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This study aimed to explore how people with myasthenia gravis experience impairments in vision, dizziness, hearing, and fatigue, and how these relate to balance confidence, community participation, and health-related quality of life. Additionally, this study investigated the utilisation and perception of the allied health role in managing these impairments in the Australian context. Visual and hearing impairments, along with fatigue, were found to be correlated with health-related quality of life and community participation to varying degrees, while visual impairment and dizziness were correlated with balance confidence. Perception and utilisation of allied health professionals was variable; common barriers to better utilisation included participant perception of clinicians having poor knowledge around myasthenia gravis, previous poor experiences with clinicians, uncertainty about the clinicians' role, and lack of awareness that symptoms were associated with myasthenia gravis. Further research exploring clinicians' knowledge of myasthenia gravis is recommended, along with education for people with the disease about symptoms associated and how to appropriately access care. [ABSTRACT FROM AUTHOR]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jenvman.2007.03.023 Byline: J. Morris (a), A.P. Bailey (b), C.S. Lawson (b), P.B. Leeds-Harrison (c), D. Alsop (d), R. Vivash (d) Keywords: Flood defence; Land use; Washlands; Agri-environment Abstract: In many river floodplains in the UK, there has been a long history of flood defence, land reclamation and water regime management for farming. In recent years, however, changing European and national policies with respect to farming, environment and flood management are encouraging a re-appraisal of land use in rural areas. In particular, there is scope to develop, through the use of appropriate promotional mechanisms, washland areas, which will simultaneously accommodate winter inundation, support extensive farming methods, deliver environmental benefits, and do this in a way which can underpin the rural economy. This paper explores the likely economic impacts of the development of flood storage and washland creation. In doing so, consideration is given to feasibility of this type of development, the environmental implications for a variety of habitats and species, and the financial and institutional mechanisms required to achieve implementation. Author Affiliation: (a) Department of Natural Resources, Building 42a, Cranfield University, Cranfield, Bedford MK43 0AL, UK (b) Department of Agriculture, The University of Reading, Earley Gate, Reading RG6 6AR, UK (c) National Soil Resources Institute, Cranfield University, Silsoe, Bedfordshire MK45 4DT, UK (d) River Restoration Centre, Silsoe Campus, Silsoe, Bedfordshire MK45 4DT, UK Article History: Received 9 August 2006; Revised 29 January 2007; Accepted 10 March 2007

Gravity-driven sliding of sediments down subaqueous slopes results in mass transport deposits (MTDs) recognised both in outcrop studies and from offshore margins where they may extend for 100's km. While seismic sections may reveal the large-scale geometry of such features, they fail to capture some of the structural and stratigraphic detail necessary for a fuller understanding of the processes involved. Using the late Pleistocene Lisan Formation sediments exposed around the Dead Sea Basin as our case study, we show that interplay between bed-parallel translational slides and associated normal faults may result in stratigraphic repetition through a process we term 'slide stacking'. This mechanism, where retrogressive slope failure results in slides cutting across earlier normal faults, produces repeated sequences with older over younger stratigraphic relationships more usually attributed to compressional (thrust) deformation. Slide stacking results in a ∼25% attenuation of the upper sequence above the basal shear surface (BSS), which is itself associated with liquefaction and fluidised sediment. The displaced stratigraphy above the BSS is also marked by sedimentary rafts that are broken into blocks by normal faults and become increasingly separated from one another during downslope translation. The hangingwalls of synthetic listric faults form roll-overs that are progressively tightened towards the underlying BSS to create overturned anticlines that apparently verge upslope. The paradoxical situation therefore arises of contractional geometries, such as older over younger stratigraphic repetition across slides, and upslope-verging recumbent anticlines with locally overturned limbs being created during downslope-directed gravity-driven extension. The downslope margin of the slide stack displays earlier normal faults that created scarps where much of the sedimentary buttress, that would otherwise support the toe of the slide, was removed. Consequently, this leads to predominantly superficial and unrestrained downslope slipping, resulting in very localised contractional geometries that do not balance the overall extension, as in classical gravity-failure models. Localised deformation of the sedimentary sequence that unconformably overlies the slide stack indicates that downslope translation continued after the initial rapid slope failure, suggesting that the entire MTD remained inherently unstable. Slide stacking operates at km scales with stratigraphic repetition governed by the throw of earlier normal faults and the amount of downslope translation. [Display omitted] • We introduce a new mechanism of slide-stacking that results in repetition of stratigraphic sequences in extensional settings marked by gravity-driven slides and MTDs. • Repetition of beds during slide stacking creates 'contractional-style' structures linked to extension. • Slide Stacking is marked by bed-parallel slides cutting earlier normal faults resulting in repeated sequences, older over younger stratigraphic relationships, and attenuated beds. • Slide Stacking is akin to 'terracotta tiles slipping over one another down a pitched roof' with translated 'tiles' of sediment infilling space evacuated along earlier normal faults. • The recognition of slide stacking on seismics may be confused with repeated thrust slices that would also form downslope of headwall scarps. [ABSTRACT FROM AUTHOR]

This exploratory study seeks to investigate the collection practices of English Literature librarians with regard to contemporary fiction, including popular genres such as detective fiction and ‘chick lit’. Results of an online survey suggest literature librarians are increasingly receptive to the acquisition of popular genres and identify the importance of adding popular titles to the collection. [ABSTRACT FROM AUTHOR]

The correct identification of 'sedimentary' folds and fabrics created during gravity-driven deformation of unlithified successions from those 'tectonic' structures formed during regional deformation is essential when interpreting geological histories preserved within the rock record. This topic has become increasingly relevant over the past 40 years as improved seismic resolution and coverage have led to the realisation that significant portions of unlithified sediments along the continental margins undergo gravity-driven deformation to create mass transport deposits (MTD's). The late-Pleistocene Lisan Formation, exposed in the Dead Sea Basin, was chosen as a case study because it remains poorly lithified, and structures developed within it are unequivocally related to 'soft-sediment' deformation (SSD) created when the succession underwent downslope-directed movement. This work tests various assertions previously used to deduce if structures were formed in unlithified sediments or during 'hard-rock' deformation (HRD) associated with subsequent tectonism. Within the Lisan Formation, we describe veins developed along fractures, and cleavage forming axial-planar to folds, that are structures previously assumed to be restricted to HRD. In addition, truncated folds, incorporation of deformed fragile fragments into overlying sediment, and cross-cutting clastic dykes are all indicative of SSD. The key diagnostic feature in establishing SSD is the sedimentary infill of irregular erosive surfaces that truncate underlying structures. Although compaction and diagenesis have not played a significant role in the case study, caution should be exercised when examining structures preserved in the rock record as folds and fabrics originally created by SSD may be considerably enhanced and altered where significant overburden exists. Image 1 • Soft-sediment deformation (SSD) is distinguished from hard-rock deformation (HRD). • This work tests previous assertions used to identify SSD and HRD. • SSD develops in gravity-driven mass transport deposits (MTDs). • Folds in SSD may develop axial-planar fabrics and mineralisation. • Key criteria in establishing SSD is truncation of structures by irregular erosive surfaces. [ABSTRACT FROM AUTHOR]

We investigate the intra- and inter-crystalline deformation processes involved in sheath fold development combining complementary fabric analysis techniques and 3D modelling by neutron tomography. The investigated sheath fold is a multi-layered sub-metre scale single-eye structure, developed in metapsammites from the Ben Hope Nappe, overlying the Moine Thrust Zone of NW Scotland. Crystallographic Preferred Orientations (CPOs) of quartz and biotite were acquired through a Neutron Diffractometer and an SEM-EBSD system to compare the full-fabric of the main phases and the active slip systems for an "in situ" structural control. Combined with orientation maps and grain size maps, results show that, despite the different structural positions of the investigated microdomains (upper vs lower fold limbs, inner vs outer sheath closures, distance from hinge of the sheath fold), quartz and biotite deformed uniformly, suggesting a constant differential stress and orientation of the kinematic vorticity axis. Previously recognized detachment horizons within the sampled sheath fold do not affect the fabric patterns recorded by quartz and biotite. This may be interpreted in two different ways: i) detachments formed during earlier active folding and prior to passive amplification of folds associated with more uniform flow to create the sheath fold geometries; ii) the quartz c-axis patterns are coeval with a late deformation phase (loading of the orogenic wedge) that pervasively obliterated the previous fabric and therefore did not preserve the active folding component. Several pieces of evidence reported here, such as top-to-SE normal-shear sense which is opposite to the regional kinematics, are more supportive of the second hypothesis. The analysis of mineral textures provides an improved dataset for the whole sheath fold and increases our understanding of recrystallization mechanisms active in shear zones. [Display omitted] • We investigate the 3D geometry and kinematics within sheath folds to determine potential flow variations. • CPOs of quartz and biotite are acquired through a Neutron Diffractometer and an SEM-EBSD system. • CPO maintains a constant shear sense throughout the fold with no evidence of active folding preserved. • Top-to-the SE normal-shear sense opposite to regional thrust kinematics suggests a late peak temperature extension phase [ABSTRACT FROM AUTHOR]

Despite the potential of sandstone-filled normal faults to significantly influence fluid transmissivity within reservoirs and the shallow crust, they have to date been largely overlooked. Fluidized sand, forcefully intruded along normal fault zones, markedly enhances the transmissivity of faults and, in general, the connectivity between otherwise unconnected reservoirs. Here, we provide a detailed outcrop description and interpretation of sandstone-filled normal faults from different stratigraphic units in central California. Such faults commonly show limited fault throw, cm to dm wide apertures, poorly-developed fault zones and full or partial sand infill. Based on these features and inferences regarding their origin, we propose a general classification that defines two main types of sandstone-filled normal faults. Type 1 form as a consequence of the hydraulic failure of the host strata above a poorly-consolidated sandstone following a significant, rapid increase of pore fluid over-pressure. Type 2 sandstone-filled normal faults form as a result of regional tectonic deformation. These structures may play a significant role in the connectivity of siliciclastic reservoirs, and may therefore be crucial not just for investigation of basin evolution but also in hydrocarbon exploration. [ABSTRACT FROM AUTHOR]

Piggyback or foreland-propagating thrust sequences, where younger thrusts develop in the footwalls of existing thrusts, are generally assumed to be the typical order of thrust development in most orogenic settings. However, overstep or ‘break-back’ sequences, where later thrusts develop above and in the hangingwalls of earlier thrusts, may potentially form during cessation of movement in gravity-driven mass transport deposits (MTDs). In this study, we provide a detailed outcrop-based analysis of such an overstep thrust sequence developed in an MTD in the southern Dead Sea Basin. Evidence that may be used to discriminate overstep thrusting from piggyback thrust sequences within the gravity-driven fold and thrust belt includes upright folds and forethrusts that are cut by younger overlying thrusts. Backthrusts form ideal markers that are also clearly offset and cut by overlying younger forethrusts. Portions of the basal detachment to the thrust system are folded and locally imbricated in footwall synclines below forethrust ramps, and these geometries also support an overstep sequence. However, new ‘short-cut’ basal detachments develop below these synclines, indicating that movement continued on the basal detachment rather than it being abandoned as in classic overstep sequences. Further evidence for ‘synchronous thrusting’, where movement on more than one thrust occurs at the same time, is provided by displacement patterns on sequences of thrust ramp imbricates that systematically increases downslope towards the toe of the MTD. Older thrusts that initiate downslope in the broadly overstep sequence continue to move and therefore accrue greater displacements during synchronous thrusting. Our study provides a template to help distinguish different thrust sequences in both orogenic settings and gravity-driven surficial systems, with displacement patterns potentially being imaged in seismic sections across offshore MTDs. [ABSTRACT FROM AUTHOR]

Three hydrocarbon reservoir cores were obtained from a high temperature non-waterflooded offshore reservoir. All three cores were taken from a 56-m section of the same well. Under sterile conditions, DNA was recovered from the inner section of each core and the microbial community profiles were deduced by sequencing the 16S rRNA marker gene. Taxonomic analysis of the Operational Taxonomic Units (OTUs) recovered, identified a high proportion of members from the Oxalobacteraceae family (38.5%) followed by members from the Pseudomonadaceae and Comamonadaceae families (29.1% and 12.8% respectively). Representatives of all these families are known to degrade hydrocarbons as well as to use nitrate as a terminal electron acceptor under anaerobic conditions. Assuming these predominant microorganisms are indigenous to the reservoir and have not been introduced with the drilling fluids they might exhibit a relatively rapid response to nitrate injection for souring control. On the contrary, very few sulfate reducing bacteria (SRBs) were detected in these cores (<0.01%) suggesting unfavorable conditions to SRB growth. This however may well rapidly change upon seawater injections in the absence of nitrate addition. This study sets the microbial profiling “baseline” for the prediction of souring through modelling as well as for any upcoming biomonitoring surveys. [ABSTRACT FROM AUTHOR]

The trends of faults and fractures in overburden next to a salt diapir are generally considered to be either parallel to the salt margin to form concentric patterns, or at right angles to the salt contact to create an overall radial distribution around the diapir. However, these simple diapir-related patterns may become more complex if regional tectonics influences the siting and growth of a diapir. Using the Sedom salt wall in the Dead Sea Fault system as our case study, we examine the influence of regional strike-slip faulting on fracture patterns around a salt diapir. This type of influence is important in general as the distribution and orientation of fractures on all scales may influence permeability and hence control fluid and hydrocarbon flow. Fractures adjacent to the N-S trending salt wall contain fibrous gypsum veins and injected clastic dykes, attesting to high fluid pressures adjacent to the diapir. Next to the western flank of the salt wall, broad (∼1000 m) zones of upturn or ‘drape folds’ are associated with NW-SE striking conjugate extensional fractures within the overburden. Within 300 m of the salt contact, fracture patterns in map view display a progressive ∼30°–35° clockwise rotation with more NNW-SSE strikes immediately adjacent to the salt wall. While some extensional faults display growth geometries, indicating that they were syn-depositional and initiated prior to tilting of beds associated with drape folding, other fractures display increasing dips towards the salt, suggesting that they have formed during upturn of bedding near the diapir. These observations collectively suggest that many fractures developed to accommodate rotation of beds during drape folding. Extensional fractures in the overburden define a mean strike that is ∼45° anticlockwise (counter-clockwise) of the N-S trending salt wall, and are therefore consistent with sinistral transtension along the N-S trending Sedom Fault that underlies the salt wall. Our outcrop analysis reveals fracture geometries that are related to both tilting of beds during drape folding, and regional strike-slip tectonics. The presence of faults and fractures that interact with drape folds suggests that deformation in overburden next to salt cannot be simply pigeon-holed into ‘end-member’ scenarios of purely brittle faulting or viscous flow. [ABSTRACT FROM AUTHOR]

While much research has recently been focussed on downslope-verging systems of gravity-driven fold and thrust belts within mass transport deposits (MTDs), rather less attention has been paid to back thrusts, which are defined as displaying the opposite vergence to the main transport direction in thrust systems. A fundamental question arises over whether back thrusts in downslope-verging MTDs record actual movement back upslope. In order to address this issue, we have examined exceptional outcrops of Pleistocene fold and thrust systems developed in MTDs around the Dead Sea Basin. Back thrusts can be interpreted in terms of a ‘ downslope-directed underthrust model’ , where material moves down slope and is driven into the footwall of the back thrust, resulting in the ‘jacking up’ of the largely passive hangingwall. Our data support this underthrust model and include the observation that stratigraphic units may be markedly thickened (up to 250%) in the footwall of back thrusts. This thickening is a consequence of pure shear lateral compaction as the ‘wedge’ of sediment is driven into the footwall to create an underthrust. In addition, back thrusts may be rotated as new back thrusts form in their footwalls, ultimately resulting in overturned thrusts. The observation that steeper back thrusts typically accommodate less displacement than gently-dipping back thrusts suggests that steepening occurred during back thrusting, and is therefore a consequence of ‘footwall wedging’. Contrary to some recent interpretations, we demonstrate that back thrusts can develop in gravity-driven systems and cannot therefore be used to distinguish different emplacement mechanisms for MTDs. [ABSTRACT FROM AUTHOR]

Cognitive and brain reserve are well studied in the context of age-associated cognitive impairment and dementia. However, there is a paucity of research that examines the role of cognitive or brain reserve in delirium. Indicators (or proxy measures) of cognitive or brain reserve (such as brain size, education, and activities) pose challenges in the context of the long prodromal phase of Alzheimer disease but are diminished in the context of delirium, which is of acute onset. This article provides a review of original articles on cognitive and brain reserve across many conditions affecting the central nervous system, with a focus on delirium. The authors review current definitions of reserve. The authors identify indicators for reserve used in earlier studies and discuss these indicators in the context of delirium. The authors highlight future research directions to move the field ahead. Reserve may be a potentially modifiable characteristic. Studying the role of reserve in delirium can advance prevention strategies for delirium and may advance knowledge of reserve and its role in aging and neuropsychiatric disease generally. [ABSTRACT FROM AUTHOR]

While imaging of mass transport deposits (MTDs) by seismic reflection techniques commonly reveals thrusts and large blocks that affect entire deposits, associated systems of folds are generally less apparent as they are typically below the limits of seismic resolution. However, such sub-seismic scale structures are important as they permit the direction of emplacement, gross kinematics and internal strain within MTDs to be determined. Here we present a rigorous description of two outcrop-scale MTDs exposed in La Peña gorge, northwestern Argentina. These Carboniferous MTDs enable us to illustrate structural changes from a compressional domain, marked by sets of imbricated sandstone layers, into an extensional domain, characterized by sheared blocks of sandstone embedded in a finer matrix. Folds may be progressively modified during slump translation, resulting in asymmetric folds, which undergo subsequent deformation leading to sheared fold limbs together with detached and rotated fold hinges. In order to constrain transport directions within the MTDs, we measured fold hinges, mud clast alignment, and thrust planes as kinematic indicators. We propose emplacement models for both MTDs based on the overall deformational behaviour of sandstone beds during translation. The first model is based on the internal geometries and structures of a fault-dominated MTD, and the second model is based on layer-normal shearing in a fold-dominated MTD. [ABSTRACT FROM AUTHOR]

Improvements in seismic reflection data from gravity-driven fold and thrust systems developed in offshore Mass Transport Deposits (MTDs) reveal a number of significant features relating to displacement along thrusts. However, the data are still limited by the resolution of the seismic method, and are unable to provide detail of local fold and thrust processes. Investigation of exceptional gravity-driven contractional structures forming part of MTDs in lacustrine deposits of the Dead Sea Basin, enables us to present the first detailed outcrop analysis of fold and thrust systems cutting unlithified ‘soft’ sediments. We employ a range of established geometric techniques to our case study, including dip isogons, fault-propagation fold charts and displacement-distance diagrams previously developed for investigation of thrusts and folds in lithified rocks. Fault-propagation folds in unlithified sediments display tighter interlimb angles compared to models developed for lithified sequences. Values of stretch, which compares the relative thickness of equivalent hangingwall and footwall sequences measured along the fault plane, may be as low as only 0.3, which is significantly less than the minimum 0.5 values reported from thrusts cutting lithified rocks, and reflects the extreme variation in stratigraphic thickness around thrust-related folds. We suggest that the simple shear component of deformation in unlithified sediments may modify the forelimb thickness and interlimb angles to a greater extent than in lithified rocks. The average spacing of thrust ramps and the thickness of the thrust sequence display an approximate 5:1 ratio across a range of scales in MTDs. In general, thicker hangingwall and footwall sequences occur with larger thrust displacements, although displacement patterns on thrusts cutting unlithified (yet cohesive) sediments are more variable than those in lithified rocks. Line-length restoration of thrust systems in MTDs reveals 42% shortening, which reduces to 35% in overlying beds. A 23% reduction in shortening by folding and thrusting along individual thrusts suggests that heterogeneous lateral compaction may increase by ∼10% towards the sediment surface. Thrust systems cutting unlithified sediments display distinct steps in cumulative displacement-distance plots representing increased rates of slip along the floor thrust, while displacement-distance plots along individual thrusts also reveal ‘horizontal steps’ relating to lithological variation. Competent units cut by thrust ramps may display the greatest displacement, which then progressively reduces both upward and sometimes downward along the ramp. This relationship demonstrates that ramps do not necessarily propagate upwards from the underlying flat as in some traditional models, but rather initiate by offset of competent horizons in the hangingwall of the detachment. Critical taper angles in MTDs may be an order of magnitude less than in accretionary complexes or lithified rocks. Overall, thrusts cutting unlithified sediments in MTDs display more variable displacement, and more pronounced displacement gradients toward fault tips, compared to thrusts cutting lithified sequences. [ABSTRACT FROM AUTHOR]

Despite the recognition that bed-parallel slip (BPS) must operate during gravity-driven deformation of basinal sediments, there is a general paucity of detailed outcrop-based observations to characterise and detect such a process. We therefore present detailed timing relationships between BPS and steeper dip-slip faults that were both created during seismically-triggered downslope-directed movement of sediments. Using the late Pleistocene Lisan Formation that was deposited around the Dead Sea Basin as our case study, we show that 'sub-seismic' decametric scale BPS planes may pre-date, post-date, or operate coevally with steeper faults generated as sediments slip downslope towards the depocentre. Older BPS can be recognised by sediment injections and minor folds and fractures, whereas younger BPS displaces marker faults downslope towards the basin. BPS operating coevally with steeper faults results in complex overprinting and development of fault-bound lenses. BPS that forms along single surfaces in the footwall of normal faults becomes separated into two distinct planes in the downthrown hangingwall block, indicating broadly coeval development. Adjacent BPS planes that operate synchronously result in synthetic and antithetic faults that 'hard-link' and transfer displacement between BPS planes. Attenuated bedding between segments of BPS that overlap and terminate next to one another suggests that 'soft-linkage' also forms between coeval BPS planes. Displacement-length relationships of measured BPS planes plot in the same range as recorded for normal faults, although BPS with larger displacements have relatively 'short' lengths, suggesting that complete BPS planes are missing due to limitations of outcrop size. Although the lack of displaced bedding across BPS makes it largely invisible on seismic sections across large-scale gravity-driven systems, it does potentially contribute towards the apparent inbalance between net extension and contraction observed in many sections across mass transport deposits. In addition, the realisation that BPS interacts with dip-slip faults to create repeated and missing sections that are particularly focussed along earlier deformed horizons and turbidites, has implications for palaeoseismic studies that assume broadly continuous stratigraphy. [Display omitted] • Key criteria are established that characterise bed-parallel slip (BPS) in gravity-driven settings. • BPS may be older, coeval or younger than dip-slip faults also generated by gravity-driven movement. • Adjacent BPS planes are 'hard-linked' through connecting faults or 'soft-linked' via attenuation or folding in intervening sediments. • Displacement - length data from BPS planes shows that length increases non-linearly with displacement. • The net effect of multiple BPS planes on the apparent dip and heave of fault zones has significant influence on section balancing. • BPS creates repeated or missing sections that has consequences for palaeoseismic studies that assume continuous core records. [ABSTRACT FROM AUTHOR]

Although it has long been recognised that passive salt diapirism may encompass sub-ordinate cycles of active diapirism, where sedimentary overburden is periodically shed off the roof of the rising salt, there has been very little study of this process around exposed salt (halite) diapirs. However, the Late Miocene-Pliocene Sedom salt wall, on the western side of the Dead Sea Basin, presents an opportunity for detailed outcrop analysis of diapiric salt and the associated depositional and deformational record of its movement during both passive and active phases of diapirism. The sub-seismic scale record of diapirism includes sedimentary breccia horizons interpreted to reflect sediments being shed off the crest of the growing salt wall, together with exceptional preservation of rotated unconformities and growth faults. Areas of more pronounced dips directed towards the salt wall are capped by unconformities, and interpreted to represent withdrawal basins within the overburden that extend for at least 1500 m from the salt margin. Elsewhere, broad areas of upturn directed away from the salt extend for up to 1250 m and are marked by a sequence of rotated unconformities which are interpreted to bound halokinetic sequences. The margins of the salt wall are defined by steep extensional boundary faults that cut upturned strata, and have enabled rapid and active uplift of the salt since the Holocene. The Sedom salt wall therefore charts the transition from passive growth marked by withdrawal basins, growth faults and unconformities, to more active intrusion associated with major boundary faults that enable the rapid uplift of overburden deposited on top of the salt to ∼100 m above regional elevations in the past 43 ka. Individual cycles of passive and active diapirism occur over timescales of <30 ka, which is up to an order of magnitude less than typically suggested for other settings, and highlights the dynamic interplay between salt tectonics and sedimentation in an environment undergoing rapid fluctuations in water level. [ABSTRACT FROM AUTHOR]

Background & Aims Although several classification systems have been proposed for characterization of Barrett’s esophagus (BE) surface patterns based on narrow-band imaging (NBI), none have been widely accepted. The Barrett’s International NBI Group (BING) aimed to develop and validate an NBI classification system for identification of dysplasia and cancer in patients with BE. Methods The BING working group, composed of NBI experts from the United States, Europe, and Japan, met to develop a validated, consensus-driven NBI classification system for identifying dysplasia and cancer in BE. The group reviewed 60 NBI images of nondysplastic BE, high-grade dysplasia, and esophageal adenocarcinoma to characterize mucosal and vascular patterns visible by NBI; these features were used to develop the BING criteria. We then recruited adult patients undergoing surveillance or endoscopic treatment for BE at 4 institutions in the United States and Europe, obtaining high-quality NBI images and performing histologic analysis of biopsies. Experts individually reviewed 50 NBI images to validate the BING criteria, and then evaluated 120 additional NBI images (not previously viewed) to determine whether the criteria accurately predicted the histology results. Results The BING criteria identified patients with dysplasia with 85% overall accuracy, 80% sensitivity, 88% specificity, 81% positive predictive value, and 88% negative predictive value. When dysplasia was identified with a high level of confidence, these values were 92%, 91%, 93%, 89%, and 95%, respectively. The overall strength of inter-observer agreement was substantial (κ = 0.681). Conclusions The BING working group developed a simple, internally validated system to identify dysplasia and EAC in patients with BE based on NBI results. When images are assessed with a high degree of confidence, the system can classify BE with >90% accuracy and a high level of inter-observer agreement. [ABSTRACT FROM AUTHOR]