Search

Silicon stable isotope ratios (δ $\delta $30Si) of over 150 stream water samples were measured during seven storm events in six small critical zone observatory (CZO) catchments spanning a wide range in climate (sub‐humid to wet, tropical) and lithology (granite, volcanic, and mixed sedimentary). Here we report a cross‐site analysis of this dataset to gain insight into stream δ $\delta $30Si variability across low‐order catchments and to identify potential climate (i.e., runoff), hydrologic, lithologic, and biogeochemical controls on observed stream Si chemical and isotopic signatures. Event‐based δ $\delta $30Si exhibit variability both within and across sites (−0.22‰ to +2.27‰) on the scale of what is observed globally in both small catchments and large rivers. Notably, each site shows distinct δ $\delta $30Si signatures that are preserved even after normalization for bedrock composition. Successful characterization of observed cross‐site behavior requires the merging of two distinct frameworks in a novel combined model describing both non‐uniform fluid transit time distributions and multiple fractionating pathways in application to low‐order catchments. The combined model reveals that site‐specific architecture (i.e., biogeochemical reaction pathways and hydrologic routing) regulates stream silicon export signatures even when subject to extreme precipitation events. Plain Language Summary: Periods of intense infiltration in the form of rainfall (storm events) or snowmelt push large volumes of dilute fluid through catchments, resulting in evacuation of dissolved solutes derived from weathering reactions. These events occur over short (daily or weekly) timescales, but these pulses of solutes released into small streams can represent a majority of total annual mass flux (from 40% to 70%). Despite their importance, storm events remain largely underrepresented in studies of weathering in watersheds due to challenges in obtaining high frequency measurements. Yet extreme events are expected to become more frequent in the future in response to a changing climate. In this study, we evaluate the dependence of weathering‐derived solute export on hydrology and biogeochemical cycling through measurements of dissolved silicon and silicon stable isotope ratios of stream waters collected during seven significant infiltration events in six small catchments spanning different bedrock lithology and climates. Each catchment was found to have unique silicon chemical and isotopic export signatures reflecting site‐specific subsurface water routing and combination of biogeochemical reactions. These signatures were found to be preserved despite the perturbation exerted by such enhanced infiltration and discharge. In this sense, catchments exhibit resilience, bending but not ceding to strong hydrologic forcing. Key Points: Silicon isotope ratios of storm events within small catchments demonstrate site‐specific biogeochemical and hydrological signaturesCross‐site behavior was successfully described using a model combining fluid transit time distributions and multiple fractionation pathwaysSite‐specific critical zone architecture remains the main control over stream silicon export signatures even under extreme precipitation conditions [ABSTRACT FROM AUTHOR]

Objectives: To assess the utility of the Idexx ProCyte Dx® haematology analyser for assessing total nucleated cell count and differential cell counts in canine cerebrospinal fluid. Materials and Methods: Seventy‐three client‐owned dogs undergoing investigations for pyrexia and/or neurological signs were prospectively included. Cerebrospinal fluid samples were assessed using an Idexx ProCyte Dx® analyser and the results were compared to those obtained with the external laboratory reference standard. Results: The Idexx ProCyte Dx® performed with good sensitivity (92.6%) and moderate specificity (67.4%) for total nucleated cell count when compared to the reference standard. Qualitative assessment of the Idexx ProCyte Dx® scatter plots, and quantitative assessment of differential cell counts where available, appeared to correlate well with the external laboratory manual differential cell counts, with a good‐to‐high agreement in 25 of 26 samples (96.2%). Clinical Significance: The Idexx ProCyte Dx® analyser performed well in determining the total nucleated cell count and differential cell counts in canine cerebrospinal fluid when compared to a reference standard of external laboratory analysis, except for cell counts higher than ~1000/μL. As the Idexx ProCyte Dx® currently only provides a cell count in 10 cells/μL increments, software modification may improve agreement between the two methods. As in human medicine, automated methods may prove useful in the future for cerebrospinal fluid analysis in addition to manual assessment, particularly in an emergency setting. [ABSTRACT FROM AUTHOR]

Objectives High-quality biopsy is an essential factor for the successful diagnosis of canine liver disease. The aim of this study was to compare various aspects of biopsies obtained by two different techniques: pretied ligating loop and cup biopsy forceps. Materials and Methods Fifteen client-owned dogs underwent laparoscopic liver biopsies for diagnosis of liver disease. Biopsies were obtained from the same liver lobe using a pre-tied ligating loop and cup biopsy forceps. Biopsy weight, volume, histological value and surgical time were compared between the two techniques. Surgical complications were recorded. Results Samples obtained with the pre-tied ligating loop were significantly heavier and larger in volume than those obtained with cup biopsy forceps. Samples obtained with the ligating loop contained significantly more portal tracts and less crush and fragmentation artefacts. The time required to obtain a liver biopsy with the pre-tied ligating loop was approximately double that of the cup biopsy forceps technique. Clinical Significance The use of a pre-tied ligating loop is a good alternative to the cup biopsy forceps technique when acquiring laparoscopic liver biopsies in dogs. [ABSTRACT FROM AUTHOR]

Elongation of randomly distributed fold segments and their potential linkage are important for hydrocarbon exploration because it can greatly influence the morphology of the reservoir and both migration and accumulation of hydrocarbons in antiformal traps. Here we study the effects of surface processes and the presence of a topographic slope on the different linkage modes that can occur, and how these parameters affect the required horizontal offset for perturbations to link. The proposed numerical model represents a sedimentary cover detached over a much weaker basal décollement layer. The upper surface is modified by mass redistribution, which is achieved by a combination of fluvial and hillslope processes. Several series of simulations were performed: (1) without surface processes or regional slope, (2) with regional slope only, (3) with fluvial incision and hillslope processes, and (4) with hillslope processes only. Model results show that the presence of a regional slope reduces the critical distance required for the transition between linkage and no linkage modes, whereas erosion and redeposition of sediments, on the contrary, increase this distance. The location of the saddle point, where fold segments link, and its vertical distance to the crests of the anticlines are different compared to the case without erosion or initial topographic slope, which potentially can affect the morphology of hydrocarbon traps. Moreover, both erosion and redeposition of sediments enhance the fold elongation (growth along the fold axis), once the erosion velocity exceeds the folding velocity. Model results have been compared to the Zagros Fold Belt. [ABSTRACT FROM AUTHOR]

A six-month-old Labrador retriever presented for investigation of a colonic mass identified as an incidental finding during exploratory coeliotomy. Computed tomography identified a lesion in the colon which occupied part of its lumen and shared blood supply with the remainder of the colon. The lesion was suspected to be a colonic duplication and it was excised by segmental colectomy during exploratory coeliotomy. Histopathology from the excised colon confirmed the diagnosis of a colonic duplication. The dog recovered uneventfully and had no complications. To the authors' knowledge, this is the first report of an asymptomatic, spherical, communicating colonic duplication and the first report to describe segmental colectomy for the management of this condition in veterinary patients. [ABSTRACT FROM AUTHOR]

Registration studies show entecavir ( ETV) to be effective and safe in NUC-naïve patients with chronic hepatitis B, but relapse rates after treatment discontinuation have not been well established. Relapse rates and predictors of relapse were evaluated in naïve HBeAg-positive and HBeAg-negative patients treated with ETV. Treatment duration was defined according to international guidelines. Virological relapse was defined as reappearance in serum of hepatitis B virus ( HBV) DNA to >2000 IU/mL after discontinuation of treatment. A hundred and sixty-nine consecutive patients were treated for a median 181 weeks. 61% were HBeAg positive, 23% had cirrhosis, and mean HBV DNA level was 6.88 ± 1.74 log10 IU/mL. Ninety-two per cent became HBV DNA negative; 71% of HBeAg+ve patients became HBeAg negative and 68% anti-HBe positive; 14% became HBsAg negative and 13% anti-HBs positive. At the end of the study, 36 patients discontinued treatment: one due to breakthrough associated with resistant variants and 35 (20%) due to sustained virological response; 33 of these patients developed HBeAg seroconversion and 18 HBsAg seroconversion. Median off-treatment time was 69 weeks. Nine patients (26%), all HBeAg positive at baseline, developed virological relapse after a median 48 weeks off-treatment, 3 of them showed HBeAg reversion and 4 lost anti-HBe. No patient with HBsAg seroconversion relapsed. HBeAg clearance after week 48 of treatment was associated with an increase risk of relapse. After ETV discontinuation, HBsAg seroconversion was maintained in 100% of the patients, HBeAg seroconversion maintained in 90%, and virological relapse rate was 24%. [ABSTRACT FROM AUTHOR]

Reasons for performing study The bronchoalveolar lavage ( BAL) procedure can return variable volumes of fluid, possibly depending on the presence of bronchial collapse during fluid aspiration and on the severity of lung inflammation. Objectives We tested the hypothesis that horses with bronchial collapse during BAL are at higher risk of having severe lung inflammation. Study design Prospective field study. Methods Bronchial collapse was graded using a new simple scoring method (0, 1 or 2) during a standardised BAL procedure in the field on 131 horses with normal, mild/moderate or severe lower airway inflammation on cytology of BAL fluid. Results Of the 131 horses, 37 (28%), 55 (42%) and 39 (30%) horses had bronchial collapse scores of 0, 1 and 2, respectively. There was a difference in collapse scores between all the BAL inflammation categories (P<0.001). Severe collapse had a positive predictive value of 0.95 for both mild/moderate and severe BAL inflammation, with a prevalence of 63% and 20%, respectively. The BAL fluid return volume in the horses with severe collapse scores was lower than volumes in the partial (score 1/2) and no collapse (score 0/2) groups (P<0.001). The BAL fluid volume was negatively correlated with BAL neutrophil percentage (P<0.001). Conclusions Airway collapse during BAL is associated with airway inflammation and neutrophilia. Potential relevance During a standardised BAL procedure, clinicians can expect lung inflammation in horses that have bronchial collapse and bronchial collapse in horses with lung inflammation. Lung inflammation may be a contributing factor in the mechanism of bronchial collapse during BAL in horses. The Summary is available in Chinese - see Supporting information. [ABSTRACT FROM AUTHOR]

Summary Reasons for performing study: The diagnosis of equine recurrent airway obstruction (RAO) and inflammatory airway disease (IAD) is based on clinical signs and increased inflammatory cell percentages in the bronchoalveolar lavage (BAL) fluid. Since a BAL is an invasive procedure, a risk-screening questionnaire (RSQ) would be a valuable screening tool for lung inflammation. Objective: To evaluate the accuracy of a RSQ to detect lower airway inflammation (LAI) in a large population of horses. Methods: A standardised BAL was performed in the field on 167 horses in Alberta, Canada. Horses were separated into 3 categories: 1) BAL normal; 2) BAL mild to moderate LAI (MLAI), and 3) BAL severe LAI (SLAI). The horse owners were asked to complete a RSQ. The RSQ scores were compared to the BAL results to determine the likelihood of a horse having MLAI, SLAI or no LAI. Results: Based on BAL cytology, 28 (17%) horses were normal and 139 (83%) were abnormal, with 110 (66%) showing MLAI and 29 (17%) SLAI. Horses with SLAI and MLAI had a mean RSQ score of 0.95 and 0.70, respectively, compared to 0.60 for normal BAL horses. Horses with SLAI showed more clinical signs than normal and MLAI horses. The sensitivity and negative predictive values of the RSQ for detecting SLAI using a cut-off score of 0.87, were excellent at 0.90 (95%CI 0.73-0.98) and 0.96 (95%CI 0.82-1.00). Questions on the clinical signs typically found in RAO cases differed significantly between horses with BAL SLAI and those with BAL normal. Conclusions: Prevalence of MLAI was high in this population. Although the RSQ did not allow differentiating normal horses from horses with MLAI, it has a high sensitivity to detect horses with SLAI and is therefore a good screening tool for SLAI. [ABSTRACT FROM AUTHOR]

Human histocompatibility leucocyte antigen (HLA)-specific monoclonal antibody probes were used to determine the affinity constant, and cell-surface density of HLA class I and class II determinants. The measurements were estimated for single-cell units of B-lymphoblastoid cell line (B-LCL) and cloned activated T cells in different functional states. Each HLA subset showed unimodal affinity constant values for the interaction with the corresponding HLA-specific antibodies. Such values ranged between 2·2 × 107 M-1 (class I) and 4·0 × 107 M-1 (class II) for different histocompatibility epitopes. In both B and T cells there was a rank order of epitope expression, class I being highly expressed (5 × 106 epitopes/cell) followed by DR, DQ and DP, (1·1-3·0 × 106 epitopes/cell). Suppressive clones carrying functionally defined stimulating determinants previously designated `DY' carried similar numbers of DR, DQ and DP binding sites to DY- non-suppressive clones, but showed selective increases of class II determinants reactive with broad class II-specific antibodies. The results are discussed in the context of the functional consequences of different patterns of HLA epitope expression in immune responses. [ABSTRACT FROM AUTHOR]

To evaluate the role of the high-affinity monocyte receptor for lipopolysaccharide (LPS), CD14, in the process of tolerance to LPS, thc human monocytic cell line Mono-Mac-6 was cultured in the absence or presence of different amounts of LPS. The kinetics of CD14 modulation in these cells showed an initial 4-day period characterized by increased cell-surface expression, rate of biosynthesis (peaking at 48 hr) and release of its soluble forms (sCD14) which correlated with the amount of LPS in the culture. At this time, tolerance to LPS was already established, as measured by tumour necrosis factor-α (TNF-α) induction, it was LPS dose dependent and persisted up to 15 days. LPS also reduced the celt proliferation rate in a dose-dependent manner. After 8 days and up to 15 days, the CD14 biosynthesis, cell-surface expression and release of sCD14 inversely correlated with the level of LPS in the culture. The 48-hr LPS-pretreated cells showed a slightly decreased CD14 affinity for LPS, a relative high number of CD14 molecules per cells, and desensitization also to a phorbol 12-myristate 13-acetate (PMA) challenge. An anti-CD14 monoclonal antibody (mAb) protected the cells from tolerization when added at the beginning of culture, as revealed by challenge with LPS and PMA. The data indicate that in this model tolerization to LPS(1) precedes CD14 down-modulation, (2) operates by alteration of the receptor affinity for LPS and by a mechanism which affects a protein kinase C (PKC)-dependent signalling pathway, and (3) that CD14 plays a critical role in the establishment of tolerance to LPS. In addition, analysis of the data suggests the existence of a PKC-independent signalling pathway for LPS tolerization and a CD14-independent mechanism for establishing tolerance. [ABSTRACT FROM AUTHOR]

The human histocompatibility leucocyte antigen (HLA) class II-associated invariant chain comprises at least four polypeptides. One of these is expressed as a membrane-bound subunit and has been designated as CD74. We investigated the expression of CD74 on B- and T-cell types utilizing monoclonal antibodies (mAb) specific for thc c-terminus of CD74. All B cells tested expressed CD74 regardless of their HLA phenotypes. High and iow CD74 expressors were provisionally assigned based on quantitative variations found in some haplotypes. A mutant cell with selective deletions of class II loci DR and DQ but with retention of DP and additional class II heterodimers synthesize normal amounts of CD74. In contrast, however, a mutant with a total class II deletion had diminished expression of CD74, suggesting that at least one of the class II isotypes is essential for full constitutive expression of CD74. Major histocompatibility complex (MHC) class II negative T-cell lines and CD3+ T cell isolated from peripheral blood did not express CD74. However, allostimulated T cells which express de novo induced class II determinants also did not express CD74. Taken together, these results show that CD74 is expressed on B cells and unexpectedly is not synthesized on de novo-induced class II positive T-cell clones. [ABSTRACT FROM AUTHOR]

An abstract of the article "Significance of atrial fibrillation in octogenarian patients with acute myocardial infarction," by J. Galcera-Tomas and colleagues is presented.

An abstract of the article "Antecedent of heart failure is not independently associated with 31-day mortality in octogenarian patients with acute myocardial infarction," by J. Galcera-Tomas and colleagues is presented.

An abstract of the article "Incidence and significance of atrial fibrillation in octogenarian patients with acute myocardial infarction," by J. Glacera-Tomas and colleagues is presented.

An abstract of the article "Mortality and variables associated with heart failure on admission in patients with acute myocardial infarction," by J. Galcera-Tomas and colleagues is presented.

Despite the efficacy of functional analyses in identifying the function of challenging behavior, clinicians report not always using them, partly due to safety concerns. Understanding how researchers employ safeguards to mitigate risks, particularly with dangerous topographies like self-injurious behavior (SIB), is important to guide research and practice. However, the results of a scoping review of functional analyses of self-injurious behavior conducted by Weeden et al. (2010) revealed that only 19.83% of publications included protections. We extended the work of Weeden et al. to determine whether reporting has improved. We observed increases in all but two types of protections reviewed by Weeden et al. Additionally, we included new protections not reported by Weeden et al. In total, 69.52% of the studies included at least one protective procedure and 44.39% specified that the protections were used for safety. It appears that reporting has increased since Weeden et al. called for improved descriptions of participant protections., (© 2024 Society for the Experimental Analysis of Behavior (SEAB).)

Introduction: Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team-based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team-based practice and care., Methods: We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team-based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice., Findings: The search identified 974 citations of which nine articles showed elements of critical reflection in team-based practice. However, since only one of the nine included articles explicitly used the term 'critical reflection' in their research, critical reflection as a theoretical concept was found to be largely missing from the current team-based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur., Conclusion: To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team-based health care., (© 2024 The Author(s). Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

The functional analysis approach described by Iwata et al. (1982/1994) has been used widely to determine the variables evoking and maintaining challenging behavior. However, one potential concern with conducting functional analyses is that repeated exposure to contingencies may induce a novel functional relation. To examine the likelihood of these potential iatrogenic effects, we evaluated social test conditions of the functional analysis for 116 participants and searched for patterns of responding indicative of acquisition. Patterns suggestive of acquisition occurred in 13.70% of tangible reinforcement conditions; however, the prevalence was only slightly lower in the attention condition (8.75%). Much lower prevalence was observed for the escape condition (2.13%). When grouped by quotient score, a pattern of acquisition was just as likely to be observed in the attention condition as in the tangible condition. Additionally, patterns indicative of acquisition were no more likely to be observed with participants who emitted automatically reinforced challenging behavior., (© 2024 Society for the Experimental Analysis of Behavior (SEAB).)

Competing stimulus assessments (CSAs) are designed to identify stimuli that reduce challenging behavior through competition with its maintaining reinforcers. Recently, Haddock and Hagopian (2020) found that over 92% of CSAs described in published studies identified at least one high-competition stimulus (i.e., a stimulus correlated with at least an 80% reduction in challenging behavior). The current study describes the outcomes of CSAs in a retrospective consecutive controlled case series study of 35 cases (individuals) admitted to an inpatient setting. Findings on the limited relation between the level of stimulus engagement and reductions in challenging behavior were replicated; however, the efficacy of CSAs was lower (only 47% of CSAs were successful in identifying one or more high-competition stimuli). Discrepant findings across studies on the efficacy of CSAs are discussed in terms of differences in the sample participants and how outcomes are reported, which vary depending on the study's research questions., (© 2023 The Authors. Journal of Applied Behavior Analysis published by Wiley Periodicals LLC on behalf of Society for the Experimental Analysis of Behavior (SEAB).)

Objectives/hypothesis: Characterize the state of vestibular compensation of subjects diagnosed with acute unilateral vestibulopathy (AUV) of peripheral origin according to the temporal organization pattern of the refixation saccades (Perez and Rey (PR) score)., Study Design: Retrospective cross-sectional study using previously collected clinical data from a tertiary referral center., Methods: Following the vestibular compensation criteria defined by Eisenman, we used the video head impulse test as the main vestibular function test and compared the results with other traditional tests: rotatory chair test (ROT), caloric test, videonystagmography, clinical situation (CLIN), and the Dizziness Handicap Inventory (DHI) questionnaire from 28 subjects (17 men, 11 women), average age 60.21 years, who were in a compensated and noncompensated vestibular situation. We used the PR score to measure the differences between the study groups. A cluster was developed to define a cutoff point that objectively distinguishes the vestibular compensation status., Results: Significant differences in the PR score were found in the state of vestibular compensation in the ROT test (P = .01), DHI (P = .04), and CLIN (P = .023). The vestibular compensation criteria that groups the original variables (PR-CLUSTER) cutoff point was 55 (P = .019)., Conclusions: The PR score is a measure of temporal organization of the refixation saccades that enables us to distinguish clearly and objectively the vestibular situation of subjects with AUV. We suggest its clinical application., Level of Evidence: NA Laryngoscope, 2020., (© 2020 The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Different bismuth quadruple therapies containing proton-pump inhibitors, bismuth salts, metronidazole, and a tetracycline have been recommended as third-line Helicobacter pylori eradication treatment after failure with clarithromycin and levofloxacin., Aim: To evaluate the efficacy and safety of third-line treatments with bismuth, metronidazole, and either tetracycline or doxycycline., Methods: Sub-study with Spanish data of the "European Registry on H pylori Management" (Hp-EuReg), international multicenter prospective non-interventional Registry of the routine clinical practice of gastroenterologists. After previous failure with clarithromycin- and levofloxacin-containing therapies, patients receiving a third-line regimen with 10/14-day bismuth salts, metronidazole, and either tetracycline (BQT-Tet) or doxycycline (BQT-Dox), or single capsule (BQT-three-in-one) were included. Data were registered at AEG-REDCap database. Univariate and multivariate analyses were performed., Results: Four-hundred and fifty-four patients have been treated so far: 85 with BQT-Tet, 94 with BQT-Dox, and 275 with BQT-three-in-one. Average age was 53 years, 68% were women. Overall modified intention-to-treat and per-protocol eradication rates were 81% (BQT-Dox: 65%, BQT-Tet: 76%, BQT-three-in-one: 88%) and 82% (BQT-Dox: 66%, BQT-Tet: 77%, BQT-three-in-one: 88%), respectively. By logistic regression, higher eradication rates were associated with compliance (OR = 2.96; 95% CI = 1.01-8.84) and no prior metronidazole use (OR = 1.96; 95% CI = 1.15-3.33); BQT-three-in-one was superior to BQT-Dox (OR = 4.46; 95% CI = 2.51-8.27), and BQT-Tet was marginally superior to BQT-Dox (OR = 1.67; 95% CI = 0.85-3.29)., Conclusion: Third-line H pylori eradication with bismuth quadruple treatment (after failure with clarithromycin and levofloxacin) offers acceptable efficacy and safety. Highest efficacy was found in compliant patients and those taking 10-day BQT-three-in-one or 14-day BQT-Tet. Doxycycline seems to be less effective and therefore should not be recommended., (© 2020 John Wiley & Sons Ltd.)

Objective: To assess whether there are differences in vestibulo-ocular reflex (VOR) gain for suppression head impulse (SHIMP) and head impulse (HIMP) video head impulse test paradigms, and if so, what are their causes., Methods: Prospective multicenter observational double-blind nonrandomized clinical study was performed by collecting 80 healthy subjects from four reference hospitals. SHIMP data was postprocessed to eliminate impulses in which early SHIMP saccades were detected. Differences between HIMP and SHIMP VOR gain values were statistically evaluated. Head impulse maximum velocity, gender, age, direction of impulse, and hospital center were considered as possible influential factors., Results: A small significant statistical difference between HIMP and SHIMP VOR gain values was found on repeated measures analysis of variance (-0.05 ± 0.006, P < 0.001). Optimized linear model showed a significant influence of age variable on the observed differences for HIMP and SHIMP gain values and did not find influence between gain values differences and maximum head impulse velocity. Both HIMP and SHIMP VOR gain values were significant lower (-0.09, P < 0.001) when the impulses were performed to the left side., Conclusion: We had observed a difference in SHIMP and HIMP gain values not adequately explained by known gain modification factors. The persistence of this slight but significant difference indicates that there are more factors causing lower SHIMP VOR gain values. This difference must to be considered in further studies as well as in the clinical SHIMP testing protocols. We hypothesized that VOR phasic response inhibition could be the underlying cause of this difference., Level of Evidence: 2b. Laryngoscope, 128:2383-2389, 2018., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)

The overjustification hypothesis suggests that extrinsic rewards undermine intrinsic motivation. Extrinsic rewards are common in strengthening behavior in persons with intellectual and developmental disabilities; we examined overjustification effects in this context. A literature search yielded 65 data sets permitting comparison of responding during an initial no-reinforcement phase to a subsequent no-reinforcement phase, separated by a reinforcement phase. We used effect sizes to compare response levels in these two no-reinforcement phases. Overall, the mean effect size did not differ from zero; levels in the second no-reinforcement phase were equally likely to be higher or lower than in the first. However, in contrast to the overjustification hypothesis, levels were higher in the second no-reinforcement phase when comparing the single no-reinforcement sessions immediately before and after reinforcement. Outcomes consistent with the overjustification hypothesis were somewhat more likely when the target behavior occurred at relatively higher levels prior to reinforcement., (© 2016 Society for the Experimental Analysis of Behavior.)

Introduction: Dizziness is a frequent complaint in patients with vestibular schwannoma (VS). An abnormal vestibulo-ocular reflex (VOR) can explain this dizziness in patients with VS. The video Head impulse test (vHIT) offers a chance to describe specifically the VOR findings in such patients., Study Design: Retrospective cases series study in a tertiary referral hospital., Methods: Fifty consecutive patients with VS were classified in accordance with the morphology of the VOR; gain, covert saccade, and overt saccade were analyzed both in the affected side and in the healthy side. For all patients, caloric tests were performed. All patients were tested before surgery., Results: Caloric response was normal in 31 of 50 patients. The video Head impulse test was abnormal in 45 of 50 patients. For the affected side, low horizontal VOR gain was found in 27 of 50 patients, covert saccade was observed in 37 of 50, and overt saccade was observed in 26 of 50. In the healthy side, vHIT was abnormal in 29 of 50 patients, with a low gain in four of 50, covert saccade in seven of 50, and overt saccade in 23 of 50. In VS, gain for the affected side is not associated with caloric response, but gain for the affected side is associated with gain in the healthy side. Covert and overt saccade for the affected side is associated with gain for the affected side. In the healthy side, overt saccade is associated with low gain for the affected side., Conclusions: Video head impulse test improves the vestibular testing before surgery in patients with VS and should be included in the usual clinical tests for these patients., Level of Evidence: 4., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Assess angular vestibular-ocular reflex (VOR) changes after treatment with intratympanic gentamicin (ITG) for Ménière's disease (MD) and impact on short-term follow-up., Design: Prospective study., Methods: Patients submitted to ITG for unilateral MD. The gain VOR and the presence of compensatory saccades elicited by rapid head impulses were measured using the video head impulse test (vHIT)., Results: The study included 31 subjects (mean age: 59 years). Functional Level Scale (FLS) distributions were 35,5% (FLS3); 32,2% (FLS4); and 32,2% (FLS5). Mean follow-up was 21 ± 7 months. Multiple injections were needed in nine patients. VOR gain in the treated ear was significantly reduced in all subjects and for all the semicircular canals (paired samples t test; P < 0,05). Gain averages after treatment were 0,61 (superior); 0,69 (horizontal); and 0,47 (posterior). A horizontal canal VOR gain superior to 0,80 after treatment was associated with the need for a second gentamicin injection (Chi-square; P = 0,003). Gain asymmetry between the symptomatic and asymptomatic ear (GASM) was increased after treatment. The rate of vestibular function reduction was 47,9%; 26,0%; and 35,8% for the superior, horizontal, and posterior canals, respectively. According to the receiving operator characteristic curve, the amount of change in GASM must be greater than 7 in order to predict the avoidance of a second procedure (area under the curve [AUC] horizontal canal = 0,861) and the amount of vestibular function reduction in the pathologic ear in patients with a controlled disease must be greater than 17,8% (AUC horizontal canal = 0,843)., Conclusions: When evaluated with the vHIT, intratympanic gentamicin changes in VOR seem to foresee short-term control of vertigo attacks., Level of Evidence: 4., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Context: Although reflection is considered a significant component of medical education and practice, the literature does not provide a consensual definition or model for it. Because reflection has taken on multiple meanings, it remains difficult to operationalise. A standard definition and model are needed to improve the development of practical applications of reflection., Objectives: This study was conducted in order to identify, explore and analyse the most influential conceptualisations of reflection, and to develop a new theory-informed and unified definition and model of reflection., Methods: A systematic review was conducted to identify the 15 most cited authors in papers on reflection published during the period from 2008 to 2012. The authors' definitions and models were extracted. An exploratory thematic analysis was carried out and identified seven initial categories. Categories were clustered and reworded to develop an integrative definition and model of reflection, which feature core components that define reflection and extrinsic elements that influence instances of reflection., Results: Following our review and analysis, five core components of reflection and two extrinsic elements were identified as characteristics of the reflective thinking process. Reflection is defined as the process of engaging the self (S) in attentive, critical, exploratory and iterative (ACEI) interactions with one's thoughts and actions (TA), and their underlying conceptual frame (CF), with a view to changing them and a view on the change itself (VC). Our conceptual model consists of the defining core components, supplemented with the extrinsic elements that influence reflection., Conclusions: This article presents a new theory-informed, five-component definition and model of reflection. We believe these have advantages over previous models in terms of helping to guide the further study, learning, assessment and teaching of reflection., (© 2014 John Wiley & Sons Ltd.)

Objectives/hypothesis: To evaluate the vestibulo-ocular reflex and its relationship with subjective balance in a long-term follow-up after vestibular schwannoma surgery., Study Design: Retrospective cohorts study in a tertiary referral hospital. Forty-nine consecutive patients on which vestibular schwannoma surgery was performed at least 1 year before., Methods: Patients are classified in accordance with the morphology of the vestibulo-ocular reflex (VOR) into two groups: Group A, in which covert and overt saccades always occur in an organized fashion; and group B, in which covert and overt saccades randomly occur during head impulse and once finished. We evaluate the presence of covert and overt saccades and the morphology of the VOR measured by the video head impulse test (vHIT) and its relationship with subjective balance measured by Dizziness Handicap Inventory (DHI)., Results: The group B patients returned a higher score in total DHI and all three subscales without any predominant subscale (P = 0,0002; t test). Group B patients were older than those in group A (P = 0,024; t test). No differences were found in sex distribution, tumor size, or side or time interval after surgery. Regarding the unaffected side, overt saccades were found to be more frequent in group B patients (P = 0.05; X(2))., Conclusions: Long-term follow-up after vestibular schwannoma surgery has shown that 22% of the patients display a particular abnormality in the VOR because refixation saccades occur in a random fashion after elicitation of the reflex in the HIT test. These patients report the higher level of vestibular disability and handicap., Level of Evidence: 2b., (© 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Context:   Current debate in medical education focuses on the nature of 'competency-based medical education' (CBME) and whether or not it should be adopted. Many medical schools claim to run 'competency-based' curricula, but the structure of their programmes can differ radically. A review of the existing CBME literature reveals that little attention has been paid to defining the concept of competence. A straightforward examination of what is meant by the term 'competence' is noticeably missing from the literature, despite its impact on medical training., Objectives:   This paper aims to illustrate the varying conceptions of 'competence' by comparing and contrasting definitions provided in the health sciences education literature and discussing their respective impacts on medical education., Methods:   A systematic review of recent publications in medical education journals published in English and French was conducted to extract definitions of competence or, if definitions were not explicitly stated, to derive the authors' implicit conception of competence. A sample of 14 definitions from articles in the health sciences education field was studied using thematic analysis., Results:   There is agreement that competence is composed of knowledge, skills and other components. Although agreement about the nature of these other components is lacking, attitudes and values are suggested to be essential ingredients of competence. Furthermore, a clear divergence in conceptions of how a competent person utilises these components is apparent. One view specifies that competence involves selecting components according to specific situations, as required. A second view places greater emphasis on the synergy that results from the use of a combination of components in a given situation., Conclusions:   These conceptual distinctions have many implications for the way CBME is implemented. A conception of competence as the selection of components may lead to a greater emphasis, in a training setting, on the mastery of each component separately. A conception of competence as the use of a combination of components leads to greater emphasis on the synergy that results as they are deployed in clinical situations., (© Blackwell Publishing Ltd 2012.)

During pregnancy, a delicate balance of innate and adaptive immune responses at the maternal-fetal interface promotes survival of the semi-allogeneic embryo and, at the same time, allows effective immunity to protect the mother from environmental pathogens. As in other tissues, antigen handling and processing in the decidualized endometrium constitutes a primary event in the onset of immune responses and is therefore likely to determine their stimulatory or tolerogenic nature. Maternal antigen-presenting cells [macrophages and dendritic cells (DCs)] are scattered throughout the decidualized endometrium during all stages of pregnancy and appear to be important players in this feto-maternal immune adjustment. This review focuses on the characterization of decidual macrophages and DCs, as well as their involvement in cell-cell interactions within the decidual leukocyte network, which are likely to influence uterine and placental homeostasis as well as the local maternal immune responses to the fetus during pregnancy.

Problem: Does a correlation exist between the expression of human leukocyte antigen (HLA) class Ia and HLA-E and what is its biological significance?, Method of Study: HLA-E transcripts were detected by reverse transcriptase-polymerase chain reaction. Metabolically labeled HLA-E heavy chains were immunoprecipited and analyzed by one-dimensional isoelectric focusing. Mouse RMA-S cells defective with regard to transporter associated with antigen processing (TAP) function were transfected with HLA-E and human beta 2-microglobulin to investigate TAP dependence of the cell-surface expression of HLA-E., Results: HLA-E is transcribed regardless of the down-regulation of polymorphic HLA class Ia expression. HLA-E is transported to the cell surface in the absence of TAP-controlled peptide loading. In human cells, the amount of HLA-E protein is very low regardless of the presence of correct peptide ligands., Conclusions: HLA-E regulates immune functions in cells that have down-regulated the expression of polymorphic HLA-class Ia molecules, either by preventing harmful natural killer cells from attacking targets that have physiologically decreased HLA-class Ia expression or by activating effector cells against virus-infected and tumor cells with impaired HLA-class Ia expression.

Problem: To determine the ontogeny of major histocompatibility complex (MHC) expression and TAP products in mouse embryos., Method of Study: mRNAs encoding MHC and associated molecules were identified by reverse transcriptase-polymerase chain reaction, and the protein products were localized by confocal microscopy., Results: mRNAs encoding class Ia (H-2Db) and class Ib (Q7/9) were present in one-cell embryos, whereas beta 2-microglobulin (beta 2-m) transcripts were not detected until the two-cell stage. Transporter TAP1, but not TAP2, transcripts were detected only in blastocysts. H-2 class Ia (classical) protein was detected on the surface of two-cell embryos, H-2 class Ib (nonclassical) protein was detected on one-cell embryos, and beta 2-m transcripts were detected on eight-cell embryos; TAP1 protein was present at low levels in the cytoplasm from the one-cell stage onward, increasing in expression in blastocysts., Conclusions: In mice, MHC class I mRNAs encoding the heavy chain of H-2- and Q7/9-encoding Qa2 molecules are synthesized soon after conception prior to implantation. Similarly, the nonpolymorphic MHC class I-associated molecule beta 2-m also is expressed before implantation. TAP1, but not TAP2, is first detected at the blastocyst stage, thus preceding the onset of TAP2 in embryonic development.