Effects of Middle-Ear Disorders on Power Reflectance Measured in Cadaveric Ear Canals

Objective: Reflectance measured in the ear canal offers a noninvasive method to monitor the acoustic properties of the middle ear, and few systematic measurements exist on the effects of various middleear disorders on the reflectance. This work uses a human cadaver-ear preparation and a mathematical middle-ear model to both measure and predict how power reflectance R is affected by the middle-ear disorders of static middle-ear pressures, middle-ear fluid, fixed stapes, disarticulated incudostapedial joint, and tympanic-membrane perforations. Design: R was calculated from ear-canal pressure measurements made on human-cadaver ears in the normal condition and five states: (1) positive and negative pressure in the middle-ear cavity, (2) fluidfilled middle ear, (3) stapes fixed with dental cement, (4) incudostapedial joint disarticulated, and (5) tympanic-membrane perforations. The middle-ear model of Kringlebotn (1988) was modified to represent the middle-ear disorders. Model predictions are compared with measurements. Results: For a given disorder, the general trends of the measurements and model were similar. The changes from normal in R, induced by the simulated disorder, generally depend on frequency and the extent of the disorder (except for the disarticulation). Systematic changes in middle-ear static pressure (up to ±300 daPa) resulted in systematic increases in R. These affects were most pronounced for frequencies up to 1000 to 2000 Hz. Above about 2000 Hz there were some asymmetries in behavior between negative and positive pressures. Results with fluid in the middle-ear air space were highly dependent on the percentage of the air space that was filled. Changes in R were minimal when a smaller fraction of the air space was filled with fluid, and as the air space was filled with more saline, R increased at most frequencies. Fixation of the stapes generally resulted in a relatively small low-frequency increase in R. Disarticulation of the incus with the stapes led to a consistent lowfrequency decrease in R with a distinctive minimum below 1000 Hz. Perforations of the tympanic membrane resulted in a decrease in R for frequencies up to about 2000 Hz; at these lower frequencies, smaller perforations led to larger changes from normal when compared with larger perforations. Conclusions: These preliminary measurements help assess the utility of power reflectance as a diagnostic tool for middle-ear disorders. In particular, the measurements document (1) the frequency ranges for which the changes are largest and (2) the extent of the changes from normal for a spectrum of middle-ear disorders

Amplification of Earthquake Ground Motions in Washington, DC, and Implications for Hazard Assessments in Central and Eastern North America

The extent of damage in Washington, DC, from the 2011 MW 5.8 Mineral, VA, earthquake was surprising for an epicenter 130 km away; U.S. Geological Survey “Did-You-Feel-It” reports suggest that Atlantic Coastal Plain and other unconsolidated sediments amplified ground motions in the city. We measure this amplification relative to bedrock sites using earthquake signals recorded on a temporary seismometer array. The spectral ratios show strong amplification in the 0.7 to 4 Hz frequency range for sites on sediments. This range overlaps with resonant frequencies of buildings in the city as inferred from their heights, suggesting amplification at frequencies to which many buildings are vulnerable to damage. Our results emphasize that local amplification can raise moderate ground motions to damaging levels in stable continental regions, where low attenuation extends shaking levels over wide areas and unconsolidated deposits on crystalline metamorphic or igneous bedrock can result in strong contrasts in near-surface material properties

Prioritizing research for integrated implementation of early childhood development and maternal, newborn, child and adolescent health and nutrition platforms

Background: Existing health and nutrition services present potential platforms for scaling up delivery of early childhood development (ECD) interventions within sensitive windows across the life course, especially in the first 1000 days from conception to age 2 years. However, there is insufficient knowledge on how to optimize implementation for such strategies in an integrated manner. In light of this knowledge gap, we aimed to systematically identify a set of integrated implementation research priorities for health, nutrition and early child development within the 2015 to 2030 timeframe of the Sustainable Development Goals (SDGs).Methods: We applied the Child Health and Nutrition Research Initiative method, and consulted a diverse group of global health experts to develop and score 57 research questions against five criteria: answerability, effectiveness, deliverability, impact, and effect on equity. These questions were ranked using a research priority score, and the average expert agreement score was calculated for each question.Findings: The research priority scores ranged from 61.01 to 93.52, with a median of 82.87. The average expert agreement scores ranged from 0.50 to 0.90, with a median of 0.75. The top-ranked research question were: i) How can interventions and packages to reduce neonatal mortality be expanded to include ECD and stimulation interventions? ; ii) How does the integration of ECD and MNCAH&N interventions affect human resource requirements and capacity development in resource-poor settings? ; and iii) How can integrated interventions be tailored to vulnerable refugee and migrant populations to protect against poor ECD and MNCAH&N outcomes? . Most highly-ranked research priorities varied across the life course and highlighted key aspects of scaling up coverage of integrated interventions in resource-limited settings, including: workforce and capacity development, cost-effectiveness and strategies to reduce financial barriers, and quality assessment of programs.Conclusions: Investing in ECD is critical to achieving several of the SDGs, including SDG 2 on ending all forms of malnutrition, SDG 3 on ensuring health and well-being for all, and SDG 4 on ensuring inclusive and equitable quality education and promotion of life-long learning opportunities for all. The generated research agenda is expected to drive action and investment on priority approaches to integrating ECD interventions within existing health and nutrition services

Modern Views on Virtue Ethics

Abstract: This paper analyzes some influential ideas in virtue ethics. Alasdair MacIntyre, in his work After Virtue, and Elizabeth Anscombe, in his controversial essay “Modern Moral Philosophy”, brought fresh ideas into moral philosophy of their time changing views on contemporary morality. They strongly influenced moral philosophers who then followed their ideas. The two philosophers criticized contemporary moral philosophies such as emotivism, utilitarianism, deontology. Elizabeth Anscombe criticized also the use of the concepts of duty and moral obligation in the absence of God as the context God had no place. For solving the quests of modern morality, both MacIntyre and Anscombe proposed that the only solution was the returning to ancient Aristotelian virtues

The amphioxus genome and the evolution of the chordate karyotype

Lancelets ('amphioxus') are the modern survivors of an ancient chordate lineage, with a fossil record dating back to the Cambrian period. Here we describe the structure and gene content of the highly polymorphic approx520-megabase genome of the Florida lancelet Branchiostoma floridae, and analyse it in the context of chordate evolution. Whole-genome comparisons illuminate the murky relationships among the three chordate groups (tunicates, lancelets and vertebrates), and allow not only reconstruction of the gene complement of the last common chordate ancestor but also partial reconstruction of its genomic organization, as well as a description of two genome-wide duplications and subsequent reorganizations in the vertebrate lineage. These genome-scale events shaped the vertebrate genome and provided additional genetic variation for exploitation during vertebrate evolution

Evidence for Updating the Core Domain Set of Outcome Measures for Juvenile Idiopathic Arthritis: Report from a Special Interest Group at OMERACT 2016

Objective. The current Juvenile Idiopathic Arthritis (JIA) Core Set was developed in 1997 to identify the outcome measures to be used in JIA clinical trials using statistical and consensus-based techniques, but without patient involvement. The importance of patient/parent input into the research process has increasingly been recognized over the years. An Outcome Measures in Rheumatology (OMERACT) JIA Core Set Working Group was formed to determine whether the outcome domains of the current core set are relevant to those involved or whether the core set domains should be revised.Methods. Twenty-four people from the United States, Canada, Australia, and Europe, including patient partners, formed the working group. Guided by the OMERACT Filter 2.0 process, we performed (1) a systematic literature review of outcome domains, (2) a Web-based survey (142 patients, 343 parents), (3) an idea-generation study (120 parents), (4) 4 online discussion boards (24 patients, 20 parents), and (5) a Special Interest Group (SIG) activity at the OMERACT 13 (2016) meeting.Results. A MEDLINE search of outcome domains used in studies of JIA yielded 5956 citations, of which 729 citations underwent full-text review, and identified additional domains to those included in the current JIA Core Set. Qualitative studies on the effect of JIA identified multiple additional domains, including pain and participation. Twenty-one participants in the SIG achieved consensus on the need to revise the entire JIA Core Set.Conclusion. The results of qualitative studies and literature review support the need to expand the JIA Core Set, considering, among other things, additional patient/parent-centered outcomes, clinical data, and imaging data

Enduring science: Three decades of observing the Northeast Atlantic from the Porcupine Abyssal Plain Sustained Observatory (PAP-SO)

Until the 1980s, the deep sea was generally considered to be a particularly stable environment, free from major temporal variations (Sanders, 1968). Studies in the abyssal northeast Atlantic by Billett et al. (1983), and subsequently Lampitt (1985) discovered seasonal pulses of surface primary production-derived particulate organic matter (phytodetritus), and hence carbon, at abyssal depths. These early observations were subsequently extended to the central oceanic region of the NE Atlantic (Pfannkuche, 1993; Thiel et al., 1989), and prompted the establishment of more concerted time series studies in the Porcupine Abyssal Plain area. Today, the Porcupine Abyssal Plain Sustained Observatory (PAP–SO) is a multidisciplinary open-ocean time series site in the NE Atlantic (48°50′N 16°30′W, 4850 m water depth; Fig. 1), focused on the study of connections between the surface and deep ocean. In situ measurements of climatically and environmentally relevant variables have been made for more than 30 years. This represents an exceptionally long time series - a recent compilation of biological time series data, across terrestrial, freshwater, and marine realms, indicates an average duration of only 13-years (Dornelas et al., 2018). Long-term time series in the deep sea are rare, particularly those collecting data from surface to seabed. The PAP-SO is one of two abyssal long-term time series sites globally (Smith et al. 2015), the other being a thirty-year time series at Station M in the northeastern Pacific Ocean (34°50′N, 123°00′W, ~4000 m water depth), maintained by the Monterey Bay Aquarium Research Institute (Smith et al., 2020). This ‘sibling’ abyssal time series site also aims to understand the connections between the surface ocean and the seabed, using many similar techniques (Smith et al., 2017), facilitating comparisons between the two sites (e.g. Durden et al., 2019; Durden et al., 2020a; Laguionie-Marchais et al., 2013; Smith et al., 2009). Another source of extended comparison is the 21 year time series Long-Term Ecological Research Observatory HAUSGARTEN, Frontiers in Arctic Marine Monitoring (FRAM) in the Fram Strait between the North Atlantic and the central Arctic Ocean (78.5°N–80°N, 05°W–11°E, 250–5500 m water depth), maintained by the Alfred Wegener Institute for Polar and Marine Research (Soltwedel et al., 2016; Soltwedel et al., 2005). Much of our understanding of temporal variation in the deep sea, and connections between the surface ocean and the seabed have been derived from research conducted at these observatories

IMPLEmenting a clinical practice guideline for acute low back pain evidence-based manageMENT in general practice (IMPLEMENT) : cluster randomised controlled trial study protocol

Background: Evidence generated from reliable research is not frequently implemented into clinical practice. Evidence-based clinical practice guidelines are a potential vehicle to achieve this. A recent systematic review of implementation strategies of guideline dissemination concluded that there was a lack of evidence regarding effective strategies to promote the uptake of guidelines. Recommendations from this review, and other studies, have suggested the use of interventions that are theoretically based because these may be more effective than those that are not. An evidencebased clinical practice guideline for the management of acute low back pain was recently developed in Australia. This provides an opportunity to develop and test a theory-based implementation intervention for a condition which is common, has a high burden, and for which there is an evidence-practice gap in the primary care setting. Aim: This study aims to test the effectiveness of a theory-based intervention for implementing a clinical practice guideline for acute low back pain in general practice in Victoria, Australia. Specifically, our primary objectives are to establish if the intervention is effective in reducing the percentage of patients who are referred for a plain x-ray, and improving mean level of disability for patients three months post-consultation. Methods/Design: This study protocol describes the details of a cluster randomised controlled trial. Ninety-two general practices (clusters), which include at least one consenting general practitioner, will be randomised to an intervention or control arm using restricted randomisation. Patients aged 18 years or older who visit a participating practitioner for acute non-specific low back pain of less than three months duration will be eligible for inclusion. An average of twenty-five patients per general practice will be recruited, providing a total of 2,300 patient participants. General practitioners in the control arm will receive access to the guideline using the existing dissemination strategy. Practitioners in the intervention arm will be invited to participate in facilitated face-to-face workshops that have been underpinned by behavioural theory. Investigators (not involved in the delivery of the intervention), patients, outcome assessors and the study statistician will be blinded to group allocation. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).The trial is funded by the NHMRC by way of a Primary Health Care Project Grant (334060). JF has 50% of her time funded by the Chief Scientist Office3/2006). of the Scottish Government Health Directorate and 50% by the University of Aberdeen. PK is supported by a NHMRC Health Professional Fellowship (384366) and RB by a NHMRC Practitioner Fellowship (334010). JG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. All other authors are funded by their own institutions