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The present study aimed to investigate whether hierarchical plateau among college counselors predicts shifts in emotional labor (surface acting and deep acting) through the mechanism of quiet quitting, and whether career inaction moderates this process. Drawing on conservation of resources theory, it is examined how hierarchical plateau drives this shift through quiet quitting and identify career inaction as a boundary condition. Using a two-wave design with 411 Chinese college counselors, we measured hierarchical plateau, quiet quitting, and career inaction at the first wave and assessed surface and deep acting three weeks later. Results indicate that counselors perceiving greater promotion constraints reported higher quiet quitting, which subsequently increased surface acting while undermining deep acting. The indirect effects through quiet quitting on surface acting and deep acting were significant, and career inaction amplified this process: college counselors who recognized the need for career change yet failed to act were especially prone to withdrawal when facing hierarchical constraints. These findings extend conservation of resources theory by specifying how structural career barriers reshape emotion regulation at work. Practically, the results suggest that addressing quiet quitting among college counselors requires interventions targeting both individual coping and the systemic conditions perpetuating hierarchical plateau.
"Quiet quitting," defined as reducing effort to the minimum required at work, has emerged as a salient feature of post-pandemic labor culture and broader critiques of "workism." Yet, little is known about its implications for mental health or the role of religion in shaping these outcomes. Drawing on data from the 2023 Measuring Employment Sentiments and Social Inequality (MESSI) study (N = 1744), a representative sample of workers in the United States, we examine the association between quiet quitting and psychological distress, and test whether religiosity-beliefs in divine control and religious service attendance-moderates this relationship. Regression results suggest that two dimensions of quiet quitting-not putting in extra effort and an unwillingness to work harder-are both positively associated with psychological distress. However, beliefs in divine control consistently buffered the relationship between quiet quitting and distress. Weekly religious attendance also attenuates distress among those who score low on our extra effort measure, though not among those who are unwilling to work harder. These findings highlight religion as both a cognitive and social resource that shapes how workers interpret and experience disengagement. By integrating research on religion, work, and mental health, we advance knowledge in the contemporary quality of working life.
Myoepithelioma-like tumor of the vulvar region (MELTVR) is a rare SMARCB1-deficient mesenchymal neoplasm of adult women that can mimic malignant vulvar sarcomas, particularly epithelioid sarcoma. Although loss of SMARCB1/INI1 expression is a defining feature, the comprehensive genomic landscape of MELTVR remains poorly characterized. We report two cases of MELTVR and performed integrated histopathologic, immunophenotypic, and molecular analyses, including whole-exome sequencing (WES) with copy number assessment and targeted RNA-based fusion testing using the Archer FusionPlex Sarcoma panel. Histologically, both tumors consisted of relatively uniform epithelioid to short spindle cells in solid nests and cords within focal myxoid stroma, with complete loss of INI1 and positivity for smooth muscle markers and focal ER/EMA expression. Genomic profiling demonstrated a quiet molecular background in both cases, with low tumor mutation burden (0.45 and 1.03 mut/Mb) and no pathogenic SNVs/indels in major cancer-associated genes. One case showed a focal homozygous deletion of the SMARCB1 locus at 22q11.2, whereas the other case exhibited INI1 loss without detectable SMARCB1 mutation or copy number loss, suggesting heterogeneous mechanisms of inactivation. CDKN2A copy number remained neutral in both tumors. No canonical sarcoma-associated gene rearrangements, including EWSR1, FUS, PLAG1, or NR4A3, were identified. Together with a review of previously reported cases, these findings support MELTVR as an SMARCB1-inactivated neoplasm with low genomic complexity and highlight the diagnostic value of NGS-based profiling in excluding malignant mimics and preventing overtreatment.
Silent cerebral infarctions (SCIs) are present in patients with a diagnosis of immune-mediated thrombotic thrombocytopenic purpura (iTTP) at a younger age and with a higher prevalence than in the general population. Prior history of stroke, cardiovascular disease and diabetes are risk factors for SCI in patients with a prior diagnosis of iTTP. Commentary on: Javed et al. Risk factors for silent cerebral infarction in immune-mediated thrombotic thrombocytopenic survivors. Br J Haematol 2026;208(2):654-660.
This study seeks to describe the lived experiences of self-identified introverts throughout a career in academic surgery. Surgeons and leaders are often perceived as extroverted, with the belief that introverts must project extroversion to succeed as surgeons or leaders. However, many surgical trainees entering academic surgery identify as introverted. Semi-structured interviews were conducted with self-identified introverted general surgery residents and attending surgeons at a tertiary academic medical center in the Northeast. Participants were purposively sampled to include junior and senior residents, early- and late-career attendings, and men and women participants. Interview transcripts were iteratively analyzed using inductive thematic analysis with a constructivist approach to develop a theoretical framework describing the experience of introverts in academic surgery. Nine surgical residents and 8 attending surgeons participated in interviews. Four overarching themes were identified: (1) the lived experiences and self-perceptions of introverts are highly individual; (2) introverts must reconcile their preferences with the necessity of extroverted behaviors in academic surgery; (3) introverted preferences for relationship-building often conflict with the interpersonal demands of a career in academic surgery; and (4) introverts evolve over a surgical career through both internally and externally motivated strategies. Introverts experience challenges surrounding the sociocultural conventions inherent to professional advancement in academic surgery. Over time, introspection, paired with support from role models and mentors, permits introverts to demonstrate their value and strengths. This study highlights opportunities for supporting the growth and development of introverts in hopes of fostering greater inclusivity within academic surgery.
With age-related hearing loss on the rise and a large bilingual (BI) population in the United States, there is an increasing need for effective assessment tools for Spanish-speaking and BI older adults. Research in this area is limited. The AzBio Sentence Test (AzBio) is used to assess speech perception in challenging listening environments. A Spanish version was recently developed to address the needs of Spanish-speaking patients, and opens new opportunities for research with BI individuals to better understand speech perception processes in both the native and the second language. This preliminary study aims to explore the characteristics of speech recognition among older BI adults by examining the performance of younger and older proficient Spanish-English BIs on the AzBio in quiet and noisy conditions. Preliminary quasi-experimental group design. Twenty-one participants were divided into three groups: eight young American English monolinguals (M = 28.12 years, range: 24-32), eight young Spanish-English BIs (M = 28.38 years, range: 23-33), and five older Spanish-English BIs (M = 58 years, range: 55-62). The AzBio was used to assess speech perception in quiet and noisy conditions in both English and Spanish, with two signal-to-noise ratios: 0 and -3 dB. Independent and paired sample statistical tests were conducted. In quiet conditions, older BIs outperformed younger ones on the Spanish version, whereas younger BIs performed better in English. However, for the older group, the linguistic advantage observed in quiet conditions disappeared in noisy environments, because performance differences with the younger group diminished when background noise was introduced. Young monolinguals and BIs showed no difference in performance on the English version. Aging poses challenges for speech recognition in noisy environments. For BIs, these difficulties extend to both languages, including the dominant one. The combined effects of bilingualism and aging negatively impact speech recognition in both languages. Understanding how individuals perform on the AzBio and other BI sentence recognition tools is essential for improving clinical assessment and intervention for those impacted by language background and age-related hearing changes.
To assess the safety and efficacy of cochlear implantation in adult patients with single-sided deafness (SSD) through a post-market approval study. Prospective, nonrandomized, single-arm multicenter post-market clinical investigation. Five tertiary referral cochlear implant (CI) centers. Thirty adults older than or equal to 18 years with profound unilateral sensorineural hearing loss (pure-tone average ≥ 80 dB HL and CNC ≤ 5%) and normal/near-normal hearing in the contralateral ear (pure-tone average ≤ 30 dB HL). Unilateral cochlear implantation with an FDA-approved CI system. Changes in speech recognition in quiet and noise, binaural hearing in noise, spatial hearing, tinnitus reduction, and quality of life. Significant improvements in speech perception in quiet and noise were demonstrated from the preoperative to the 12-month postoperative timepoint. Target-to-masker separated hearing tasks showed significant improvements for both head shadow and binaural squelch at the 12-month postoperative timepoint. Significant effects of the CI were also seen for tinnitus reduction, quality of life improvement, fatigue reduction, and self-reported benefits. This prospective, multicenter post-market approval study reports on the outcomes of CI for SSD in a cohort of adult patients. Significant improvements in speech in quiet and noise at 12 months were demonstrated. In addition, significant benefit was observed for all patient-reported outcome measures including tinnitus reduction, listening fatigue, quality of life, and spatial hearing. Cochlear implantation is an excellent treatment option for SSD patients and has a positive impact on many aspects of patients' lives and well-being.
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. 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"). 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). 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.
Rapid and reliable heart-rate (HR) assessment is critical during neonatal resuscitation. Contactless monitoring may serve as a valuable adjunct to conventional methods, but the clinical performance of millimeter-wave radar under routine resuscitation-related maneuvers remains unclear. We evaluated the performance and workflow feasibility of a millimeter-wave multiple-input multiple-output (MIMO) radar system for contactless neonatal HR assessment. In this single-center prospective study, we conducted two sequential experiments. In the factor-quantification experiment, 60 clinically stable neonates in the neonatal intensive care unit (NICU) were monitored simultaneously with radar and a 3-lead ECG bedside monitor as the reference. We assessed HR measurement performance under quiet baseline conditions and four simulated resuscitation-related maneuvers: drying, oronasal suctioning, auscultation, and postural change. Measurement error was quantified using root-mean-square error (RMSE), and agreement was evaluated using Bland-Altman analysis. In the real-workflow experiment, 26 neonates on a radiant warmer in the operating room were enrolled. We analyzed 115 auscultation windows by comparing mean radar-derived HR with auscultated HR at the window level and by stratifying per-second radar-derived HR errors within each window. Under quiet baseline conditions, radar-derived HR showed agreement with ECG, with most RMSE values below the predefined 10-bpm descriptive benchmark. Measurement performance was relatively preserved during simulated drying, suctioning, and auscultation. In contrast, postural change significantly increased error and caused systematic HR underestimation. In the real-workflow experiment, window-level differences between mean radar-derived HR and auscultated HR within auscultation windows were centered near 0 bpm. In the per-second error analysis within auscultation windows, errors of ≤5 bpm were the most frequent category, whereas errors of >15 bpm were uncommon. Millimeter-wave MIMO radar showed relatively small HR measurement error for contactless short-window assessment under quiet baseline conditions, particularly when the infant remained stable and oriented toward the sensor. Postural change was the dominant source of increased measurement error and may limit reliability during thoracic reorientation. These findings support the potential role of radar as an adjunct tool for short-window HR assessment during neonatal care and resuscitation-related conditions. Continuous beat-to-beat accuracy was not validated in this study and requires further investigation using continuous ECG-based reference standards.
Plasma composition in the solar atmosphere differs between the photosphere and corona, producing an observable difference in elemental abundance known as the first ionization potential (FIP) effect. The FIP effect is characterized by the ratio of low to high FIP elements, giving a number known as the FIP bias. FIP bias values vary between different regions of the solar atmosphere, with typical observed values of approximately 1 for coronal holes, approximately 1.5-2 for the quiet Sun and approximately 3 for active regions. The Extreme ultraviolet Imaging Spectrometer (EIS) onboard the Hinode spacecraft has enabled the widespread use of the Si X/S X line pair as a FIP bias diagnostic, but EIS observes other line pairs that can be used to estimate FIP bias. We consider three FIP bias diagnostics observed by Hinode/EIS (Si X/S X, Ca XIV/Ar XIVand Fe XVI/S XIII), comparing the FIP bias between the quiet Sun and an active region. We also assume a range of signal-to-noise ratio (SNR) cut-off values for each pixel, finding that while the SNR cut-off affects the number of useable pixels, higher (lower) SNR cut-offs remove (retain) a tail of high FIP bias values within the measured distribution. However, the median value of the FIP bias distribution remains largely unchanged. These results show the importance of a more nuanced view of FIP bias when using this vitally important diagnostic rather than a simplistic one-size-fits-all approach. This article is part of the Theo Murphy meeting issue 'Solar atmospheric abundances in space and time'.
Traditional sway metrics (path length, sway area) show high inter- and intra-subject variability and ignore the Center-of-Mass (CoM)/Center-of-Pressure (CoP) relationship with the base-of-support (BoS), limiting their ability to fully capture balance control mechanisms in people with multiple sclerosis (PwMS). Does virtual time-to-contact (VTC) provide a more consistent assessment of quiet-stance balance than traditional sway metrics in PwMS and healthy controls? 119 PwMS and 48 matched healthy controls completed three 30 s standing trials under eyes-open, eyes-closed, and foam-surface conditions. CoM (pelvic markers) and BoS (foot markers) were used to compute VTC, path length, and sway area. Mixed ANOVA method examined task and group effects. Consistency was quantified with coefficient of variation (CV; intra-subject variability across trials) and Robust MAD/IQR (inter-subject variability). Bonferroni-corrected paired tests compared metrics. Increasing task difficulty impaired balance across all metrics (p < 0.001). Controls exhibited higher VTC and lower path length and sway area than PwMS (p < 0.001). Across all task conditions and in both groups, VTC displayed the lowest CV compared to path length and sway area (p < 0.001), underscoring its superior trial-to-trial consistency. Similarly, VTC showed the smallest inter-subject variability, with both Robust MAD and IQR significantly lower than those of traditional sway metrics (p < 0.001). By integrating the critical CoM-BoS relationship, VTC yields substantially more consistent quiet-stance measurements than traditional sway metrics in PwMS and controls. Its higher repeatability across trials and lower between-subject spread enhance sensitivity for detecting clinical change and evaluating interventions.
Sequential bilateral cochlear implantation is being increasingly considered in paediatric patients with bilateral profound hearing loss, particularly when the contralateral ear shows limited residual hearing or poor speech discrimination. Although auditory benefits of a second cochlear implant (CI2) have been reported, concerns remain regarding possible vestibular impairment after surgery. This study aimed to provide a preliminary prospective evaluation of early audiological and vestibular outcomes in children undergoing sequential bilateral cochlear implantation and to explore whether the age at implantation or the inter-implant interval influenced longitudinal trajectories. Ten children with prelingual bilateral profound sensorineural hearing loss who underwent sequential bilateral cochlear implantation were prospectively enrolled. Assessments were performed at baseline and during follow-up up to 12 months after CI2 activation. The audiological evaluation included pure-tone audiometry, speech recognition in quiet with CI2 alone and bilaterally, and speech-in-noise testing in frontal and lateralised configurations. The vestibular evaluation included static stabilometry and video head impulse testing. Patient-reported outcomes were assessed using the speech, spatial and qualities of hearing scale for children. Longitudinal changes were analysed using mixed-effects models with false discovery rate correction. Unilateral speech recognition with CI2 improved significantly over time, with median word recognition increasing from 0% at 3 months to 60% at 12 months (p < 0.0001; q = 0.0001). The speech-in-noise performance also improved significantly in the frontal and F1C configurations. Bilateral speech recognition in quiet remained stable at high levels, consistent with a ceiling effect. The vestibular measures were broadly stable at the group level, and the SSQ scores showed modest, non-significant changes. Exploratory analyses did not identify consistent effects of the implantation age or inter-implant interval on longitudinal trajectories. Sequential bilateral cochlear implantation was associated with early auditory benefit, particularly for CI2 unilateral performance and speech perception in noise, without evidence of major short-term vestibular deterioration.
Background/Objectives: This study investigated auditory perception and psychosocial well-being in long-term cochlear implant (CI) users, with a particular focus on the effects of auditory (re)habilitation on learned helplessness and speech-in-noise perception, representing everyday listening performance. Methods: Thirty CI users and thirty peers with typical hearing (TH) participated in the study. Speech perception was assessed using the Hearing in Noise Test (HINT) and the Matrix Test in both quiet and noisy listening conditions. Psychosocial status was evaluated using the Learned Helplessness Scale (LHS), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). Perceived hearing quality was evaluated using the Hearing Implant Sound Quality Index (HISQUI). Results: CI users showed significantly poorer speech perception performance than TH participants (p < 0.05), whereas between-group psychosocial outcomes, including LHS, BDI, and BAI scores, did not differ significantly (p > 0.05). Positive correlations were observed between Matrix and HINT scores in quiet and noisy conditions. Positive associations were also observed between CI hearing thresholds and HINT/Matrix results in noisy conditions. Within the prelingually deaf CI subgroup, age at implantation was correlated with CI thresholds, as well as with speech perception performance across both tests (p < 0.05). Conclusions: Although CI users showed significantly poorer speech perception performance, their levels of learned helplessness, depression, and anxiety were comparable to those of their TH peers. These results suggest auditory benefits following long-term CI rehabilitation, while psychosocial status appears to be within a typical range despite persistent listening difficulties in daily life.
Background/Objectives: Hearing loss is a leading cause of disability worldwide, with speech perception representing a key functional outcome of auditory rehabilitation. While hearing aids improve audibility, outcomes vary substantially across clinical subgroups. This study aimed to compare speech perception outcomes after hearing aid fitting in adults with conductive and sensorineural hearing loss and to identify determinants of variability in rehabilitation outcomes. Methods: This prospective longitudinal observational study included 250 adults with clinically confirmed bilateral conductive or sensorineural hearing loss who underwent standardized audiological assessment, bilateral hearing-aid fitting, immediate post-fitting evaluation, and 3-month follow-up in Kazakhstan between January 2023 and December 2024. Participants were classified as having conductive (n = 100) or sensorineural hearing loss (n = 150) based on audiometric criteria. Speech perception was assessed using a Kazakh-language open-set speech audiometry test. Multivariable linear regression models were used to estimate differences in 3-month aided speech perception after adjustment for the corresponding immediate post-fitting aided score and prespecified demographic, clinical, and audiometric covariates. Linear mixed-effects models were used separately to assess change in aided speech perception from immediate post-fitting to 3 months and to test whether this change differed by hearing-loss type. Propensity score matching was performed as a secondary sensitivity analysis. Results: Patients with conductive hearing loss demonstrated consistently higher speech perception scores than those with sensorineural hearing loss across all conditions. At 3 months, adjusted analyses showed no significant difference between groups for aided speech perception in quiet at 60 dB SPL, whereas sensorineural hearing loss remained associated with lower aided speech perception in noise at 60 dB SPL with SNR +3 dB (β = -1.73; 95% CI: -3.10 to -0.36; p = 0.014). In mixed-effects models assessing repeated aided scores from immediate post-fitting to 3 months, sensorineural hearing loss was associated with lower overall aided speech perception in both quiet and noise conditions. A modest improvement over time was observed only for speech perception in noise, and the group-by-time interaction was not statistically significant. Increasing age, higher tonal thresholds, advanced hearing loss stage, and living alone were independently associated with poorer outcomes. Conclusions: Aided speech perception scores were high after hearing-aid fitting in both conductive and sensorineural hearing loss; however, patients with sensorineural hearing loss showed persistently poorer outcomes, particularly in noise. These findings highlight the importance of incorporating speech-in-noise assessment and addressing clinical and social determinants to support hearing rehabilitation.
Center of pressure (CoP) metrics derived from force plates are widely used to quantify postural control, but laboratory-grade systems limit routine clinical and field implementation. Portable low-cost force plates could enable physiotherapists to monitor balance longitudinally, provided that their measurements are sufficiently reliable and clinically interpretable. This study addresses a gap in the literature by systematically comparing the test-retest reliability of CoP outcomes across bipedal and single-leg stance conditions using a portable low-cost force plate, providing device-specific and task-specific validation data relevant to clinical and field-based implementation. This test-retest reliability study included 27 healthy young adults who completed two laboratory sessions 7-10 days apart. In each session, participants performed three 30-s trials of bipedal quiet stance and three 30-s trials of single-leg stance on each leg barefoot with standardized arm position and visual fixation. Mean values across repetitions were analyzed. Relative reliability was assessed using two-way mixed-effects ICC for absolute agreement (3,1), with 95% confidence intervals. Absolute reliability was quantified using typical error (TE) and coefficient of variation (CV). Paired t-tests evaluated systematic between-session differences. Across all outcomes, single-leg stance demonstrated substantially higher inter-session reliability compared to bipedal stance. Measures of total CoP displacement and velocity during single-leg stance exhibited good to excellent reliability (ICC = 0.85-0.90) and low absolute error (CV ≈ 8%), with direction-specific displacements showing similarly consistent results (ICC = 0.83-0.90; CV generally < 10%). In contrast, the CoP ellipse area and standard deviation measures were considerably less stable (ICC = 0.57-0.79) and displayed markedly higher variability (CV ≈ 16%-23%). The contrast was even more pronounced in the bipedal stance, where reliability was poor to moderate across all parameters (ICC = 0.39-0.65), with the ellipse area exhibiting excessive variability (CV > 60%). Notably, no systematic between-session differences were observed for most outcomes, further supporting the consistency of the measurements. In healthy young adults, single-leg stance provides more reliable CoP measures than bipedal quiet stance when using a portable low-cost force plate. Displacement- and velocity-based outcomes during single-leg stance appear most suitable for repeated assessments and monitoring. MDC95 values should be interpreted strictly as measurement-error thresholds and not as indicators of clinical responsiveness or meaningful clinical change because responsiveness was not evaluated.
To describe cochlear implant outcomes in a patient with bilateral rapidly progressive hearing loss secondary to Kelch-like protein-11 (KLHL11) IgG rhombencephalitis. A 26-year-old male presenting to neurotology clinic at a tertiary care center for evaluation of bilateral rapidly progressive sensorineural hearing loss, unresponsive to systemic corticosteroid therapy. Bilateral simultaneous cochlear implantation. Postimplant speech testing (CNC word, AzBio sentence scoring), and changes to hearing function with fluctuations in systemic disease symptomatology. Preoperative testing demonstrated poor speech perception (bilateral AzBio sentence in quiet: 43%, right-sided CNCw score: 38%, and left-sided CNCw score: 0%). Despite systemic disease progression of KLHL11-IgG rhombencephalitis, including worsening cerebellar ataxia and dysarthria, cochlear implant performance did not decrease at the time of last follow-up. At 1-year, binaural and monaural speech testing were both significantly improved compared with the 1-month testing (bilateral AzBio sentence in quiet: 91%, right-sided CNCw score: 70%, and left-sided CNCw score: 32%). Cochlear implantation may offer meaningful auditory rehabilitation in patients with KLHL11-IgG associated rhombencephalitis with relative auditory nerve sparing, despite ongoing disease progression. Further studies are required to evaluate the durability and generalizability of cochlear implantation across the spectrum of disease-related hearing loss.
The COVID-19 pandemic accelerated burnout, attrition, and psychological disengagement without formal departure-termed "quiet quitting." Variable-centered methods obscure heterogeneity in how workers adapt to sustained adversity, and no prior study has applied Latent Profile Analysis (LPA) across the full pandemic-to-endemic transition. To identify latent profiles of healthcare workers based on teamwork climate, job satisfaction, and emotional exhaustion, and to describe their annual distribution across six survey waves (2020-2025) at a Taiwanese medical center. This repeated cross-sectional study analyzed 16,730 anonymous annual responses using the Taiwan Patient Safety Culture Survey. LPA was applied to teamwork climate, job satisfaction, and emotional exhaustion (reverse-coded). Multinomial logistic regression modeled survey year as continuous and categorical (2020 reference). Three profiles emerged: Balanced and Resilient (52.6%), Dedicated but Exhausted (24.2%), and Disengaged ("quiet quitter," 23.1%). The Dedicated profile peaked in 2021 (31.2%) and declined; the Disengaged profile reached 27.5% in 2023 (adjusted OR 1.27, 95% CI 1.10-1.46, p = 0.001). Female sex, nursing role, and 3-10-year tenure were each independently associated with disengagement. Combining low teamwork and satisfaction with preserved well-being, this profile admits two readings-commitment erosion or adaptive boundary-setting. At the population level, the Dedicated but Exhausted share declined while disengagement rose during the peak crisis and partially receded. Profile-specific responses-workload relief for the Exhausted, trust-rebuilding for the Disengaged-should address each demographic association independently. Longitudinal designs with behavioral outcomes are needed to test whether profile membership predicts subsequent organizational behavior.
To compare operative times and audiometric outcomes between robotic-assisted cochlear implantation (CI) and manual insertion. Retrospective study. Tertiary academic center. Patients undergoing CI between October 2022 and October 2024. Robotic-assisted or manual CI. Operative time and audiometric outcomes between techniques. Fifty-one patients (17 robotic-assisted, 34 manual) were included. Demographics were similar between cohorts, although the robotic cohort was older {median [interquartile range (IQR)] 74.4 y [56.1 to 83.1] vs. 60.1 y [42.3 to 72.5], P=0.025}. Operative time did not differ significantly; robotic-assisted cases showed a median increase of ~20 minutes with substantial interquartile overlap and no statistically significant difference (P=0.171). Preoperatively, the robotic cohort demonstrated higher aided speech perception [consonant-nucleus-consonant word (CNC-w) 22% vs. 0%, P=0.003; (CNC phoneme) CNC-p 45% vs. 15%, P=0.014; AzBio-Quiet 28% vs. 5%, P=0.006] and better low-frequency thresholds (250 to 500 Hz; 60 vs. 72.5 dB HL, P=0.003), whereas unaided speech reception threshold (SRT), word recognition score (WRS), and pure-tone average at 0.5, 1, 2, and 3 kHz (PTA) did not differ. Postoperatively, both cohorts improved, with no significant between-group differences at 3, 6, or 12 months or most recent follow-up for SRT, CNC-w, CNC-p, AzBio-Quiet, or aided PTA. Robotic-assisted CI electrode insertion was associated with a limited, non-statistically significant operative time increase and similar short-term to intermediate-term audiometric outcomes compared with manual insertion.
Healthy aging is often accompanied by a loss of hearing sensitivity and a reduced ability to understand speech in both quiet and noisy environments. From a physiological perspective, neural oscillations are thought to fundamentally contribute to parse the speech signal into meaningful units and to extract linguistically relevant information at multiple hierarchical levels. Given that syllables are essential structural elements of the speech signal that recur with quasi-rhythmic periodicity and are firmly anchored in slow amplitude modulations of the acoustic envelope, we exploited the potential of frequency-tagging to examine effects of pure-tone hearing loss and background noise on syllable representation at the neural level. We used electroencephalography and compared peak amplitudes in a narrow-band frequency range corresponding to the syllabic speech rate in two samples of older adults with normal hearing (N=44) and mild-to-moderate age-related hearing loss (N=38) while participants listened to naturalistic sentences presented in quiet or embedded in multi-talker babble noise. The behavioral indices confirmed that the multi-talker babble noise condition was more demanding, and that hearing loss was generally associated with reduced intelligibility, but not with lower comprehension. Notably, the effects of background noise and hearing loss were also clearly represented at the cortical level, with similar neural response properties. In fact, both acoustically and physiologically impoverished speech signals were expressed in a weaker neural representation of syllables. These results provide neurophysiological evidence for an analogous but qualitatively different neural attenuation of syllable representation under adverse listening conditions and in individuals with pure-tone hearing loss.
Objective Previous studies of finger pulse plethysmography have used large changes in finger height to assess how pressure influences light transmission. Light transmission is affected by pulsation transmitted from the arterial pressure, and also by the volume of blood held in the finger vasculature. Smaller changes of hand height, in relation to the neck, could elucidate more precisely the pressures and mechanisms associated with vascular volume changes.
Approach We studied 18 (15 male, 3 female) healthy young volunteers in warm quiet surroundings, with one arm supported horizontally at the level of the shoulder. Comparisons were made with the hand placed 5 cm above and 5 cm below the horizontal, in random sequence. Red and infrared transmission were recorded from a standard pulse oximeter finger probe. Sections of recording were chosen where short periods of vasoconstriction were absent. Total absorbance values at peak and trough, and absorbance pulse amplitude, were calculated. We compared measures in the two hand positions, and before and after inflation of a cuff at the wrist, within each subject.
Main results In the dependent position, infrared light absorbances were greater: peak, 0.054 (0.043, 0.070) and trough (0.053 (0.045, 0.069) (median, quartiles) (P < 0.0001). Pulse amplitude was unaffected. Cuff inflation had no effect on the peak and trough values, but pulse amplitude decreased: the difference between paired values for infrared was 0.0049 (0.0075, 0.0015) and red, 0.0030 (0.0043, 0.0010) (median paired difference, 95% confidence limits). (P < 0.005).
Significance The minimal effect of cuff venous obstruction supports previous work reporting flow limitation in venous drainage of the arm. Our observations suggest that an increase in filling pressure caused by lowering the hand by 10 cm increases overall blood volume in the finger, suggesting that the plethysmograph waveform may result from pressure changes much less than arterial.