Sex Differences in Faculty Positions Among Top-Ranked US Otolaryngology Departments

Objective

This study aims to characterize the top-ranked departments in otolaryngology to provide an indicator of the state of diversity within otolaryngology and to draw a comparison with other medical and surgical fields.

Study Design

This cross-sectional study examined the 20 highest-ranked otolaryngology programs according to the US News & World Report ranking of best hospitals for ear, nose and throat.

Setting

Academic otolaryngology departments in the United States.

Methods

Faculty demographic and biographical data were collected from departmental websites. The Web of Science h-index was used as a surrogate for academic productivity. Descriptive statistics and chi-square analysis were used to characterize the cohort and compare otolaryngology with other fields.

Results

Of 562 otolaryngologists on faculty at the 20 highest-ranked programs, 413 (73.5%) were men and 149 (26.5%) were women. Among the faculty in the cohort, 174 (31.0%) were professors, 145 (25.8%) were associate professors, and 183 (32.6%) were assistant professors. Across faculty appointments, the proportion of women grew smaller as academic rank increased. When compared with all faculty across US medical schools, the departments in this study had significantly lower proportions of female professors (P = .0047), associate professors (P = .0009), and assistant professors (P = .0005). Male faculty members had higher h-indices than their female counterparts among professors (P = .004), associate professors (P = .008), assistant professors (P = .0002), and clinical assistant professors (P = .0009).

Conclusion

Women are underrepresented across all academic ranks in top-ranked otolaryngology programs. The current state of diversity in otolaryngology yields many opportunities to advance representation for women in the field.

Adverse Event Reporting in Otolaryngology

OBJECTIVES

Adverse events are common occurrences in hospitals that detract from quality of care. There are few data on errors in otolaryngology (ENT) and even fewer data comparing ENT to other services.

METHODS

We retrospectively reviewed adverse event data collected across a regional hospital network from July 2014 to August 2017. We examined categories of adverse events that occurred most commonly in ENT and compared the number of adverse events reported in ENT to those reported across all other departments. Descriptive analysis and the paired t test were used to analyze the data.

RESULTS

Two hundred ninety-one adverse events were reported in ENT departments during the period studied compared to 58,219 events reported across all other specialties. In ENT, the most commonly reported adverse events occurred in the perioperative setting, followed by issues regarding equipment and medical devices and, lastly, airway management. Across all other departments, the most common categories included medication and fluid errors, falls, and safety and security events. ENT departments had significantly higher proportions of perioperative and airway management errors and significantly lower proportions of events related to diagnosis and treatment (P = .004), falls (P < .001), lab results and specimens (P = .001), medication and fluids (P < .001), and safety and security (P < .001).

CONCLUSION

Perioperative and airway management errors occur with a statistically higher frequency in ENT compared to other in-patient and out-patient departments across hospitals. It is important to analyze adverse event reporting in surgical specialties to ensure the development of appropriate quality initiatives.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:509-512, 2021.

The adverse health effects of punitive immigrant policies in the United States: A systematic review

BACKGROUND

Immigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities.

METHODS

In this systematic review, we searched the following databases from inception-May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work Abstracts (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included.

FINDINGS

6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women's and children's health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study.

INTERPRETATION

Many punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.

Trends in outpatient intervention for pediatric ankyloglossia

OBJECTIVES

Anecdotally, there has been an increase in ankyloglossia referrals and frenotomy procedures performed in recent years. Many studies have characterized frenotomy indications and outcomes, but none have quantified how the frequency of referrals and interventions have changed over time in the outpatient setting. This study analyzes temporal trends in the diagnosis and intervention of ankyloglossia in a pediatric otolaryngology practice to further clarify how patterns of management of this condition have changed over time.

METHODS

This study was a retrospective chart review of patients evaluated for ankyloglossia in an outpatient pediatric otolaryngology clinic between 2008 and 2018. The chi-square test for trend was used to assess yearly changes in the referral numbers, surgical interventions, and procedure indication prevalence proportions of interest.

RESULTS

Referral numbers and frenotomy procedures increased as a percentage of total office visits from 2008 to 2018 (P = 0.0026, P < 0.0001). The trend in frenotomies was especially pronounced in the 0 to 2-month age group (P < 0.0001) but was not observed in the 2 months to 1-year (P = 0.30) or 1- to 4-year (P = 0.40) age groups. Frenotomy performed for concerns of feeding (P < 0.0001) increased over the study period, but there was no significant increase in procedures performed for speech concerns (P = 0.13).

CONCLUSION

Significant increases in referrals for frenotomy and number of frenotomy procedures performed are demonstrated, especially in young infants for feeding concerns. It is unlikely representative of a true increase in the incidence of ankyloglossia, but rather the result of cultural and clinical factors driving referrals and intervention.

Economic evaluation of a multi-disciplinary community-based intervention programme for New Zealand children and adolescents with obesity

OBJECTIVE

To determine whether Whānau Pakari, a home-based, 12-month multi-disciplinary child obesity intervention programme was cost-effective when compared with the prior conventional hospital-based model of care.

METHODS

Whānau Pakari trial participants were recruited January 2012-August 2014, and randomised to either a high-intensity intervention (weekly sessions for 12 months with home-based assessments and advice, n=100) or low-intensity control (home-based assessments and advice only, n=99). Trial participants were aged 5-16 years, resided in Taranaki, Aotearoa/New Zealand (NZ), with a body mass index (BMI) ≥98th centile or BMI >91st centile with weight-related comorbidities. Conventional group participants (receiving paediatrician assessment with dietitian input and physical activity/nutrition support, n=44) were aged 4-15 years, and resided in the same or another NZ centre. The change in BMI standard deviation score (SDS) at 12 months from baseline and programme intervention costs, both at the participant level, were used for the economic evaluation. A limited health funder perspective with costs in 2016 NZ$ was taken.

RESULTS

The per child 12-month Whānau Pakari programme costs were significantly lower than in the conventional group. In the low-intensity group, costs were NZ$939 (95% CI: 872, 1007) (US$648) lower than the conventional group. In the high-intensity intervention group, costs were NZ$155 (95% CI: 89, 219) (US$107) lower than in the conventional group. BMI SDS reductions were similar in the three groups.

CONCLUSIONS

A home-based, multi-disciplinary child obesity intervention had lower programme costs per child, greater reach, with similar BMI SDS outcomes at 12 months when compared with the previous hospital-based conventional model.

Role of ultrasonography and computed tomography in the evaluation of focal splenic lesions

OBJECTIVE: To study the role of ultrasonography and computed tomography in the evaluation of focal splenic lesions, to compare their diagnostic accuracies, to study the differential diagnosis of focal splenic lesions, to evaluate the imaging features of common lesions and to calculate the incidence of focal splenic involvement in lymphomas. MATERIALS AND METHODS: A prospective study of 46 patients was undertaken in whom focal lesions in the spleen were detected on USG, CT or both. In all patients, USG was done and images were stored. Five mm thick contiguous sections were obtained from the spleen before and after injection of intravenous contrast material in the portovenous phase. RESULTS: Of the focal splenic lesions 28 (60.8%) were benign and 18 (39.2%) were malignant. The spectrum of benign lesions included cysts (4), infarcts (10), abscesses (9) HIV+ve cases with focal hypodense splenic lesions (5) and a case of inflammatory pseudotumour. Malignant lesions included 6 cases each of Hodgkin′s and non-Hodgkin′s lymphoma and 6 cases of metastatic deposits in the spleen. Diagnostic accuracy of plain CT was 78.7%, of USG 87.2% and of CECT was 100%. Lesion detection was significantly improved by contrast enhancement. NHL, especially the high grade lymphomas presented with large nodular pattern of involvement of spleen whereas Hodgkin′s lymphoma presented in majority of cases with small nodular pattern of involvement. Imaging features of infarcts corresponded to the classic wedge shaped peripheral pattern in a majority,(80%) and were extensive with hilar sparing in 20%. CONCLUSION: We concluded that contrast enhanced CT is the ideal modality for detection of focal splenic lesions, with USG being used mainly for follow up. The spectrum of differentials of focal splenic lesions in our study corresponded with reports in literature.

[Phimosis, hydrocele and varicocele. 3 frequent pathologies in the male child and adolescent]

A review is made of the three most frequent benign andrological pathologies in children and teenagers. The clinical and physiopathological aspects are analysed both practically and theoretically. The therapeutic measures most commonly taken in treatment are referred.

Percutaneous sclerotherapy of varicocele

Percutaneous sclerotherapy of varicocele was considered in 21 patients with left sided varicocele, 16 of whom had recurrences after left spermatic vein ligation in the past. Percutaneous sclerotherapy was possible in 17 patients (80.9%). There were no serious complications with venography or sclerotherapy, and the recurrence rate was 17.6%. Percutaneous sclerotherapy is therefore a simple, safe and effective treatment of testicular vein insufficiency.

Trypanosoma cruzi: strain selection by different schedules of mouse passage of an initially mixed infection

From an initial double infection in mice, established by simultaneous and equivalent inocula of bloodstream forms of strains Y and F of Trypanosoma cruzi, two lines were derived by subinoculations: one (W) passaged every week, the other (M) every month. Through biological and biochemical methods only the Y strain was identified at the end of the 10th and 16th passages of line W and only the F strain at the 2nd and 4th passages of line M. The results illustrate strain selection through laboratory manipulation of initially mixed populations of T. cruzi.

Trypanosoma cruzi: inoculation schedules and re-isolation methods select individual strains from doubly infected mice, as demonstrated by schizodeme and zymodeme analyses

Groups of mice received double infections with the Y and F strains of Trypanosoma cruzi, the first inoculum of either strain being followed by a second inoculum of the other strain on day 5, 15, 30-40, or 60-65. Parasites were re-isolated from blood into culture, either directly or with an intermediate passage in gamma-irradiated mice, at intervals between 7 and 35 days after the second inoculation. Strain identification in the re-isolated material was by electrophoresis of kDNA fragments generated by the EcoRI restriction endonuclease and by electrophoresis for glucosephosphate isomerase isozymes. Both strains were identified in 22% of re-isolates originating from the experimental mice and only one of them was present in the remaining re-isolates, strain F being the most frequent. In some instances either Y or F was re-isolated from the same blood source, depending on whether culturing had been preceded or not by passage through a mouse. These results are certainly related to strain differences in the various aspects of host-parasite relationship and, possibly, growth rates in culture. The results demonstrate that: (1) more than one strain of T. cruzi can coexist in the same host; (2) the timing and method of parasite isolation from the vertebrate host act as selective factors, and further passages (in mice or cultures) may completely eliminate one (or more) strain from originally mixed trypanosome population, and (3) kDNA restriction "fingerprints" and isozyme profiles are simple, sensitive, and reliable techniques for strain identification both in single and mixed preparations.

A nucleotidase from Leishmania tropica Promastigotes: partial purification and properties

Nucleotidase activity which had been found in various subcellular fractions of Leishmania tropica has been partially purified from the supernatant of the Triton X-100 treated pellet of the 100 000 g centrifugation of the L. tropica homogenate by CM-cellulose column chromatography, Con A-Sepharose affinity chromatography, isoelectrofocusing and column chromatography on Sephacryl S-300. The enzyme showed the characteristics of a nucleotidase (EC 3.1.3.31) with a broad substrate specificity. It was inhibited by the products of the reaction and by alpha, beta-methylene adenosine 5'diphosphate and adenosine 5'-9-thiomonophosphate. Nucleotidase activity of intact Leishmania cells and the inhibitory effect of Concanavalin A on the activity of the enzyme suggest also surface-associated properties of the enzyme.

Isolation of an enriched plasma membrane-subpellicular microtubule fraction of Leishmania mexicana amazonensis

A cell fractionation procedure previously developed for Trypanosoma cruzi was applied to isolated the plasma membrane of promastigotes of Leishania mexicana amazonensis. The cell, swollen in an hypotonic mediun, were disrupted in the presence of a nonionic detergent and the membrane fraction isolated by differencial centrifugation. Electron microscopy showed that the fraction consisted of pieces of the plasma membrane associated with subpellicular microtubules. It was also shown that this fraction is able to induce cell-mediated immune response in mice.

Isolation and properties of flagella of trypanosomatids

A procedufe is described for the isolation of flagella of Crithidia fasciculata, Herpetomonas samuelpessoai and Leishmania tarentolae in a highly purified state and giving reasonably good yield. The 3 types of flagella give a similar electrophoretic pattern of proteins. It is shown that H. samuelpessoai and, to a lesser extent, C. fasciculata flagella confer protection against Trypanosoma cruzi infection.