The clinical usefulness of aided cortical auditory evoked potentials (CAEPs) remains unclear despite several decades of research. One major contributor to this ambiguity is the wide range of variability across published studies and across individuals within a given study; some results demonstrate expected amplification effects, while others demonstrate limited or no amplification effects. Recent evidence indicates that some of the variability in amplification effects may be explained by distinguishing between experiments that focused on physiological detection of a stimulus versus those that differentiate responses to two audible signals, or physiological discrimination. Herein, we ask if either of these approaches is clinically feasible given the inherent challenges with aided CAEPs. N1 and P2 waves were elicited from 12 noise-masked normal-hearing individuals using hearing-aid-processed 1000-Hz pure tones. Stimulus levels were varied to study the effect of hearing-aid-signal/hearing-aid-noise audibility relative to the noise-masked thresholds. Results demonstrate that clinical use of aided CAEPs may be justified when determining whether audible stimuli are physiologically detectable relative to inaudible signals. However, differentiating aided CAEPs elicited from two suprathreshold stimuli  is problematic and should not be used for clinical decision making until a better understanding of the interaction between hearing-aid-processed stimuli and CAEPs can be established. The potential clinical benefits of a measure of brain encoding and plasticity in hearing aid users have driven a growing interest in aided cortical auditory evoked potentials (CAEPs). A better understanding of the effects of hearing aids on brain function, and resulting behavior, may improve the current science underlying successful rehabilitation of hearing loss. CAEPs, a type of event-related electroencephalography  recorded 50–300 ms following stimulus onset, are thought to reflect neural activity in reverberant thalamocortical circuits . AidMethodological differences contribute to the variable results that exist in the aided CAEP literature. Much of the existing aided CAEP literature can be grouped into two general approaches: (1) a focus on physiological response detection, or (2) emphasis on physiological response discrimination. The physiological detection approach compares the CAEPs from an (inaudible or barely audible) unaided stimulus, to the response obtained from the same stimulus that has been processed by a hearing aid and delivered at a suprathreshold level. In this case, the unaided CAEP is often absent or weak, while the aided CAEP is often present with robust waveform morphology. The absence or presence of a response demonstrates a good correlation with inaudible and audible stimuli, amounting to a physiological correlate of detecting the presence of sound. Historically, CAEPs have successfully been used to estimate behavioral thresholds  of both normal-hearing and hearing-impaired populations –24. HoweIn contrast to the physiological detection approach, the physiological discrimination approach compares CAEPs from two audible stimuli to determine differences between the waveforms . Physiological discrimination is measured by specific differences in waveform morphology  between two present waveforms. The different focus of these two approaches contributes to the variability in the existing literature involving aided CAEPs. Significant changes in waveform morphology  were often found when individuals/groups were tested in studies that used a physiological detection approach, comparing inaudible to audible conditions e.g., , 14, 17), 1714, 1In addition to considering the audibility of the signal, it is equally important to take into account the audibility of the underlying noise and its relationship to the signal . SNR is a key contributor to both unaided and aided CAEP morphology , 25. Acc Will aided CAEPs be different for a near-threshold signal relative to a suprathreshold signal ?  Will aided CAEPs be different for two suprathreshold signals ? The purposes of this study are to characterize the existing aided CAEP literature relative to two potential clinical approaches, and to determine whether these approaches  demonstrate clinical utility for encoding hearing-aid-processed signals. Specifically, we asked two questions: We set out to answer these questions in the aided CAEP domain by recording hearing aid output and eliciting CAEPs with the recorded stimuli. CAEPs were recorded using hearing-aid-processed stimuli. In addition, a background noise masker was presented to the normal-hearing participants as a means of simulating the audibility factors that are present when an individual with hearing impairment is fit with a hearing aid. Testing noise-masked normal-hearing participants allowed tight control of audibility  while avoiding hearing-impairment-related confounds associated with recording CAEPs from individuals with hearing impairment. Twelve individuals (six women and six men) participated in the study . All participants were right handed with normal hearing from 250 to 8000 Hz (≤20 dB HL), were in good general health, reported no significant history of otologic or neurologic disorders, and denied use of mood or sleep-altering medications. All participants provided informed consent, and all research complied with the regulations of the Portland Veterans Affairs Medical Center Institutional Review Board.Hearing-aid-processed stimuli were used to elicit CAEPs. Signals were 1000-Hz tones recorded from the output of two hearing aids: Hearing Aid A was a currently available digital hearing aid, Hearing Aid B was the same analogue hearing aid used in previous studies from our laboratory , 4. The  The goal was to record three signals that varied in signal-to-noise ratio (SNR). As indicated in θ, a near-threshold level at which both tone and hearing aid noise were inaudible due to the noise masker amplitude (intended to represent an inaudible unaided condition); Low, a level at which the signal was above the level of the noise masker but the hearing aid noise was below; Mid and High, two levels at which the signal and hearing aid noise were both audible but absolute signal level differed. Due to the higher ratio of signal level to hearing aid noise obtained in the higher input level recording from Hearing Aid B, five stimulus levels were necessary in order to span the range of audible and inaudible signals. In total, 13 experimental conditions were presented to each participant. Notice that, within each block of hearing aid conditions, the SNR between the signal level and the hearing aid noise remains constant , 8 dB for Hearing Aid B (Recording 2), 23 dB for Hearing Aid B (Recording 3), while the overall stimulus output level changes in 10 dB steps. However, the effective SNR was much smaller for Near θ and Low conditions due to the background noise masker. Levels displayed in A schematic depicting the hearing aid signal  and noise levels in relation to the background noise masker for each hearing aid condition is shown in  The hearing aid noise spectra obtained from the three 59 dB hearing aid condition presentations are represented in In order to simulate hearing-impaired thresholds and to control the audibility of the hearing-aid-processed signal and underlying hearing aid noise, a continuous background noise masker was created in Matlab passing a Gaussian white noise through a series of 1/3 octave band filters with center frequencies from 100 to 5000 Hz. The output of the filters was adjusted to generate a noise masker with a spectrum matching the thresholds of a patient with a moderate, sloping hearing loss. The spectrum of the noise masker was verified with a spectrum analyzer in 1/3 octave bands. In addition, behavioral thresholds at octave and interoctave frequencies from 250 to 8000 Hz were established using ER-3A  insert earphones. The thresholds of four participants were established using 1 dB steps in a 1-up, 2-down procedure while the background masker was played through the audiometer. Mean behavioral thresholds for the four individuals were 11.0, 15.75, 22.25, 24.25, 28.0, 34.75, 44.75, 43.25, and 8.75 dB HL at frequencies of 250, 500, 750, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, respectively.For each of the 13 conditions, a recorded 50-tone wav file was repeated three times, yielding a total of 150 tone presentations recording over approximately six minutes for each condition. Both the noise masker and hearing aid noise were continuous throughout each block of trials, and all stimuli were presented in the right ear using an ER-3A insert earphone and the Stim2 system . The presentation order of the three hearing aid conditions was randomized across subjects, and the various stimulus levels were randomized within each hearing aid condition to minimize order effects across participants. Two-minute listening breaks were given between each condition, and subjects were offered a longer break after one hour of testing. Acquisition sessions lasted three hours and consisted of consenting, audiometric testing, electrode placement, and CAEP acquisition. Participants were seated comfortably in a double-walled sound attenuating booth, and they were instructed to ignore the auditory stimuli and to watch a closed-captioned movie of their choice. μV were rejected from averaging. After artifact rejection, the remaining sweeps were averaged and filtered offline from 1 Hz  to 30 Hz . Averages for 98% of conditions tested had more than 100 accepted trials; the remaining 2% had between 70 and 100 accepted trials. N1 and P2 peak amplitudes and latencies were determined by agreement of two judges. Each judge used temporal electrode inversion, global field power (GFP) traces, and even and odd sweep waveform versions (to demonstrate replication) for a given condition. Peaks in the Near θ conditions were very difficult to identify because of the electrophysiological noise. Therefore, in order to quantify synchrony in the near-threshold conditions, the rectified area was measured in the time region from 40 to 300 ms as a representation of synchrony of the P1-N1-P2 complex. Area values were generated at all Near θ and Low conditions.  Evoked potential activity was recorded using an Electro-Cap International, Inc. cap which housed 64 tin electrodes. The ground electrode was located on the forehead and Cz was the reference electrode. Data were rereferenced offline to an average reference. Horizontal and vertical eye movement was monitored with electrodes located inferiorly and at the outer canthi of both eyes. The recording window consisted of a 100-ms prestimulus period and a 700-ms poststimulus time. Using Scan 4.5 , evoked responses were analog bandpass filtered online from 0.15 to 100 Hz (12 dB/octave roll off) and converted using an analog-to-digital sampling rate of 1000 Hz. Trials with eye-blink artifacts were corrected offline using Neuroscan software. This blink reduction procedure calculates the amount of covariation between each evoked potential channel and a vertical eye channel using spatial, singular value decomposition and removes the vertical blink activity from each electrode on a point-by-point basis to the degree that the evoked potential and blink activity covaried . After bWe fit the linear mixed model representation of the repeated measures analysis of variance (ANOVA). This model has the two-fold advantage of (1) being fit using maximum likelihood so that all observations are included in the analysis and not just observations for subjects with complete data, and (2) taking into account nonsymmetrical variances that may occur across conditions. Main effects of hearing aid condition were tested for two contrasts: Low versus Mid and Mid versus High. The Mid versus High comparison directly tests the physiological discrimination approach while the Low versus Mid comparison verifies that when SNR is changing, the aided CAEP is also likely to change. Where main effects were found, post-hoc comparisons were made for each hearing aid condition. θ versus Low for the three hearing aid conditions. Area measures were used because of the large number of absent responses in the Near θ condition. To test the effectiveness of the physiological detection approach, paired comparisons were completed on rectified area measures of Near The current study investigated the ability of aided CAEPs to demonstrate amplification effects using both neural physiological response detection and physiological discrimination approaches. Based on a review of literature, we hypothesized that aided CAEPs would show the most robust effect of amplification in neural response detection approaches which correlate with the difference in response to audible versus inaudible stimuli. In contrast, aided CAEP discrimination approaches that reflect the ability of the auditory system to represent differences between audible hearing-aid-processed stimuli were expected to show weak amplification effects. Results, presented below, are organized to address these two primary hypotheses.θ condition  to the Low condition . For Hearing Aid B (Recording 3), two different Low conditions were used; however, to simplify the data analysis, all data for the two Low conditions were averaged together to result in a measurement for one Low condition. Butterfly plots  and the global field power plots , making statistical analysis using traditional peak latency and amplitude values difficult; therefore, an area measure  was used to provide an overall measure of synchrony in the P1-N1-P2 region of the waveform. θ and Low conditions for all three hearing aid conditions. Paired comparisons between Near θ and Low conditions generally demonstrated significantly higher areas for Low conditions relative to Near θ conditions: This study addressed the effects of amplification on audible and inaudible stimuli by comparing the Near e scalp; ) calculat = −2.077, df = 11, p = .062; Hearing Aid A (Recording 1): t = −2.853, df = 11, p = .016; Hearing Aid B (Recording 2): t = −4.225, df = 11, p = .003.Hearing Aid B (Recording 3): The discrimination task of the current study measured the ability of aided CAEP measures to reflect differences between two clearly audible stimuli . To demonstrate the main effect of signal level, butterfly and GFP plots were constructed from grand average responses across subjects and hearing aid recordings for Mid and High conditions , right.  N1 and P2 peak amplitude and latency data for the Low, Mid, and High conditions are displayed in Results from previous literature indicate that CAEP responses are more sensitive to changes in SNR than to changes in absolute signal level , 25. In This visual impression is confirmed by the significant main effect of Low to Mid level conditions on N1 and P2 amplitudes and latencies, which is not found in the comparison between Mid to High level conditions . FurtherThe purpose of this study was to help clarify some of the variability that is seen in decades of aided CAEP research. This variability is shown in θ curve shows an absent response in most cases; whereas, the Mid and sometimes Low conditions show present responses. The physiological detection approach appears to be a reasonable use of aided CAEPs because these measures are sensitive to differences in detectability of an inaudible or barely audible signal and a suprathreshold signal. Our results, and the results of other past studies, demonstrate robust amplification effects when taking a detection approach , 16, 17.aided CAEPs is still lacking. When evoking CAEPs with hearing-aid-processed stimuli, it remains unclear when a discrimination approach is valid; it may be valid only for specific hearing aids, specific hearing aid settings, specific stimuli, or as in this study, specific conditions . Certainly, clinical decisions based on a physiological discrimination approach would be premature. Additional research is needed to delineate what hearing aid and stimulus interactions are affecting the evoked response.  In contrast, these data and examples from the literature , 15, 20  It is important to consider subject factors as well. The audibility of a broadband stimulus and the underlying noise will vary depending on the hearing configuration of the individual being tested. The participants in this study were young normal-hearing individuals, and a noise masker was used to simulate thresholds that were comparable with a typical sloping hearing loss. However, even with tightly controlled audibility and a pure tone stimulus, variability across participants was found. It should be noted that the method of scaling used in the design of this study to modify signal level is different than clinical hearing aid gain adjustments in that modification of gain can lead to a wide range of acoustic modifications to the signal. While SNR has been shown to remain similar across gain settings in some hearing aids , SNR canAs mentioned above, the problems related to the physiological discrimination approach likely result from a combination of subject and stimulus factors. SNR and onset modification are two stimulus characteristics whose importance has been demonstrated in the literature e.g., , 29–31).–31.29–31The results of this study seem to indicate that the contribution of stimulus factors can be minimized when the physiological detection approach is used. Specific signal-processing modifications made by the hearing aid are less important when the comparison response waveform is absent. In contrast, subtle acoustic changes  are essential when comparing two audible signals in a physiological discrimination approach. To characterize acoustic changes, it is necessary to complete in-the-canal recordings of hearing-aid-processed signals. Only then can measures of the important signal modifications be made and related to the resulting aided CAEPs. Two approaches for using aided CAEPs, physiological detection and physiological discrimination, were tested to determine the clinical usefulness of each. Results are in agreement with an analysis of the literature see , and the


There is growing evidence indicating the insulin-like growth factor 1 receptor (IGF-1R) plays a critical role in the progression of human colorectal carcinomas. IGF-1R is an attractive drug target for the treatment of colon cancer. Picropodophyllin (PPP), of the cyclolignan family, has recently been identified as an IGF-1R inhibitor. The aim of this study is to determine the therapeutic response and mechanism after colorectal carcinoma treatment with PPP.in vivo therapeutic efficacy of PPP, mice implanted with human colorectal carcinoma xenografts underwent PPP treatment.Seven colorectal carcinoma cell lines were treated with PPP. Following treatment, cells were analyzed for growth by a cell viability assay, sub-G1 apoptosis by flow cytometry, caspase cleavage and activation of AKT and extracellular signal-regulated kinase (ERK) by western blot analysis. To examine the TP53 wild-type but not mutated colorectal carcinoma cell lines. The treatment of PPP also induced apoptosis in TP53 wild-type cells as evident by the presence of sub-G1 cells and the cleavage of caspase-9, caspase-3, DNA fragmentation factor-45 (DFF45), poly (ADP-ribose) polymerase (PARP), and X-linked inhibitor of apoptosis protein (XIAP). The loss of BAD phosphorylation in the PPP-treated TP53 wild type cells further suggested that the treatment induced apoptosis through the BAD-mediated mitochondrial pathway. In contrast, PPP treatment failed to induce the phosphorylation of AKT and ERK and caspase cleavage in TP53 mutated colorectal carcinoma cell lines. Finally, PPP treatment suppressed the growth of xenografts derived from TP53 wild type but not mutated colorectal carcinoma cells.PPP treatment blocked the phosphorylation of IGF-1R, AKT and ERK and inhibited the growth of TP53 mutations with the resistance of treatment of colorectal carcinoma cells in culture and in a xenograft mouse model with the IGF-1R inhibitor PPP. TP53 mutations often occur in colorectal carcinomas and could be used as a biomarker to predict the resistance of colorectal carcinomas to the treatment by this IGF-1R inhibitor.We report the association of  The IGF-1R signaling pathway plays an important role in the formation and progression of human cancers and has been targeted for cancer treatment . IGF-1R Epidemiological studies have revealed the association of high concentrations of serum IGF-I and IGF-II with the increased risk of developing several human cancers including colorectal carcinomas -10. ExamThe characterization of the crystallographic structures of the insulin receptor and IGF-1R has enabled the development of IGF-1R specific inhibitors -24. PicrTP53 mutations with PPP resistance in the carcinoma cell lines in culture and a xenograft model. While human colorectal carcinomas harbor frequent mutations of APC, TP53, PIK3CA and KRAS2). At the end of treatment, the mice were sacrificed and the tumors were harvested and weighed at necropsy.The animal studies were approved by the Institutional Animal Care and Use Committee of Emory University. The HCT-8 cells or Caco2 cells . The differences in the means between two groups were analyzed with two-tailed unpaired Student’s Earlier studies have revealed increased levels of the IGF-1R mRNA in human colorectal carcinoma tumors ,15. To eTP53 mutations [http://cancer.sanger.ac.uk/cancergenome/projects/cosmic). In contrast, HCT-8 [http://cancer.sanger.ac.uk/cancergenome/projects/cosmic) are TP53 wild-type cell lines. These analyses suggest the association of TP53 mutations with the PPP resistance of colorectal carcinoma cells to PPP treatment.Next, we examined how colorectal carcinoma cell lines respond to PPP treatment. To this end, each of the cell lines was treated with a series of PPP concentrations for 72 hours. A cell viability assay showed PPP treatment significantly inhibited the growth of the sensitive cell lines HCT-8 and SW948. Slight inhibition of the growth of the resistant cell lines CACO-2, COLO-205, COLO-320, DLD-1 and HT-29 was found at much higher doses  mice for the generation of subcutaneous flank xenografts. The mice were closely monitored and once xenografts reached approximate size of 150–200 mm3, the mice were divided into two groups. In the treatment group, mice were treated with PPP (50 mg/kg) and in the control group, mice were treated with saline. The mice were treated through oral gavage, twice per week for three weeks. Tumor volumes were measured and the results showed that PPP treatment significantly inhibited the growth of the TP53 wild-type HCT-8 colorectal carcinoma xenografts  mice. Once subcutaneous xenografts were formed approximately 150–200 mm3 in size, the mice were treated either with PPP (50 mg/kg) or saline through oral gavage, twice per week for three weeks. The results showed no significant difference in the tumor sizes between the treatment and control group of mice, as indicated by the measured tumor volumes (Figure TP53 mutated CACO-2 colorectal carcinoma xenografts (Figure TP53 wild type colorectal carcinoma may respond to the treatment of PPP whereas TP53 mutated carcinomas are most likely resistant to the treatment.To examine whether the s Figure A and thes Figure B. Westers Figure C. Taken Colorectal carcinoma is the second leading cause of cancer-related deaths in the United States ; thus, tPreclinical studies have shown that the GEO colorectal carcinoma cell line and xenografts respond to the treatment of a dual IGF-1R/insulin receptor kinase inhibitor, PQIP . HoweverAfter examining a panel of colorectal carcinoma cell lines and xenografts, we have found that the cell lines respond differently to the treatment of PPP, an IGF-1R inhibitor . Some ofTP53 mutations in colorectal carcinomas. The p53 tumor suppressor regulates apoptosis in many types of cells and mutations of the TP53 gene result in the loss of its function in control of apoptosis in cancer cells [TP53 mutations commonly occur in human colorectal carcinomas [TP53 gene status can be used as a biomarker to predict the responsiveness of colorectal carcinomas to the treatment of IGF-1R targeted therapies.The salient feature of this study is that most colorectal carcinoma cell lines are resistant to the treatment of PPP. PPP treatment does block IGF-1R phosphorylation but fails to inhibit the downstream AKT and ERK pathway or induce BAD-mediated mitochondrial apoptosis. These findings are consistent with the clinical trials of IGF-1R targeted agents that have not shown much clinical activity against human cancers . Our dater cells . TP53 murcinomas . Our stuTP53 wild-type colorectal carcinoma cells. We have also found a correlation between TP53 mutation and PPP resistance in human colorectal carcinoma cells. Both p53 and IGF-1R proteins are the substrates of MDM2 and the presence of MDM2 in both TP53 wild-type and mutated carcinoma cells suggests that PPP-induced ERK activation in TP53 mutated carcinoma cells occurs through a p53-independent manner. The PPP-induced ERK activation contributes in part to the resistance of TP53 mutated colorectal carcinoma to the IGF-1R inhibitor PPP.The discovery of PPP as an IGF-1R inhibitor  by a resTP53 mutations are associated with PPP resistance in colorectal carcinoma and indicated that determining the TP53 gene status as wild-type or mutated can be used as a biomarker to predict the responsiveness of colorectal carcinoma in human clinical trials.The IGF-1R inhibitor, PPP, is currently in clinical trials for the treatment of human cancers. We have found the majority of colorectal carcinoma cell lines are resistant to PPP treatment due to failure of activation of the intracellular AKT and ERK growth pathway and induction of the BAD-induced mitochondrial apoptosis pathway. Furthermore, we have found that The authors declare that they have no competing interests.QW and ABC designed the study; QW, FW, CL, KZ and ACB performed the experiments; QW and FW analyzed and interpreted the results; GL, TL and CH contributed materials. ACB and CH wrote the manuscript. CGH edited and revised the manuscript. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2407/13/521/prepub


Similar trends were observed for the number of bolls per FP. In general, HLFP reduced plant height and boll weight. However, the lines responded differently to HLFP treatment in terms of their total numbers of fruiting positions, boll numbers, seed cotton yields, etc. Our results also suggested that HFLP responses might be delayed for some agronomy traits of some cotton genotypes, and that hanging labels from early-opening flowers might influence the properties related with those that opened later on.Agricultural crops experience diverse mechanical stimuli, which may affect their growth and development. This study was conducted to investigate the effects of mechanical stresses caused by hanging labels from the flower petioles (HLFP) on plant shape and cotton yields in four cotton varieties: CCRI 41, DP 99B, CCRC 21, and BAI 1. HLFP significantly reduced plant height by between 7.8% and 36.5% in all four lines and also significantly reduced the number of fruiting positions per plant in the CCRI 41, DP 99B and CCRC 21 lines. However, the number of fruiting positions in BAI 1 was unaffected. HLFP also significantly reduced the boll weight for all four cultivars and the seed cotton yields for CCRI 41, DP 99B and BAI 1. Conversely, it significantly increased the seed cotton yield for CCRC 21 by 11.2%. HLFP treatment did not significantly affect the boll count in the fruiting branches of the 1 Plants are immobile and therefore unable to escape from threats or unfavorable environments. Consequently, they have evolved diverse mechanisms for coping with and mitigating the effects of various stresses Agricultural plants are subject to many different kinds of mechanical stress, including shaking Mimosa pudica, respond rapidly via specialized responsive mechanisms, but others respond slowly ArabidopsisDifferent plant species respond to mechanical stress in different ways. Some plants, such as In cotton production, it is common to hang labels on flower petioles in order to record the times at which they blossomed and started forming bolls. The mechanical stimulus caused by this practice may affect the growth and development of the cotton plant, but its potential impact has not previously been investigated. Therefore, the work reported herein was conducted to investigate the responses of different cotton genotypes to the mechanical stress caused by hanging labels from cotton flower petioles, in terms of plant shape and yield.Four commercialized transgenic insect-resistant cotton cultivars, CCRI41, DP 99B, CCRC21 and BAI1, were used in this study. CCRI41 was bred by the Cotton Research Institute of the Chinese Academy of Agricultural Sciences; CCRC21 was bred by the Cotton Research Center of the Shandong Academy of Agricultural Sciences; DP 99B was bred by Monsanto Company; and BAI1 was bred by Henan Institute of Sciences and Technology.In China, transgenic insect-resistant cotton cultivars are widely adopted in the yield in recent years. Maybe, insect-resistant gene transformation could result in the different responses of cotton plants to mechanical stress, but it was not in the research scopes of this experiment. Therefore, only transgenic cotton cultivars were used in this experiment. All four cultivars have growth periods of around 130 days. However, CCRI41 and DP 99B cultivars often pre-maturely senesced, BAI1 was resistant to pre-mature senescence, and CCRC21 was in between them.−1 (determined by extraction with 1 M KCl), an available P content of 16.2 mg kg−1 (determined by extraction with 0.5 M NaHCO3), and an available K content of 158.5 mg kg−1 (determined by extraction with 1 M NH4OAC). Planting was conducted in 2009 and 2010 at the experimental field station  of the Henan Institute of Science and Technology, Xinxiang, Henan Province.The four cotton cultivars were planted in a sandy loam soil with a pH of 8.5 (water: soil  =  5 1), an organic matter content of 0.60% (determined by digestion with potassium dichromate under strongly acidic conditions), an available nitrogen content of 18.6 mg kgth, 2009 and 2010, according to a random block design with four biological replicates. Each block contained 4 plots, and each plot was planted with only one cultivar. Each plot contained four 10 m long rows with an inter-row spacing of 0.8 m and an intra-row spacing of 0.27 m. The planting density was 45,000 plants per hm2.The cotton seeds were sowed under plastic film mulching, respectively, on April 262 before sowing. In the early flowering stage, additional quantities of urea-N (150 kg N per hm2) and K (75 kg K per hm2) were applied by top-dressing. All plots were treated with chemical pesticides to keep insects away.Conventional agricultural practices were applied in the study. 150 kg N, 100 kg P and 75 kg K in the form of urea, diammonium phosphate and potassium sulphate, respectively, were applied per hmDuring early flowering season, 5 adjacent plants in one of the central rows of each plot were selected and tagged with labels that were hung from their flower petioles during 9–10 A.M every day and kept in place throughout the blossoming stage. HLFP was made for each flower at its opening day. The anthesis and boll-opening dates for the tagged plants were recorded on their labels.A label with a thin thread at its one end weighted 337±20 (mean±SD) mg with length of 3.5 cm, width of 3.0 cm and thickness of 2.2 mm. The label was tied to flower petiole by thin thread and vertically suspended when tagging. The labels are widely used in field experiment of cotton.st FB, 2nd FB, etc, from the bottom. The fruiting positions were numbered horizontally, as the 1st FP, 2nd FP, etc. from the stem. The fruiting position length was defined as the distance between the 1st FP and the main stem or between adjacent FPs; the distance between the stem and the 1st FP was recorded as the 1st FP length (FPL), while that between the 1st and 2nd FPs was recorded as the 2nd FPL, and so on. The fruiting branch length (FBL) was calculated as the sum of all FPLs on a single branch, i.e., the distance between the main stem and the terminal FP.During the harvest season, the numbers of fruiting branches (FB) and fruiting positions (FP) on each plant were counted; the height of the stem (from base to tip) was measured, along with the length of each fruiting branch and the location of each fruiting position. The fruiting branches were recorded as the 1st to 4th FBs, the second layer consisted of the 5th to 8th, the third layer consisted of the 9th to 12th, and all FBs from the 13th upwards were assigned to the fourth layer. All fruiting positions more distal than the 3rd FP on a given fruiting branch were collectively referred to as >3rd FPs. The number of bolls, fruiting branches and fruiting position lengths within each FB layer were calculated. Since many plants had fewer than 13 fruiting branches and many fruiting branches had fewer than three fruiting positions, data for the fourth fruiting branch layer and for fruiting position numbers greater than three on any given branch were not subjected to statistical analysis.We defined four ‘layers’ of fruiting branches: the first layer consisted of the 1nd and October 22nd. All opened bolls were harvested and counted. The harvested cotton was weighed as seed cotton yield per plant. Boll weight was average seed cotton weight of all harvested opened bolls in one plant. Ginned cotton was used for determination of fiber quality traits such as fiber length, fiber strength, micronaire, uniformity index and fiber elongation with high volume instrument (HVI).Cotton was harvested twice, on September 22t-test was used to identify significant differences (at the p<0.05 level) between the mean results for different treatments and those observed for control plants.The experiment was first conducted in 2009 and then repeated in 2010, with both replicates yielding similar results. In both cases, 20 control and treated plants of each genotype were studied, and were distributed evenly among the four experimental plots. The two-year experimental results were pooled and subjected to statistical analysis by means of analysis of variance (ANOVA), and Student's As shown in st, 2nd and 3rd layers was reduced by 22.1%, 29.5% and 47.9%, respectively, for CCRI 41; by 35.4%, 30.7% and 50.7%, respectively, for DP 99B; by 16.4%, 23.1% and 41.2%, respectively, for BAI 1; and by 4.5%,8.3%,35.4%, respectively, for CCRC 21  reported that manual shaking of plants had no significant effects on cotton boll growth st FB open first, followed by the 2nd FB, etc.), and flowers closer to the stem open before those at more distant positions . The labels used in this work were therefore attached in the same temporal order by daily labeling detailed in “materials and methods”, which may have caused memory effects whereby FBL of higher fruiting branch layers and boll number on higher fruiting branches or at more distal flowering points would have been influenced by the mechanical stress experienced by previously flowers-tagged labels. This could potentially have increased the magnitude of their HLFP responses.In some cases, plants may exhibit delayed responses to stress st, 2nd, and 3rd fruiting branch layers length in all four studied genotypes (st and 2nd FB layers in the CCRI 41 and DP 99B cultivars but significantly reduced the boll numbers in the 3rd and 4th layers (HLFP had increasingly severe effects on the 1enotypes . Howeverh layers . Similarh layers . The cumHLFP decreased plant height, the number of fruiting positions and boll weight in four cotton genotypes. However, different genotypes seemed to respond differently to HLFP with respect to variables such as plant height and seed cotton weight. In addition, some cotton plants may exhibit delayed responses in some agronomy traits to HLFP treatment.


The objective of this research is to find the factors associated with tinnitus masker from the literature, and by using the large amount of audiology data available from a large NHS  hearing aid clinic. The factors evaluated were hearing impairment, age, gender, hearing aid type, mould and clinical comments.The research includes literature survey for factors associated with tinnitus masker, and performs the analysis of audiology data using statistical and data mining techniques.This research uses a large audiology data but it also faced the problem of limited data for tinnitus.It uses 1,316 records for tinnitus and other diagnoses, and 10,437 records of clinical comments from a hearing aid clinic.The research is looking for variables associated with tinnitus masker, and in future, these variables can be combined into a single model to develop a decision support system to predict about tinnitus masker for a patient.The results demonstrated that tinnitus maskers are more likely to be fit to individuals with milder forms of hearing loss, and the factors age, gender, type of hearing aid and mould were all found significantly associated with tinnitus masker. In particular, those patients having Age < =55 years were more likely to wear a tinnitus masker, as well as those with milder forms of hearing loss. ITE (in the ear) hearing aids were also found associated with tinnitus masker. A feedback on the results of association of mould with tinnitus masker from a professional audiologist of a large NHS  was also taken to better understand them. The results were obtained with different accuracy for different techniques. For example, the chi-squared test results were obtained with 95% accuracy, for Support and Confidence only those results were retained which had more than 1% Support and 80% Confidence.The variables audiograms, age, gender, hearing aid type and mould were found associated with the choice of tinnitus masker in the literature and by using statistical and data mining techniques. The further work in this research would lead to the development of a decision support system for tinnitus masker with an explanation that how that decision was obtained. This research deals with a big heterogeneous audiology data from a large NHS  facility, containing audiograms, structured data  and free text . This research looks for factors associated with tinnitus masker on the basis of large data by doing the mining and analysis of this data.Deafness Research UK  states tTinnitus can be caused by different factors including exposure to loud noises, head trauma, and a variety of diseases Snow . TinnituTinnitus is found to be highly correlated with hearing impairment and severity of impairment Davis . It has Age ≤ 54) were less likely to have tinnitus  is another method of tinnitus treatment  is related to many therapies that aim to deal with issues such as nervousness, sadness and post-traumatic stress disorder (PTSD). In the daily lives of people emotions affect their behaviour, and this is the basis of CBT. For example, a patient having a lack of information about tinnitus might have ideas that would make him more nervous and upset. But in reality these ideas are false and giving the correct information about tinnitus might help to improve the condition.Self-help techniques, such as taking rest, listening to music and joining tinnitus support groups, are also important for people for dealing with their tinnitus. For example, anxiety can increase tinnitus, therefore doing exercise regularly such as meditation or yoga might reduce tinnitus. Joining a tinnitus support group also gives the opportunity to share tinnitus experience with other tinnitus sufferers, which can also prove helpful by giving more understanding of tinnitus and how to better deal with it.The minimal masking level (MML) of tinnitus is a possible predictor of acceptance of tinnitus masker treatment and also a measure of treatment success . This database contains a statistical overview of past and present status of patients’ tinnitus data , various outcomes of tinnitus examinations , audiological examinations , and demographic information for 1630 patients with tinnitus who were examined at Tinnitus Clinic of the Oregon Hearing Research Center, Department of Otolaryngology, Oregon Health & Science University, between 1981 to 1994. This database was created for classifying and preparing different studies of tinnitus causes, for research on the tinnitus affected population such as assessing and managing tinnitus. The existence of this database has contributed much towards the understanding of tinnitus  and ITE (in the ear) prescribed to patients as ITE hearing aids are generally not available on NHS, UK. The factors found in the literature for tinnitus masker are audiograms, age, gender and hearing aid type. These factors along with other factors–mould and comment texts, are also available in the available audiology data. All the available records in the database for each field (factors mentioned above) under study were used for tinnitus with/without masker, keeping the criterion that none of the field values should be empty. Although, this research uses a large audiology data but it also faced the problem of limited data for tinnitus, as there were only 1,316 records for tinnitus and other diagnosis.The objective of this research is to find the factors associated with tinnitus masker from the literature, and by using the large amount of audiology data available from a large NHS, UK hearing aid clinic.This large audiology data contains two types of data about tinnitus that is, one of the diagnosis types given in the diagnosis field is “tinnitus”, and there is also a “masker” field where the type of tinnitus masker prescribed (if any) is recorded, in this study for processing the data for masker field only the presence or absence of masker is considered. It is important to mention that this audiology data was anonymised as there were NO actual patient ids, names, addresses and phone numbers given. Thus, no actual patient can be traced down.The background and significance section discussed a number of causes and problems related to tinnitus and maskers. Tinnitus causes such as hearing impairment, age and gender have been found in the literature and these factors will also be used in this study. The most common treatment for tinnitus is the use of a masker. Since this large database includes both which patients were diagnosed with tinnitus and which were fitted with a tinnitus masker, these fields can act as the gold standard for finding significant variables associated with tinnitus masker.Clustering of hearing aid patient audiograms was performed on right ear air conduction (ac) frequencies from 250 to 8000 Hz  number of ‘tinnitus with masker’ in cluster 1 was 431 * 173 / 1137 = 65.58. The significance of this is that the observed value is less than the expected value, suggesting that there is a negative degree of association between the “tinnitus with masker” and the severe hearing loss cluster. The remainder of the test is then performed to discover if this association is statistically significant. Next the Oij and Eij values were used to calculate an overall chi-squared value for the relationship between “tinnitus with masker” and cluster, using the Eq. The row total for “tinnitus with masker” is the total number of times “masker” was prescribed to patients in the two clusters = 40 + 391 = 431. The column total for cluster 1 is the total number of patients assigned to cluster 1 over all tinnitus patients = 173. The grand total is the total number of patient records in the study = 1137. Thus the “expected” .The Chi-squared test can show the existence of associations in the data, and other association measures based on the contingency table can be used to measure the strength of the relationship between the variables in medical data. Support and confidence are measures of the interestingness of associations between variables  with “tinnitus with masker” are shown in Table An audiologist from a large NHS facility said that the “N8” mould is an open fitting ear mould which doesn’t obstruct the ear canal, so allows natural hearing to complement output from the hearing aid and is required when there is a small or no hearing loss, for example, in tinnitus maskers. Patients with significant hearing loss with tinnitus are generally given hearing aids and the environmental sounds picked up will mask the tinnitus. Hence there is a high correlation between “N8” mould and tinnitus masker.The Chi-squared test informed about the presence of an association, while Yule’s Q produces the strength and direction of the association. Yule’s Q is in the range -1 to +1, where the sign indicates the direction of the relationship and the absolute value indicates the strength of the relationship. In Tables Support and confidence are measures of the interestingness of a rule. Support reflects the usefulness of a rule, and confidence its certainty  was also taken to better understand them. The results were obtained with different accuracy for different techniques. For example, the chi-squared test results were obtained with 95% accuracy, for Support and Confidence only those results were retained which had more than 1% Support and 80% Confidence. It is important to mention that some other factors that could not be tested with this data were cosmetic reasons, comfort in wearing, ease of use with spectacles and the measure of masking relief provided by tinnitus maskers.The sets of variables found in Table It is a study involving audiology data NOT human directly. This data was given to the Department of Computing, Engineering & Technology, University of Sunderland, Sunderland, UK, for Research purpose by a large National Health Services facility after making the data anonymised. So, there was no need to obtain any permission as long as it is being used for research purpose. The author has been working on this data for his research at University of Sunderland and this paper is one of the outcomes of his research.A large database of audiology data from a large NHS  facilityData analysis of audiology data using various statistical and data mining techniquesTinnitus and maskerUnconventional study to find factors associated with tinnitus maskerAssociation analysis of tinnitus and maskerImproved quality of service in audiology clinics, so that the variables found can be emphasized, and when the decision support system to predict for tinnitus masker would be developedThis research includes both BTE (behind the ear) and ITE (in the ear) hearing aids, as ITE aids are generally not available on NHS  prescriptionsThis research finds variables associated with tinnitus maskerThis study includes comment and feedback given by a professional audiologist from a large NHS facility on the association of mould with tinnitus maskerIt does not include factors such as comfort in wearing of masker, ease of use with spectacles and measure of masking relief


GJB2 with postnatal PCHI in Chinese Hans . This common genotype in Eastern Asians was present in a substantial percentage (20%) of postnatal PCHI subjects, and its prevalence was significantly increased in normal-hearing newborns who failed at least one newborn hearing screen. Our results indicated that the p.V37I exclusive genotype of GJB2 may cause subclinical hearing impairment at birth and increases risk for postnatal PCHI. Genetic testing of GJB2 in East Asian newborns will facilitate prompt detection and intervention of postnatal PCHI.Postnatal permanent childhood hearing impairment (PCHI) is frequent (0.25%–0.99%) and difficult to detect in the early stage, which may impede the speech, language and cognitive development of affected children. Genetic tests of common variants associated with postnatal PCHI in newborns may provide an efficient way to identify those at risk. In this study, we detected a strong association of the p.V37I exclusive genotype of  Hearing is critical for normal development and acquisition of speech. Early detection with intervention and habilitation for permanent childhood hearing impairment (PCHI) leads to significantly better speech, language and cognitive development GJB2 gene are the most common genetic cause for deafness GJB2-associated hearing impairment are congenital, a small number of individuals with bi-allelic GJB2 mutations have been reported who initially passed the NHS but were subsequently identified with hearing loss in their infancy or early childhood GJB2 mutation, however, has been reported specifically associated with postnatal PCHI.Genetic testing in newborns has been proposed as a potentially effective way to detect postnatal PCHI that are either not present at birth or associated with subclinical hearing loss GJB2 is highly prevalent in East Asians, with a allele frequency of 4.3% in Thai GJB2  have the potential to produce protein product), it can lead to non-fully penetrant, mild-to-moderate hearing impairment that is sometimes progressive GJB2 is associated with postnatal PCHI and serves as a genetic risk-indicator for PCHI.The p.V37I mutation of A total of 45 unrelated Chinese Han children with bilateral postnatal PCHI  were recruited from Shanghai, China. Among them, fourteen children (group 1) passed the NHS in both ears but developed bilateral postnatal PCHI  before age 9 years. Ten of these 14 children were identified and recruited though a large scale preschool hearing screen conducted by the Xinhua Hospital and the Shanghai Child Health Care Institute during year 2009–2010, and the remaining four through their clinic visits to the Xinhua Hospital. Thirty-one children (group 2) did not receive NHS at birth but passed the pediatric hearing tests of their kindergarten enrollment physical examination at the age of 2–4 years. All these 31 children developed bilateral PCHI  before age 9 years and were recruited clinically through Xinhua Hospital.A total of 1516 Chinese Han newborns were recruited from Putuo Women and Children Hospital, Shanghai during 2009. Follow-up of their NHS results showed that 1405 newborns passed the initial hearing screen, 99 newborns failed the initial screen but passed the repeat screen, and 12 newborns failed both screens (Hearing diagnostic results unknown). We also recruited 173 Chinese Han infants who failed both NHSs but were subsequently diagnosed as normal hearing  from the Shanghai Children's Medical Center, one of the major Children Hearing Impairment Diagnosis Centers in Shanghai.All subjects or their parents gave written, informed consent to participate in this study. This study was approved by the Ethics Committee of the Shanghai Jiaotong University School of Medicine, Xinhua Hospital and was in compliance with the Declaration of Helsinki.The newborn hearing screening of the subjects in this study were preformed uniformly through the Universal Newborn Hearing Screening Program (UNHSP) in Shanghai following standardized testing criteria and procedures as previously decribed Hearing tests of the pre-kindergarten children in Shanghai were routinely performed during their kindergarten enrollment physical examination by the Shanghai Child Health Care Institute using pediatric audiometers. In this study, a large scale preschool hearing screens were also performed in 21427 children between age 3 and 6 years in Shanghai by the Xinhua Hospital and the Shanghai Child Health Care Institute between October 2009 and September 2010 as previously described Audiological evaluations were performed for all subjects with postnatal PCHI, including otoscope examination, tympanometry, pure tone audiometry (PTA), play PTA, visual reinforcement audiometry and auditory brainstem response (ABR). Children with conductive hearing impairment due to otitis media with effusion (OME) and eustachian tube dysfunction were excluded for further study. Mean hearing threshold was calculated by pure tone averages in the better ear at 0.5, 1, 2 and 4 kHz. Bilateral permanent childhood hearing impairment (PCHI) was defined as mean hearing threshold exceeded 40 dB HL GJB2 gene was performed by PCR amplification and bidirectional sequencing as previously described GJB2 was defined as either homozygosity of p.V37I or compound heterozygosity of p.V37I and another GJB2 truncating mutation. Fisher's exact test and the odds ratio calculation were used to compare the prevalence of the p.V37I exclusive genotype of GJB2 among different subject groups. P values were presented as the result of two-tailed analysis.Genetic and statistical analyses of the study were performed in the Molecular Biology of Hearing and Deafness Research Laboratory, Xinhua Hospital. Genomic DNA was extracted from either whole blood samples or fresh buccal swab samples. Mutation screening of the GJB2 was performed in 45 Chinese Han children with postnatal PCHI and 1516 ethnically-matched control newborns .Mutation screening of newborns . From coGJB2 was 21.4% (3/14) in postnatal PCHI group 1 who passed NHS at birth, and 19.4% (6/31) in postnatal PCHI group 2 who passed the pediatric hearing tests during their kindergarten enrollment physical examination, both significantly higher than the prevalence of 0.4% (6/1516) in the ethnically matched control newborns  of postnatal PCHI cases in Chinese.The prevalence of the p.V37I exclusive genotype of P = 0.024, P = 1.7×10−8). The increased prevalence of the p.V37I exclusive genotype in normal-hearing newborns who failed at least one NHS suggested that the p.V37I exclusive genotype causes subclinical or borderline slight hearing loss at birth and increases risk for postnatal PCHI.The 1516 control newborns can be categorized into three sub-groups based on their NHS results: 1405 newborns who passed the initial screen (sub-group 1), 99 newborns who failed the initial screen but passed the repeat screen (sub-group 2), and 12 newborns who failed both screens (sub-group 3). The prevalence of the p.V37I exclusive genotype was 2.0% (2/99) in sub-group 2, significantly higher than the prevalence of 0.14% (2/1405) in sub-group 1  and is present in a substantial percentage (20.0%) of children with postnatal PCHI , the p.V37I exclusive genotype may still cause subclinical or borderline slight hearing loss at birth and increase the risk for postnatal PCHI, as prevalence of the p.V37I exclusive genotype increased significantly in normal-hearing newborns who failed at least one NHS . TherefoGJB2 p.V37I exclusive genotype is warranted in East Asian newborns. This screening can be performed either universally in all newborns or preferentially in those who fail at least one NHS. One of the interesting findings in this study is the increased frequency of the p.V37I exclusive genotype in newborn who failed at least one NHS compared to those who passed the initial NHS. It will be important to study whether the former newborns have a higher likelihood to develop postnatal PCHI. If this turns out to be the case, then different strategies for incorporating genetic testing into NHS should be evaluated to identify which strategy would be optimal.Based on these results, we propose that wide-spread genetic testing for the GJB2. We also found that the prevalence of this genotype increased significantly in normal-hearing newborns who failed at least one newborn hearing screen. Based on these results, we concluded that the p.V37I exclusive genotype of GJB2 causes subclinical hearing loss at birth and increases risk for postnatal PCHI. Our study may form basis to support wide-spread genetic test of the p.V37I exclusive genotype of GJB2 in East Asian newborns. Continued audiologic monitoring should be offered to children who carry this genetic variant to facilitate prompt detection and intervention of postnatal PCHI, which in turn will benefit the speech, language and cognitive development of the affected children.In summary, our study revealed a strong association of PCHI with the p.V37I exclusive genotype of


Telephone communication is a challenge for many hearing-impaired individuals. One important technical reason for this difficulty is the restricted frequency range (0.3–3.4 kHz) of conventional landline telephones. Internet telephony (voice over Internet protocol [VoIP]) is transmitted with a larger frequency range (0.1–8 kHz) and therefore includes more frequencies relevant to speech perception. According to a recently published, laboratory-based study, the theoretical advantage of ideal VoIP conditions over conventional telephone quality has translated into improved speech perception by hearing-impaired individuals. However, the speech perception benefits of nonideal VoIP network conditions, which may occur in daily life, have not been explored. VoIP use cannot be recommended to hearing-impaired individuals before its potential under more realistic conditions has been examined.To compare realistic VoIP network conditions, under which digital data packets may be lost, with ideal conventional telephone quality with respect to their impact on speech perception by hearing-impaired individuals.We assessed speech perception using standardized test material presented under simulated VoIP conditions with increasing digital data packet loss (from 0% to 20%) and compared with simulated ideal conventional telephone quality. We monaurally tested 10 adult users of cochlear implants, 10 adult users of hearing aids, and 10 normal-hearing adults in the free sound field, both in quiet and with background noise.P = .001) for cochlear implant users, 18% (P = .002) for hearing aid users, and 53% (P = .001) for normal-hearing adults. With a packet loss of 10%, the maximum benefits were 30% (P = .002) for cochlear implant users, 6% (P = .38) for hearing aid users, and 33% (P = .002) for normal-hearing adults.Across all participant groups, mean speech perception scores using VoIP with 0%, 5%, and 10% packet loss were 15.2% (range 0%–53%), 10.6% (4%–46%), and 8.8% (7%–33%) higher, respectively, than with ideal conventional telephone quality. Speech perception did not differ between VoIP with 20% packet loss and conventional telephone quality. The maximum benefits were observed under ideal VoIP conditions without packet loss and were 36% (VoIP offers a speech perception benefit over conventional telephone quality, even when mild or moderate packet loss scenarios are created in the laboratory. VoIP, therefore, has the potential to significantly improve telecommunication abilities for the large community of hearing-impaired individuals. Engaging in telephone conversations is a challenge for many hearing-impaired individuals, including hearing aid and cochlear implant users -4. ReducThe two main technical limitations of conventional telephones for hearing-impaired individuals are, first, the frequency restriction and second, the digital data compression used in conventional telephony to maximize the network infrastructure utilization.In addition, issues related to coupling the telephone to a hearing aid or a cochlear implant may further reduce speech perception by the hearing-impaired end user, even when assistive telephone listening devices are used -14. FinaFrom a theoretical perspective, Internet telephony (voice over Internet protocol [VoIP]) should offer improved speech perception to the end user, as the transmitted frequency range is double that of conventional telephones (0.1–8 kHz vs 0.3–3.4 kHz). The association between improved speech perception and the presentation of speech at higher bandwidths has been repeatedly shown in the literature -17. AddiThese technical advantages of Internet telephony translate into improved speech perception by hearing-impaired and normal-hearing adults, at least when simulated under ideal laboratory conditions . HoweverWe conducted all tests between January and June 2009 at the University Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, Bern, Switzerland. The study protocol was approved by the local institutional review board. All patients gave written informed consent.Participants in the study were 20 hearing-impaired adults, consisting of 10 users of cochlear implants and 10 users of hearing aids, and 10 normal-hearing adults. All test participants were at least 18 years old and were selected from the institution’s clinical database. Mean age was 46 years in the cochlear implant group, 68 years in the hearing-impaired group, and 35 years in the normal-hearing group. A total of 90% of participants who were tested in our previous experimental study [All tests were performed in the free sound field in a sound-treated room. The speech test material was played on an audio compact disc (CD) player connected to an audiometer  and was reproduced using a pair of loudspeakers  situated 1 m from the front of the patient’s head.All tests were conducted monaurally. The most suitable ear was selected based on the inclusion criteria; if both ears were equally suitable, the ear commonly used for telephony was used. The opposite ear canal was occluded with an earplug . The specified average attenuation of these earplugs is 24.6–41.6 dB in the 250- to 4000-Hz range. Bilateral cochlear implant users had to switch off one of their devices to produce homogeneous and comparable data. Monaural testing was necessary because not all individuals had the same degree of hearing loss on both sides, and speech perception performance varied between the first and second listening device. In addition, monaural testing more realistically reflects the use of a conventional telephone handset.We used the standardized German Hochmair-Schulz-Moser (HSM) Sentence Test  in quietThe original audio CD files of the HSM Sentence Test were converted into a wave-format audio file using the Switch Audio File Converter software, version 1.05 . The speech and noise channels were mixed to mono wave files with a sampling rate of 44.1 kHz, thereby allowing identical signal processing for speech and noise. Before encoding, the audio files were low-pass filtered using MATLAB software, version 7.9.0.529 .The audio files were then converted again into raw files using Switch Audio File Converter software. To generate a VoIP simulation with different extents of packet loss, the raw data were encoded using simulation software (a voice engine demonstration application) in conjunction with a modern iPCMwb codec . lost to a found state of the underlying Markov model: q = 1 / loss length [We simulated 4 different scenarios: 1 scenario without packet loss and 3 scenarios with packet losses of 5%, 10%, and 20%. In s length ,24. Fina. We coded the files at a sampling rate of 8 kHz. Before encoding, we used MATLAB software to limit the upper frequency range of the original wave files to 4 kHz.To simulate conventional telephone audio quality, we implemented a PSTN G.711 A-Law codec, which is a standard in PSTNs, in the Switch Audio File Converter softwareAll 5 audio CDs  were reproduced using an active loudspeaker system (Genelec Type 1030 A). They were calibrated in the free sound field using a Type 2636 measuring amplifier and a Type 4133 FF measuring microphone connected to a Type 2619 preamplifier . We used a Pistonphone Brüel & Kjær 4288 precision calibrator to calibrate the measurement arrangement. The final measurements showed no difference in the sound pressure levels of speech signals across different audio signals.P < .05 was considered significant. When applying a Bonferroni correction for multiple testing, PBonf £ .0125 was considered significant.W used a 2-tailed Wilcoxon matched-pairs signed rank test to compare the scores obtained under different VoIP versus telephone quality simulations. For the condition with no packet loss . Mean speech perception scores were 15.2% (range 0%–53%) higher in the sentence test using VoIP with no packet loss, 10.6% (4%–46%) with mild packet loss, and 8.8% (7%–33%) with medium packet loss across the 3 groups  with different VoIP qualities under half of the conditions , part E.When we experimentally increased VoIP packet loss from 0% to 10%, speech perception scores dropped only mildly  was not inferior to a perfect conventional telephone simulation in the majority of test conditions and for most of the tested participants.Our research group earlier showed the superiority of VoIP versus conventional telephony simulations under perfect network conditions . The maiCochlear implant users had the lowest speech perception scores of all 3 tested groups in our study , which iThe second reason for the advantage of VoIP is the conservation of high audio quality through digital signal processing using the chosen iPCMwb codec. In the first study by our group, speech perception scores that were assessed with VoIP quality were equal to scores obtained with frequency-restricted (0.1–8 kHz), uncompressed audio CD quality . This meSpeech perception is more challenging with increasing competing noise, or decreasing SNRs. In particular, elderly hearing-impaired individuals with predominant high-frequency hearing loss suffer in noisy test conditions; in addition to complication from competing noise, the high-frequency content of speech is missing. VoIP may be helpful, because it transmits the high-frequency content of speech and because it offers the possibility of presenting the speech signal simultaneously to both ears through external loudspeakers, thereby allowing binaural hearing, which is a well-known advantage for speech perception in noise. Additionally, wired or wireless links enabling binaural hearing from 1 telephone signal are already available for hearing aids and cochlear implants.The measurement of packet loss under real VoIP transmission is a challenge for many VoIP companies because there is no constant data transmission over the Internet . Packet A decade ago, when VoIP telephony was not so highly developed, the average packet loss for a large number of measurement traces has been reported to be below 8% (p < 0.08 and q > 0.8) . Since tIt can therefore be assumed that telecommunication using VoIP should substantially improve speech perception compared with conventional telephony under real network conditions, since the benefit of VoIP was measurable for most of the test participants up to an experimental packet loss of 10% in our study. A packet loss of more than 10% has a significant impact on sound quality with tone bursts, interruptions, extended time delay, and jitter of the audio signal. This is shown in The calculations and models of packet loss depend on the measuring method used -35. HoweTo our knowledge, no other group has assessed the speech perception of hearing-impaired individuals using Internet telephony under adverse network conditions. The results of the present study therefore fill an important gap. Measuring packet loss under controlled laboratory conditions offers the opportunity to systematically address a highly variable phenomenon in the real network.Many technical parameters that may further influence speech perception by the end user have not been addressed in the present study. Every conversation can be disturbed when data packets arrive late to the receiver . A jitteOur test results may be important for hearing-impaired individuals, including hearing aid and cochlear implant users, because there is now strong experimental evidence for real improvement in speech perception when using VoIP instead of conventional telephones. The study is also important for physicians, audiologists, cochlear implant engineers, speech therapists, and other professionals who care for hearing-impaired individuals. Professionals should encourage hearing-impaired individuals to try VoIP, which is typically downloadable at no cost from most providers. Patients who already own a computer may be able to gain the benefits of VoIP at no cost. The use of external loudspeakers connected to the computer may further improve speech perception by permitting bilateral hearing and additional amplification through the volume control, which should be mentioned to the patients. Hearing aid and cochlear implant accessories, such as an FM transmitter and 3.5-mm audio jack, may also be helpful for coupling the computer directly to the hearing device. Patients should be advised that both sender and receiver should have a good microphone and loudspeaker system to take advantage of VoIP’s broadband advantage over conventional telephony.Speech perception by hearing-impaired individuals and normal-hearing adults is improved when using perfect VoIP versus perfect conventional telephony transmission under controlled laboratory conditions. The superiority of VoIP persists even under experimental adverse network conditions, but not to the same extent and not for all tested individuals. Cochlear implant users seem to benefit more than hearing aid users because their devices are better suited to exploit VoIP’s broadband frequency range.


The code shapes include rectangle, circle, etc. Differently shaped coded micro-carriers could carry different antigens for detection of its complementary antibody. These many shapes of coded micro-carriers would be used simultaneously allowing us to make multiple detections for different antibodies at the same time. A molding process is applied for fabrication of the ferromagnetically coded micro-carriers where Fe material (Fe powder mixed with binder) is shaped in many tiny molds to produce the coded shapes used for identification of the bio-molecules. Magnetic force is used to control the movement and location of the ferromagnetic coded micro-carriers to prevent the loss during the hybridization process. The results of image process and analysis system testing are satisfactory. The results of our micro-carrier detection system for two sets of R and B color analysis are proportional to those obtained from ELISA antibody detection.This paper describes a method for producing a novel type of ferromagnetic coded micro-carrier. The ferromagnetic coded micro-carriers are about 200 μm in length, 200 μm in width and 50 μm in thickness, and contain eight code elements with two distinguishable codes (hollow and solid), allowing for 2 Early theorization of developmental biochip systems ,2 can beOn the whole, though, there has been little published in the literature on how to control the movement of coded micro-carriers. Early attempts  at exploThis study focuses on a new coded micro-carrier design and a control method for them . A simpl2.2.1.At the present time, there are two main kinds of biochip systems being used worldwide, the micro-array biochip system, and the coded micro-carrier biochip system. In the past, coded micro-carriers were made utilizing a LIGA-like process . The mosOur new coded micro-carriers or “ferromagnetic coded micro-carriers” are made by a Metal Injection Molding (MIM) process –11. MIM Molding : a mold Injection : the Fe Stripping the micro-carriers : when thUltra-sonic cleaning : to avoiSurface modification : it is nAddition of conjugate bio-molecules : a layerThe code is represented by different shapes such as rectangles, circles, and so on. The fabrication process for creating the coded micro-carriers includes the following steps:The ferromagnetic coded micro-carriers can be controlled by using an applied magnetic field. They hybridize with unknown bio-molecules, combining to form conjugate bio-molecules and micro-carriers. The labeling color and the coding of the micro-carriers can be detected microscopically.2.2.There are some crystalline materials that, because of their crystallization structure and microscopic organization, exhibit the property of ferromagnetism, for example, Fe, Ni, and so on. A ferromagnetic material such as iron can be temporarily magnetized by the addition of a magnetic field. 2.3.2 layer is coated onto the surface of the micro-carrier by an immersion method. During the period of immersion, a magnetic circuit is applied to generate a magnetic field, to force the ferromagnetic coded micro-carriers to stay clustered in the same position, and avoid their disappearance during the transfer operation from one glass tube or well to the other.Using only the method described above we could not bind proteins successfully to the surface of the ferromagnetic coded micro-carrier, without changing its surface properties –14. To s2 film layer by the immersion process, the ferromagnetic coded micro-carriers are ultrasonically dried with extra dry N2.After the application of the SiOStep 1: A few ferromagnetic coded micro-carriers 10–15 pieces) are placed into each well of a 96-well plate, and 100 μL GAL1  pieces a added, aStep 2: The liquid is removed and each well washed three times with a 200 μL PBST (PBS containing 0.1% Tween 20) for 10 min.Step 3: The ferromagnetic coded micro-carriers are moved to clean wells by the application of a magnetic force.Step 4: The PBST is removed and 100 μL of a blocking buffer (5% Bovine Serum Albumin in PBST) added to each well before shaking for 1 h at room temperature.Step 5: The blocking buffer is removed and 100 μL of the first antibody  with several different dilutions  added to each well before shaking for 1 h at room temperature.Step 6: The first antibody is removed as well as any unbounded first antibody by washing three times with PBST for 10 min.Step 7: One hundred μL of the secondary antibody   are added to each well, before shaking for 1 h at room temperature.Step 8: The secondary antibody, as well as any unbounded secondary antibody is removed by washing 3 times with PBST for 10 min.Step 9: The BCIP/NBT alkaline phosphatase substrate solution in each well is removed. Reactions are facilitated under light-avoiding conditions until a dark purple color appears on the ferromagnetic coded micro-carriers (about 30 min).2O is added to stop the reaction.Step 10: The BCIP/NBT substrate is removed, and ddHStep 11: Microscopic images of the ferromagnetic coded micro-carriers can be obtained with a microscope and a CCD camera. The features and characteristics of the images are then analyzed by a computer.Step 12: During steps 1 to 10, a magnetism field is generated by an NdFeB magnet to keep the ferromagnetic coded micro-carriers in the wells, decreasing the loss of micro-carriers during the experiments See .The hybridization process and interaction of the ferromagnetic coded micro-carriers with the proteins, step (f) in Section 2.1, is described in more detail as follows:The procedures in steps 1 through 11 are repeated without the ferromagnetic coded micro-carriers, and the experimental data recorded for each well (TEST FILTER: 570 nm) with an ELISA reader .2.4.Step 1: First choose two kinds of ferromagnetic coded micro-carriers with different codes (coding A and coding B). Place a few ferromagnetic coded micro-carriers into separate wells of a 96-well plate. 100 μL of GAL1 are added to a well containing coding A ferromagnetic coded micro-carriers. 100 μL of HSP27 are added to another well containing coding B ferromagnetic coded micro-carriers before shaking overnight at 4 °C.Step 2: The liquid is removed and each well washed three times with a 200 μL PBST (PBS containing 0.1% Tween 20) for 10 min.Step 3: The two kinds of ferromagnetic coded micro-carriers are moved to a clean well by the application of magnetic force.Step 4: The PBST is removed, and add 100 μL of a blocking buffer (5% Bovine Serum Albumin in PBST) added to each well before shaking for 1 h at room temperature.Step 5: The blocking buffer is removed and 100 μL of the unknown antibody added into the well before shaking for 1 h at room temperature.Step 6: The unknown antibody, and any unbounded unknown anti-body is removed by washing three times with PBST for 10 min.Step 7: One hundred μL of the secondary antibody   are added to the well, before shaking for 1 h at room temperature.Step 8: The secondary antibody and any unbounded secondary antibody is removed by washing three times with PBST for 10 min.Step 9: The BCIP/NBT alkaline phosphatase substrate solution is added into the well, to facilitate reactions under light-avoiding conditions until a dark color appears on the ferromagnetic coded micro-carriers (about 30 min).2O added to stop the reaction.Step 10: The BCIP/NBT substrate is removed, and ddHStep 11: Microscopic images of the ferromagnetic coded micro-carriers can be obtained with a microscope and a CCD camera. The features and characteristics of the images are then analyzed on the computer.Step 12: During steps 1 to 10, an NdFeB magnet is utilized to keep the ferromagnetic coded micro-carriers in the well, and decrease micro-carrier loss during the experiments.The hybridization process and multiplexed detection of ferromagnetic coded micro-carriers with unknown antibodies, are described in more detail below:2.5.We developed a platform for holding the ferromagnetic coded micro-carriers after hybridization, as a method for preserving and testing the bio-molecular information. A schematic illustration of the experimental apparatus used in the present study is shown in The magnetic circuit device creates a magnetic field on the x/y table. The magnetic force keeps the ferromagnetic coded micro-carriers on the surface of the x/y table. To avoid the problem of the micro-carriers overlapping, non-magnetic blades are used to let a single layer of ferromagnetic coded micro-carriers pass through, while sweeping off the overlapping micro-carriers.In this testing system, there is more than one microscope focused on the x/y table, so that images of the coded micro-carriers can be caught simultaneously by multiple-microscopes and CCD cameras. The use of multiple-microscopes increases the testing area on the x/y table as well as the testing speed. This multiple microscope testing system can collect large amounts of coded micro-carrier information. The improved contrast image fusion is used for information analysis . The imaAfter the image fusion process, we obtain clearer images of the coded micro-carriers. The composition of the color distribution on the coded micro-carriers is then analyzed. The analysis is carried out using the MATLAB software package. First, the contours and positions of the coded micro-carriers are computed. Next, color distribution information is calculated. Both qualitative and quantitative data analyses are performed.Enzyme-Linked ImmunoSorbent Assay (ELISA) assays are used to examine the relationships between variable conditions. Two different techniques were used in this investigation. Finally, the experimental data obtained from ferromagnetic coded micro-carriers after image processing and the ELISA assays are compared and evaluated.2.6.Here we have different coding methods indicated in 8 unique codes.Barcode coding which has been shown in 8 unique codes.Circular-hole coding which has been shown in 3.In The wells and results of the ELISA assays are illustrated in Overall, the results are very positive, being as expected in terms of the relationship between the digital image processing and ELISA measurement results. Both types of experimental results show a clear and strong relationship between the 1°Ab dilution ratio and the measurement data. The ELISA measurement data and the dilution ratio of 1°Ab are shown to be positively correlated with one another. Looked at in another way, the gray levels of the color component on the coded micro-carriers are significantly moderately negatively related to the 1°Ab dilution ratios. The gray level increases in value with decreasing dilution ratio. This can be explained by an increase in the density of 1°Ab, so the color on the coded micro-carriers shows a darkening phenomenon.G). The density of antibody (I) can be expressed as follows:I is the density of the antibody, K is the proportional constant and G is the gray level value.Therefore, we transfer the gray level expression by 255 minus the gray level value  or for mobile magnetic field-directed application (in the future), which a conventional micro-arrays can not do. Our ferromagnetic coded micro-carriers can be fixed in place by the use of magnetic force which also decreases the chip loss during the hybridization process, washing process and so on. In the future, we will inject the ferromagnetic coded micro-carriers (or nano-carriers) into vascular and guide them by outside magnetic field to the location of interesting area [in vivo by testing the skin of Drosophila (see There are some multiple functional chips in existence such as, micro-array systems. However, our chips can be used for ing area –7. For ehila see . We alsoOur ferromagnetic coded micro-carriers were analyzed by image processing with CCD cameras and computer. A simple and cost effective solution for bio-molecular applications is developed. The ferromagnetic coded micro-carrier requires no expensive equipment, offers great flexibility, and more capability to test unknown biomaterials.


Universal newborn hearing screening (UNHS) was started in the Hospital Universiti Sains Malaysia (HUSM) in January 2003. To comply with international standards, we determined the outcome of the newborn hearing screening program for the first 5 years of its implementation, from January 2003 to December 2007.The program screened all infants who were delivered in HUSM. In a retrospective review, the outcomes in terms of coverage, prevalence of hearing impairment, referral rate for each screening, age at detection of hearing impairment and at hearing aid-fitting were analyzed.Ninety-eight percent of newborns were screened. The study included 16 100 randomly selected newborns. The initial screening referral rate was 25.5%. The prevalence of default for second and third screening was 33.9% and 40.7%, respectively. The mean (SD) age at detection of hearing impairment was 3.3 months (0.86). The mean (SD) age at fitting of a hearing aid was 13.6 (4.8) months. The prevalence of hearing impairment was 0.09%.A newborn hearing screening program is an important tool for early diagnosis and treatment. Even though the prevalence of hearing impairment may be low, the problem needs to be addressed early as the development of infants requires normal hearing. Prevalence figures for permanent congenital sensorineural hearing loss are 1.5 to 2.2 per 1000 live births,23The mean age that hearing impairment is detected has decreased from 12 to 24 months to 3 to 6 months since introduction of newborn hearing screening programs in the United States.6In Malaysia, audiological and intervention services for the hearing-impaired children have been slowly developing since the early 1990s. A few hospitals have been implementing hospital-based newborn hearing screening since the early 2000s. The implementation of universal newborn hearing screening in Malaysia has been supported by the awareness of the negative impacts of late detection of permanent congenital hearing loss and the positive impact of early intervention on language, cognitive, educational and social development skills of the growing infant.7The objective of this retrospective study was to assess the outcome of the newborn hearing screening program at Hospital Universiti Sains Malaysia (HUSM) within the first 5 years of its implementation, from 1 January 2003 to 31 December 2007. We sought to evaluate the coverage, prevalence, the initial screening referral rate, the number of defaulters, the age at detection of hearing impairment and age at hearing aid-fitting. A sample of all newborns delivered within the study period was identified by systematic random sampling that involved taking every other patient  from the hearing screening records of the Hospital Universiti Sains Malaysia (HUSM).The registry records contained data for the first, second and third hearing screen. The medical records of newborns who failed the third screening were traced and all data analyzed. In our center, the first screening was done in the ward by trained personnel  supervised by an audiologist. Both ears were cleaned prior to every screening. The first screening was done using distortion product otoacoustic emissions (DPOAE) and Bio-Logic Audx none with a frequency of 2 kHz, 3 kHz and 4 kHz. The screening was done at the bedside where the newborns usually slept beside their mothers. If the surroundings were too noisy, the screening was done in a quiet room. Screening was usually done after feeding. The second screening was also done using the otoacoustic emissions with the same frequency. This screening was done in a sound-treated room in the otorhynolarynology clinic by technicians or audiologists. The third screening was done and the diagnosis of hearing impairment confirmed by an audiologist by using a diagnostic auditory brainstem response. Defaulters are babies that did not re-appear for the second or third screening.Of the 33 427 delivered babies in HUSM, 32 745 (98%) were screened and 16 100 newborns were selected for study by systematic random sampling, including 8255 (51%) boys and 7845 (49%) girls; 97.5% were Malays, reflecting the population of the state. The mean (SD) age at detection of hearing impairment was 3.3 months (0.86). The mean (SD) age at fitting of a hearing aid was 13.6 (4.8) months. The prevalence of hearing impairment was 0.09%.Figure 1. That percentage varied by year .The percentage of newborns who passed, were referred or failed is shown in Universal newborn hearing screening (UNHS) has been widely accepted and is being implemented worldwide. UNHS is designed to identify, as early as possible, congenital and acquired hearing loss. Early identification of hearing loss is imperative to prevent problems related to speech, language, social life and schooling from occurring at a later stage in life. This program requires all babies to be screened before discharge from the hospital. However, despite medical advances in screening instruments, UNHS is still restricted to developed countries. This is mostly due to the cost of the instruments and the manpower used in the screening program.The coverage of newborns screened in our study was 98%. This percentage is high and achieves the quality indicator of screening established by the Joint Committee on Infant Hearing (JCIH), which is “more than 95%.”9The prevalence of hearing impairment detected during this study was only 0.09%, which is lower than that of other studies because of the high default rates among the newborns after they failed the third screening. The default rates were also high for subsequent follow-ups, which made confirmation of the hearing impairment difficult. The number of newborns who continued the follow-up until the diagnosis was made was small. These problems need to be addressed and solutions sought. The rate of defaults affects the accuracy of the true figure for prevalence.In Malaysia, Abdullah et al found that the prevalence of hearing loss was 0.42% (16/3762).15The initial screening referral rate in our study was 25.5%, which is higher compared to that found in related studies done in Malaysia.9In another study, OAE was reported to have a high false-positive rate (about 15%) at the initial screening on the first day, which was then reduced by about 50% with each repeated screening.Another factor that can cause a high failure rate is the site of the screening test. Brass et al advocated that the screening be done in a quiet or soundproof room.21The default rate in the second and third screening in our study was 33.9% and 40.7%, respectively. The reasons for the occurrence of these problems should be thoroughly investigated in order to improve the newborn hearing screening program in HUSM. Other similar studies in Malaysia also showed a high percentage of defaulters for both second and third screenings.910Despite that, another aspect that needs to be considered is parental concern. This is very important because false-positive results are inevitable. A false-positive result can cause unnecessary worries to the parents. Vohr et al found that mothers whose infants did not pass the routine newborn hearing screening described significantly greater worry about hearing screening than mothers whose infants had been screened, but who had not yet been informed of their infant’s screening result.The objective of UNHS is to identify babies who have hearing loss and to provide necessary intervention as soon as possible. In this study, the age when hearing impairment was detected using diagnostic ABR ranged from 2.4 to 5.2 months . The age at hearing aid–fitting in this study ranged from 5 months to 18 months . One of the newborns detected at 5 months had successfully undergone cochlear implant. The success of a newborn hearing screening program depends on many components, such as commitment from various disciplines, regular evaluation of the program and efforts towards creating public awareness about hearing loss and early intervention. Many published studies on universal newborn hearing screening have demonstrated that this program is feasible and beneficial. At HUSM, the newborn hearing screening program, still needs regular evaluation to ensure quality improvement.


Cochlear implants known to provide support in individuals with bilateral hearing loss may also be of great benefit for individuals with unilateral hearing loss. This case report demonstrates the positive effects of cochlear implantation on speech understanding in noise conditions in patients with unilateral hearing loss and normal hearing on the contralateral side. To the best of our knowledge, the data presented here are from the first few cases to receive a cochlear implant for unilateral hearing loss.Four Caucasian German men, two aged 48 and the others aged 51 and 57 years old, with post-lingual unilateral hearing loss and normal hearing on the contralateral side were implanted with a cochlear implant. All our patients were members of the German army. Before and after implantation, they were given a battery of speech tests in different hearing conditions to assess the effect of unilateral cochlear implantation on speech understanding in noise conditions. Test results showed that all patients benefited from unilateral cochlear implantation, particularly in terms of speech understanding in noise conditions.Unilateral cochlear implantation might be a successful treatment method for patients with unilateral hearing loss not benefiting from alternative treatment options. The results of this case report open up the field of cochlear implantation for expanded criteria and new areas of research. Despite these impediments, the impact of a complete UHL is often minimized by the presence of (near) normal hearing (NH) on the contralateral side. However, different studies have shown that the normal hearing capabilities of these individuals do not compensate for their UHL . Lin et et al.  addresseAlthough it is recognized that patients with UHL encounter problems in speech recognition in noise conditions or sound localization, only very few treatment methods are available to these patients . Currentet al. [et al. [In contrast to these treatment options for UHL, bilateral HL is mainly treated by cochlear implantation. The effectiveness of bilateral cochlear implants (CIs) has been demonstrated in the last several years ,7. Patieet al. , bilater [et al. .Borrelia infection. Patient S4 also showed a normal middle ear status and was implanted with a CI after a duration of hearing loss of 33 months.Patient S1 was a 48-year-old Caucasian German man with post-lingual UHL and NH on his contralateral ear. The etiology of his hearing loss was unknown, and his middle ear status was normal. He had a duration of deafness of 11 months before unilateral implantation with a CI. Patient S2 was a 51-year-old Caucasian German man also with post-lingual UHL and NH on his contralateral ear. His hearing loss was caused by acoustic trauma; his middle ear status was reported to be normal. Patient S2 had a duration of deafness of 45 months before unilateral CI implantation. Patient S3 was a 48-year-old Caucasian German man with post-lingual UHL and NH on his contralateral ear. He had lost his hearing due to a stapedectomy; he showed a normal middle ear status. Patient S3 was implanted unilaterally with a CI after a duration of deafness of 96 months. Patient S4 was a 57-year-old Caucasian German man with post-lingual UHL and NH on his contralateral ear. His hearing loss was due to a Our patients did not wear hearing aids (HAs) before implantation as their hearing loss (HL) was too profound for HAs to provide sufficient acoustic amplification. Since all our patients were members of the German Army, which is obliged by law to provide the best possible compensation for any kind of disability, treatment costs were no issue. Our patients, who all had leading positions within the army, consistently reported a high level of distress often related to feelings that their job was at risk because of their HL and were thus highly motivated for CI treatment. All our patients were thoroughly counseled and signed informed consent before implantation. Authorization was provided by the Germany Army, as our patients were treated in an army hospital in Germany.100 implant and a standard electrode of 31.5 mm in length . Our patients also received the OPUS 2 speech processor including the FineStructure coding strategy. In all patients, first fitting of the CI was performed approximately four weeks after implantation and included the adjustment of electrical hearing thresholds, the most comfortable stimulation levels as well as frequency allocation and compression characteristics. Our patients received aural rehabilitation therapy for patients with CI in their hearing centers. Bilateral testing was performed once a monosyllable understanding in quiet conditions of 50% correctness was achieved.All our patients were implanted with the PULSARCIPure tone audiometry testing was performed in the NH ear, in the hearing impaired ear before CI implantation and, post-operatively, in the CI-only condition six months after first fitting. During testing in the CI-only condition, the contralateral ear was plugged and masked with 80 dB wideband noise. All our patients had NH on the contralateral side with mean hearing thresholds of 5 dB to 30 dB HL across tested frequencies (250 kHz to 8 kHz). Pre-operatively, our patients showed pure tone thresholds averaging between 80 dB and 100 dB in the hearing impaired side  to -90° (left) and with a separation of 18°. Our patients were positioned on an adjustable chair in the center of the semicircle of loudspeakers. All tests, the tested conditions and the time of testing are displayed in Table The Freiburg monosyllable test  20 list.The dichotic listening test  includedThe Hochmair-Schulz-Moser (HSM) sentence test  (30 listThe Oldenburg Sentence Test (OLSA)  , ranging from 0 (very low) to 10 (very high). Our patients stated a high level of CI acceptance, integration of CI hearing, increased ease of listening especially in noise situations and a regaining of acoustic orientation abilities. After our patients became accustomed to the CI sound, they also rated the quality of the sound signals generated by the CI to be good. No negative interference of NH when using the CI was reported. This can probably be attributed to advancing CI technology having developed modern coding strategies with high frequency resolution and temporal processing. Overall, the subjective ratings of the CI were more positive than results of the objective testing.It should be emphasized, however, that the VAS was not validated, but shows a tendency of how the CI is perceived. It must furthermore be stated that the subjective results might possibly be influenced by psychological effects, such as our patients' high motivation and expectations towards CI implantation. It might thus be interesting for future studies to focus in greater detail on the subjective benefits of unilateral CIs in particular, as well as on possible psychological effects influencing the subjective perception.This contrast between objective and subjective benefits might also be due to the fact that the speech tests are designed for bilateral HL and not for NH on the contralateral side. The results in the acoustic-only condition might be dominated by the NH ear, thus decreasing the measurable difference between acoustic-only and binaural test results. A further explanation might be that all our patients reported improved sound localization abilities, which, however, cannot be fully reflected in speech tests, even if two separately placed speech sources are used. It would be an attractive aspect for future unilateral CI studies to include localization tests and to investigate if subjective and objective results continue to show different levels of improvement. Furthermore, future studies should include a greater subject population and adapted speech tests focusing on unilateral hearing so that statistical significance can be demonstrated.et al. [Our patients in the present study had profound UHL for which HAs would not have rendered sufficient acoustic amplification. Since all our patients were members of the German army, treatment costs were no issue; however, generally, cost effectiveness plays an important role in health care structures. Regardless, based on the results of studies by Bond et al. , for exaOur patients showed a small but important benefit from unilateral cochlear implantation in speech recognition in noise conditions. The subjective benefits suggest a high degree of integration of the artificial auditory input through the CI. Restored sound localization and a regained spatial awareness were also reported and might be of interest in future research.Written informed consent was obtained from the patients for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.The authors declare that they have no competing interests.All authors contributed to the manuscript and reviewed, edited and approved the final report.