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Geographic Information Systems (GIS) and multivariate statistical analyses were used to partition the United States into Human Influenced Water Environmental Classes (HIWECs) for the purpose of determining hydrologically similar units within the conterminous United States. Such a framework could be used to investigate various categories of watersheds throughout the country or to establish observatory sites in variant hydrologies. These HIWECs represent areas that are relatively homogeneous with respect to the human influence variables of land cover, population density, and water use; the climate variables of temperature and precipitation; and the physical variables of slope, bedrock permeability, and soil permeability. These variables combine to characterize hydrologic condition and collectively represent the major hydrologic variability that exists across the U.S. GIS was first used to break each of the variables into low to high ranges. Multivariate statistics were then used to identify and cluster areas that share similar characteristics in multivariate data space. HIWECS can serve as a framework for development of water research and management; observatory sites can be selected to capture variant hydrologies that incorporate the human influence element with the criteria that each type of human-influenced hydrologic condition, or class, be represented. [ABSTRACT FROM AUTHOR]

Hearing loss affects approximately 30 million people in the United States. It has been estimated that only approximately 20% of people with hearing loss significant enough to warrant amplification actually seek assistance for amplification. A significant interest in middle ear implants has emerged over the years to facilitate patients who are noncompliant with conventional hearing aides, do not receive significant benefit from conventional aides, or are not candidates for cochlear implants. From the initial studies in the 1930s, the technology has greatly evolved over the years with a wide array of devices and mechanisms employed in the development of implantable middle ear hearing devices. Currently, these devices are generally available in two broad categories: partially or totally implantable using either piezoelectric or electromagnetic systems. The authors present an up-to-date overview of the major implantable middle ear devices. Although the current devices are largely in their infancy, indications for middle ear implants are ever evolving as promising studies show good results. The totally implantable devices provide the user freedom from the social and practical difficulties of using conventional amplification. [ABSTRACT FROM AUTHOR]

Objectives: Social media has enabled discussion of relevant topics within otolaryngology. With increasing academic discourse occurring on virtual platforms, it is important to examine who is influencing these discussions. This study thus aims to: (1) identify the top Twitter influencers in otolaryngology and (2) assess the relationship between Twitter influence and academic impact., Study Design: Cross-sectional analysis., Setting: Twitter., Methods: The Right Relevance program was used to identify and rank the top 75 Twitter influencers, excluding organizations, according to the search terms "otolaryngology," "head and neck surgery," "ear nose throat," "rhinology," "head and neck," "laryngology," "facial plastics," and "otology." Demographic data and h-index were collected for each influencer. Correlational analyzes were performed to assess the relationships between Twitter rank and geographic location, sex, subspecialty, and h-index., Results: The majority of the top 75 influencers were otolaryngologists (87%), female (68%), and located in the United States (61%). General otolaryngology (n = 20, 31%) was more well-represented than any individual subspecialty including facial plastics (n = 10, 15%), rhinology (n = 10, 15%), and neurotology (n = 9, 14%). There was a significant relationship between Twitter rank and h-index (Spearman ρ value of -0.32; 95% confidence interval: -0.51 to -0.01; P = .006). Twitter rank was not significantly correlated with subspecialty, sex, or geographic location (P > .05)., Conclusion: The majority of Twitter influencers within otolaryngology were otolaryngologists, female, and located in the United States. Social media influence is positively associated with academic impact among otolaryngologists., (© 2024 The Authors. Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Interventions to address social drivers of health (SDH), such as food insecurity, transportation, and housing, can reduce future health care costs but require up-front investment. Although Medicaid managed care organizations have incentives to reduce costs, volatile enrollment patterns and coverage changes may prevent them from realizing the full benefits of their SDH investments. This phenomenon results in the "wrong-pocket problem," in which managed care organizations underinvest in SDH interventions because they cannot capture the full benefit. We propose a financial innovation, an SDH bond, to increase investments in SDH interventions. Issued by multiple managed care organizations in a Medicaid coverage region, the bond would raise immediate funds for SDH interventions that are coordinated across the organizations and delivered to all enrollees of the region. As the benefits of SDH interventions accrue and cost savings are realized, the amount managed care organizations must pay back to bond holders adjusts according to enrollment, addressing the wrong-pocket problem.

Objective: To report speech outcomes after cochlear implantation (CI) for asymmetric hearing loss (AHL) and assess the influence of contralateral hearing., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: One hundred eighty-eight adults (mean age, 70 yr) undergoing CI for AHL from 2015 to 2020. Candidacy included pure-tone average (PTA) at least 70 dB hearing level and AzBio in quiet 60% or less in the implanted ear and AzBio in quiet greater than 40% in the contralateral ear., Main Outcome Measures: PTA; Consonant-Nucleus-Consonant (CNC) word, AzBio sentences scores; Speech, Spatial, and Qualities of Hearing Scale (SSQ)., Results: Mean preoperative PTA and AzBio in the implanted and contralateral ears were 85.2 and 68.1 dB hearing level and 24.7% and 69.2%, respectively. Mean CNC in the implanted ear increased from 18.3% preoperatively to 44.4% ( p < 0.0001) at 6 months and 49.3% ( p < 0.0001) at 12 months. Mean AzBio in the implanted ear improved from 24.7% preoperatively to 60.3% ( p < 0.0001) at 6 months and 64.3% ( p < 0.0001) at 12 months. Patients demonstrated significant improvement in all SSQ domains at 6 and 12 months. When comparing patients with preoperative contralateral AzBio greater than 60% versus 41% to 60%, no significant differences existed in postoperative CNC scores (6-mo: 47% versus 41%, p = 0.276; 12-mo: 51% versus 47%, p = 0.543). There were no significant differences in 6-month ( p = 0.936) or 12-month ( p = 0.792) CNC scores between patients with AHL (contralateral ear AzBio >40%) and 169 unilateral CI patients meeting the traditional Medicare criteria (contralateral ear AzBio ≤40%)., Conclusion: CI recipients with AHL derive significant speech improvements, supporting individual ear consideration for CI candidacy and patient benefit outside of current Medicare criteria., Competing Interests: K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas; is on the clinical advisory board for Frequency Therapeutics; and is on the Board of Directors for the American Auditory Society. The other authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: To characterize the influence of expanding indications on the profile of adults undergoing cochlear implantation (CI) at a high-volume CI center., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: 774 adults undergoing CI evaluation from August 2015 to August 2020., Main Outcome Measures: Demographics; audiometry; speech recognition; speech, spatial, and qualities of hearing scale (SSQ-12)., Results: Of 745 (96.3%) patients qualifying for implantation, 642 (86.6%) pursued surgery. Median age at evaluation was 69 years; 56.3% were men; 88.2% were Caucasian. Median distance to our center was 95 miles. The majority (51.8%) had public insurance (Medicare, Medicaid), followed by private (47.8%) and military (0.4%). Mean PTA, CNC, and AzBio in quiet and noise for the ear to be implanted were 85.2 dB HL, 15.0%, and 19.2% and 3.5%, respectively. Hybrid/EAS criteria were met by 138 (18.5%) CI candidates, and 436 (77.0%) unilateral CI recipients had aidable contralateral hearing for bimodal hearing configurations. Younger age (odds ratio [OR], 0.96; 95% confidence interval, 0.93-0.99) and non-Caucasian race (OR, 6.95; 95% confidence interval, 3.22-14.98) predicted candidacy. Likelihood of surgery increased for Caucasian (OR, 8.08; 95% confidence interval, 4.85-13.47) and married (OR, 2.28; 95% confidence interval, 1.50-3.47) patients and decreased for those with public insurance (OR, 0.45; 95% confidence interval, 0.29-0.69). A lower SSQ-12 score predicted both candidacy and surgery., Conclusion: Despite expansions in criteria, speech understanding remained extremely low at CI evaluation. Younger age and non-Caucasian race predicted candidacy, and Caucasian, married patients with private insurance and lower SSQ scores were more likely to pursue surgery., Competing Interests: Conflicts of Interest: K.O.T. has served as an advisory board member for GlaxoSmithKline. D.S.H. is a consultant for Advanced Bionics, Cochlear Americas, MED-EL GmbH, Stryker, Synthes, Grace Medical, and Oticon. R.G. is a consultant for Advanced Bionics, Akouos, and Cochlear Americas, is on the clinical advisory board for Frequency Therapeutics, and is on the Board of Directors for the American Auditory Society. The remaining authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Objective: To characterize the catchment area and patient profile of large cochlear implant (CI) centers in the United States., Study Design: Multi-institutional retrospective case series., Setting: Tertiary referral CI centers., Methods: Patients who underwent CI surgery at 7 participating CI centers between 2015 and 2020 were identified. Patients' residential zip codes were used to approximate travel distances and urban vs rural residential areas., Results: Over the 6-year study period (2015-2020), 6313 unique CI surgical procedures occurred (4529 adult, 1784 pediatric). Between 2015 and 2019, CI procedures increased by 43%. Patients traveled a median 52 miles (interquartile range, 21-110) each way; patients treated at rural CI centers traveled greater distances vs those treated at urban centers (72 vs 46 miles, P < .001). Rural residents represented 61% of the patient population and traveled farther than urban residents (73 vs 24 miles, P < .001). Overall, 91% of patients lived within a 200-mile radius of the institution, while 71% lived within a 100-mile radius. In adults, multiple regression analysis redemonstrated an association between greater travel distances and (1) older age at the time of CI and (2) residential rural setting (both P < .001, r 2 = 0.2)., Conclusions: While large CI centers serve geographically dispersed populations, most patients reside within a 200-mile radius. Strategies to expand CI utilization may leverage remote programming, telemedicine, and strategic placement of new centers and satellite clinics to ameliorate travel burden.

Objective: Social media is a powerful networking tool among health care organizations. This study determines correlations between program reputation and social media activity and popularity, specifically among otolaryngology residency programs., Methods: Accredited programs, excluding military and osteopathic, in the United States were included. Activity and popularity on Facebook, Twitter, and Instagram were assessed during the same 7-month period from 2016 to 2020. Doximity Residency reputation scores (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with top hospitals versus those with unranked hospitals) were utilized to compare differences based on reputation., Results: Of 104 programs, 91 (88%) had social media accounts. Instagram and Twitter were more commonly used than Facebook, with 78 (75%), 49 (47%), and 42 (40%) accounts, respectively. The cumulative use of all three platforms grew yearly, while Twitter (R 2  = 0.9863) and Instagram (R 2  = 0.9955) presence increased exponentially. Doximity's top quartile programs had more Facebook (P = .020), Twitter (P < .001), and Instagram (P = .102) accounts. First-quartile programs also adopted each platform months before fourth-quartile programs. Stratified by US News & World Report, ranked programs had more social media accounts, with 24 (53%) on Facebook (P = .028), 32 (71%) on Twitter (P < .001), and 37 (82%) on Instagram (P = .155). Programs with higher reputations were more active and exhibited increased likes and followers over time., Conclusion: Social media use among otolaryngology programs has grown exponentially, with Instagram and Twitter becoming the dominant platforms. Higher ranked programs are more active on social media, have more followers, and adopt social media earlier., Level of Evidence: 4 Laryngoscope, 131:2455-2460, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: Over two-thirds of the adult population in the United States use Facebook. Despite the high interest in and use of social media by the general public, the presence and accessibility of health care organizations on social media has not yet been fully evaluated., Objective: To determine the use and popularity of social media among otolaryngology residency programs in the United States., Design, Setting, and Participants: A cross-sectional study of the presence of accredited otolaryngology residency programs in the United States in an internet data repository was conducted. Programs were stratified by Doximity Residency Navigator reputation rankings (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with hospitals ranked in the top 50 vs programs affiliated with unranked hospitals). Social media sites and activity for each program were assessed using internet searches. The study was conducted in April 2017., Results: Among 101 otolaryngology residency programs, 30 were found to have social media sites (29.7%). Facebook and Twitter were the most commonly used services, with 25 (24.8%) and 14 (13.9%) accounts, respectively. Based on Doximity Residency Navigator rankings, programs in the first quartile were more likely to have Facebook profiles than programs in the fourth quartile (42.3% vs 12.0%; absolute difference, 30%; 95% CI, 2.9% to 52.6%). First- and second-quartile programs showed increased Facebook activity. There was greater Twitter presence in first- vs fourth-quartile programs (19.2% vs 8.0%; absolute difference, 11.2%; 95% CI, -11.6% to 33.0%). Higher-quartile programs were more active on Twitter and exhibited increased numbers of likes and followers. Analysis of US News & World Report rankings revealed that ranked programs had higher rates of presence, activity, and popularity on both Facebook and Twitter. However, these were smaller differences than seen when comparing Doximity Residency Navigator rankings. Correlation between the 2 ranking systems was indicated (Spearman ρ = 0.59; 95% CI, 0.34 to 0.76)., Conclusions and Relevance: This study suggests that otolaryngology residency programs with higher Doximity Residency Navigator reputation rankings have a stronger presence on social media. Smaller trends were observed for programs in the top 50 US News & World Report rankings. Overall, social media use among otolaryngology programs seems relatively low, and this may present an opportunity to increase communication with the public via these technologies.

Burnout is common among physicians. Chronic sources of burnout have been previously examined, but little is known about the impact of acute stressors on physician burnout. Otolaryngology residents applying for competitive fellowships provide a good example for how professional disappointment may cause burnout. As otolaryngology comprises highly successful, highly competitive individuals, a long history of success may leave otolaryngologists ill-equipped to cope with such failures. Otolaryngologists should be aware of such pitfalls, preparing appropriate coping mechanisms in cases of professional disappointment.