Experience-Dependent Plasticity in Nucleus Laminaris of the Barn Owl.

Interaural time differences (ITDs) are a major cue for sound localization and change with increasing head size. Since the barn owl's head width more than doubles in the month after hatching, we hypothesized that the development of their ITD detection circuit might be modified by experience. To test this, we raised owls with unilateral ear inserts that delayed and attenuated the acoustic signal, and then measured the ITD representation in the brainstem nucleus laminaris (NL) when they were adults. The ITD circuit is composed of delay line inputs to coincidence detectors, and we predicted that plastic changes would lead to shorter delays in the axons from the manipulated ear, and complementary shifts in ITD representation on the two sides. In owls that received ear inserts starting around P14, the maps of ITD shifted in the predicted direction, but only on the ipsilateral side, and only in those tonotopic regions that had not experienced auditory stimulation prior to insertion. The contralateral map did not change. Thus, experience-dependent plasticity of the ITD circuit occurs in NL, and our data suggest that ipsilateral and contralateral delays are independently regulated. As a result, altered auditory input during development leads to long-lasting changes in the representation of ITD.Significance Statement The early life of barn owls is marked by increasing sensitivity to sound, and by increasing ITDs. Their prolonged post-hatch development allowed us to examine the role of altered auditory experience in the development of ITD detection circuits. We raised owls with a unilateral ear insert and found that their maps of ITD were altered by experience, but only in those tonotopic regions ipsilateral to the occluded ear that had not experienced auditory stimulation prior to insertion. This experience-induced plasticity allows the sound localization circuits to be customized to individual characteristics, such as the size of the head, and potentially to compensate for imbalanced hearing sensitivities between the left and right ears.

Non-invasive fluid biomarkers in the diagnosis of mild traumatic brain injury (mTBI): a systematic review.

BACKGROUND: Despite approximately 55.9 million annual mild traumatic brain injuries (mTBIs) worldwide, the accurate diagnosis of mTBI continues to challenge clinicians due to symptom ambiguity, reliance on subjective report and presentation variability. Non-invasive fluid biomarkers of mTBI offer a biological measure to diagnose and monitor mTBI without the need for blood draws or neuroimaging. The objective of this study is to systematically review the utility of such biomarkers to diagnose mTBI and predict disease progression. METHODS: A systematic review performed in PubMed, Scopus, Cochrane and Web of Science followed by a manual search of references without a specified timeframe. Search strings were generated and run (27 June 2022) by a research librarian. Studies were included if they: (1) included human mTBI subjects, (2) assessed utility of a non-invasive biomarker and (3) published in English. Exclusion criteria were (1) non-mTBI subjects, (2) mTBI not assessed separately from moderate/severe TBI, (3) required intracranial haemorrhage or (4) solely assesses genetic susceptibility to mTBI. RESULTS: A total of 29 studies from 27 subject populations (1268 mTBI subjects) passed the inclusion and exclusion criteria. Twelve biomarkers were studied. Salivary RNAs, including microRNA, were assessed in 11 studies. Cortisol and melatonin were assessed in four and three studies, respectively. Eight salivary and two urinary biomarkers contained diagnostic or disease monitoring capability. DISCUSSION: This systematic review identified several salivary and urinary biomarkers that demonstrate the potential to be used as a diagnostic, prognostic and monitoring tool for mTBI. Further research should examine miRNA-based models for diagnostic and predictive utility in patients with mTBI. PROSPERO REGISTRATION NUMBER: CRD42022329293.

Model organisms and systems in neuroethology: one hundred years of history and a look into the future.

The Journal of Comparative Physiology lived up to its name in the last 100 years by including more than 1500 different taxa in almost 10,000 publications. Seventeen phyla of the animal kingdom were represented. The honeybee (Apis mellifera) is the taxon with most publications, followed by locust (Locusta migratoria), crayfishes (Cambarus spp.), and fruitfly (Drosophila melanogaster). The representation of species in this journal in the past, thus, differs much from the 13 model systems as named by the National Institutes of Health (USA). We mention major accomplishments of research on species with specific adaptations, specialist animals, for example, the quantitative description of the processes underlying the axon potential in squid (Loligo forbesii) and the isolation of the first receptor channel in the electric eel (Electrophorus electricus) and electric ray (Torpedo spp.). Future neuroethological work should make the recent genetic and technological developments available for specialist animals. There are many research questions left that may be answered with high yield in specialists and some questions that can only be answered in specialists. Moreover, the adaptations of animals that occupy specific ecological niches often lend themselves to biomimetic applications. We go into some depth in explaining our thoughts in the research of motion vision in insects, sound localization in barn owls, and electroreception in weakly electric fish.

Cerebellar Inputs in the American Alligator (Alligator mississippiensis).

Crocodilians (alligators, crocodiles, and gharials) are the closet living relatives to birds and, as such, represent a key clade to understand the evolution of the avian brain. However, many aspects of crocodilian neurobiology remain unknown. In this paper, we address an important knowledge gap as there are no published studies of cerebellar connections in any crocodilian species. We used injections of retrograde tracers into the cerebellum of the American alligator (Alligator mississippiensis) to describe for the first time the origin of climbing and mossy fiber inputs. We found that inputs to the cerebellum in the American alligator are similar to those of other nonavian reptiles and birds. Retrograde labeled cells were found in the spinal cord, inferior olive, reticular formation, vestibular and cerebellar nuclei, as well as in nucleus ruber and surrounding tegmentum. Additionally, we found no retrogradely labeled cells in the anterior rhombencephalon which suggest that, like other nonavian reptiles, crocodilians may lack pontine nuclei. Similar to birds and other nonavian reptiles, we found inputs to the cerebellum from the pretectal nucleus lentiformis mesencephali. Additionally, we found retrogradely labeled neurons in two nuclei in the pretectum: the nucleus circularis and the interstitial nucleus of the posterior commissure. These pretectal projections have not been described in any other nonavian reptile to date, but they do resemble projections from the nucleus spiriformis medialis of birds. Our results show that many inputs to the cerebellum are highly conserved among sauropsids and that extensive pretectal inputs to the cerebellum are not exclusive to the avian brain. Finally, we suggest that the pontine nuclei of birds are an evolutionary novelty that may have evolved after the last common ancestor between birds and crocodilians, and may represent an intriguing case of convergent evolution with mammals.

Art therapy-based interventions to address burnout and psychosocial distress in healthcare workers-a systematic review.

BACKGROUND: Burnout and psychosocial distress are serious and growing issues for healthcare workers (HCWs) and healthcare systems across the globe. Exacerbated by changes in healthcare delivery during and following the Covid-19 pandemic, these issues negatively affect HCW wellbeing, clinical outcomes and patient safety. Art Therapy has demonstrated promise as a suitable but under researched intervention, warranting further investigation. This systematic review aims to ascertain what art therapy-based interventions used to address burnout and / or psychosocial distress in HCWs have been reported in the health and social care literature and how these have been evaluated. METHODS: Six databases (PubMed, PsycINFO, MEDLINE, EMBASE, CINAHL, ProQuest Central), Google Scholar and three clinical trial registries (CENTRAL, ICTRP and ClinicalTrials.gov) were searched for studies using art therapy-based methods to engage with burnout risk or psychosocial distress in HCWs. Following screening for eligibility study characteristics and outcomes were extracted by two reviewers independently. Studies were evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Outcomes were grouped for analysis. Quantitative and qualitative results were synthesised and integrated using narrative synthesis. RESULTS: Twenty-seven studies, drawn from thirteen countries, spanning five continents were selected for inclusion. Fifty percent were published in the last five years, indicating growing global research in the field. Fourteen studies used quantitative research methods and thirteen used qualitative methods. A total of 1580 participants took part in the studies, with nurses most broadly represented (59%). Interventions were mostly delivered in groups (95%) and by an art therapist (70%). Heterogeneity and insufficient randomised controlled trials precluded the possibility of meta-analysis. However, a review of available data showed evidence of medium to large effects for emotional exhaustion (burnout), work-related stress and common mental health issues. A content analysis of qualitative data of perceived effect complemented quantitative findings. CONCLUSION: Global research into the use of art therapy-based methods to address burnout and psychosocial distress in HCWs is growing. Whilst further high-quality evidence such as randomised controlled trials would be beneficial, findings suggest that art therapy-based methods should be strongly considered as an acceptable and effective treatment for symptoms of emotional exhaustion (burnout) and psychosocial distress in HCWs.

Hearing without a tympanic ear.

The ability to sense and localize sound is so advantageous for survival that it is difficult to understand the almost 100 million year gap separating the appearance of early tetrapods and the emergence of an impedance-matching tympanic middle ear - which we normally regard as a prerequisite for sensitive hearing on land - in their descendants. Recent studies of hearing in extant atympanate vertebrates have provided significant insights into the ancestral state(s) and the early evolution of the terrestrial tetrapod auditory system. These reveal a mechanism for sound pressure detection and directional hearing in 'earless' atympanate vertebrates that may be generalizable to all tetrapods, including the earliest terrestrial species. Here, we review the structure and function of vertebrate tympanic middle ears and highlight the multiple acquisition and loss events that characterize the complex evolutionary history of this important sensory structure. We describe extratympanic pathways for sound transmission to the inner ear and synthesize findings from recent studies to propose a general mechanism for hearing in 'earless' atympanate vertebrates. Finally, we integrate these studies with research on tympanate species that may also rely on extratympanic mechanisms for acoustic reception of infrasound (<20 Hz) and with studies on human bone conduction mechanisms of hearing.

Anatomical Comparative Study of the External Nasal Nerve in Caucasian and Asian: Application for Minimizing Nerve Damage in Rhinoplasty.

BACKGROUND: The numbness of the nasal tip is the main symptom of the external nasal nerve injury, especially after rhinoplasty. This postoperative syndrome can reduce the patient's satisfaction with the operation. Having a better understanding of the anatomical structure and intraoperative protection can effectively avoid nerve injury. At present, the anatomical research on this nerve is all from Asia. This study aims to fill the gap in the anatomical study of this nerve in Caucasians and provides comparative results with Asians. MATERIAL AND METHODS: A total of 20 Caucasian cadavers were embalmed using the Thiel method. On dissection, after complete exposure of the external nasal nerves, the distance between the exit point of the external nasal nerve and the nasal midline was measured, and the morphology of the nerves was compared with the Asian data. The nerves were classified into types based on their branching pattern. RESULTS: The nerve plane was the same as the Asian record. The distance ranged from 5.08 to 11.94 mm (mean, 8.31 ± 1.85 mm). This distance has statistical significant difference compared with the Asian population (P < 0.01). The average distance is larger, and the distribution range of the exit point is wider. On classification, 35 of 40 cases had the same type results as those previously reported, with the primary types I, II and III. Five new varieties were found which are classified as subtypes of the primary types and a new type IV. Furthermore, the bifurcation position in two-thirds of the type II cases and variations is proximal to that seen in the Asian population. CONCLUSIONS: The anatomical structure of the external nasal nerve in Caucasians and Asians has obvious differences. This nerve in Caucasians is more likely to be damaged during rhinoplasty than Asians. Except the primary types, the classification of the external nasal nerve also includes subtypes and type IV. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Strongly directional responses to tones and conspecific calls in the auditory nerve of the Tokay gecko, Gekko gecko.

The configuration of lizard ears, where sound can reach both surfaces of the eardrums, produces a strongly directional ear, but the subsequent processing of sound direction by the auditory pathway is unknown. We report here on directional responses from the first stage, the auditory nerve. We used laser vibrometry to measure eardrum responses in Tokay geckos and in the same animals recorded 117 auditory nerve single fiber responses to free-field sound from radially distributed speakers. Responses from all fibers showed strongly lateralized activity at all frequencies, with an ovoidal directivity that resembled the eardrum directivity. Geckos are vocal and showed pronounced nerve fiber directionality to components of the call. To estimate the accuracy with which a gecko could discriminate between sound sources, we computed the Fisher information (FI) for each neuron. FI was highest just contralateral to the midline, front and back. Thus, the auditory nerve could provide a population code for sound source direction, and geckos should have a high capacity to differentiate between midline sound sources. In brain, binaural comparisons, for example, by IE (ipsilateral excitatory, contralateral inhibitory) neurons, should sharpen the lateralized responses and extend the dynamic range of directionality.NEW & NOTEWORTHY In mammals, the two ears are unconnected pressure receivers, and sound direction is computed from binaural interactions in the brain, but in lizards, the eardrums interact acoustically, producing a strongly directional response. We show strongly lateralized responses from gecko auditory nerve fibers to directional sound stimulation and high Fisher information on either side of the midline. Thus, already the auditory nerve provides a population code for sound source direction in the gecko.

Group-based cognitive stimulation therapy for dementia: a qualitative study on experiences of group interactions.

OBJECTIVES: Cognitive Stimulation Therapy (CST) is an evidence-based group intervention shown to improve cognition and quality of life in dementia and is widely implemented across the NHS. However, no attempt has been made to understand the possible advantages, and/or disadvantages, of delivering CST in a group format. The main aim of the present study was to explore experiences of group interactions in CST and longer-term maintenance CST (MCST) groups. METHOD: A total of twenty-one semi-structured in-depth interviews were conducted across four separate groups delivered in London, the East Midlands, South West and South East of England; including two CST and two MCST groups. Group members with mild to moderate dementia and facilitators from these groups were interviewed. Thematic analysis was used to analyse the data using NVivo software. RESULTS: The final analysis identified six themes: 'benefits and challenges of group expression', 'importance of companionship and getting to know others, 'togetherness and shared identity', 'group entertainment', 'group support' and 'cognitive stimulation through the group'. The inter-connecting relationship between these themes are synthesised and summarised. CONCLUSION: Findings support the notion that therapeutic advantages inherent to the group format exist in group-based CST. New insights into the challenges related to a group format are also highlighted and discussed. Future research may benefit from exploring the relationship between the identified experiences of group interactions and clinical outcomes.

Neural Maps of Interaural Time Difference in the American Alligator: A Stable Feature in Modern Archosaurs.

Detection of interaural time differences (ITDs) is crucial for sound localization in most vertebrates. The current view is that optimal computational strategies of ITD detection depend mainly on head size and available frequencies, although evolutionary history should also be taken into consideration. In archosaurs, which include birds and crocodiles, the brainstem nucleus laminaris (NL) developed into the critical structure for ITD detection. In birds, ITDs are mapped in an orderly array or place code, whereas in the mammalian medial superior olive, the analog of NL, maps are not found. As yet, in crocodilians, topographical representations have not been identified. However, nontopographic representations of ITD cannot be excluded due to different anatomical and ethological features of birds and crocodiles. Therefore, we measured ITD-dependent responses in the NL of anesthetized American alligators of either sex and identified the location of the recording sites by lesions made after recording. The measured extracellular field potentials, or neurophonics, were strongly ITD tuned, and their preferred ITDs correlated with the position in NL. As in birds, delay lines, which compensate for external time differences, formed maps of ITD. The broad distributions of best ITDs within narrow frequency bands were not consistent with an optimal coding model. We conclude that the available acoustic cues and the architecture of the acoustic system in early archosaurs led to a stable and similar organization in today's birds and crocodiles, although physical features, such as internally coupled ears, head size, or shape, and audible frequency range, vary among the two groups.SIGNIFICANCE STATEMENT Interaural time difference (ITD) is an important cue for sound localization, and the optimal strategies for encoding ITD in neuronal populations are the subject of ongoing debate. We show that alligators form maps of ITD very similar to birds, suggesting that their common archosaur ancestor reached a stable coding solution different from mammals. Mammals and diapsids evolved tympanic hearing independently, and local optima can be reached in evolution that are not considered by global optimal coding models. Thus, the presence of ITD maps in the brainstem may reflect a local optimum in evolutionary development. Our results underline the importance of comparative animal studies and show that optimal models must be viewed in the light of evolutionary processes.

Zebrin Expression in the Cerebellum of Two Crocodilian Species.

While in birds and mammals the cerebellum is a highly convoluted structure that consists of numerous transverse lobules, in most amphibians and reptiles it consists of only a single unfolded sheet. Orthogonal to the lobules, the cerebellum is comprised of sagittal zones that are revealed in the pattern of afferent inputs, the projection patterns of Purkinje cells, and Purkinje cell response properties, among other features. The expression of several molecular markers, such as aldolase C, is also parasagittally organized. Aldolase C, also known as zebrin II (ZII), is a glycolytic enzyme expressed in the cerebellar Purkinje cells of the vertebrate cerebellum. In birds, mammals, and some lizards (Ctenophoresspp.), ZII is expressed in a heterogenous fashion of alternating sagittal bands of high (ZII+) and low (ZII-) expression Purkinje cells. In contrast, turtles and snakes express ZII homogenously (ZII+) in their cerebella, but the pattern in crocodilians is unknown. Here, we examined the expression of ZII in two crocodilian species (Crocodylus niloticus and Alligator mississippiensis) to help determine the evolutionary origin of striped ZII expression in vertebrates. We expected crocodilians to express ZII in a striped (ZII+/ZII-) manner because of their close phylogenetic relationship to birds and their larger and more folded cerebellum compared to that of snakes and turtles. Contrary to our prediction, all Purkinje cells in the crocodilian cerebellum had a generally homogenous expression of ZII (ZII+) rather than clear ZII+/- stripes. Our results suggest that either ZII stripes were lost in three groups (snakes, turtles, and crocodilians) or ZII stripes evolved independently three times (lizards, birds, and mammals).

Dynamics of synaptic extracellular field potentials in the nucleus laminaris of the barn owl.

Synaptic currents are frequently assumed to make a major contribution to the extracellular field potential (EFP). However, in any neuronal population, the explicit separation of synaptic sources from other contributions such as postsynaptic spikes remains a challenge. Here we take advantage of the simple organization of the barn owl nucleus laminaris (NL) in the auditory brain stem to isolate synaptic currents through the iontophoretic application of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-receptor antagonist 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo-benzo[ f]quinoxaline-7-sulfonamide (NBQX). Responses to auditory stimulation show that the temporal dynamics of the evoked synaptic contributions to the EFP are consistent with synaptic short-term depression (STD). The estimated time constants of an STD model fitted to the data are similar to the fast time constants reported from in vitro experiments in the chick. Overall, the putative synaptic EFPs in the barn owl NL are significant but small (<1% change of the variance by NBQX). This result supports the hypothesis that the EFP in NL is generated mainly by axonal spikes, in contrast to most other neuronal systems. NEW & NOTEWORTHY Synaptic currents are assumed to make a major contribution to the extracellular field potential in the brain, but it is hard to directly isolate these synaptic components. Here we take advantage of the simple organization of the barn owl nucleus laminaris in the auditory brain stem to isolate synaptic currents through the iontophoretic application of a synaptic blocker. We show that the responses are consistent with a simple model of short-term synaptic depression.

Contribution of action potentials to the extracellular field potential in the nucleus laminaris of barn owl.

Extracellular field potentials (EFP) are widely used to evaluate in vivo neural activity, but identification of multiple sources and their relative contributions is often ambiguous, making the interpretation of the EFP difficult. We have therefore analyzed a model EFP from a simple brainstem circuit with separable pre- and postsynaptic components to determine whether we could isolate its sources. Our previous papers had shown that the barn owl neurophonic largely originates with spikes from input axons and synapses that terminate on the neurons in the nucleus laminaris (NL) (Kuokkanen PT, Wagner H, Ashida G, Carr CE, Kempter R. J Neurophysiol 104: 2274-2290, 2010; Kuokkanen PT, Ashida G, Carr CE, Wagner H, Kempter R. J Neurophysiol 110: 117-130, 2013; McColgan T, Liu J, Kuokkanen PT, Carr CE, Wagner H, Kempter R. eLife 6: e26106, 2017). To determine how much the postsynaptic NL neurons contributed to the neurophonic, we recorded EFP responses in NL in vivo. Power spectral analyses showed that a small spectral component of the evoked response, between 200 and 700 Hz, could be attributed to the NL neurons' spikes, while nucleus magnocellularis (NM) spikes dominate the EFP at frequencies ≳1 kHz. Thus, spikes of NL neurons and NM axons contribute to the EFP in NL in distinct frequency bands. We conclude that if the spectral components of source types are different and if their activities can be selectively modulated, the identification of EFP sources is possible. NEW & NOTEWORTHY Extracellular field potentials (EFPs) generate clinically important signals, but their sources are incompletely understood. As a model, we have analyzed the auditory neurophonic in the barn owl's nucleus laminaris. There the EFP originates predominantly from spiking in the afferent axons, with spectral power ≳1 kHz, while postsynaptic laminaris neurons contribute little. In conclusion, the identification of EFP sources is possible if they have different spectral components and if their activities can be modulated selectively.

Auditory brainstem response wave III is correlated with extracellular field potentials from nucleus laminaris of the barn owl.

The auditory brainstem response (ABR) is generated in the auditory brainstem by local current sources, which also give rise to extracellular field potentials (EFPs). The origins of both the ABR and the EFP are not well understood. We have recently found that EFPs, especially their dipole behavior, may be dominated by the branching patterns and the activity of axonal terminal zones [1]. To test the hypothesis that axons also shape the ABR, we used the well-described barn owl early auditory system. We recorded the ABR and a series of EFPs between the brain surface and nucleus laminaris (NL) in response to binaural clicks. The ABR and the EFP within and around NL are correlated. Together, our data suggest that axonal dipoles within the barn owl nucleus laminaris contribute to the ABR wave III.

Education, Practice, and Competency Gaps of Anesthetists in Ethiopia: Task Analysis.

PURPOSE: This study assessed the needs and gaps in the education, practice and competencies of anesthetists in Ethiopia. DESIGN: A cross-sectional study design was used. METHODS: A questionnaire consisting of 74 tasks was completed by 137 anesthetists who had been practicing for 6 months to 5 years. FINDINGS: Over half of the respondents rated 72.9% of the tasks as being highly critical to patient outcomes, and reported that they performed 70.2% of all tasks at a high frequency. More than a quarter of respondents reported that they performed 15 of the tasks at a low frequency. Nine of the tasks rated as being highly critical were not learned during pre-service education by more than one-quarter of study participants, and over 10% of respondents reported that they were unable to perform five of the highly critical tasks. CONCLUSIONS: Anesthetists rated themselves as being adequately prepared to perform a majority of the tasks in their scope of practice.

Development of auditory sensitivity in the barn owl.

Adult barn owl hearing is acute, but development of this sense is not well understood. We, therefore, measured auditory brainstem responses in barn owls from before the onset of hearing (posthatch day 2, or P2) to adulthood (P69). The first consistent responses were detected at P4 for 1 and 2 kHz, followed by responses to 0.5 and 4 kHz at P9, and 5 kHz at P13. Sensitivity to higher frequencies increased with age, with responses to 12 kHz appearing about 2 months after hatching, once the facial ruff was mature. Therefore, these altricial birds achieve their sensitivity to sound during a prolonged period of development, which coincides with maturation of the skull and facial ruff (Haresign and Moiseff in Auk 105:699-705, 1988).

A circuit for detection of interaural time differences in the nucleus laminaris of turtles.

The physiological hearing range of turtles is approximately 50-1000 Hz, as determined by cochlear microphonics ( Wever and Vernon, 1956a). These low frequencies can constrain sound localization, particularly in red-eared slider turtles, which are freshwater turtles with small heads and isolated middle ears. To determine if these turtles were sensitive to interaural time differences (ITDs), we investigated the connections and physiology of their auditory brainstem nuclei. Tract tracing experiments showed that cranial nerve VIII bifurcated to terminate in the first-order nucleus magnocellularis (NM) and nucleus angularis (NA), and the NM projected bilaterally to the nucleus laminaris (NL). As the NL received inputs from each side, we developed an isolated head preparation to examine responses to binaural auditory stimulation. Magnocellularis and laminaris units responded to frequencies from 100 to 600 Hz, and phase-locked reliably to the auditory stimulus. Responses from the NL were binaural, and sensitive to ITD. Measures of characteristic delay revealed best ITDs around ±200 µs, and NL neurons typically had characteristic phases close to 0, consistent with binaural excitation. Thus, turtles encode ITDs within their physiological range, and their auditory brainstem nuclei have similar connections and cell types to other reptiles.

Evolution of Sound Source Localization Circuits in the Nonmammalian Vertebrate Brainstem.

The earliest vertebrate ears likely subserved a gravistatic function for orientation in the aquatic environment. However, in addition to detecting acceleration created by the animal's own movements, the otolithic end organs that detect linear acceleration would have responded to particle movement created by external sources. The potential to identify and localize these external sources may have been a major selection force in the evolution of the early vertebrate ear and in the processing of sound in the central nervous system. The intrinsic physiological polarization of sensory hair cells on the otolith organs confers sensitivity to the direction of stimulation, including the direction of particle motion at auditory frequencies. In extant fishes, afferents from otolithic end organs encode the axis of particle motion, which is conveyed to the dorsal regions of first-order octaval nuclei. This directional information is further enhanced by bilateral computations in the medulla and the auditory midbrain. We propose that similar direction-sensitive neurons were present in the early aquatic tetrapods and that selection for sound localization in air acted upon preexisting brain stem circuits like those in fishes. With movement onto land, the early tetrapods may have retained some sensitivity to particle motion, transduced by bone conduction, and later acquired new auditory papillae and tympanic hearing. Tympanic hearing arose in parallel within each of the major tetrapod lineages and would have led to increased sensitivity to a broader frequency range and to modification of the preexisting circuitry for sound source localization.

Identifying gaps in the practices of rural health extension workers in Ethiopia: a task analysis study.

BACKGROUND: Health extension workers (HEWs) are the frontline health workers for Ethiopia's primary health care system. The Federal Ministry of Health is seeking to upgrade and increase the number of HEWs, particularly in remote areas, and address concerns about HEWs' pre-service education and practices. The aim of this study was to identify gaps in HEWs' practices and recommend changes in their training and scope of practice. METHODS: A cross-sectional descriptive task analysis was conducted to assess the work of rural HEWs who had been in practice for six months to five years. One hundred participants were invited from 100 health posts in five regions of Ethiopia. HEWs self-reported on 62 tasks on: frequency, criticality (importance), where the task was learned, and ability to perform the task. Descriptive statistics, including frequencies and percentages, were computed for each variable. Task combinations were examined to identify tasks performed infrequently or for which HEWs are inadequately prepared. RESULTS: A total of 82 rural HEWs participated in the study. Nearly all HEWs rated every task as highly critical to individual and public health outcomes. On average, most HEWs (51.5%-57.4%) reported learning hygiene and environmental sanitation tasks, disease prevention and control tasks, family health tasks, and health education and communication tasks outside of their pre-service education, primarily through in-service and on-the-job training. Over half of HEWs reported performing certain critical tasks infrequently, including management of supplies, stocks and maintenance at the facility and management of the cold chain system. Almost all HEWs (95.7-97.2%) perceived themselves as competent and proficient in performing tasks in all program areas. CONCLUSION: HEWs were insufficiently prepared during pre-service education for all tasks that fall within their scope of practice. Many learned tasks through in-service or on-the-job training, and some tasks were not learned at all. Some tasks that are part of expected HEW practice were performed infrequently, potentially reducing the effectiveness of the Health Extension Program to provide preventive and basic curative health care services to communities. Findings should alert policy makers to the need to review HEWs' scope of practice, update pre-service education curricula and prioritize in-service training modules.