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Objectives/hypothesis: Characterization of leadership within otolaryngology is key to evaluating trends and promoting program advancement. This study evaluates representation of women in otolaryngology holding residency and fellowship directorships, or chair positions, comparing sex differences in academic rank, years in practice, and scholarly activity.Study Design: Cross sectional analysis.Methods: A comprehensive list of otolaryngology residency and fellowship directors from Accreditation Council for Graduate Medical Education-accredited programs in 2017 to 2018 was compiled. Academic rank and years in practice were determined from departmental websites, with online search tools used as secondary resources. The h-index was utilized as a measure of research productivity. Regression analysis was performed to analyze these variables.Results: Among the 306 directorships, women held 57 (18.6%) of these positions, 27 (26.5%) residency and 30 (14.7%) fellowship directorships. Of the 99 chair positions, five (5.1%) were held by women. The majority (53.6%) of male directors were full professors, whereas only 26.3% of females were full professors (P = .04). Mean years in practice for female directors (13.9 ± 6.8) was less than that of male directors (20.3 ± 9.4, P < .0001). Similarly, mean h-index for female directors (11 ± 7.2) was lower than for males (17.5 ± 12.5, P = .0001). After controlling for academic rank and years of practice in a multivariable regression, the h-index remained lower for women than for men (P = .03).Conclusions: Women are disproportionately underrepresented in positions of residency and fellowship directorships, and chair positions, consistent with other specialties. Women in leadership had lower academic ranks, fewer years of practice, and lower h-indices than their male counterparts. This may represent a shift in academic otolaryngology as female otolaryngologists seek early involvement in leadership.Level Of Evidence: 4 Laryngoscope, 130:1664-1669, 2020. [ABSTRACT FROM AUTHOR]

Objective  The accuracy of structural magnetic resonance imaging (MRI) to predict later cerebral palsy (CP) in newborns with perinatal brain injury is variable. Diffusion tensor imaging (DTI) and task-based functional MRI (fMRI) show promise as predictive tools. We hypothesized that infants who later developed CP would have reduced structural and functional connectivity as compared with those without CP. Study Design  We performed DTI and fMRI using a passive motor task at 40 to 48 weeks' postmenstrual age in 12 infants with perinatal brain injury. CP was diagnosed at age 2 using a standardized examination. Results  Five infants had CP at 2 years of age, and seven did not have CP. Tract-based spatial statistics showed a widespread reduction of fractional anisotropy (FA) in almost all white matter tracts in the CP group. Using the median FA value in the corticospinal tracts as a cutoff, FA was 100% sensitive and 86% specific to predict CP compared with a sensitivity of 60 to 80% and a specificity of 71% for structural MRI. During fMRI, the CP group had reduced functional connectivity from the right supplemental motor area as compared with the non-CP group. Conclusion  DTI and fMRI obtained soon after birth are potential biomarkers to predict CP in newborns with perinatal brain injury. [ABSTRACT FROM AUTHOR]

In longitudinal studies in which a medical device is used to monitor outcome repeatedly and frequently on the same patients over a prespecified duration of time, two clustering goals can arise. One goal is to assess the degree of heterogeneity among patient profiles. A second yet equally important goal unique to such studies is to determine frequency and duration of monitoring sufficient to identify longitudinal changes. Considering these goals jointly would identify clusters of patients who share similar patterns over time and characterize temporal stability within each cluster. We use a biclustering approach, allowing simultaneous clustering of observations at both patient and time levels and using a nonparametric hierarchical Bayesian model. Because clustering units at the time level (i.e., time points) are ordered and hence unexchangeable, we utilize a multivariate Dirichlet process mixture model by specifying a Dirichlet process prior at the patient level whose base measure employs change points at the time level to achieve the desired joint clustering. We consider structured covariance between consecutive time points and assess model performance through simulation studies. We apply the model to data on 24-hrambulatory blood pressure monitoring and examine the relationship between diastolic blood pressure and pediatric obstructive sleep apnoea. [ABSTRACT FROM AUTHOR]

Investigation of the brain connectome using functional magnetic resonance imaging (fMRI) and measures derived from graph theory analysis has emerged as a new approach to study brain development, cognitive function, and neurophysiological disorders. Here we use graph theory analysis to examine the influence of age, sex, and neurocognitive measures on developmental changes to the global and regional topology of functional brain networks derived from fMRI data recorded in 189 healthy subjects from the age of 0–18 years during rest. We observed that Global Efficiency and Rich‐Club coefficient increased with age and Local Efficiency and Small‐Worldness decreased with age, while Modularity at the global level showed an inverted U‐shaped trajectory during development. Marginally significant differences were observed in Local Efficiency, Small‐Worldness, and Modularity at a global level between boys and girls throughout development. We also examine the effects of neurocognitive measures in boys and girls globally and locally. Our results provide new insight to understand brain maturation of functional brain connectome and its relation to cognitive development from birth through adolescence. [ABSTRACT FROM AUTHOR]

Abstract The white matter of the brain develops in a robust, regionally-variant, nonlinear manner during childhood. To relate white matter connectivity to performance, these regional nonlinear effects of age must be accounted for. Here, we identify white matter correlates of gross intellectual functioning using cutting-edge diffusion analyses inside a data-driven two-step regression framework. A total of 98 participants, ages 3–18 years, were included in the analyses. First, white matter connectivity was modeled as a function of age for each fiber direction at each voxel, extracted from the spin distribution function, using a 6th-order B-spline. The smoothing parameter for each direction was chosen by minimizing generalized cross-validation (GCV), which prevents overfitting while remaining sensitive to potentially nonlinear effects of age. In the second step, the resulting Gaussian residuals were modeled as a function of either full-scale IQ (FSIQ), or of verbal IQ (VIQ) and performance IQ (PIQ), using a linear regression framework (connectometry). Graph theoretical analyses were also performed to assess how each predictor relates to global topological changes, including average clustering coefficient, characteristic path length, global efficiency, average local efficiency, and small worldness. Analyses revealed widespread positive associations between white matter connectivity and FSIQ, including regions of the corpus callosum, fornix, and corticothalamic tracts (FDR q <.05). A separate regression model revealed a selective positive relationship between VIQ and white matter connectivity in predominately frontal tracts (e.g., anterior corticothalamic radiations, fornix, anterior corpus callosum, frontopontine tracts); in contrast, PIQ predicted white matter connectivity in the posterior brain (e.g. parietopontine tracts, posterior corticothalamic radiations, posterior corticostriatal projections), (FDR q <.05). No negative correlations were observed. Graph analyses revealed FSIQ, VIQ while controlling for PIQ, and PIQ while controlling for VIQ increase clustering coefficient, global efficiency, local efficiency, and small worldness, and decrease characteristic path length of the network. Results indicate regional white matter changes related to cognitive skills in childhood, independent of age. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether STOP-BANG (snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, gender) scores are associated with immediate postoperative adverse events in veterans undergoing surgery.Methods: In this prospective cohort study, veterans presenting to the presurgical clinic at a Veterans Affairs hospital answered the STOP-BANG questionnaire, which was scored as high risk (5-8), intermediate risk (3-4), and low risk (0-2) for obstructive sleep apnea (OSA), during a 6-month study period. Immediate postoperative respiratory and cardiovascular adverse events were recorded.Results: The patient population included 1,080 veterans. Ninety-five patients (8.8%) experienced adverse events, of which 74 (6.9%) were respiratory and 21 (1.9%) were cardiovascular in nature. Patients with high-risk STOP-BANG scores (5-8) had significantly greater odds of having an adverse event odds ratio (OR) 2.1 (95% confidence interval [CI]: 1.4, 3.3) and hypoxia OR 2.8 (95% CI: 1.7, 4.6) compared to those with low- to intermediate-risk scores (0-4). Among patients with OSA, those with high-risk scores (5-8) had greater odds of an adverse event OR 3.9 (95% CI: 1.1, 13.9) and hypoxia OR 3.7 (95% CI: 1.1, 13.0) compared to those with low- to intermediate-risk scores (0-4). Patients without a history of OSA with high-risk scores (5-8) did not have significantly greater odds of an adverse event OR 1.5 (95% CI: 0.82, 2.6) or a hypoxic event OR 1.7 (95% CI: 0.87, 3.4) compared to those with low- to intermediate-risk scores (0-4).Conclusion: The STOP-BANG questionnaire was useful in the veteran population because high-risk scores were predictive of adverse events, in particular, hypoxia for patients with a previous diagnosis of OSA. In the future, this may direct studies and clinical activities aimed at optimizing safe and effective perioperative practices.Level Of Evidence: 2b Laryngoscope, 129:259-264, 2019. [ABSTRACT FROM AUTHOR]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Objective. To examine the effect of patient selection criteria on immunization practice assessment outcomes. Methods. In 3 high- (50%-85%) and 7 low- ([is less than] 25%) Medicaid pediatric practices in urban eastern Virginia, we assessed immunization rates of children 12 and 24 months old comparing the standard criteria (charts in the active files excluding those that documented the child moved or went elsewhere) with 3 alternative criteria for selecting active patients: 1) follow-up: the chart contained a complete immunization record or the patient was found to be active in the practice through follow-up contact by phone or mail; 2) seen in the past year. the chart indicated that the patient was seen in the practice in the past year; 3) consecutive: patients that were seen consecutively for any reason. Results. Of the 1823 charts assessed in the high- and low-Medicaid practices, follow-up identified 61% and 83% as active patients; 78% and 95% were ever seen in the past year. At 24 months, mean practice immunization rates were lower for standard (70%) than all 3 alternative criteria (78%-86%). Immunization rate differences between standard and alternative criteria were greater in high- (17%,23%) than low-Medicaid practices (5%-13%). Conclusion. The standard for practice assessment should be based on a consistent definition of active patients as the immunization rate denominator. Pediatrics 2000;106:171-176; immunization assessment, quality of pediatric care, methodologic research, Medicaid, assessment of preventive services., ABBREVIATIONS. CDC, Centers for Disease Control and Prevention; PROS, Pediatric Research in Office Settings (network); UTD, up-to-date; DTP, diphtheria-tetanus-whole cell or acellular pertussis vaccine; MMR, measles-mumps-rubella vaccine; Hib, Haemophilus influenzae [...]

It is well known that infants born very preterm (VPT) often demonstrate deficits in mathematical abilities in early childhood which are associated with poorer academic outcomes. Mathematic skills are also critical for other areas of functioning. However, it is not known whether mathematics skills are associated with adaptive functioning in children born preterm. Infants born at ≤31 weeks gestation and full term were recruited at birth and followed over time. At the 36-month corrected age assessment, children were administered the Early Number Concepts subtest of the Differential Abilities Scale, Second Edition, and caregivers completed the Adaptive Behavior Assessment System, Third Edition. After controlling for age, sex, cognitive abilities, and caregiver education, performance on the mathematics measure was uniquely and positively associated with adaptive behavior for preschool children in the VPT group only. Exploratory analyses revealed this association to be specifically related to the Practical and Social composites. Knowledge of concepts of number and quantity were associated with better adaptive functioning, particularly for behaviors related to functioning at home and in the community and play/social functioning, for children born VPT. Although replication is warranted, it would appear that mathematical skills may be an important early intervention target for children born VPT. [ABSTRACT FROM AUTHOR]