Faculty Bibliography

OBJECTIVES/OBJECTIVE:Prior research has shown that, among normal hearing college students, Hispanic-identifying participants experience higher levels of environmental noise and lower signal to noise ratios as compared with White non-Hispanic participants. The primary objective of this study was to examine whether these differences extend to cochlear implant (CI) users by using CI datalogging to quantify characteristics of the listeners' auditory environments. The authors further examined whether differences in auditory environments between groups persisted after controlling for demographic and socioeconomic factors. The primary socioeconomic variable of interest was population density, as it strongly correlates with other socioeconomic factors (e.g., education and income) and is more likely to directly influence auditory environments. DESIGN/METHODS:A retrospective chart review of CI patients at a tertiary medical center in New York City identified 80 adults (38 Hispanic, 42 White non-Hispanic) for further review. Demographic variables were compiled, and home addresses were used to obtain population-based socioeconomic data via the U.S. Census. Datalogging information extracted from the CI speech processor included hours of total use and time spent in different auditory environments, classified by the CI software into sound levels (in dBA) and sound scenes ("noise," "quiet," "speech in noise," "speech in quiet," "music," and "other"). RESULTS:Despite similar levels of device usage, there was a statistically significant group difference in the percentage of time spent in each scene: Hispanic-identifying participants spent more time in "speech in noise," "music," and "noise"; White non-Hispanics spent more time in "quiet" and "other." The Hispanic participants lived in census tracts with higher population density, which correlated with higher sound levels (>70 dBA) in the environment. Group differences in auditory environments remained statistically significant after controlling for age, CI experience, and population density (median daily level difference ~2.4 dB). CONCLUSIONS:Even after accounting for demographic and socioeconomic factors, the two groups showed distinct auditory environments, indicating a possible cultural contribution to these differences. Audiologists counseling CI patients regarding auditory environments should be conscious of their patients' cultural background and may consider the impact of listening preferences when advising on which environments to seek out or avoid.

PURPOSE/OBJECTIVE:Obesity is increasingly encountered among patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory or cardiac failure. It alters respiratory and cardiovascular physiology and drug pharmacokinetics and introduces technical and logistical challenges that may complicate patient selection, ECMO initiation, cannulation, anticoagulation, and monitoring. This review summarizes current evidence regarding the epidemiology, physiological implications, outcomes, and management of obesity in patients supported with veno-venous (VV) or veno-arterial (VA) ECMO. RESULTS:Available evidence, largely retrospective and based on body mass index classifications, suggests that obesity should not be considered a contraindication to VV-ECMO, with outcomes comparable to or potentially better than those of patients without obesity. However, obesity-related respiratory mechanics may exaggerate the apparent severity of lung injury, emphasizing the need for optimized conventional ARDS management, including appropriate ventilatory strategies and prone positioning, before ECMO initiation. In contrast, outcomes during VA-ECMO are more heterogeneous, particularly in extracorporeal cardiopulmonary resuscitation (ECPR), and may be influenced by patient selection, comorbidities, and timing of support. Obesity also creates important technical challenges requiring individualized cannulation, anticoagulation, and perfusion strategies. CONCLUSION/CONCLUSIONS:Obesity alone should not preclude access to ECMO, particularly VV-ECMO. Successful management requires anticipation of obesity-related challenges, appropriate infrastructure, and structured multidisciplinary protocols. Further prospective studies are needed to clarify obesity-specific risks, optimize management strategies, and evaluate long-term outcomes.

OBJECTIVE:Pediatric tracheostomy emergencies are high-acuity events requiring rapid, coordinated team-based care. This study assessed objective team performance and used in situ simulation to identify systems factors, including latent safety threats (LSTs) and resilience supports, that influence pediatric tracheostomy emergency readiness across diverse clinical settings. METHODS:In situ simulations of pediatric tracheostomy emergencies (obstructed or partially dislodged tubes) were conducted across inpatient floors, critical care units, and emergency departments at 11 pediatric hospitals. Time to completion of critical actions was recorded using the NeoCHART+™ for PEAK-II mobile application. Structured debriefs identified LSTs and resilience supports at unit and hospital levels. Multivariable Cox proportional hazards models assessed predictors of time-critical actions (tube replacement, suction, first effective ventilation) and the percentage of critical actions completed. RESULTS:Sixty-seven baseline simulations were conducted across 11 institutions. Seventy-seven percent of teams replaced an identical tracheostomy tube within 5 minutes (median 188.4 seconds, [IQR 165.3, 204.6]). Teams reported a median of 3.2 LSTs per simulation (IQR 3.0, 4.0). Common LSTs included attempted ventilation through occluded tracheostomy tubes, unclear leadership, ambiguous role definitions, and non-standardized equipment locations. Teams with a RT and at institutions with a dedicated tracheostomy team performed time-critical actions faster. DISCUSSION/CONCLUSIONS:In situ simulation revealed LSTs, resilience supports, and performance variability that may influence effective pediatric tracheostomy emergency response at the systems level. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Variability identified in systems factors and team performance can guide targeted interventions to improve pediatric tracheostomy emergency preparedness.

Bacterial keratitis (BK) is a common subtype of infectious keratitis, the most common cause of corneal blindness globally. While antibiotics are the mainstay of treatment for BK, numerous nonantibiotic treatments and adjuncts have emerged in recent years. These include, but are not limited to, collagen cross-linking, phototherapy, immunomodulators, and various forms of transplantation. The purpose of this work is to provide a comprehensive summary of the current literature, highlight promising areas of progress, and identify gaps and areas for further work in the management of BK. With rising resistance to antibiotics, this review echoes and emphasizes the call to study and establish alternative and adjunctive strategies for BK treatment.

BACKGROUND:Chronic axial spinal pain is one of the leading causes of disability. The literature demonstrates that expenditures for low back and neck pain continue to rise, not only in parallel with increasing disability, but also with escalating healthcare costs, accounting for the highest spending among multiple disease categories. Based on current evidence utilizing controlled diagnostic blocks, facet joints, nerve root dura, and sacroiliac joints have been identified as potential sources of spinal pain. STUDY DESIGN/METHODS:A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. OBJECTIVE:To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. METHODS:Methodological quality of the included studies was assessed using the Quality Appraisal of Reliability Studies (QAREL) instrument. Only diagnostic accuracy studies meeting at least 50% of the predefined inclusion criteria were included in the analysis.The strength of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria. Levels of evidence were classified using a modified best evidence synthesis, ranging from Level I to Level V.Data sources included relevant literature identified through PubMed and other electronic searches published from 1966 through September 2025, Cochrane reviews, and manual searches of the bibliographies of primary and review articles. OUTCOME MEASURES/METHODS:Eligible studies were required to use placebo-controlled or comparative local anesthetic blocks. A positive diagnostic standard was defined as at least 50% pain relief from baseline scores along with the ability to perform previously painful movements. RESULTS:The available evidence demonstrated Level I for lumbar facet joint nerve blocks, based on 18 studies employing dual diagnostic blocks, demonstrating 75% to 80% pain relief, with an average prevalence of 16% to 45% and estimated or presumed false-positive rates of 25% to 50%.Evidence for the diagnosis of cervical facet joint pain using cervical facet joint nerve blocks is Level II, derived from 12 controlled diagnostic accuracy studies, showing substantial heterogeneity and internal inconsistency. Reported prevalence ranged from 36% to 67% with ≥ 80% pain relief and estimated or presumed false-positive rates of 26% to 63%.The level of evidence for the diagnostic accuracy of thoracic facet joint nerve blocks is Level II, based on 3 studies using dual diagnostic blocks, demonstrating 80% or greater pain relief, with prevalence ranging from 34% to 48% and estimated or presumed false-positive rates ranging from 42% to 58%. LIMITATIONS/CONCLUSIONS:Limitations of this systematic review include the limited number of studies involving the thoracic spine, ongoing debate regarding the appropriate reference standard, challenges in determining false-positive rates, concerns regarding the appropriateness of diagnostic blocks, the scarcity of recent publications, and issues related to clinical utility. CONCLUSION/CONCLUSIONS:There is Level I evidence for the diagnostic accuracy of lumbar facet joint nerve blocks and Level II evidence for cervical and thoracic facet joint nerve blocks in the evaluation of chronic spinal pain.

BACKGROUND:This study evaluated differences in surgical and clinical outcomes among patients who have identical versus different implant sizes in sequential total knee arthroplasty (TKA) surgeries. METHODS:We retrospectively reviewed patients who underwent primary, elective, staged, bilateral, same-surgeon, same-prosthesis TKA between 2011 and 2024 at a large academic health system. Patients were grouped by femoral and tibial implant size consistency: same femoral and tibial (SS), different femoral, same tibial, different tibial, same femoral, and different femoral and tibial (DD). RESULTS:A total of 4,536 TKAs were performed in 2,268 patients. The SS had the shortest length of stay compared to DD (51.8 versus 58.2 hours, P < 0.001). The majority had the same femoral (75.6%) and tibial (76.6%) sizes in both knees, whereas polyethylene thickness varied. Undergoing contralateral surgery within one year was associated with receiving the same implant sizes (P < 0.001). The DD were more common in manual surgery, and the SS were more common using navigation assistance (P < 0.001). Different assistance modalities between surgeries increased different femoral, same tibial and DD, whereas the same navigation assistance increased SS (P < 0.001). Complication and revision rates were not significantly different between the groups. All groups showed improvement in their Knee injury and Osteoarthritis Outcome Score for Joint Replacement and Patient-Reported Outcomes Measurement Information System Pain Intensity and Interference scores with no significant intergroup differences (P > 0.05). CONCLUSIONS:Over one-third of patients (37.3%) undergoing staged, bilateral TKA received different implant sizes for at least one component, and over half had different polyethylene thicknesses. Although implant size consistency was influenced by factors such as time between surgeries and assistance modality, these variations did not significantly affect length of stay, complications, or patient-reported outcomes. Surgeons should be aware that minor implant size differences between knees are common, even when using the same prosthesis.