Fantasy text is characterized by events that violate our general world knowledge (GWK). And yet, as we become familiar with a fantasy character, their impossible abilities become part of our knowledge-base (GWK), which then can support impossible actions. In four experiments, we used well-known fantasy characters to explore the impact of fantasy-related inconsistencies that violated passage context but were consistent with GWK. By changing the traditional source of the fantasy conflict (context rather than GWK), we were able to explore the competition between context and GWK under conditions in which their roles were reversed. Experiment 1a demonstrated that contextual violations that were consistent with GWK caused immediate comprehension difficulty, despite the presence of fantasy contextual details within the passage. In Experiment 1b, when inconsistencies occurred at the global level, readers were not initially disrupted when reading inconsistent target lines; however, delayed disruption was recorded on a spillover line. In Experiment 2, surrounding context contained neutral details and readers were again disrupted on inconsistent target lines. In Experiment 3, the impact of the fantasy and neutral context was compared directly. Results replicated those found in Experiments 1b and 2. All experiments are discussed within the Resonance, Integration, and Validation (RI-Val) model of comprehension.

Disclosure: O.P. Olujide: None. D.M. Kombo: None. A.E. Cook: None. S.S. Dhage: None. Introduction and background: Alemtuzumab, a humanised monoclonal antibody targeting CD52 glycoprotein found on most mature leukocytes, is used in the treatment of relapsing-remitting multiple sclerosis (MS). It significantly reduces relapse rate and disability progression in both treatment-naive patients and those on disease modifying drugs. Due to its immunomodulatory effects, Alemtuzumab is associated with the development of secondary autoimmunity, with thyroid disease the most common, affecting approximately 30% of patients. Among those with thyroid dysfunction, Graves' disease accounts for up to 70% of cases, while Alemtuzumab-induced thyroid eye disease (AI-TED) is less frequently observed. AI-TED is an inflammatory condition associated with antibody-mediated activation of the thyroid-stimulating hormone receptor (TSHR) in orbital tissues. It has been reported in approximately 14% of patients with Alemtuzumab-induced Graves' disease, although it can also occur independently. Case presentation and Discussion: We reviewed two patients who developed AI-TED between 1-3 years after treatment. The average clinical activity score (CAS) on presentation was 3/7, which also represented the peak score during the active phase of the disease. Both patients were treated with lubricant eye drops, selenium, and intravenous methylprednisolone, with one requiring Mycophenolate Mofetil (MMF) and Azathioprine as second-line agents before achieving remission. We discussed the diagnosis and treatment, along with a review of relevant literature to aid in understanding and managing this condition. Conclusion: As the use of Alemtuzumab in managing MS increases, the incidence of Al-TED is likely to rise. Al-TED can develop several years after treatment, necessitating a high index of suspicion for timely diagnosis, particularly in cases of mild disease. The potential for significant morbidity in moderate to severe TED underscores the importance of early recognition and appropriate treatment. Presentation: Saturday, July 12, 2025

Theoretical perspectives in discourse processing research have long been divided into camps that focus on either memory-based or explanation-based processing; memory-based researchers focus on the passive processes that underlie comprehension, whereas explanation-based researchers emphasize the role of strategic processing. An assumption common to both perspectives is that passive processes dominate early comprehension and strategic processes come into play later. There is little agreement, however, on the transition from passive to strategic processing or the factors that influence if, and when, that transition occurs. This chapter summarizes critical issues, findings, and methodologies in understanding processes involved in comprehension, with a discussion of the implications of current models for methodological issues in measuring both passive and strategic processing.

INTRODUCTION:This study was undertaken with an aim to identify any common factors or trends among patients of orbital cellulitis that developed neurological complications.METHODS:A 24-month retrospective review of patients was undertaken to include those showing clinical deterioration and neurological complications on radiological imaging, after being treated for orbital cellulitis at Manchester Royal Eye Hospital. The study specifically looked at the site of orbital collection, sinus involvement, types of neurological complications and whether these were detected at initial presentation, surgical input and microbiology findings.RESULTS:Nine patients (9/26) developed associated neurological complications during the study period. (February 2018 and January 2020) This included subdural empyema in six patients; leptomeningeal enhancement in two and septic emboli in one patient. All the patients had associated significant pan-sinusitis at initial presentation. Neurological complications were detected in three patients at the time of admission and after clinical deterioration and further investigations in the rest.CONCLUSION:A superior orbital abscess and Streptococcus mileri infection had higher risk of neurological complications. It is worth debating whether patients with chronic sinusitis who develop orbital cellulitis need earlier surgical input rather than a conservative treatment. Patients who fail to improve clinically need to be re-imaged to look for possible neurological complications.

Graves orbitopathy is both disabling and disfiguring. Medical therapies to reduce inflammation are widely used, but there is limited trial data beyond 18 months of follow-up.METHODS:Three-year follow-up of a subset of the CIRTED trial (N = 68), which randomized patients to receive high-dose oral steroid with azathioprine/placebo and radiotherapy/sham radiotherapy.RESULTS:Data were available at 3 years from 68 of 126 randomized subjects (54%). No additional benefit was seen at 3 years for patients randomized to azathioprine or radiotherapy with regard to a binary clinical composite outcome measure (BCCOM), modified European Group on Graves' Orbitopathy score, or Ophthalmopathy Index.Clinical Activity Score (CAS), Ophthalmopathy Index, and Total Eye Score improved over 3 years (P < .001). However, quality of life at 3 years remained poor. Of 64 individuals with available surgical outcome data, 24 of 64 (37.5%) required surgical intervention. Disease duration of greater than 6 months before treatment was associated with increased need for surgery [odds ratio (OR) 16.8; 95% CI 2.95, 95.0; P = .001]. Higher baseline levels of CAS, Ophthalmopathy Index, and Total Eye Score but not early improvement in CAS were associated with increased requirement for surgery.CONCLUSION:In this long-term follow-up from a clinical trial, 3-year outcomes remained suboptimal with ongoing poor quality of life and high numbers requiring surgery. Importantly, reduction in CAS in the first year, a commonly used surrogate outcome measure, was not associated with improved long-term outcomes.

Despite the centrality of the protagonist during narrative comprehension, evidence indicates that readers do not typically approach the text from the protagonist's point of view. Experiments 1a-1c demonstrated that both explicit task instructions and the first-person point of view resulted in comprehension being influenced by perspective-relevant information; this indicated that readers were adopting the perspective of the protagonist. However, Experiments 2a-3b showed that even when readers adopt the protagonist's perspective, they cannot do so to the exclusion of related perspective-irrelevant information. Results are discussed in the context of the RI-Val model of comprehension in which perspective-relevant information and perspective-irrelevant information are both available and compete for influence during comprehension.

A 65-year old woman presented with 3-year history of painless, gradual swelling of the right upper eyelid associated with proptosis. Computed tomography (CT) and magnetic resonance imaging (MRI) of the orbit showed a well circumscribed soft tissue mass in the supero-lateral orbit. An excision biopsy of the lesion was performed via lateral orbitotomy. Histopathology examination and immunochemistry staining confirmed the diagnosis of cavernous angioleiomyoma. The tumour was excised completely. Orbital angioleiomyoma is a rare benign tumour and the lesion can cause visual morbidity, particularly when intraconal. Despite sophisticated imaging modalities, histopathological analysis is essential for diagnosis. Angioleiomyoma should be included in the differential diagnosis of well-defined orbital lesions. Complete surgical excision carries a low risk of recurrence.

Much of the coursework in pre-service teacher education programs focuses on “best practices” in classroom teaching that span from general pedagogical knowledge and pedagogical content knowledge (e.g., methods, management, assessment, etc.), in addition to supervised practica and student teaching experiences. Given that pre-service (and in-service) education students are being prepared for a career in teaching, coursework should also prepare them to understand, critique, and adapt to changes in best practices that occur over the course of their careers. The authors argue that one of the best ways to prepare students for changes in educational practices is to help them understand where best practices come from in the first place—primary research in education. Reading, thinking critically about, and applying the findings from primary research articles can improve the professional development of pre-service teachers. The goals of this chapter are to 1) provide a review of the benefits of requiring primary research articles as required readings in undergraduate curriculum, 2) underscore the argument for why primary research should be included in pre-service teacher education curriculum, and 3) offer a model for how this could be implemented in a pre-service teacher education curriculum.

To discriminate between truthful and deceptive individuals, the ocular-motor deception test (ODT) makes within-subject comparisons of recorded physiological and behavioral response time. In two mock crime experiments, we tested for effects of factors that might improve the efficiency and accuracy of the ODT. In each experiment, half of the participants were guilty of stealing $20 from a secretary’s wallet and the other half were innocent. Experiment 1 compared the accuracy of an ODT that directly asks if a person committed illicit acts with accuracy of an ODT that indirectly asks if the person provided false answers on a questionnaire about those illicit acts. Experiment 2 manipulated item presentation, feedback during the practice ODT, and inter-question intervals. In one presentation format, items were sequenced such that no two items of the same type appeared in succession (distributed). In the other condition, items of the same type were presented in succession (blocked). In Experiment 1, accuracy of classifications as guilty or innocent by logistic regression were significantly higher for participants asked directly about their involvement in the crimes (83%) than for participants asked if they falsified their answers on the pre-test questionnaire (60%). In Experiment 2, 86% and 83% of participants in the distributed and blocked conditions were correctly classified, respectively. Feedback during practice and differences in interval-event intervals had no discernible effects on ocular-motor measures. The results suggest that the ODT should stimulate the individual emotionally with direct questions about illicit behaviors, and cognitively or attentionally with unpredictable transitions between question types.

The majority of eye tracking studies in reading are on issues dealing with word level or sentence level comprehension. By comparison, relatively few eye tracking studies of reading examine questions related to higher level comprehension in processing of longer texts. We present data from an eye tracking study of anaphor resolution in order to examine specific issues related to this discourse phenomenon and to raise more general methodological and theoretical issues in eye tracking studies of discourse processing. This includes matters related to the design of materials as well as the interpretation of measures with regard to underlying comprehension processes. In addition, we provide several examples from eye tracking studies of discourse to demonstrate the kinds of questions that may be addressed with this methodology, particularly with respect to the temporality of processing in higher level comprehension and how such questions correspond to recent theoretical arguments in the field.

BACKGROUND:Standard treatment for thyroid eye disease is with systemic corticosteroids. We aimed to establish whether orbital radiotherapy or antiproliferative immunosuppression would confer any additional benefit. METHODS:CIRTED was a multicentre, double-blind, randomised controlled trial with a 2 × 2 factorial design done at six centres in the UK. Adults with active moderate-to-severe thyroid eye disease associated with proptosis or ocular motility restriction were recruited to the trial. Patients all received a 24 week course of oral prednisolone (80 mg per day, reduced to 20 mg per day by 6 weeks, 10 mg per day by 15 weeks, and 5 mg per day by 21 weeks) and were randomly assigned via remote computerised randomisation to receive either radiotherapy or sham radiotherapy and azathioprine or placebo in a 2 × 2 factorial design. Randomisation included minimisation to reduce baseline disparities in potential confounding variables between trial interventions. Patients and data analysts were masked to assignment, whereas trial coordinators (who monitored blood results), pharmacists, and radiographers were not. The radiotherapy dose was 20 Gy administered to the retrobulbar orbit in ten to 12 fractions over 2 to 3 weeks. Azathioprine treatment was provided for 48 weeks at 100-200 mg per day (dispensed as 50 mg tablets), depending on bodyweight (100 mg for <50 kg, 150 mg 50-79 kg, 200 mg for ≥80 kg). The primary outcomes were a binary composite clinical outcome score and an ophthalmopathy index at 48 weeks, and a clinical activity score at 12 weeks. The primary analysis was based on the intention-to-treat allocation and safety was assessed in all participants. This study is registered with ISRCTN, number 22471573. FINDINGS:Between Feb 15, 2006, and Oct 3, 2013, 126 patients were recruited and randomly assigned to groups: 31 patients to radiotherapy plus azathioprine, 31 to sham radiotherapy and azathioprine, 32 to radiotherapy and placebo, and 32 to sham radiotherapy and placebo. Outcome data were available for 103 patients (54 for sham radiotherapy vs 49 for radiotherapy and 53 for placebo vs 50 for azathioprine), of whom 84 completed their allocated treatment of radiotherapy or sham radiotherapy and 57 continued to take azathioprine or placebo up to 48 weeks. There was no interaction betweeen azathioprine and radiotherapy (pinteraction=0·86). The adjusted odds ratio (ORadj) for improvement in the binary clinical composite outcome measure was 2·56 (95% CI 0·98-6·66, p=0·054) for azathioprine and 0·89 (0·36-2·23, p=0·80) for radiotherapy. In a post-hoc analysis of patients who completed their allocated therapy the ORadj for improvement was 6·83 (1·66-28·1, p=0·008) for azathioprine and 1·32 (0·30-4·84, p=0·67) for radiotherapy. The ophthalmopathy index, clinical activity score, and numbers of adverse events (161 with azathioprine and 156 with radiotherapy) did not differ between treatment groups. In both groups, the most common adverse events were mild infections. No patients died during the study. INTERPRETATION:In patients receiving oral prednisolone for 24 weeks, radiotherapy did not have added benefit. We also did not find added benefit for addition of azathioprine in the primary analysis; however, our conclusions are limited by the high number of patients who withdrew from treatment. Results of post-hoc analysis of those who completed the assigned treatment suggest improved clinical outcome at 48 weeks with azathioprine treatment. FUNDING:National Eye Research Centre, Above and Beyond, and Moorfields Eye Charity.

During comprehension, readers' general world knowledge and contextual information compete for influence during integration and validation. Fantasy narratives, in which general world knowledge often conflicts with fantastical events, provide a setting to examine this competition. Experiment 1 showed that with sufficient elaboration, contextual information can dominate the integration and validation of fantastical information. In Experiments 2a and 2b, contextual support was diminished and general world knowledge dominated integration and validation and disrupted fantasy comprehension. Experiment 3 demonstrated that skilled readers make better use of contextual elaborations during integration and validation than less skilled readers, leading to different consequences for comprehension.

Readers do not always adopt the perspective of the protagonist; however, they will under certain conditions. Experiments 1a and 1b showed that readers will take the perspective of the protagonist from the third-person point of view, but only when explicitly instructed to do so. Experiment 2 demonstrated that reading from the first-person point of view is a text-based manipulation that encourages readers to adopt the perspective of the protagonist. The results of Experiments 3a and 3b replicated the findings of Experiments 1a and 2. Experiment 4 established that simply increasing readers’ attention to the text does not lead to adoption of the protagonist’s perspective; moreover, this suggests that when it does occur, protagonist perspective adoption is not the result of increased attention, but strategic processing.

The RI-Val model of comprehension includes a validation process in which linkages formed by integration are matched against active memory. In five experiments, we investigated factors that influence validation. Reading times were measured on target sentences that contained either correct information or semantically related, but incorrect content. Experiment 1 demonstrated that strong contextual support for shared features between correct and incorrect terms delayed processing difficulty associated with incorrect information. Experiment 2 confirmed that contextual information needed to be available in memory in order to influence validation. Experiments 3a and 3b showed that strong contextual support for distinguishing features between correct and incorrect terms led to immediate processing difficulty associated with incorrect information, whereas features-in-common led to delayed difficulty. Experiments 4 and 5 showed that the timing of validation effects is sensitive to subtle changes in task demands. The combined results are consistent with the assumptions of the RI-Val model.

Fantasy-text is a genre in which events routinely violate rules we know to be true in the real world. In four experiments, we explored the inherent contradiction between unrealistic fictional events and general world knowledge (GWK) to examine these competing information sources within the context of an extended fantasy-narrative. Experiments 1a and 1b demonstrated that fantasy-unrelated inconsistencies caused disruption to comprehension despite an abundance of contextual support for real-world impossible events that violate GWK. Experiment 2a demonstrated that fantasy-related inconsistencies caused disruption when they occurred at the local level and the fantasy-context stood in direct opposition to the target sentence. However, Experiment 2b demonstrated that disruption can be initially eliminated when readers encountered fantasy-related violations at the global level, but delayed-processing difficulty occurred on the spillover sentence, downstream of the target sentence. All four experiments are discussed within the context of the RI-Val model.

Previous studies demonstrated that outdated information may be reactivated and disrupt subsequent processing of newly encoded information. However, previous studies focused on the impact of outdated information that had been backgrounded in memory. The present experiments examined the immediate influence of outdated information; backgrounding information was reduced so that both outdated and current protagonist characteristics were active in memory when readers encountered content that was inconsistent with the outdated information. In Experiments 1 and 2, the order of introduction of outdated and current information was varied; across the two experiments, the elaboration of the current information was also manipulated. When both current and outdated information are still active in memory, only the most recent information influenced comprehension; this was true regardless of whether it was elaborated. These results inform the conditions under which outdated information influences comprehension and are interpreted within the context of the RI‐Val model of comprehension.HighlightsWhat is already known about this topic Previous studies have demonstrated that whether outdated information influences the validation process depends on how quickly readers gain access to this information (e.g., O'Brien, Cook, & Guéraud, ; O'Brien, Rizzella, Albrecht, & Halleran, ); that is, validation is mediated by factors that affect the reactivation process (Cook & O'Brien, ). When information has been backgrounded in memory (i.e., when outdated information is not currently active), the order in which updated versus outdated information occurred does not differentially impact the validation process (Guéraud, Harmon, & Peracchi, ). What this paper adds Previous research has focused on how outdated information that had been backgrounded in memory was subsequently reactivated and influenced validation. However, factors that directly influence the validation process remain unknown. In this set of studies, we explored whether memory factors such as elaboration and recency of presentation of information directly influence validation when the information in question is already active in memory, that is, when outdated information co‐occurred in memory with updated, current information. Results demonstrated that when current and outdated information co‐occur in memory, only the most recent information impacts the validation process (Experiment 1); elaborating on the current information did not override this effect (Experiment 2). Implications for theory This research adds to the overall understanding of how the contents of active memory influence the validation process.