SIRT4 loss reprograms intestinal nucleotide metabolism to support proliferation following perturbation of homeostasis

The intestine is a highly metabolic tissue, but the metabolic programs that influence intestinal crypt proliferation, differentiation, and regeneration are still emerging. Here, we investigate how mitochondrial sirtuin 4 (SIRT4) affects intestinal homeostasis. Intestinal SIRT4 loss promotes cell proliferation in the intestine following ionizing radiation (IR). SIRT4 functions as a tumor suppressor in a mouse model of intestinal cancer, and SIRT4 loss drives dysregulated glutamine and nucleotide metabolism in intestinal adenomas. Intestinal organoids lacking SIRT4 display increased proliferation after IR stress, along with increased glutamine uptake and a shift toward de novo nucleotide biosynthesis over salvage pathways. Inhibition of de novo nucleotide biosynthesis diminishes the growth advantage of SIRT4-deficient organoids after IR stress. This work establishes SIRT4 as a modulator of intestinal metabolism and homeostasis in the setting of DNA-damaging stress.

My Precious Friend: Human-Robot Interactions in Home Care for Socially Isolated Older Adults

OBJECTIVES

Using a friendship framework, we explored interactions between a multi-functional companion robot and older adults residing in a low-resource community in South Korea.

METHODS

We conducted in-depth interviews with 12 older adults who kept a doll-shaped companion robot called Hyodol for 18 months on average. We applied the Framework Analysis Method to explore three types of friendship (i.e., friendships of utility, pleasure, and the good) that participants cultivated with the robot.

RESULTS

The most common aspect of utility companionship reported by all participants was Hyodol's role as their health coach who reminded them to take medication and to exercise. Participants also found pleasure in playing with Hyodol and reported reduced feelings of loneliness. In the absence of other social supports, all participants also regarded Hyodol as a surrogate family member or human-friend, and interacted with Hyodol as such.

CONCLUSIONS

Findings illustrated high acceptability of Hyodol among these socially isolated older adults especially during the global COVID-19 pandemic, suggesting that a humanoid like Hyodol could be complementary to homecare services for solo-living older adults.

CLINICAL IMPLICATIONS

Well-designed robot interventions, as complements to existing aging service and clinical interventions, have a potential to improve health behaviors among socially isolated older adults.

Rural pensions, intra-household bargaining, and elderly medical expenditure in China

China's rural elderly spend less on medical expenditures as they age despite declining health, raising welfare concerns. This paper investigates the role of intrahousehold bargaining power on health expenditures of the elderly by evaluating the impact of cash transfers from a new social pension program. The program provided windfall payments to those above age 60, making it possible to employ a regression discontinuity design based on age of eligibility to estimate causal effects. Using data from the 2011 and 2013 waves of the China Health and Retirement Longitudinal Study, we find that receiving pension payments increases both the utilization of outpatient care and outpatient expenditures by the elderly who experienced illness. This result is robust to controlling for total household expenditures per capita, ruling out income effects as the main channel. Consistent with pensions increasing elderly bargaining power, we find that pensions significantly increase medical expenditures only for those elderly who co-reside with children or grandchildren but have no effect on those who live independently.

Reducing single-use cutlery with green nudges: Evidence from China's food-delivery industry

Rising consumer demand for online food delivery has increased the consumption of disposable cutlery, leading to plastic pollution worldwide. In this work, we investigate the impact of green nudges on single-use cutlery consumption in China. In collaboration with Alibaba's food-delivery platform, Eleme (which is similar to Uber Eats and DoorDash), we analyzed detailed customer-level data and found that the green nudges-changing the default to "no cutlery" and rewarding consumers with "green points"-increased the share of no-cutlery orders by 648%. The environmental benefits are sizable: If green nudges were applied to all of China, more than 21.75 billion sets of single-use cutlery could be saved annually, equivalent to preventing the generation of 3.26 million metric tons of plastic waste and saving 5.44 million trees.

Health Information on Pre-Exposure Prophylaxis From Search Engines and Twitter: Readability Analysis

BACKGROUND

Pre-exposure prophylaxis (PrEP) is proven to prevent HIV infection. However, PrEP uptake to date has been limited and inequitable. Analyzing the readability of existing PrEP-related information is important to understand the potential impact of available PrEP information on PrEP uptake and identify opportunities to improve PrEP-related education and communication.

OBJECTIVE

We examined the readability of web-based PrEP information identified using search engines and on Twitter. We investigated the readability of web-based PrEP documents, stratified by how the PrEP document was obtained on the web, information source, document format and communication method, PrEP modality, and intended audience.

METHODS

Web-based PrEP information in English was systematically identified using search engines and the Twitter API. We manually verified and categorized results and described the method used to obtain information, information source, document format and communication method, PrEP modality, and intended audience. Documents were converted to plain text for the analysis and readability of the collected documents was assessed using 4 readability indices. We conducted pairwise comparisons of readability based on how the PrEP document was obtained on the web, information source, document format, communication method, PrEP modality, and intended audience, then adjusted for multiple comparisons.

RESULTS

A total of 463 documents were identified. Overall, the readability of web-based PrEP information was at a higher level (10.2-grade reading level) than what is recommended for health information provided to the general public (ninth-grade reading level, as suggested by the Department of Health and Human Services). Brochures (n=33, 7% of all identified resources) were the only type of PrEP materials that achieved the target of ninth-grade reading level.

CONCLUSIONS

Web-based PrEP information is often written at a complex level for potential and current PrEP users to understand. This may hinder PrEP uptake for some people who would benefit from it. The readability of PrEP-related information found on the web should be improved to align more closely with health communication guidelines for reading level to improve access to this important health information, facilitate informed decisions by those with a need for PrEP, and realize national prevention goals for PrEP uptake and reducing new HIV infections in the United States.

Examining thematic and emotional differences across Twitter, Reddit, and YouTube: The case of COVID-19 vaccine side effects

Social media discourse has become a key data source for understanding the public's perception of, and sentiments during a public health crisis. However, given the different niches which platforms occupy in terms of information exchange, reliance on a single platform would provide an incomplete picture of public opinions. Based on the schema theory, this study suggests a 'social media platform schema' to indicate users' different expectations based on previous usages of platform and argues that a platform's distinct characteristics foster distinct platform schema and, in turn, distinct nature of information. We analyzed COVID-19 vaccine side effect-related discussions from Twitter, Reddit, and YouTube, each of which represents a different type of the platform, and found thematic and emotional differences across platforms. Thematic analysis using k-means clustering algorithm identified seven clusters in each platform. To computationally group and contrast thematic clusters across platforms, we employed modularity analysis using the Louvain algorithm to determine a semantic network structure based on themes. We also observed differences in emotional contexts across platforms. Theoretical and public health implications are then discussed.

Formation and fate of an engram in the lateral amygdala supporting a rewarding memory in mice

Memories allow past experiences to guide future decision making and behavior. Sparse ensembles of neurons, known as engrams, are thought to store memories in the brain. Most previous research has focused on engrams supporting threatening or fearful memories where results show that neurons involved in a particular engram ("engram neurons") are both necessary and sufficient for memory expression. Far less is understood about engrams supporting appetitive or rewarding memories. As circumstances and environments are dynamic, the fate of a previously acquired engram with changing circumstances is unknown. Here we examined how engrams supporting a rewarding cue-cocaine memory are formed and whether this original engram is important in reinstatement of memory-guided behavior following extinction. Using a variety of techniques, we show that neurons in the lateral amygdala are allocated to an engram based on relative neuronal excitability at training. Furthermore, once allocated, these neurons become both necessary and sufficient for behavior consistent with recall of that rewarding memory. Allocated neurons are also critical for cocaine-primed reinstatement of memory-guided behavior following extinction. Moreover, artificial reactivation of initially allocated neurons supports reinstatement-like behavior following extinction even in the absence of cocaine-priming. Together, these findings suggest that cocaine priming after extinction reactivates the original engram, and that memory-guided reinstatement behavior does not occur in the absence of this reactivation. Although we focused on neurons in one brain region only, our findings that manipulations of lateral amygdala engram neurons alone were sufficient to impact memory-guided behavior indicate that the lateral amygdala is a critical hub region in what may be a larger brain-wide engram.

Socially Assistive Humanoid Robots: Effects on Depression and Health-Related Quality of Life among Low-Income, Socially Isolated Older Adults in South Korea

Using a mixed-method study design, we examined the effects of a socially assistive humanoid robot (SAHR), called Hyodol, on depressive symptoms and health-related quality of life (HRQOL) of low-income, socially isolated older adults (N = 180). Quantitative outcomes were assessed at baseline (before Hyodol deployment) and at 3 and 6 months after baseline. Results showed reduced depressive symptoms and improved HRQOL at 3 months; however, these positive effects did not extend to 6 months. Ten focus group participants perceived Hyodol to be a valuable companion especially during the COVID outbreak. These results suggest that while Hyodol may have provided companionship for some low-income, socially isolated older adults during home confinement, its effects on depression and HRQOL were limited. Further research is needed to assess long-term effects of SAHRs as appropriate tools for reducing social isolation and improving behavioral health among community-dwelling older adults.

Management of a salivary fistula following removal of mandibular distractors in a neonate

There are multiple management options for treatment of iatrogenic salivary fistulas including reduced oral intake, pressure dressings, total parotidectomy, tympanic neurectomy, surgical repair, radiation therapy, and pharmacotherapy. However, the optimal management of salivary fistulas is unclear due to uncertain efficacy and adverse outcomes. We present a case of a neonate that developed a submandibular fistula following removal of mandibular distractors and was ultimately successfully managed using intralesional botulinum toxin injection. The purpose of this communication is to summarize the management of this complication in the context of the current literature.

The cost-effectiveness of targeted screening for congenital cytomegalovirus in newborns compared to clinical diagnosis in the US

OBJECTIVE

Congenital cytomegalovirus (cCMV) is the leading environmental cause of hearing loss (HL) among children, affecting four in one thousand newborns. cCMV testing in the US is currently based on clinical diagnosis which does not consistently identify cCMV cases and precludes early intervention to prevent and reduce the severity of HL. We estimated the cost-effectiveness of targeted newborn screening and cCMV testing among newborns compared to clinical diagnosis.

METHODS

We use a decision-analytic model to estimate the costs of preventing HL progression, of additional cases of severe HL, of identifying a case of HL one year earlier, and of identifying an additional case of cCMV, through targeted screening and cCMV testing for infants failing two newborn hearing screens with follow-up to age five. We also estimate the costs of nationwide implementation of a newborn screening and testing program. Model pathways were based on best practices for screening, testing, and treatment. Probabilities were drawn from the published literature; costs were estimated based on Medicare reimbursement rates. Probabilistic and scenario analyses were conducted to determine the robustness of results.

RESULTS

Targeted testing and cCMV screening, compared to standard of care, cost an additional $2.96 (±2.26) per infant screened and identified 0.00038 (±0.00022) cases of HL, 3.8 in 10000 children, at a cost of $8197 (±4217) per case of HL identified. Implementing targeted screening for all children in the US was estimated to cost $193,229.

CONCLUSIONS

Although cases numbers are small, our model shows that targeted newborn screening and cCMV testing reduced cases of HL progression. Adoption of newborn targeted screening as standard of care should be considered given it may prevent disability at very low cost.

International comparability of reference unit costs of education services: when harmonizing methodology is not enough (PECUNIA project)

BACKGROUND

Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries.

METHODS

The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers.

RESULTS

The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other.

DISCUSSION

The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs.

A Novel Approach to Characterize State-level Food Environment and Predict Obesity Rate Using Social Media Data: Correlational Study

BACKGROUND

Community obesity outcomes can reflect the food environment to which the community belongs. Recent studies have suggested that the local food environment can be measured by the degree of food accessibility, and survey data are normally used to calculate food accessibility. However, compared with survey data, social media data are organic, continuously updated, and cheaper to collect.

OBJECTIVE

The objective of our study was to use publicly available social media data to learn the relationship between food environment and obesity rates at the state level.

METHODS

To characterize the caloric information of the local food environment, we used food categories from Yelp and collected caloric information from MyFitnessPal for each category based on their popular dishes. We then calculated the average calories for each category and created a weighted score for each state. We also calculated 2 other dimensions from the concept of access, acceptability and affordability, to build obesity prediction models.

RESULTS

The local food environment characterized using only publicly available social media data had a statistically significant correlation with the state obesity rate. We achieved a Pearson correlation of 0.796 between the predicted obesity rate and the reported obesity rate from the Behavioral Risk Factor Surveillance System across US states and the District of Columbia. The model with 3 generated feature sets achieved the best performance.

CONCLUSIONS

Our study proposed a method for characterizing state-level food environments only using continuously updated social media data. State-level food environments were accurately described using social media data, and the model also showed a disparity in the available food between states with different obesity rates. The proposed method should elastically apply to local food environments of different sizes and predict obesity rates effectively.

Emotional Adjustment in Children with Vocal Fold Nodules

INTRODUCTION

Vocal fold nodules (VNs) in children are benign, bilateral, callous-like lesions at the junction of the anterior third and posterior two-thirds of the true vocal folds. Chronic, repetitive, and intense vocal behavior is often cited as the primary etiology; however, difficulties with emotional adjustment may predispose some children towards extreme and possibly phonotraumatic vocal activity, thereby contributing secondarily to the development of VNs.

OBJECTIVES

This case-control study examined the association between features of emotional adjustment and VNs in children.

METHODS

Parents of children with VNs (N = 40, Mage = 7.5, SDage = 2.03) and two medical control groups [ie, voice disordered, but not VNs (VDCs; N = 40, Mage= 7.09, SDage = 2.01) and vocally normal controls (VNCs; N = 40, Mage = 7.6, SDage = 1.54)] participated in the study. Features of emotional adjustment were assessed using two inventories: the Parent Rating scale for Reactive and Proactive Aggression and the Revised Child Anxiety and Depression Scale - Parent version.

RESULTS

As compared with the VNCs, children with VNs were significantly more aggressive (P = 0.042, Cohen's d = 0.47) whereas the VDCs were more depressed (P = 0.013, Cohen's d = 0.60). Furthermore, VDCs experienced more separation anxiety than VNs (P = 0.038, Cohen's d = 0.45) and VNCs (P = 0.021, Cohen's d = 0.55). No other significant between-group differences were identified between the VNs and VDCs.

CONCLUSIONS

When present, elevated aggression may represent a risk factor for VNs formation in children, and possibly influence treatment outcomes. Therefore, the current results highlight the importance of understanding the role of emotional adjustment in the evaluation and treatment of dysphonia in children.

Predictive Role of Aortic Valve Calcium score on post-procedural outcomes and mortality after Transcatheter aortic valve replacement

Introduction

Extent of aortic valve (AV) calcium increases as degenerative aortic valve stenosis progresses. Initial studies postulated AV calcium (AVC) score to be a predictor of complications such as need for pacemaker implantation, paravalvular regurgitation and mortality after Trans-catheter Aortic valve Replacement (TAVR). However, evidence regarding the impact of AVC score as a predictor of post-procedural complications and mortality has been conflicting.

Objective

This study aimed to determine the prognostic impact of AVC as predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.

Methods

We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was obtained retrospectively. Patients were divided into two groups: 1) Non-severe AVC score group [women <1200 Agatston unit (AU) and men <2000 AU]; 2) Severe AV Calcium Score group [women >1200 AU and men >2000 AU]. Primary outcome was 1-year mortality.

Results

Among 466 patients included in the analysis, 352 patients were included severe AVC group while 114 patients were in the non-severe AVC group. Patients in the severe AVC group were older (81±8 vs 79±8 years), were predominantly males (79% vs 71%), and had less diabetes mellitus (31% vs 42%, p=0.02). Post-TAVR AV dimensionless index (0.58±0.13 vs 0.58±0.12, p=0.8) and AV mean gradient (9.5±4.9 vs 9.2±5.4 mmHg) were not statistically different between both groups. There was no statistical difference in the need for PPM (12% vs 7%, p=0.16), post-TAVR stroke (1.5% vs 0%), post-TAVR major complications (17.4% vs 10%, p=0.07), 30 day (3.7% vs 4.4%), and 1-year mortality (13.6 vs 11.4, p=0.6) between both groups.

Conclusion

Our study report that the severity of AVC score does not have a prognostic impact on major post-procedural outcomes and mortality after TAVR.

Funding Acknowledgement

Type of funding sources: None.

Sex-based differences of the impact of aortic valve calcium score on mortality and post-procedural outcomes after trans-catheter aortic valve replacement

Introduction

Sex based differences exist in the presentation, outcomes, and management of cardiovascular diseases. Although aortic valve calcium (AVC) score has been postulated to be associated with post-procedural outcomes after transcatheter aortic valve replacement (TAVR), data on the impact of AVC score on procedural outcomes after TAVR based on sex have been scarce.

Objective

The aim of the present study was to elucidate sex related differences in the prognostic impact of AVC score as a predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.

Methods

We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was calculated retrospectively. Primary outcome was 1-year mortality. Patients were divided into two groups: 1) Non-severe AVC score group [women <1200 Agatston unit (AU) and men <2000 AU]; 2) Severe AVC Score group [women >1200 AU and men >2000 AU]. Cox-regression model was used to predict effect of variables on 1-year mortality in male and female patients.

Results

Among 466 patients included, 268 patients were male and 198 were female (57.5% vs 42.5%). When compared with males, female patients had significantly lower AVC score (p<0.001), aortic valve area (AVA) (p<0.001), obstructive CAD (p<0.001), and history of previous PCI (p<0.004), and CABG (<0.001) but had a significantly higher STS score (6.7±3.2 vs 5.8±3.3 P=0.01). There was no difference between need for permanent pacemaker (PPM) implantation (11% vs 9.6%, p=0.4), major complications (16% vs 15%, p=0.9), stroke (0.8% vs 1.6%, p=0.7), 30-day (3.7% vs 4%, p=0.9), and 1-year mortality (14% vs 12%, p=0.6) between males and females, respectively. Female patients required smaller bio-prosthetic valves compared with males (26±3.2 vs 30±3, p<0.001). Cox regression analysis for female patients showed BMI, hemoglobin level, and AVA independently predicted 1-year mortality, while there was no impact of severe AVC score (>1200 AU) on 1-year mortality in females. Similarly, Cox regression analysis for male patients showed there was no impact of severe AVC score (>2000 AU) on 1-year mortality in males. When males in the severe AVC group were compared with female patients in the severe AVC group, there was no difference in 30 day (4.3% vs 3.3%, p=0.82) and 1-year mortality (14.2% vs 13.3%, p=0.77). Similarly, in the severe AVC group there was no difference between need for PPM implantation (12.8% vs 12.1%, p=0.9), major complications (19.7% vs 15.8%, p=0.4), and stroke (2.2% vs 1%, p=0.6) between males and females, respectively.

Conclusion

There were no sex differences in the impact of AVC score on mortality and post-procedural outcomes after TAVR.

Funding Acknowledgement

Type of funding sources: None.

Tweets Related to Motivation and Physical Activity for Obesity-Related Behavior Change: Descriptive Analysis

BACKGROUND

Obesity is one of the greatest modern public health problems, due to the associated health and economic consequences. Decreased physical activity is one of the main societal changes driving the current obesity pandemic.

OBJECTIVE

Our goals are to fill a gap in the literature and study whether users organically utilize a social media platform, Twitter, for providing motivation. We examine the topics of messages and social network structures on Twitter. We discuss social media's potential for providing peer support and then draw insights to inform the development of interventions for long-term health-related behavior change.

METHODS

We examined motivational messages related to physical activity on Twitter. First, we collected tweets related to physical activity. Second, we analyzed them using (1) a lexicon-based approach to extract and characterize motivation-related tweets, (2) a thematic analysis to examine common themes in retweets, and (3) topic models to understand prevalent factors concerning motivation and physical activity on Twitter. Third, we created 2 social networks to investigate organically arising peer-support network structures for sustaining physical activity and to form a deeper understanding of the feasibility of these networks in a real-world context.

RESULTS

We collected over 1.5 million physical activity-related tweets posted from August 30 to November 6, 2018. A relatively small percentage of the tweets mentioned the term motivation; many of these were made on Mondays or during morning or late morning hours. The analysis of retweets showed that the following three themes were commonly conveyed on the platform: (1) using a number of different types of motivation (self, process, consolation, mental, or quotes), (2) promoting individuals or groups, and (3) sharing or requesting information. Topic models revealed that many of these users were weightlifters or people trying to lose weight. Twitter users also naturally forged relations, even though 98.12% (2824/2878) of these users were in different physical locations.

CONCLUSIONS

This study fills a knowledge gap on how individuals organically use social media to encourage and sustain physical activity. Elements related to peer support are found in the organic use of social media. Our findings suggest that geographical location is less important for providing peer support as long as the support provides motivation, despite users having few factors in common (eg, the weather) affecting their physical activity. This presents a unique opportunity to identify successful motivation-providing peer support groups in a large user base. However, further research on the effects in a real-world context, as well as additional design and usability features for improving user engagement, are warranted to develop a successful intervention counteracting the current obesity pandemic. This is especially important for young adults, the main user group for social media, as they develop lasting health-related behaviors.

Customizable interdental splinting for repair of pediatric mandibular fractures in children with mixed dentition: A novel technique

OBJECTIVE

Repair of pediatric mandibular fractures (PMFs) can be challenging due to the lack of permanent dentition for immobilization, and the presence of unerupted teeth and growth plates in the mandible limiting the space for fixation. Interdental splinting (IDS) has been advocated to provide temporary fixation without the need for mandibular plating; however, there is sparse description of the surgical methodology, and data on long term outcomes are even more limited. The aim of this study is to present our technique and outcomes using a novel technique for IDS repair of pediatric mandible fractures.

STUDY DESIGN

Observational retrospective chart review.

SETTING

Tertiary care pediatric hospital.

SUBJECTS AND METHODS

Pediatric patients requiring operative repair for mandibular fracture at our tertiary care institution between 2004 and 2021 were included. Patients over 18 years of age, those who died due to associated injuries, or those who underwent non-IDS repairs were excluded. Subjects with at least 3 months of follow-up were assessed for efficacy of surgical repair and short-term adverse outcomes, and at least 1 year for long-term adverse events. Descriptive statistics were obtained.

RESULTS

Twenty-three children were included in the study with an average age of 7.4 years (range 2-17 years). Fifty-two percent (52.2%) were female. The most common fracture site was the condyle, occurring in 16 children (70%). The indication for operative repair in all cases was malocclusion. The average duration of maxillomandibular fixation (MMF) with the novel IDS was 21 days (range 12-42 days). The average length of follow up was 1.6 years (range 3 months-11 years). All children had restored, functional occlusion at follow up with none requiring further orthodontic or dental intervention. Three children of the total cohort (13.0%) had prolonged hospitalization beyond 48 h for poor oral intake. Five children (21.7%) experienced minor long-term complications including persistent temporomandibular joint pain (n = 1, 4.3%), infection (n = 2, 8.7%), hypertrophic scar (n = 1, 4.3%) and exposure of hardware (n = 1, 4.3%).

CONCLUSION

PMFs resulting in malocclusion are safely and effectively managed with operative repair utilizing a customizable IDS, with few observed short- and long-term complications.

The contribution of fetal-derived tissue resident macrophages to cytomegalovirus-associated sensorineural hearing loss

Cytomegalovirus (CMV) is the most common congenital viral infection in the developed world and the leading cause of non-genetic sensorineural hearing loss (SNHL) in children. Congenital CMV causes progressive SNHL long after acute infection has resolved, suggesting a lasting effect on the developing host immune response within the cochlea and surrounding temporal bone marrow (TB). Using fate-mapping models, we have investigated the contribution of fetal-derived tissue resident macrophages (TRMs) to normal cochlear development and function, and their role in mediating CMV-associated SNHL. Our analysis defined two distinct myeloid population within the inner ear: 1) classical tissue resident macrophages (F4/80hiCD11blo) that highly express CD64 and are found exclusively in cochlear tissue; and 2) transitional monocytes (F4/80midCD11bhi) that express both CD64 and Ly6C and are found in cochlea and TB. Fate mapping of these populations uncovered dual contribution of fetal-derived cochlear TRMs from yolk sac (YS) and fetal liver (FL) hematopoiesis. Transitional monocytes increase during acute CMV infection, acting as drivers of expanded lymphoid populations after CMV resolves. Importantly, analysis of Flt3-Cre labeling within myeloid populations suggests that TRMs are replaced by BM-derived populations at later postnatal stages following CMV infection, coinciding with SNHL. Ongoing work examines spatial distribution of distinct fetal-derived TRMs along cochlear architecture, defining transcriptional regulation differences between YS-, FL-, and adult-derived TRMs in response to CMV, and examining how replacement of fetal-derived TRMs with adult-derived TRMs affects tissue function and response to infection.

Supported by grants from University of Utah Molecular Medicine and Immunology, Inflammation and Infectious Disease (3i) Initiative and NIAID (T32 5T32AI138945)

Self-regulation in children with vocal fold nodules: A multilevel analysis

INTRODUCTION

Vocal fold nodules (VNs) represent the most common cause of voice disorders in children. Phonotrauma related to chronic, repetitive, intense vocal activity is often cited as the proximate cause of VNs. However, diminished self-regulation (SR) may predispose some children toward extreme phonotraumatic voice use, thereby contributing secondarily to their development. This case-control study examined the association between features of SR and VNs in children.

METHOD

Parents of children with VNs (N = 40, Age Mean = 7.5, SD = 2.03 years) and vocally normal, medical controls (VNCs; N = 40, Age Mean = 7.6, SD = 1.54 years) completed the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2; Gioia, Isquith, Guy & Kenworthy, 2015), an inventory that evaluates components of SR in children.

RESULTS

Children with VNs, as compared with the vocally normal control group, were described as (i) impulsive (i.e., scoring significantly worse on the Behavior Regulation Index, BRI; P < 0.001, Cohen's d = 0.86), and (ii) emotionally dysregulated (i.e., scoring significantly worse on the Emotional Regulation Index, ERI; P < 0.001, Cohen's d = 0.81).

CONCLUSIONS

Diminished SR in some children with VNs may contribute to phonotraumatic vocal behaviors and potentially attenuate the effectiveness of voice therapy.

Implications and Preventions of Cyberbullying and Social Exclusion in Social Media: Systematic Review

Background

The growth of social networking has created a paradigm in which many forms of personal communication are being replaced by internet communication technologies, such as social media. This has led to social issues, such as cyberbullying. In response, researchers are investigating cyberbullying to determine its implications in various life sectors.

Objective

This manuscript reviews the methods, results, and limitations of the current cyberbullying research and discusses the physical and mental repercussions of cyberbullying and social exclusion as well as methods of predicting and counteracting these events. On the basis of the findings, we discuss future research directions.

Methods

Using ScienceDirect, ACM Digital Library, and PubMed, 34 research articles were used in this review. A review was conducted using the selected articles with the goal of understanding the current landscape of cyberbullying research.

Results

Studies have analyzed correlations between depressive and suicidal ideations in subjects as well as relationships in the social, educational, and financial status of the perpetrators. Studies have explored detection methods for monitoring cyberbullying. Automated detection has yet to become effective and accurate; however, several factors, such as personal background and physical appearance, have been identified to correlate with the likelihood that a person becomes a survivor or perpetrator of web-based cybervictimization. Social support is currently common in recovery efforts but may require diversification for specific applications in web-based incidents.

Conclusions

Relations between social status, age, gender, and behaviors have been discovered that offer new insights into the origins and likeliness of cyberbullying events. Rehabilitation from such events is possible; however, automatic detection is not yet a viable solution for prevention of cyberbullying incidents. Effects such as social exclusion and suicidal ideations are closely tied to incidents of cyberbullying and require further study across various social and demographical populations. New studies should be conducted to explore the experiences of survivors and perpetrators and identify causal links. The breadth of research includes demographics from China, Canada, Taiwan, Iran, the United States, and Namibia. Wider ranges of national populations should be considered in future studies for accurate assessments, given global internet communication technology activity. The studies emphasize the need for formal classification terminology. With formal classification, researchers will have a more definite scope, allowing specific research on a single definable topic rather than on general bullying events and symptoms. Of all the studies, 2 used a longitudinal design for their research methodology. The low number of longitudinal studies leaves gaps between causation and correlation, and further research is required to understand the effects of cyberbullying. Research addressing ongoing victimization is required for the various forms of cyberbullying; social support offers the most effective current standard for prevention.

Eyelash trichomegaly: a systematic review of acquired and congenital aetiologies of lengthened lashes

Long eyelashes have been popularized and many commercially available products exist to achieve eyelash growth as a desired cosmetic effect. Eyelash trichomegaly may be induced by medications, procedures, or be related to medical conditions; however, the exact mechanisms that govern eyelash growth are not well elucidated. This study aims to identify and summarize aetiologies associated with eyelash trichomegaly. We report a systematic review of 148 clinical trials, prospective and retrospective studies, and case reports describing all evidence-based potential aetiologies of eyelash trichomegaly obtained from the Medline/PubMed and Cochrane Library through January 2021. Inclusion criteria were defined as (i) human studies involving congenital and acquired diseases in which eyelash trichomegaly is a characteristic or (ii) assessment of trichomegaly as an adverse or desired effect of a medication or procedure. Exclusion criteria included: animal studies, articles not available in English, outcomes unrelated to eyelash trichomegaly, and secondary review articles. Pharmacologic agents associated with eyelash trichomegaly included prostaglandin analogues (15-keto fluprostenol isopropyl ester, bimatoprost, latanoprost, and travoprost), epidermal growth factor receptor inhibitors (cetuximab, erlotinib, and panitumumab), interferon-alpha, and calcineurin inhibitors (tacrolimus and cyclosporine). Surgical procedures of the eyelid, as well as allergic rhinitis, atopic dermatitis, HIV, ichthyosis vulgaris (IV), uveitis, and vernal keratoconjunctivitis were also associated with increased eyelash growth. Congenital disorders associated with lengthened eyelashes included Cantú syndrome, CHOPS syndrome, Coffin-Siris syndrome, congenital heart disease, Cornelia de Lange syndrome, Costello syndrome, familial trichomegaly, Floating Harbor syndrome, Hermansky-Pudlak syndrome, Kabuki-Makeup syndrome, KBG syndrome, Oliver-McFarlane syndrome, Rubinstein-Taybi syndrome, and Smith-Magenis syndrome. While the most common cause of eyelash trichomegaly is topical bimatoprost use, better understanding of pathways implicated in eyelash trichomegaly may lead to the discovery of additional medications to stimulate eyelash growth and create avenues for future therapeutic interventions.

Understanding user responses to the COVID-19 pandemic on Twitter from a terror management theory perspective: Cultural differences among the US, UK and India

This study uses a new approach to understand people's varied responses to the COVID-19 pandemic. Heightened media coverage and surging death tolls undoubtedly increase individuals' death-related thoughts. Thus, this study draws on terror management theory to analyze the general public's reactions during which mortality is salient. Twitter data were collected from three countries—the US, the UK, and India. Topic modeling analysis using Latent Dirichlet Allocation identified a total of seven themes reflecting two types of defenses: proximal defenses and distal defenses. Proximal defenses included calls for behavioral changes in response to COVID-19. Distal defenses included searching for meaning, political polarization and government incompetence, racial division, and sharing up-to-date information. During a prolonged crisis, anxiety-buffering systems can be undermined and lead to either maladaptive defenses (i.e., psychological distress) or new forms of defenses (i.e., adjusting to the new normal). The analysis highlights cultural differences in defenses across the three countries. Theoretical and practical implications for public health practitioners and social media platform managers are then discussed.

Personality in Children With Vocal Fold Nodules: A Multitrait Analysis

Purpose Vocal fold nodules (VNs) are bilateral, symmetrical, callous-like lesions secondary to phonotrauma and possibly related to specific personality traits. This case-control study examined the relation between personality and VNs in children within the context of the Trait Theory of VNs. Method Parents of children with VNs (N = 39, M = 7.43, SD = 2.01 years) and two medical control groups (i.e., voice disordered controls, but not VNs [VDCs; N = 40, M = 7.09, SD = 2.01 years] and vocally normal controls [VNCs; N = 40, M = 7.6, SD = 1.54 years]) completed the Inventory of Child Individual Differences, a personality instrument that describes the Big Five superfactors as well as 15 lower order personality traits. Results Children with VNs, as compared with VNCs, were (a) emotionally reactive (i.e., higher N-Neuroticism, p < .005, Cohen's d = 0.53), (b) Antagonistic, Strong-Willed, and less Compliant (i.e., lower A-Agreeableness, p < .014, Cohen's d = 0.59), and (c) Distractible and Disorganized (i.e., lower C-Conscientiousness, p < .009, Cohen's d = 0.62). Both voice disordered groups displayed elevated scores on the personality superfactor of Neuroticism (N; and the "Negative Emotions" lower order trait). Conclusions The combination of personality traits identified in this study (i.e., high N, low A and C) may play a central role in VNs development and possibly attenuate voice therapy success. Children with VNs displayed a similar personality typology as women with VNs, with the exception of elevated Extraversion (E), thereby providing support for the relevance of the Trait Theory of VNs in both children and adults. Clinicians treating children with voice disorders, including VNs, should consider their underlying personality traits in assessment and management.

A Cross-Sectional Survey Evaluating Awareness of Congenital Cytomegalovirus Among Audiologists and Speech-Language Pathologists

Purpose Congenital cytomegalovirus (cCMV) is the most common congenital infection worldwide and a leading environmental cause of pediatric hearing loss (HL). The objective of this study was to evaluate audiologists and speech-language pathologists (SLPs) on awareness and knowledge of cCMV. Method A multiple-choice survey assessing awareness, knowledge, and practice patterns was sent electronically to audiologists and SLPs of the American Speech-Language-Hearing Association. Results were compared between audiologists and SLPs and within stratified groups of audiologists. Data were collected, and descriptive analysis was performed. Results Ninety-four audiologists and 317 SLPs responded. Most audiologists were somewhat or very familiar with cCMV (85.9%), while only 26% of SLPs responded that they were at least somewhat familiar with cCMV (p < .0001). When comparing audiologists' and SLPs' knowledge of symptoms, transmission, and diagnostic age for cCMV, audiologists had higher scores in all categories (p < .0001). Audiologists were then stratified into subgroups to evaluate the association of the given subgroup with their overall knowledge. The more advanced audiology training, the more knowledgeable the respondent was regarding HL progression (p = .002). Audiologists who were more familiar with cCMV scored better in most categories compared to those reporting somewhat or less familiar; these findings were only significant for knowledge of symptoms (p < .0001). Audiologists who were sometimes or frequently evaluating children less than 5 years of age had a better understanding of HL presentation among cCMV patients than those who rarely saw this patient population. Those who were in practice for < 20 years frequently knew the time-sensitive age of diagnosis than respondents in practice longer. Conclusions As a leading environmental cause of pediatric HL, cCMV is frequently encountered by audiologists and SLPs. This study highlights knowledge gaps and areas where targeted education is needed for both groups.

Noninvasive Monitoring of Mantle Cell Lymphoma by Immunoglobulin Gene Next-Generation Sequencing in a Phase 2 Study of Sequential Chemoradioimmunotherapy Followed by Autologous Stem-Cell Rescue

Limited information exists in mantle cell lymphoma (MCL) on the performance of next-generation sequencing–based assay of immunoglobulin gene rearrangements for minimal residual disease (MRD) assessment. Posttreatment peripheral blood samples were collected from 16 MCL patients and analyzed with the Adaptive Biotechnologies MRD assay, which identified early molecular relapse. We observed more sensitivity in the cellular versus acellular compartment.

Using Social Media to Understand Online Social Factors Concerning Obesity: A Systematic Review (Preprint)

Background

Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity.

Objective

This study aims to examine web-based social factors in relation to obesity research.

Methods

We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed.

Results

In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users’ connection to the real world.

Conclusions

We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user’s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle.

A Retrospective Cohort Comparing Left and Right Middle Cerebral Artery Ischemic Stroke Functional Outcomes in Acute Inpatient Rehabilitation

BACKGROUND

To date, no large population studies compare left and right middle cerebral artery (MCA) strokes and corresponding patient performance in acute rehabilitation as measured by the Functional Independence Measure (FIM).

OBJECTIVE

To compare granular performance data using the six FIM subcategories between left and right MCA territory strokes. This may foster development of individualized rehabilitation programs and affect rehabilitation policy based on phenotypic variations.

DESIGN

Retrospective cohort study.

SETTING

Inpatient rehabilitation facilities, using Uniform Data System for Medical Rehabilitation data from 2015 to 2017.

PATIENTS

Individuals with MCA strokes admitted to inpatient rehabilitation facilities (n = 38 812).

MAIN OUTCOME MEASURES

Mean FIM efficiency and FIM gain within the six FIM subcategories (self-care, sphincter control, transfers, locomotion, communication, and social cognition) were compared between left and right MCA strokes. All were stratified by admission FIM severity categories (<40, 40-80, >80). The study also examined length of stay and percentage discharged to home.

RESULTS

Mean FIM efficiency was significantly higher for left MCA strokes compared to right MCA strokes. Left MCA strokes with admission FIM <40 and 40-80 had significantly higher FIM efficiencies within the majority of FIM subcategories. However, left and right MCA strokes with admission FIM > 80 did not display any significant differences. Overall, patients with left MCA strokes were discharged to home at a significantly higher percentage. Patients with left MCA strokes with admission FIM 40-80 had on average a 2-day shorter length of stay than those with right MCA strokes.

CONCLUSIONS

Overall, patients with left MCA ischemic strokes had shorter length of stays, higher FIM efficiencies, and larger FIM gains than those with right MCA strokes. These results allow clinicians to counsel patients regarding functional gains based on diagnosis and to tailor rehabilitation programs to impairments encountered in left and right MCA territories. Including laterality of stroke and admission functional status would also improve algorithms for determining reimbursement.

What Can Social Media Tell Us About Patient Symptoms: A Text-Mining Approach to Online Ovarian Cancer Forum

BACKGROUND

Ovarian cancer (OvCa) patients suffer from symptoms that severely affect quality of life. To optimally manage these symptoms, their symptom experiences must be better understood. Social media have emerged as a data source to understand these experiences.

OBJECTIVE

The objective of this study was to use topic modeling (ie, latent Dirichlet allocation [LDA]) to understand the symptom experience of OvCa patients through analysis of online forum posts from OvCa patients and their caregivers.

INTERVENTIONS/METHODS

Ovarian cancer patient/caregiver posts (n = 50 626) were collected from an online OvCa forum. We developed a symptom dictionary to identify symptoms described therein, selected the top 5 most frequently discussed symptoms, extracted posts that mentioned at least one of those symptoms, and conducted LDA on those extracted posts.

RESULTS

Pain, nausea, anxiety, fatigue, and skin rash were the top 5 most frequently discussed symptoms (n = 4536, 1296, 967, 878, and 657, respectively). Using LDA, we identified 11 topic categories, which differed across symptoms. For example, chemotherapy-related adverse effects likely reflected fatigue, nausea, and rash; social and spiritual support likely reflected anxiety; and diagnosis and treatment often reflected pain.

CONCLUSION

The frequency of a symptom discussed on a social media platform may not include all symptom experience and their severity. Indeed, users, who are experiencing different symptoms, mentioned different topics on the forum. Subsequent studies should consider the influence of additional factors (eg, cancer stage) from discussions.

IMPLICATIONS FOR PRACTICE

Social media have the potential to prioritize and answer the questions about clinical care that are frequently asked by cancer patients and their caregivers.

Should hearing targeted screening for congenital cytomegalovirus infection Be implemented?

Since 2013, after Utah became the first state to implement hearing targeted early CMV screening, a national debate has been percolating about whether this approach should be introduced nationally. Currently Utah, Iowa, Connecticut, and New York have passed legislation mandating early CMV screening, and over 100 birth hospitals across the United States have voluntarily implemented early CMV screening programs as part of their standard of care. We reviewed the evidence related to this approach and used the Wilson and Jungner (1968) criteria to evaluate this method of screening. Based on these criteria, there is substantial rationale and evidence to support a hearing targeted approach to screen for congenital CMV. Given this evidence, we currently recommend that infants who fail newborn hearing screen should undergo CMV screening.

Should You Follow the Better-Hearing Ear for Congenital Cytomegalovirus Infection and Isolated Sensorineural Hearing Loss?

OBJECTIVE

To describe the progression of sensorineural hearing loss (SNHL) in the better- and poorer-hearing ears in children with asymptomatic congenital cytomegalovirus (CMV) infection with isolated SNHL.

STUDY DESIGN

Longitudinal prospective cohort study.

SETTING

Tertiary medical center.

SUBJECTS AND METHODS

We analyzed hearing thresholds of the better- and poorer-hearing ears of 16 CMV-infected patients with isolated congenital/early-onset or delayed-onset SNHL identified through hospital-based CMV screening of >30,000 newborns from 1982 to 1992.

RESULTS

By 12 months of age, 4 of 7 patients with congenital/early-onset SNHL developed worsening thresholds in the poorer-hearing ear, and 1 had an improvement in the better-hearing ear. By 18 years of age, all 7 patients had worsening thresholds in the poorer-hearing ear and 3 patients had worsening thresholds in the better-hearing ear. Hearing loss first worsened at a mean age of 2 and 6 years in the poorer- and better-hearing ears, respectively. Nine patients were diagnosed with delayed-onset SNHL (mean age of 9 years vs 12 years for the poorer- and better-hearing ears), 6 of whom had worsening thresholds in the poorer-hearing ear and 1 in both ears.

CONCLUSION

In most children with congenital CMV infection and isolated SNHL, the poorer-hearing ear worsened earlier and more precipitously than the better-hearing ear. This study suggests that monitoring individual hearing thresholds in both ears is important for appropriate interventions and future evaluation of efficacy of antiviral treatment.

Adopting Social Media for Improving Health: Opportunities and Challenges

Social media's ubiquitous influence is changing the landscape of health-related practices. Health organizations and individuals continue to utilize social media for health with mixed results. We discuss current perspectives and challenges of using social media for improving health outcomes. We conclude this paper by highlighting five specific areas that warrant further investigation to better harness social media for health.

The Role of Antioxidants in the Treatment of Congenital CMV-Related Hearing: A Case-Control Study

Objective

Antioxidants have been used as a therapeutic measure for several causes of hearing loss, and this study aims to examine the use of antioxidants in children with congenital cytomegalovirus (cCMV)–related hearing loss.

Study Design

Case-control study.

Setting

Academic pediatric hospital.

Subjects and Methods

A retrospective chart review of pediatric patients with cCMV-related hearing loss treated with and without antioxidants (vitamins A, C, and E and magnesium, known as ACE-Mg) was completed. The primary end point was the mean change in hearing thresholds for the right and left ears after therapy. An evaluation of the mean change in thresholds was evaluated at the following frequencies: 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. A 2-sample t test and multiple linear regression were used to evaluate the data.

Results

A total of 78 children with cCMV-related hearing loss were included in the study, of whom 10 were treated with antioxidants. The average amount of time in which antioxidants were taken was 387 days. When comparing cases and controls, there was no differences in the mean change of hearing thresholds at each frequency for both the right and left ears (P > .05). Length of antioxidant therapy and age at which therapy was initiated had no effect on hearing scores (P > .05).

Conclusions

Oxidative stress plays a role in the pathogenesis of cCMV-related hearing loss. ACE-Mg is a safe adjuvant therapy for the treatment of hearing loss in children; however, this study demonstrates no hearing-related benefit from ACE-Mg antioxidant therapy.

Congenital Cytomegalovirus and Hearing Loss: A Pilot Cross-Sectional Survey of Otologists' and Pediatric Otolaryngologists' Knowledge

Objective

To evaluate pediatric otolaryngologists, neurotologists, and otologists on awareness and knowledge of congenital cytomegalovirus (cCMV).

Study Design

Pilot cross-sectional online survey.

Setting

Otolaryngology practices.

Subjects and Methods

An electronic multiple-choice questionnaire was sent email listserv to physician members of the American Society of Pediatric Otolaryngology and American Otological Society. The survey assessed demographics, physician awareness, and practice patterns. Data were collected and analyzed.

Results

Seventy (14.5%) pediatric otolaryngologists and otologists responded. All responded that they are familiar with cCMV. Most were familiar with symptoms associated with cCMV with the exception of petechia/purpura. Less than 50% knew the incidence/natural history of cCMV-induced hearing loss. Only 63% knew that saliva or urine polymerase chain reaction/culture should be performed prior to 3 weeks of age. Less than half knew the indications for dry blood spot testing, and many incorrectly recommended serologic saliva or urine testing in a child >3 weeks old. Most respondents do not offer any diagnostic testing for cCMV or referral for antiviral therapy for those who may benefit from this treatment. Most either did not know the cCMV screening policy or did not have one at their institution.

Conclusion

Despite a relatively low overall response rate, this study suggests several knowledge gaps and underutilization of cCMV testing by physicians who frequently encounter pediatric hearing loss. The findings from this pilot study demonstrate the need for further educational directives focused on cCMV to improve knowledge and incorporation of cCMV best practices.

Home, school, and community deprivations: A multi-context approach to childhood poverty in China

Few studies of childhood poverty in China have considered social deprivations, and fewer still have considered deprivations in contexts beyond the household. In this article, the authors propose a multi-context poverty measure that includes economic and social deprivations in the family, school, and community domains. The authors compare this measure to standard money-metric measures of poverty using a 15-year longitudinal study of children from 100 villages in Northwest China. Nearly a quarter of multi-context poor children are not income poor, while almost three-fourths of the income poor are not multi-context poor. Social and community deprivations are only weakly associated with "money-metric" deprivations but are significantly linked with short and long-term welfare outcomes for children. The multi-context approach can be tailored to index household and community poverty alleviation targets.

Long-term hearing outcomes of children with symptomatic congenital CMV treated with valganciclovir

OBJECTIVES

Congenital human cytomegalovirus (cCMV) is a leading cause of pediatric hearing loss. Recent literature has suggested that valganciclovir (VGCV) therapy can improve hearing outcomes. The objective of this study was to evaluate the long-term hearing outcomes among symptomatic CMV patients treated with VGCV.

METHODS

A retrospective chart review of symptomatic CMV patients treated with VGCV was completed. The primary endpoint was the change in best ear hearing scores prior to treatment and after follow-up audiograms. A paired-sample t-test was used to evaluate the data.

RESULTS

A total of 16 children were included in the study and participants were followed for an average of 3.2 years. There was a measurable worsening, but not a statistically significant change in the best ear hearing scores, where the mean change was 11.9 dB (p-value = 0.070). However, 14/16 patients (87.5%, p-value<0.001) were found to have clinically significant worsening of hearing. The mean change in hearing scores for the left and right ear was 14.2 dB (p-value = 0.023) and 15.5 dB (p-value = 0.032), respectively. Mean elapsed time for progressive loss was 2.6 ± 0.2 years. When comparing the better or worse ear, there was no pattern for which ear deteriorated earlier or more frequently.

CONCLUSIONS

Our data did show a measurable, but not a statistically significant worsening outcome in best ear hearing. There was a significant change in both left and right ear hearing. Our results suggest that VGCV may provide only a short-term improvement in hearing outcomes; however, these preliminary post-hoc findings suggest the need for a more rigorous evaluation.

Hearing Loss and Failed Newborn Hearing Screen

Hearing loss is the most common congenital defect. With early diagnosis and intervention, we are able to improve speech and language outcomes in this population. In this article, we discuss the implications of the newborn hearing screen, as well as diagnostic interventions, management, and intervention, and the increasing role of congenital cytomegalovirus screening.