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Context--Living donation is studied with much less intensity among African Americans than among the general population. Examination of barriers to living donation can lead to effective strategies to educate dialysis patients and their families about this alternative. Objective--To explore the correlates of likelihood of becoming a living donor among community-recruited African American adults. Design/Participants--Cross-sectional data were gathered via self-administered questionnaire from 425 African American adults, age 18 years and older, who were recruited from 9 churches in Atlanta. Main Outcome Measures--Self-reported likelihood of becoming a living donor to a close family member, an extended family member or friend, or a stranger. Results--More than three-quarters of participants were willing to act as living donors to a close family member or spouse and two-thirds to friends or extended family. For likelihood of donating to a friend or extended family member, only willingness to engage in deceased donation was significantly associated; to a stranger, both willingness to engage in deceased donation and attitudes toward donation were significantly associated. Knowledge of and personal experiences with donation and/or transplantation were not significantly associated with likelihood of any type of living donation. Conclusions--Findings indicate widespread support for living donation to a close family member or spouse. These findings have important implications for dialysis patients who must decide whether to approach friends and/or family about the possibility of serving as a living donor and emphasize the need for interventions to help facilitate this process. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop and evaluate the psychometric properties of a scale measuring prenatal breast-feeding self-efficacy. METHODS: A 20-item scale was administered to a sample of 279 low-income pregnant women. RESULTS: Results from this study provide evidence for internal consistency (Cronbach's alpha = .89) and validity of this measure of prenatal breast-feeding self-efficacy in this population. A factor analysis of the scale indicated 4 themes. The instrument distinguished between women who intended to breast-feed and those who intended to formula feed. CONCLUSION: A valid and reliable scale measuring self-efficacy for breast-feeding during pregnancy may help health care providers design interventions to increase breast-feeding rates. [ABSTRACT FROM AUTHOR]

Although the likelihood of fire-related death in homes with smoke alarms is about one-half that in homes without alarms, alarm effectiveness is limited by behavior. Only 16% of residents of homes with alarms have developed and practiced plans for escape when the alarm sounds. We reviewed literature to identify behavioral constructs that influence smoke alarm use. We then convened experts in the behavioral aspects of smoke alarms who reviewed the constructs and determined that the appropriate areas for behavioral focus were formulating, practicing, and implementing escape plans should an alarm sound. They subsequently identified important behaviors to be addressed by burn-prevention programs and incorporated the constructs into a behavioral model for use in such programs. Finally, we organized the available literature to support this model and make programmatic recommendations. Many gaps remain in behavioral research to improve fire escape planning and practice. Future research must select the target behavior, apply behavioral theories, and distinguish between initiation and maintenance of behaviors associated with planning, practicing, and implementing home fire escape plans. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the influence of breast-feeding attitudes, social norms, and prior experience on predicting breast-feeding intention utilizing the theories of reasoned action and planned behavior. METHODS: Low-income pregnant women (n = 963) completed a theory-based questionnaire. RESULTS: Attitudes were more predictive of breast-feeding intention than were norms, regardless of parity or prior behavior. Among multiparous women, amount of prior breast-feeding experience contributed independently to predicting breast-feeding intention and rendered norms insignificant. CONCLUSION: Results support the theories. Breast-feeding promotions targeting low-income women should emphasize enhancing women's personal breast-feeding attitudes, and, among primiparous women, promoting positive breast-feeding attitudes among their significant others. [ABSTRACT FROM AUTHOR]

PURPOSE: When one compares National Health and Nutrition Examination Survey III (NHANES III) data to previous national surveys it appears that oral health in the United States has improved. The purpose of this study was to determine if this trend holds for prisoners in Iowa, specifically in regard to number of decayed teeth, number of decayed surfaces, and number of missing teeth. METHODS: This original research is a report of cross-sectional data regarding untreated decay and missing teeth. A representative sample of inmates newly admitted to the Iowa Medical Classification Center (IMCC) between June and December 1998 was selected. Oral health data were collected from records obtained as the result of dental treatment screening examinations conducted by the IMCC staff dental hygienist. Demographic data were obtained from questionnaires. The oral health status of this Iowa inmate population was compared with the status of previously studied samples of inmates throughout the nation using descriptive and parametric statistics and with dentate, noninstitutionalized U.S. adults using descriptive, non-parametric, and parametric statistics. RESULTS: Of the 174 study participants, 149 were male and 25 were female. On average, male inmates had 7.09 decayed teeth, 15.3 surfaces of decay, and 4.07 missing teeth. The female inmates averaged 5.56 teeth with untreated decay, 14.4 surfaces of decay, and 5.12 missing teeth. Findings showed that male Iowa inmates have more untreated decay than previously studied samples of inmates throughout the nation. IMCC Caucasian male inmates had 1.6 to 7.8 times as many untreated decayed teeth as previous inmates, while African American inmates showed 1.2 to 3.4 times as many untreated decayed teeth. The Iowa male inmates had fewer missing teeth than most of the inmate comparison groups. Compared with dentate, noninstitutionalized U.S. adults, the IMCC inmates, male and female combined, had 8.4 times the amount of untreated decay but similar numbers of missing teeth. CONCLUSIONS: Newly admitted male and female inmates were disparate from the general dentate U.S. adult population in terms of untreated decay. This also was found for IMCC male inmates compared to previous studies of male inmates. Inmates of both genders at IMCC did not appear to be disparate with the comparison population with regard to number of missing teeth. [ABSTRACT FROM AUTHOR]

Bicycle helmet purchase, use, consistent use, and correct use are determined by a complex set of factors. Behavioral theory suggests that they are influenced by the reciprocal association between individual characteristics such as, expectations, skills, attitudes, and beliefs; social influences such as social norms and peer pressure; and environmental factors such as availability, accessibility, and cost. These factors can be influenced through counseling and other interventions. While a review of the literature suggests that many bicycle helmet programs have not been planned using behavioral models and knowledge from the behavioral sciences, many studies include information that supports behavioral principles. This paper describes the behavioral principles and their application to the problem of increasing bicycle helmet use. Recommendations for practitioners are included. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine the feasibility of using the cognitive evaluation theory to examine pregnant women's intention to breast-feed. METHODS: A questionnaire designed to measure intrinsic and extrinsic motivation was administered to 228 pregnant women. RESULTS: Results provide evidence for reliability and validity of the revised instrument in this population. A factor analysis suggests the instrument measures 2 types of intrinsic motivation, one type of extrinsic motivation, and motivation related to the baby. The instrument distinguished differences in motivation between women who intend to breast-feed and those who intend to formula feed. CONCLUSION: This study helps elucidate motivational factors involved in infant-feeding decisions. [ABSTRACT FROM AUTHOR]

This study examined the applicability of the transtheoretical model and a model derived from the theory of reasoned action for predicting breast-feeding intention among low-income pregnant women. Participants completed a 70-item self-report questionnaire assessing their breast-feeding attitudes, intentions, and support. A positive correlation existed between Stages of Change for breast-feeding and the number of Processes of Change used by respondents. A negative correlation existed between Stages of Change for breast-feeding and the number of negative breast-feeding beliefs held by respondents. Furthermore, women's normative beliefs and outcome beliefs were significantly correlated with breast-feeding intention in manners consistent with the model developed from the theory of reasoned action. After accounting for significant sociodemographic and lifestyle factors, the Processes of Change and outcome beliefs remained independently correlated with breast-feeding intention. These models are capable of predicting the intention to breast-feed and might offer an innovative approach for further breast-feeding research and intervention development. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to describe the relationship between breastfeeding intention among socioeconomically disadvantaged pregnant women and maternal demographics, previous breastfeeding experience, and social support. Methods: A cross-sectional, convenience sampling strategy was employed for data collection. Low-income women (n = 1001) in a public hospital completed a six-page questionnaire about their infant feeding plans, demographics, and social support. Simple regression analyses were conducted to compare maternal breastfeeding intention with the hypothesized correlates. Results: Breastfeeding intention was positively correlated with older maternal age, higher education, more breastfeeding experience, Hispanic ethnicity, and hearing about breastfeeding benefits from family members, the baby's father, and lactation consultants, but not from other health professionals. Health professionals' attitudes were less influential on women's infant feeding decisions than the attitudes and beliefs of members of women's social support networks. When controlling for breastfeeding experience (none vs any), some findings varied, indicating a need for breastfeeding interventions tailored to women's level of experience. Conclusion: Use of peer counselors and lactation consultants, inclusion of a woman's family members in breastfeeding educational contacts, and creation of breastfeeding classes tailored to influential members of women's social support networks may improve breastfeeding rates among low-income women, especially those with no breastfeeding experience, more effectively than breastfeeding education to pregnant women that is solely conducted by health professionals. [ABSTRACT FROM AUTHOR]

Focuses on a study which examined breastfeeding intention using transtheoretical model and the theory of reasoned action. Feasibility of using the two theories to explain breastfeeding intention; Inter-relationships between the two theories; Methodology; Results and discussion.

PURPOSE: This small pilot study examined the validity of visual dental hygiene screenings (VDHS) in conditions found in local communities. METHODS: A sample of 126 children in kindergarten through second grade was screened by 2 dental hygienists and inspected by a dentist. None of the assessors had more than minimal experience and training in epidemiological methodologies. Two dental hygienists noted teeth as decayed or not decayed using only a tongue blade and a goose-neck lamp (VDHS). The dentist noted decay by tooth and surface using a mirror, explorer, portable dental chair, as well as a goose-neck lamp; this examination is referred to as a mirror, tactile dental inspection (MTDI). The dentist's assessment (MTDI) was the 'gold standard.' Data were analyzed using frequency distributions, sensitivity, specificity, and kappa coefficient statistics, as well as other statistics to test the significance of differences and to investigate explanations for discrepancies between the VDHS and MTDI. RESULTS: Sensitivity and specificity for the VDHS for all teeth were 61% and 96%, with a kappa coefficient of 0.6. Analysis of the discrepancies between the VDHS and the MTDI suggest that, for primary teeth, the sensitivity of the VDHS is greater when: (1) lesions are large (i.e. multi surface) and (2) single surface lesions are located anteriorly. No statistically significant explanations were found for differences in permanent teeth. CONCLUSION: In this study, VDHS demonstrated high specificity and moderate sensitivity for caries identification. [ABSTRACT FROM AUTHOR]

Providers who referred patients to Reach to Recovery (Reach), an American Cancer Society breast cancer support group, were compared with those who did not to evaluate whether providers who identified problems with the program were less likely to make referrals. Also considered were contact with a Reach volunteer, having a Reach program in the area, years since residency or medical training, perceived value of the Reach program belief that one's peers refer patients to Reach, urban or rural location of practice, and size of practice. When other variables were considered, physicians who identified problems with Reach were no less likely to refer patients to the program than those who did not. The factors most associated with referral (P < .001) were 'having a Reach program in the area' and 'having had contact with a Reach volunteer.' Implication of these findings and the experience of conducting the evaluation through the Collaborative Evaluations Fellows project are discussed. [ABSTRACT FROM AUTHOR]

Objective: Some cochlear implant (CI) recipients with unilateral hearing loss (UHL) have functional acoustic hearing in the implanted ear, warranting the fitting of an ipsilateral electric-acoustic stimulation (EAS) device. The present study assessed speech recognition and subjective hearing abilities over time for EAS users with UHL., Study Design: Prospective, repeated-measures., Setting: Tertiary referral center., Patients: Adult CI recipients with normal-to-moderate low-frequency acoustic thresholds in the implanted ear and a contralateral pure-tone average (0.5, 1, and 2 kHz) ≤25 dB HL., Main Outcome Measures: Participants were evaluated preoperatively and at 1, 3, and 6 months post-activation. Speech recognition for the affected ear was evaluated with CNC words in quiet. Masked speech recognition in the bilateral condition was evaluated with AzBio sentences in a 10-talker masker (0 dB SNR) for three spatial configurations: target from the front and masker either colocated with the target or presented 90 degrees toward the affected or contralateral ear. Responses to the Speech, Spatial, and Qualities of Hearing Scale subscales were used to assess subjective hearing abilities., Results: Participants experienced significant improvements in CNC scores ( F(3,13) = 14.90, p < 0.001), and masked speech recognition in the colocated ( F(3,11) = 3.79, p = 0.043) and masker toward the contralateral ear ( F(3,11) = 4.75, p = 0.023) configurations. They also reported significantly better abilities on the Speech Hearing ( F(3,13) = 5.19, p = 0.014) and Spatial Hearing ( F(3,13) = 10.22, p = 0.001) subscales., Conclusions: Adults with UHL and functional acoustic hearing in the implanted ear experience significant improvements in speech recognition and subjective hearing abilities within the initial months of EAS use as compared with preoperative performance and perceptions., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objectives: Research samples that are representative of patient populations are needed to ensure the generalizability of study findings. The primary aim was to assess the efficacy of a study design and recruitment strategy in obtaining a participant sample that was representative of the broader cochlear implant (CI) patient population at the CI center. A secondary aim was to review whether the CI recipient population was representative of the state population., Methods: Demographic variables were compared for a research participant sample (n = 79) and the CI patient population (n = 338). The participant sample was recruited from the CI patient population. The study design included visits that were at the same location and frequency as the recommended clinical follow-up intervals. The demographics for the combined group (participant sample and patient population) were then compared to the reported demographics for the population in North Carolina., Results: There were no significant differences between the participant sample and patient population for biological sex, age at implantation, racial distribution, socioeconomic position, degree of urbanization, or drive time to the CI center (p ≥ 0.086). The combined CI recipient population was significantly different from the North Carolina population for the distributions of race, ethnicity, and degree of urbanization (p < 0.001)., Conclusion: The study design and recruitment strategy allowed for recruitment of a participant sample that was representative of the CI patient population. Disparities in access to cochlear implantation persist, as supported by the significant differences in the combined CI recipient population and the population for our state., Level of Evidence: 3 Laryngoscope, 134:4101-4110, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective(s): FDA-approved indications for cochlear implantation include patients with severe-to-profound unilateral hearing loss (UHL) or asymmetric hearing loss (AHL); however, these indications are not covered for Medicare beneficiaries. We assessed the outcomes of cochlear implant (CI) use for older adults with UHL or AHL., Methods: Eighteen older adults (≥65 years of age at surgery) with UHL/AHL participated in a prospective, longitudinal investigation evaluating outcomes of CI use. Speech recognition for the affected ear was evaluated with consonant-nucleus-consonant (CNC) words. Spatial hearing was assessed with measures of sound source localization and sentence recognition in noise. The target sentence was presented from the front and the masker was either co-located with the target (SoNo), presented toward the affected ear (SoNci) or contralateral ear (SoNcontra). Perceived benefit was assessed with the Speech, Spatial, and Qualities of Hearing scale (SSQ) and the Tinnitus Handicap Inventory (THI)., Results: Participants experienced significant improvements with CI use for CNC words (mean [SD]; preop: 8% [10%], 1 yr: 51% [22%], 5 yr: 50% [19%]), masked sentence recognition (SoNcontra preop: 5% [6%], 1 yr: 22% [15%], 5 yr: 41% [14%]), and localization (preop: 76° [18°], 1 yr: 40° [11°], 5 yr: 41° [14°]), and reported significant improvements in hearing abilities (SSQ Spatial Hearing preop: 3 [1], 1 yr: 6 [2], 5 yr: 6 [2]) and tinnitus severity (THI preop: 16 [18], 1 yr: 4 [14], 5 yr: 6 [12])., Conclusion: Older adults with UHL/AHL experience significant improvements in speech recognition, spatial hearing, and subjective perceptions (e.g., hearing abilities and tinnitus severity) with a CI as compared to pre-operative abilities., Level of Evidence: IV Laryngoscope, 2024., (© 2024 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Misplacement of electrode arrays in the internal auditory canal (IAC) presents a unique clinical challenge. Speech recognition is limited for cochlear implant (CI) users with misplaced arrays, and there are risks with revision surgery including facial and/or cochlear nerve injury., Databases Reviewed: PubMed, Embase, and Scopus., Methods: A literature search was performed from inception to September 2023. The search terms were designed to capture articles on misplaced arrays and the management options. Articles written in English that described cases of array misplacement into the IAC for children and adults were included. The level of evidence was assessed using Oxford Center for Evidence Based Medicine guidelines. Descriptive statistical analyses were performed., Results: Twenty-eight cases of arrays misplaced in the IAC were identified. Thirteen (46%) were patients with incomplete partition type 3 (IP3), and 7 (25%) were patients with common cavity (CC) malformations. Most misplaced arrays were identified postoperatively (19 cases; 68%). Of these cases, 11 (58%) were managed with array removal. No facial nerve injuries were reported with revision surgery. Eight cases (42%) were left in place. Several underwent mapping procedures in an attempt improve the sound quality with the CI., Conclusion: Electrode array misplacement in the IAC is a rare complication that reportedly occurs predominately in cases with IP3 and CC malformations. Removal of misplaced arrays from the IAC reportedly has not been associated with facial nerve injuries. Cases identified with IAC misplacement postoperatively can potentially be managed with modified mapping techniques before proceeding with revision surgery., (Copyright © 2024, Otology & Neurotology, Inc.)

Competing Interests: The authors declare no conflicts of interest.

Objective: The study was conducted to evaluate the safety and efficacy of mild internal jugular (IJV) compression via an FDA approved compression collar for symptomatic treatment of venous pulsatile tinnitus., Methods: This is a prospective study that recruited 20 adult patients with venous pulsatile tinnitus. Participants completed the Tinnitus Handicap Inventory (THI), were fitted with the collar, and rated symptom intensity on a 10-point tinnitus intensity scale before and during collar use. Once weekly for 4 weeks, they answered a survey quantifying days used, average tinnitus intensity before and after wearing the collar each day of use, and any safety concerns. Lastly, they completed an exit interview. The primary outcome was symptomatic relief, with secondary outcomes of safety, effect of treatment setting, effect of time, and quality of life assessed via nonparametric testing., Results: 18 participants completed the study, and 276 paired daily before use/during use intensity scores were submitted. The median symptom intensity without the collar was 6 (IQR 4, 7), whereas with the collar it was 3 (IQR 2, 5), for a median symptomatic relief of 50%. The collar had a significant effect in reducing symptom intensity (p < 0.0001) and burden of illness via the THI (p < 0.0001). There was no effect of setting, frequency, or time on symptomatic relief with the collar. There were no adverse safety events reported aside from minor discomfort upon initial application., Conclusions: Venous compression collars offer acute symptom relief for patients with venous pulsatile tinnitus. Further study is needed to assess safety and efficacy of longitudinal use., Level of Evidence: 4 Laryngoscope, 134:3342-3348, 2024., (© 2024 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Children with cochlear nerve deficiency (CND) have wide variability in outcomes with cochlear implant (CI) use. The current study aims to report a large cohort of pediatric CI recipients with CND and to evaluate for factors that may predict improved performance., Methods: The current study is a retrospective review of pediatric CI recipients with CND at a tertiary academic hospital. Variables including cochlear nerve status (hypoplasia vs aplasia), age at implantation, cochleovestibular malformation, bony cochlear nerve aperture, internal auditory canal aperture, and cognitive delay were evaluated for predictors of postoperative performance. A stepwise multinomial regression analysis was performed., Results: Forty-seven CI recipients (54 ears) were included in the analysis. A majority (59%) showed auditory capabilities with their CI. Twenty percent of recipients achieved some level of open-set speech perception with their CI. The regression analysis identified cochlear nerve status and cognitive delay as predictors of performance. CI recipients with cochlear nerve hypoplasia had significantly improved performance compared to those with aplasia ( p  = 0.003). Recipients with cognitive delay had more limited benefit than those without cognitive delay ( p  = 0.033)., Conclusions: Children with CND can benefit from CI use, with outcomes spanning from non-use to development of spoken language. Predictive factors for improved performance include a lack of cognitive delay and cochlear hypoplasia rather than aplasia. These can be important considerations for parent counseling and decision making.

Objective: To detail a modified surgical technique for implantation of the Osia 2 Bone Conduction Hearing Aid (BCHA) system and to assess intra- and postoperative outcomes of this technique., Methods: A retrospective review was performed for cases undergoing implantation of an Osia 2 BCHA at a tertiary academic medical center. Modifications were made to the surgical procedure including: horizontal or curvilinear incisions, placement of the osseointegrated screw slightly superior to the plane of the external auditory canal, and double layer wound closure. Data regarding outcomes including demographics, incision type, surgical time, drilling requirements, and complications were collected using the electronic medical record., Results: A total of twenty-eight cases were evaluated with 57.1% and 42.9% utilizing horizontal and curved incisions, respectively. The median age for recipients was 43.1 years with six pediatric cases included in the study. Median operative time was 58 min (43-126 min). The majority of cases required minimal (60.7%) or no drilling (28.6%) with a significant increase in operative time for those requiring moderate drilling versus minimal to no drilling (F = 8.02, p = 0.002). There were no intraoperative complications. One (3.6%) postoperative seroma occurred which resolved with conservative management., Conclusion: The proposed modified surgical technique is a safe and effective method for implantation of the transcutaneous BCHA system with a low complication rate. Keys include incision design, implant placement, and two-layered closure to minimize wound tension. These modifications can improve ease of the procedure and reduce operative time. These techniques also appear to be applicable to the pediatric population., Level of Evidence: 3 Laryngoscope, 134:2401-2404, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Determine variables that influence post-activation performance for cochlear implant (CI) recipients who lost low-frequency acoustic hearing., Methods: A retrospective review evaluated CNC word recognition for adults with normal to moderately severe low-frequency hearing (preoperative unaided thresholds of ≤70 dB HL at 250 Hz) who were implanted between 2012 and 2021 at a tertiary academic center, lost functional acoustic hearing, and were fit with a CI-alone device. Performance scores were queried from the 1, 3, 6, 12, and 24-month post-activation visits. A linear mixed model evaluated the effects of age at implantation, array length (long vs. mid/short), and preoperative low-frequency hearing (normal to mild, moderate, and moderately severe) on speech recognition with a CI alone., Results: 113 patients met the inclusion criteria. There was a significant main effect of interval (p < 0.001), indicating improved word recognition post-activation despite loss of residual hearing. There were significant main effects of age (p = 0.029) and array length (p = 0.038), with no effect of preoperative low-frequency hearing (p = 0.171). There was a significant 2-way interaction between age and array length (p = 0.018), indicating that older adults with mid/short arrays performed more poorly than younger adults with long lateral wall arrays when functional acoustic hearing was lost., Conclusion: CI recipients with preoperative functional low-frequency hearing experience a significant improvement in speech recognition with a CI alone as compared to preoperative performance-despite the loss of low-frequency hearing. Age and electrode array length may play a role in post-activation performance. These data have implications for the preoperative counseling and device selection for hearing preservation candidates., Level of Evidence: 4 Laryngoscope, 134:1868-1873, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: Comparison of acute speech recognition for cochlear implant (CI) alone and electric-acoustic stimulation (EAS) users listening with default maps or place-based maps using either a spiral ganglion (SG) or a new Synchrotron Radiation-Artificial Intelligence (SR-AI) frequency-to-place function., Methods: Thirteen adult CI-alone or EAS users completed a task of speech recognition at initial device activation with maps that differed in the electric filter frequency assignments. The three map conditions were: (1) maps with the default filter settings (default map), (2) place-based maps with filters aligned to cochlear SG tonotopicity using the SG function (SG place-based map), and (3) place-based maps with filters aligned to cochlear Organ of Corti (OC) tonotopicity using the SR-AI function (SR-AI place-based map). Speech recognition was evaluated using a vowel recognition task. Performance was scored as the percent correct for formant 1 recognition due to the rationale that the maps would deviate the most in the estimated cochlear place frequency for low frequencies., Results: On average, participants had better performance with the OC SR-AI place-based map as compared to the SG place-based map and the default map. A larger performance benefit was observed for EAS users than for CI-alone users., Conclusion: These pilot data suggest that EAS and CI-alone users may experience better performance with a patient-centered mapping approach that accounts for the variability in cochlear morphology (OC SR-AI frequency-to-place function) in the individualization of the electric filter frequencies (place-based mapping procedure)., Level of Evidence: 3 Laryngoscope, 133:3540-3547, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To investigate the incidence of electrode contacts within the functional acoustic hearing region in cochlear implant (CI) recipients and to assess its influence on speech recognition for electric-acoustic stimulation (EAS) users., Study Design: Retrospective review., Setting: Tertiary referral center., Patients: One hundred five CI recipients with functional acoustic hearing preservation (≤80 dB HL at 250 Hz)., Interventions: Cochlear implantation with a 24-, 28-, or 31.5-mm lateral wall electrode array., Main Outcome Measures: Angular insertion depth (AID) of individual contacts was determined from imaging. Unaided acoustic thresholds and AID were used to calculate the proximity of contacts to the functional acoustic hearing region. The association between proximity values and speech recognition in quiet and noise for EAS users at 6 months postactivation was reviewed., Results: Sixty percent of cases had one or more contacts within the functional acoustic hearing region. Proximity was not significantly associated with speech recognition in quiet. Better performance in noise was observed for cases with close correspondence between the most apical contact and the upper edge of residual hearing, with poorer results for increasing proximity values in either the basal or apical direction ( r14 = 0.48, p = 0.043; r18 = -0.41, p = 0.045, respectively)., Conclusion: There was a high incidence of electrode contacts within the functional acoustic hearing region, which is not accounted for with default mapping procedures. The variability in outcomes across EAS users with default maps may be due in part to electric-on-acoustic interference, electric frequency-to-place mismatch, and/or failure to stimulate regions intermediate between the most apical electrode contact and the functional acoustic hearing region., Competing Interests: Disclosures of funding and conflicts of interest: Author K.D.B. serves on the surgical advisory board for MED-EL Corp and Advanced Bionics. M.T.D. is supported by a research grant from MED-EL Corporation. A.B.O. serves on the audiology advisory board for MED-EL Corporation and Advanced Bionics. She is also a consultant for Cochlear Corporation., (Copyright © 2023, Otology & Neurotology, Inc.)

Objectives: Assess the long-term patterns of perceived tinnitus severity and subjective benefit for adult cochlear implant (CI) users with asymmetric or unilateral hearing loss (AHL or UHL)., Methods: Forty adults underwent cochlear implantation as part of a prospective clinical trial assessing the outcomes of CI use in cases of AHL (n = 20) and UHL (n = 20). Subjective measures included the Tinnitus Handicap Inventory (THI), the Speech, Spatial, & Qualities of Hearing Scale (SSQ), and the Abbreviated Profile of Hearing Aid Benefit (APHAB). Responses were obtained preoperatively and at routine intervals out to 5 years post-activation., Results: For subjective benefit, participants with AHL and UHL reported a significant improvement as compared to preoperative abilities, which was maintained with long-term CI use. For perceived tinnitus severity, participants with AHL and UHL reported a significant reduction with CI use as compared to preoperative perceptions. The perceived tinnitus severity significantly differed for the AHL and UHL cohorts over time. This pattern of results is likely influenced by the worse perceived severity levels for the UHL cohort preoperatively and the fluctuating perceived severity levels for some participants in the AHL cohort post-activation., Conclusion: Adults with AHL and UHL report an early, significant reduction in perceived tinnitus severity and improvement in quality of life with CI use that is generally maintained with long-term device use. Questionnaires such as the THI, SSQ, and APHAB may contribute to a more holistic assessment of the benefits of cochlear implantation in this population., Level of Evidence: 2 Laryngoscope, 133:2792-2797, 2023., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objective: To assess long-term binaural hearing abilities for cochlear implant (CI) users with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL)., Methods: A prospective, longitudinal, repeated measures study was completed at a tertiary referral center evaluating adults with UHL or AHL undergoing cochlear implantation. Binaural hearing abilities were assessed with masked speech recognition tasks using AzBio sentences in a 10-talker masker. Performance was evaluated as the ability to benefit from spatial release from masking (SRM). SRM was calculated as the difference in scores when the masker was presented toward the CI-ear (SRM ci ) or the contralateral ear (SRM contra ) relative to the co-located condition (0°). Assessments were completed pre-operatively and at annual intervals out to 5 years post-activation., Results: Twenty UHL and 19 AHL participants were included in the study. Linear Mixed Models showed significant main effects of interval and group for SRM contra . There was a significant interaction between interval and group, with UHL participants reaching asymptotic performance early and AHL participants demonstrating continued growth in binaural abilities to 5 years post-activation. The improvement in SRM showed a significant positive correlation with contralateral unaided hearing thresholds (p = 0.050) as well as age at implantation (p = 0.031)., Conclusions: CI recipients with UHL and AHL showed improved SRM with long-term device use. The time course of improvement varied by cohort, with the UHL cohort reaching asymptotic performance early and the AHL cohort continuing to improve beyond 1 year. Differences between cohorts could be driven by differences in age at implantation as well as contralateral unaided hearing thresholds., Level of Evidence: 3 Laryngoscope, 133:1480-1485, 2023., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Rationale: Project UPLIFT is an evidence-based epilepsy self-management program shown to prevent and treat depression through an 8-session, group telehealth intervention. Since 2012, the program has been disseminated by training community-based providers to deliver UPLIFT to people with epilepsy (PWE). Limited research has described the adoption, implementation, and practice-based maintenance of self-management programs like UPLIFT. We sought to gain a better understanding of this process from trained program adopters., Methods: A cross-sectional evaluation of adoption and implementation experiences was conducted. An online survey with closed- and open-ended questions was distributed to 120 UPLIFT program adopters to collect information about reasons for being trained and experiences implementing the program. Survey items were developed based on the RE-AIM model to assess program reach, effectiveness, adoption, implementation, and maintenance. For closed-ended responses, frequencies and cross-tabs were calculated. Open-ended responses were reviewed and grouped by theme., Results: 41 respondents completed the survey (34% response rate). Respondents were from a variety of organizations including clinical (39%, n = 16), educational/research (17%, n = 7), and Epilepsy Foundation affiliates/chapters (12%, n = 5), among others. The most frequently endorsed reason for training in UPLIFT was an interest in supporting PWE (73%, n = 30). Most respondents rated delivering UPLIFT as very important (49%, n = 20) or important (32%, n = 13) to the organization. Sixty-one percent (n = 25) of respondents reported implementing (implementors) UPLIFT. Of those who had not yet implemented UPLIFT, 50% (n = 8) planned on implementing it at some point. Among program implementors, the most frequently reported implementation facilitators included participant interest (68%, n = 17), training (68%, n = 17), and organizational support (64%, n = 16). Program implementors indicated having program champions (80%, n = 20). The most frequently reported implementation challenge reported was recruitment (72%, n = 18). In open-ended responses, funding was a key theme that would facilitate continued implementation, but 48% (n = 12) responded that did not have access to resources and/or funding to help continue offering UPLIFT. Developing partnerships was recommended to improve the reach and maintenance of the program. Despite challenges, implementors agreed (44%, n = 11) or strongly agreed (36%, n = 9) that UPLIFT was effective in addressing mental health problems among program participants, and 76% (n = 19) plan on continuing to offer UPLIFT., Conclusion: Implementation surveys increase understanding of program adoption and impact for dissemination trainees. Implementation benefits from program champions, strong partnerships, and sustained funding. Continued refinement of implementation support, such as developing a sustained referral system, maintaining relationships with trainees, supporting evaluation activities, and exploring opportunities for program updates to further enhance adoption, implementation, and maintenance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Prostate-specific membrane antigen (PSMA) positron emission tomography/computerised tomography (PET/CT) is increasingly being utilised in the diagnostic pathway for prostate cancer (PCa). Recent publications have suggested that this might help identify those who can avoid biopsy., Objective: The primary objective of this study was to determine whether PET magnetic resonance imaging (MRI) fusion could negate the need to biopsy prior to prostatectomy in a selected population of men., Design Setting and Participant: Multiparametric MRI (mpMRI) for PCa is our standard of care prior to prostate biopsy. Biopsy-naïve men with one or more Prostate Imaging Reporting and Data System (PI-RADS) 4 or 5 lesions ≥10 mm on mpMRI were invited to undergo PSMA PET/CT prior to biopsy. Following ethics approval, 60 men were recruited between September 2020 and March 2021. The key exclusion criteria included a previous history of PCa and previous prostate surgery or biopsy., Outcome Measurements and Statistical Analysis: A positive PET MRI fusion scan was defined as "consistent with" as per the Memorial Sloan Kettering Cancer Center lexicon of certainty, and concordance with biopsy results was analysed. Clinically significant PCa (csPCa) was defined as grade group (GG) ≥2 on pathology. A chi-square analysis was performed with statistical significance defined at p  < 0.05., Results and Limitations: A total of 71 mpMRI lesions were positive on 61 (86%) PET MRI fusion scans. Fifty-nine of 61 lesions biopsied confirmed csPCa in 54 (92%). Of five of 59 lesions for which either biopsy was negative or low-grade cancer was found, three had rebiopsy of which two were confirmed to have csPCa corroborating with PET MRI fusion and one was reconfirmed to have GG1 only. For the remaining two, both had another lesion elsewhere in the gland confirming csPCa, and hence rebiopsy was not performed. Ultimately, 56 of 59 (95%) lesions with a positive PET MRI fusion scan were confirmed to have csPCa. All GG ≥3 cancers had a positive PET MRI fusion scan., Conclusions: This prospective study of PET MRI fusion assessment of men with PI-RADS 4 or 5 lesion ≥10 mm on mpMRI confirms that the majority of men (95%) with a positive PET MRI fusion scan will have csPCa. This supports recently published retrospective data suggesting that selected men might avoid prostate biopsy prior to radical prostatectomy., Patient Summary: In this research, we have confirmed that prostate-specific membrane antigen positron emission tomography/computerised tomography in combination with magnetic resonance imaging could have an important role in enabling a diagnosis of prostate cancer. Using the combination of these scans, we could confidently predict the presence of aggressive prostate cancer in some men for which treatment is warranted. This means that there are some men who could possibility proceed directly to having prostate cancer surgery without the need for a confirmatory prostate biopsy., (© 2022 The Authors. Published by Elsevier B.V. on behalf of European Association of Urology.)

Objectives/hypothesis: To assess whether early, significant improvements in sound source localization observed in cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear are maintained after 5 years of CI use., Study Design: Prospective, repeated measures study., Methods: Participants were recruited from a sample of CI + NH listeners (n = 20) who received their device as part of a prospective clinical trial investigating outcomes of CI use for adult cases of single-sided deafness. Sound source localization was assessed annually after the clinical trial endpoint (1-year post-activation). Listeners were asked to indicate the perceived sound source for a broadband noise burst presented randomly at varied intensity levels from one of 11 speakers along a 180° arc. Performance was quantified as root-mean-squared (RMS) error., Results: Linear mixed models showed superior post-activation performance was maintained with long-term CI use as compared to preoperative abilities (P < .001). Unexpectedly, a significant improvement (P = .009) in sound source localization was observed over the long-term post-activation period (1-5 years). To better understand these long-term findings, the response patterns for the 11 participants who were evaluated at the 1- and 5-year visits were reviewed. This subgroup demonstrated a significant improvement in RMS error (P = .020) and variable error (P = .031), indicating more consistent responses at the 5-year visit., Conclusion: Adult CI + NH listeners experience significant improvements in sound source localization within the initial weeks of listening experience, with additional improvements observed after long-term device use. The present sample demonstrated significant improvements between the 1-year and 5-year visits, with greater accuracy and consistency noted in their response patterns., Level of Evidence: 3 Laryngoscope, 132:2453-2458, 2022., (© 2022 The American Laryngological, Rhinological and Otological Society, Inc.)

Aims: We aimed to determine what key resources, mechanisms, and contextual factors are necessary to integrate depression and diabetes treatment into low-resource settings., Methods: A realist evaluation framework was employed to conduct a comparative case study. Data were collected through document review, key informant interviews ( n = 4), activity logs, and interviews with implementing health care providers (n = 11) to test and refine program theories for collaborative care., Results: Efforts to enhance patient care coordination (i.e., adapting clinics' patient flow and resources, on-going trainings, and on-site support for care coordinators) improved implementation of depression treatment by usual care diabetes physicians. Clinician's avoidance of the term depression was identified as a barrier to mental health counseling and treatment., Conclusions: The variations in organizational features and processes linked to implementation activities across two clinics provided an opportunity to examine how and why different contextual factors help or hinder the implementation process. Findings from this study demonstrate that successful implementation of an integrated depression and diabetes care model is feasible in a low-resource setting, while the revised program theories provide an explanatory framework of coordinated care implementation processes that can inform future efforts to disseminate and scale this care model., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Purpose of Review: Children and adults with unilateral or asymmetric hearing loss (UHL/AHL) have poorer spatial hearing (e.g. speech understanding in complex maskers and localization) and quality of life compared with peers with normal hearing bilaterally. Patients with UHL/AHL experience limited benefits with contralateral-routing technologies (e.g. bone conduction, CROS hearing aid systems). Cochlear implantation allows for stimulation of the auditory pathway for the poorer hearing ear. The present study reviews the recent literature on outcomes of cochlear implant use for recipients with UHL/AHL., Recent Findings: Recent research corroborates previous investigations of the significant benefits on measures of spatial hearing, tinnitus severity and quality of life for adult cochlear implant recipients. These benefits are also observed in pediatric cochlear implant recipients, with an association of better outcomes with younger ages at implantation for congenital cases and shorter durations of UHL/AHL for acquired cases. In addition, randomized trials demonstrate better outcomes with cochlear implant use versus contralateral-routing technologies., Summary: Cochlear implantation supports better spatial hearing and quality of life in children and adults with UHL/AHL as compared to alternative listening conditions. Current research supports the expansion of candidacy criteria and insurance coverage for cochlear implantation for patients with UHL/AHL to improve their binaural hearing., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Review the effectiveness of an alternative mapping procedure of a precurved electrode array in the internal auditory canal (IAC)., Design: A 7-year-old bilateral cochlear implant (CI) recipient of precurved arrays transferred to the study site and demonstrated no speech recognition with the left CI. Imaging revealed bilateral incomplete partition type III malformations. For the left CI, four contacts were observed in the basal cochlear turn and 18 contacts were coiled in the IAC. The family decided against revision surgery. Pitch ranking was completed to map the contacts in the IAC that were perceptually discrete and tonotopically organized., Results: For the left CI, PB-K word recognition improved from no recognition to 32% after 1 month and to 52% after 3 months. In the bilateral CI condition, performance improved from 56 to 72% after 1 month and 80% after 3 months., Conclusion: A precurved array in the IAC creates difficult management decisions. Direct stimulation of the auditory nerve resulted in better monaural and bilateral speech recognition, likely due to better spectral representation of the speech signal. Individualizing the map using imaging and behavioral findings may improve performance for malpositioned arrays when revision surgery is not pursued., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Managing one's own symptoms, medications, treatments, lifestyle, and psychological and social aspects of chronic disease is known as self-management. The Institute of Medicine has identified three categories of epilepsy self-management, including medication management, behavior management, and emotional support. Overall, there has been limited research of interventions measuring epilepsy self-management behaviors. The present study aimed to develop an abbreviated version of the full, previously published, Adult Epilepsy Self-Management Measurement Instrument (AESMMI) using confirmatory factor analysis. Data come from a cross-sectional survey of people with epilepsy. The sample included adults with epilepsy (n = 422), who reported that a clinician diagnosed them with epilepsy or a seizure disorder. We ran confirmatory factor analyses in testing the abbreviated scale. The scale was reduced using a theory-driven data-informed approach. The full AESMMI length was reduced by 40% (from 65 to 38 items) with an overall internal consistency of 0.912. The abbreviated AESMMI retained the 11 subdomains, with Cronbach's alphas from 0.535 to 0.878. This reduced item scale can be useful for assessing self-management behaviors for people with epilepsy or measuring outcomes in self-management research., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The T7 primase-helicase plays a pivotal role in the replication of T7 DNA. Using affinity isolation of peptide-nucleic acid crosslinks and mass spectrometry, we identify protein regions in the primase-helicase and T7 DNA polymerase that form contacts with the RNA primer and DNA template. The contacts between nucleic acids and the primase domain of the primase-helicase are centered in the RNA polymerase subdomain of the primase domain, in a cleft between the N-terminal subdomain and the topoisomerase-primase fold. We demonstrate that residues along a beta sheet in the N-terminal subdomain that contacts the RNA primer are essential for phage growth and primase activity in vitro. Surprisingly, we found mutations in the primase domain that had a dramatic effect on the helicase. Substitution of a residue conserved in other DnaG-like enzymes, R84A, abrogates both primase and helicase enzymatic activities of the T7 primase-helicase. Alterations in this residue also decrease binding of the primase-helicase to ssDNA. However, mass photometry measurements show that these mutations do not interfere with the ability of the protein to form the active hexamer., Competing Interests: Conflict of interest The authors declare that they have no conflicts of interest with the contents of this article., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: People with psychogenic nonepileptic seizures (PNES) are at elevated risk of multiple psychiatric comorbidities. Current treatment gaps highlight the need for time-limited, distance-delivered interventions that can be cost-effectively delivered to patients with PNES. Project UPLIFT is a self-management program addressing mood problems in epilepsy that has not previously been adapted for PNES. The purpose of this study was to assess the feasibility and acceptability of UPLIFT for patients with PNES., Methods: Project UPLIFT was minimally adapted by a multidisciplinary research group at Dartmouth-Hitchcock Medical Center. Participants were recruited into a nonrandomized pilot study and were assessed at baseline, after completing the intervention, and at 1-month follow-up., Results: The intervention was adapted and delivered without additional modification. A total of eight participants enrolled in the trial, and six participated in the first session. All six participants who started UPLIFT completed the intervention, with a 98% attendance record across the eight sessions. At follow-up, 100% reported that UPLIFT provided useful tools for daily life. All participants continued using UPLIFT after completing the program, and 83% felt it helped with seizure management. Preliminary results provide proof-of-concept for future efficacy trials., Conclusion: This study provides initial support for the feasibility and acceptability of Project UPLIFT, minimally adapted for patients with PNES. As a time-limited program that can be distance-delivered to groups of patients, UPLIFT may be well-suited for the healthcare environment brought on by the COVID-19 pandemic., Competing Interests: Declaration of Competing Interest The study was funded by an internal grant within the Department of Neurology at Dartmouth-Hitchcock Medical Center. BCJ receives support as the Louis and Ruth Frank Chair of Neuroscience, Geisel School of Medicine at Dartmouth College, in addition to research support from Neuropace, Inc., NIH, the Defense Advanced Research Projects Agency, and CDC. No other financial disclosures were reported by the authors of this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Introduction: Cochlear implant (CI) recipients with normal hearing (NH) in the contralateral ear experience a significant improvement in sound source localization when listening with the CI in combination with their NH-ear (CI + NH) as compared to with the NH-ear alone. The improvement in localization is primarily due to sensitivity to interaural level differences (ILDs). Sensitivity to interaural timing differences (ITDs) may be limited by auditory aging, frequency-to-place mismatches, the signal coding strategy, and duration of CI use. The present report assessed the sensitivity of ILD and ITD cues in CI + NH listeners who were recipients of long electrode arrays that provide minimal frequency-to-place mismatches and were mapped with a coding strategy that presents fine structure cues on apical channels., Methods: Sensitivity to ILDs and ITDs for localization was assessed using broadband noise (BBN), as well as high-pass (HP) and low-pass (LP) filtered noise for adult CI + NH listeners. Stimuli were 200-ms noise bursts presented from 11 speakers spaced evenly over an 180° arc. Performance was quantified in root-mean-squared error and response patterns were analyzed to evaluate the consistency, accuracy, and side bias of the responses. Fifteen listeners completed the task at the 2-year post-activation visit; seven listeners repeated the task at a later annual visit., Results: Performance at the 2-year visit was best with the BBN and HP stimuli and poorer with the LP stimulus. Responses to the BBN and HP stimuli were significantly correlated, consistent with the idea that CI + NH listeners primarily use ILD cues for localization. For the LP stimulus, some listeners responded consistently and accurately and with limited side bias, which may indicate sensitivity to ITD cues. Two of the 7 listeners who repeated the task at a later annual visit experienced a significant improvement in performance with the LP stimulus, which may indicate that sensitivity to ITD cues may improve with long-term CI use., Conclusions: CI recipients with a NH-ear primarily use ILD cues for sound source localization, though some may use ITD cues as well. Sensitivity to ITD cues may improve with long-term CI listening experience., (© 2022 S. Karger AG, Basel.)

Objective: Assess the influence of cochlear implant (CI) use on the perceived listening effort of adult and pediatric subjects with unilateral hearing loss (UHL) or asymmetric hearing loss (AHL)., Study Design: Prospective cohort., Setting: Tertiary referral center., Patients: Adults and children with UHL or AHL., Intervention: Cochlear implantation. Subjects received their CI as part of a clinical trial assessing the effectiveness of cochlear implantation in cases of UHL and AHL., Main Outcome Measures: Responses to the Listening Effort pragmatic subscale on the Speech, Spatial, and Qualities of Hearing Scale (SSQ) or SSQ for Children with Impaired Hearing (SSQ-C) were compared over the study period. Subjects or their parents completed the questionnaires preoperatively and at predetermined postactivation intervals. For the adult subjects, responses were compared to word recognition in quiet and sentence recognition in noise., Results: Forty adult subjects (n = 20 UHL, n = 20 AHL) and 16 pediatric subjects with UHL enrolled and underwent cochlear implantation. Subjects in all three groups reported a significant reduction in perceived listening effort within the initial months of CI use (p < 0.001; η2 ≥ 0.351). The perceived benefit was significantly correlated with speech recognition in noise for the adult subjects with UHL at the 12-month interval (r(20) = .59, p = 0.006)., Conclusions: Adult and pediatric CI recipients with UHL or AHL report a reduction in listening effort with CI use as compared to their preoperative experiences. Use of the SSQ and SSQ-C Listening Effort pragmatic subscale may provide additional information about a CI recipient's experience beyond the abilities measured in the sound booth., (Copyright © 2021, Otology & Neurotology, Inc.)

Background: The aim of this study was to identify factors that influence patients' motivation and ability to self-manage their diabetes and depressive symptoms., Methods: From 2016 to 17, in-depth interviews were conducted with 62 patients receiving the INDEPENDENT care model across two clinics in India. Using a realist evaluation approach, a hypothesized program theory for patient activation was tested and refined., Findings: The refined theory demonstrates that motivation, education, and engagement cumulatively contribute to patient activation., Conclusion: The results indicate that positive and sustained patient-provider relationships drive patient motivation and enhance implementation of the care model., (Copyright © 2020 Elsevier Ltd. All rights reserved.)