Identifying the Origin of Effects of Contralateral Noise on Transient Evoked Otoacoustic Emissions in Unanesthetized Mice

Descending neural pathways in the mammalian auditory system are known to modulate the function of the peripheral auditory system. These pathways include the medial olivocochlear (MOC) efferent innervation to outer hair cells (OHCs) and the acoustic reflex pathways mediating middle ear muscle (MEM) contractions. Based on measurements in humans (Marks and Siegel, companion paper), we applied a sensitive method to attempt to differentiate MEM and MOC reflexes using contralateral acoustic stimulation in mice under different levels of anesthesia. Separation of these effects is based on the knowledge that OHC-generated transient evoked otoacoustic emissions (TEOAE) are delayed relative to the stimulus, and that the MOC reflex affects the emission through its innervation of OHC. In contrast, the MEM-mediated changes in middle ear reflectance alter both the stimulus (with a short delay) and the emission. Using this approach, time averages to transient stimuli were evaluated to determine if thresholds for a contralateral effect on the delayed emission, indicating potential MOC activation, could be observed in the absence of a change in the stimulus pressure. This outcome was not observed in the majority of cases. There were also no statistically significant differences between MEM and putative MOC thresholds, and variability was high for both thresholds regardless of anesthesia level. Since the two reflex pathways could not be differentiated on the basis of activation thresholds, it was concluded that the MEM reflex dominates changes in TEOAEs induced by contralateral noise. This result complicates the identification of purely MOC-induced changes on OAEs in mice unless the MEM reflex is inactivated surgically or pharmacologically.     

Examining Patient Perspectives on Weight Management Support in the Primary Care Setting

Obesity affects more than one-third of Americans and is a leading cause of preventable death. Integrating patient perspectives into obesity treatment can help primary care providers (PCPs) intervene more effectively. In this study, we describe patients’ experiences with PCPs concerning the diagnosis and treatment of obesity and offer suggestions for patient-centered care in weight management. We conducted four focus groups with patients of a university medical system-associated family practice who had a BMI?≥?30. Interview questions addressed general weight management perceptions and preferences for weight management support in a primary care setting. Patients completed a brief demographic survey at the conclusion of the group. Four authors independently coded focus group notes to identify themes and determine saturation using qualitative thematic analysis. We resolved discrepancies by team discussion. Thirty primary care patients participated, of whom 23 were female and whose average age was 50. Twenty-four had attempted to lose weight in the past 12 months and had discussed management with their providers. Analyses identified four themes regarding weight management in a primary care setting: motivation and weight management, the provider–patient relationship, desire for concrete weight loss plans, and limitations of the primary care setting. Motivation was named as a weight management obstacle. Participants felt that PCPs need to be partners in weight management efforts and also recognized limitations of PCP time and expertise. They endorsed an integrated behavioral approach that includes physical activity and nutrition support. Improving PCP delivery of evidence-based treatment for obesity will lead to increased patient attempts to lose weight. Incorporating patients’ desires for concrete plans, ongoing support, and referral to integrated service (e.g., nutritionists, care managers, behavioral health providers) programs can increase patient engagement and success. The chronic disease care and Patient Centered Medical Home models offer guidance for ensuring sustainability of weight management services.     

The cutaneous manifestations of tuberous sclerosis complex

Tuberous sclerosis complex (TSC) is a genetic multisystem disease with variable manifestations that can prominently involve the skin. The diagnosis of this disorder has evolved over the past two centuries. The 2012 TSC criteria emphasizes the importance of dermatological findings; orocutaneous manifestations account for 4 of 11 major criterion and 3 of 6 minor criterion. A detailed clinical dermatological evaluation is recommended for both pediatric and adult patients undergoing initial evaluation for TSC. Comprehensive dermatologic evaluation is extremely helpful when assessing these lesions and constructing a differential diagnosis.     

Challenges for Teaching Injury Prevention in a Juvenile Detention Center

This case study explored the injury related experiences and perceptions of youth in detention and the delivery of first aid education in youth detention contexts. It aimed to develop an understanding of how a mainstream injury prevention intervention could be modified for youth detention populations. Teacher and student reactions to the program were examined and injury checklists, focus groups, and staff interviews were conducted. Analysis revealed serious injuries related to criminal behaviors, violence, dangerous driving, and substance use. Recommendations for youth detention interventions include lesson flexibility, discussions, role-plays, visual materials, peer support strategies, student-teacher relationships, and positive reinforcement.     

Effects of Androgen Disruption by DDE on the Development and Functioning of the Immune System in Japanese Quail

We hypothesized that immunosuppression in birds that is caused by exposure to antiandrogenic chemicals occurs mainly through disruption of the development of the androgen-sensitive avian lymphoid organ, the bursa of Fabricius. Injections of 20.0 or 40.0 μg of p,p′-DDE [ethylene, 1,1-dichloro-2,2-bis(p-chlorophenyl)], an antiandrogen, were administered at embryonic day 1. Bursas from only chicks treated with DDE were larger than, had fewer follicles, and exhibited vacuolization within follicles compared with controls; spleens were unaffected. No differences in either immune response test were observed. This study demonstrates that the bursa may play a role in androgen-active endocrine disrupting chemical-induced immunosuppression.