An ensemble reconstruction of global monthly sea surface temperature and sea ice concentration 1000-1849.

This paper describes a global monthly gridded Sea Surface Temperature (SST) and Sea Ice Concentration (SIC) dataset for the period 1000-1849, which can be used as boundary conditions for atmospheric model simulations. The reconstruction is based on existing coarse-resolution annual temperature ensemble reconstructions, which are then augmented with intra-annual and sub-grid scale variability. The intra-annual component of HadISST.2.0 and oceanic indices estimated from the reconstructed annual mean are used to develop grid-based linear regressions in a monthly stratified approach. Similarly, we reconstruct SIC using analog resampling of HadISST.2.0 SIC (1941-2000), for both hemispheres. Analogs are pooled in four seasons, comprising of 3-months each. The best analogs are selected based on the correlation between each member of the reconstructed SST and its target. For the period 1780 to 1849, We assimilate historical observations of SST and night-time marine air temperature from the ICOADS dataset into our reconstruction using an offline Ensemble Kalman Filter approach. The resulting dataset is physically consistent with information from models, proxies, and observations.

Student Misbehaviour and Teacher Coercion. A Comparative Study of Contextual Factors in Primary and Secondary Education Teachers.

This study analyses the relation between student misbehaviour and teacher coercion from a teacher perspective by taking further contextual variables into account. Our participants were 480 male/female secondary education and 351 primary education teachers from the Spanish Autonomous Community of Aragón (Spain). This study forms part of the 2017 Coexistence Study in Aragón Education Centres. According to the theoretical framework and the SEM (structural equation modeling), the results revealed a close relationship between student misbehaviour and teacher coercion, although other contextual variables also appeared in the regression equation: in coexistence rules and in teacher competence. We ultimately found a certain degree of difference between the primary and secondary education levels. On the secondary school level, teacher conflicts were associated with student misbehaviour, while coexistence rules and participative and inclusive activities predicted teacher coercion. Conversely, on the primary school level, participative and inclusive activities predict a lower frequency of student misbehaviour, while teacher competence predicts a lower frequency of teacher coercion.

Funciones Ejecutivas en Estudiantes con Trastorno Específico del Lenguaje al Comienzo de la Escolarización Básica / Executive Functions in Students with Specific Language Impairment at the Beginning of Elementary Education

Resumen Las funciones ejecutivas (FE) constituyen un conjunto de habilidades implicadas en el control y regulación del funcionamiento cognitivo. La relación entre fe y desarrollo del lenguaje es especialmente relevante en la conceptualización de los trastornos lingüísticos. El objetivo del estudio consistió en explorar el uso diferencial de fe en dos grupos: Desarrollo Lingüístico Típico (DLT) y Trastorno Específico del Lenguaje (TEL). Participaron 44 estudiantes (56,82 % niños), 22 DLT y 22 TEL, con edades entre 6,00-6,92 años (M=6.17, DT=.19). El factor diagnóstico previo mostró efectos significativos en atención ejecutiva (p<.001, η2 parcial =.77), memoria de trabajo (p<.001, if parcial =.67), flexibilidad cognitiva (p<.01, η2 parcial =.15), y planificación (p<.001, η2 parcial =.63). En todos los casos, salvo en flexibilidad cognitiva, el tamaño del efecto fue fuerte. Los resultados avalarían la tesis de no especificidad en TEL y la posible presencia de disfunciones cognitivas generales que subyacen al trastorno.

Abstract The executive functions (EF) constitute a set of skills involved in the control and regulation of cognitive functioning. The relation between EF and the development of language is especially relevant regarding the conceptualization of linguistic disorders. This study aims to explore the differential use of EF between two groups: Typical Language Development (TLD) and Specific Language Impairment (SLI). The participants were 44 students (56,82% boys), 22 TLD and 22 SLI, with ages between 6,00-6,92 years (M=6.17, SD=.19). The previous diagnostic factor showed significant effects in executive attention (p<.001, η2 partial =.77), working memory (p<.001, η2 partial =.67), cognitive flexibility (p<.01, η2 partial =.15), and planning (p< .001, η2 partial =.63). In every case, except for cognitive flexibility, the effect was strong. The results would support the thesis of non-specificity in the SLI and the possible presence of general cognitive dysfunctions that underlie the disorder.

Identificación de patrones instruccionales de mediación relacionados con progresos en comprensión lectora en contextos de desventaja sociocultural / Identifying instructional mediation patterns related with progress in reading comprehension in contexts of sociocultural disadvantage

Identificar factores instruccionales específicos relacionados con progresos en comprensión lectora es esencial para optimizar el aprendizaje y orientar la intervención, especialmente en contextos de desventaja socio-cultural o dificultades de aprendizaje. Este estudio pretende identificar patrones instruccionales de mediación eficaces en la explicación del progreso en comprensión. Se grabaron, transcribieron y analizaron sistemáticamente 82 sesiones-clase, y se registraron pautas de mediación relativas a diferentes procesos lectores. Los patrones de mediación fueron analizados mediante codificación y categorización del contenido con el programa Maxqdea-7. Fueron consideradas 19 categorías, que aglutinaron 178 unidades de información significativas (pautas/conductas de mediación). La muestra estuvo compuesta por 21 docentes y 821 estudiantes de tercero a octavo grado de Educación Básica de escuelas públicas de Chile ubicadas en contextos de-privados socialmente. El progreso lector se midió con la prueba estandarizada CL-PT, aplicada al principio y al final del curso escolar. Los resultados permitieron identificar pautas específicas de mediación significativas en la explicación del progreso, especialmente el patrón M_17 (Mediación del uso de estrategias para la activación e integración de conocimientos previos) explicaba el 26% de la varianza (r = .55, p < .01; R2ajustado = .26, F (1, 19) = 8.19, p = .01). Se discuten las implicaciones educativas de estos resultados

Identifying specific instructional factors related to progress in reading comprehension is essential to optimize learning and guide intervention, especially in contexts of sociocultural disadvantage or learning difficulties. This study aims to identify effective mediational instructional patterns in the explanation of progress in reading comprehension. Teaching guidelines were systematically recorded in relation to different reading processes. Eighty-two sessions were recorded, transcribed and analyzed by coding and categorizing the content of the sessions through the Maxqdea-7 program. Nineteen categories were considered, which comprised 178 significant units of information (mediation guidelines). The sample consisted of 21 teachers and 821 students from third to the eighth grade of public schools of Chile located in deprived contexts. Reading progress was measured with the standardized CL-PT test, which was applied at the beginning and end of the school year. The results have allowed identifying mediation patterns with a significant relevance in the explanation of reading progress, especially the pattern M_P17 (Mediation of the use of strategies for the activation and integration of previous knowledge) managed to explain 26% of the variance in the progress (r = .55, p < .01; R2adjusted = .26, F(1, 19) = 8.19, p = .01). The educational implications of these results are discussed

Consenso sobre el tratamiento de la disfunción tubárica obstructiva mediante dilatación con balón / Consensus on treatment of obstructive Eustachian tube dysfunction with balloon Eustachian tuboplasty

OBJETIVO: Existe una gran variabilidad en el diagnóstico de la disfunción tubárica obstructiva y su tratamiento mediante la dilatación tubárica con balón (DTB). El objetivo de este trabajo es presentar unas recomendaciones de consenso sobre las indicaciones, contraindicaciones, metodología, complicaciones y resultados de la DTB. MATERIALES Y MÉTODOS: Presentamos un consenso sobre la DTB, mediante revisión sistemática de la literatura desde 1966 hasta noviembre de 2018, términos MESH Eustachian tube and (dilation or dysfunction), recogiendo un total de 1.943 artículos en español, inglés, alemán y francés. Del total de artículos revisados se seleccionaron 139 cuyo abstract era relevante, incluyendo 2 consensos internaciones sobre diagnóstico, 7 revisiones sistemáticas y 2 ensayos clínicos aleatorizados sobre la DTB. RESULTADOS: Las indicaciones de la DTB son el barotrauma, la otitis media secretora, la otitis media adhesiva, la atelectasia y el fracaso de una timpanoplastia, siempre que se haya podido demostrar una disfunción tubárica obstructiva crónica. La efectividad de la DTB es mayor en el barotrauma y la otitis media secretora. Hay estudios publicados de elevada evidencia sobre la DTB, cuyos buenos resultados se mantienen a largo plazo, frente a tratamiento médico conservador. CONCLUSIONES: La DTB es un procedimiento quirúrgico mínimamente invasivo que ha demostrado su efectividad y seguridad en el tratamiento de la disfunción tubárica crónica en adultos y en niños. Las indicaciones en las que es más efectiva son el barotrauma y la otitis media secretora

No disponible

Consensus on treatment of obstructive Eustachian tube dysfunction with balloon Eustachian tuboplasty. / Consenso sobre el tratamiento de la disfunción tubárica obstructiva mediante dilatación con balón.

OBJECTIVE: There is a great variability in diagnosis of obstructive Eustachian tube dysfunction and its treatment by balloon Eustachian tuboplasty (BET). The aim of this paper was to present a consensus on indications, contraindications, methodology, complications and results after BET. MATERIAL AND METHODS: We obtained a consensus on BET, after a systematic review of the literature on BET from 1966 to November 2018, using MESH terms «Eustachian tube and (dilation or dysfunction)¼, including a total of 1.943 papers in Spanish, English, German and French. We selected 139 papers with a relevant abstract, including two international consensuses, seven systematic revisions, and two randomised control trials on BET. RESULTS: The indications for BET are barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed. BET is more effective in barotrauma and serous otitis media. There are high- evidence reports on BET showing good results that persist long-term, as compared to conservative medical treatment. CONCLUSIONS: BET is a surgical, minimally invasive treatment that has shown its effectiveness and safety in obstructive Eustachian tube dysfunction in adults and children. It is most effective in barotrauma and serous otitis media.

Promotores de reserva cognitiva en adultos mayores con alto riesgo de demencia cortical / Promoters of Cognitive Reserve in the Elderly with High Risk of Cortical Dementia

Introducción: La reserva cognitiva constituye un elemento central para entender cómo responde el cerebro a la neuropatología durante el ciclo vital. Objetivo: Comprender los factores promotores de reserva cognitiva desde la experiencia de vida de adultos mayores sin deterioro cognitivo y con alto riesgo de demencia cortical. Métodos: Estudio cualitativo, con base en método Grounded Theory. Se realizan entrevistas semiestructuradas en profundidad a siete adultos mayores. En el análisis, se aplica la técnica de comparación constante según modelo de Glasser y Straus, utilizando Atlas ti/7. Resultados: Desde el análisis axial surgen cinco categorías interrelacionadas: actividad mental, experiencias gratificantes, cuidados, eventos traumáticos y características de personalidad. Se aprecia un patrón constante de experiencias vitales mentalmente estimulantes, relacionado principalmente a actividades de cuidado y experiencias gratificantes, no asociadas a educación formal. Conclusiones: Se distingue un proceso dinámico que involucra experiencias y eventos de vida cotidiana, tanto personales como ambientales, ocupacionales y del estilo de vida, que operan secuencialmente durante el ciclo vital; estos factores podrían incidir significativamente en los mecanismos neurobiológicos y actuar como promotores de reserva cognitiva. Se obtiene un modelo de promotores de reserva cognitiva que podría utilizarse en programas de salud cognitiva para contrarrestar la neuropatología(AU)

Introduction: Cognitive reserve constitutes an element central to understanding how the brain responds to neuropathology during the life cycle. Objective: To understand the factors that promote cognitive reserve from the life experience of the elderly without cognitive deterioration and with high risk of cortical dementia. Methods: Qualitative study, methodologically based on grounded theory. In-depth semi-structured interviews are conducted on seven elderlies. In the analysis, the constant comparison technique is applied according to the model by Glaser and Strauss, using ATLAS-Ti 7. Results: Five interrelated categories emerge from the axial analysis: mental activity, gratifying experiences, care, traumatic events, and personality traits. There is a constant pattern of mentally-stimulating life experiences, mainly related to care activities and gratifying experiences, not associated with formal education. Conclusions: A dynamic process is distinguished that involves experiences and events of daily life, both personal and environmental, occupational and related to lifestyle, which operate sequentially during the life cycle. These factors could significantly influence neurobiological mechanisms and act as promoters of cognitive reserve. A model of cognitive reserve promoters is obtained that could be used in cognitive health programs to counteract neuropathology(AU)

No evidence for globally coherent warm and cold periods over the preindustrial Common Era.

Earth's climate history is often understood by breaking it down into constituent climatic epochs1. Over the Common Era (the past 2,000 years) these epochs, such as the Little Ice Age2-4, have been characterized as having occurred at the same time across extensive spatial scales5. Although the rapid global warming seen in observations over the past 150 years does show nearly global coherence6, the spatiotemporal coherence of climate epochs earlier in the Common Era has yet to be robustly tested. Here we use global palaeoclimate reconstructions for the past 2,000 years, and find no evidence for preindustrial globally coherent cold and warm epochs. In particular, we find that the coldest epoch of the last millennium-the putative Little Ice Age-is most likely to have experienced the coldest temperatures during the fifteenth century in the central and eastern Pacific Ocean, during the seventeenth century in northwestern Europe and southeastern North America, and during the mid-nineteenth century over most of the remaining regions. Furthermore, the spatial coherence that does exist over the preindustrial Common Era is consistent with the spatial coherence of stochastic climatic variability. This lack of spatiotemporal coherence indicates that preindustrial forcing was not sufficient to produce globally synchronous extreme temperatures at multidecadal and centennial timescales. By contrast, we find that the warmest period of the past two millennia occurred during the twentieth century for more than 98 per cent of the globe. This provides strong evidence that anthropogenic global warming is not only unparalleled in terms of absolute temperatures5, but also unprecedented in spatial consistency within the context of the past 2,000 years.

Escolar con malaria por plasmodium falciparum de África: riesgo para la salud pública en Honduras / School child with Plasmodium falciparum malaria from Africa: public health risk in Honduras

Antecedentes: Los viajes a zonas endémicas con parásitos resistentes, la respuesta evolutiva de Plasmodium y los sistemas sanitarios debilitados, comprometen el control mundial y local de la malaria. Descripción del Caso clínico: Niño, 6 años, atendido en Hospital Escuela Universitario (HE), Tegucigalpa, referido desde Siguatepeque, Comayagua, por dudas en diagnóstico de laboratorio y antecedente de vivir en África y cuatro episodios de malaria por P. falciparum (2015-2017). Al ingreso presentó cuadro entérico e informe de Plasmodium spp. Se inició tratamiento con cloroquina, omitida y substituida al día siguiente por derivado de artemisinina al confirmar P. falciparum y 0.7% de eritrocitos parasitados. Presentó buena respuesta clínica y parasitológica, egresando al 7mo día intrahospitalario después de 72 horas afebril. La gota gruesa al egreso informó estadios sexuales de P. falciparum, administrándose primaquina al estar disponible 7 días después. En control ambulatorio al 5to día post-egreso, no se observaron parásitos aunque persistían leucocitos con pigmento malárico fagocitado. Cuatro familiares convivientes en África fueron examinados. El padre, que informó cefalea leve y febrícula, fue detectado con estadios asexuales de P. falciparum; presentó buena respuesta al tratamiento con derivado de artemisinina. Conclusiones: La descripción del caso y los diferentes eslabones en su manejo clínico y epidemiológico, reflejan la potencialidad de complicación de la malaria. La introducción de parásitos resistentes a la cloroquina constituye una amenaza de salud pública, principalmente ante fallas evitables en el sistema sanitario. Es necesario fortalecer el diagnóstico temprano y tratamiento oportuno especialmente en el contexto de la eliminación de malaria en Mesoamérica...(AU)

Integrating Curriculum-Based Dynamic Assessment in Computerized Adaptive Testing: Development and Predictive Validity of the EDPL-BAI Battery on Reading Competence.

In recent decades there have been significant changes in the conceptualization of reading as well as in the perception of how this activity should be assessed. Interest in the analysis of reading processes has led to the emergence of new explanatory models based primarily on the contributions of cognitive psychology. In parallel, there have been notable advances in measurement procedures, especially in models based on Item Response Theory (IRT), as well as in the capacity and performance of specific software programs that allow data to be managed and analyzed. These changes have contributed significantly to the rise of testing procedures such as computerized adaptive tests (CATs), whose fundamental characteristic is that the sequence of items presented in the tests is adapted to the level of competence that the subject manifests. Likewise, the incorporation of elements of dynamic assessment (DA) as the prompts are gradually offered allows for obtaining information about the type and degree of support required to optimize the subject's performance. In this sense, the confluence of contributions from DA and CATs offers a new possibility for approaching the assessment of learning processes. In this article, we present a longitudinal research developed in two phases, through which a computerized dynamic adaptive assessment battery of reading processes (EDPL-BAI) was configured. The research frame involved 1,831 students (46% girls) from 13 public schools in three regions of Chile. The purpose of this study was to analyze the differential contribution on reading competence of dynamic scores obtained in a subsample composed of 324 (47% girls) students from third to sixth grade after the implementation of a set of adaptive dynamic tests of morpho-syntactic processes. The results achieved in the structural equation modeling indicate a good global fit. Individual relationships show a significant contribution of calibrated score that reflects estimated knowledge level on reading competence, as well as dynamic scores based on the assigned value of graduated prompts required by the students. These results showed significant predictive values on reading competence and incremental validity in relation to predictions made by static criterion tests.

Utility of diffusion-weighted magnetic resonance imaging in the diagnosis of cholesteatoma and the influence of the learning curve.

OBJECTIVE: The aim of this study is to assess the usefulness and reliability of this technique in our center, correlating the radiological and surgical findings and to study the influence of the learning curve by comparing the initial results with a radiological analysis performed 3 years after. STUDY DESIGN: Retrospective cohort study. METHODS: 67 patients with clinical cholesteatoma suspicion were included in the study, 24 with previously not operated cholesteatoma and 43 with suspicion of recurrent or residual cholesteatoma. All of them underwent diffusion-weighted magnetic resonance imaging, comparing these results with the histological confirmation after surgery. At 3 years, a blind radiological review of these cases was performed and the results were compared with those obtained after the first assessment to objectify the influence of the learning curve. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of the total sample were 93.9, 77.8, 92 and 82.4. The overall results after the blind review of the cases were 95.9, 94.4, 97.9 and 89.5, respectively. CONCLUSION: The diffusion-weighted magnetic resonance imaging is a very useful technique during the diagnostic process of doubtful cases of cholesteatoma, especially in cases of follow-up. As for the influence of the learning curve, we observed a clear improvement in the specificity of the test.

From global circulation to local flood loss: Coupling models across the scales.

Comprehensive flood risk modeling is crucial for understanding, assessing, and mitigating flood risk. Modeling extreme events is a well-established practice in the atmospheric and hydrological sciences and in the insurance industry. Several specialized models are used to research extreme events including atmospheric circulation models, hydrological models, hydrodynamic models, and damage and loss models. Although these model types are well established, and coupling two to three of these models has been successful, no assessment of a full and comprehensive model chain from the atmospheric to local scale flood loss models has been conducted. The present study introduces a model chain setup incorporating a GCM/RCM to model atmospheric processes, a hydrological model to estimate the catchment's runoff reaction to precipitation inputs, a hydrodynamic model to identify flood-affected areas, and a damage and loss model to estimate flood losses. Such coupling requires building interfaces between the individual models that are coherent in terms of spatial and temporal resolution and therefore calls for several pre- and post-processing steps for the individual models as well as for a computationally efficient strategy to identify and model extreme events. The results show that a coupled model chain allows for good representation of runoff for both long-term runoff characteristics and extreme events, provided a bias correction on precipitation input is applied. While the presented approach for deriving loss estimations for particular extreme events leads to reasonable results, two issues have been identified that need to be considered in further applications: (i) the identification of extreme events in long-term GCM simulations for downscaling and (ii) the representativeness of the vulnerability functions for local conditions.

Síndrome hemofagocítico secundario a leishmaniasis visceral en un lactante mayor: reporte de caso / Hemophagocytic síndrome secondary to visceral leishmaniasis in a toddler: report of a case

El síndrome hemofagocítico está caracterizado por la activación anómala del sistema inmune. De etiología primaria o secundaria a enfermedades infecciosas, metabólicas, inmunitarias o neoplásicas. Con incidencia de 0,12 a 1 casos por cada 100 000 niños y una sobrevida de dos meses de no recibir tratamiento. Se diagnostica con 5 de 8 criterios propuestos por la Asociación Internacional de Histocitosis, y tratamiento según etiología. . Se presenta el caso de un paciente masculino de 15 meses de edad, procedente una zona endémica de leishmaniasis (Choluteca, Honduras), que ingresó al Hospital Escuela Universitario con cuadro clínico de fiebre prolongada y hepatoesplenomegalia. En los exámenes auxiliares de detectó: pancitopenia, serología positiva para leishmania, hipertrigliceridemia y valor de ferritina aumentada. Se hizo el diagnóstico de leishmaniasis visceral y síndrome hemofagocítico. Se trató con antimoniato de meglumina por 28 días, metilprednisolona y prednisona; con evolución favorable. El síndrome hem ofagocítico podría ocurrir secundario a leishmaniasis visceral por lo que su diagnóstico debería sospecharse tempranamente para un tratamiento oportuno y mejor pronóstico

The hemophagocytic syndrome is characterized by an abnormal activation of the immune system. This condition may be primary or secondary to infectious, metabolic, immunological, or malignant conditions. Its incidence is 0.12 to 1 case per 100,000 children, and the survival time is around two months with no therapy. The condition is diagnosed with the occurrence of 5 of 8 criteria proposed by the International Histiocytosis Association, and its therapy is according the original etiology. We present the case of a 15-month old male patient, who was brought from Choluteca (an endemic area for leishmaniasis), who was admitted to the University Hospital with prolonged fever and hepatosplenomegaly. Laboratory tests showed pancytopenia, positive serology for Leishmania, hypertriglyceridemia, and increased ferritin levels. Visceral leishmaniasis and hemophagocytic syndrome were diagnosed. The patient received meglumine antimoniate for 28 days, and also methylprednisolone and prednisone; and he had a favorable outcome. The hemophagocytic syndrome may be secondary to visceral leishmaniasis, and its diagnosis should be promptly suspected in order to have timely therapy and a better prognosis

Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio / Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear

Introducción. Las fístulas espontáneas de líquido cefalorraquídeo (LCR) al oído medio por dehiscencias espontáneas óseas del tegmen pueden ser origen de hipoacusia de transmisión y complicarse con meningitis u otras complicaciones intracraneales. El tratamiento quirúrgico para el cierre de estas comunicaciones anómalas puede realizarse por vía transmastoidea o por abordaje por fosa craneal media (FCM). Material y métodos. Se realiza un estudio retrospectivo de los pacientes intervenidos en nuestro servicio de fístulas de LCR espontáneas a oído medio por medio de abordaje por FCM en un período de 6años (2009-2014). Resultados. Se intervienen 13 pacientes con fístulas espontáneas por este abordaje, siendo el síntoma de presentación de todos ellos la hipoacusia de transmisión. En todos los casos se realiza un cierre multicapa (músculo, fascia temporal y cortical ósea) para cerrar el defecto o defectos existentes. El seguimiento mínimo en todos ellos es de 14meses, con cierre de la fístula en todos los casos salvo en uno, que precisó reintervención. No hubo complicaciones intraoperatorias ni postoperatorias debido a la técnica empleada, y la audiometría se normaliza en todos los casos, salvo en el caso de fracaso mencionado. Conclusiones. El abordaje por FCM y cierre en multicapa es una técnica adecuada y eficaz para el cierre de fístulas de LCR espontáneas a oído medio y consigue, además del cierre de la comunicación, el re-establecimiento de la audición (AU)

Introduction. Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. Material and methods. We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). Results. Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. Conclusions. The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients (AU)

Dynamic Assessment of Reading Difficulties: Predictive and Incremental Validity on Attitude toward Reading and the Use of Dialogue/Participation Strategies in Classroom Activities.

Dynamic Assessment (DA) has been shown to have more predictive value than conventional tests for academic performance. However, in relation to reading difficulties, further research is needed to determine the predictive validity of DA for specific aspects of the different processes involved in reading and the differential validity of DA for different subgroups of students with an academic disadvantage. This paper analyzes the implementation of a DA device that evaluates processes involved in reading (EDPL) among 60 students with reading comprehension difficulties between 9 and 16 years of age, of whom 20 have intellectual disabilities, 24 have reading-related learning disabilities, and 16 have socio-cultural disadvantages. We specifically analyze the predictive validity of the EDPL device over attitude toward reading, and the use of dialogue/participation strategies in reading activities in the classroom during the implementation stage. We also analyze if the EDPL device provides additional information to that obtained with a conventionally applied personal-social adjustment scale (APSL). Results showed that dynamic scores, obtained from the implementation of the EDPL device, significantly predict the studied variables. Moreover, dynamic scores showed a significant incremental validity in relation to predictions based on an APSL scale. In relation to differential validity, the results indicated the superior predictive validity for DA for students with intellectual disabilities and reading disabilities than for students with socio-cultural disadvantages. Furthermore, the role of metacognition and its relation to the processes of personal-social adjustment in explaining the results is discussed.

Middle cranial fossa approach for the repair of spontaneous cerebrospinal fluid leaks to the middle ear. / Abordaje por fosa media para el cierre de fístulas de líquido cefalorraquídeo espontáneas a oído medio.

INTRODUCTION: Spontaneous cerebrospinal fluid (CSF) leaks to the middle ear due to tegmen tympani defects can result in hearing loss or hypoacusis and predispose to meningitis as well as other neurological complications. Surgical repair of the defect can be performed through a middle cranial fossa (MCF) approach or a transmastoid approach. MATERIAL AND METHODS: We conducted a retrospective study of the patients in our Department due to a spontaneous CSF leak to the middle ear treated using a MCF approach during a 6-year period (2009-2014). RESULTS: Thirteen patients with spontaneous CSF leak to the middle ear were treated with this approach. The primary and first symptom in all of them was conductive hearing loss. In all cases, the defect or defects were closed in a multilayer manner using muscle, temporalis fascia and cortical bone. Minimum follow-up in this series was 14 months, with successful closure in all but one patient (who required reintervention). We found no intra- or postoperative complications due to the craniotomy, and the audiometry improved and normalised in all cases except for the failed case. CONCLUSIONS: The MCF approach with a multilayer closure of the defect is an effective technique for repairing spontaneous CSF leaks to the middle ear and for restoring hearing in these patients.

Utilidad de la petrosectomía subtotal en el tratamiento de la otitis media crónica / Management of chronic otitis media by subtotal petrosectomy

Introducción y Objetivos: La petrosectomía subtotal consiste en la eliminación completa de todas las celdas neumáticas del hueso temporal. La Trompa de Eustaquio se oblitera y el conducto auditivo externo se cierra. El objetivo de este estudio es describir el uso de esta técnica en el manejo de determinados casos de otitis media crónica. Material y Método: Se realiza un estudio retrospectivo de los pacientes intervenidos en nuestro hospital de petrosectomía subtotal para el tratamiento de otitis medias crónicas en un período de 5 años (2008-2012). Se recogieron datos de su historia clínica, exploración otomicroscópica, audiometría, radiología, hallazgos quirúrgicos, complicaciones postquirúrgicas y seguimiento posterior (incluyendo Resonancia magnética con difusión) con un mínimo de 24 meses de seguimiento. Resultados: En este período se realizaron 28 petrosectomías para el tratamiento de otitis medias crónicas. 15 casos fueron secundarias, es decir, el oído ya había sido intervenido con anterioridad y en 13 casos se trató de una actitud primaria. 15 de estos casos no tenían una audición útil. El postoperatorio inmediato transcurrió sin incidencias en todos los casos salvo en uno en el que ocurrió una infección. A largo plazo, debieron reintervenirse dos casos por mostrar la Resonancia restricción en la difusión a los dos años de la cirugía. Conclusiones: La necesidad del empleo de la petrosectomía subtotal en el tratamiento de las otitis medias crónicas es rara pero deberemos tenerlo en cuenta en aquellos casos recurrentes en los que exista una hipoacusia severa a profunda así como en casos con buena reserva coclear si coexiste una complicación añadida (AU)

Introduction and Objectives: Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. Material and Methods: We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. Results: In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. Conclusions: A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications (AU)

Evaluación del cambio en el umbral de la vía ósea en pacientes operados de estapedectomía / Study of the improvement in bone conduction threshold after stapedectomy

Introducción y objetivos: La alteración del umbral auditivo de la vía ósea no solo corresponde a enfermedad localizada en el oído interno y nervio coclear, sino que puede ser secundaria a enfermedad presente en el oído medio, como ocurre en la otosclerosis. El objetivo de este estudio es analizar el resultado audiológico posquirúrgico y evaluar el efecto de la estapedectomía en el umbral auditivo de la vía ósea en pacientes con otosclerosis. Material y métodos: Estudio retrospectivo de 95 pacientes (116 oídos) con hipoacusia de transmisión y mixta, diagnosticados de otosclerosis e intervenidos de forma consecutiva con la misma técnica de estapedectomía con platinectomía total. Se realizó audiometría tonal de las frecuencias 500, 1.000, 2.000 y 4.000Hz para la vía aérea y ósea en todos los casos de forma pre- y posquirúrgica (al mes y al año del procedimiento). Resultados: Se obtuvo un cierre del umbral diferencial de audición, con un valor residual<10dB en el 92,2% de los pacientes y<5dB en el 79,3%. La ganancia media obtenida en la vía aérea fue de 25dB. Los pacientes con afectación preoperatoria de la vía ósea mostraron una mejoría significativa en las frecuencias 1.000 (6dB) y 2.000 (12dB), con desaparición del escotoma de Carhart. Estos resultados se mantuvieron sin cambios al año de seguimiento. Conclusiones: Comprobamos una mejoría significativa de la vía ósea en las frecuencias 1.000 y 2.000Hz, con desaparición del escotoma de Carhart tras estapedectomía en pacientes diagnosticados de otosclerosis que presentan hipoacusia mixta (AU)

Introduction and objectives: Bone conduction threshold depression is not always a result of inner ear and cochlear nerve pathology. In fact, middle ear pathologies may be responsible for such threshold depression, as occurs in otosclerosis. The aims of this study were to evaluate the improvement of bone conduction threshold in patients with otosclerosis that underwent stapedectomy and to study the postoperative audiological results. Material and methods: This was a retrospective study on 95 patients (116 ears) diagnosed with otosclerosis having conductive or mixed hearing loss that received surgery (stapedectomy and complete removal of the footplate) consecutively. Audiometry was performed on all patients pre- and postoperatively (one month and one year after surgery). Bone and air conduction thresholds were measured at 4 frequencies (500, 1000, 2000 and 4000Hz). Results: The air-bone gap was closed, with a residual air-bone gap below 10dB in 92.2% of the patients and below 5dB in 79.3% of the cases. The air conduction threshold improved an average of 25dB. The patients that had an affected bone conduction threshold preoperatively improved bone conduction postoperatively at the frequencies of 1000 and 2000Hz (6 and 12dB, respectively). Consequently, the Carhart notch disappeared on the audiogram. These results were maintained at one year of follow up. Conclusions: We found a significant improvement in the bone conduction threshold at the frequencies of 1000 and 2000Hz and a disappearance of the Carhart notch in the audiogram after stapedectomy and total footplate removal in patients diagnosed with otosclerosis having mixed hearing loss (AU)

Study of the improvement in bone conduction threshold after stapedectomy. / Evaluación del cambio en el umbral de la vía ósea en pacientes operados de estapedectomía.

INTRODUCTION AND OBJECTIVES: Bone conduction threshold depression is not always a result of inner ear and cochlear nerve pathology. In fact, middle ear pathologies may be responsible for such threshold depression, as occurs in otosclerosis. The aims of this study were to evaluate the improvement of bone conduction threshold in patients with otosclerosis that underwent stapedectomy and to study the postoperative audiological results. MATERIAL AND METHODS: This was a retrospective study on 95 patients (116 ears) diagnosed with otosclerosis having conductive or mixed hearing loss that received surgery (stapedectomy and complete removal of the footplate) consecutively. Audiometry was performed on all patients pre- and postoperatively (one month and one year after surgery). Bone and air conduction thresholds were measured at 4 frequencies (500, 1000, 2000 and 4000Hz). RESULTS: The air-bone gap was closed, with a residual air-bone gap below 10dB in 92.2% of the patients and below 5dB in 79.3% of the cases. The air conduction threshold improved an average of 25dB. The patients that had an affected bone conduction threshold preoperatively improved bone conduction postoperatively at the frequencies of 1000 and 2000Hz (6 and 12dB, respectively). Consequently, the Carhart notch disappeared on the audiogram. These results were maintained at one year of follow up. CONCLUSIONS: We found a significant improvement in the bone conduction threshold at the frequencies of 1000 and 2000Hz and a disappearance of the Carhart notch in the audiogram after stapedectomy and total footplate removal in patients diagnosed with otosclerosis having mixed hearing loss.

Management of chronic otitis media by subtotal petrosectomy. / Utilidad de la petrosectomía subtotal en el tratamiento de la otitis media crónica.

INTRODUCTION AND OBJECTIVES: Subtotal petrosectomy is the complete exenteration of all air cell tracts of the temporal bone. The isthmus of the Eustachian tube is obliterated and the external auditory canal is closed. The aim of this study was to describe the use of this technique in the management of certain cases of chronic otitis media. MATERIAL AND METHODS: We conducted a retrospective revision of the patients treated in our Institution with this technique for chronic otitis media in a 5-year period (2008-2012). All charts were reviewed and data from the otomicroscopy, audiometry, radiology, surgical findings, postoperative complications and follow-up (including diffusion magnetic resonance imaging, MRI) of a minimum of 24 months were collected. RESULTS: In this period petrosectomy was performed on 28 patients for chronic otitis media. We treated 13 cases as primary cases, while 15 cases were secondary (patients that had already undergone another procedure in that ear). Fifteen cases had no serviceable hearing. Only 1 case had an immediate postoperative complication (infection); during the posterior follow-up, 2 cases had to be reoperated for diffusion restriction in the mastoid area revealed in the MRI 2 years after surgery. CONCLUSIONS: A subtotal petrosectomy is rarely performed for the treatment of chronic otitis media. However, it is a technique that we have to keep in mind for the treatment of certain cases where there is recurrence and deep hearing loss, as well as in cases with good cochlear reserve if the disease coexists with other complications.