The Manchurian candidate: chiropractors as propagators of neoliberalism in health care.

The rise of neoliberalism has influenced the health care sector, including the chiropractic profession. The neoliberal infiltration of market justice behavior is in direct conflict with the fiduciary agreement to serve the public good before self-interests and has compromised the chiropractor, who now may act as an agent of neoliberalism in health care. The purpose of this paper is to present an overview of the impact of neoliberalism on the chiropractic profession and provide recommendations for a professional philosophical shift from a market justice model to a communal and social justice model.

Modulation frequency discrimination with modulated and unmodulated interference in normal hearing and in cochlear-implant users.

Differences in fundamental frequency (F0) provide an important cue for segregating simultaneous sounds. Cochlear implants (CIs) transmit F0 information primarily through the periodicity of the temporal envelope of the electrical pulse trains. Successful segregation of sounds with different F0s requires the ability to process multiple F0s simultaneously, but it is unknown whether CI users have this ability. This study measured modulation frequency discrimination thresholds for half-wave rectified sinusoidal envelopes modulated at 115 Hz in CI users and normal-hearing (NH) listeners. The target modulation was presented in isolation or in the presence of an interferer. Discrimination thresholds were strongly affected by the presence of an interferer, even when it was unmodulated and spectrally remote. Interferer modulation increased interference and often led to very high discrimination thresholds, especially when the interfering modulation frequency was lower than that of the target. Introducing a temporal offset between the interferer and the target led to at best modest improvements in performance in CI users and NH listeners. The results suggest no fundamental difference between acoustic and electric hearing in processing single or multiple envelope-based F0s, but confirm that differences in F0 are unlikely to provide a robust cue for perceptual segregation in CI users.

Assessing the role of spectral and intensity cues in spectral ripple detection and discrimination in cochlear-implant users.

Measures of spectral ripple resolution have become widely used psychophysical tools for assessing spectral resolution in cochlear-implant (CI) listeners. The objective of this study was to compare spectral ripple discrimination and detection in the same group of CI listeners. Ripple detection thresholds were measured over a range of ripple frequencies and were compared to spectral ripple discrimination thresholds previously obtained from the same CI listeners. The data showed that performance on the two measures was correlated, but that individual subjects' thresholds (at a constant spectral modulation depth) for the two tasks were not equivalent. In addition, spectral ripple detection was often found to be possible at higher rates than expected based on the available spectral cues, making it likely that temporal-envelope cues played a role at higher ripple rates. Finally, spectral ripple detection thresholds were compared to previously obtained speech-perception measures. Results confirmed earlier reports of a robust relationship between detection of widely spaced ripples and measures of speech recognition. In contrast, intensity difference limens for broadband noise did not correlate with spectral ripple detection measures, suggesting a dissociation between the ability to detect small changes in intensity across frequency and across time.

Using health information technology to engage communities in health, education, and research.

The August 2011 Clinical and Translational Science Awards conference "Using IT to Improve Community Health: How Health Care Reform Supports Innovation" convened four "Think Tank" sessions. Thirty individuals, representing various perspectives on community engagement, attended the "Health information technology (HIT) as a resource to improve community health and education" session, which focused on using HIT to improve patient health, education, and research involvement. Participants discussed a range of topics using a semistructured format. This article describes themes and lessons that emerged from that session, with a particular focus on using HIT to engage communities to improve health and reduce health disparities in populations.

Comparing spatial tuning curves, spectral ripple resolution, and speech perception in cochlear implant users.

Spectral ripple discrimination thresholds were measured in 15 cochlear-implant users with broadband (350-5600 Hz) and octave-band noise stimuli. The results were compared with spatial tuning curve (STC) bandwidths previously obtained from the same subjects. Spatial tuning curve bandwidths did not correlate significantly with broadband spectral ripple discrimination thresholds but did correlate significantly with ripple discrimination thresholds when the rippled noise was confined to an octave-wide passband, centered on the STC's probe electrode frequency allocation. Ripple discrimination thresholds were also measured for octave-band stimuli in four contiguous octaves, with center frequencies from 500 Hz to 4000 Hz. Substantial variations in thresholds with center frequency were found in individuals, but no general trends of increasing or decreasing resolution from apex to base were observed in the pooled data. Neither ripple nor STC measures correlated consistently with speech measures in noise and quiet in the sample of subjects in this study. Overall, the results suggest that spectral ripple discrimination measures provide a reasonable measure of spectral resolution that correlates well with more direct, but more time-consuming, measures of spectral resolution, but that such measures do not always provide a clear and robust predictor of performance in speech perception tasks.

Spatial tuning curves from apical, middle, and basal electrodes in cochlear implant users.

Forward-masked psychophysical spatial tuning curves (fmSTCs) were measured in 15 cochlear-implant subjects, 10 using monopolar stimulation and 5 using bipolar stimulation. In each subject, fmSTCs were measured at several probe levels on an apical, middle, and basal electrode using a fixed-level probe stimulus and variable-level maskers. Tuning curve slopes and bandwidths did not change significantly with probe level for electrodes located in the apical, middle, or basal region although a few subjects exhibited dramatic changes in tuning at the extremes of the probe level range. Average tuning curve slopes and bandwidths did not vary significantly across electrode regions. Spatial tuning curves were symmetrical and similar in width across the three electrode regions. However, several subjects demonstrated large changes in slope and/or bandwidth across the three electrode regions, indicating poorer tuning in localized regions of the array. Cochlear-implant users exhibited bandwidths that were approximately five times wider than normal-hearing acoustic listeners but were in the same range as acoustic listeners with moderate cochlear hearing loss. No significant correlations were found between spatial tuning parameters and speech recognition; although a weak relation was seen between middle electrode tuning and transmitted information for vowel second formant frequency.