Eye movement responses to caloric vestibular irrigations reveal the contribution of voluntary processes to autonomic reflexes

editorial reviewedCan autonomic reflexes inform us about higher-order cognitive processes ? To address this issue, we studied habituation (a form of non-associative learning) of the slow, uncontrolled eye movement response (nystagmus) following repetitive caloric (warm water) vestibular irrigation. After a 30s irrigation trial (total trials=6), participants (n=26) either kept their gaze fixated, or let their gaze free, testing voluntary adaptations of the nystagmus response measured with electrooculography (EOG). Participants also reported the intensity of the vertigo that they experienced after each irrigation. We found that the amplitude of the nystagmus response decreased over repetitive irrigations, revealing a clear habituation (repeated measures ANOVA with participants as random factor, F(5)=-18.8, p<0.001). We further showed that the amplitude of nystagmus is reduced after the gaze fixation condition compared to the freely moving gaze (interaction between irrigation and fixation, F(5,1)=5.1, p=0.025). Finally, by relying on a model comparison approach, we demonstrate that the oculomotor response holds partial information on the decrease of the vertigo experienced over successive irrigations, suggesting a bi-directional interaction between central and autonomic processes (Likelihood-ratio chi-squared test between mixed-models predicting vertigo response and including or excluding the duration of nystagmus, 2(12)=11.96, p=0.013). These findings suggest that reflexes carry partial information about voluntary processes. From the interoceptive active inference framework, these results might be relevant for evidencing signs of sentience when this cannot be communicated overtly

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Laparoscopic Sleeve Gastrectomy for Late Adolescent Population

International audienc

La contre-culture au Québec

Ce livre entend combler une lacune, celle de la méconnaissance de la contre-culture au Québec, un phénomène majeur qui, au cours d'une décennie particulièrement effervescente, a traîné dans son sillage des milliers de jeunes gens que l'extrême gauche ou le néonationalisme - des courants rivaux, si l'on peut dire - n'attiraient pas. Assez étrangement, peu d'études existent sur ce mouvement, sa sensibilité particulière et ses manifestations symboliques, d'où l'intérêt de cet ouvrage qui vise précisément à dresser le panorama de ses artistes et de leurs productions les plus marquantes, de l'Infonie au Jazz libre du Québec, en passant par Victor Lévy-Beaulieu, Josée Yvon, Mainmise ou le Front de libération homosexuel. À partir de la contribution de spécialistes de divers domaines – musique, littérature, théâtre, cinéma, art visuel, sociologie –, le livre fait le point sur ce vent de contestation qui a balayé l'Amérique des années 1960 et 1970 et sur ce qu'il a semé dans un Québec « hors de la carte », selon les mots de Raôul Duguay, l'un des plus célèbres représentants de la mouvance québécoise

Aspectos Temporais na Aula: cadência, ritmo e momento oportuno

This article presents a reflection about the temporal aspects of daily life in the classroom. The specificity of the topic is related to how these temporal elements can be useful for understanding the movements in the class practice in literacy classes. The aim is to analyze the constituting temporal elements in class with an emphasis on cadence, pace and opportune moment. In the analysis, we adopt some theoretical precepts of Certeau and the dimensions of time drawn up by Heller to approach the topic. The results indicate that the reflections on temporal aspects in the daily life of the classroom are fundamental in the class process and powerful in an analytical perspective to understand mediation.O presente artigo apresenta uma reflexão sobre os aspectos temporais cotidianos na sala de aula. A especificidade do tema recai sobre como esses elementos temporais podem ser úteis para a compreensão dos movimentos na prática da aula em turmas de alfabetização. Objetiva-se analisar sobre os elementos temporais constitutivos na aula com ênfase na cadência, ritmo e momento oportuno. Na análise, adotam-se alguns preceitos teóricos de Certeau e as dimensões de tempo elaboradas por Heller para a abordagem do tema. Os resultados indicam as reflexões sobre os aspectos temporais no cotidiano da sala de aula é fundante no processo da aula e potente em uma perspectiva analítica para compreender a mediação