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Article ; Online: Evaluating Fixed Single-Point Parameters When Applied to Vestibular Evoked Myogenic Potentials: The Effect of Single Point and Signal Window.

Romero, Daniel J / Clinard, Christopher / Zalewski, Christopher / Piker, Erin

2024 Volume 45, Issue 3, Page(s) 753–759

Abstract: Objectives: Several studies have applied a common objective detection algorithm (fixed single point [ Fsp ]) for detection of the vestibular evoked myogenic potential (VEMP). However, fundamental parameters of Fsp , such as establishing the location and ...

Abstract	Objectives: Several studies have applied a common objective detection algorithm (fixed single point [ Fsp ]) for detection of the vestibular evoked myogenic potential (VEMP). However, fundamental parameters of Fsp , such as establishing the location and duration of a signal window, have not been examined. In addition, Fsp criterion values used for response detection have not been established for cervical VEMPs (cVEMPs) or ocular VEMPs (oVEMPs). The purpose of this article was to investigate the effect of various single points and signal windows on Fsp , as well as determining Fsp criteria to determine response presence for cVEMP and oVEMP in a group of young healthy participants. Design: Twenty young healthy adults under the age of 30 and with no history of hearing or balance concerns were enrolled in the study protocol. Air-conducted cVEMPs and oVEMPs were evoked using 500 Hz tone bursts at 123 dB pSPL recorded at a fixed electromyography activation of 50 µV for cVEMPs and 35° gaze angle for oVEMPs. Responses were analyzed off-line using visual and objective detection. Fsp was applied to cVEMPs and oVEMPs using a range of single points and signal windows. Results: Noise variance was lowest for cVEMPs at the latency of P1, and for oVEMPs noise variance was not significantly different across the single-point latencies. On average, extending the length of the signal window lowered the Fsp value in cVEMPs and oVEMPs. An Fsp value of 2.0 was chosen as the criterion cutoff associated with the 95th percentile during no-response conditions using group data for cVEMPs and oVEMPs, respectively. Fsp values for cVEMPs and oVEMPs were not significantly different from each other. Discussion: This study established single-point latency and time-window parameters for VEMP-related applications of the Fsp detection algorithm. Fsp criteria values were established for cVEMP and oVEMP. Using these parameters, responses were detected in all participants.
MeSH term(s)	Adult ; Humans ; Vestibular Evoked Myogenic Potentials/physiology ; Hearing ; Electromyography ; Hearing Tests ; Neck
Language	English
Publishing date	2024-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	603093-2
ISSN	1538-4667 ; 0196-0202
ISSN (online)	1538-4667
ISSN	0196-0202
DOI	10.1097/AUD.0000000000001468
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Article ; Online: Temporal Modulation Transfer Functions of Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials in Young Adults.

Lawlor, Kerri J / Clinard, Christopher G / Piker, Erin G

Ear and hearing

2022 Volume 43, Issue 5, Page(s) 1456–1465

Abstract: Objectives: Cervical vestibular-evoked myogenic potentials (cVEMPs) are widely used to evaluate saccular function in clinical and research applications. Typically, transient tonebursts are used to elicit cVEMPs. In this study, we used bone-conducted ... ...

Abstract	Objectives: Cervical vestibular-evoked myogenic potentials (cVEMPs) are widely used to evaluate saccular function in clinical and research applications. Typically, transient tonebursts are used to elicit cVEMPs. In this study, we used bone-conducted amplitude-modulated (AM) tones to elicit AMcVEMPs. This new approach allows the examination of phase-locked vestibular responses across a range of modulation frequencies. Currently, cVEMP temporal modulation transfer functions (TMTFs) are not well defined. The purposes of the present study were (1) to characterize the AMcVEMP TMTF in young, healthy individuals, (2) to compare AMcVEMP TMTFs across different analysis approaches, and (3) to determine the upper frequency limit of the AMcVEMP TMTF. Design: Young adults (ages 21 to 25) with no history of vestibular lesions or middle ear pathologies participated in this study. Stimuli were amplitude-modulated tones with a carrier frequency of 500 Hz and modulation frequencies ranging from 7 to 403 Hz. Stimuli were presented at 65 dB HL via a B81 bone-oscillator. Results: AMcVEMP waveforms consisted of transient onset responses, steady-state responses, and transient offset responses; the behavior of these different types of responses varied with modulation frequency. Differences in the TMTF shape were noted across different measures. The amplitude TMTF had a sharp peak, while signal-to-noise ratio and phase coherence TMTFs had broader shapes with plateaus across a range of modulation frequencies. Amplitude was maximal at modulation frequencies of 29 and 37 Hz. Signal-to-noise ratio maintained its peak value at modulation frequencies between 17 Hz and 127 Hz. Phase coherence and modulation gain maintained their peak values at modulation frequencies between 17 Hz and 143 Hz. Conclusions: AMcVEMPs reflect transient onset and offset responses, as well as a sustained response with the periodicity of an amplitude-modulation frequency. AMcVEMP TMTFs had variable shapes depending on the analysis being applied to the response; amplitude had a narrow shape while others were broader. Average upper frequency limits of the AMcVEMP TMTF were as high as approximately 300 Hz in young, healthy adults.
MeSH term(s)	Acoustic Stimulation ; Adult ; Humans ; Signal-To-Noise Ratio ; Vestibular Evoked Myogenic Potentials/physiology ; Vestibule, Labyrinth ; Young Adult
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	603093-2
ISSN	1538-4667 ; 0196-0202
ISSN (online)	1538-4667
ISSN	0196-0202
DOI	10.1097/AUD.0000000000001221
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Article ; Online: Effects of Stimulus Polarity on Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials.

Clinard, Christopher G / Lawlor, Kerri J / Piker, Erin G

Journal of the American Academy of Audiology

2022 Volume 32, Issue 9, Page(s) 588–595

Abstract: Background: Traditional approaches to cervical vestibular-evoked myogenic potentials use a transient stimulus to elicit an onset response. However, alternate approaches with long duration stimuli may allow the development of new methodologies to better ... ...

Abstract	Background: Traditional approaches to cervical vestibular-evoked myogenic potentials use a transient stimulus to elicit an onset response. However, alternate approaches with long duration stimuli may allow the development of new methodologies to better understand basic function of the vestibular system, as well as potentially developing new clinical applications. Purpose: The objective of this study was to examine the effects of stimulus polarity on response properties of amplitude-modulated cervical vestibular-evoked myogenic potentials (AMcVEMPs). Research design: Prospective, repeated-measures, within-subjects design. Study sample: Participants were 16 young, healthy adults (ages 21-38 years). Data collection and analysis: Amplitude-modulated tones, with carrier frequency of 500 Hz and modulation frequency of 37 Hz, were used to elicit AMcVEMPs. Responses were analyzed in three different stimulus polarity conditions: condensation, rarefaction, and alternating. The resulting data were analyzed for differences across polarity conditions. Results: AMcVEMP amplitudes, both raw and corrected for tonic muscle activation, were equivalent across the different stimulus phase conditions. In addition, response signal-to-noise ratio and phase coherence were equivalent across the different phases of the stimulus. Conclusion: Analyses of AMcVEMPs are stable when the carrier frequency starting phase is altered and the phase of the temporal envelope is constant.
MeSH term(s)	Acoustic Stimulation/methods ; Adult ; Humans ; Prospective Studies ; Signal-To-Noise Ratio ; Vestibular Evoked Myogenic Potentials/physiology ; Young Adult
Language	English
Publishing date	2022-02-17
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1132599-9
ISSN	2157-3107 ; 1050-0545
ISSN (online)	2157-3107
ISSN	1050-0545
DOI	10.1055/s-0041-1733968
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Article ; Online: Inter-trial coherence as a measure of synchrony in cervical vestibular evoked myogenic potentials.

Clinard, Christopher G / Piker, Erin G / Romero, Daniel J

Journal of neuroscience methods

2022 Volume 377, Page(s) 109628

Abstract: Background: Cervical vestibular evoked myogenic potentials (cVEMPs) are surface-recorded responses that reflect saccular function. Analysis of cVEMPs has focused, nearly exclusively, on time-domain waveform measurements such as amplitude and latency of ... ...

Abstract	Background: Cervical vestibular evoked myogenic potentials (cVEMPs) are surface-recorded responses that reflect saccular function. Analysis of cVEMPs has focused, nearly exclusively, on time-domain waveform measurements such as amplitude and latency of response peaks, but synchrony-based measures have not been previously reported. New method: Time-frequency analyses were used to apply an objective response-detection algorithm and to quantify response synchrony. These methods are new to VEMP literature and have been adapted from previous auditory research. Air-conducted cVEMPs were elicited using a 500 Hz tone burst in twenty young, healthy participants. Results: Time-frequency characteristics of cVEMPs and time-frequency boundaries for response energy were established. An inter-trial coherence analysis approach revealed highly synchronous responses with representative inter-trial coherence values of approximately 0.7. Comparison with existing methods: Inter-trial coherence measures were highly correlated with conventional amplitude measures in this group of young, healthy adults (R Conclusions: Synchrony-based time-frequency analyses were successfully applied to cVEMP data and this type of analysis may be helpful to differentiate synchrony from amplitude in populations with disrupted neural synchrony.
MeSH term(s)	Acoustic Stimulation/methods ; Adult ; Humans ; Vestibular Evoked Myogenic Potentials/physiology
Language	English
Publishing date	2022-05-23
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	282721-9
ISSN	1872-678X ; 0165-0270
ISSN (online)	1872-678X
ISSN	0165-0270
DOI	10.1016/j.jneumeth.2022.109628
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Article ; Online: Nonlinearity in bone-conducted amplitude-modulated cervical vestibular-evoked myogenic potentials: harmonic distortion products.

Clinard, Christopher G / Lawlor, Kerri J / Thorne, Andrew P / Piker, Erin G

Journal of neurophysiology

2022 Volume 127, Issue 3, Page(s) 791–800

Abstract: Otolith organs of the balance system, the saccule and utricle, encode linear acceleration. Integrity of the saccule is commonly assessed using cervical vestibular-evoked myogenic potentials (cVEMPs) arising from an inhibitory reflex along the ... ...

Abstract	Otolith organs of the balance system, the saccule and utricle, encode linear acceleration. Integrity of the saccule is commonly assessed using cervical vestibular-evoked myogenic potentials (cVEMPs) arising from an inhibitory reflex along the vestibulospinal pathway. Conventional approaches to eliciting these responses use brief, transient sounds to elicit onset responses. Here we used long-duration amplitude-modulated (AM) tones to elicit cVEMPs (AMcVEMPs) and analyzed their spectral content for evidence of nonlinear processing consistent with known characteristics of vestibular hair cells. Twelve young adults (ages 21-25) with no hearing or vestibular pathologies participated in this study. AMcVEMPs were elicited by bone-conducted AM tones with a 500-Hz carrier frequency. Eighteen modulation frequencies were used between 7 and 403 Hz. All participants had robust distortion products at harmonics of the modulation frequency. Total harmonic distortion ranged from approximately 10 to 80%. AMcVEMPs contain harmonic distortion products consistent with vestibular hair cell nonlinearities, and this new approach to studying the otolith organs may provide a noninvasive, in vivo method to study nonlinearity of vestibular hair cells in humans.
MeSH term(s)	Adult ; Hearing ; Humans ; Saccule and Utricle ; Vestibular Evoked Myogenic Potentials/physiology ; Vestibule, Labyrinth/physiology ; Young Adult
Language	English
Publishing date	2022-02-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80161-6
ISSN	1522-1598 ; 0022-3077
ISSN (online)	1522-1598
ISSN	0022-3077
DOI	10.1152/jn.00347.2021
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Article ; Online: Effects of Tonic Muscle Activation on Amplitude-Modulated Cervical Vestibular Evoked Myogenic Potentials (AMcVEMPs) in Young Females: Preliminary Findings.

Clinard, Christopher G / Thorne, Andrew P / Piker, Erin G

Journal of the Association for Research in Otolaryngology : JARO

2020 Volume 21, Issue 5, Page(s) 445–461

Abstract: Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or ... ...

Abstract	Cervical vestibular evoked myogenic potentials (cVEMPs) are usually elicited by transient tonebursts, but when elicited by amplitude-modulated (AM) tones, they can provide new information about cVEMPs. Previous reports of cVEMPs elicited by AM tones, or AMcVEMPs, have not systematically examined the effects of tonic EMG activation on their response properties. Fourteen young, healthy female adults (ages 20-24) with clinically normal audiograms participated in this study. AMcVEMPs were elicited with bone-conducted 500 Hz tones amplitude modulated at a rate of 37 Hz and recorded for five different EMG targets ranging from 0 to 90 μV. Amplitude increased linearly as tonic EMG activation increased. Signal-to-noise ratio (SNR) was minimal at 0 μV, but robust and with equivalent values from 30 to 90 μV; phase coherence and EMG-corrected amplitude had findings similar to SNR across EMG target levels. Interaural asymmetry ratios for SNR and phase coherence were substantially lower than those for raw or corrected amplitude. AMcVEMP amplitude scaled with tonic EMG activation similar to transient cVEMPs. Signal-to-noise ratio, phase coherence, and EMG-corrected amplitude plateaued across a range of EMG values, suggesting that these properties of the response reach their maximum values at relatively low levels of EMG activation and that higher levels of EMG activation are not necessary to record robust AMcVEMPs.
MeSH term(s)	Electromyography ; Female ; Humans ; Signal-To-Noise Ratio ; Vestibular Evoked Myogenic Potentials ; Young Adult
Language	English
Publishing date	2020-08-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2021417-0
ISSN	1438-7573 ; 1525-3961
ISSN (online)	1438-7573
ISSN	1525-3961
DOI	10.1007/s10162-020-00766-z
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Zs.A 5410: Show issues

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Article ; Online: Comparison of Bone-Conducted Cervical VEMPs Elicited by B71 and B81 Bone Vibrators.

Romero, Daniel J / Piker, Erin G / Thorne, Andrew / Clinard, Christopher

Ear and hearing

2021 Volume 42, Issue 3, Page(s) 596–605

Abstract: Objective: A variety of stimulus delivery methods can elicit vestibular evoked myogenic potentials (VEMPs). The current study compared bone conduction (BC) cervical VEMPs (cVEMPs) across two different clinical bone vibrators. It was hypothesized that ... ...

Abstract	Objective: A variety of stimulus delivery methods can elicit vestibular evoked myogenic potentials (VEMPs). The current study compared bone conduction (BC) cervical VEMPs (cVEMPs) across two different clinical bone vibrators. It was hypothesized that the B81 transducer would be more effective for producing larger BC-cVEMP peak to peak amplitudes due to its low-frequency advantages in pure-tone audiometry applications. Design: Twenty young adults under the age of 40 years with no reported history of hearing or balance disorders participated in the study. BC cVEMPs were elicited using two clinical bone transducers: the Radioear B71 bone vibrator and the Radioear B81 bone vibrator. Both transducers were calibrated using the acoustic method of calibration before data collection, and the linear dynamic range of the transducers was determined. Participants were asked to sit and match a fixed electromyography (EMG) target level of 100 µV, while BC cVEMPs were recorded using stimulus frequencies of 250, 500, and 750 Hz. Results: Statistically significant differences in raw amplitude at 250 and 750 Hz between the B71 and B81 were observed; the B71 produced larger peak to peak amplitudes over the B81. At 500 Hz, larger amplitudes were observed with the B71, but results were not statistically significant. The B71 produced significantly lower cVEMP thresholds at all three frequencies. Across both transducers, 500 Hz produced the largest peak to peak amplitude compared with 250 and 750 Hz. Peak to peak amplitude did not increase above 55 dB nHL for 250 and 500 Hz, but amplitude continued to increase at 750 Hz. Discussion: The present study found statistically significant differences in BC-cVEMP amplitude and threshold between the B71 and B81, but results were not what we hypothesized. In general, the B71 elicited larger BC-cVEMP amplitudes and lower thresholds compared with the B81. Additionally, 500 Hz was found to be the best frequency for both BC transducers, contrasting previous studies suggesting lower frequencies yield larger BC-cVEMP amplitudes. It is possible that these average differences could also be clinically significant when looking at individual amplitude differences. Larger peak to peak amplitudes at 500 Hz may be partially due to the underlying physical levels used in the current study, as well as the output spectra of the transducers, and may explain the larger response amplitudes observed at 500 Hz compared with 250 Hz.
MeSH term(s)	Acoustic Stimulation ; Acoustics ; Adult ; Bone Conduction ; Hearing ; Hearing Tests ; Humans ; Vestibular Evoked Myogenic Potentials ; Young Adult
Language	English
Publishing date	2021-02-13
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603093-2
ISSN	1538-4667 ; 0196-0202
ISSN (online)	1538-4667
ISSN	0196-0202
DOI	10.1097/AUD.0000000000000978
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Zs.A 1548: Show issues

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Article: Effects of Stimulus Polarity on Amplitude-Modulated Cervical Vestibular-Evoked Myogenic Potentials

Clinard, Christopher G. / Lawlor, Kerri J. / Piker, Erin G.

Journal of the American Academy of Audiology

2021 Volume 32, Issue 09, Page(s) 588–595

Abstract	Background: Traditional approaches to cervical vestibular-evoked myogenic potentials use a transient stimulus to elicit an onset response. However, alternate approaches with long duration stimuli may allow the development of new methodologies to better understand basic function of the vestibular system, as well as potentially developing new clinical applications. Purpose: The objective of this study was to examine the effects of stimulus polarity on response properties of amplitude-modulated cervical vestibular-evoked myogenic potentials (AMcVEMPs). Research Design: Prospective, repeated-measures, within-subjects design. Study Sample: Participants were 16 young, healthy adults (ages 21–38 years). Data Collection and Analysis: Amplitude-modulated tones, with carrier frequency of 500 Hz and modulation frequency of 37 Hz, were used to elicit AMcVEMPs. Responses were analyzed in three different stimulus polarity conditions: condensation, rarefaction, and alternating. The resulting data were analyzed for differences across polarity conditions. Results: AMcVEMP amplitudes, both raw and corrected for tonic muscle activation, were equivalent across the different stimulus phase conditions. In addition, response signal-to-noise ratio and phase coherence were equivalent across the different phases of the stimulus. Conclusion: Analyses of AMcVEMPs are stable when the carrier frequency starting phase is altered and the phase of the temporal envelope is constant.
Keywords	otolith ; VEMP ; cVEMP ; phase locking ; stimulus polarity ; steady-state
Language	English
Publishing date	2021-10-01
Publisher	Thieme Medical Publishers, Inc.
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	1132599-9
ISSN	2157-3107 ; 1050-0545
ISSN (online)	2157-3107
ISSN	1050-0545
DOI	10.1055/s-0041-1733968
Database	Thieme publisher's database

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Article ; Online: Neural representation of dynamic frequency is degraded in older adults.

Clinard, Christopher G / Cotter, Caitlin M

Hearing research

2015 Volume 323, Page(s) 91–98

Abstract: Older adults, even with clinically normal hearing sensitivity, often report difficulty understanding speech in the presence of background noise. Part of this difficulty may be related to age-related degradations in the neural representation of speech ... ...

Abstract	Older adults, even with clinically normal hearing sensitivity, often report difficulty understanding speech in the presence of background noise. Part of this difficulty may be related to age-related degradations in the neural representation of speech sounds, such as formant transitions. Frequency-following responses (FFRs), which are dependent on phase-locked neural activity, were elicited using sounds consisting of linear frequency sweeps, which may be viewed as simple models of formant transitions. Eighteen adults (ten younger, 22-24 years old, and nine older, 51-67 years old) were tested. FFRs were elicited by tonal sweeps in six conditions. Two directions of frequency change, rising or falling, were used for each of three rates of frequency change. Stimulus-to-response cross correlations revealed that older adults had significantly poorer representation of the tonal sweeps, and that FFRs became poorer for faster rates of change. An additional FFR signal-to-noise ratio analysis based on time windows revealed that across the FFR waveforms and rates of frequency change, older adults had smaller (poorer) signal-to-noise ratios. These results indicate that older adults, even with clinically-normal hearing sensitivity, have degraded phase-locked neural representations of dynamic frequency.
MeSH term(s)	Acoustic Stimulation ; Adult ; Age Factors ; Aged ; Aging/psychology ; Audiometry ; Auditory Pathways/physiopathology ; Auditory Threshold ; Comprehension ; Humans ; Middle Aged ; Noise/adverse effects ; Perceptual Masking ; Pitch Perception ; Speech Intelligibility ; Speech Perception ; Time Factors ; Young Adult
Language	English
Publishing date	2015-05
Publishing country	Netherlands
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	282629-x
ISSN	1878-5891 ; 0378-5955
ISSN (online)	1878-5891
ISSN	0378-5955
DOI	10.1016/j.heares.2015.02.002
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Article ; Online: Aging degrades the neural encoding of simple and complex sounds in the human brainstem.

Clinard, Christopher G / Tremblay, Kelly L

Journal of the American Academy of Audiology

2013 Volume 24, Issue 7, Page(s) 590–9; quiz 643–4

Abstract: Background: Older adults, with or without normal peripheral hearing sensitivity, have difficulty understanding speech. This impaired speech perception may, in part, be due to desynchronization affecting the neural representation of acoustic features. ... ...

Abstract	Background: Older adults, with or without normal peripheral hearing sensitivity, have difficulty understanding speech. This impaired speech perception may, in part, be due to desynchronization affecting the neural representation of acoustic features. Here we determine if phase-locked neural activity generating the brainstem frequency-following response (FFR) exhibits age-related desynchronization and how this degradation affects the neural representation of simple and complex sounds. Purpose: The objectives of this study were to (1) characterize the effects of age on the neural representation of simple tones and complex consonant-vowel stimuli, (2) determine if sustained and transient components of the FFR are differentially affected by age, and (3) determine if the inability to encode a simple signal predicts degradation in representation for complex speech signals. Research design: Correlational. Study sample: Thirty four adults (aged 22-77 yr) with hearing thresholds falling within normal limits. Data collection and analysis: Stimuli used to evoke FFRs were 1000 Hz tone bursts as well as a consonant-vowel /da/ sound. Results: The neural representation of simple (tone) and complex (/da/) stimuli declines with advancing age. Tone-FFR phase coherence decreased as chronological age increased. For the consonant-vowel FFRs, transient onset and offset response amplitudes were smaller, and offset responses were delayed with age. Sustained responses at the onset of vowel periodicity were prolonged in latency and smaller in amplitude as age increased. FFT amplitude of the consonant-vowel FFR fundamental frequency did not significantly decline with increasing age. The ability to encode a simple signal was related to degradation in the neural representation of a complex, speechlike sound. Tone-FFR phase coherence was significantly related to the later vowel response components but not the earlier vowel components. Conclusions: FFR components representing the tone and consonant-vowel /da/ stimulus were negatively affected by age, showing age-related reductions in response synchrony and amplitude, as well as prolonged latencies. These aging effects were evident in middle age, even in the absence of significant hearing loss.
MeSH term(s)	Acoustic Stimulation/methods ; Adult ; Age Factors ; Aged ; Aging/physiology ; Audiometry, Evoked Response/methods ; Audiometry, Evoked Response/statistics & numerical data ; Auditory Pathways ; Auditory Threshold ; Brain Stem/physiopathology ; Evoked Potentials, Auditory, Brain Stem/physiology ; Female ; Humans ; Male ; Middle Aged ; Psychoacoustics ; Reaction Time/physiology ; Regression Analysis ; Scalp ; Speech Acoustics ; Speech Perception/physiology ; Young Adult
Language	English
Publishing date	2013-06-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1132599-9
ISSN	2157-3107 ; 1050-0545
ISSN (online)	2157-3107
ISSN	1050-0545
DOI	10.3766/jaaa.24.7.7
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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