervention services occurring concurrently-how do we know which of these is truly the most significant or even the exact formula that is right for any particular child? This is the question the author asked numerous times regarding patient R.T.

Case Study of 4-Year-Old Boy

R.T. is a 56-month-old male child with sensorineural hearing loss bilaterally. R.T. did not pass newborn hearing screening. Subsequently, at age 2 months, hearing loss was confirmed. Auditory brainstem response (ABR), otoacoustic emissions (OAE), auditory steady state response (ASSR), and high frequency tympanometry testing was completed, and results were consistent between measures indicating a moderate-to-severe sensorineural hearing loss bilaterally. Earmold impressions were taken, and R.T. was fit with binaural amplification at 2.5 months of age.

R.T.’s first behind-the-ear (BTE) hearing aids (“A”) were 53/125 dB 16-channel DSP devices. Directional microphone programming was available, but not enabled. The noise-reduction option was enabled. Real-ear to coupler difference (RECD) was obtained for each ear, and hearing aids were programmed to DSL targets. Real-ear speechmap verification measures were obtained and within recommended targets.

Three weeks later, after R.T.’s father, who was a ship captain, returned home from a trip, the family visited the office for follow-up. R.T.’s father insisted the hearing aids be changed to something smaller, repeatedly expressing his displeasure with the size of the hearing aids on his tiny son’s ears. He was counseled with regard to the optimal choice for his son; however, he was firmly insistent that smaller hearing instruments be ordered. They were changed to 52/118 dB 7-channel DSP devices (“B”). The noise-reduction algorithm was enabled and directional-microphone option was disabled.

Follow-up with R.T. consisted of changing earmolds every 2 months and behavioral testing beginning at 6 months. After three test sessions, a complete audiogram was obtained and was consistent with previous electrophysiologic test results. R.T. was receiving home-based auditory training for 30 minutes two times per week, which was the allowance from the county. In addition, R.T.’s mother educated herself extensively regarding language stimulation and enriching R.T.’s language environment. Beginning at 8 months, R.T.’s mother took him to a speech language pathologist with experience in auditory training.

Because R.T.’s father was frequently away from his family, R.T.’s mother took extensive video of him to send to his father. Examining video of R.T. at different time intervals was a way for the author to observe his language development. At 11 months, while R.T. was clearly producing utterances, they consisted mostly of yells, screams, and open-mouth back vowels. No consonants were heard in his repertoire and R.T.’s mother commented that he didn’t produce any.

This was concerning and his hearing was reevaluated. Test results were consistent with previous tests. R.T.’s mother inquired about trying different hearing instruments. The audiologist was interested in readjusting the current instruments to maximize high frequencies.
At 1 year, R.T.’s mother enrolled him in a part-time day care to expose him to multiple typical language models.

Consonants began to appear in his utterances at 13 months, and his syllables were typical of canonical babbling. Hearing was reevaluated every 3 to 4 months and was stable with the exception of several episodes of otitis media. Nevertheless, language continued to progress with more spontaneous utterances produced and expansion of consonant repertoire. R.T.’s receptive language skills were improving and better than his expressive language, which research indicates is typical.

At 24 months, upon the recommendation of the treating pediatric audiologist, R.T.’s mother added therapy with a certified auditory-verbal (A-V) therapist for 1 hour each week. The trip to the A-V therapist was 3 hours round trip and thus only possible once a week. Video from this time indicated that R.T. had more speech-like utterances; however, most were unintelligible to everyone except his mother who seemed to understand about 50%. After 2 months of working with the A-V therapist, it was reported to the pediatric audiologist that R.T. did not seem to be adequately amplified in the high frequencies. R.T.’s hearing was reevaluated, and a decrease in the high frequencies was present in each ear. Adjustment to the current hearing aids did not yield enough gain and new hearing instruments were ordered.

R.T.’s third set (“C”) of 60/125 dB 20-channel DSP hearing instruments were fit at 27 months. The noise reduction algorithm was enabled, and adaptive directionality was enabled in Program 2, which R.T.’s mother could engage in noisy situations. Real-ear speechmap verification measures were completed and targets were matched. On R.T.’s first visit to the A-V therapist post-fitting, a very significant and positive difference in his high frequency hearing was detected. Shortly after this, at approximately 30 months, R.T’s language began to explode and his mom reported that he seemed to add 10 to 15 words to his vocabulary each day! His intelligibility was rapidly improving and 50% of what he said to anyone was intelligible. As all pediatric audiologists would likely agree, this was great news.

Recently, R.T. received a comprehensive speech, language, and hearing evaluation. At age 3 years 11 months, R.T. had +742 receptive words and +596 spoken words on the Cottage Acquisition Scales for Listening, Language and Speech (CASLLS). He had a standard score (SS) of 98 (4 year, 1 month equivalent) on the Expressive Vocabulary Test-2 and a SS of 82 (3 year, 2 month equivalent) on the Peabody Picture Vocabulary Test. The Preschool Language Scale-4 results indicated an auditory comprehension SS of 89, an expressive language SS of 89, and a total language SS of 88 (3 year, 7 month equivalent). Word recognition scores with amplification were 88% with the Word Intelligibility by Picture Identification (WIPI) and 76% using the Phonetically Balanced Kindergarten (PBK) words.
Characteristics between R.T.’s three hearing instruments were compared.

Those most notable include attack/release times, number of channels, and noise reduction. Noise reduction was a commonality between all instruments, although different algorithms were used for each. While some have speculated that noise reduction could distort the speech signal and alter perception, especially in children, Stelmachowicz reported no adverse effects on speech perception for children 5 to 10 years old. These researchers also commented that attention may improve in some children due to a decreased listening effort.
Another variable among instruments was number of independently programmed channels. Warner-Henning and Bentler studied number of channels as they relate to compression ratio and release time. Effect of channels was directly related to release time and effectiveness of compression. The greater the number of channels coupled with the fastest release time rendered compression most effective (p 480). Kuk and Marcoux reported the greater the number of channels, the better the instrument can match gain needs, providing amplification where needed. R.T.’s instruments varied with respect to channels ranging from 7 to 20. Interesting to note, R.T. was switched from hearing instrument “B” to “C” because “B” could not match gain needs in high frequencies and it had fewer channels.

Each hearing instrument varied in terms of attack and release times. Fast-acting wide dynamic range compression (WDRC) is defined by Kuk and Marcoux as less than 10 ms attack time and 100 ms release time, while slow-acting is defined as greater than 50 ms attack time and 1000 ms release time. Dillon and Souza reported slow-acting WDRC allows for more consistent audibility by preserving consonants, while Davies-Venn reported fast-acting WDRC was reported to be better for low-level speech. While each device did vary in terms of attack and release times, all fell within the category, as defined above, of fast-acting WDRC.
As characteristics between all three devices do not appear to be divergent enough to account for R.T.’s language breakthrough, perhaps the answer can be found in therapy. Initially, R.T. received 1 hour of intervention per week, increased to 2 hours per week at 8 months. At 24 months, this was increased to 3 hours per week with the addition of A-V therapy. R.T.’s mother received instruction and coaching on language stimulation from each therapist and read copious amounts of information on auditory training. She took every opportunity to stimulate language.
Whereas early intervention, specifically A-V therapy, is known to be beneficial in terms of the development of oral communication in HI children, Hogan found a greater rate of language development in HI children after beginning A-V therapy versus before A-V therapy.

Since age of intervention and age of amplification varied significantly in this study, it was difficult to characterize optimal time to begin therapy. However, 70% of participants demonstrated average to above-average rate of acquisition of language after 12 months of A-V therapy compared to below-average rate of language development before therapy.

In R.T.’s case, before A-V therapy, his rate of language development was below average. After only 6 months of A-V therapy, his rate of language development was noted to be “remarkable” by his A-V therapist.
The final not-easily-quantifiable factor-and the one that can only be documented anecdotally-is the involvement of R.T.’s mother. She was a constant and consistent positive language model for her child. She actively participated in his therapy sessions and sought information on her own, applying it every day to expand R.T.’s communication skills.

In a study by Moeller,the importance of family involvement was confirmed as one of the two most important factors to ensure the best possible language outcome. In fact, strong family support was even shown to counteract late identification and late enrollment in intervention services. According to the rating scale used by Moeller, R.T.’s mother would likely rank as a “5”, or ideal, in terms of early intervention involvement.

Thanks to early detection, early intervention, and strong family involvement, R.T. is mainstreamed into a typical preschool and will attend kindergarten in the fall alongside his normal-hearing peers. His language skills are assessed as typical for his hearing and chronological ages.

This is the golden ring that pediatric audiologists strive to achieve. While R.T.’s case appears to be the prototypical success story, there were a complicated set of factors all interacting to enable him to arrive at this point.

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Nov 122011
 

This brash assertion opens an article from the late 1980s that reviews methods of coupling hearing instruments to ears with minimal occlusion of the ear canal. In fairness, it was indeed the case that much had been investigated on the topic of open fittings in the previous two decades. Although primarily dealing with the acoustics of open fittings, issues such as candidacy and benefit were also studied. A common thread in this early literature was that acoustic feedback constituted the main limitation of open fittings and was a key reason that they were relegated to special cases.

Early in the 21st century, two hearing instruments designed specifically for open fittings became commercially available. One of these was the ReSoundAIR from GN ReSound (2003), which was a small BTE-style device coupled to the ear with thin acoustic tubing and non-occluding eartips. The other was the Vivatone (2004), also a small BTE, but with the receiver encased in a protective sheath and placed in the ear of the wearer with a wire connection to the device. While there had been a few marketed devices intended for open fittings prior to these, no others had such a major impact on the hearing industry.

Within a few years, virtually all hearing aid manufacturers offered products based on one of these concepts; today, the open-fit hearing aid appears to be here to stay. The proliferation of open-fit devices has also upset the balance of hearing aid styles sold away from custom in-the-ear models-respondents to a recent US survey stated that 41.6% of all hearing aids they dispensed the previous year were open-fit mini-BTEs.

We hypothesize that a main reason for the surge in popularity of open fitting is that current open-fit products offer solutions to the “side effects” of hearing aids for those with mild-to-moderate high frequency hearing losses, which tip their cost/benefit analyses in favor of amplification. In addition to their cosmetic appeal, open-fit hearing aids are generally physically comfortable to wear, eliminate occlusion-related complaints, and reduce the occurrence of feedback. In our clinical experience, patients with high frequency hearing losses typically did not perceive the benefits of conventionally fitted amplification as outweighing the drawbacks, and we considered them to be “hard-to-fit.”

Mecklenburger and Joergensen explored whether candidates for open-fit hearing aids exhibit less potential for benefit of amplification than a normative group encompassing a broader range of hearing losses as determined by a typical outcome measure. They compared the Abbreviated Profile of Hearing Aid Benefit (APHAB) results for 85 individuals with mild-to- severe high frequency hearing losses who participated in clinical trials with various open-fit devices to normative data from Cox and Alexander.
The results clearly indicated that individuals who meet audiometric open-fit candidacy criteria generally have less to gain in terms of benefit of amplification, as the percentage of problems experienced was significantly less on all of the communication-related subscales. This finding implies that these candidates are less likely to put up with much inconvenience, bother, or discomfort to get those benefits.

This paper takes the opportunity to review a couple of important “dos” and “don’ts” in selecting and fitting this game-changing style of hearing device.
What is an open fitting? Because the new generation of open-fit products has been so strongly associated with thin-tube and receiver-in-the-ear styles, many consider any device falling into either of these categories to be “open fit.”
However, either of these types of hearing aids can also be fit with either a custom micro mold or occluding plastic dome, thereby making them anything but open. A more useful way to define open fitting is in terms of low frequency acoustics: If low frequency energy can pass freely in and out of the ear canal when the hearing aid is worn, then it is an open fitting. Defined in this way, any style of existing or not-yet-invented hearing aid can be an open fitting as long as it meets the criterion of allowing low frequencies to enter and leave the ear canal unhindered.

Open fitting impacts the sound pressure levels achieved in the ear canal in two important ways. For one thing, real-ear low frequency gain will be negligible, and this is discussed in further detail below. Another significant effect of open fitting is an enhancement of real-ear gain in the region of the unaided ear canal resonance.

An in-house study with 20 adult participants sought to quantify this effect in order to tune factory settings for open-fit hearing aids, and to more accurately simulate real-ear gain in fitting software for this type of fitting. In this investigation, a device was programmed to provide a fixed amount of amplifier gain, but was coupled to the participants’ ears with different types of open domes and a fully occluding ear tip. The real-ear gain of the open domes compared to the occluded condition showed an increase of 6 to 7 dB around the frequency of the open ear canal resonance. This is consistent with results reported by Mueller and Ricketts, who found an enhancement ranging 5 to 10 dB in the 2 to 4 kHz frequency range with hearing aids fit as open relative to occluded with the same amplifier gain.

Don’t Expect Low Frequency Gain from Any Open-fit Hearing Aid
One of the greatest advantages of open fitting is that self-generated low frequency sound can escape from the ear canal, thus avoiding the perception of a boomy-sounding own voice or unbearably loud crunching when chewing. Low frequency sounds that are audible to the user can also enter the ear, preserving important cues to localization and contributing to natural sound quality for users with good low frequency hearing.

It is also clear that the inability to build up low frequency sound pressure levels in the ear canal also means it is unrealistic to achieve low frequency gain for hearing loss compensation in this region. To account for the severe roll-off below about 800 Hz, substantial low frequency gain exceeding the capabilities of the small receivers used in hearing aids would be necessary. Attempting to accomplish this would lead to both distorted sound quality and excessive current drain, as it would involve driving the receiver into saturation during most of its operating time.

What does all this mean for the dispensing professional? For one thing, it is important to understand and follow the manufacturer’s guidelines for telling the fitting software module that the fitting is open. For some manufacturers, this means defining acoustic parameters at the start of the fitting. Other manufacturers, including ReSound, ask the fitter to “reconfigure” the hearing aid as either open fit or closed fit. Once the fitting software has this information, it will adjust the amplifier gain behind the scenes to account for both the extra high frequency gain that is afforded by the open fit, as well as the inability of the device to provide low frequency gain for the open condition.

As mentioned, the manufacturer may account for the change in acoustics by the gain prescription, as well as the frequency response of the device. For example, the ReSound philosophy is that the sound pressure level required at the tympanic membrane to achieve audibility does not depend on how the sound gets there. This means that the proprietary gain prescription for our hearing aids is not dependent on the device or the way the device is coupled to the ear.

For conventional hearing aids that can be fit open with large venting, these effects might not be compensated at all. Add to that the individual variation of how hearing aids perform in ears, and the fact that simulated real-ear gains in manufacturers’ fitting software may overestimate actual real-ear gains, and it would seem to be in the best interest of patients to perform verification measures.

Verification is the most straightforward way of finding out whether prescribed targets are met, and how amplified sounds fit into the patient’s residual dynamic range without having to delve into each manufacturer’s specific approach to open fittings. Output measures using live or recorded speech are particularly helpful in demonstrating for the patient what the hearing aid is doing, as the perceptual effects of an open-fit product can be subtle.

As representatives of a manufacturer of open-fit hearing aids, the authors have often been asked by clinicians how they should change verification protocols for this type of fitting. In our clinic, the only accommodation we make to verification of open fittings is to use the equipment manufacturer’s “open” feature. When enabled, this feature will use a “modified substitution method” to adjust the signal presentation level, and disable the reference microphone on the probe during the actual measurement.

The rationale for this is that, because there is less damping of the amplified sound leaking from the ear canal when it is not occluded, there is a danger of elevated sound pressure level present at the measurement equipment’s reference microphone. This will cause the automatic gain control of the probe microphone equipment to decrease the signal level, resulting in erroneous calculation of actual gain by the equipment-and misleading representation of output.

Summary

The acoustics of open-fit hearing aids should be taken into consideration when fitting, and are handled differently by manufacturers. In addition, this type of fitting depends on feedback cancellation techniques to make them useful for a broad number of users. Verification measures on open fittings provide reliable and helpful ways to check how amplified sound fits into the user’s dynamic range of hearing, to learn about the effectiveness of feedback cancellation, and to counsel users on how their hearing aids work to help them hear better.

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Nov 122011
 

November 2011 – In the field of hearing health care, counseling has long been identified as a critical variable in achieving successful outcomes. Research has consistently shown that, when the human dynamics of hearing loss are not addressed through counseling, the result is poor acceptance of hearing solutions, low levels of patient satisfaction, and general frustration by consumers and dispensing professionals alike.

Ida Institute has identified a continuing and growing need for simple, patient-centered methods, tools, and processes that will enable hearing care professionals to help people with hearing loss achieve better outcomes. Ida’s mission-to foster a better understanding of the human dynamics associated with hearing loss-encompasses a commitment to both the practitioner and the patient with hearing impairment. Our purpose is a simple one: to enable people to “live well with hearing loss.”

The Institute’s work toward realizing this purpose has benefited significantly from the efforts of a faculty of leading audiologists from around the world, as well as representatives of various allied health disciplines. The papers in this special section, prepared by Ida Institute faculty members, focus on the delicate balance that exists in shifting traditional patient-counseling techniques to a more patient-centered, health-behavior change approach. We hope that the concepts and strategies presented by our esteemed contributors provide new insight into practical and actionable ways for patient-centered care. We also hope that you will be inspired to consider how you might contribute to effecting change in your own practice and, more globally, in the discipline of hearing care.

While Ida seminars, workshops, tools, and methods have been well received and implemented in private practices, public clinics, and academic institutions around the world, our experience has been that making significant changes in practice worldwide by addressing the human dynamics of hearing loss has been challenging and complex.

Because there are many interdependent processes and variables at odds with each other, it has been difficult for members of the Ida community to both change personal behavior and implement Ida principles and methods within their workplaces. We believe that the reason for this difficulty is that existing organizational structures and systems may work against patient-centered changes.

This is a common theme in many industries and professions, as the leaders for change work toward improvements in quality, processes, efficiency, and policy. Some change models involve an entire organization (macro), while others may affect only a small group within the organization or even individuals (micro).

Getting to a new desired end state is often described as a journey, but in large, complex health care organizations, and even in small private clinics, a change journey may include unexpected outcomes, detours, and/or roadblocks. For most national health care systems, change and reform are high on the agenda in line with a drive for more efficient use of resources and increased quality of care for patients.

The Ida Institute will continue to explore this topic in our next seminar series of workshops, collaborating with clinicians who experience challenges to patient-centered care on a daily basis, as well as managers and other decision makers who set guidelines for clinical operation. Policymakers in both clinical practice and academics will join the collaboration to address obstacles to patient-centered care from a comprehensive, discipline-wide perspective.

We invite you to join us as we work toward creating change that will benefit the hearing care profession and its practitioners and, most importantly, make living well with hearing loss a reality for people across the globe.

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Nov 112011
 

2011 – As a young professor of physics, Wallace Sabine made his mark at Harvard University in 1895 by studying the poor acoustics of two newly built lecture halls. His studies came at the urgent request of Harvard’s president who fielded numerous complaints about the inability to hear and understand the lectures in these halls. Professor Sabine-who eventually became known as the “father of architectural acoustics” in the United States, and the unit “sabin” now defines the acoustic absorption of various materials-outlined the components necessary to achieve good hearing within structures.

These “elements of good hearing” are as true today as they were when Sabine first enumerated them more than 115 years ago. The difference is that, today, we can measure and quantify these elements.

It was only 19 years earlier that Alexander Graham Bell uttered the first intelligible sentence-“Mr. Watson, come here, I want to see you.”-over the device he originally called the “acoustic telegraph.” In 1915, Bell made the first transcontinental call from New York to San Francisco. It was then that the telephone became a serious contender to the telegraph as a means of long-distance person-to-person communication.

Owning a phone in the 1900’s was a luxury. Today it is a necessity. So, for those who find it difficult to hear using a phone, a hearing loss can isolate them. Good communication over the phone reconnects loved ones, friends, and associates, and serves to overcome the isolation that so often accompanies hearing loss. The popular AT&T advertising slogan to “reach out and touch someone” was meaningless to those with a hearing loss who could not hear and understand using a phone.

How Speech Is Transmitted and Generated on a Phone

In a telephone, the microphone in the mouthpiece of the handset transforms voice into electricity. When the air vibrations of your mouth reach the diaphragm in the microphone, it vibrates. This vibration is much like the feeling you get in your hands when you are holding a can of soda or a bottle of water and a jet passes over or loud music is playing. Because the diaphragm in the phone is metallic, its vibration changes the surrounding electrical field, which in turn creates fluctuations in electrical current that mimic the sound wave. Because these electrical currents are so tiny, a small amplifier is needed to boost their volume in order for the current to pass into the phone for processing. Once processed by the phone, these electrical fluctuations pass into the telephone wire, through your house wiring, and onto relay and switching devices installed and maintained by your local phone company.

Sound is characterized by its level and frequency. The level (or loudness) of a sound is given in decibels (dB)-or 1/10th of a bell (a unit named in honor of Alexander Graham Bell). A unit of 0 dB represents the softest sounds that normal-hearing individuals can hear; 60 dB is the level of conversational speech; 100 dB is the level of a loud rock group playing at a concert; 120 dB is the level considered uncomfortably loud. Hence, the range of hearing is essentially from 0 to 120 dB for normal-hearing people.

We know that the human voice is a complex, broadband source, generating multiple tones in a complex frequency pattern that fluctuates in a complicated temporal pattern. Voices in normal conversation range from about 200 to 6000 Hz. Because of their design, telephones are unable to transmit the full speech range. Instead, most phones only transmit frequencies between about 300 and 3300 Hz. But this is not a big limitation because, in sentence conversation, speech understanding for normal-hearing individuals over the phone is better than 95%.

As dispensing professionals, we know that the tones of speech, as generated by the vocal cords, occur below 1000 Hz. Accordingly, vowel sounds are considered low frequency sounds. In contrast, the fricatives of speech-or consonant sounds- occur above 1000 Hz.

Hearing Loss and Amplified Phones

Much of what we know about speech production and hearing comes from the early research of the Bell Telephone system. This early research identified the normal range of hearing as extending from 20 to 20,000 Hz and from 0 to 120 dB. Speech sounds fall inside this range: approximately from 300 Hz to 6000 Hz and from 20 to 50 dB. When a dispensing professional conducts a pure tone test, these frequencies and others just outside this range are tested.

On the audiogram, 0 dB represents the normal-hearing threshold line. As hearing gets worse, the Xs and Os drop below this line and speech sounds get weaker. In general, we define “hearing loss” as thresholds that fall to 20 dB or below. Most hearing losses involve high frequency threshold losses (above 1000 Hz) that are significantly poorer than the low frequencies. With this pattern, consonant sounds are much weaker than vowel sounds. Consequently, speech sounds are muffled.

Another complication is recruitment or the abnormal growth of loudness. There are audio logical tests that measure or indicate if this is a problem, and the presence of recruitment indicates that outer hair cells in the cochlea are damaged. If a lot of inner hair cells in the cochlea are damaged, then speech sounds undergo an aural distortion. In many cases, this distortion exists no matter how much amplification a person is provided to overcome a loss of sensitivity. Dispensing professionals normally conduct speech recognition tests and speech-in-noise tests to determine the degree of cochlear or neural distortion that a patient experiences.

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Nov 102011
 

November 2011 – With medical care so dependent on increasingly complex medical equipment, patient safety demands that clinical/biomedical engineering departments become more involved than ever. Administrators at Saint Mary’s Hospital, Waterbury, Conn, have understood this for a long time. As a result, Ted Barbeau, director of clinical engineering, has a hand in a variety of nontraditional clinical engineering workings at the facility.

Holding the additional title of safety officer, the biomed veteran of more than 2 decades sits on a lot of committees these days. It was not always this way. “Expectations of our function have changed a lot,” Barbeau says. “When I first started working here more than 20 years ago, my boss maybe sat on the employee safety committee and the capital budget committee.”

Since then, administrators at Saint Mary’s have taken pains to integrate the department into numerous facets of health care delivery. Product standards committee? Check. Regulatory oversight? You bet. Even the nursing leadership committee has a clinical engineering presence.

The philosophical approach leads to a culture where biomeds do not merely look at devices that hook up to patients. “As part of the product standards committee which Anders Johansson, CBET, sits on, we’re looking at new catheters, lotions, blood pressure cuffs, or any new supply that patients can use,” Barbeau says. “If there is a new regulation, we know about it. All this not only helps the environment of care, it improves medication management, human resource standards, and ultimately, the whole hospital.”

Members of the nursing leadership committee have come to appreciate biomed involvement, and when it comes time to look at new devices, they seek clinical engineering input. “We are also on the workers’ safety committee, the Environment of Care committee, and the value assessment committee,” Barbeau adds. “We look at the financial end and the medical end. All new equipment must go through that committee before we will be allowed to get a no-charge purchase order and get it in here for evaluation.”

Safety Through Innovation

With nine staff members overseeing 4,500 pieces of equipment, the biomed department stays busy. More importantly, they are able to leverage a wide-ranging knowledge base that fosters improvisation when necessary.

Joe Veneziano, CE, found out that surgeons were looking for a device that could serve a dual purpose as a mount for two IV poles, but also be situated so clinicians could hand off defibrillator cables and IV lines over the top of the sterile field and into the nonsterile field where the cables could be connected to the appropriate equipment.

Clinicians wanted to be able to do this at the head of the table so nothing would fall down and get contaminated. “I created a special bracket assembly by improvising with two clamps from a Philips monitor that is used for mounting multiparameter modules,” Veneziano explains. “I took two of those and an old IV pole off of an old cart, and I tapped both ends of them with a certain thread and screwed the brackets into each end-both of which were mounted to IV poles. They really liked it. I didn’t think much of it, but they made a big deal. I ended up winning the innovation award for the year.”

This matter-of-fact inventiveness becomes contagious at Saint Mary’s, and the examples are numerous.

A special bracket designed by Saint Mary’s clinical engineers, and specially made by a local machine shop, allows biomeds to mount invasive blood pressure manifolds so they are not in the way of anesthesiologists who are routinely involved with open-heart procedures.

When anesthesiologists needed a scope light mounted to the side of a machine, Greg Varcas, CBET, designed a plate to bolt to the anesthesia machine. Diane Lassy, CBET, who works part time as a biomedical technician at Saint Mary’s, got into the act by recruiting her husband to help out. “I asked my husband (who owns and operates a machine shop) to make us plates, which were to be bolted to the side of the device for the scopes,” Lassy says.

A magnetic “medication management calendar wheel” to support the new 28-day Joint Commission medication management standard for multidose vials is yet another innovation. The idea germinated from within the regulatory oversight committee, and Barbeau ultimately came up with a design featuring a perpetual circular calendar.

One arrow points at the current date, and another arrow points 28 days in advance. It is completely magnetic in the back, and will stick to any refrigerator. “It is handy and people can’t say they are going to lose it, and that is why I made it magnetic,” Barbeau says. “I am going to try to market this for Saint Mary’s as soon as we get a working model in the next few weeks. We have already had prototypes out there and people like it, so I’m confident it is going to be well received.”

Rules of the Game

Everyone who plays ball at Saint Mary’s eventually comes to know the rule: Three strikes and you get educated. The policy grew out of a familiar scenario that most biomeds know all too well. An item gets checked, no problems are discovered, and still the equipment ends up back in the queue a few days later.

It can get frustrating, but there is a way to make it stop. “If a device shows up in our department three times within a specific quarter and there is no problem found, we go back and do a mandatory in-service education,” Veneziano says. “There is probably a user out there who needs some reinforcement education for that device. This person may think there is a problem with the equipment, but it really just speaks to proper use.”

In the case of defibrillators, the state of Connecticut requires a daily discharge test, but even with such vigilance, problems can crop up. In one case, users were attempting to use a unit with the internal mode selected, which acts as a type of safety latch. In this case, the mandatory in-service took all of 30 seconds, but time saved down the road was far more dramatic.

Spiritual Meets Physical

More than a century after laying the cornerstone in 1907, innovation at Saint Mary’s Hospital remains a part of the mission that includes a spiritual component. While the days of multiple on-site clergy members are gone, Barbeau makes it a point to never lose sight of the founders’ aims. “We are a Catholic health care organization, and most of the religious staff that used to operate within these walls are gone,” he says. “In fact, there is only one nun left on a day-to-day basis, so I joined a committee to support the mission of the hospital-and that is to provide excellent health care in a spiritually enriched environment to improve the health of our community.”

When it comes to the decidedly worldly endeavor of imaging, looking inward via technological means has led Saint Mary’s to focus heavily on repairing virtually all of its own imaging devices. The effort began in earnest during the early 1980s when imaging modalities in general became increasingly more sophisticated.

The manager of the department in 1983 came to Saint Mary’s after orchestrating a large purchase on behalf of Siemens Healthcare. He ultimately left Siemens to work for the hospital, bringing along yet another imaging expert with him. From these humble beginnings came a tradition of gradually getting ahead of the learning curve.

Since knowledge has been passed down and cultivated over the years, Barbeau believes the department is better equipped to handle turnover. “As the guys who started the department got ready to retire, we had been thinking about how we were going to replace them years before,” Barbeau says. “We had that 4- to 5-year learning curve, which is the biggest obstacle in a lot of hospitals with in-house departments. You don’t have that kind of time to invest in new people that are going to be taking over the imaging department. We’ve always had two or three people involved in imaging here.”

Nowadays, up to a dozen people may pitch in, but it consistently devotes at least two main people to handling the wide variety of devices that includes two Philips Brilliance CT suites that are 1 to 2 years old, plus a Shimadzu interventional radiology suite acquired in 2005. Systems on-site, to name a few, include Siemens radiology rooms, Toshiba digital rooms, and a Fisher Mammoview system.

“We just purchased a new Siemens Axiom Artis DFC, which is a vascular suite,” Barbeau says. “We also do nuclear medicine. We have Philips/ADAC cameras, a new Siemens Symbia S, and a Philips cardio MD nuclear medicine camera. We have a whole line of Philips ultrasound and Siemens echo ultrasound equipment as well.”

Saint Mary’s Toshiba Vantage MRI system features Pianissimo technology, which significantly reduces exam noise. Instead of the loud grinding that other MRI systems produce, the sound is more akin to a gentle tapping. While in-house staff maintains most of the imaging, Barbeau uses the OEM for the Toshiba.

The Rainbow Stairwell

Working on the theory that a little exercise can lead to a healthier workforce, and ultimately better patient care, Barbeau set Tristan Ramas, MS, CE, and Alex Pinoliar, CBET, to the decidedly unusual task of creating a rainbow staircase (see cover photo). If you remember the foot-activated piano in the old Tom Hanks’ film Big, you may get the idea.

The project grew out of a leadership meeting designed to boost health and wellness among hospital employees. “We built a new gym here last year, and the membership hasn’t quite reached full expectations,” Barbeau says. “Like any good hospital, we have elevators all over the place for our patients and visitors, but our staff use them as well when oftentimes the stairs go unattended. So I wanted to promote use of the stairs here at the hospital and make it fun at the same time. I came up with an idea to light the stairs up, and add a musical note for each step.”

Since biomeds are renowned for their know-how, it was not long before Pinoliar and Ramas were asked to make the odd assignment a reality. “I have a program called multi sim where I lay out all the electronics and then I put on a prototype board,” Ramas explains. “I don’t have to wire anything up using a soldering iron. I just connect them on this board. Yes, I have taken a lot of electronics courses.”

“There are two flights of stairs,” Pinoliar says. “With both flights, there are 21 steps in all. Because of housekeeping restrictions it is not pressure activated, so Tristan designed it to work with infrared signals. I don’t think you will find it anywhere else in the world.”

Barbeau is now concocting a list of new ideas to keep the team busy for the next few years. Each biomed is assigned one annual “fun” project, with interns handling most of the work. The projects serve to keep things exciting while giving the Saint Mary’s biomed team a slightly hipper image.

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