IMPORTANCE Cochlear implant users generally display poor pitch perception. Flat-panel computed tomography (FPCT) has recently emerged as a modality capable of localizing individual electrode contacts within the cochlea in vivo. Significant place-pitch mismatch between the clinical implant processing settings given to patients and the theoretical maps based on FPCT imaging has previously been noted. OBJECTIVE To assess whether place-pitch mismatch is associated with poor cochlear implant-mediated pitch perception through evaluation of an individualized, image-guided approach toward cochlear implant programming on speech and music perception among cochlear implant users. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of 17 cochlear implant users with MED-EL electrode arrays was performed at a tertiary referral center. The study was conducted from June 2016 to July 2017. INTERVENTIONS Theoretical place-pitch maps using FPCT secondary reconstructions and 3-dimensional curved planar reformation software were developed. The clinical map settings (eg, strategy, rate, volume, frequency band range) were modified to keep factors constant between the 2 maps and minimize confounding. The acclimation period to the maps was 30 minutes. MAIN OUTCOMES AND MEASURES Participants performed speech perception tasks (eg, consonant-nucleus-consonant, Bamford-Kowal-Bench Speech-in-Noise, vowel identification) and a pitch-scaling task while using the image-guided place-pitch map (intervention) and the modified clinical map (control). Performance scores between the 2 interventions were measured. RESULTS Of the 17 participants, 10 (58.8%) were women; mean (SD) was 59 (11.3) years. A significant median increase in pitch scaling accuracy was noted when using the experimental map compared with the control map (4 more correct answers; 95% CI, 0-8). Specifically, the number of pitch-scaling reversals for notes spaced at 1.65 semitones or greater decreased when an image-based approach to cochlear implant programming was used vs the modified clinical map (4 mistakes; 95% CI, 0.5-7). Although there was no observable median improvement in speech perception during use of an image-based map, the acute changes in frequency allocation and electrode channel deactivations used with the image-guided maps did not worsen consonant-nucleus-consonant (−1% correct phonemes, 95% CI, −2.5% to 6%) and Bamford-Kowal-Bench Speech-in-Noise (0.5-dB difference; 95% CI, −0.75 to 2.25 dB) median performance results relative to the clinical maps used by the patients. CONCLUSIONS AND RELEVANCE An image-based approach toward ochlear implant mapping may improve pitch perception outcomes by reducing place-pitch mismatch. Studies using a longer acclimation period with chronic stimulation over months may help assess the full range of the benefits associated with personalized image-guided cochlear implant mapping.

A recombinant macrophage infectivity potentiator (rMIP) protein of Neisseria meningitidis induces significant serum bactericidal antibody production in mice and is a candidate meningococcal vaccine antigen. However, bioinformatics analysis of MIP showed some amino acid sequence similarity to human FK506-binding proteins (FKBPs) in residues 166 to 252 located in the globular domain of the protein. To circumvent the potential concern over generating antibodies that could recognize human proteins, we immunized mice with recombinant truncated type I rMIP proteins that lacked the globular domain and the signal leader peptide (LP) signal sequence (amino acids 1 to 22) and contained the His purification tag at either the N or C terminus (C-term). The immunogenicity of truncated rMIP proteins was compared to that of full (i.e., full-length) rMIP proteins (containing the globular domain) with either an N-or C-terminal His tag and with or without the LP sequence. By comparing the functional murine antibody responses to these various constructs, we determined that C-term His truncated rMIP (؊LP) delivered in liposomes induced high levels of antibodies that bound to the surface of wild-type but not ⌬mip mutant meningococci and showed bactericidal activity against homologous type I MIP (median titers of 128 to 256) and heterologous type II and III (median titers of 256 to 512) strains, thereby providing at least 82% serogroup B strain coverage. In contrast, in constructs lacking the LP, placement of the His tag at the N terminus appeared to abrogate bactericidal activity. The strategy used in this study would obviate any potential concerns regarding the use of MIP antigens for inclusion in bacterial vaccines. N eisseria meningitidis (meningococcus) infections contribute significantly to mortality and morbidity worldwide (1). Implementation of capsular polysaccharide-protein conjugate vaccines against serogroups A, C, Y, and W into the routine immunization schedules of developed countries has been successful (2-5), but this approach cannot be used for serogroup B strains. The polysaccharide capsule of serogroup B meningococci (MenB) shows structural mimicry of human fetal brain neural cell adhesion molecules (6). Licensed MenB vaccines based on lipooligosaccharide (LOS)-depleted outer membrane (OM) vesicles (V) have been used to control serosubtype strain-specific clonal outbreaks of MenB infection, e.g., in Norway (7), Cuba (8), Brazil (9), and New Zealand (10), but they do not provide cross-strain protection (11). Recently, the 4CMenB (Bexsero) vaccine, developed using a genome-based reverse-vaccinology approach (12), has received a license from the European Union and has been recommended by the Joint Committee for Vaccination and Immunization for the routine vaccination of infants in the United Kingdom since 2014. The vaccine consists of the factor H binding protein (fHbp, fused to GNA2091 carrier protein), neisserial heparin binding protein (NHBA, fused to GNA1030 carrier protein), and an adhesin, NadA, mixed with the Men...

The results of this investigation demonstrate that the use of a standard 226 Hz probe tone is not ideal for measurement of the eSRT. The use of higher probe tone frequencies (i.e., 678 or 1000 Hz) resulted in lower eSRT levels when compared with the eSRT levels obtained with use of a 226 probe tone. In addition, 4 of the 23 participants included in this study did not have a measureable eSRT with use of a 226 Hz probe tone, but all of the participants had measureable eSRT with use of both the 678 and 1000 Hz probe tones. Additional work is required to understand the clinical implication of these changes in the context of cochlear implant programming.

The problem and the solution. Organization development (OD) is a data-driven process for change,and as a result,the successful application of OD interventions and tools has become increasingly dependent on the use of information technology. This chapter focuses on the role of information (or data) in contemporary change efforts, and the impact that technology has had on the practice of OD over the past decade.Following a case study of a Web-enabled platform used to drive culture change, the chapter closes with a discussion of the unexpected consequences and potential issues involved with the use of technology for OD initiatives that need to be addressed.

Objectives: Variations in loudness are a fundamental component of the music listening experience. Cochlear implant (CI) processing, including amplitude compression, and a degraded auditory system may further degrade these loudness cues and decrease the enjoyment of music listening. This study aimed to identify optimal CI sound processor compression settings to improve music sound quality for CI users.Design: Fourteen adult MED-EL CI recipients participated (Experiment No. 1: n = 17 ears; Experiment No. 2: n = 11 ears) in the study. A software application using a modified comparison category rating (CCR) test method allowed participants to compare and rate the sound quality of various CI compression settings while listening to 25 real-world music clips. The two compression settings studied were (1) Maplaw, which informs audibility and compression of soft level sounds, and (2) automatic gain control (AGC), which applies compression to loud sounds. For each experiment, one compression setting (Maplaw or AGC) was held at the default, while the other was varied according to the values available in the clinical CI programming software. Experiment No. 1 compared Maplaw settings of 500, 1000 (default), and 2000. Experiment No. 2 compared AGC settings of 2.5:1, 3:1 (default), and 3.5:1. Results:In Experiment No. 1, the group preferred a higher Maplaw setting of 2000 over the default Maplaw setting of 1000 (p = 0.003) for music listening. There was no significant difference in music sound quality between the Maplaw setting of 500 and the default setting (p = 0.278). In Experiment No. 2, a main effect of AGC setting was found; however, no significant difference in sound quality ratings for pairwise comparisons were found between the experimental settings and the default setting (2.5:1 versus 3:1 at p = 0.546; 3.5:1 versus 3:1 at p = 0.059).Conclusions: CI users reported improvements in music sound quality with higher than default Maplaw or AGC settings. Thus, participants preferred slightly higher compression for music listening, with results having clinical implications for improving music perception in CI users.