Simultaneous Presentation Research Articles

Designing the rotary switch operation feeling based on cross-modal correspondences between tactile and auditory sensations

In recent years, the number of physical switches in in-vehicle devices has been reduced by consolidating several different control functions into a single control interface through active tactile devices. However, for such tactile devices to provide an improved user experience, the design must be carefully created to provide an appropriate operational feeling for each control function. The aim of this study was to find the best suitable combination of tactile and auditory sensations for the rotary knob-type tactile device to improve the user experience. The Semantic Differential method was used in the first experiment to evaluate electronically generated operating sounds, which enables the determination of the relationship between auditory impressions and acoustic features. In the second experiment, "the suitability of the combination of stimuli" was used to evaluate the impressions as an index during the simultaneous presentation of tactile and operating sounds. The results revealed a tendency for the stimuli to be perceived as "well-combined," with cross-modal correspondences between tactile and auditory sensations.

Influence of visual information on the perception of environmental sounds

The purpose of this study is to clarify the influence of visual information on perception of environmental sounds. Audiovisual stimuli (360-degree video and ambisonic recordings) sampled at 6 locations in a region were presented to subjects through VR system with headphone and were rated by subjects in various evaluation items on a 7-step categorical scale. Stimuli presentation has three modes: only auditory stimulation (auditory single-mode), only visual stimulation (visual single-mode), and simultaneous presentation of audiovisual stimulation (multi-mode). Evaluation results were subjected to analysis of variance, significance tests and factor analysis to clarify differences in evaluation tendencies between modes. The dispersion of the evaluation values for auditory aspect under multi-mode tends to be smaller than that under auditory single-mode. It was found that visual information generally has the influence of relieving the impression of prominent environmental sounds. In addition, multi-mode evaluation tends to be related with evaluation obtained in visual single-mode, especially in evaluation items common to audio and visual. And it will be tried to explain the evaluation results in relation to the expected sound state for visual stimuli.

Abstract 18707: Concomitant Occurrence of Takotsubo Cardiomyopathy and Posterior Reversible Encephalopathy Syndrome: An Uncommon Encounter With Shared Pathophysiology

CASE PRESENTATION: A 61-year-old African American woman presented in an unconscious state after a seizure. She was febrile, tachycardic, tachypneic alongside elevated lactate, leukocyte counts, and procalcitonin levels. Initial high-sensitivity troponin I was notably raised at 4,217 ng/l, with ekg revealing a new onset left bundle branch block (LBBB). Patient was intubated and needed pressor support. Echocardiogram revealed hypokinesis in the basal-mid left ventricle, with a significantly decreased ejection fraction (EF) of 40%. Chest imaging showed a consolidation in the left lower lobe, and Hemophilus influenzae was identified in the sputum culture. A subsequent lumbar puncture yielded elevated leukocytes and proteins, suggesting a secondary meningitic process. DISCUSSION: She was started on antibiotic therapy for pneumonia and meningitis. LV hypokinesis was thought to be due to Takotsubo cardiomyopathy (TTC) or myocardial infarction. Although uncommon LBBB can be seen in TTC. Her clinical presentation, echocardiogram findings further points her LBBB and troponinemia towards TTC than Myocardial infarction. Patient was managed conservatively. Neuroimaging later on revealed restricted diffusion in bilateral occipital and parietal lobes, consistent with Posterior Reversible Encephalopathy Syndrome (PRES). A delayed coronary angiogram after clinical stabilization ruled out obstructive atherosclerotic disease. Weakness and ataxia improved over the course. EF at discharge was 80%.This case illustrates the possibility of concomitant TTS and PRES, conditions hypothesized to arise following intense physical or emotional stress, in this case, likely triggered by pneumonia and meningitis. This clinical scenario underscores the importance of awareness and understanding of these two entities and their potential for simultaneous presentation, providing valuable insights for clinical decision-making in such complex cases.

Rational design of Au NPs satellite nanostructure modified microelectrode for dual-mode detection of mercury ions in algal solution

Developing a microelectrode with in-situ multiple sensing modes will greatly expand the applicability and reliability of the analytical platform. Hence, a functional substrate with a satellite-like nanostructure was constructed on a gold microelectrode (Au ME). This structure not only amplifies the surface-enhanced Raman scattering (SERS) signal of the labeled molecule (4-nitrobenzenthiol, NBT) on the functionalized Au NPs, but also ensures the good electrical properties of the proposed functionalized microelectrode (Au ME/Au-AuNDNA). Based on this feature, the highly toxic heavy metal mercury ions (Hg2+) were used as a model to verify this dual modal analytical platform. Significantly, the proposed microelectrode has a satisfactory sensitivity to Hg2+and allows the simultaneous presentation of analytical results by dual-mode of SERS signal turn-off (LOD 2.7 × 10−11 M) and current signal turn-on (LOD 6.4 × 10−9 M), the detected concentration of Hg2+ is below the dangerous limit of World Health Organization (WHO) and the U.S. Environmental Protection Agency (EPA). This relies mainly on the formation of thymine-Hg2+-thymine (T-Hg2+-T) by the modified probe B ssDNA on the microelectrode to disrupt the satellite structure with AuNDNA, while the applied potential reduces the Hg2+ captured by T-Hg2+-T on the microelectrode surface. Such a fascinating analytical strategy was further evaluated in an environmental water sample simulated with algal solution and still showed a reliable analytical capability. Thus, the proposed dual-mode sensing concept not only opens new avenues for the coordinated application of novel electrochemical and SERS sensing techniques, but also provides a foundation for in-situ detection based on micro/nanoscale electrodes.

The ordinal distance effect in working memory: does it exist in the absence of confounds?

In most daily-life situations, briefly remembering actions or words is not sufficient to reach a goal. You often have to remember them in a specific order. One behavioural observation of the processing of ordinal information in working memory is the ordinal distance effect. It refers to the facilitation in the ordinal processing of items that are at distant positions in comparison to items close to each other in working memory. So far, the ordinal distance effect has always been investigated with a simultaneous presentation of the items of the memory sequences. Such a presentation created a confound: items distant by their ordinal distance were also distant by their physical distance (i.e., the visuospatial distance between their positions on the screen). In the present study, we investigated whether the ordinal distance effect can be observed in the absence of a physical confound using a sequential presentation of the items of the memory sequence. Our findings revealed a combination of reversed and standard distance effects, unchanged by physical characteristics. The presence of a reversed distance effect suggests that a serial scanning strategy confers an advantage for adjacent items. Different strategies apply to the ordinal judgment of adjacent versus more distant items in verbal working memory. Interestingly, when ruling out the confound of primacy and recency effects, the standard distance effect disappeared while the reversed distance effect remained. Ultimately, our findings question the existence of the ordinal distance effect as a separate effect from other working memory confounds.

Simultaneous Neuro-Ophthalmic Presentation and Progression of Idiopathic Intracranial Hypertension and Multiple Sclerosis.

Simultaneous Neuro-Ophthalmic Presentation and Progression of Idiopathic Intracranial Hypertension and Multiple Sclerosis.

The effects of feature extinction in dual-response feature-positive discriminations.

In a typical feature-positive discrimination, responding is reinforced (+) during the target stimulus (A) on trials with the feature stimulus (X), but not during target-alone trials (A-). When X and A are presented simultaneously, direct control by X is typically observed; however, when the stimuli are presented serially, X sets the occasion for responding to A. In the current dual-response procedures, one response (e.g., left lever press) was reinforced during feature-target trials (XA+) and a different response (e.g., right lever press) was reinforced during target-alone trials (A+). In Experiment 1, rats received either serial (X → A+) or simultaneous (X:A+) presentations of the feature-target compound along with target-alone trials (A+). Contrary to our predictions, the serial group failed to learn the discrimination and the simultaneous group demonstrated occasion setting. In Experiment 2, the salience of the feature was increased, which resulted in direct control by the feature in both groups. In Experiment 3, an additional serial group was included with a longer interval between the feature (X) and target (A). Despite the reduced temporal proximity of X to reinforcement, direct control was again observed in all groups. The current pattern of results in the simultaneous and serial groups is interpreted in relation to the enhanced salience of A relative to X, due to separate pairings of A-alone with reinforcement in the dual-response procedure. Consistent with previous findings, occasion setting was observed when A was most salient relative to X (Experiment 1, simultaneous group), but direct control was found when the salience of X was increased (Experiments 2-3). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Treatment Evaluation of Successive and Simultaneous Visual Stimulus Presentation During Tact Training with Children with Autism

A Treatment Evaluation of Successive and Simultaneous Visual Stimulus Presentation During Tact Training with Children with Autism

Event-Related Desynchronization of MEG Alpha-Band Oscillations during Simultaneous Presentation of Audio and Visual Stimuli in Children with Autism Spectrum Disorder.

Alpha-band (8-12 Hz) event-related desynchronization (ERD) or a decrease in alpha power in electro- and magnetoencephalography (EEG and MEG) reflects the involvement of a neural tissue in information processing. It is known that most children with autism spectrum disorder (ASD) have difficulties in information processing, and, thus, investigation of alpha oscillations is of particular interest in this population. Previous studies have demonstrated alterations in this neural activity in individuals with ASD; however, little is known about alpha ERD during simultaneous presentation of auditory and visual stimuli in children with and without ASD. As alpha oscillations are intimately related to attention, and attention deficit is one of the common co-occurring conditions of ASD, we predict that children with ASD can have altered alpha ERD in one of the sensory domains. In the present study, we used MEG to investigate alpha ERD in groups of 20 children with ASD and 20 age-matched typically developing controls. Simple amplitude-modulated tones were presented together with a fixation cross appearing on the screen. The results showed that children with ASD had a bilateral reduction in alpha-band ERD in the auditory but not visual cortex. Moreover, alterations in the auditory cortex were associated with a higher presence of autistic traits measured in behavioral assessment.

A Case of Progressive Multifocal Leucoencephalopathy and Cerebral Toxoplasmosis in an HIV-Infected Patient

Abstract Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system (CNS) caused by the reactivation of John Cunningham polyomavirus (JCV). Most often, this disease is observed in patients with severe immune suppression, such as those with AIDS. Cerebral toxoplasmosis results from the reactivation of a latent infection with Toxoplasma gondii, an intracellular parasite. This parasitosis is relatively rare in the United States, while in some regions of Europe the seropositive population is over 90%. Similarly, to PML, cerebral toxoplasmosis develops in stages of advanced immune deficiency. Both of these opportunistic infections of the central nervous system can cause severe neurological symptoms, and their simultaneous presentation can represent a diagnostic and therapeutic problem. We present a case of a 59-year-old patient with a newly diagnosed HIV infection with manifestations of epilepsy and progressive cognitive impairment. The patient was diagnosed initially with cerebral toxoplasmosis and subsequently with progressive multifocal leukoencephalopathy.

Overlap syndrome of anti-aquaporin 4 positive neuromyelitis optica spectrum disorder and primary Sjögren's syndrome: a systematic review of individual patient data.

Central nervous system (CNS) involvement can occur in primary Sjögren's syndrome (pSS) due to co-existing neuromyelitis optica spectrum disorder (NMOSD) which has a highly relapsing course requiring indefinite immunosuppression, and if not diagnosed early, damage accrual occurs over time leading to permanent disability and morbidity. In this review, we describe and outline the clinical course and outcomes of anti-aquaporin 4 (AQP4) antibody seropositive NMOSD with pSS overlap cases. To investigate the co-existence of AQP4 + NMOSD with pSS, we conducted a review of individual patient data from case reports and case series found in major databases. The study extracted clinico-demographic features, imaging and laboratory profiles, treatment approaches, and outcomes of these patients. Inclusion criteria for the review required patients to have positivity for anti-AQP4 or NMO-IgG autoantibodies in the blood and/or cerebrospinal fluid (CSF) and exhibit at least one manifestation of both pSS and NMOSD. In this overlap between AQP4 + NMOSD and pSS, 44 patients were included of whom 41 (93.2%) were females. The mean age of pSS onset was 44.8 ± 18.4years and NMOSD onset was 43.2 ± 19.8years. In 20 (45.5%) patients, NMOSD preceded pSS onset, 13 (29.5%) NMOSD occurred after pSS onset, and 11 (25%) patients had a simultaneous presentation. 31 (70.5%) patients experienced acute transverse myelitis, 21 (47.7%) optic neuritis, 14 (31.8%) cerebral syndrome, 10 (22.7%) acute brainstem syndrome, 5 (11.4%) area postrema syndrome, and 2 (4.5%) diencephalic clinical syndromes. For the treatment of acute phase, 40 (90.9%) patients received intravenous methylprednisolone, 15 (34.1%) received plasma exchange, and 10 (22.7%) received intravenous immunoglobulin; and for the induction/maintenance therapy, 16 (36.4%) patients received cyclophosphamide, 6 (13.6%) received rituximab, 16 (36.4%) received azathioprine, and 10 (22.7%) received mycophenolate mofetil. Disease course was monophasic in 2 (4.5%) and relapsing in 27 (61.4%) patients. At median (IQR) follow-up duration of 2.4 (6) years, 39 (88.6%) patients showed improvement, 3 (6.8%) showed stabilization and 2 (4.5%) showed worsening of their NMOSD manifestations. In this overlap syndrome of AQP4 + NMOSD and pSS, patients have a neurologically disabling disorder that can mimic neurological manifestations of pSS, frequently occurs prior to the onset of pSS, has a relapsing course, responds well to immunosuppressants, and necessitates indefinite treatment. Collaborative multicentre studies are needed to clarify the natural history and outcomes of this rare overlap syndrome.

Simultaneous Presentation of Dexamethasone and Nerve Growth Factor via Layered Carbon Nanotubes and Polypyrrole to Interface Neural Cells.

The implantation of neural electrodes usually induces acute and chronic inflammation, which can result in the formation of glial scars encapsulating the implanted electrodes and the loss of neurons near the active electrode sites. Local presentation of anti-inflammatory drugs or neural protective factors has been evidenced as an effective strategy to modulate inflammatory responses and promote electrode-neuron integration. Here, a novel delivery system for the simultaneous presentation of both anti-inflammatory drugs (dexamethasone, Dex) and nerve-growth-promoting factors (nerve growth factor, NGF) from the electrode sites was developed via layer-structured carbon nanotubes and conductive polymers. The modified electrodes exhibited higher charge storage capacitance and lower electrochemical impedance compared to unmodified electrodes and electrodes coated with polypyrrole/Dex. Dex released from the functional coating under controlled electrochemical stimulation was able to inhibit the lipopolysaccharide-induced secretion or mRNA transcription of inflammatory cytokines, including nitric oxide, TNF-α, and IL-6 in RAW264.7 cells, and control the activation of cultured astrocytes. In addition, the functional coatings did not show a toxic effect on PC12 cells and primary neural cells but exhibited promoted activities on the adhesion, growth, and neurite extension of neural cells.

Enhanced perceptual selection of predicted stimulus orientations following statistical learning.

Perception is influenced by predictions about the sensory environment. These predictions are informed by past experience and can be shaped by exposure to recurring patterns of sensory stimulation. Predictions can enhance perception of a predicted stimulus, but they can also suppress it by favoring novel and unexpected sensory information that is inconsistent with the predictions. Here we employed statistical learning to assess the effects of exposure to consistent sequences of oriented gratings on subsequent visual perceptual selection, as measured with binocular rivalry. Following statistical learning, the first portion of a learned sequence of stimulus orientations was presented to both eyes, followed by simultaneous presentation of the next grating in the sequence to one eye and an orthogonal unexpected orientation to the other eye. We found that subjects were more likely to perceive the grating that matched the orientation that was consistent with the predictive context. That is, observers were more likely to see what they expected to see, compared to the likelihood of perceiving the unexpected stimulus. Some other studies in the literature have reported the opposite effect of prediction on visual perceptual selection, and we suggest that these inconsistencies may be due to differences across studies in the level of the visual processing hierarchy at which competing perceptual interpretations are resolved.

Simultaneous Occurrence of Noma in Identical Twin Brothers

Background: Noma is a devastating orofacial gangrenous condition that may cause significant mutilation of the facial anatomy. The pathogenesis is poorly understood and has been reported in a setting of low socioeconomic and unhygienic conditions with associated malnutrition. We present this condition in identical twin brothers. Clinical Description: Two identical twin brothers presented with painful swelling of the cheek with ulcerative defects in their upper lips. Both belonged to an impoverished family, and were malnourished, unimmunized, with poor oral hygiene. The typical anatomical presentation of the lesions with the characteristic family setting made the diagnosis consistent with noma (cancrum oris). Other siblings living in the same family with similar background conditions were unaffected. Management: After clinical stabilization, definitive surgical care, including debridement and regular dressings was done under the cover of intravenous antibiotics. With aggressive management along with nutritional rehabilitation and oro-muscular physiotherapy, the acute phase subsided and the patients were discharged in the scarring phase, with a plan for surgical reconstruction of the defect at a later date. Conclusions: The simultaneous presentation of noma in identical twins, with the sparing of other siblings living in the same contributing circumstances, raises suspicion of a genetic basis for this condition, which is as yet unknown. As the etiopathogenesis of noma is evolving, further evidence is needed to establish a genetic predisposition.

Does the type of task affect prey discrimination learning in avian predators?

AbstractWhen learning to discriminate between palatable and unpalatable prey, predators may encounter the prey either simultaneously or in a sequence. The two types of discrimination tasks, which are frequently used in experiments focused on aposematism and mimicry, may considerably differ in difficulty, as they differ in the information available to predators during individual encounters with prey. Surprisingly, there are very few studies directly comparing the performance of predators between sequential and simultaneous discrimination tasks using otherwise identical experimental design, the same predators and prey. We tested the effect of the type of discrimination task on the effectiveness of discrimination learning in adult and juvenile great tits (Parus major). Birds were trained to discriminate between palatable and unpalatable artificial prey items baited with mealworms soaked either in water or quinine. Prey shape, colours and patterns were derived from real shield bug species. We compared the performance of birds tested with two discriminative cues, colour and pattern, using three discrimination tasks: (1) sequential—alternating presentation of one palatable and one unpalatable prey item, (2) two‐choice—simultaneous presentation of one palatable and one unpalatable prey item and (3) multiple‐choice—simultaneous presentation of multiple palatable and unpalatable prey items. Colour was a more effective discriminative cue than pattern for both adult and juvenile birds. Adults performed better than juveniles regardless of task. The birds performed equally well in the sequential and two‐choice tasks, but their performance in the multiple‐choice task was worse than in the other two tasks. However, these differences were only present when the birds used the pattern as a discriminative cue. The birds tested with colour, a more salient cue, performed equally well in all three tasks. Type of discrimination task may therefore affect the learning performance of predators, but the effect also depends on the saliency of a particular discriminative cue.

Effects of predictive and incentive value manipulation on sign- and goal-tracking behavior

When a neutral stimulus is repeatedly paired with an appetitive reward, two different types of conditioned approach responses may develop: a sign-tracking response directed toward the neutral cue, or a goal-tracking response directed toward the location of impending reward delivery. Sign-tracking responses have been postulated to result from attribution of incentive value to conditioned cues, while goal-tracking reflects the assignment of only predictive value to the cue. We therefore hypothesized that sign-tracking rats would be more sensitive to manipulations of incentive value, while goal-tracking rats would be more responsive to changes in the predictive value of the cue. We tested sign- and goal-tracking before and after devaluation of a food reward using lithium chloride, and tested whether either response could be learned under negative contingency conditions that precluded any serendipitous reinforcement of the behavior that might support instrumental learning. We also tested the effects of blocking the predictive value of a cue using simultaneous presentation of a pre-conditioned cue. We found that sign-tracking was sensitive to outcome devaluation, while goal-tracking was not. We also confirmed that both responses are Pavlovian because they can be learned under negative contingency conditions. Goal-tracking was almost completely blocked by a pre-conditioned cue, while sign-tracking was much less sensitive to such interference. These results indicate that sign- and goal-tracking may follow different rules of reinforcement learning and suggest a need to revise current models of associative learning to account for these differences.

Comparison of the Components of Brainstem Auditory Responses Using Click and Chirp Stimuli in Premature Infants

Background and Objectives: Prematurity means that the baby is born before 37 months of age, which leads to various problems, including hearing defects. Timely detection of hearing loss with the help of tools that facilitate this identification, can have a significant impact on the child’s personal, social, and educational development. The aim of the present study was to achieve better responses using the chirp stimulus along with the click. The chirp stimulus can compensate for the time delay caused by low-frequency stimuli and increases the simultaneous presentation of high and low frequencies in the cochlea. Therefore, the morphology of the waves is improved, and the amplitude of responses increases; thus, the waves can be better identified despite the prematurity of the infants. Methods: Eighy newborns were examined in four groups, which were divided into term and preterm groups based on gestational age (including late preterm, moderate, and very preterm). The intensity of the click and chirp stimuli was fixed at 40 and 80 dB. The amplitude and latency of waves I, III, and V, the inter-peak latencies of I-III, III-V, and I-V, as well as the ratio of the amplitude of wave V/I were among the compared parameters. It should be mentioned in tables paired t-test was used in cases marked with *. Wilcoxon test was used in other cases. Results: The chirp stimulus mainly had less latency than the click stimulus and created a larger amplitude at a high intensity (80 dB). In the intensity close to the threshold, i.e. 40 dB, these findings were slightly different. The more developed the infants, the stronger the responses and the more effective the chirp stimulus in eliciting responses. Conclusion: The chirp stimulus was more effective in obtaining multiple components of brainstem-evoked responses in infants, especially preterm infants, and investigating the status of their auditory system. The use of a higher sample size could lead to an increase in the growth of clinical use and better efficiency of diagnostic protocols and responses.

189-LB: LDL Cholesterol Reduction and Cardiovascular Outcomes in High-Risk Primary Prevention Patients

Background: Current guidelines recommend reducing LDL cholesterol in patients at high risk for a first major adverse cardiovascular event (primary prevention). However, these recommendations are predominately based on clinical trials conducted many years ago. Most contemporary trials of LDL-cholesterol lowering therapies have enrolled only secondary prevention patients. Some authorities have questioned whether the benefits of cholesterol lowering exceed the harms in primary prevention patients. Currently, lipid-lowering therapies are underutilized in high-risk patients without a prior event, particularly in women and patients with diabetes. More than half of eligible patients are not currently receiving LDL-cholesterol lowering therapies. Methods: The CLEAR Outcomes trial reported cardiovascular outcomes for bempedoic acid treatment compared with placebo in a mixed population of primary and secondary prevention patients unable or unwilling to take guideline-recommended doses of statins (N=13,970). The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction (MI), nonfatal stroke, or coronary revascularization. The results of the CLEAR OUTCOMES trial were presented and simultaneously published in the NEJM on March 4. The hazard ratio for the primary end point for the full population was 0.87 (95% CI 0.79-0.96), P=0.004. Results: In the CLEAR Outcomes trial, 4206 patients (30%) met high risk primary prevention entry criteria, two thirds with diabetes. The HR in these primary prevention patients was lower than the HR for secondary prevention patients, 0.68 (95% CI 0.53-0.87), with a significant interaction P value (0.03). The current Late Breaking Trial will report detailed results for the primary and all key secondary endpoints for the 4206 patients enrolled based on high risk primary prevention criteria. Full results will be available in mid-April for simultaneous presentation and publication during the ADA meeting. Disclosure S. Nissen: Research Support; Eli Lilly and Company, AbbVie Inc., AstraZeneca, Bristol-Myers Squibb Company, ESPERION Therapeutics, Inc., New Amsterdam Pharma, Novartis, Patient-Centered Outcomes Research Institute, Silence Therapeutics. For the clear outcomes trial investigators: n/a. Funding National Heart, Lung, and Blood Institute (K23HL153774 to J.E.T.); University of Toronto (to B.R.S.)

Leveraging machine learning to examine engagement with a digital therapeutic.

Digital Therapeutics (DTx) are evidence-based software-driven interventions for the prevention, management, and treatment of medical disorders or diseases. DTx offer the unique ability to capture rich objective data about when and how a patient engages with a treatment. Not only can one measure the quantity of patient interactions with a digital treatment with high temporal precision, but one can also assess the quality of these interactions. This is particularly useful for treatments such as cognitive interventions, where the specific manner in which a patient engages may impact likelihood of treatment success. Here, we present a technique for measuring the quality of user interactions with a digital treatment in near-real time. This approach produces evaluations at the level of a roughly four-minute gameplay session (mission). Each mission required users to engage in adaptive and personalized multitasking training. The training included simultaneous presentation of a sensory-motor navigation task and a perceptual discrimination task. We trained a machine learning model to classify user interactions with the digital treatment to determine if they were "using it as intended" or "not using it as intended" based on labeled data created by subject matter experts (SME). On a held-out test set, the classifier was able to reliably predict the SME-derived labels (Accuracy = .94; F1 Score = .94). We discuss the value of this approach and highlight exciting future directions for shared decision-making and communication between caregivers, patients and healthcare providers. Additionally, the output of this technique can be useful for clinical trials and personalized intervention.

A Paradoxical Clinical Coincidence: Benign Paroxysmal Positional Vertigo and Bilateral Vestibulopathy.

Benign paroxysmal positional vertigo (BPPV) and bilateral vestibulopathy (BVL) are two completely different forms of vestibular disorder that occasionally occur in the same patient. We conducted a retrospective review searching for that coincidence in our database of the patients seen over a 15-year period and found this disorder in 23 patients, that is 0.4%. More frequently they occurred sequentially (10/23) and BPPV was diagnosed first. Simultaneous presentation occurred in 9/23 patients. It was subsequently studied, but in a prospective manner, in patients with BPPV on all of whom a video head impulse test was performed to search for bilateral vestibular loss; we found it was slightly more frequent (6/405). Both disorders were treated accordingly, and it was found that the results follow the general trend in patients with only one of those disorders.