bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ionizing Radiation Dose to the Skin Assessed after Rapid Detection of 232Th in Consumer Products
Authors: Karbiwnyk Christine , Stafford Philip , Malkin Elon , Garnick Kelly , Scott Thomas A. , Wei Cong 
Published: November 2024

Abstract
After some consumer products indicated elevated levels of 232Th progeny by gamma-ray spectrometry, a microwave digestion and inductively coupled plasma-mass spectrometry (ICP-MS) procedure was implemented for the direct assay of 232Th content to ensure compliance with Federal regulations and guidelines. Levels of 232Th were determined by ICP-MS based on standard calibration using a 205Tl internal standard. The method had a method detection limit (MDL) of 0.15 Bq g−1 and a lower limit of quantification (LLOQ) of 0.65 Bq g−1 for 232Th, making it a suitable confirmatory method following gamma-ray spectrometry. The 232Th activity concentration calculated from the ICP-MS results ranged from 2.0–3.4 Bq g−1 for the kinesiology tape samples and 20 Bq g−1 for the silicone ion bracelet. The VARSKIN+1.0 software program was used to calculate the shallow dose equivalent of ionizing radiation from 232Th and its progeny from the ICP-MS results. The skin dose to the consumer wearing the kinesiology tape ranged from 0.48–1.6 mSv y−1. The skin dose to the consumer with constant wear of the silicone ion bracelet was estimated to be 17 mSv y−1. Although 232Th may be determined indirectly by assay of high abundance gamma rays produced by its progeny, the US Code of Federal Regulations (CFR) requires the direct assay of 232Th for confirmatory analysis. We found this ICP-MS method to be a rapid 232Th confirmatory technique compared to a chemical separation followed by alpha spectrometry procedure.
Reconsidering the City of New York Directive on Mental Health Involuntary Removals
Authors: Camejo Daniel A. , Bido-Medina Richard O. , Koh Katherine A. , Keuroghlian Alex S. 
Published: November 2024

Abstract

Background
Homelessness is a visible manifestation of large-scale societal challenges, such as lack of affordable housing, poverty, and health inequities. Governments may miss opportunities to address these structural problems by removing people experiencing homelessness from public spaces. On 29 November 2022, after a press conference by Mayor Eric Adams, the city of New York issued a directive entitled Mental Health Involuntary Removals. The program authorized mental health providers and NYPD officers to take any person into custody who appears mentally ill and displays inability to meet basic living needs, even when no dangerous act has been observed.

Methods
We reviewed the existing literature from 1973 to 2023 for studies, enacted legislation, state and federal policies, and interventions related to homelessness, mental health, and admission of people experiencing homelessness into psychiatric hospitals in the United States. We used academic databases, including PubMed, PsycInfo, and JSTOR for peer-reviewed articles, government reports, and policy analyses. Our search strategy included keyword combinations such as “homelessness and mental health,” “policy interventions for homeless populations,” and “health care services costs.” We applied inclusion criteria focusing on reports and articles that directly address the intersectionality of homelessness, mental health policy, and psychiatric care.

Results
Homelessness and mental illness frequently intersect, creating complex challenges that require nuanced solutions. Forced hospitalization of people experiencing homelessness in New York City, while intended to address critical social and health care issues, carries a risk for significant long-term harm. This approach places strain on the mental health care system and may ultimately exacerbate the problems it purports to resolve.
Phosphatidylserine-Positive Live Sperm as a Biomarker of Fertility Status: Evidence from Patients Undergoing Varicocele Treatment
Authors: George C. D. , Poudel B. , Cielencki C. , Hamzeh Y. , Charles D. , Purcell S. , Manka D. , Ravichandran K. S. , Smith R. P. , Kavoussi P. K. , Lysiak J. J. 
Published: November 2024

Purpose:
Phosphatidylserine exposed on live and motile sperm is necessary for sperm:egg fusion, and emerging data suggest it is a biomarker for fertilization competent sperm. Men with varicocele often display infertility, and one of the known causes is poor sperm quality. Here, we sought to determine whether the percentage of phosphatidylserine-positive live sperm (PS+ live sperm) could serve as a reliable indicator of male fertility.

Materials and Methods:
Semen samples from cryo-banked pregnancy-proven donors, from self-identified pregnancy-reported donors, and from men seeking infertility treatment for varicocele were analyzed for phosphatidylserine exposure on live sperm. Semen samples were also analyzed premicrosurgical and postmicrosurgical varicocele repair to determine whether varicocele repair led to a change in the percentage of PS+ live sperm.

Results:
Semen samples from “pregnancy-proven” donors (n = 31) had 82% ± 2% PS+ live sperm and samples from “self-identified pregnancy-reported” donors (n = 34) had 87% ± 1%. Men presenting with a varicocele (n = 80) had significantly lower PS+ live sperm with 68% ± 3%. PS+ live sperm correlated with reported pregnancies in patients with varicocele, whereas total motile sperm count did not. Varicocele repair (n = 10) led to a significant increase in PS+ live sperm, and 2 of the patients reported pregnancies after varicocele repair.

Conclusions:
These results suggest that the percentage of PS+ live sperm in an ejaculate correlates with male fertility status and could help in guiding treatment options for patients with varicoceles.
Early Hearing Outcomes and Audiological Experiences With a Novel Fully Implanted Cochlear Implant
Authors: Dornhoffer James R. , DeJong Melissa D. , Driscoll Colin L.W. , Saoji Aniket A. 
Published: November 2024

Objective
To review audiological experiences and early hearing outcomes from the early feasibility study of a fully implanted cochlear implant.

Study Design
Prospective cohort.

Setting
Tertiary academic medical center.

Patient
Three adults (two—male, one female) with bilateral sensorineural hearing loss.

Interventions
Implantation with a fully implanted cochlear implant as part of an early feasibility study.

Outcomes
Postoperative unaided and aided pure-tone audiometry, tympanometry, mapping parameters, speech perception, battery life, and quality-of-life assessment.

Results
All patients in the early feasibility study of this fully implanted cochlear implant now use their devices regularly. Preoperative and postoperative audiometric measurements showed that their residual hearing in the implanted ear decreased slightly after surgery but was preserved. All patients had type A tympanograms after their transient middle ear effusion resolved. Electrical stimulation levels were comparable to those routinely used in traditional cochlear implants. Two of the three patients use a hearing aid in the implanted ear for additional gain and show significant improvement in speech perception since implantation. Average battery life before recharging is 4 days. All patients are regular users with two showing improvement in quality-of-life metrics after receiving the fully implanted cochlear implant.

Conclusion
The patient experience and hearing outcomes from the early feasibility study of a novel fully implanted cochlear implant are detailed in this study and demonstrate ease of operation and daily use by all participants. All patients obtained hearing, but two of three use a hearing aid with their device to overcome unanticipated implant circuitry noise and achieve improved speech perception scores. Current work is focused on reducing this system noise to allow for the device to be used as intended, without a hearing aid.
How to Teach an “Old Dog” New Tricks: Improving Clinical Efficiency in a Well-Established Cochlear Implant Program
Authors: Holcomb Meredith A. , Smeal Molly R. 
Published: November 2024

Objective
To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program.

Setting
Tertiary referral center.

Patients
CI candidates and CI users.

Interventions
Implementation of a new CI service delivery model.

Main Outcome Measures
CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden.

Results
De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019–2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care.

Conclusion
If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.
Hybrid Cochlear Implant Outcomes and Improving Outcomes With Electric–Acoustic Stimulation
Authors: Reinhart Paul , Parkinson Aaron , Gifford René H. 
Published: November 2024

Introduction
Electric–acoustic stimulation (EAS) provides cochlear implant (CI) recipients with preserved low-frequency acoustic hearing in the implanted ear affording auditory cues not reliably transmitted by the CI including fundamental frequency, temporal fine structure, and interaural time differences (ITDs). A prospective US multicenter clinical trial was conducted examining the safety and effectiveness of a hybrid CI for delivering EAS.

Materials and Methods
Fifty-two adults (mean age 59.9 yr) were enrolled in the study and followed up to 5 years postactivation. Testing included unaided and aided audiometric thresholds, speech perception (Consonant–Nucleus–Consonant [CNC] words in quiet and AzBio sentences +5 dB SNR), and patient-reported outcomes (Speech, Spatial, and Qualities of Hearing Scale).

Results
Functionally aidable hearing, defined as low-frequency pure-tone average (125–500 Hz) <80 dB HL, was maintained for 77% of patients through 1 year, with 66.7% maintaining through 5 years. Speech perception was significantly improved at all postoperative timepoints compared with preoperative performance with hearing aid(s), and patient-reported outcomes indicated significantly improved subjective speech understanding, spatial hearing, and sound quality. Participants with preserved acoustic hearing using EAS reported significantly higher subjective spatial hearing and sound quality than participants with electric-only hearing in the implanted ear.

Discussion
Patients with high-frequency hearing loss demonstrate significant long-term benefit with a hybrid CI including high rates of functional hearing preservation, significantly improved speech perception, and subjective patient-reported outcomes. EAS with binaural acoustic hearing affords benefit for subjective spatial hearing and sound quality beyond CI listening configurations using monaural acoustic hearing.
Screening for Developmental Delays in Pediatric Cochlear Implant Candidates and Recipients
Authors: Warrick Mallory , Sherman Sophie , King Kaylene , LaRosa Angela , McRackan Theodore R. , Coker-Bolt Patty , Schvartz-Leyzac Kara C. 
Published: November 2024

Objective
Conduct a pilot clinical improvement project to effectively screen children with hearing loss for developmental delays. Children with hearing loss and cochlear implants (CIs) are at risk for additional developmental delays; however, screening to aid in early identification and referral for developmental delays is not routinely performed at CI centers. It is important to consider all aspects of child development to maximize CI outcomes and access to language.

Study Design
Caregivers of 31 children completed the Ages and Stages Questionnaire (ASQ) and the Sensory Profile-2 (SP2), which are standardized questionnaires that assess developmental milestones in areas of communication, gross motor, fine motor, problem solving, personal–social, and sensory integration.

Setting
Participants were prospectively evaluated at a CI center in a tertiary medical center.

Patients
Participants included children, aged ≤5 years old with bilateral hearing loss who use CIs or who were CI candidates, and their families.

Main Outcome Measures
Scores on ASQ and SP2 questionnaires.

Results
Thirty-one children were screened, and approximately 40 to 50% screened positive for risk of developmental delay in areas excluding communication and received referrals for evaluations in occupational therapy (n = 16; 51.6%), physical therapy (n = 13; 41.9%), and developmental pediatrics (n = 13; 41.9%). Of children referred and seen for evaluations, six were diagnosed with developmental delays in at least one developmental area beyond the communication domains.

Conclusions
Routine screening in children with significant hearing loss can successfully detect developmental delays, which may go unnoticed. This proactive approach enables timely and comprehensive treatment for developmental delays beyond those solely related to communication.
The Memphis SOUND Project: The Development of a Community-Based Research Project to Address Hearing Health Disparities Among Black Adults Who Qualify for Cochlear Implants
Authors: Warren Sarah E. , Coco Laura , Allen Iris , Flinner Gretchen Nibert , Coffelt Jordan Alyse , Ladner Kathryn , Holloway C. Alise , Yawn Robert J. 
Published: November 2024

Objective
The objective of this article is to introduce the concept of community-based participatory research as a means to understand barriers to cochlear implant access racially minoritized populations.

Background
Black adults living in the United States experience unique barriers to cochlear implantation. Community-based research approaches can be used to understand and address these barriers.

Application
The Memphis SOUND Project is a community-based research initiative that seeks to address hearing health disparities by examining utilization of hearing healthcare among Black adults. Preliminary findings introduce motivators and barriers related to CI intervention in this population.

Conclusion
This Memphis SOUND Project provides valuable insights to the benefits of community-based research in understanding and addressing CI utilization disparities.
Artificial Intelligence Tracking of Otologic Instruments in Mastoidectomy Videos
Authors: Liu George S. , Parulekar Sharad , Lee Melissa C. , El Chemaly Trishia , Diop Mohamed , Park Roy , Blevins Nikolas H. 
Published: November 2024

Objective
Develop an artificial intelligence (AI) model to track otologic instruments in mastoidectomy videos.

Study Design
Retrospective case series.

Setting
Tertiary care center.

Subjects
Six otolaryngology residents (PGY 3–5) and one senior neurotology attending.

Interventions
Thirteen 30-minute videos of cadaveric mastoidectomies were recorded by residents. The suction irrigator and drill were semi-manually annotated. Videos were split into training (N = 8), validation (N = 3), and test (N = 2) sets. YOLOv8, a state-of-the-art AI computer vision model, was adapted to track the instruments.

Main Outcome Measure(s)
Precision, recall, and mean average precision using an intersection over union cutoff of 50% (mAP50). Drill speed in two prospectively collected live mastoidectomy videos by a resident and attending surgeon.

Results
The model achieved excellent performance for tracking the drill (precision 0.93, recall 0.89, and mAP50 0.93) and low performance for the suction irrigator (precision 0.67, recall 0.61, and mAP50 0.62) in test videos. Prediction speed was fast (~100 milliseconds per image). Predictions on prospective videos revealed higher mean drill speed (8.6 ± 5.7 versus 7.6 ± 7.4 mm/s, respectively; mean ± SD; p < 0.01) and duration of high drill speed (>15 mm/s; p < 0.05) in attending than resident surgery.

Conclusions
An AI model can track the drill in mastoidectomy videos with high accuracy and near–real-time processing speed. Automated tracking opens the door to analyzing objective metrics of surgical skill without the need for manual annotation and will provide valuable data for future navigation and augmented reality surgical environments.
Barriers to Cochlear Implant Uptake in Adults: A Scoping Review
Authors: Neukam Jonathan D. , Kunnath Ansley J. , Patro Ankita , Gifford René H. , Haynes David S. , Moberly Aaron C. , Tamati Terrin N. 
Published: November 2024

Introduction
Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake.

Methods
Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework.

Results
The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria.

Discussion
Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.
Pain Control after Otologic Surgery: Do Nonopioid Analgesics Suffice?
Authors: Bulbul Mustafa G. , Jafary Zulkifl , Kellermeyer Brian M. , Shapiro Scott B. 
Published: November 2024

Objective
Investigate whether nonopioid analgesics (NOA) provide adequate pain control after otologic surgery.

Study Design
Retrospective multicenter cohort.

Setting
Two quaternary academic medical centers.

Patients
Patients over 12 years old who underwent otologic surgery involving the middle ear and/or mastoid at two centers over a 5-month period.

Interventions
Patients were prescribed acetaminophen and ibuprofen postoperatively and instructed to contact the surgical team if pain control was inadequate, in which case an opioid medication was prescribed. Level of pain and medication use were assessed with a standardized questionnaire, 1 week after surgery.

Main Outcome Measures
Postoperative pain levels during the first week after surgery (0–10); proportion of patients requiring opioid medication.

Results
Sixty-seven patients were included. Of these, 37% underwent tympanomastoidectomy, 27% cochlear implant, 19.5% postauricular tympanoplasty, 10.5% transcanal tympanoplasty, and 6% had a different surgery. The median of the average level of pain in the first 7 days was 5/10 (IQR 3–6). The median highest level of pain was 5 (IQR 4–8). The median current level of pain was 3 (IQR 1–5). Seven patients (10%) required breakthrough opioid pain medication. The remaining 90% utilized NOA only. One week after surgery, 60% were taking nonopioid analgesics only while the remaining 40% were not taking any pain medication at all. Although opioids were required infrequently, there were no significant differences in medication use between the two centers.

Conclusions
NOA provide adequate pain control for most patients after middle ear and mastoid otologic surgery. Opioid analgesics do not routinely need to be prescribed.
Whole lung lavage: considerations from the anesthesiology perspective
Authors: Sikachi Rutuja , Anders Megan 
Published: November 2024

Purpose of review
Whole lung lavage (WLL) remains the standard treatment for pulmonary alveolar proteinosis (PAP). The procedure involves meticulous preparation, including a multidisciplinary team and appropriate facilities, to ensure patient safety and procedural success. Effective anesthesia management is essential to allow for successful completion of the procedure and prevent complications.

Recent findings
Effective anesthesia management, including total intravenous anesthesia (TIVA) and careful intraoperative monitoring, is essential to prevent complications such as hypoxemia and fluid overload. Proper airway control with a double-lumen tube, careful positioning, and continuous monitoring during the lavage phase are key to minimizing risks. Challenges such as fluid spillage and ventilation-perfusion mismatch must be managed proactively with techniques such as fiberoptic bronchoscopy and recruitment maneuvers. In cases of severe hypoxemia, advanced options like extra-corporeal membrane oxygenation (ECMO) or sequential lavage may be required.

Summary
WLL is a pivotal treatment for PAP, offering significant relief and improvement for many patients despite the challenges in standardizing the procedure due to the rare nature of the condition. Involvement of a multidisciplinary team involving pulmonologist, anesthesiologist, critical care personnel, operating room personnel and in some cases and centers, cardiothoracic surgeon and perfusionist is critical to the success of the procedure.
Focal classic intradural extramedullary ependymoma near the conus medullaris: A case report and literature review
Authors: Kang Xingui , Hu Tao , Shi Keqiang , Hu Quanze , Yu Bin , Zhu Ziqi , Wu Desheng , Huang Yufeng 
Published: November 2024

Rationale:
To enhance clinicians’ comprehension of conus medullaris region ependymomas and elevate their diagnostic accuracy.

Patient concerns:
A 26-year-old female patient had 10 months of low back pain and right lower limb pain.

Diagnoses:
Lumbar magnetic resonance imaging (MRI) scan revealed a circular abnormal signal in the spinal canal at the level of L2. Pathological examination confirmed classic ependymoma.

Interventions:
The patient underwent tumor resection surgery.

Outcomes:
Postoperatively, the patient’s right lower limb soreness improved, and no new neurological deficits were observed.

Lessons:
Focal classic intradural extramedullary ependymomas near the conus medullaris are rare. Close follow-up with MRI of the craniospinal axis is necessary. Hormonal factors may influence the development of ependymomas in this unusual location. The appearance of these tumors on MRI and contrast-enhanced MRI scans is variable.