Predictors of Emotional Prosody Identification by School-Age Children With Cochlear Implants and Their Peers With Normal Hearing.

OBJECTIVES: Children with cochlear implants (CIs) vary widely in their ability to identify emotions in speech. The causes of this variability are unknown, but this knowledge will be crucial if we are to design improvements in technological or rehabilitative interventions that are effective for individual patients. The objective of this study was to investigate how well factors such as age at implantation, duration of device experience (hearing age), nonverbal cognition, vocabulary, and socioeconomic status predict prosody-based emotion identification in children with CIs, and how the key predictors in this population compare to children with normal hearing who are listening to either normal emotional speech or to degraded speech. DESIGN: We measured vocal emotion identification in 47 school-age CI recipients aged 7 to 19 years in a single-interval, 5-alternative forced-choice task. None of the participants had usable residual hearing based on parent/caregiver report. Stimuli consisted of a set of semantically emotion-neutral sentences that were recorded by 4 talkers in child-directed and adult-directed prosody corresponding to five emotions: neutral, angry, happy, sad, and scared. Twenty-one children with normal hearing were also tested in the same tasks; they listened to both original speech and to versions that had been noise-vocoded to simulate CI information processing. RESULTS: Group comparison confirmed the expected deficit in CI participants' emotion identification relative to participants with normal hearing. Within the CI group, increasing hearing age (correlated with developmental age) and nonverbal cognition outcomes predicted emotion recognition scores. Stimulus-related factors such as talker and emotional category also influenced performance and were involved in interactions with hearing age and cognition. Age at implantation was not predictive of emotion identification. Unlike the CI participants, neither cognitive status nor vocabulary predicted outcomes in participants with normal hearing, whether listening to original speech or CI-simulated speech. Age-related improvements in outcomes were similar in the two groups. Participants with normal hearing listening to original speech showed the greatest differences in their scores for different talkers and emotions. Participants with normal hearing listening to CI-simulated speech showed significant deficits compared with their performance with original speech materials, and their scores also showed the least effect of talker- and emotion-based variability. CI participants showed more variation in their scores with different talkers and emotions than participants with normal hearing listening to CI-simulated speech, but less so than participants with normal hearing listening to original speech. CONCLUSIONS: Taken together, these results confirm previous findings that pediatric CI recipients have deficits in emotion identification based on prosodic cues, but they improve with age and experience at a rate that is similar to peers with normal hearing. Unlike participants with normal hearing, nonverbal cognition played a significant role in CI listeners' emotion identification. Specifically, nonverbal cognition predicted the extent to which individual CI users could benefit from some talkers being more expressive of emotions than others, and this effect was greater in CI users who had less experience with their device (or were younger) than CI users who had more experience with their device (or were older). Thus, in young prelingually deaf children with CIs performing an emotional prosody identification task, cognitive resources may be harnessed to a greater degree than in older prelingually deaf children with CIs or than children with normal hearing.

Senescent human melanocytes drive skin ageing via paracrine telomere dysfunction.

Cellular senescence has been shown to contribute to skin ageing. However, the role of melanocytes in the process is understudied. Our data show that melanocytes are the only epidermal cell type to express the senescence marker p16INK4A during human skin ageing. Aged melanocytes also display additional markers of senescence such as reduced HMGB1 and dysfunctional telomeres, without detectable telomere shortening. Additionally, senescent melanocyte SASP induces telomere dysfunction in paracrine manner and limits proliferation of surrounding cells via activation of CXCR3-dependent mitochondrial ROS. Finally, senescent melanocytes impair basal keratinocyte proliferation and contribute to epidermal atrophy in vitro using 3D human epidermal equivalents. Crucially, clearance of senescent melanocytes using the senolytic drug ABT737 or treatment with mitochondria-targeted antioxidant MitoQ suppressed this effect. In conclusion, our study provides proof-of-concept evidence that senescent melanocytes affect keratinocyte function and act as drivers of human skin ageing.

Cochlear Implant Compression Optimization for Musical Sound Quality in MED-EL Users.

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

Classical creativity: A functional magnetic resonance imaging (fMRI) investigation of pianist and improviser Gabriela Montero.

Improvisation is sometimes described as instant composition and offers a glimpse into real-time musical creativity. Over the last decade, researchers have built up our understanding of the core neural activity patterns associated with musical improvisation by investigating cohorts of professional musicians. However, since creative behavior calls on the unique individuality of an artist, averaging data across musicians may dilute important aspects of the creative process. By performing case study investigations of world-class artists, we may gain insight into their unique creative abilities and achieve a deeper understanding of the biological basis of musical creativity. In this experiment, functional magnetic resonance imaging and functional connectivity were used to study the neural correlates of improvisation in famed Classical music performer and improviser, Gabriela Montero. GM completed two control tasks of varying musical complexity; for the Scale condition she repeatedly played a chromatic scale and for the Memory condition she performed a given composition by memory. For the experimental improvisation condition, she performed improvisations. Thus, we were able to compare the neural activity that underlies a generative musical task like improvisation to 'rote' musical tasks of playing pre-learned and pre-memorized music. In GM, improvisation was largely associated with activation of auditory, frontal/cognitive, motor, parietal, occipital, and limbic areas, suggesting that improvisation is a multimodal activity for her. Functional connectivity analysis suggests that the visual network, default mode network, and subcortical networks are involved in improvisation as well. While these findings should not be generalized to other samples or populations, results here shed insight into the brain activity that underlies GM's unique abilities to perform Classical-style musical improvisations.

Perception of Child-Directed Versus Adult-Directed Emotional Speech in Pediatric Cochlear Implant Users.

OBJECTIVES: Cochlear implants (CIs) are remarkable in allowing individuals with severe to profound hearing loss to perceive speech. Despite these gains in speech understanding, however, CI users often struggle to perceive elements such as vocal emotion and prosody, as CIs are unable to transmit the spectro-temporal detail needed to decode affective cues. This issue becomes particularly important for children with CIs, but little is known about their emotional development. In a previous study, pediatric CI users showed deficits in voice emotion recognition with child-directed stimuli featuring exaggerated prosody. However, the large intersubject variability and differential developmental trajectory known in this population incited us to question the extent to which exaggerated prosody would facilitate performance in this task. Thus, the authors revisited the question with both adult-directed and child-directed stimuli. DESIGN: Vocal emotion recognition was measured using both child-directed (CDS) and adult-directed (ADS) speech conditions. Pediatric CI users, aged 7-19 years old, with no cognitive or visual impairments and who communicated through oral communication with English as the primary language participated in the experiment (n = 27). Stimuli comprised 12 sentences selected from the HINT database. The sentences were spoken by male and female talkers in a CDS or ADS manner, in each of the five target emotions (happy, sad, neutral, scared, and angry). The chosen sentences were semantically emotion-neutral. Percent correct emotion recognition scores were analyzed for each participant in each condition (CDS vs. ADS). Children also completed cognitive tests of nonverbal IQ and receptive vocabulary, while parents completed questionnaires of CI and hearing history. It was predicted that the reduced prosodic variations found in the ADS condition would result in lower vocal emotion recognition scores compared with the CDS condition. Moreover, it was hypothesized that cognitive factors, perceptual sensitivity to complex pitch changes, and elements of each child's hearing history may serve as predictors of performance on vocal emotion recognition. RESULTS: Consistent with our hypothesis, pediatric CI users scored higher on CDS compared with ADS speech stimuli, suggesting that speaking with an exaggerated prosody-akin to "motherese"-may be a viable way to convey emotional content. Significant talker effects were also observed in that higher scores were found for the female talker for both conditions. Multiple regression analysis showed that nonverbal IQ was a significant predictor of CDS emotion recognition scores while Years using CI was a significant predictor of ADS scores. Confusion matrix analyses revealed a dependence of results on specific emotions; for the CDS condition's female talker, participants had high sensitivity (d' scores) to happy and low sensitivity to the neutral sentences while for the ADS condition, low sensitivity was found for the scared sentences. CONCLUSIONS: In general, participants had higher vocal emotion recognition to the CDS condition which also had more variability in pitch and intensity and thus more exaggerated prosody, in comparison to the ADS condition. Results suggest that pediatric CI users struggle with vocal emotion perception in general, particularly to adult-directed speech. The authors believe these results have broad implications for understanding how CI users perceive emotions both from an auditory communication standpoint and a socio-developmental perspective.

Early childhood mental health consultation: Care providers' experiences of the consultative relationship.

This article presents findings from a qualitative research study exploring child care teachers' experiences receiving early childhood mental health consultation (ECMHC). As an emerging intervention in early childhood education, ECMHC is already yielding promising results, namely in helping teachers better address challenging behaviors in their classroom and promote a more nurturing classroom environment. However, there remains a lack of personal testimony from teachers who receive this intervention. Considering that teachers are the primary focus of most ECMHC interventions, the purpose of this study was to examine child care teachers' personal experiences receiving consultation. Eight child care teachers were interviewed for this study. Results from this study illuminate key interpersonal processes in the development of the consultant-consultee relationship, indicate what teachers consider to be the most helpful components of consultation, and speak to the challenges that teachers experience in consultation. By examining the personal testimony of child care teachers who have received ECMHC services, consultants and researchers can consider ways to expand and improve future implementation of ECMHC.

Este artículo presenta resultados de un estudio de investigación cualitativa que explora experiencias de los maestros de guardería infantil que reciben la consulta de salud mental en la temprana niñez (ECMHC). Como una intervención que surge en el campo de la educación en la temprana niñez (ECE), la ECMHC está ya mostrando resultados prometedores, particularmente al ayudar a maestros a manejar mejor las conductas que son un desafío en la sala de clases y a promover un ambiente más acogedor dentro del aula. Sin embargo, se nota aún la falta de testimonios personales por parte de los maestros que reciben esta intervención. Considerando que los maestros son el enfoque principal de la mayoría de las intervenciones ECMHC, el propósito de este estudio fue examinar las experiencias de los maestros de guardería infantil que reciben esta consulta. Se entrevistaron ocho maestros de guardería infantil para este estudio. Los resultados de este estudio dan luz a procesos interpersonales claves en el desarrollo de la relación entre consulta y consultante, indican lo que los maestros consideran ser los componentes de la consulta que más ayudan, y hablan sobre los retos que los maestros experimentan en el proceso de consulta. Por medio de examinar el testimonio personal de maestros de guardería infantil que han recibido los servicios de ECMHC, los consultantes y los investigadores pueden considerar maneras de expandir y mejorar la futura implementación de ECMHC.

Cet article présente les résultats d'une étude de recherches qualitatives explorant les expériences des puéricultrices de crèches recevant une consultation de santé mentale précoce de l'enfance (abrégé en anglais ECMHC). En tant qu'intervention émergente dans l'éducation de la petite enfance, l'ECMHC offre déjà des résultats promettant, en particulier dans la manière dont elle aide les enseignants à mieux adresser des comportements difficiles dans leur classe et dont elle promeut un environnement éducatif plus chaleureux. Il reste cependant un manque de témoignages personnels d'enseignants ayant reçu cette intervention. Vu que les enseignants sont les premiers ciblés par la plupart des interventions ECMHC, le but de cette étude était d'examiner les expériences personnes des puéricultrices ou puériculteurs recevant l'intervention. Huit enseignants ont été interviewés pour cette étude. Les résultats de cette étude illuminent les processus interpersonnels clés dans le développement de la relation consultant-consulté, indiquent ce que les enseignants considèrent comme étant les composantes les plus importantes de la consultation, et montrent les défis dont les enseignants font l'expérience en consultation. En examinant le témoignage personnel de puéricultrices ou puériculteurs ayant reçu les services ECMHC, les consultants et les chercheurs peuvent considérer des manières d'étendre et d'améliorer la mise en place à venir de l'ECMHC.

Mesalamine did not prevent recurrent diverticulitis in phase 3 controlled trials.

BACKGROUND & AIMS: No therapy has been proven to prevent the recurrence of diverticulitis. Mesalamine has shown efficacy in preventing relapse in inflammatory bowel disease, and there is preliminary evidence that it might be effective for diverticular disease. We investigated the efficacy of mesalamine in preventing recurrence of diverticulitis in 2 identical but separate phase 3, randomized, double-blind, placebo-controlled, multicenter trials (identical confirmatory trials were conducted for regulatory reasons). METHODS: We evaluated the efficacy and safety of multimatrix mesalamine vs placebo in the prevention of recurrent diverticulitis in 590 (PREVENT1) and 592 (PREVENT2) adult patients with ≥1 episodes of acute diverticulitis in the previous 24 months that resolved without surgery. Patients received mesalamine (1.2 g, 2.4 g, or 4.8 g) or placebo once daily for 104 weeks. The primary end point was the proportion of recurrence-free patients at week 104. Diverticulitis recurrence was defined as surgical intervention at any time for diverticular disease or presence of computed tomography scan results demonstrating bowel wall thickening (>5 mm) and/or fat stranding consistent with diverticulitis. For a portion of the study, recurrence also required the presence of abdominal pain and an increase in white blood cells. RESULTS: Mesalamine did not reduce the rate of diverticulitis recurrence at week 104. Among patients in PREVENT1, 53%-63% did not have disease recurrence, compared with 65% of those given placebo. Among patients in PREVENT2, 59%-69% of patients did not have disease recurrence, compared with 68% of those given placebo. Mesalamine did not reduce time to recurrence, and the proportions of patients requiring surgery were comparable among treatment groups. No new adverse events were identified with mesalamine administration. CONCLUSIONS: Mesalamine was not superior to placebo in preventing recurrent diverticulitis. Mesalamine is not recommended for this indication. ClinicalTrials.gov ID: NCT00545740 and NCT00545103.

The Human Affectome.

Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.

Personality and emotion dysregulation profiles predict differential engagement in a wide range of health-risk behaviors.

OBJECTIVE: Health-risk behaviors have an unclear etiology and college students have elevated risk for engagement. Emotion dysregulation and several personality dimensions have been implicated in health-risk behaviors, but these constructs have rarely been studied together. Further, it is unknown if different types of health-risk behaviors have distinct etiologies. PARTICIPANTS: 2077 college students completed a cross-sectional survey. METHODS: Latent profile analysis discerned classes of participants from emotion dysregulation and personality dimensions. Differential engagement in self-injury, suicidality, disordered eating, substance misuse, and unprotected sex was evaluated across classes. RESULTS: Three classes were identified, which were primarily distinguished by emotion dysregulation, urgency, and neuroticism. Health-risk behaviors generally increased across classes with increasing emotion-related constructs. Self-injury and suicidality demonstrated different patterns than other health-risk behaviors. CONCLUSIONS: Results elucidate heterogeneity in health-risk behavior engagement. Focusing on emotional difficulties may be more important for reducing self-injury and suicidality than disordered eating, substance misuse, and risky sex.

Once-daily MMX(®) mesalamine for endoscopic maintenance of remission of ulcerative colitis.

OBJECTIVES: Treatment with mesalamine to maintain endoscopic remission (mucosal healing) of ulcerative colitis (UC) has been shown to reduce the risk of relapse and is the recommended first-line maintenance therapy. To improve treatment adherence, a mesalamine formulation that can be administered once-daily, MMX(®) mesalamine (Lialda; Shire Pharmaceuticals LLC, Wayne, PA), was developed. This study was conducted to determine the efficacy and safety of once-daily MMX mesalamine compared with twice-daily delayed-release mesalamine (Asacol; Warner Chilcott, Dublin, Ireland) for maintaining endoscopic remission in patients with UC. METHODS: A multicenter, randomized, double-blind, 6-month, active-control trial was conducted to assess the non-inferiority of once-daily MMX mesalamine 2.4 g/day compared with twice-daily delayed-release mesalamine at a total daily dose of 1.6 g/day in patients with UC in endoscopic remission. The primary end point was maintenance of endoscopic remission at month 6 in the per-protocol (PP) population. RESULTS: Overall, 826 patients were randomized and dosed. The primary objective (non-inferiority) was met. At month 6, 83.7 and 77.8% of patients receiving MMX mesalamine in the PP and intent-to-treat (ITT) populations, respectively, had maintained endoscopic remission compared with 81.5% (PP) and 76.9% (ITT) of patients receiving delayed-release mesalamine (95% confidence interval for difference: -3.9%, 8.1% (PP); -5.0%, 6.9% (ITT)). Time to relapse was not significantly different between the two treatment groups (log-rank test, P=0.5116 (PP); P=0.5455 (ITT)). The proportion of patients with adverse events was 37.1 and 36.0% in patients receiving MMX mesalamine and delayed-release mesalamine, respectively. CONCLUSIONS: Once-daily dosing of MMX mesalamine 2.4 g/day was shown to be well tolerated and non-inferior to twice-daily dosing with delayed-release mesalamine 1.6 g/day for maintenance of endoscopic remission in patients with UC.

School Readiness Test and Intelligence in Preschool as Predictors of Middle School Success: Result of an Eight-Year Longitudinal Study.

Research has shown that the development of cognitive and social skills in preschool predicts school readiness in kindergarten. However, most longitudinal studies are short-term, tracking children's development only through the early elementary school years. This study aims to investigate the long-term impact of preschool predictors, intelligence, and mothers' education on grade six school performance. This study presents the results of an eight-year-long longitudinal study. The sample includes 202 Hungarian children (89 boys) from a disadvantaged region of southeastern Hungary. The independent variables were the preschool measures: DIFER (Diagnostic System for Assessing Development), a widely used, standardized school readiness test that measures cognitive and social skills; the Raven intelligence test; and socioeconomic status. The dependent variables in grade six were: National Standardized tests in math and reading (NABC, National Assessment of Basic Competencies) and school grades (GPA). Cronbach's alpha reliability of each test is above 0.76. Correlations and a series of multiple regressions were used for analysis. All three independent variables have significant predictive power for school performance in sixth grade. DIFER skills were the best predictors for reading achievement, intelligence for math achievement, and GPA was best predicted by mothers' education. The results show that developing preschool skills, mothers' education and IQ in preschool are essential to long-term learning success.

Multi-Voiced Music Bypasses Attentional Limitations in the Brain.

Attentional limits make it difficult to comprehend concurrent speech streams. However, multiple musical streams are processed comparatively easily. Coherence may be a key difference between music and stimuli like speech, which does not rely on the integration of multiple streams for comprehension. The musical organization between melodies in a composition may provide a cognitive scaffold to overcome attentional limitations when perceiving multiple lines of music concurrently. We investigated how listeners attend to multi-voiced music, examining biological indices associated with processing structured versus unstructured music. We predicted that musical structure provides coherence across distinct musical lines, allowing listeners to attend to simultaneous melodies, and that a lack of organization causes simultaneous melodies to be heard as separate streams. Musician participants attended to melodies in a Coherent music condition featuring flute duets and a Jumbled condition where those duets were manipulated to eliminate coherence between the parts. Auditory-evoked cortical potentials were collected to a tone probe. Analysis focused on the N100 response which is primarily generated within the auditory cortex and is larger for attended versus ignored stimuli. Results suggest that participants did not attend to one line over the other when listening to Coherent music, instead perceptually integrating the streams. Yet, for the Jumbled music, effects indicate that participants attended to one line while ignoring the other, abandoning their integration. Our findings lend support for the theory that musical organization aids attention when perceiving multi-voiced music.

Emotional development is complicated.

In this commentary on the special issue on emotional development, I focus on the papers by Holodynski and Seeger (2019) and by Hoemann, Xu, and Barrett (2019). I suggest that although understanding our emotions is an important part of emotional development; emotional development cannot be reduced to concept development, even when such concepts include understanding of physiological and behavioral responses and feelings. I highlight the importance of emotions as promoters of immediate and urgent responses that cannot and should not be preceded by contemplative thought, and as the core of who we are as individuals, and I discuss the many levels at which emotional development occurs-from gene to behavior. I recommend that interdisciplinary teams work together to enable research that helps the field in better understanding emotional development in its full complexity. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Time to Symptom Resolution in Ulcerative Colitis With Multimatrix Mesalazine Treatment: A Pooled Analysis.

BACKGROUND AND AIMS: Patients with ulcerative colitis [UC] require rapid and complete relief of symptoms, particularly stool frequency and rectal bleeding. The aim of this study was to determine time to symptom resolution in patients with UC during induction treatment with multimatrix mesalazine, and the proportion of patients remaining symptom-free and in endoscopic remission after 12 months of maintenance. METHODS: A pooled analysis of 5 pivotal clinical trials, including >1300 patients, evaluating multimatrix mesalazine for treatment of mild-to-moderate active UC was conducted. Time to symptom resolution was defined as the period between first drug dosage date and first 3 consecutive days of induction therapy when the patient achieved a score of 0 [normal] on a modified UC Disease Activity Index for stool frequency and/or rectal bleeding. RESULTS: Median [95% confidence interval] time to resolution of stool frequency was 52 (45-not estimable [NE]) days for placebo versus 38 [34-41] days for multimatrix mesalazine [combined dose groups, 2.4 or 4.8 g/day]; time to resolution of rectal bleeding was 35 [20-NE] days for placebo versus 15 [14-17] days for multimatrix mesalazine [combined dose groups]. Among those who achieved resolution of both stool frequency and rectal bleeding during induction, 67.4% maintained symptom scores of 0 at Month 12. No relationship was observed between rapidity of symptom resolution during induction treatment and achievement of endoscopic remission at Month 12. CONCLUSIONS: Induction with multimatrix mesalazine provided rapid and prolonged symptom resolution in addition to endoscopic remission at Month 12.

Mapping the interconnected neural systems underlying motivation and emotion: A key step toward understanding the human affectome.

As a part of a larger Affectome Project (http://neuroqualia.org/background.php) with an overarching goal of mapping and redefining biological substrates of feelings and emotions, we explored the neural underpinnings for the functions of motivation and emotion. Historically emotion and motivation have been placed into distinct neural circuits and examined separately. We propose a novel view of significant neural convergence of emotion and motivation, in contrast to conventional neural-based frameworks emphasizing segregation. Evidence from diverse research areas in emotion and motivation was reviewed, pinpointing key neural regions of overlap. The findings support important neural sharing between emotion and motivation, suggesting that these two functions are tightly intertwined with one another in the brain. Neural overlap does not necessarily imply continuous functional overlap. Even if identical brain regions/systems are activated for motivation and emotion, this activation may involve distinct and unique patterns of connection and information flow as the network shifts functionality. This review highlights the crucial importance of further research to explicate the patterns and modes of responding of these overlapping systems.

Impact of Auditory-Motor Musical Training on Melodic Pattern Recognition in Cochlear Implant Users.

OBJECTIVE: Cochlear implant (CI) users struggle with tasks of pitch-based prosody perception. Pitch pattern recognition is vital for both music comprehension and understanding the prosody of speech, which signals emotion and intent. Research in normal-hearing individuals shows that auditory-motor training, in which participants produce the auditory pattern they are learning, is more effective than passive auditory training. We investigated whether auditory-motor training of CI users improves complex sound perception, such as vocal emotion recognition and pitch pattern recognition, compared with purely auditory training. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary academic center. PATIENTS: Fifteen postlingually deafened adults with CIs. INTERVENTION(S): Participants were divided into 3 one-month training groups: auditory-motor (intervention), auditory-only (active control), and no training (control). Auditory-motor training was conducted with the "Contours" software program and auditory-only training was completed with the "AngelSound" software program. MAIN OUTCOME MEASURE: Pre and posttest examinations included tests of speech perception (consonant-nucleus-consonant, hearing-in-noise test sentence recognition), speech prosody perception, pitch discrimination, and melodic contour identification. RESULTS: Participants in the auditory-motor training group performed better than those in the auditory-only and no-training (p < 0.05) for the melodic contour identification task. No significant training effect was noted on tasks of speech perception, speech prosody perception, or pitch discrimination. CONCLUSIONS: These data suggest that short-term auditory-motor music training of CI users impacts pitch pattern recognition. This study offers approaches for enriching the world of complex sound in the CI user.

Association Between Flat-Panel Computed Tomographic Imaging-Guided Place-Pitch Mapping and Speech and Pitch Perception in Cochlear Implant Users.

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

A tonal-language benefit for pitch in normally-hearing and cochlear-implanted children.

In tonal languages, voice pitch inflections change the meaning of words, such that the brain processes pitch not merely as an acoustic characterization of sound but as semantic information. In normally-hearing (NH) adults, this linguistic pressure on pitch appears to sharpen its neural encoding and can lead to perceptual benefits, depending on the task relevance, potentially generalizing outside of the speech domain. In children, however, linguistic systems are still malleable, meaning that their encoding of voice pitch information might not receive as much neural specialization but might generalize more easily to ecologically irrelevant pitch contours. This would seem particularly true for early-deafened children wearing a cochlear implant (CI), who must exhibit great adaptability to unfamiliar sounds as their sense of pitch is severely degraded. Here, we provide the first demonstration of a tonal language benefit in dynamic pitch sensitivity among NH children (using both a sweep discrimination and labelling task) which extends partially to children with CI (i.e., in the labelling task only). Strong age effects suggest that sensitivity to pitch contours reaches adult-like levels early in tonal language speakers (possibly before 6 years of age) but continues to develop in non-tonal language speakers well into the teenage years. Overall, we conclude that language-dependent neuroplasticity can enhance behavioral sensitivity to dynamic pitch, even in extreme cases of auditory degradation, but it is most easily observable early in life.

Botulinum toxin and the facial feedback hypothesis: can looking better make you feel happier?

The facial feedback hypothesis suggests that muscular manipulations which result in more positive facial expressions may lead to more positive emotional states in affected individuals. In this essay, we hypothesize that the injection of botulinum toxin for upper face dynamic creases might induce positive emotional states by reducing the ability to frown and create other negative facial expressions. The use of botulinum toxin to pharmacologically alter upper face muscular expressiveness may curtail the appearance of negative emotions, most notably anger, but also fear and sadness. This occurs via the relaxation of the corrugator supercilii and the procerus, which are responsible for brow furrowing, and to a lesser extent, because of the relaxation of the frontalis. Concurrently, botulinum toxin may dampen some positive expressions like the true smile, which requires activity of the orbicularis oculi, a muscle also relaxed after toxin injections. On balance, the evidence suggests that botulinum toxin injections for upper face dynamic creases may reduce negative facial expressions more than they reduce positive facial expressions. Based on the facial feedback hypothesis, this net change in facial expression may potentially have the secondary effect of reducing the internal experience of negative emotions, thus making patients feel less angry, sad, and fearful.

Tonguing behaviours in persons with Down syndrome: moderator of the effects of negative mood on behaviour problems.

BACKGROUND: There is concern that tongue protrusion may be maladaptive in individuals with Down syndrome (DS). However, tonguing and other self-manipulatory behaviours have been shown to contribute to emotion regulation in children without disabilities. METHOD: Sixty individuals with intellectual disability (40 with DS, 20 of mixed aetiology) and their parents were videotaped during a puzzle-book task. Empirical relationships between observed tongue protrusion, other observed nonverbal behaviours, and reported negative mood, maladaptive behaviours, and stress-inducing characteristics were assessed. RESULTS: Individuals with DS and reported negative mood who did not engage in tonguing were more likely to display internalising and externalising behaviours and stress-inducing characteristics, whereas those who did engage in tonguing were not more likely to display these characteristics. CONCLUSION: These findings are consistent with the possibility that tongue protrusion serves an emotion regulation function for individuals with DS.