Evaluating the impact of an educational intervention on the history of racism in America for teaching structural competency to medical academicians.

BACKGROUND: A challenge facing many Academic Health Centers (AHCs) attempting to revise health professions education to include the impact of racism as a social and structural determinant of health (SSDoH) is a lack of broad faculty expertise to reinforce and avoid undermining learning modules addressing this topic. To encourage an institutional culture that is in line with new anti-racism instruction, we developed a six-part educational series on the history of racism in America and its impact on contemporary health inequities for teaching structural competency to health professions academicians. METHODS: We developed a six-hour elective continuing education (CE) series for faculty and staff with the following objectives: (1) describe and discuss race as a social construct; (2) describe and discuss the decolonization of the health sciences and health care; (3) describe and discuss the history of systemic racism and structural violence from a socio-ecological perspective; and (4) describe and discuss reconciliation and repair in biomedicine. The series was spread over a six-month period and each monthly lecture was followed one week later by an open discussion debriefing session. Attendees were assessed on their understanding of each objective before and after each series segment. RESULTS: We found significant increases in knowledge and understanding of each objective as the series progressed. Attendees reported that the series helped them grapple with their discomfort in a constructive manner. Self-selected attendees were overwhelmingly women (81.8%), indicating a greater willingness to engage with this material than men. CONCLUSIONS: The series provides a model for AHCs looking to promote anti-racism and structural competency among their faculty and staff.

Interview Invitations for Otolaryngology Residency Positions Across Demographic Groups Following Implementation of Preference Signaling.

Importance: Preference signaling is a new initiative in the residency application process that has been adopted by 17 specialties that include more than 80% of applicants in the 2023 National Resident Matching cycle. The association of signals with interview selection rate across applicant demographics has not been fully examined. Objective: To assess the validity of survey-based data on the association of preference signals with interview offers and describe the variation across demographic groups. Design, Setting, and Participants: This cross-sectional study examined the interview selection outcomes across demographic groups for applications with and without signals in the 2021 Otolaryngology National Resident Matching cycle. Data were obtained from a post-hoc collaboration between the Association of American Medical Colleges and the Otolaryngology Program Directors Organization evaluating the first preference signaling program used in residency application. Participants included otolaryngology residency applicants in the 2021 application cycle. Data were analyzed from June to July 2022. Exposures: Applicants were provided the option of submitting 5 signals to otolaryngology residency programs to indicate specific interest. Signals were used by programs when selecting candidates to interview. Main Outcomes and Measures: The main outcome of interest was the association of signaling with interview selection. A series of logistic regression analyses were conducted at the individual program level. Each program within the 3 program cohorts (overall, gender, and URM status) was evaluated with 2 models. Results: Of 636 otolaryngology applicants, 548 (86%) participated in preference signaling, including 337 men (61%) and 85 applicants (16%) who identified as underrepresented in medicine, including American Indian or Alaska Native; Black or African American; Hispanic, Latino, or of Spanish origin; or Native Hawaiian or other Pacific Islander. The median interview selection rate for applications with a signal (48% [95% CI, 27%-68%]) was significantly higher than for applications without a signal (10% [95% CI, 7%-13%]). No difference was observed in median interview selection rates with or without signals when comparing male (46% [95% CI, 24%-71%] vs 7% [95% CI, 5%-12%]) and female (50% [95% CI, 20%-80%] vs 12% [95% CI, 8%-18%]) applicants or when comparing applicants who identified as URM (53% [95% CI, 16%-88%] vs 15% [95% CI, 8%-26%]) with those who did not identify as URM (49% [95% CI, 32%-68%] vs 8% [95% CI, 5%-12%]). Conclusions and Relevance: In this cross-sectional study of otolaryngology residency applicants, preference signaling was associated with an increased likelihood of applicants being selected for interview by signaled programs. This correlation was robust and present across the demographic categories of gender and self-identification as URM. Future research should explore the associations of signaling across a broad range of specialties and the associations of signals with inclusion and position on rank order lists and match outcomes.

Implementation of a Near-Peer Surgical Anatomy Teaching Program into the Surgery Clerkship.

OBJECTIVE: The objective of this study was to describe the implementation of Clinical Anatomy Mentorship Program (CAMP), a novel near-peer surgical anatomy teaching program, into the KU School of Medicine (KUSOM) Surgery Clerkship curriculum. DESIGN: Prospective qualitative and quantitative study. SETTING: Single institution, tertiary care hospital. PARTICIPANTS: All M3s at KUSOM on their surgery clerkship were eligible for inclusion for the learner cohort, n = 106. A group of M4s self-identified as CAMP mentors were eligible for inclusion for the teacher cohort, n = 40. RESULTS: M3s have statistically significant higher self-efficacy (p < 0.001) scores after participating in CAMP. Among open-ended comments written by M3s, significant themes highlighted that CAMP taught them a much-needed refresher on anatomy, gave them an introduction to surgical anatomy, and felt peer-to-peer teaching created a safe environment to ask questions. M4 mentors reported statistically significant (p < 0.001) increases in self-efficacy and confidence in teaching skills after teaching CAMP sessions. Among open-ended comments written by M4 mentors, significant themes highlighted that CAMP helped them develop their teaching skills and confidence in the operating room. CONCLUSIONS: In line with current medical education practices, KUSOM has significantly decreased anatomy in the curriculum. We responded to this shift by implementing CAMP, designed to address specific medical student needs for a surgically oriented anatomy instruction. CAMP has been effective at addressing student concerns about anatomy knowledge gaps. CAMP has enhanced self-efficacy, anatomy knowledge, and operating room exposure in M3s, and self-efficacy, teaching skills, surgical anatomy knowledge, and surgical confidence in M4s.

A Systematic Review of Head and Neck Cancer Health Disparities: A Call for Innovative Research.

OBJECTIVE: (1) Describe the existing head and neck cancer health disparities literature. (2) Contextualize these studies by using the NIMHD research framework (National Institute on Minority Health and Health Disparities). (3) Explore innovative ideas for further study and intervention. DATA SOURCES: Ovid MEDLINE, Embase, Web of Science, and Google Scholar. REVIEW METHODS: Databases were systematically searched from inception to April 20, 2020. The PRISMA checklist was followed (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Two authors reviewed all articles for inclusion. Extracted data included health disparity population and outcomes, study details, and main findings and recommendations. Articles were also classified per the NIMHD research framework. RESULTS: There were 148 articles included for final review. The majority (n = 104) focused on health disparities related to at least race/ethnicity. Greater than two-thirds of studies (n = 105) identified health disparities specific to health behaviors or clinical outcomes. Interaction between the individual domain of influence and the health system level of influence was most discussed (n = 99, 66.9%). Less than half of studies (n = 61) offered specific recommendations or interventions. CONCLUSIONS: There has been extensive study of health disparities for head and neck cancer, largely focusing on individual patient factors or health care access and quality. This review identifies gaps in this research, with large numbers of retrospective database studies and little discussion of potential contributors and explanations for these disparities. We recommend shifting research on disparities upstream toward a focus on community and societal factors, rather than individual, and an evaluation of interventions to promote health equity.

The Value of Diversity, Equity, and Inclusion in Otolaryngology.

Diversity impacts performance of our teams, fosters innovation, and improves outcomes of our patients in otolaryngology head and neck surgery. In addition to the moral imperative, increasing the otolaryngology diversity workforce will decrease health care disparities while equity and justice can increase the culture humility to take care of an increasingly diverse patient population. To move toward justice, otolaryngology departments need to end biases in faculty hiring, development, research evaluations, and publication practices. The more intentional our efforts, the more benefit to our patients, providers, staff, learners, and society.

Invisible Spread and Perceived Stress Amidst COVID-19.

INTRODUCTION: There are limited reports on the mental health toll associated with the fear of spreading coronavirus disease 2019 (COVID-19) and the associated stay-at-home orders. The goal of the present study was to characterize the self-reported stress of participants from the Kansas City Metropolitan Area (KCMA) and to examine the relation between potential for asymptomatic spread and perceived stress. METHODS: This prospective convenience sample study enrolled 461 participants from May 4 to May 22, 2020. Participants were consented and surveyed prior to free SARS-CoV-2 testing. Measures employed included the Perceived Stress Scale-10 and a comprehensive COVID-19 questionnaire. During the study period, testing resources were limited. In the community, only symptomatic individuals or close contacts of known positives could be tested. Our program aimed to reach those who were unable to access testing resources due to their asymptomatic status or other barriers to care. RESULTS: Worry about asymptomatic spread was associated significantly with greater perceived stress (p < 0.001). Higher stress was reported among women (p < 0.001), Hispanic/Latinx (p = 0.001), non-Black/ African American individuals (p < 0.001), and those reporting the presence of COVID-19 symptoms (p = 0.001). CONCLUSIONS: The COVID-19 pandemic has caused significant economic, social, and health disruptions around the world. Distress is significantly related to concern over unintentionally contributing to the spread of SARS-CoV-2 through asymptomatic transmission. In addition to examining outcomes like distress, future research should characterize the modifiable psychotherapeutic processes that might be targeted through intervention among those experiencing distress.

Discontinuation and nonpublication of pediatric otolaryngology clinical trials.

OBJECTIVES: Randomized controlled trial (RCT) discontinuation and nonpublication are potential mechanisms of waste in resources and lead to decreased advancement of medical science and compromised ethical issues in all specialties. However, the prevalence of discontinued or unpublished RCTs regarding common pediatric otolaryngology disorders and interventions remains unclear. STUDY DESIGN: Cross-sectional analysis. METHODS: Retrospective analysis of common pediatric otolaryngology RCTs registered in ClinicalTrials.gov up until November 2, 2018. Data were collected from the registry, and publication status was identified. If a reason for trial discontinuation or nonpublication was not identified through a systematic search, corresponding trialists were contacted through email. RESULTS: After exclusion, 260 RCTs were included for analysis. Analysis found 198 (76%) RCTs were completed, and 62 (24%) trials were discontinued. The most commonly reported reasons for RCT discontinuation were program termination by sponsor or management (7/24; 29.2%), lack of participant enrollment, difficulty recruiting, or slow accrual (7/24; 29.2%). A total of 192 (192/260; 73.8%) published RCTs and 68 (68/260; 26.2%) unpublished RCTs were identified. Twenty-six (26/62; 42%) of the discontinued RCTs reached publication, while 36 (58%) remained unpublished. Regarding the completed RCTs, 166 of 198 (83.8%) completed trials reached publication, while 32 (32/198; 16.2%) remained unpublished after trial completion. CONCLUSIONS: Approximately 1 in 4 of included RCTs were discontinued or did not reach publication. Findings suggest further guidance is needed for RCTs regarding common pediatric otolaryngology disorders and interventions. LEVEL OF EVIDENCE: NA.

Diversity and Inclusion-Why Does It Matter.

Otolaryngology has historically lagged behind other specialties with respect to diversity, equity and inclusion (DEI) and remains one of the least diverse specialties as it relates to gender, race and ethnicity. Strategies aimed at increasing DEI include programs designed to provide mentorship, coaching, and sponsorship. Pipeline efforts, inclusivity on committees, bi-directional communication, and equal pay are additional DEI efforts that have been successful in recruiting and retaining those under-represented in medicine (URiM). Closing the equity gap requires commitment; daily action and measuring progress is required. Finally, use feedback to make refinements as opportunities exist to continually improve DEI efforts.

African American Otolaryngologists: Current Trends and Factors Influencing Career Choice.

OBJECTIVES: 1) Identify factors that influence African American physicians to choose a career in otolaryngology; 2) determine the predominant practice setting for African American otolaryngologists who can be role models; and 3) determine if the presence of an African American otolaryngologist in academic setting influences career choice. METHODS: Survey methodology included a 15-item survey to determine trends in practice and factors that influenced choice of specialty. RESULTS: The results were reviewed for trends influencing career choice and practice location and stratified by age group. Most African American otolaryngologists are in academic practice and have subspecialty fellowship training. Enjoying medical student clerkship was the most frequently cited reason why African Americans chose otolaryngology as a career regardless of age. Early exposure was a driving factor in those 30 to 40 years old. Receiving mentorship was less influential in career choice for all age groups, but there was a positive association between those who were mentored in training and those who mentor faculty. CONCLUSION: The findings suggest the continued need for initiatives to increase African Americans in our specialty. Encouraging early exposure, intentional mentoring of students, and development of African American role models who can be mentors may help increase the number of African American otolaryngologist faculty. This can help our specialty achieve racial parity in a percentage that matches the number of African Americans in the United States workforce. LEVEL OF EVIDENCE: 5 Laryngoscope, 130:2336-2342, 2020.

The effects of cognitive load and optical flow on antagonist leg muscle coactivation during walking for young and older adults.

The purpose of this study was to compare how healthy aging interacts with environments that challenge cognitive load and optical flow to affect antagonist leg muscle coactivation during walking. We measured leg muscle activity in sixteen older adults (70.4 ±â€¯4.2 years) and twelve young adults (23.6 ±â€¯3.9 years) walking on a treadmill at their preferred speed while watching a speed-matched virtual hallway. Cognitive load was challenged using a dual-task to interfere with available attentional resources. Optical flow was challenged using perturbations designed to create a perception of lateral imbalance. We found antagonist coactivation increased with aging, independent of condition. We also found that, compared to unperturbed walking, only in the presence of optical flow perturbations did the older adults increase their antagonist coactivation. Antagonist coactivation in the young adults was not affected by either condition. Our findings provide evidence that antagonist leg muscle coactivation in healthy older adults is more sensitive to walking environments that challenge optical flow than environments that challenge cognitive load. As increased antagonist coactivation may indicate compromised balance, these findings may be relevant in the design of living environments to reduce falls risk.

Steroid Versus Antibiotic Drops in the Prevention of Postoperative Myringotomy Tube Complications.

OBJECTIVES: To determine the incidence of early postoperative tympanostomy tube insertion otorrhea and obstruction in pediatric patients receiving antibiotic ear drops with or without steroid perioperatively. METHODS: A retrospective chart review was performed on patients who underwent outpatient myringotomy and tube placement. Patients from June 2013 to February 2014 received ciprofloxacin/dexamethasone perioperatively while patients from May 2014 to April 2015 received ofloxacin. Statistical analysis was performed to compare outcomes between the cohorts. RESULTS: One hundred thirty-four patients received topical ciprofloxacin/dexamethasone, and 116 patients received topical ofloxacin. The rate of postoperative otorrhea was 5.2% for the ciprofloxacin/dexamethasone group and 8.2% for the ofloxacin group. Tube obstruction was seen in 6.0% of the ciprofloxacin/dexamethasone group and 5.2% in the ofloxacin group. Neither outcome had a statistically significant difference ( P = .21 and .85, respectively). There was no difference in the rate of effusion at the time of tube placement between the 2 cohorts ( P = .16), and this included subgroup analysis based on effusion type (mucoid, purulent, serous). Patients with a mucoid effusion at the time of surgery were more likely to experience otorrhea/obstruction than patients with dry ears (odds ratio = 2.23, P = .02). CONCLUSION: No significant difference in the incidence of immediate postoperative tympanostomy tube otorrhea or obstruction was seen between the antibiotic-steroid and antibiotic alone cohorts, regardless of effusion type. Overall, patients with mucoid effusions are more likely to develop tube otorrhea or obstruction at follow-up. Cost-effective drops should be used when prescribing topical therapy to prevent complications after ear tubes.

Visuomotor Entrainment and the Frequency-Dependent Response of Walking Balance to Perturbations.

Visuomotor entrainment, or the synchronization of motor responses to visual stimuli, is a naturally emergent phenomenon in human standing. Our purpose was to investigate the prevalence and resolution of visuomotor entrainment in walking and the frequency-dependent response of walking balance to perturbations. We used a virtual reality environment to manipulate optical flow in ten healthy young adults during treadmill walking. A motion capture system recorded trunk, sacrum, and heel marker trajectories during a series of 3-min conditions in which we perturbed a virtual hallway mediolaterally with systematic changes in the driving frequencies of perceived motion. We quantified visuomotor entrainment using spectral analyses and balance deficits using trunk sway, gait variability, and detrended fluctuation analyses (DFA). ML kinematics were highly sensitive to visual perturbations, and instinctively synchronized (i.e., entrained) to a broad range of driving frequencies of perceived ML motion. However, the influence of visual perturbations on metrics of walking balance was frequency-dependent and governed by their proximity to stride frequency. Specifically, we found that a driving frequency nearest to subjects' average stride frequency uniquely compromised trunk sway, gait variability, and step-to-step correlations. We conclude that visuomotor entrainment is a robust and naturally emerging phenomenon during human walking, involving coordinated and frequency-dependent adjustments in trunk sway and foot placement to maintain balance at the whole-body level. These findings provide mechanistic insight into how the visuomotor control of walking balance is disrupted by visual perturbations and important reference values for the emergence of balance deficits due to age, injury, or disease.

Gait variability in healthy old adults is more affected by a visual perturbation than by a cognitive or narrow step placement demand.

Gait variability measures have been linked to fall risk in older adults. However, challenging walking tasks may be required to elucidate increases in variability that arise from subtle age-related changes in cognitive processing and sensorimotor function. Hence, the study objective was to investigate the effects of visual perturbations, increased cognitive load, and narrowed step width on gait variability in healthy old and young adults. Eleven old (OA, 71.2±4.2 years) and twelve young (YA, 23.6±3.9 years) adults walked on a treadmill while watching a speed-matched virtual hallway. Subjects walked: (1) normally, (2) with mediolateral visual perturbations, (3) while performing a cognitive task (serial seven subtractions), and (4) with narrowed step width. We computed the mean and variability of step width (SW and SWV, respectively) and length (SL, SLV) over one 3-min trial per condition. Walking normally, old and young adults exhibited similar SWV and SLV. Visual perturbations significantly increased gait variability in old adults (by more than 100% for both SWV and SLV), but not young adults. The cognitive task and walking with narrowed step width did not show any effect on SWV or SLV in either group. The dramatic increase in step width variability when old adults were subjected to mediolateral visual perturbations was likely due to increased reliance on visual feedback for assessing whole-body position. Further work is needed to ascertain whether these findings may reflect sub-clinical balance deficits that could contribute to the increased fall risk seen with advancing age.

Advanced age brings a greater reliance on visual feedback to maintain balance during walking.

We implemented a virtual reality system to quantify differences in the use of visual feedback to maintain balance during walking between healthy young (n=12, mean age: 24 years) and healthy old (n=11, 71 years) adults. Subjects walked on a treadmill while watching a speed-matched, virtual hallway with and without mediolateral visual perturbations. A motion capture system tracked center of mass (CoM) motion and foot kinematics. Spectral analysis, detrended fluctuation analysis, and local divergence exponents quantified old and young adults' dynamic response to visual perturbations. Old and young adults walked normally with comparable CoM spectral characteristics, lateral step placement temporal persistence, and local divergence exponents. Perturbed visual flow induced significantly larger changes in mediolateral CoM motion in old vs. young adults. Moreover, visual perturbations disrupted the control of lateral step placement and compromised local dynamic stability more significantly in old than young adults. Advanced age induces a greater reliance on visual feedback to maintain balance during waking, an effect that may compensate for degradations in somatosensation. Our findings are relevant to the early diagnosis of sensory-induced balance impairments and also point to the potential use of virtual reality to evaluate sensory rehabilitation and balance training programs for old adults.

Empirical evaluation of gastrocnemius and soleus function during walking.

Distinguishing gastrocnemius and soleus muscle function is relevant for treating gait disorders in which abnormal plantarflexor activity may contribute to pathological movement patterns. Our objective was to use experimental and computational analysis to determine the influence of gastrocnemius and soleus activity on lower limb movement, and determine if anatomical variability of the gastrocnemius affected its function. Our hypothesis was that these muscles exhibit distinct functions, with the gastrocnemius inducing limb flexion and the soleus inducing limb extension. To test this hypothesis, the gastrocnemius or soleus of 20 healthy participants was electrically stimulated for brief periods (90 ms) during mid- or terminal stance of a random gait cycle. Muscle function was characterized by the induced change in sagittal pelvis, hip, knee, and ankle angles occurring during the 200 ms after stimulation onset. Results were corroborated with computational forward dynamic gait models, by perturbing gastrocnemius or soleus activity during similar portions of the gait cycle. Mid- and terminal stance gastrocnemius stimulation induced posterior pelvic tilt, hip flexion and knee flexion. Mid-stance gastrocnemius stimulation also induced ankle dorsiflexion. In contrast mid-stance soleus stimulation induced anterior pelvic tilt, knee extension and plantarflexion, while late-stance soleus stimulation induced relatively little change in motion. Model predictions of induced hip, knee, and ankle motion were generally in the same direction as those of the experiments, though the gastrocnemius's results were shown to be quite sensitive to its knee-to-ankle moment arm ratio.

Pediatric sialadenitis.

Sialadenitis in the pediatric population accounts for up to 10% of all salivary gland disease. Viral parotitis and juvenile recurrent parotitis are the two most common causes. Multiple factors, independently or in combination, can result in acute, chronic, or recurrent acute salivary gland inflammation. Sialendoscopy has emerged as the leading diagnostic technique and intervention for pediatric sialadenitis. Sialendoscopy is a safe and effective gland-preserving treatment of pediatric sialadenitis. Investigational studies are needed to address the impact of steroid instillation, postoperative stenting, and long-term outcomes of pediatric sialendoscopy. This article presents a comprehensive review of pathophysiology, clinical presentation, diagnosis, and treatment of pediatric sialadenitis.

The modulation of forward propulsion, vertical support, and center of pressure by the plantarflexors during human walking.

The gastrocnemius and soleus both contribute to the ankle plantarflexor moment during the mid- and terminal stance phases of gait. The gastrocnemius also generates a knee flexion moment that may lead to dynamic function that is unique from the soleus. This study used a muscle stimulation protocol to experimentally compare the contributions of individual plantarflexors to vertical support, forward propulsion and center of pressure (CoP) movement during normal gait. Twenty subjects walked on an instrumented treadmill at self-selected speeds with stimulating surface electrodes affixed over the medial gastrocnemius and soleus muscles. Short duration pulse trains (90 ms) were used to stimulate either the gastrocnemius or soleus at 20% or 30% of the gait cycle (GC) of random strides. Changes in ground reactions between stimulated and non-stimulated strides were evaluated to characterize the influence of each muscle on whole body movement during mid- (stimulation onset at 20% GC) and late (30% GC) stance. The gastrocnemius and soleus each induced an increase in vertical support and anterior progression of the CoP in mid-stance. However, late stance gastrocnemius activity induced forward acceleration, while both mid- and terminal stance soleus activity induced braking of forward velocity. The results suggested that the individual plantarflexors exhibit unique functions during normal gait, with the two muscles having opposite effects on forward propulsion. These empirical results are important both for enhancing the veracity of models used to predict muscle function in gait and also clinically as physicians seek to normalize gait in patients with plantarflexor dysfunction.