Evolution of Italian Universal Newborn Hearing Screening Programs.

BACKGROUND: The aim of this study was to evaluate the state of implementation of the Universal Newborn Hearing Screening Programs in Italy and to determine the effect that an ad hoc legislation may have on the percentage of infants screened for detection of hearing impairment in nurseries. MATERIAL AND METHODS: Italian Newborn Hearing Screening data were obtained during four national surveys (years 2003, 2006, 2008, and 2011). The screening rates obtained by the Regions which adopted or did not adopt a legislation to increase the newborns' coverage were compared. RESULTS: In 2011, the average coverage rate was 78.3%, but in 12 out of 20 Regions it exceeded 95%. Coverage rate was greater in Regions that implemented an ad hoc legislation compared to Regions that did not. As a matter of fact, Regions which passed the legislation screened more than 95% of infants, whereas Regions without legislation reported a mean screening rate of nearly 67% of newborns. CONCLUSION: Current results seem to confirm that a specific legislation might have a decisive effect on the increase of rate of coverage of newborn hearing screenings.

Susceptibility of linear and nonlinear otoacoustic emission components to low-dose styrene exposure.

OBJECTIVE: To investigate potential susceptibility of active cochlear mechanisms to low-level styrene exposure by comparing TEOAEs in workers and controls. DESIGN: Two advanced analysis techniques were applied to detect sub-clinical changes in linear and nonlinear cochlear mechanisms of OAE generation: the wavelet transform to decompose TEOAEs into time-frequency components and extract signal-to-noise ratio and latency of each component, and the bispectrum to detect and extract nonlinear TEOAE contributions as quadratic frequency couplings (QFCs). STUDY SAMPLE: Two cohorts of workers were examined: subjects exposed exclusively to styrene (N = 9), and subjects exposed to styrene and noise (N = 6). The control group was perfectly matched by age and sex to the exposed group. RESULTS: Exposed subjects showed significantly lowered SNR in TEOAE components at mid-to-high frequencies (above 1.6 kHz) and a shift of QFC distribution towards lower frequencies than controls. No systematic differences were observed in latency. CONCLUSION: Low-level styrene exposure may have induced a modification of cochlear functionality as concerns linear and nonlinear OAE generation mechanisms. The lack of change in latency seems to suggest that the OAE components, where generation region and latency are tightly coupled, may not have been affected by styrene and noise exposure levels considered here.

Gold nanoparticles as enablers of cell membrane permeabilization by time-varying magnetic field: influence of distance and geometry.

This study is based on the quantification of the influence of the presence of gold nanoparticles (Au NPs), of their geometry and their distance from cell membrane during time-varying electromagnetic fields cell membrane permeabilization on the pores opening dynamics. Results showed that the combined use of Au NPs and time-varying magnetic field can improve significantly the permeabilization of cell membrane. The presence of Au NPs allowed to reach transmembrane potential values enabling the cell membrane permeabilization only when placed at very short distance, equal to 20 nm. Both geometry and variability of the positioning in proximity of the cell membrane showed a strong influence on the probability of enabling pores opening. Clinical Relevance- This study provides a better comprehension about the mechanisms, still not completely understood, underlying cell membrane permeabilization by combining Au NPs and time-varying magnetic fields.

Application of Stochastic Dosimetry for assessing the Human RFEMF Exposure in a 5G indoor Scenario.

In recent years the introduction of 5G networks is causing a drastically change of human exposure levels in the radio frequency range. The aim of this paper is on expanding the knowledge on this issue, assessing the exposure levels for a particular case of indoor 5G scenario, where the presence of an Access Point (AP) was simulated. Coupling the traditional deterministic computational method with an innovative stochastic approach, called Polynomial Chaos Kriging, allowed to evaluate the exposure variability of an user considering the 3D beamforming capability of the antenna. The exposure levels, expressed in terms of specific absorption rate (SAR) in specific tissues, showed low values compared to ICNIRP guidelines.

Contactless Cell Permeabilization by Time-Varying Magnetic fields: Modelling Transmembrane Potential and Mechanical Stress in in- vitro Experimental Set-Up.

The feasibility of using time-varying magnetic field as a contactless cells permeabilization method was demonstrated by experimental results, but the underlying mechanism is still poorly understood. In this study a numerical analysis of the transmembrane potential (TMP) at cell membranes during permeabilization by time-varying magnetic fields was proposed, and a first quantification of mechanical stress induced by the magnetic and electric fields and hypothesized to play an important role in the permeabilization mechanism was carried out. TMP values induced by typical in-vitro experimental conditions were far below the values needed for membrane permeabilization, with a strong dependence on distance of the cell from the coil. The preliminary assessment of the mechanical pressure and potential deformation of cells showed that stress values evaluated in conditions in which TMP values were too low to cause membrane permeabilization were comparable to those known to influence the pore opening mechanisms.Clinical Relevance- Results represent a significant step towards a better comprehension of the mechanism underlying cell membrane permeabilization by time-varying magnetic fields.

Assessment of Children Exposure Variability to Near-Field Sources using Stochastic Dosimetry.

In this paper, the exposure of a child to a hairdryer model is evaluated. Nowadays, the assessment of children exposure to near-field sources has become in fact a topic of high interest, because it was found that even domestic appliances could be relevant for children exposure level. Therefore, the aim of the present work is to use a method based on stochastic dosimetry to assess the exposure variability due to near-field sources, not limiting it only on some worst-case exposure scenario. In particular, electric field amplitudes induced in specific tissues composing the central nervous system and the peripheral nervous system (following the ICNIRP guidelines) were analyzed. The results highlight a high exposure variability depending on the hairdryer position in respect with the child.

Computational simulation of electromagnetic fields on human targets for magnetic targeting applications.

In the last few years, the use of nanoparticles for therapeutic applications has attracted the interest of many scientists, who are looking for effective methods to target nanoparticles linked to drugs directly to the diseased organs. Among them, magnetic targeting consists of magnetic systems (magnets or coils) which can impress high gradient magnetic fields and then magnetic forces on the magnetic nanoparticles. Despite some studies have reported an effective improvement in drug delivery by using this technique, there is still a paucity of studies able to quantify and explain the experimental results. In this scenario, "in silico" models allow to analyze and compare different magnetic targeting systems in their ability to generate the required magnetic field gradient for specific human targets.In this paper we then evaluated, by means of computational electromagnetics techniques, the attitude of various ad-hoc designed magnetic systems in targeting the heart tissues of differently aged human anatomical models.

Influence of cochlear implant-like operating conditions on wavelet speech processing.

This study assessed the influence of 'non-ideal' operating conditions typical of cochlear implants (CIs) on the behavior of the wavelet transform (WT) when used to process speech. Particular attention was given to the effect of limited stimulation rate and limited number of channels, typical of CI speech processing, on the performance of the WT. Computer simulations and psychoacoustic recognition tests of WT-processed speech were implemented. The crucial role played by the 'non-ideal' operating conditions on WT speech processing was put in evidence. Psychoacoustic recognition tests proved to be fundamental to evaluate feasibility of WT speech processing for CIs.

Clinical Data Reuse or Secondary Use: Current Status and Potential Future Progress.

Objective: To perform a review of recent research in clinical data reuse or secondary use, and envision future advances in this field. Methods: The review is based on a large literature search in MEDLINE (through PubMed), conference proceedings, and the ACM Digital Library, focusing only on research published between 2005 and early 2016. Each selected publication was reviewed by the authors, and a structured analysis and summarization of its content was developed. Results: The initial search produced 359 publications, reduced after a manual examination of abstracts and full publications. The following aspects of clinical data reuse are discussed: motivations and challenges, privacy and ethical concerns, data integration and interoperability, data models and terminologies, unstructured data reuse, structured data mining, clinical practice and research integration, and examples of clinical data reuse (quality measurement and learning healthcare systems). Conclusion: Reuse of clinical data is a fast-growing field recognized as essential to realize the potentials for high quality healthcare, improved healthcare management, reduced healthcare costs, population health management, and effective clinical research.

Auditory cortical responses in patients with cochlear implants.

Currently, the most commonly used electrophysiological tests for cochlear implant evaluation are Averaged Electrical Voltages (AEV), Electrical Advisory Brainstem Responses (EABR) and Neural Response Telemetry (NRT). The present paper focuses on the study of acoustic auditory cortical responses, or slow vertex responses, which are not widely used due to the difficulty in recording, especially in young children. Aims of this study were validation of slow vertex responses and their possible applications in monitoring postimplant results, particularly restoration of hearing and auditory maturation. In practice, the use of tone-bursts, also through hearing aids or cochlear implants, as in slow vertex responses, allows many more frequencies to be investigated and louder intensities to be reached than with other tests based on a click as stimulus. Study design focused on latencies of N1 and P2 slow vertex response peaks in cochlear implants. The study population comprised 45 implant recipients (aged 2 to 70 years), divided into 5 different homogeneous groups according to chronological age, age at onset of deafness, and age at implantation. For each subject, slow vertex responses and free-field auditory responses (PTAS) were recorded for tone-bursts at 500 and 2000 Hz before cochlear implant surgery (using hearing aid amplification) and during scheduled sessions at 3rd and 12th month after implant activation. Results showed that N1 and P2 latencies decreased in all groups starting from 3rd through 12th month after activation. Subjects implanted before school age or at least before age 8 yrs showed the widest latency changes. All subjects showed a reduction in the gap between subjective thresholds (obtained with free field auditory responses) and objective thresholds (obtained with slow vertex responses), obtained in presurgery stage and after cochlear implant. In conclusion, a natural evolution of neurophysiological cortical activities of the auditory pathway, over time, was found especially in young children with prelingual deafness and implanted in preschool age. Cochlear implantation appears to provide hearing restoration, demonstrated by the sharp reduction of the gap between subjective free field auditory responses and slow vertex responses threshold obtained with hearing aids vs. cochlear implant.

Influence on the mechanisms of generation of distortion product otoacoustic emissions of mobile phone exposure.

Mobile phones have become very commonly used throughout the world within a short period of time. Although there is no clear evidence to show harmful physiological effects of electromagnetic fields (EMF) at the levels used by mobile phones, there is widespread public concern that there may be potential for harm. Because mobile phones are usually held close to the ear, it is appropriate to study effects on hearing. In this study, the outer hair cell function of 15 subjects was assessed by DPOAE recording before and after a controlled EMF exposure. To increase the sensitivity of DPOAE recording to identify even small changes in hearing function, an inverse fast Fourier transform (IFFT) analysis and time-domain windowing was applied to separate the two generation mechanisms of DPOAE, the so-called place-fixed and wave-fixed mechanisms, in order to verify if EMF can affects the two DPOAE emission mechanisms. Statistical analysis of the data showed that 10 min of EMF exposure at the maximum power (2 W at 900 MHz or 1 W at 1800 MHz) does not induce any changes in either DPOAE generation mechanism.

Objective measures of perceptual quality for predicting speech intelligibility in sensorineural hearing loss.

An objective method to predict speech intelligibility in sensorineural hearing loss of different types and increasing degrees of severity is proposed and validated with experimental data. The novel approach is based on the combined use of acoustic simulations of impaired perception and objective measures of perceptual speech quality (PESQ). Acoustic simulations were obtained after degradation of the original, non distorted, speech waveforms by spectral smearing, expansive nonlinearity, and level scaling. PESQ was used to measure perceptual quality of the acoustic simulations obtained by varying the degree of the simulated hearing loss. A logistic function was applied to transform PESQ scores into predicted intelligibility scores. A set of CV and VC syllables in /a/, /u/, and /i/ contexts was used as reference test material. The method was validated with subjective measures of intelligibility of the degraded speech obtained in a group of 10 normal hearing subjects. Overall, prediction of experimental speech intelligibility through the transformed PESQ measures was good (R(2)=0.7; RMSE=0.08) revealing that the proposed approach could be a valuable aid in real clinical applications.

Time-frequency distributions of click-evoked otoacoustic emissions.

Emissions evoked by broad-band stimuli, such as clicks, show a 'frequency dispersion' reminiscent of the place-frequency distribution along the cochlea. Analysis of the time-frequency properties of transiently evoked otoacoustic emissions (TEOAEs) is therefore of considerable interest due to their close relation with cochlear mechanisms. In particular, since OAEs in response to click stimuli are expected to evoke a cumulative response from the whole cochlea, the analysis of click-evoked OAEs can yield a global view of cochlear function. Wavelet analysis is performed to obtain time-frequency distributions of click-evoked OAEs at various intensity levels from normal ears. By means of the inverse wavelet transform, the recorded responses are decomposed into elementary components representing the contribution within a narrow frequency band to the cumulative OAE. The relationship between the frequency of the elementary components, latency and level of stimulation is described.

Frequency and temporal analysis of contralateral acoustic stimulation on evoked otoacoustic emissions in humans.

Previous studies have shown that the effect of contralateral acoustic stimulation (CAS) on ipsilateral evoked otoacoustic emissions (EOAE) depends somewhat upon the spectrum of the eliciting stimulus. The latency of the EOAE, however, is itself frequency-dependent. Consequently, two general ways of analyzing the effects of CAS may be considered: by frequency band or by temporal segment. In this study, we analyzed the effects of CAS both ways in the same subjects, essentially simultaneously. The frequency analysis of the EOAE derived from the wavelet transform (WT). The WT is known to provide a robust approach to the analysis of non-stationary signals and was anticipated to avoid possible time-frequency confounds of the cochlear mechanical system. For comparison, a more basic analysis - using a temporal moving window - was employed. The results largely support earlier findings and confirm that in humans the greatest suppression of EOAEs by CAS is obtained for lower frequency and/or longer latency EOAE components. Despite expectations for the WT analysis, the more basic, temporal, analysis tended to yield the clearer results.

Wavelet analysis of click-evoked otoacoustic emissions.

Time-frequency distribution methods are being widely used for the analysis of a variety of biomedical signals. Recently, they have been applied also to study otoacoustic emissions (OAE's), the active acoustic response of the hearing end organ. Click-evoked otoacoustic emissions (CEOAE's) are time-varying signals with a clear frequency dispersion along with the time axis. Analysis of CEOAE's is of considerable interest due to their close relation with cochlear mechanisms. In this paper, several basic time-frequency distribution methods are considered and compared on the basis of both simulated signals and real CEOAE's. The particular structure of CEOAE's requires a method with both a satisfactory time and frequency resolution. Results from simulations and real CEOAE's revealed that the wavelet approach is highly suitable for the analysis of such signals. Some examples of the application of the wavelet transform to CEOAE's are provided here. Applications range from the extraction of normative data from adult and neonatal OAE's to the extraction of quantitative parameters for clinical purposes.

Two-dimensional filter to facilitate detection of transient-evoked otoacoustic emissions.

This paper implements a filtering technique to enhance the signal-to-noise ratio (SNR) and, in turn, the detection of transient-evoked otoacoustic emissions (TEOAE's), generated by healthy human cochlea. One can increase the SNR by compiling an image of recorded TEOAE from more than one stimulus intensity, averaged over a few sweeps, which can be further processed by means of two-dimensional spatial mean filters. Averaging some 60 sweeps recorded to stimuli at several intensity levels requires one-forth of the collection time needed for a classical set of responses (average of 260 sweeps), and obtains approximately the same final SNR. The relation between the performances of the proposed technique and the SNR of the rapidly acquired responses before filtering is also investigated.

A volume-conduction analysis of magnetic stimulation of peripheral nerves.

Magnetic stimulation is a method to study several nervous disorders as well as the intact nervous system in humans. Interest in magnetic stimulation of peripheral nerves has grown rapidly, but difficulties in locating the site of excitation have prevented it from becoming a routine clinical tool. It has been reasoned that the activating function of long and straight nerves is the first spatial derivative of the electric field component parallel to the nerves. Therefore, to predict the site of activation, one has to compute this field feature. We describe here an analytical mathematical model and investigate the influence of volume-conductor shape on the induced field. Predictions of the site of activation are given for typical stimulation coil arrangements and these results are compared with experimental and literature data. Comparisons suggest that the activating function is not simply the spatial gradient of the induced electric field, but that other mechanisms are also involved. The model can be easily utilized in the search for more efficient coil constructions and improved placements with respect to the target nerves.

Temporal segmentation and multiple-source analysis of short-latency median nerve SEPs.

Short-latency (10-50 ms) median nerve somatosensory evoked potentials (SEPs) from four normal subjects were analysed by means of temporal segmentation techniques and source derivation methods. In each case the responses were recorded using 32 electrodes. Dipolar optimization was carried out with a time-varying technique, using three different approaches: regional source estimation, spherical source estimation (one radial and one tangential component), and multiple dipolar approach. This was to assess the relative influence on the dipolar solution of the different optimization techniques. The effect of the different number of channels in the estimation procedures has been also investigated. The methods of optimization are crucial, particularly for the orientation of P22. In all cases the source location estimated with the 32-electrode montage was shifted towards the centre of the spheres.

Time-frequency distribution methods for the analysis of click-evoked otoacoustic emissions.

Click-evoked otoacoustic emissions (CEOAEs) are time-varying signals with a clear frequency dispersion along with the time axis. Analysis of CEOAEs is of considerable interest due to their close relation with cochlear mechanisms. The particular structure of CEOAEs requires a time-frequency method with both a satisfactory time and frequency resolution. In this paper, several basic time-frequency distribution methods are considered and compared on the basis of both simulated signals and real CEOAEs. Results from simulations and real CEOAEs revealed that the wavelet approach is highly suitable for the analysis of such signals. Some examples of the application of the Wavelet Transform to CEOAEs are provided here. Applications range from the extraction of normative data from adult OAEs to the extraction of quantitative parameters for clinical purposes.

Analysis of temporal non-stationarities in EEG signals by means of parametric modelling.

A method for the analysis of variability of EEG signals is described. We examined simulated signals and real EEGs obtained from a normal subject and two epileptic patients. The first step of the method is based on autoregressive (AR) modelling of short EEG epochs. Prediction coefficients of the AR model were computed as a function of time from partially-overlapping moving windows of 2 s duration. The temporal behaviour of these coefficients was analysed to detect variability: quasi-stationary activity causes only smooth changes in the coefficients while variations in the amplitude and/or the frequency content of the signal are shown to produce sharp changes in the coefficients. A segmentation algorithm was developed to detect and quantify with a numerical value (Difference Measure, DM) the AR coefficients variations.