Objectives: To assess subjectively perceived, real-world benefits longitudinally for unilateral cochlear implant (CI) recipients in a multinational population treated routinely. To identify possible predictors of self-reported benefits. Design: This was a prospective, multicenter, repeated-measures study. Self-assessment of performance at preimplantation and postimplantation at 1, 2, and 3 years using standardized, validated, local language versions of the Speech, Spatial, and Qualities of Hearing Scale (SSQ), and the Health Utilities Index Mark 3 (HUI3) was performed. Outcomes were analyzed using a longitudinal mixed-effects model incorporating country effect. Patient demographics were explored for associations with change over time. Subjects: Two hundred ninety-one routinely treated, unilateral CI recipients, aged 13-81 years, from 9 clinics across 4 countries. Results: Highly significant improvements were observed for all outcome measures (p < 0.0001). Postimplantation, mean outcome scores remained stable beyond 1 year, with notable individual variability. A significant association for one or more outcomes with preimplantation contralateral hearing aid use, telephone use, age at implantation, implantation side, preimplantation comorbidities, dizziness, and tinnitus was observed (p < 0.004). Conclusions: Longitudinal benefits of CI treatment can be measured using clinically standardized self-assessment tools to provide a holistic view of patient-related benefits in routine clinical practice for aggregated data from multinational populations. Self-reported outcomes can provide medical-based evidence regarding CI treatment to support decision-making by health service providers.

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The main objective of this study was to calculate the economic value (including externalities) of a created wetland located in a peri-urban park in Catalonia, Spain. The wetland, which covers an area of 1 ha, was constructed in 2003 and receives a secondary treated wastewater flow of between 100 and 250 m(3)/day. The externalities of the wetland were evaluated using the travel cost method. The value of the wetland is expressed in terms of the price of the water that flows through the system, which is estimated to range from 0.71 to 0.75 €/m(3). The value of positive externalities (1.25 €/m(3)) was greater than private costs (from 0.50 to 0.54 €/m(3)). These results constitute empirical evidence that created wetlands in peri-urban parks can be considered to be a source of positive externalities when used in environmental restoration projects focusing on the reuse of treated wastewater. This study also illustrates 1) the small influence of the hydraulic infrastructure depreciation costs on the private costs of constructed wetlands (less than 10%), and 2) the low investment costs of constructed wetlands in comparison with operation and maintenance costs (less than 10% of total private costs).

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