Incorporating Vestibular Evoked Myogenic Potential (VEMP) assessment into our clinical practice

Vestibular Evoked Myogenic Potentials (VEMPs) are short-latency electromyographic responses evoked by intense acoustic stimuli. They are measured in the ipsilateral, tonically-contracted sternocleidomastoid (SCM) muscle. The VEMP response is thought to arise from the vestibulocollic (also called sacculocollic) reflex. Since its introduction in 1992 (Colebatch et al.), VEMP testing is gradually becoming a part of standard vestibular assessment in many clinics. VEMPs have been found in response to various stimuli including loud clicks, short tone bursts, head taps and short duration DC currents presented to the mastoid. (Colebatch et al., 1994; Murofushi et al., 1996; Akin & Murnane, 2001; Cheng & Murofushi, 2001; Colebatch, 2001; de Waele, 2001; Ödkvist, 2001; Basta et al., 2005). The purpose of this article is to review the literature on VEMP testing in an effort to determine the clinical, best practice of their use. We will explore the recommended measurement parameters, what constitutes a normal response, how several types of pathology affect VEMPs and why we should consider incorporating VEMP assessment into our standard vestibular evaluation protocol

Characterization of barley yellow dwarf virus subgenomic RNAs

Transcription of subgenomic RNAs (sgRNAs) is a common strategy used by many positive strand RNA viruses of plants and animals to regulate viral gene expression. Barley yellow dwarf virus (BYDV) produces three nested 3\u27-coterminal subgenomic RNAs in infected cells. SgRNA1 serves as the messenger for the structural and movement proteins. sgRNA2 encodes a small open reading frame (ORF6), that appears not to be translated. The role of sgRNA3 is unknown, as it encodes no ORFs. Neither sgRNA2 nor sgRNA3 is needed for BYDV RNA replication in oat protoplasts. However, sgRNA2 does function as a riboregulator of viral translation in virus-infected protoplasts. This dissertation focuses on the control of synthesis of sgRNA2, and the biological roles of sgRNAs 2 and 3 in plants.;The first aim is to determinine the primary and secondary structures in BYDV RNA required for synthesis of subgenomic RNA2. The minimal promoter for sgRNA2 was previously mapped to a 143 nt region (nt 4810-4952) just downstream of its putative transcription start site at nt 4809. This region encompasses the 3\u27 BYDV cap-independent translation element (BTE, nts 4814-4918) that is essential for virus replication. Deletion of the entire 3\u27 BTE from within a duplicated copy of the sgRNA2 promoter did not affect sgRNA2 synthesis from this promoter, confirming the functional independence of the sgRNA2 promoter from the 3\u27 BTE. I also found that a small stem-loop containing the conserved hexanucleotide sequence GUGAAG at its 5\u27 end supports basal levels of sgRNA2 synthesis. All functional sgRNA2 promoter constructs retained potential base pairing between sequences flanking the BTE. This reveals that the sgRNA2 promoter is split by the embedded 3\u27 BTE and that both the primary and secondary structures are required for sgRNA synthesis. Such an overlapping arrangement of translational and transcriptional control signals has not been observed in other viruses.;The second aim is to examine the roles of sgRNA2 and sgRNA3 in whole plant infections. Infectivity of viral RNA containing mutations that knock out synthesis of one or both of these RNAs was tested. All sgRNA knockout mutants infected oat plants and usually showed normal levels of viral RNA accumulation, disease onset, and symptoms. ELISA revealed that coat protein levels in plants infected with the mutants deficient in sgRNA2 alone, or sgRNA2 and sgRNA3 were about double that observed in plants infected with wild-type virus. SgRNA3 knockout mutant virus gave wild-type levels of coat protein. SgRNA2 was found to modestly inhibit virion accumulation, while the absence of sgRNA3 in virus infections had little effect on virus accumulation and disease development in infected oats. These surprising results are the first example of subgenomic RNAs that are apparently dispensible for virus infection. They indicate that sgRNA2 must play only a minor role as a riboregulator of viral gene expression. However, absence of sgRNAs 2 and/or 3 may reduce virus fitness in subtle ways that were not detected in my experiments

Program Evaluation: The Impact of an Elementary Afterschool Program on Educating the Tenets of the Whole Child

This dissertation was designed to provide an increased understanding of what is involved in providing whole child education. The researcher of this dissertation evaluated teacher awareness, changes in instructional behaviors, and the impact on culture as a result of an elementary afterschool program. All teachers were instructed to focus on their perspective in relation to providing the tenets of whole child education in the studied elementary afterschool program. Throughout this study, teachers were the primary focus implementing strategies which were specific to a rural elementary afterschool program to investigate currently utilized strategies and teacher awareness of the different tenets and components of whole child education. Research revealed a correlation of current practices and whole child tenets. A program evaluation that examined teacher awareness of the whole child and the impact of their current strategies being implemented in their elementary afterschool program was the study’s purpose. Teaching practices and the climate of the school were also part of the research study. The program evaluation was conducted through analyzing data gathered from surveys, interviews, and focus groups. An examination of the data indicated specific commonalities across the survey, interviews, and focus groups. The data from the survey indicated a high level of agreement from teachers that the elementary afterschool program met the tenets and components of whole child education. The common themes extracted from the interviews and focus groups revealed that there have been moderate changes in teacher instructional practices and low to moderate changes in the school climate and culture. While teachers frequently stated that they saw the benefits of the elementary afterschool program for the students, increased communication concerning increasing school-wide buy-in and creating a whole child education culture was stated to be a need

Investigating medical handover practice: a process evaluation of a new initiative from an acute setting

Aims: To independently evaluate and assess the potential benefits and drawbacks of an innovative approach to the delivery of morning medical handover, in an acute medical emergency assessment unit (EAU). Methods: A survey was conducted with junior and middle-grade doctors attending the handover (N = 14). Three focus groups, with middle-grade doctors (n = 5), junior doctors (n = 11) and senior nurses (n = 3), were conducted to gain further insights into the views and experiences of attendees. Interviews with two medical consultants and two directors of postgraduate medical education were conducted to gain insight into the strategic training and management perspective. Focus groups and interviews were recorded, transcribed, and analysed using thematic analysis. The timeframe was May–August 2014. Results: Quantitative survey data were analysed using SPSS, generating descriptive frequencies. 79% of respondents preferred to discuss safety incidents verbally, 79% found it helpful to learn about clinical guidelines and 50% regarded the process as too long on most days. Qualitative findings revealed that the handover was regarded as a crucial process for prioritising and managing patients and communicating critical information across a multidisciplinary team. Including a nursing perspective was consistently viewed as particularly beneficial, owing to nurses’ detailed overview of patients within the unit. Discussing audit results, care bundles and clinical reminders was viewed as well placed, owing to their concise nature. However, the danger of detracting from the clinical handover by incorporating education and a lack of a consistent clear focus was highlighted. Detailed patient presentations and theoretical discussions were considered to be more suitable in an alternative setting, potentially during rounds and bedside teaching. Suggestions of utilising an electronic system, separating the night team handover from an EAU morning meeting, and changing shift times were also discussed. Conclusions: The foremost principle of a handover is to ensure that there is a robust clinical handover of continuous patient care from the outgoing to the incoming team. While there is the potential to augment this process with unique educational elements, it is essential that the delivery and content are carefully managed and structured in a manner that does not detract from the primary focus of a clinical handover and compromise clinical decision making. The handover model may benefit from having a more consistent time-bound structure, allowing the team to have a clear focus on managing and directing optimal patient care, whilst providing relevant educational aspects that improve patient safety and quality of care

Investigating optimal handover practice: an evaluation of a new initiative from an acute medical setting

Aims To independently evaluate and assess the potential benefits and drawbacks of an innovative approach to the delivery of morning medical handover, in an acute medical emergency assessment unit (EAU). Methods A survey was conducted with junior and middle-grade doctors attending the handover (N=14). Three focus groups, with middle-grade doctors (n=5), junior doctors (n=11) and senior nurses (n=3), were conducted to gain further insights into the views and experiences of attendees. Interviews with two medical consultants and two directors of postgraduate medical education were conducted to gain insight into the strategic training and management perspective. Focus groups and interviews were recorded, transcribed, and analysed using thematic analysis. The timeframe was May– August 2014. Results Quantitative survey data were analysed using SPSS, generating descriptive frequencies. 79% of respondents preferred to discuss safety incidents verbally, 79% found it helpful to learn about clinical guidelines and 50% regarded the process as too long on most days. Qualitative findings revealed that the handover was regarded as a crucial process for prioritising and managing patients and communicating critical information across a multidisciplinary team. Including a nursing perspective was consistently viewed as particularly beneficial, owing to nurses’ detailed overview of patients within the unit. Discussing audit results, care bundles and clinical reminders was viewed as well placed, owing to their concise nature. However, the danger of detracting from the clinical handover by incorporating education and a lack of a consistent clear focus was highlighted. Detailed patient presentations and theoretical discussions were considered to be more suitable in an alternative setting, potentially during rounds and bedside teaching. Suggestions of utilising an electronic system, separating the night team handover from an EAU morning meeting, and changing shift times were also discussed. Conclusions The foremost principle of a handover is to ensure that there is a robust clinical handover of continuous patient care from the outgoing to the incoming team. While there is the potential to augment this process with unique educational elements, it is essential that the delivery and content are carefully managed and structured in a manner that does not detract from the primary focus of a clinical handover and compromise clinical decision making. The handover model may benefit from having a more consistent time-bound structure, allowing the team to have a clear focus on managing and directing optimal patient care, whilst providing relevant educational aspects that improve patient safety and quality of care

The Evaluation of Two Different Harvesting \u27Topbunch\u27 and \u27Hi-Crop\u27 Collards (Brassica Oleracea (L)) Leaves from Plants Grown in a Wiregrass Tunnel House

A study was conducted to determine if a 100% or 50% harvest intensity of ‘Topbunch’ collards leaves could be a recommended practice for Tunnel House producers. The experiment was conducted as a split-plot design with harvest dates as main plots, and harvesting intensity of 100% or 50% of leaves as sub-plots. All treatments were replicated three times, drip irrigated, and fertilized according to soil test recommendations. The results showed significant interactions between harvest methods and dates for number and weight of leaves harvested. There were also significant differences for the weight of leaves harvested and numbers. The leaf recovery rates were greater for plants that had 50% of their leaves harvested compared to those which had 100% of their leaves harvested. This higher recovery rate for the former suggests that the harvest interval could be reduced in the future from 21 to 15 or 18 days

The combined effects of genetic risk and perceived discrimination on blood pressure among African Americans in the Jackson Heart Study

Both genomics and environmental stressors play a significant role in increases in blood pressure (BP). In an attempt to further explain the hypertension (HTN) disparity among African Americans (AA), both genetic underpinnings (selected candidate genes) and stress due to perceived racial discrimination (as reported in the literature) have independently been linked to increased BP among AAs. Although Gene x Environment interactions on BP have been examined, the environmental component of these investigations has focused more on lifestyle behaviors such as smoking, diet, and physical activity, and less on psychosocial stressors such as perceived discrimination

The TYK2-P1104A Autoimmune Protective Variant Limits Coordinate Signals Required to Generate Specialized T Cell Subsets

TYK2 is a JAK family member that functions downstream of multiple cytokine receptors. Genome wide association studies have linked a SNP (rs34536443) within TYK2 encoding a Proline to Alanine substitution at amino acid 1104, to protection from multiple autoimmune diseases including systemic lupus erythematosus (SLE) and multiple sclerosis (MS). The protective role of this SNP in autoimmune pathogenesis, however, remains incompletely understood. Here we found that T follicular helper (Tfh) cells, switched memory B cells, and IFNAR signaling were decreased in healthy individuals that expressed the protective variant TYK2A1104 (TYK2P). To study this variant in vivo, we developed a knock-in murine model of this allele. Murine Tyk2P expressing T cells homozygous for the protective allele, but not cells heterozygous for this change, manifest decreased IL-12 receptor signaling, important for Tfh lineage commitment. Further, homozygous Tyk2P T cells exhibited diminished in vitro Th1 skewing. Surprisingly, despite these signaling changes, in vivo formation of Tfh and GC B cells was unaffected in two models of T cell dependent immune responses and in two alternative SLE models. TYK2 is also activated downstream of IL-23 receptor engagement. Here, we found that Tyk2P expressing T cells had reduced IL-23 dependent signaling as well as a diminished ability to skew toward Th17 in vitro. Consistent with these findings, homozygous, but not heterozygous, Tyk2P mice were fully protected in a murine model of MS. Homozygous Tyk2P mice had fewer infiltrating CD4+ T cells within the CNS. Most strikingly, homozygous mice had a decreased proportion of IL-17+/IFNγ+, double positive, pathogenic CD4+ T cells in both the draining lymph nodes (LN) and CNS. Thus, in an autoimmune model, such as EAE, impacted by both altered Th1 and Th17 signaling, the Tyk2P allele can effectively shield animals from disease. Taken together, our findings suggest that TYK2P diminishes IL-12, IL-23, and IFN I signaling and that its protective effect is most likely manifest in the setting of autoimmune triggers that concurrently dysregulate at least two of these important signaling cascades

Identification and Functional Characterization of <i>G6PC2</i> Coding Variants Influencing Glycemic Traits Define an Effector Transcript at the <i>G6PC2-ABCB11</i> Locus

Genome wide association studies (GWAS) for fasting glucose (FG) and insulin (FI) have identified common variant signals which explain 4.8% and 1.2% of trait variance, respectively. It is hypothesized that low-frequency and rare variants could contribute substantially to unexplained genetic variance. To test this, we analyzed exome-array data from up to 33,231 non-diabetic individuals of European ancestry. We found exome-wide significant (P<5×10-7) evidence for two loci not previously highlighted by common variant GWAS: GLP1R (p.Ala316Thr, minor allele frequency (MAF)=1.5%) influencing FG levels, and URB2 (p.Glu594Val, MAF = 0.1%) influencing FI levels. Coding variant associations can highlight potential effector genes at (non-coding) GWAS signals. At the G6PC2/ABCB11 locus, we identified multiple coding variants in G6PC2 (p.Val219Leu, p.His177Tyr, and p.Tyr207Ser) influencing FG levels, conditionally independent of each other and the non-coding GWAS signal. In vitro assays demonstrate that these associated coding alleles result in reduced protein abundance via proteasomal degradation, establishing G6PC2 as an effector gene at this locus. Reconciliation of single-variant associations and functional effects was only possible when haplotype phase was considered. In contrast to earlier reports suggesting that, paradoxically, glucose-raising alleles at this locus are protective against type 2 diabetes (T2D), the p.Val219Leu G6PC2 variant displayed a modest but directionally consistent association with T2D risk. Coding variant associations for glycemic traits in GWAS signals highlight PCSK1, RREB1, and ZHX3 as likely effector transcripts. These coding variant association signals do not have a major impact on the trait variance explained, but they do provide valuable biological insights