The effect of school size and class size on school preparedness.

The purpose of the present study was to understand students' school readiness as a function of student and teacher behaviors but also school size and class size using both linear and non-linear analytical approaches. Data came from 21,903 schools distributed across 80 countries as per the 2018 cohort of the PISA database. Results pointed to a preference for the Cusp model in that the relationship between school and class sizes with achievement proved to be best described by the non-linearity of the Cusp catastrophe model. The critical benchmarks were a school size of 801 students and a class size of 27 students for which increases beyond those thresholds were linked to nonlinearity and unpredictability in school readiness. For this reason, we suggest using the cusp catastrophe model from Nonlinear Dynamical Systems Theory (NDST) to understand more fully such complex phenomena.

Machine Learning-Assisted Survey on Charge Storage of MXenes in Aqueous Electrolytes.

Pseudocapacitance is capable of both high power and energy densities owing to its fast chemical adsorption with substantial charge transfer. 2D transition-metal carbides/nitrides (MXenes) are an emerging class of pseudocapacitive electrode materials. However, the factors that dominate the physical and chemical properties of MXenes are intercorrelated with each other, giving rise to challenges in the quantitative assessment of their discriminating importance. In this perspective, literature data on the specific capacitance of MXene electrodes in aqueous electrolytes is comprehensively surveyed and analyzed using machine-learning techniques. The specific capacitance of MXene electrodes shows strong dependency on their interlayer spacing, where confined H2O in the interlayer space should play a key role in the charge storage mechanism. The electrochemical behavior of MXene electrodes is overviewed based on atomistic insights obtained from data-driven approaches.

Long-term efficacy of balloon dilation of the pediatric Eustachian tube: A six-year matched cohort study.

PURPOSE: Balloon dilation of the Eustachian tube (BDET) has not been evaluated extensively in children outside of retrospective case series. The purpose of this study is to report the long-term safety and efficacy of this procedure in children with matched controls. MATERIALS AND METHODS: This is a two-center retrospective matched cohort study. Children having undergone tympanostomy tube (TT) placement and adenoidectomy with recurrence of symptoms underwent BDET at an academic affiliated multi-specialty practice. Comparison was made with children receiving TT at a tertiary medical center, matching for number of prior TT, prior adenoidectomy, age, and sex. Outcome measures were risk of failure and the need for additional surgery. Kaplan-Meier survival plots were used to compare risk of failure. RESULTS: Thirty-three Eustachian tubes were dilated in 20 patients, aged 14 months-14 years. All patients had previously undergone TT insertion and adenoidectomy. Patients undergoing BDET had normal post-operative tympanograms in 80 % of cases. Mean follow up was 6.7 years with 2 patients failing in the BDET group and 8 in the TT insertion group. Dilated patients had a significantly lower risk of failure than those who underwent TT insertion (adjusted HR: 0.18; 95 % CI: 0.04, 0.81; p = 0.03). The probability of being failure free at six years was 88 % (95 % CI: 71, 95 %) in the BDET cohort and 53 % (95 % CI: 33, 70 %) in the TT insertion cohort. There were no complications. CONCLUSIONS: BDET appears to be safe and possibly superior to TT placement in children with refractory Eustachian tube dysfunction. LEVEL OF EVIDENCE: 2b.

Patulous Eustachian Tube Dysfunction Symptoms Following Balloon Dilation.

OBJECTIVE: Clinicians increasingly perform balloon dilation of the Eustachian tube (BDET) to treat obstructive Eustachian tube dysfunction (OETD) refractory to medical management. Reported complications have been limited and include patulous Eustachian tube dysfunction (PETD). This multicenter study investigates the incidence of PETD and associated factors. METHODS: Consecutive patients at three academic centers undergoing BDET (January 2014-November 2019) for OETD refractory to medical therapy were included. PETD was diagnosed by patient-reported symptoms of autophony of voice and/or breathing. Associated factors studied include age, sex, comorbidities, balloon size, duration of inflation, repeat BDET, and adjunctive procedures. RESULTS: BDET procedures (n = 295 Eustachian tubes) were performed on 182 patients. Mean age was 38.4 years (SD 21.0; range 7-78) and 41.2% were female. Twenty cases of PETD (6.8% of procedures; 9.3% of patients) occurred following BDET. Risk of PETD did not vary by institution, comorbidities, or adjunctive procedure. Age ≤18 years (adjusted risk ratio [RR] = 3.26; 95% confidence interval [CI]: 1.24, 8.54; p = 0.02), repeat BDET (RR = 3.26; 95% CI: 2.15, 4.96; p < 0.001), and severe preoperative Eustachian tube inflammation (RR = 2.83; 95% CI: 1.10, 7.28; p = 0.03) were associated with increased risk of developing PETD in the multivariable model. Most symptoms were reported as mild or intermittent. CONCLUSION: BDET caused PETD symptoms in approximately 7% of dilated Eustachian tubes in this study with increased risk for younger patients and those with severe inflammation or undergoing repeat dilations. Although most cases were self-limited, symptoms can persist. Awareness of risk factors may aid clinicians in limiting this complication. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:3152-3157, 2023.

Pediatric Dysphonia: When to Refer.

The reported prevalence of voice disorders in the pediatric population varies widely between studies, ranging from 3.9% to 23%. Despite this, not all children with dysphonia are referred to a voice specialist for further evaluation. The objective of this study is to examine the relationship between dysphonia history, voice assessment, and laryngeal findings to help guide referrals of dysphonic children. A retrospective review was conducted of pediatric patients at a tertiary voice clinic between January 2014 and December 2017. Data including dates of presentation, demographics, co-morbidities, presenting symptoms, laryngeal exam findings, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores, and Pediatric Voice Handicap Index (pVHI) scores were collected and analyzed. Of 475 patients initially identified, 459 met inclusion criteria and were reviewed. In all, 272 (59.3%) were male and 187 (40.7%) were female. Mean age at first presentation was 8.6 years old (range: 2-18). Males were more likely to present at a younger age than females. CAPE-V data were available for 439 patients, and pVHI data were available for 109 patients. The mean CAPE-V Overall Severity score was 38.2. The mean total pVHI score was 25.4. Males had higher CAPE-V Overall Severity (40.0 vs. 35.4), Roughness (32.2 vs. 27.6), and Strain scores (37.2 vs. 32.4) than females. Patient pVHI scores did not differ by gender. In all, 283 patients self-reported a length of symptoms prior to evaluation. Children with a longer duration of symptoms prior to evaluation had higher CAPE-V Overall Severity scores. Diagnoses of vocal fold movement impairment and benign vocal fold lesions that were not nodules were associated with higher average CAPE-V Overall Severity scores. Overall, 310 patients (67.5%) were recommended intervention for their dysphonia. These patients had higher CAPE-V Overall Severity scores than those who were solely recommended observation (42.8 vs. 28.0). Males were more likely than females to present with dysphonia and presented with more severe perceptual dysphonia scores on average. The length of symptoms and certain diagnoses correlated with higher CAPE-V Scores. Referrals to a pediatric voice clinic should be considered in patients with a dysphonia history lasting greater than 3 months and in patients with more severe symptoms.

Juvenile Nasopharyngeal Angiofibroma: Outcomes Analysis Based Upon Hospital Volume.

OBJECTIVE: To evaluate the management of juvenile nasopharyngeal angiofibroma (JNA) from a national perspective with outcomes comparison based on hospital volume. STUDY DESIGN: Ten-year Pediatric Health Information Systems (PHIS) data analysis. METHODS: The PHIS database was queried for the diagnosis of JNA. Data regarding demographics, surgical approach, embolization, length of stay, charges, readmission, and revision surgery was collected and analyzed. Hospitals were classified as low volume if fewer than 10 cases and high volume if greater than or equal to 10 cases during the study period. A random effects model compared outcomes based on hospital volume. RESULTS: A total of 287 JNA patients were identified with a mean age of 13.8 (± 2.7) years. Nine hospitals were classified as high volume, accounting for a total of 121 patients. The mean length of hospitalization, blood transfusion rate, and 30-day readmissions did not differ significantly by hospital volume. Patients cared for at high-volume institutions were less likely to require postoperative mechanical ventilation (8.3% vs. 25.0%; adjusted RR = 0.32; 95% CI 0.14-0.73; p < 0.01) or return to the operating room for residual disease than patients admitted to low-volume hospitals (7.4% vs. 20.5%; adjusted RR = 0.38; 95% CI 0.18-0.79; p = 0.01). CONCLUSIONS: The management of JNA is complex from both an operative and perioperative management standpoint. Over the past decade, nearly half (42.2%) of JNA patients have been managed at nine institutions in the United States. These centers have significantly lower rates of postoperative mechanical ventilation and the need for revision surgery. LEVEL OF EVIDENCE: 3 Laryngoscope, 133:3216-3220, 2023.

Newborn Hearing Screening Results in Patients with Enlarged Vestibular Aqueduct.

OBJECTIVES: Enlarged vestibular aqueduct (EVA) is the most common anatomic abnormality contributing to permanent hearing loss (HL) in children. Although the association between EVA and HL is well-documented, the pass rate for the newborn hearing screening (NBHS) for patients with EVA-related HL is not. Our objective was to investigate the association between NBHS results and audiologic and clinical outcomes in a large cohort of pediatric patients with EVA. METHODS: This was a retrospective chart review of patients seen in the Boston Children's Hospital (BCH) Department of Otolaryngology and Communication Enhancement with confirmed HL, known NBHS results, and confirmed EVA. Demographic, clinical, audiologic, and imaging data were collected from the medical record. Frequency-specific data points from pure-tone audiograms and/or automated auditory brainstem response tests were recorded, and four-frequency pure tone average was calculated using air conduction thresholds at 500, 1000, 2000, and 4000 Hz. RESULTS: Of the 183 patients included in the study, 84 (45.9%) passed their NBHS, whereas 99 (54.1%) did not pass. Compared with patients who did not pass, patients who passed were more likely to have unilateral EVA and unilateral HL, whereas they were less likely to undergo cochlear implantation and to have causative SLC26A4 variants. CONCLUSIONS: EVA-associated HL may be identified at birth or during childhood, with nearly half the patients in this cohort passing their NBHS. Our results provide prognostic information for patients with EVA who pass their NBHS and highlight the importance of regular hearing monitoring for children not initially suspected of having HL. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:2786-2791, 2023.

Barriers to Voice Therapy in Dysphonic Children.

BACKGROUND: The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy. METHODS: A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between January 2014 and December 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data include demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Distance to therapy site was approximated using patient zip codes. RESULTS: Three hundred and forty-six children were included, 224 (65%) boys and 122 (35%) girls. In the 2 years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs 7.6 [SD 3.8] years; P = 0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs 24.3 [SD 23.9] miles; P< 0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs public). Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs 37.4 [SD 18.0]; P = 0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy. pVHI scores did not differ between the two groups. CONCLUSION: Older age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with higher likelihood of receiving voice therapy. Gender, insurance status, and pVHI scores did not affect likelihood of receiving voice therapy. Patients may primarily consider ease of access and necessity of treatment when considering voice therapy.

Capacity assessment to secure COVID-19 waste treatment in Vietnam.

The accelerated generation of COVID-19 waste under the Delta-fuelled outbreak placed a sudden burden on waste disposal in Vietnam. To secure the treatment of COVID-19 waste amid the pandemic uncertainty, treatment capacity was assessed by determining treatment occupancy rate-the ratio of estimated demand to calculated capacity-both nationally and in Ho Chi Minh City. At the general occupancy rate for COVID-19 waste treatment of 7.4%, the country was capable of handling COVID-19 waste, with a capacity to treat 62 191 t month-1. However, Ho Chi Minh City became overwhelmed, indicated by a treatment occupancy rate of up to 780% during the Delta outbreak, as the unanticipated growth of demand for COVID-19 waste treatment caused waste to back up. The assessment results, in addition to current legislation, support collaboration in waste treatment as a solution to using existing resources to address the acute shortage of treatment capacity, so as to secure COVID-19 waste treatment. The findings could be used by other developing countries to tackle the waste problem in the pandemic era. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-022-01529-z.

Analysis of COVID-19 waste management in Vietnam and recommendations to adapt to the 'new normal' period.

Amid the 4th wave of COVID-19, Vietnam reopened its economy, which placed extra burdens on the COVID-19 waste management system. This study analyzed existing issues and recommended adaptations to secure appropriate management of COVID-19 waste under the 'new normal' pandemic period. Results showed changes in COVID-19 waste characteristics (e.g., rapid rise in waste generation, lower percentage of plastic) and multiple other issues (e.g., presence of COVID-19 waste in municipal waste, lack of temporary storage sites and local treatment capacity), along with greater waste-handling responsibilities placed on authorities and higher infection risks. To adapt to the 'new normal', introduction of separate handling routes and collaboration in waste treatment were recommended. Employing the network of pharmacies used for vaccination would require COVID-19 waste collection from scattered, small-scale sources as part of the waste management solution. Also, following the 4R initiatives (reduce, reuse, recycle, recovery) could help ease the burden on the country's waste system and provide additional opportunities to move towards a circular economy in the post-acute COVID-19 era. The findings should contribute to a safer co-existence with the virus through appropriate waste management in Vietnam and could be used to tackle waste problems in other developing countries. Supplementary Information: The online version contains supplementary material available at 10.1007/s10163-022-01563-x.

Model for projecting the generation of used disposable diapers in the era of depopulation and aging in Japan.

Japan has entered a period of depopulation and aging ahead of any other country. One concern in an aging population is increases in the generation of used disposable diapers. The use of disposable diapers, which are largely composed of plastic, can be an important issue as we work towards building a carbon-free society and break away from using fossil-derived plastics. This study aimed to develop a model to project the future generation of used disposable diapers in each municipality in Japan through 2045 and to identify the effects on municipal solid waste (MSW) management. We revealed the per capita generation of used disposable diapers, distinguishing disposable diaper products, urine and faeces in an online survey of 2000 respondents. The generation of used disposable diapers was estimated to increase in general, but the amount was projected to decrease in rural areas where the population of elderly people would decline. The proportion of used disposable diapers in combustible waste was projected to increase by 2045 in almost all municipalities of Mie Prefecture. Based on the scenario in which disposable diaper products would become lighter in the future because of technical improvements, we concluded that the impact of the decrease in the lower heating value (LHV) of used disposable diapers on the incineration process cannot be ignored in the future.

Utility of telemedicine in tracheostomy-dependent children.

Objectives: Telemedicine can improve access to pediatric otolaryngology care by decreasing travel time and cost, and lowering the risk of viral transmission during the SARS-CoV-2 (COVID-19) pandemic. This study aims to identify the clinical role and outcomes of telemedicine for tracheostomy-dependent children before and during the COVID-19 pandemic. Methods: Retrospective chart review of 42 tracheostomy-dependent pediatric patients who utilized telemedicine between October 2013 and April 2020 (pre-COVID-19), and 111 patients who utilized telemedicine between May 2020 and July 2021 (during COVID-19) at a tertiary free-standing children's hospital outpatient clinic. Results: The majority of pre-COVID-19 telecommunication solely addressed tracheostomy stomal concerns as compared with during COVID-19 (99% vs. 3%, p < .001), while telecommunication during COVID-19 was mainly used for routine follow-up as compared with pre-COVID-19 (99% vs. 0%, p < .001). Telemedicine visits during COVID-19 were significantly less likely to result in the need for in-person office visits as compared with those pre-COVID-19 (4% vs. 22%; p < .001). There was no significant difference in urgent emergency department (ED) evaluation following telemedicine pre- and during COVID-19 (16% vs. 11%). The most common reasons for ED presentation both pre- and during COVID-19 following telemedicine visit included respiratory distress, dislodged tracheostomy tube, and tracheostomy bleeding. Conclusion: The clinical role of telemedicine has evolved from problem-based evaluation to routine follow-up during the COVID-19 pandemic. Although telemedicine can decrease the need for in-person office evaluation of routine tracheostomy concerns, respiratory complications and tracheostomy bleeding still require urgent in-person ED evaluation. Level of evidence: Level 4.

Herpes Zoster and Long-Term Risk of Cardiovascular Disease.

Background We investigated the longitudinal association of herpes zoster (HZ), commonly known as "shingles," and long-term risk of stroke or coronary heart disease (CHD) among participants in 3 large US cohorts, the NHS (Nurses' Health Study), NHS II (Nurses' Health Study II), and HPFS (Health Professionals Follow-Up Study). Methods and Results Participants were 79 658 women in the NHS (2000-2016), 93 932 women in the NHS II (2001-2017), and 31 440 men in the HPFS (2004-2016), without prior stroke or CHD. Information on HZ, stroke, and CHD was collected on biennial questionnaires and confirmed by medical record review. Cox proportional hazards regression models were used to estimate multivariable-adjusted hazard ratios for stroke and for CHD according to years since HZ compared with never HZ. During >2 million person-years of follow-up, 3603 incident stroke and 8620 incident CHD cases were documented. History of HZ was significantly and independently associated with higher long-term risk of stroke and CHD. In pooled analyses, compared with individuals with no history of HZ, the multivariable-adjusted hazard ratios (95% CIs) for stroke were 1.05 (0.88-1.25) among those with 1 to 4 years since HZ, 1.38 (1.10-1.74) for among those with 5 to 8 years since HZ, 1.28 (1.03-1.59) among those with for 9 to 12 years since HZ, and 1.19 (0.90-1.56) among those with ≥13 years since HZ. For CHD, the corresponding multivariable-adjusted hazard ratios (95% CIs) were 1.13 (1.01-1.27) for 1 to 4 years, 1.16 (1.02-1.32) for 5 to 8 years, 1.25 (1.07-1.46) for 9 to 12 years, and 1.00 (0.83-1.21) for ≥13 years. Conclusions HZ is associated with higher long-term risk of a major cardiovascular event. These findings suggest there are long-term implications of HZ and underscore the importance of prevention.

Comparison of outcomes for balloon dilation of the Eustachian tube under local vs general anesthesia.

Objective: To compare the effectiveness of balloon dilation of the Eustachian tube (BDET) under local versus general anesthesia in the treatment of obstructive Eustachian tube dysfunction (OETD). Study Design: Retrospective review. Methods: Consecutive patients ages ≥18 with persistent OETD having failed adequate medical therapy underwent BDET between 2013 and 2018 under local or general anesthesia. Inclusion criteria were persistent type B or C tympanograms with symptoms or type A with symptoms upon barochallenge. Objective outcome measures were tympanometry, otoscopy and the need for additional subsequent intervention (revision dilation and tympanostomy tube). Primary outcome (failure) was defined as no change or worse in tympanogram. Results: The 191 patients (332 ETs), ages 18-88 years (mean 58.0) underwent BDET. The 112 patients (59%) were female. The 107 procedures (32%) were performed under local anesthesia. Mean duration of follow-up was 3.1 years (SD 1.9). Tympanograms improved to type A in 88% for BDET under local and 74% for general anesthesia at 12 months. Probability of being failure-free at 5 years was 70% (95% confidence interval [CI]: 52%-82%) in the local anesthesia group versus 65% (95% CI: 55%-73%) in the general anesthesia group. Risk of failure did not significantly differ between the groups (HR = 0.60; 95% CI: 0.27-1.31; p = .20). Conclusion: BDET under local anesthesia is effective in treating OETD and results in sustained improvements over 2 years. The procedure was successfully performed in all but one case utilizing a precise anesthesia protocol, and results are comparable with the procedure performed under general anesthesia. Level of evidence: 4.

Management of Intracranial Sinusitis Complications in Children and Adolescents: Similarities and Differences Among Otolaryngology Subspecialists.

The purpose of this study was to compare the management of intracranial sinusitis complications in pediatric patients between members of the American Rhinologic Society (ARS) and the American Society of Pediatric Otolaryngology (ASPO). A cross-sectional web-based survey was distributed twice to the ASPO and ARS membership over an 8-month period. The overall survey response rate was 12.1% (7.5% of ARS members and 17.3% of ASPO members). Recommended management was similar with respect to the use of intravenous antibiotics, nasal saline irrigations, topical decongestants, and nasal steroid sprays. Recommendations diverged with regards to systemic steroid use and urgent/emergent endoscopic sinus surgery (ESS). ARS members were more likely to recommend systemic corticosteroids. ASPO members were more likely to recommend immediate ESS. Based on survey responses, we found differences in practice patterns among subspecialists, which indicates additional collaborative research between societies is necessary to develop and disseminate evidence-based guidelines for these patients. Level of Evidence: 4.

Degradation of SARS-CoV-2 specific ribonucleic acid in samples for nucleic acid amplification detection.

The degradation of SARS-CoV-2 specific ribonucleic acid (RNA) was investigated by a numerical modeling approach based on nucleic acid amplification test (NAAT) results utilizing the SmartAmp technique. The precision of the measurement was verified by the relative standard deviation (RSD) of repeated measurements at each calibration point. The precision and detection limits were found to be 6% RSD (seven repeated measurements) and 94 copies/tube, respectively, at the lowest calibration point. RNA degradation curves obtained from NAAT data on four different temperatures were in good agreement with the first-order reaction model. By referring to rate constants derived from the results, the Arrhenius model was applied to predict RNA degradation behavior. If the initial RNA concentration was high enough, such as in samples taken from infected bodies, the NAAT results were expected to be positive during testing. On the other hand, if initial RNA concentrations were relatively low, such as RNA in residual viruses on environmental surfaces, special attention should be paid to avoid false-negative results. The results obtained in this study provide a practical guide for RNA sample management in the NAAT of non-human samples.

Oxygen Redox Versus Oxygen Evolution in Aqueous Electrolytes: Critical Influence of Transition Metals.

Aqueous lithium-ion batteries are promising electrochemical energy storage devices owing to their sustainable nature, low cost, high level of safety, and environmental benignity. The recent development of a high-salt-concentration strategy for aqueous electrolytes, which significantly expands their electrochemical potential window, has created attractive opportunities to explore high-performance electrode materials for aqueous lithium-ion batteries. This study evaluates the compatibility of large-capacity oxygen-redox cathodes with hydrate-melt electrolytes. Using conventional oxygen-redox cathode materials (Li2 RuO3 , Li1.2 Ni0.13 Co0.13 Mn0.54 O2 , and Li1.2 Ni0.2 Mn0.6 O2 ), it is determined that avoiding the use of transition metals with high catalytic activity for the oxygen evolution reaction is the key to ensuring the stable progress of the oxygen redox reaction in concentrated aqueous electrolytes.

Hearing Stability in Patients With Unilateral Hearing Loss Due to Congenital CMV.

OBJECTIVE: To determine the incidence and severity of progressive hearing loss in both ears in a population of longitudinally-tracked patients with unilateral hearing loss due to congenital cytomegalovirus (cCMV). By determining the natural history of unilateral hearing loss due to cCMV infection, we aim to facilitate therapeutic recommendations. STUDY DESIGN: Retrospective chart review. SETTING: Two tertiary care hospitals. METHODS: Pure-tone averages (PTAs) based on yearly audiograms were calculated for each patient for both ears, and changes were assessed using a linear mixed-effects model. RESULTS: A total of 32 patients with cCMV with congenital, unilateral hearing loss were enrolled. Of these, 4 (12.5%) had progressive losses ≥10 dB by PTA in the initially normal-hearing ear. For the hearing-impaired side, the mean (SD) PTA at initial presentation was 67.9 (29.2) dB. Eight patients initially in this cohort had profound hearing impairment, and of the other 24 patients, 17 (70.8%) had hearing loss progression. Hearing levels stabilized in the initially normal-hearing and hearing-impaired ear when patients were approximately 10 and 2 years old, respectively. CONCLUSION: In 32 patients with unilateral hearing loss related to cCMV, 4 (12.5%) exhibited a shift in hearing levels in the normal-hearing ear that progressively stabilized by age 10 years. For ears with congenital hearing loss, progressive stabilization of hearing occurred by age 2 years.

The impact of social distancing during the COVID-19 pandemic on rates of pediatric idiopathic intussusception.

BACKGROUND: The causes of idiopathic ileocolic intussusception are unknown, with infection as the most likely culprit. Recently, social distancing measures were implemented during the coronavirus disease 2019 (COVID-19) pandemic to decrease transmissible infectious diseases, creating an opportune setting to study the role of infection on the pathogenesis of intussusception on a population level. OBJECTIVE: To investigate the impact of social distancing on intussusception. MATERIALS AND METHODS: We retrospectively reviewed air contrast enemas and pylorus ultrasounds performed between March 2010 and March 2021 to identify cases of ileocolic intussusception and hypertrophic pyloric stenosis (HPS), using the latter as a negative control. The study time frame was divided into two periods: pre-pandemic (March 2010-February 2020) and pandemic (April 2020-March 2021). The number of cases that occurred in these two time periods were compared using the Poisson regression model. RESULTS: Of the 407 cases of idiopathic ileocolic intussusception identified, 396 occurred in the pre-pandemic time period (mean = 39.6 per 12-month period) and 11 occurred in the 12-month pandemic time period. The mean monthly number of intussusceptions showed a decline of 72% (95% confidence interval [CI] 49-85%) between the pre-pandemic and pandemic time periods (3.3 vs. 0.9 monthly cases; P < 0.001). In contrast, the mean monthly number of HPS did not differ significantly (P = 0.19). CONCLUSION: Social distancing-imposed to curb the spread of infection during the COVID-19 pandemic-resulted in a significant decline in ileocolic intussusception, lending strong support to the theory that infection is the dominant cause of intussusception.

A Retrospective Study of Hearing Loss in Patients Diagnosed with Peroxisome Biogenesis Disorders in the Zellweger Spectrum.

OBJECTIVES: Peroxisome Biogenesis Disorders in the Zellweger Spectrum (PBD-ZSD) are autosomal recessive disorders characterized by defects in peroxisome function, biosynthesis, and/or assembly. Despite its frequent documentation, hearing loss associated with PBD-ZSD has not been extensively characterized. The purpose of this retrospective natural history study was to better characterize the hearing loss associated with PBD-ZSD and to provide additional insight into the evaluation and management of PBD-ZSD patients with hearing loss. DESIGN: Audiological data from medical records of 42 patients with PBD-ZSD or D-bifunctional protein deficiency were collected from an ongoing longitudinal retrospective natural history study. An initial dataset of 300 audiograms and/or audiometric test results from the 42 patients were used to characterize the degree of hearing loss, type of hearing loss, relationships between air and bone conduction thresholds, age-related changes in hearing loss, and benefit with amplification. RESULTS: The majority of PBD-ZSD patients in this study presented with moderately-severe to severe hearing loss and relatively slow rates of longitudinal changes in hearing sensitivity. Improvements in hearing thresholds were observed with use of hearing aid amplification. Though bone conduction data were limited, air-bone gaps and air conduction threshold fluctuations observed in several patients suggest there may be an increased occurrence of mixed hearing losses in PBD-ZSD populations. CONCLUSION: The results of this retrospective study provide insight into the hearing loss associated with PBD-ZSD, but also emphasize the need for more complete assessments of hearing loss type and middle ear function in these patients. The addition of more comprehensive datasets to the ongoing natural history study will enhance our understanding of the pathophysiology underlying PBD-ZSD and guide the development of targeted evaluation and management recommendations for patients with PBD-ZSD.