Geospatial evaluation of access to otolaryngology care in the United States.

Objectives: This county-level epidemiological study evaluated the travel distance to the nearest otolaryngologist for continental US communities and identified socioeconomic differences between low- and high-access regions. Methods: Geospatial analysis of publicly available 2015-2022 NPI records was combined with US census data to identify geospatial gaps in otolaryngologist distribution. Moran's index geospatial clustering in distance to the nearest county with an otolaryngologist was used as the core metric for differential access determination. Univariate logistic analysis was conducted between low- and high-access counties for 20 socioeconomic and demographic variables. Results: Nationally, the average person was 22 miles from an otolaryngologist. 444 counties were identified as geospatially "low access" with increased travel distance in the Midwest, Great Planes, and Nevada with a median of 47 miles. 1231 counties in the Eastern United States and Western Coast were identified as "high access" with a 3-mile median travel distance. Areas of low access to otolaryngological care had smaller median populations (12,963 vs. 558,306), had smaller percent Black and Asian populations (2% vs. 11%, 1% vs. 5%, respectively), had a greater percent American Indian population (2% vs. 1%), were less densely populated (8 vs. 907 people per square mile), had fewer percent college graduates (20% vs. 34%), and fewer otolaryngologists per county (median: 0.01-20). Conclusion: These findings highlight disparity in otolaryngology care in the United States and the need for otolaryngology funding initiatives in the Midwest and Great Plains regions. Level of Evidence: Level 3.

Impact of Ergonomics on Muscle Fatigue During Surgical Drilling Using Surface Electromyography.

OBJECTIVE: To investigate the relationship between ergonomic positions and electromyographic muscle activity during otologic drilling. STUDY DESIGN: Cross-over experimental trial. SETTING: Tertiary Academic Medical Center. METHODS: Surgeon participants were tasked with delicate eggshell drilling in 3 different seated positions: "neutral," "slouched," and "craned." Surface electromyography (sEMG) sensors recorded the amplitude and frequency of muscle activity. The joint analysis of spectrum and amplitude (JASA) method, which combines temporal trends in frequency and amplitude, was used to identify trials that exhibited patterns of fatigue. RESULTS: The sEMG amplitude and frequency responses demonstrated wide temporal changes. In a majority of experiments, amplitude increased over the course of the experiment, while frequency remained more stable. On analysis of variance testing, only the mean frequency of the deltoid differed significantly between postures (P = .02). Under the JASA framework, external carpi radialis and upper trapezius experienced fatigue in nearly half of the trials regardless of position (47% vs 49%). The upper trapezius demonstrated fatigue during 46% and 69% of the "craned" and "slouched" trials, respectively, compared to just 31% of the "neutral" trials. Fewer attendings demonstrated upper trapezius fatigue compared to trainees (33% vs 62%). Female surgeons experienced fatigue in more trials than male counterparts (73% vs 25%). CONCLUSION: This study highlights a first step in quantifying the relationship between operating postures and muscle fatigue. Results suggest that specific muscle groups are more susceptible to fatigue; gender and experience may also impact muscle activity.

Long-term assessment of the functional independence measure in sports-related spinal cord injury.

CONTEXT: Patients with spinal cord injury (SCI) secondary to traumatic sports-related etiology potentially face loss of independence. The Functional Independence Measure (FIM) assesses the amount of assistance patients require and has shown sensitivity to changes in patient functional status post injury. OBJECTIVES: We aimed to (1) examine long-term outcomes following sports-related SCI (SRSCI) using FIM scoring at the time of injury, one year, and five years post-injury, and (2) determine predictors of independence at one and five-year follow-up considering surgical and non-surgical management. Few studies have investigated the cohort analyzed in this study. METHODS: The 1973-2016 National Spinal Cord Injury Model Systems (SCIMS) Database was used to develop a SRSCI cohort. The primary outcome of interest captured functional independence using a multivariate logistic regression, defined by FIM individual scores greater than or equal to six, evaluated at one and five years. RESULTS: A total of 491 patients were analyzed, 60 (12%) were female, 452 (92%) underwent surgery. The cohort demographics were stratified by patients with and without spine surgery and evaluated for functional independence in FIM subcategories. Increased time spent in inpatient rehabilitation and FIM score at post-operative discharge were associated with greater likelihood of functional ability at both one and five-year follow-up. CONCLUSION: Our study demonstrated that SRSCI patients are a unique subset of SCI patients for whom factors repeatedly associated with independence at one year follow-up were dissimilar to those associated with independence at five-year follow-up. Larger prospective studies should be conducted to establish guidelines for this unique subcategory of SCI patients.

Refractory seizures secondary to radiation-induced focal cortical dysplasia/neuronal gigantism: illustrative case.

BACKGROUND: Focal cortical dysplasia is a structural cause of drug-resistant epilepsy commonly identified in childhood. In rare cases, radiation-induced injury has led to radiation-induced cortical dysplasia, also known as "focal neuronal gigantism." OBSERVATIONS: The authors present a 53-year-old woman with recurrent status epilepticus events after she had radiation therapy and surgery for a left frontal meningioma several years prior. Imaging revealed findings consistent with radiation necrosis and possible recurrence. The patient's status epilepticus events required escalating therapies to manage. Scalp electroencephalography indicated that the seizure's origin was in the left hemisphere. A craniotomy was performed to remove the left frontal lesion, and histopathology was consistent with radiation-induced focal cortical dysplasia/neuronal gigantism. The patient's seizures ceased following the surgery, and she remains on maintenance antiseizure medications. LESSONS: Radiation-induced focal cortical dysplasia/neuronal gigantism is an incredibly rare complication of therapy. However, it warrants consideration in the context of radiation necrosis and intractable epilepsy.

Early Predictors and Outcomes of American Spinal Injury Association Conversion at Discharge in Surgical and Nonsurgical Management of Sports-Related Spinal Cord Injury.

OBJECTIVE: This study aims to evaluate the rate of improvement in neurologic recovery of patients with sports-related spinal cord injury (SRSCI) who had surgical intervention (SS) and those who did not (NSS). We aimed to 1) evaluate the rate of American Spinal Injury Association (ASIA) conversion in patients with and without surgery, and 2) assess predictors of conversion in ASIA grade. METHODS: The National Spinal Cord Injury Model Systems Database (SCIMS) was used from 1973 to 2016. Patients with SRSCI were included. The primary outcome was rate of conversion in ASIA grade. Multivariate logistic regression was performed with separate subgroup analysis on patients with cervical injury (represented by odds ratio [OR]; 95% confidence interval [CI]). RESULTS: A total of 1647 patients had SRSCI with 1502 (91%) SSs. Most patients (88%) were male, white (87%), and between the ages of 15 and 29 years (63%). Patients undergoing SS had significantly longer inpatient rehabilitation length of stay (LOS) (P < 0.001) and a more patients undergoing SS had complete motor or sensory loss compared with the NSS group. Multivariate logistic regression showed that injury at the thoracic level (OR, 0.41; 95% CI, 0.21-0.78), age 15-29 years (OR, 0.44; 95% CI, 0.20-0.97]), water-based injury (OR, 0.45; 95% CI, 0.21-0.95), and ASIA impairment grades of B, C, and D at admission were significantly associated with ASIA SCORE conversion. CONCLUSIONS: We found that patients undergoing SS had longer LOS and a higher prevalence of complete injuries. Surgical intervention was not associated with conversion in ASIA grade to an improved status at time of discharge in a large cohort of patients with SRSCI and in a subcohort of patients with cervical SRSCI.

A Mosquito Pick-and-Place System for PfSPZ-based Malaria Vaccine Production.

The treatment of malaria is a global health challenge that stands to benefit from the widespread introduction of a vaccine for the disease. A method has been developed to create a live organism vaccine using the sporozoites (SPZ) of the parasite Plasmodium falciparum (Pf), which are concentrated in the salivary glands of infected mosquitoes. Current manual dissection methods to obtain these PfSPZ are not optimally efficient for large-scale vaccine production. We propose an improved dissection procedure and a mechanical fixture that increases the rate of mosquito dissection and helps to deskill this stage of the production process. We further demonstrate the automation of a key step in this production process, the picking and placing of mosquitoes from a staging apparatus into a dissection assembly. This unit test of a robotic mosquito pick-and-place system is performed using a custom-designed micro-gripper attached to a four degree of freedom (4-DOF) robot under the guidance of a computer vision system. Mosquitoes are autonomously grasped and pulled to a pair of notched dissection blades to remove the head of the mosquito, allowing access to the salivary glands. Placement into these blades is adapted based on output from computer vision to accommodate for the unique anatomy and orientation of each grasped mosquito. In this pilot test of the system on 50 mosquitoes, we demonstrate a 100% grasping accuracy and a 90% accuracy in placing the mosquito with its neck within the blade notches such that the head can be removed. This is a promising result for this difficult and non-standard pick-and-place task. NOTE TO PRACTITIONERS­: Automated processes could help increase malaria vaccine production to global scale. Currently, production requires technicians to manually dissect mosquitoes, a process that is slow, tedious, and requires a lengthy training regimen. This paper presents an an improved manual fixture and procedure that reduces technician training time. Further, an approach to automate this dissection process is proposed and the critical step of robotic manipulation of the mosquito with the aid of computer vision is demonstrated. Our approach may serve as a useful example of system design and integration for practitioners that seek to perform new and challenging pick-and-place tasks with small, non-uniform, and highly deformable objects.

A BIOMECHANICAL AND THERMAL ANALYSIS FOR BONE AUGMENTATION OF THE PROXIMAL FEMUR.

In this study, we aim to create and validate a Finite Element (FE) model to estimate the bone temperature after cement injection and compare the simulation temperature results with experimental data in three key locations of the proximal femur. Simulation results suggest that the maximum temperature-rise measured at the bone surface is 10°C which occurs about 12 minutes after the injection. Temperature profiles measured during the experiment showed an agreement with those of the simulation with an average error of 1.73°C Although additional experiments are required to further validate the model, results of this study suggest that this model is a promising tool for bone augmentation planning to lower the risk of thermal necrosis.