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BACKGROUND:
While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided deafness (SSD) and asymmetric hearing loss (AHL), in recent years, cochlear implants (CIs) have increasingly become a viable treatment choice, particularly in countries where regulatory approval and reimbursement schemes are in place. Part of the reason for this shift is that the CI is the only device capable of restoring bilateral input to the auditory system and hence of possibly reinstating binaural hearing. Although several studies have independently shown that the CI is a safe and effective treatment for SSD and AHL, clinical outcome measures in those studies and across CI centers vary greatly. Only with a consistent use of defined and agreed-upon outcome measures across centers can high-level evidence be generated to assess the safety and efficacy of CIs and alternative treatments in recipients with SSD and AHL.
METHODS:
This paper presents a comparative study design and minimum outcome measures for the assessment of current treatment options in patients with SSD/AHL. The protocol was developed, discussed, and eventually agreed upon by expert panels that convened at the 2015 APSCI conference in Beijing, China, and at the CI 2016 conference in Toronto, Canada.
RESULTS:
A longitudinal study design comparing CROS-HA, BCD, and CI treatments is proposed. The recommended outcome measures include (1) speech in noise testing, using the same set of 3 spatial configurations to compare binaural benefits such as summation, squelch, and head shadow across devices; (2) localization testing, using stimuli that rove in both level and spectral content; (3) questionnaires to collect quality of life measures and the frequency of device use; and (4) questionnaires for assessing the impact of tinnitus before and after treatment, if applicable.
CONCLUSION:
A protocol for the assessment of treatment options and outcomes in recipients with SSD and AHL is presented. The proposed set of minimum outcome measures aims at harmonizing assessment methods across centers and thus at generating a growing body of high-level evidence for those treatment options.
The effect of fluctuating maskers on speech understanding of high-performing cochlear implant users
(2016)
Objective: The present study evaluated whether the poorer baseline performance of cochlear implant (CI) users or the technical and/or physiological properties of CI stimulation are responsible for the absence of masking release. Design: This study measured speech reception thresholds (SRTs) in continuous and modulated noise as a function of signal to noise ratio (SNR). Study sample: A total of 24 subjects participated: 12 normal-hearing (NH) listeners and 12 subjects provided with recent MED-EL CI systems. Results: The mean SRT of CI users in continuous noise was −3.0 ± 1.5 dB SNR (mean ± SEM), while the normal-hearing group reached −5.9 ± 0.8 dB SNR. In modulated noise, the difference across groups increased considerably. For CI users, the mean SRT worsened to −1.4 ± 2.3 dB SNR, while it improved for normal-hearing listeners to −18.9 ± 3.8 dB SNR. Conclusions: The detrimental effect of fluctuating maskers on SRTs in CI users shown by prior studies was confirmed by the current study. Concluding, the absence of masking release is mainly caused by the technical and/or physiological properties of CI stimulation, not just the poorer baseline performance of many CI users compared to normal-hearing subjects. Speech understanding in modulated noise was more robust in CI users who had a relatively large electrical dynamic range.
The ability to detect a signal masked by noise is improved in normal-hearing (NH) listeners when interaural phase differences (IPD) between the ear signals exist either in the masker or the signal. We determined the impact of different coding strategies in bilaterally implanted cochlear implant (BiCI) users with and without fine-structure coding (FSC) on masking level differences. First, binaural intelligibility level differences (BILD) were determined in NH listeners and BiCI users using their clinical speech processors. NH subjects (n=8) showed a significant mean BILD of 7.5 dB. In contrast, BiCI users (n=9) without FSC as well as with FSC revealed a barely significant mean BILD (0.4 dB respectively 0.6 dB). Second, IPD thresholds were measured in BiCI users using either their speech processors with FS4 or direct stimulation with FSC. With the latter approach, synchronized stimulation providing an interaural accuracy of stimulation timing of 1.67 µs was realized on pitch matched electrode pairs. The resulting individual IPD threshold was lower in most of the subjects with direct stimulation than with their speech processors. These outcomes indicate that some BiCI users can benefit from increased temporal precision of interaural FSC and adjusted interaural frequency-place mapping presumably resulting in improved BILD.
The ability to detect a target signal masked by noise is improved in normal-hearing listeners when interaural phase differences (IPDs) between the ear signals exist either in the masker or in the signal. To improve binaural hearing in bilaterally implanted cochlear implant (BiCI) users, a coding strategy providing the best possible access to IPD is highly desirable. In this study, we compared two coding strategies in BiCI users provided with CI systems from MED-EL (Innsbruck, Austria). The CI systems were bilaterally programmed either with the fine structure processing strategy FS4 or with the constant rate strategy high definition continuous interleaved sampling (HDCIS). Familiarization periods between 6 and 12 weeks were considered. The effect of IPD was measured in two types of experiments: (a) IPD detection thresholds with tonal signals addressing mainly one apical interaural electrode pair and (b) with speech in noise in terms of binaural speech intelligibility level differences (BILD) addressing multiple electrodes bilaterally. The results in (a) showed improved IPD detection thresholds with FS4 compared with HDCIS in four out of the seven BiCI users. In contrast, 12 BiCI users in (b) showed similar BILD with FS4 (0.6 ± 1.9 dB) and HDCIS (0.5 ± 2.0 dB). However, no correlation between results in (a) and (b) both obtained with FS4 was found. In conclusion, the degree of IPD sensitivity determined on an apical interaural electrode pair was not an indicator for BILD based on bilateral multielectrode stimulation.
BiCI users’ sensitivity to interaural phase differences for single- and multi-channel stimulation
(2016)
Vertriebspolitik hat in den letzten Jahren, verstärkt etwa durch Trends zur Optimierung logistischer Ketten, aber auch zum Online-Handel, als Marketing-Instrument enorm an Bedeutung gewonnen. Gleichzeitig und fast in gleichem Maße wuchs aber auch die Anzahl diesbezüglicher rechtlicher Regulierungen zu den vertrieblichen Aktivitäten von Unternehmen kontinuierlich an. Die nachstehende Übersicht zeigt beispielhaft die Vielfalt an zu beachtenden Regelungen auf. Um eine effizient begründete und so durchaus zwingend notwendige Reduktion der Komplexität derart umfassender Regelwerke zu erreichen, die davon betroffenen Funktions- und Entscheidungsträger eines Unternehmens also „den Wald vor lauter Bäumen“ noch erkennen zu lassen, vor allem aber um diese wirkungsvoll zu unterstützen, lehnt sich das vorliegende Arbeitspapier bei der Vor- und Darstellung der betreffenden Rechtsnormen an die, in der Betriebswirtschaftslehre, speziell im Marketing, üblichen Strukturen der vertriebspolitischen Aktivitäten eines Unternehmens an. Dementsprechend wird der Rechtsrahmen der Vertriebspolitik nach Rechtsnormen, die zum einen die akquisitorische, zum anderen die logistische Distribution betreffen, gegliedert. Weiterhin wird bei der akquisitorischen Distribution unterschieden in direkten und indirekten Vertrieb mit einer weiteren Unterteilung des indirekten Vertriebes nach Absatzmittlern und Absatzhelfern. Ein derartiger Aufbau vermag die Behandlung der zumeist komplizierten juristischen Sachverhalte zu einem durchaus nicht nur praxisrelevanten, sondern auch praxisgeeigneten Forschungsbeitrag werden zu lassen.
Ziel des vorliegenden Leitfadens für den Mittelstand ist es, zu einer Lösung der im Spannungsfeld zwischen Marketing und Recht zu bewältigenden Aufgaben, die von vielen heute als die wichtigsten der Unternehmensführung überhaupt angesehen werden, beizutragen. In diesem Sinne liefert der Leitfaden Ihnen einen umfassenden Überblick über den, das Marketing beeinflussenden Rechtsrahmen und zeigt gleichzeitig Gestaltungsoptionen eines präaktiven Handelns auf. Der Leitfaden lehnt sich, dieses Ziel unterstützend, dem klassischen Kanon der Marketinginstrumente an.
Auf Grund der hohen Bedeutung des Internets als Informations-, Kommunikations- und Absatzkanal werden Online-Marketing Maßnahmen immer wichtiger. Dies gilt auch für kleine und mittelständische Unternehmen (KMU). Vielfach haben diese allerdings Schwierigkeiten mit der Nutzung von Online-Marketing Maßnahmen, unter anderem fehlt es häufig am nötigen Know-How. Im Mittelpunkt der Studie stehen Online-Marketing Maßnahmen und deren Nutzung bei kleinen und mittelständischen Unternehmen in der Region Ortenau. Hierzu wurde im Dezember 2015 eine Online-Befragung mit 2.138 Unternehmen durchgeführt. Daneben wurden 2.138 Webseiten im Hinblick auf Suchmaschinenoptimierungsmaßnahmen mit dem Google Online-Tool PageSpeed Insights analysiert. In der Studie werden zunächst die untersuchten Online-Marketing Maßnahmen vorstellt. Im Mittelpunkt dieses Ergebnisberichtes stehen die Ergebnisse der Online-Befragung zur aktuellen Nutzung von Online-Marketing Maßnahmen in der Region Ortenau. Darüber hinaus werden die Resultate einer Analyse zur Suchmaschinenoptimierung präsentiert. Durch die Verknüpfung der Ergebnisse aus der Online-Befragung sowie der SEO-Analyse werden abschließend Handlungsempfehlungen vorgestellt, wie kleine und mittelständische Unternehmen von Online-Marketing Maßnahmen profitieren können.
Predictive Analytics als Governance- und Managementanwendung - Zukunftsorientiertes Controlling
(2016)
Remote code attestation protocols are an essential building block to offer a reasonable system security for wireless embedded devices. In the work at hand we investigate in detail the trustability of a purely software-based remote code attestation based inference mechanism over the wireless when e.g. running the prominent protocol derivate SoftWare-based ATTestation for Embedded Devices (SWATT). Besides the disclosure of pitfalls of such a protocol class we also point out good parameter choices which allow at least a meaningful plausibility check with a balanced false positive and false negative ratio.
In the last decade, IPv6 over Low power Wireless Personal Area Networks (IEEE802.15.4), also known as 6LoWPAN, has well evolved as a primary contender for short range wireless communications and holds the promise of an Internet of Things, which is completely based on the Internet Protocol. The authors' team has developed a 6LoWPAN protocol stack in C language, the stack without the necessity to use a specific design environment or operating system. It is highly flexible, modular, and portable and can be enhanced by several interesting modules, like a Wake-On-Radio-(WOR) MAC layer or a TLS1.2 based security sublayer. The stack is made available as open source at https://github.com/hso-esk/emb6. It was extensively tested on the Automated Physical Testbed (APTB) for Wireless Systems, which is available in the authors' lab and allows a flexible setup and full control of arbitrary topologies. The results of the measurements demonstrate a very good stability and short-term with long-term performance also under dynamic conditions.
Wireless communication systems more and more become part of our daily live. Especially with the Internet of Things (IoT) the overall connectivity increases rapidly since everyday objects become part of the global network. For this purpose several new wireless protocols have arisen, whereas 6LoWPAN (IPv6 over Low power Wireless Personal Area Networks) can be seen as one of the most important protocols within this sector. Originally designed on top of the IEEE802.15.4 standard it is a subject to various adaptions that will allow to use 6LoWPAN over different technologies; e.g. DECT Ultra Low Energy (ULE). Although this high connectivity offers a lot of new possibilities, there are several requirements and pitfalls coming along with such new systems. With an increasing number of connected devices the interoperability between different providers is one of the biggest challenges, which makes it necessary to verify the functionality and stability of the devices and the network. Therefore testing becomes one of the key components that decides on success or failure of such a system. Although there are several protocol implementations commonly available; e.g., for IoT based systems, there is still a lack of according tools and environments as well as for functional and conformance testing. This article describes the architecture and functioning of the proposed test framework based on Testing and Test Control Notation Version 3 (TTCN-3) for 6LoWPAN over ULE networks.