bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing Fine-Grained Speech Discrimination in Young Children With Bilateral Cochlear Implants
Authors: Peng Zhao Ellen , Hess Christi , Saffran Jenny R. , Edwards Jan R. , Litovsky Ruth Y. 
Published: January 2019

Hypothesis:
Children of 2 to 3 years old with cochlear implants can perform consonant discriminations using fine-grained acoustic cues.

Background:
Children born with severe-to-profound deafness are provided with early cochlear implantation (<2 yr) to maximize oral communication outcomes. Little is known regarding their abilities to discriminate consonant contrasts for accurately identifying speech sounds.

Methods:
Using a Reaching for Sound paradigm to collect behavioral responses, consonant contrast discrimination was measured in 13 children with bilateral cochlear implants (BiCIs; aged 28–37 mo), and 13 age-matched normal-hearing (NH) children. Four contrast pairs were tested: 1) place + voicing, 2) place, 3) voicing, and 4) reduced voice-onset-time cue. Using standard processing strategies, electrodograms showing pulsatile stimulation patterns were created retrospectively to assess the spectral-temporal cues delivered through the clinical speech processors.

Results:
As a group, children with BiCIs were able to discriminate all consonant contrasts at a level that was above chance, but their performance was poorer than NH children. Larger individual variability in discrimination performance was found in children with BiCIs. Stepwise regression revealed that, in the place contrast, chronological age was correlated with improved discrimination performance among children with BiCIs.

Conclusion:
Children with BiCIs were able to discriminate consonant contrasts using fine-grained spectral-temporal cues above chance level but more poorly than their NH peers. Electrodogram analysis confirmed the access to spectral-temporal cues in the consonant contrasts through clinical speech processors. However, the cue saliency might not have be enough for children with BiCIs to achieve the same discrimination accuracy as NH children.
Mobile Internet Telephony Improves Speech Intelligibility and Quality for Cochlear Implant Recipients
Authors: Guignard Jérémie , Senn Pascal , Koller Roger , Caversaccio Marco , Kompis Martin , Mantokoudis Georgios 
Published: January 2019

Objective:
The objective of this study was to investigate the benefit of mobile Voice over Internet protocol (VoIP) over conventional mobile phone calls (Global System for Mobile Communications, GSM) on speech intelligibility and quality for cochlear implant (CI) recipients.

Study Design:
Cross-sectional, prospective.

Setting:
Tertiary referral center.

Patients:
A volunteer sample of experienced, German-speaking, adult CI recipients was considered. Volunteers with less than 50% aided monosyllabic word discrimination were excluded.

Intervention:
Smartphone communication was changed from GSM to VoIP on two separate devices (A and B).

Main Outcome Measures:
Speech intelligibility was assessed with the Hochmair-Shulz-Moser (HSM) test in noise, speech quality with the mean opinion score (MOS) survey and the perceptual evaluation of speech quality (PESQ) algorithm.

Results:
With device A, the mean HSM scores were 64.40% ± 32.41 with GSM and 77.28% ± 21.60 with VoIP (p = 0.0573). 66.7% of patients had a higher score with VoIP. For device B the means were 53.90% ± 21.77 and 69.07% ± 21.09 (p < 0.0001). 94.1% patients scored better with VoIP.
With device A the average MOS scores were 3.12 ± 1.52 and 4.08 ± 0.95 (p = 0.0078). 76.9% of patients gave a higher score with VoIP. With device B the means were 2.71 ± 1.08 and 3.528 ± 1.44 (p = 0.0068). 56.3% of patients gave a higher score with VoIP. The effect was smaller when using an accessory cable. PESQ scores were significantly higher with VoIP (p < 0.001) in all configurations.

Conclusions:
CI recipients experience speech intelligibility and quality improvements using VoIP on a smartphone compared with conventional mobile phone calls.
Coexistent Vestibular Schwannoma and Creutzfeldt–Jakob Disease: Recognition and Infection Control
Authors: Thomas Andrew J. , Casazza Geoffrey C. , MacDonald Joel D. , Gurgel Richard K. 
Published: January 2019

Objectives:
We describe the first known case of coexistent vestibular schwannoma (VS) and Creutzfeldt–Jakob disease (CJD). Our objectives are to use this case as a general lesson for the subspecialist otolaryngologist to remain vigilant to alternative diagnoses, and to specifically improve understanding of the diagnosis and management of CJD as relevant to the practice of otolaryngology and skull base surgery.

Methods:
Retrospective case review performed in June 2016 at an academic, tertiary, referral center.

Results:
A 55-year-old man presents with one month of worsening disequilibrium and short-term memory loss. Magnetic resonance imaging (MRI) (T1, T2) identified a 4 mm left VS which was then surgically resected. Postoperatively, his neurological status decline continued, and subsequent MRI identified patterns of FLAIR hyperintensity and diffusion restriction consistent with CJD. While CSF analysis (tau and 14-3-3) and EEG was inconclusive, serial imaging and the clinical course were highly suggestive of CJD. A probable diagnosis was made, surgical instruments quarantined, and infection control involved to minimize transmission risk. The patient died 6 months after symptom onset.

Conclusions:
Patients with CJD may initially present with otolaryngologic symptoms. MRI signal abnormality in the basal ganglia on diffusion weighted imaging and FLAIR sequences in conjunction with physical findings and clinical course may help make a probable diagnosis CJD. Prions are resistant to traditional sterilization and additional measures must be taken to prevent iatrogenic transmission.

Level of Evidence: Level 4—Case series
Can Couples With MCV≥80, MCH<26, HbA2<3.2, HbF<3 be Classified as Low-risk β-Thalassemia Group?
Authors: Mirzakhani Mohsen , Tarrahi Mohammad J. , Baghersad Atefe , Maracy Mohammad R. 
Published: January 2019

Background and Aim:
Thalassemia screening instructions in Iran categorizes couples with mean corpuscular volume (MCV)=75 to 80, mean corpuscular hemoglobin (MCH)=26 to 27, hemoglobin A2 (HbA2)<3.5, and hemoglobin fetal (HbF)<3 indices as low-risk couples, and therefore further genetic testing is not obligatory. This study examined the possibility of classifying couples with MCH<26 and MCV≥80 indices in the low-risk group when their HbF was <3 and HbA2 was <3.2.

Methodology:
This was a cross-sectional study. The data included results from cell blood count and HbA2 prenatal diagnosis (PND) and HbF tests taken by 22 health care centers in Esfahan province, central Iran, throughout the years 2012-2016. The inclusion criterion was the registering of MCV, MCH, and PND results of the participants. From the 5804 participants, 5624 individuals were included in the study.

Results:
The sensitivity and specificity of the screening program were 99.7 and 53.12, respectively. Ten cases (0.18%) with thalassemia trait had indices MCV≥80 and MCH≥26 including 3 cases (0.05%) with concurrent α and β-thalassemia mutations and 7 cases (0.12%) with HbS mutations. Altogether, 553 subjects (9.83%) had MCV≥80 and MCH<26 indices, and only 1 case (0.018%) was found with β-thalassemia mutations (codon8 (-AA)/WT genotype).

Conclusions:
Subjects with MCV≥80, MCH<26, HbA2<3.2, and HbF<3 cell blood count indices could be grouped as low-risk couples if normal HbA2 and HbF values are considered. The results of this study also indicate that there is a chance of missing concurrent α and β-thalassemia or HbS hemoglobinopathies in the current screening program given the fact that genetic testing is not considered for couples with MCV and MCH in the low-risk range. HbF testing could be conducted to prevent these missing cases.
Evaluation of Insulin-mediated Regulation of AKT Signaling in Childhood Acute Lymphoblastic Leukemia
Authors: Wang Jian , Xue Hong-Man , Chen Yan-Ru , Xu Hong-Gui , Lin Shao-Fen , Tang Xi-Kang , Chen Chun 
Published: January 2019

Objective:
Hyperglycemia increases the risk of early recurrence and high mortality in some adult blood cancers. In response to increased glucose levels, insulin is secreted, and several studies have shown that insulin-induced AKT signaling can regulate tumor cell proliferation and apoptosis. The AKT pathway is aberrantly activated in adult acute lymphoblastic leukemia (ALL), but the mechanisms underlying this activation and its impact in pediatric patients with ALL are unclear.

Materials and Methods:
We evaluated the insulin-induced chemoresistance and AKT pathway activation by measuring cell proliferation, apoptosis, and other parameters in ALL cell lines (Jurkat and Reh cells), as well as in primary pediatric leukemic cell samples, after culture with insulin, the chemotherapeutic drugs daunorubicin (DNR), vincristine (VCR), and L-asparaginase (L-Asp), or anti-insulin-like growth factor-1 receptor (IGF-1R) monoclonal antibody.

Results:
DNR, VCR, and L-Asp-induced toxicity in Jurkat and Reh cells was reduced in the presence of insulin. DNR promoted cell proliferation, whereas DNR, VCR, and L-Asp all reduced apoptosis in both cell lines cotreated with insulin compared with that in cell lines treated with chemotherapeutics alone (P<0.05). Furthermore, addition of an anti-IGF-1R monoclonal antibody promoted apoptosis, downregulated IGF-1R expression, and decreased the phosphorylation of AKT, P70S6K, and mTOR intracellular signaling pathway proteins in both cell lines, as well as in primary cultures (P<0.05).

Conclusions:
Our results suggest that insulin-induced chemoresistance and activation of the AKT signaling pathway in pediatric ALL cells.
Prevention of Long-term Adverse Health Outcomes With Cardiorespiratory Fitness and Physical Activity in Childhood Acute Lymphoblastic Leukemia Survivors
Authors: Lemay Valérie , Caru Maxime , Samoilenko Mariia , Drouin Simon , Alos Nathalie , Lefebvre Geneviève , Levy Emile , Lippé Sarah , Marcil Valérie , Sultan Serge , Bertout Laurence , Krajinovic Maja , Laverdière Caroline , Raboisson Marie-Josée , Sinnett Daniel , Andelfinger Gregor , Curnier Daniel 
Published: January 2019

Background:
Most childhood acute lymphoblastic leukemia (ALL) survivors develop chronic treatment-related adverse effects several years after the end of therapy. A regular practice of physical activity and a good cardiorespiratory fitness have the potential to reduce the risk of chronic disease and improve quality of life. The aim of this study was to evaluate in a cohort of ALL survivors, the association between a good cardiorespiratory fitness or the respect of physical activity guidelines and major long-term health outcomes.

Methods:
In total, 247 ALL survivors underwent a cardiopulmonary exercise test, completed a physical activity questionnaire and a battery of clinical examinations. We calculated the odds ratio to obtain the preventive fraction (PF) to evaluate the effects of the cardiorespiratory fitness and physical activity levels on health outcomes (ie, obesity, metabolic health, cardiac health, cognitive health and mood, bone health).

Results:
Despite their young age, 88% of the participants presented at least one adverse health outcome, and 46% presented ≥3. Their cardiorespiratory fitness was also lower than expected with a median VO2 peak reaching 84% of the predicted value. In the analyses using cardiorespiratory fitness, statistically significant PFs were observed for obesity (0.30), low–high-density lipoprotein-cholesterol (0.21) and depression (0.26). In the physical activity level analyses, statistically significant PFs were observed for obesity, depression, and low bone mineral density, with a PF of 0.55, 0.81, and 0.60, respectively.

Conclusions:
Our results indicate that a good cardiorespiratory fitness and physical activity level induced a preventive action for most health outcomes studied and was associated with a lower late adverse effects prevalence in ALL survivors.
Health Coaching for Patients With Type 2 Diabetes Mellitus to Decrease 30-Day Hospital Readmissions
Authors: Sullivan Veronica H. , Hays Mary M. , Alexander Susan 
Published: January 2019

Purpose/Objectives:
The purpose of this program was to provide health coaching to patients with a primary or secondary diagnosis of Type 2 diabetes mellitus (T2DM) to increase self-management skills and reduce 30-day readmissions.

Primary Practice Setting:
The setting was a 273-bed, acute care not-for-profit hospital in the southern region of the United States.

Findings/Conclusions:
Health coaching that emphasized self-management, empowered patients to set healthy goals, and provided support through weekly reminders to improve self-management for patients with T2DM in this pilot program. The majority of patients reported accomplishment of goals with 16 out of 20 patients who did not require inpatient stay 30 days after discharge from the acute care facility.

Implications for Case Management Practice:
The T2DM piloted program can easily be modified to fit other chronic illness that require routine monitoring and complex regimens to remain healthy. Case managers have the opportunity to coach on the importance of lifestyle modification and self-management support for patients with chronic illness with follow-up interactive phone visits after hospital discharge. Motivation and confidence through coaching may increase self-efficacy and better management of self-care and reduce the burden of unplanned hospital readmissions.
Improving Early Discharge Using a Team-Based Structure for Discharge Multidisciplinary Rounds
Authors: Patel Hemali , Yirdaw Essey , Yu Amy , Slater Lisa , Perica Katharine , Pierce Read G. , Amaro Connie , Jones Christine D. 
Published: January 2019

Purpose of Study:
Miscommunications during the complex process of discharging patients from acute care facilities can lead to adverse events, patient dissatisfaction, and delays in discharge. Brief multidisciplinary discharge rounds (MDRs) can increase communication between stakeholders and shorten a patient's length of stay (LOS). At our tertiary academic medical center, case managers (CMs) have historically been assigned patients by physical unit location rather than by provider teams caring for patients. As a result, medicine teams often interact with several unit-based CMs due to lack of geographically cohorted patients, leading to inefficiency and fragmentation in discharge planning communication. Our aim was to implement and evaluate the impact of multidisciplinary, team-based discharge planning rounds (MDR) for general medicine patients.

Primary Practice Setting:
A tertiary academic medical center.

Methodology and Sample:
Using the model for continuous improvement, we implemented and optimized MDR on 2 of 4 internal medicine resident ward teams that care for general internal medicine patients, including creation of a multidisciplinary team, improving physician continuity.

Results:
During the pilot, 1,584 patients were discharged from all medicine teams—825 from pilot teams and 759 from control teams. The proportion of patients with discharge before noon (DBN) orders was 41.2% on pilot versus 29.6% on control teams. Length of stay was 92.2 hr versus 97.2 hr, and 30-day readmission rate was 16.0% versus 18.3% for the pilot versus control teams, respectively. After the pilot concluded, we continued to have resident continuity on pilot teams but returned to the unit-based CM model. During this time, the proportion of DBN orders and LOS were similar between the pilot and control teams (29.0% vs. 24.3% and 95.8 hr vs. 96.6 hr, respectively). The 30-day readmission rate was 12.6% compared with 18.9% for the pilot versus control teams.

Implications for Case Management Practice:
Our team-based MDR pilot improved interdisciplinary relationships and communication and resulted in shorter LOS, earlier discharge times, and lower 30-day readmissions.
A Focus Group Study of Provider and Patient Perceptions of Communicating Advanced Care Planning Wishes Using Digital Storytelling
Authors: Hutson Sadie P. , Hankins Lauren R. 
Published: January 2019

Advanced care planning (ACP) and end-of-life discussions are especially difficult among persons living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) as a result of patients' lack of trust in family and providers, HIV-related stigma, misunderstood spirituality concerns, social isolation, and other factors. Previous research has demonstrated that relatively few persons living with HIV/AIDS engage in ACP, yet developing culturally sensitive methods of ACP is imperative. One such method is digital storytelling, a video narrative that can be used to share ideas or aspects of a life story.
The aim of this study was to examine perspectives from providers and persons living with HIV/AIDS about the acceptability, benefits, and technological challenges of and barriers to using digital storytelling for ACP. A qualitative descriptive design was employed using focus groups of 21 participants in South Central Appalachia. Transcribed data were analyzed using qualitative content analysis. Findings revealed patient and provider ideas about ACP, factors related to digital story acceptability, stigma against persons living with HIV/AIDS, and concern for the legality of ACPs expressed in digital story format. Future research should focus on the process of creating digital stories as an intervention to improve ACP in this unique aggregate.
Women's Experiences of Breastfeeding-Related Pain
Authors: Jackson Kimberley T. , Mantler Tara , O'Keefe-McCarthy Sheila 
Published: January 2019

AbstractPurpose:Breastfeeding-related pain is commonly experienced early in the postpartum period and is an important contributor to breastfeeding cessation, yet little is known about what this pain means to women and how it is experienced. The purpose of this study was to gain a better understanding of the phenomenon of breastfeeding-related pain, how women experience this pain, and the meaning it holds for them.Study Design and Methods:Interpretive descriptive methods and inductive content analysis were used. Women were recruited using purposive sampling with a snowball approach. Data were collected via one-to-one interviews using a semistructured interview guide with postpartum women having experienced breastfeeding-related pain in the past 2 months.Results:Fourteen postpartum women who met inclusion criteria were interviewed. They were predominantly Caucasian, well educated, and had greater than average Canadian annual household incomes. The dominant emerging discourse revealed three key themes: (a) interplay between breastfeeding pain and context, (b) action enablers and/or barriers, and (c) breastfeeding outcomes.Clinical Implications:Breastfeeding-related pain is an unpleasant sensory and affective experience for women during the postpartum period. Availability and accessibility of breastfeeding supports are essential to enable women to achieve their breastfeeding goals. Providing anticipatory guidance may help women to cope more effectively with their breastfeeding-related pain.
Intraorbital Dermoid Cyst With Zygomaticofrontal Suture Erosion in an Adult
Authors: Howard Brittany E. , Masood Maheer M. , Clark Joseph M. , Thorp Brian D. 
Published: January 2019

Background:
Dermoid cysts are squamous epithelium-lined sacs that result from abnormal migration of ectodermal cells. They are typically superficial and present in children. This study reviews a rare patient with a congenital dermoid cyst occurring as a superolateral intraorbital and extraconal mas.

Method:
Clinical report and review of the literature.

Results:
A 27-year-old male presented with progressive left hypoglobus, proptosis, and diplopia. On computed tomography, a 2.0 × 2.1 × 1.1 cm well circumscribed mass centered on, and extended into, the frontozygomatic suture with smooth remodeling of the frontal bone. Magnetic resonance imaging showed heterogeneous T1 and T2 hyperintensity with hypointensity on fat suppression. A dermoid cyst originating from the frontozygomatic suture was suspected. Excision was performed through a left orbitocranial approach with a lateral orbitotomy through an upper eyelid crease incision. The mass occurred in the superior-lateral portion of the left orbit and originated from the intraorbital surface of the zygomaticofrontal suture line with significant bony remodeling without osseous transgression. The mass was removed completely including the lateral portion of the zygomaticofrontal suture. Pathologic examination was consistent with a dermoid cyst. Postoperative examination revealed resolution of his presenting headaches and diplopia.

Conclusion:
Congenital dermoid cysts occurring within the craniofacial region occur most commonly in the lateral orbit involving the superficial surface of the frontozygomatic suture. This patient represents the rare occurrence of a dermoid cyst originating from the deep surface of the frontozygomatic suture, resulting in delayed presentation and orbital symptoms of hypoglobus and diplopia. Definitive treatment remains complete surgical excision.
Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria
Authors: Sayegh Farah , Ludwig David C. , Ascha Mona , Vyas Krishna , Shakir Afaaf , Kwong Jeffrey W. , Swanson Marco , Evans Morgan W. , Gatherwright James , Morrison Shane D. 
Published: January 2019

Background:
Interest in facial masculinization surgery is expected to increase as gender-affirming surgery becomes more widely accepted and available. The purpose of this study is to summarize the current literature describing operative techniques in facial masculinization surgery and provide an algorithmic approach to treating this patient population.

Methods:
PubMed, EMBASE, and Medline databases were queried for literature on operative techniques and outcomes of facial masculinization surgery in transgender and cisgender patients, published through July 2018. Data on patient demographics, follow-up, operative techniques, complications, and outcomes were collected.

Results:
Fifteen of the 24 identified studies met inclusion criteria. Two studies discussed the outcomes of 7 subjects (6 trans-male and 1 cis-male) who underwent facial masculinization procedures. No objective outcomes were reported in either study; however, subjects were generally satisfied and there were no complications. The remaining studies reviewed operative techniques utilized in the cisgender population.

Conclusion:
A summary of considerations for each facial anatomic subunit and respective operative techniques for facial masculinization is presented. Current facial masculinization procedures in cisgender patients may be considered in the transgender patient population with favorable outcomes. However, further research is needed on techniques and objective outcome measures of facial masculinization procedures in the transgender population.