Ear & Hearing

Introduction: Auditory brainstem response (ABR) is a standard objective method for estimating hearing threshold, especially in patients who cannot reliably participate in behavioral audiometry. However, ABR interpretation is usually performed by an expert. This study evaluated whether two general-purpose artificial intelligence (AI) multimodal large language model (LLM) chatbots, ChatGPT and Qwen, can accurately estimate ABR hearing thresholds from ABR waveform images. The accuracy was measured by comparisons with the judgements of 3 expert audiologists. Methods: A total of 500 images each containing several ABR waveforms recorded at different stimulus intensities were analyzed. Three expert audiologists established the reference auditory thresholds based on visual identification of wave V at the lowest stimulus intensity, with the most frequent judgment among the three used as the reference. Each waveform image was independently submitted to ChatGPT (version 5.1) and Qwen (version 3Max) using the same standardized prompt and without additional clinical context. Agreement with the expert thresholds was assessed as mean errors and correlations. Sensitivity and specificity for detecting hearing loss (>20 dB nHL) were also calculated. In cases where the AI and expert thresholds nominally matched, corresponding latency measures were also compared. Results: Auditory thresholds derived from both LLMs correlated strongly with expert opinion, with Pearson r = 0.954 for ChatGPT and r = 0.958 for Qwen. ChatGPT showed a mean error of +5.5 dB and Qwen showed a mean error of -2.7 dB. Exact nominal agreement with expert values was achieved in 34.6% of ChatGPT estimates and 35.6% of Qwen estimates; agreement within +/-10 dB was observed in 75.6% and 80.0% of cases, respectively. For hearing-loss classification, ChatGPT achieved 100% sensitivity but low specificity (20.4%), whereas Qwen showed a more balanced profile with 91.6% sensitivity and 67.5% specificity. Curiously, estimates of wave V latency were markedly poor for both LLMs, with systematic underestimation and weak correlations with the expert judgements. Conclusion: ChatGPT and Qwen demonstrated a moderate ability to estimate ABR thresholds from waveform images, although their performance was not good enough for independent clinical use. Both models captured general patterns of hearing loss severity, but there was systematic bias, limited specificity and sensitivity balance, and poor latency estimation. General-purpose multimodal LLMs may have potential as assistive or preliminary tools, but clinically reliable ABR interpretation will likely require specialized, domain-trained AI systems with expert oversight.

Conductive hearing loss (CHL) with a normal otoscopic exam can be difficult to diagnose because routine clinical measures such as audiometric air-bone gaps (ABGs) can identify a conductive component but often cannot distinguish among specific underlying mechanical pathologies (e.g., stapes fixation versus superior canal dehiscence, which may produce similar audiograms). Wideband tympanometry (WBT) is a fast, noninvasive test that can provide additional mechanical information across a broad range of frequencies (200 Hz to 8 kHz). However, WBT metrics are influenced by variations in ear canal geometry and probe placement and can be challenging to interpret clinically. In this study, we extend prior WBT absorbance-based classification work by estimating the middle ear input impedance at the tympanic membrane (ZME), a WBT-derived metric intended to reduce ear canal effects. To estimate ZME, we fit an analog circuit model of the ear canal, middle ear, and inner ear to raw WBT data collected at tympanometric peak pressure (TPP). Data from 27 normal ears, 32 ears with superior canal dehiscence, and 38 ears with stapes fixation were analyzed. A multinomial logistic regression classifier was trained using principal component analysis (retaining 90% variance) and stratified 5-fold cross-validation with regularization. We compared feature sets based on ABGs alone, ABGs combined with absorbance, and ABGs combined with the magnitude of ZME. The combination of ABGs and the magnitude of ZME produced the best performance, achieving an overall accuracy of 85.6% compared to 80.4% for ABGs alone and 78.4% for ABGs combined with absorbance. These results suggest that incorporating model-derived middle ear impedance features with standard audiometric measures (ABGs) can improve automated pathology classification for stapes fixation and superior canal dehiscence.

Objectives: Patients with Cystic fibrosis (CF) often receive aminoglycosides (AGs) to manage recurrent pulmonary infections, placing them at risk for ototoxicity. Chronic AG use can lead to complex cochlear damage affecting inner and outer hair cells, the stria vascularis, and spiral ganglion neurons. The greatest damage is typically in the basal cochlear region, which encodes high-frequency hearing, with additional involvement of more apical regions. While extended-high-frequency (EHF) hearing loss (EHFHL; 9-16 kHz) is often the earliest sign of AG ototoxicity, speech in noise (SiN) effects are rarely studied. Our overall hypothesis is that SiN perception difficulties in individuals with CF, treated with AGs, are related to combined cochlear and neural damage, primarily in the EHF range but also in the standard frequency (SF; 0.25-8 kHz) range. Three mechanisms that contribute to SiN perception were evaluated in children and young adults: 1) a primary effect of reduced EHF sensitivity, measured by pure-tone audiometry (PTA) and transient-evoked otoacoustic emissions (TEOAEs); 2) a secondary effect of subclinical damage in the SF range, measured by PTA and TEOAEs; and 3) additional neural effects, measured by middle ear muscle reflex (MEMR) threshold (afferent) and growth functions (efferent).Design:A total of 185 participants were enrolled; 101 individuals with CF treated with intravenous AGs and 84 age and sex-matched Controls without hearing concerns or CF. Assessments included EHF and SF PTA; the Bamford-Kowal-Bench (BKB)-SIN test for SiN perception; double-evoked TEOAEs with chirp stimuli from 0.71 to 14.7 kHz; and ipsilateral and contralateral wideband MEMR thresholds and growth functions using broadband stimuli. Results: Reduced sensitivity at EHFs (PTA, TEOAEs) was not associated with impaired SiN perception in the CF group. SF hearing, regardless of EHF status, was the primary predictor of SiN performance in the CF group. Increased MEMR growth was also significantly associated with poorer SiN in the CF group. Conclusions: In CF, impaired SiN perception was primarily predicted by SF hearing impairment, with additional involvement of the efferent auditory pathway through increased MEMR growth. These results build on prior evidence for efferent neural effects due to ototoxic exposures, supporting both sensory (afferent) and neural (efferent) mechanisms that contribute to listening difficulties in CF. Thus, preventive and intervention strategies should consider these combined mechanisms in people with AG ototoxicity to address their SiN problems.

ObjectiveThe objective of this study is to assess the quality, empathy, and readability of large language model (LLM) responses regarding otologic questions from patients as they compare to verified physician responses in other patient-driven forums. This study aims to predict the potential utility of LLMs in patient-centered communication. Study DesignComparative study SettingsInternet MethodsA sample of 49 otology-related questions posted on Reddit r/AskDocs1 between January 2020 and June 2025 were selected using search terms including "hearing loss," "ear infection," "tinnitus," "ear pain," and "vertigo." Posts were retrieved using Reddits "Top" filter. Each question was answered by a verified doctor on Reddit and three AI LLMs (ChatGPT-4o, ClaudeAI, Google Gemini). Responses were scored by five evaluators. ResultsCommon otologic concerns posed in patient questions were otalgia (38.7%), vertigo (28.6%), tinnitus (24.5%), hearing loss (22.4%), and aural fullness (20.4%). LLM responses were longer than physician responses (mean 145 vs 67 words; p < .05) and rated higher in quality (10.95 vs 9.58), empathy (7.26 vs 5.18), and readability (4.00 vs 3.73); (all p < .05). Evaluators correctly identified AI versus physician responses in 89.4% of cases with higher sensitivity for detecting physician responses (93.5%). By Flesch-Kincaid grade level, ChatGPT produced the most readable content (mean 7.25), while ClaudeAI responses were more complex (11.86; p < .05). ConclusionLLM responses received higher ratings in quality, empathy, and readability than those of physicians in response to a variety of otologic concerns. When appropriately implemented, such systems may enhance access to understandable otologic information and complement clinician-delivered care.

Cochlear implant (CI) users typically experience difficulties perceiving musical harmony due to a restricted spectro-temporal resolution at the electrode-nerve interface, resulting in limited pitch perception. We investigated how stimulus parameters affect discrimination of complex-tone triads (three-voice chords), aiming to identify conditions that maximize perceptual sensitivity. Six post-lingually deafened CI listeners completed a same/different task with harmonic complex tones, while spectral complexity, voice(s) containing a pitch change, and temporal synchrony (simultaneous vs. sequential triad presentation) were manipulated. CI listeners discriminated harmonically relevant one-semitone pitch changes within triads when spectral complexity was reduced to three or five components per voice, with significantly better performance for three-component compared to nine-component tones. Sensitivity was observed for pitch changes in the high voice or in both high and low voices, but not for changes in only the low voice. Single-voice sensitivity predicted simultaneous-triad sensitivity when controlling for spectral complexity and voice with pitch change. Contrary to expectations, sequential triad presentation did not improve discrimination. An analysis of processor pulse patterns suggests that difference-frequency cues encoded in the temporal envelope rather than place-of-excitation cues underlie perceptual triad sensitivity. These findings support reducing spectral complexity to enhance chord discrimination for CI users based on temporal cues.

Functional near infrared spectroscopy (fNIRS) is increasingly used in hearing and communication research, with advantages such as robustness to movement artifacts, improved spatial resolution, and flexibility of contexts in which it can be applied. At the same time, the field is progressively moving towards more continuous, naturalistic listening paradigms resulting in the widespread adoption of speech tracking analyses such as temporal response functions (TRFs) in electroencephalography (EEG) and magnetoencephalography (MEG) studies. However, it remains unclear whether these analyses can be applied to slower haemodynamic signals measured by fNIRS. In the present study, we investigated whether a TRF framework can similarly be applied to fNIRS data recorded during continuous speech perception. Eight participants listened to speech simultaneously while fNIRS signals were acquired in a hyperscanning setup. Speech features were regressed onto the haemodynamic responses to test the feasibility and interpretability of fNIRS-based TRFs. Prediction correlations between observed and modelled fNIRS signals across speech features were higher than those typically reported for EEG- and comparable to those reported for MEG-TRF studies. Moreover, these correlations did not overlap with a null distribution generated from triallJmismatched fNIRS data, confirming statistical significance and were slightly greater than those obtained from a conventional GLM approach. Our findings support that TRF estimation method can yield meaningful and statistically significant responses from fNIRS data. HighlightsO_LITRF modelling can be meaningfully applied to fNIRS data acquired during speech listening tasks. C_LIO_LIPrediction correlations between actual and modelled fNIRS signals were above chance level, with values comparable to previous EEG/MEG studies. C_LIO_LITRFs explained more fNIRS variance than a conventional GLM approach. C_LI

Objective Cerebral palsy (CP) affects approximately 1 million Americans and 18 million individuals worldwide, yet contemporary US epidemiologic data remains limited. We aimed to use Cerebral Palsy Research Network (CPRN) clinical registry to describe demographics and clinical characteristics of individuals with CP across the US and determine associations with gross motor function and genetic etiology. Methods Registry subjects were included if they had clinician-confirmed CP and prospectively entered data for Gross Motor Function Classification System (GMFCS) Level, gestational age, genetic etiology, CP distribution, and tone/movement types. Logistic regression was used to determine which of these variables plus race, sex, ethnicity, and age were associated with GMFCS level and genetic etiology. Results A total of 9,756 children and adults with CP from 22 CPRN sites met inclusion criteria. Participants were predominantly White (73.0%), male (57.3%), non-Hispanic (87.8%), and younger than 18 years (73.7%). Most were classified as GMFCS levels I-III (55.6%), born preterm (52.8%), had spasticity (83.8%), and had quadriplegia (41.9%); 12.2% were identified as having a genetic etiology. Tone/movement types, CP distribution, and gestational age were significantly associated with both GMFCS level and genetic etiology (p<0.001). Compared to White individuals, Black individuals were more likely to have greater gross motor impairment (p<0.001). Conclusion In this large US cohort, clinical and demographic factors, including race, were associated with gross motor function and genetic etiology in CP. These findings highlight persistent disparities and demonstrate the value of a national clinical registry for informing prognostication, quality improvement efforts, and targeted genetic testing strategies.

Background Functional neurological disorder (FND) is a common neurological condition characterised by symptoms which vary characteristically with attention. In the sensory realm, these symptoms frequently take the form of 'phantom' perception in the absence of sensation. While the condition is generally regarded not to cause auditory symptoms, tinnitus is a phantom perception which varies with symptom-focused attention, and is suggested to have similar underlying mechanisms to those proposed for FND. Based on this, we hypothesized that tinnitus might reflect the same underlying process as FND, and that it would therefore be more common in people with FND (pwFND). Methods Using an international database, we compared the proportions of pwFND who reported tinnitus with a control group. To ensure that observed differences were not attributable to agreement bias in symptom reporting, we also conducted an experiment where pwFND and controls were asked to report which symptoms they had experienced in the past month, 14 of which were symptoms of FND, and 7 of which were unrelated. Results Rates of tinnitus were significantly higher in the FND group (54% HDI 50 - 57%, n=732) than the control group (17% HDI 8.5 - 25%, n=59). In the symptom reporting experiment, pwFND (n=38) reported more FND-related symptoms than controls (n=38), but there was no between-group difference in reporting of non-FND related symptoms. Discussion Based on the markedly higher prevalence of tinnitus in pwFND than controls, and the substantial overlap in mechanisms and phenomenology, we believe tinnitus should be considered a possible symptom of FND, where both conditions reflect a failure of symptom resolution after incitement by a peripheral stimulus.

Background Phonemic awareness deficits are a core feature of Specific Learning Disorder-Reading (SLD-R). How task- and language-specific factors influence these deficits in alphasyllabary languages may help clarify the cognitive mechanisms underlying reading impairment in SLD-R. Methods Thirty children with a DSM-5 diagnosis of SLD-R (mean age 11.4 years) and 29 age-matched typically developing children were given phoneme blending (words and pseudowords) and segmentation tasks in Malayalam. The effects of age and consonant clusters on task performance were evaluated. Results Children with SLD-R performed significantly worse than controls across most phonemic awareness tasks, with the largest deficits observed in pseudoword blending and word blending, and smaller deficits in segmentation. No significant difference was observed for initial phoneme deletion. In typically developing children, age showed strong positive correlations with phonemic performance across most tasks, whereas the SLD-R group showed weak or absent correlations, except in word blending and initial phoneme deletion. Consonant clusters significantly affected performance in both groups, with SLD-R showing more severe deficits. Conclusions Phonemic awareness deficits observed in SLD-R in alphasyllabary languages like Malayalam are more prominent in tasks where lexical support is absent, like pseudoword blending. These deficits vary across task types and linguistic complexity. Phonemic awareness improves with age in typically developing children, while improvement is uneven in children with SLD-R. The findings suggest that phonemic awareness deficits are a core feature of SLD-R across languages, but their manifestation is shaped by orthographic and linguistic characteristics of the writing system.

Background. Brain development is altered in neonates with congenital heart disease (CHD). However, development in the perioperative period remains incompletely understood. Purpose. This study used Structural Covariance Component (SCC) analysis to identify brain regions showing spatial patterns of coordinated expansion and contraction that differ between neonates with CHD after cardiac intervention and healthy controls, as well as pre-to postoperative changes and effects of perioperative risk factors. Study type. Prospective. Population. The cohort included 41 neonates with CHD who underwent cardiac surgery or catheterization and 359 healthy neonates. Field strength and sequence. 3 Tesla T2-weighted turbo-spin-echo sequence. Assessment: Brain MRI were motion-corrected and reconstructed using an established neonatal algorithm. Jacobian determinants calculated from non-linear registration of MRI to a neonatal template were input into an Independent Component Analysis to identify SCCs (N=40). SCC weightings were extracted, reflecting the degree to which the pattern of covariance is expressed in each neonate. Statistical tests. Postoperative SCC weightings were compared to healthy neonates using a general linear model or robust regression. Pre- and postoperative SCC weightings were compared using a linear mixed effect model. Pre- to postoperative differences were calculated and associations with age at surgery, cardiopulmonary bypass duration, and postoperative paediatric intensive care unit stay were assessed using partial spearman's rank correlation. Analyses were adjusted for covariates and corrected for multiple comparisons using False Discovery Rate. Results. 16/40 SCCs showed significant differences between neonates with CHD after surgery and controls, including white matter, cortical- and deep grey matter, brainstem, and CSF regions, with seven also showing significant perioperative change. A further nine SCCs only showed significant perioperative change. Perioperative risk factors were not associated with perioperative change. Data conclusion. This data-driven approach highlights region-specific postoperative alterations and perioperative changes in brain morphology of neonates with CHD. Evidence level. 1. Technical Efficacy. Stage 3.

Information about eye movements is necessary for linking auditory and visual information across space. Recent work has suggested that such signals are incorporated into processing at the level of the ear itself (Gruters, Murphy et al. 2018). Here we report confirmation that the eye movement signals that reach the ear can produce perceptual consequences, via a case report of an unusual participant with tensor tympani myoclonus who hears sounds when she moves her eyes. The sounds she hears could be recorded with a microphone in the ear in which she hears them (left), and occurred for large leftward eye movements to extreme orbital positions of the eyes. The sounds elicited by this participants eye movements were reminiscent of eye movement-related eardrum oscillations (EMREOs, (Gruters, Murphy et al. 2018, Brohl and Kayser 2023, King, Lovich et al. 2023, Lovich, King et al. 2023, Lovich, King et al. 2023, Abbasi, King et al. 2025, Sotero Silva, Kayser et al. 2025, King and Groh 2026, Leon, Ramos et al. 2026, Sotero Silva, Brohl et al. 2026)), but were larger and longer lasting than classical EMREOs, helping to explain why they were audible to her. Overall, the observations from this patient help establish that (a) eye movement-related signals specifically reach the tensor tympani muscle and that (b) when there is an abnormality involving that muscle, such signals can lead to actual audible percepts. Given that the tensor tympani contributes to the regulation of sound transmission in the middle ear, these findings support that eye movement signals reaching the ear have functional consequences for auditory perception. The findings also expand the types of medical conditions that produce gaze-evoked tinnitus, to date most commonly observed in connection with acoustic neuromas.

Objective To examine group differences and continuity in caregiving environments of infants born preterm from Spanish- and English-speaking families. Study Design We conducted a prospective cohort study of Spanish- (n = 17) and English-speaking (n = 23) families of infants born preterm (< 32 weeks gestation). Caregiver-infant engagement was assessed neonatally via hospital visitation and skin-to-skin (STS) care, and at home via child-directed adult word counts/hour (CD-AWC/hour) from all-day audio recordings. Result No significant group differences were observed in family visitation, neonatal STS care, or in-home verbal engagement, although STS care rates varied considerably, especially within Spanish-speaking families. Across both groups, greater STS care was associated with higher CD-AWC/hour at home. Conclusion Spanish- and English-speaking families showed comparable patterns of caregiver-infant engagement, as a group, however, many Spanish-speaking families engaged in less STS than English-speaking families. STS care predicted caregiver-infant verbal engagement at home, highlighting continuity from hospital to home.

A substantial body of evidence demonstrates that measures from mammograms are predictive of breast cancer risk. In this matched case-control study, mammograms acquired near the time of diagnosis were analyzed to investigate bilateral breast asymmetry as measure of short-term risk prediction. Specifically, contralateral breast images were compared with measures derived in the Fourier domain (FD); this technique summarizes power in concentric radial bands that cover the Fourier plane. Equivalently, this approach can be described as a multiscale characterization of the image. The summarized power difference between respective contralateral bands produces an asymmetry measure. Full field digital mammography (FFDM) and synthetic two-dimensional images from digital breast tomosynthesis (DBT) were investigated for women that had both types of mammograms acquired at the same time. Odds ratios (ORs) and the area under the receiver operating curves (Azs) were generated from conditional logistic regression modeling with 95% confidence intervals. Raw unprocessed FFDM images produced significant findings: OR = 1.90 (1.58, 2.29) and Az = 1.72 (0.67, 0.76) per one standard deviation unit. Associations were significant but attenuated for both clinical FFDM and DBT images: OR = 1.31 (1.11, 1.54) and Az = 0.63 (0.58, 0.67); and OR = 1.48 (1.25, 1.76) and Az = 0.65 (0.60, 0.70), respectively. Results suggest that clinical FFDM and DBT images are inferior to raw FFDM images in capturing breast asymmetry with information loss for breast cancer risk prediction. Moreover, these DBT images have lower spatial resolution but produced stronger associations than the clinical FFDM images.

Introduction: The Pubertal Development Scale (PDS) is widely used for puberty assessment, yet its psychometric properties and norms are limited to research data. This study examined the psychometric properties of parent- and self-report PDS and established continuous norms in nationally representative samples. Methods: We analyzed two deidentified survey samples: a parent-report sample of children aged 6-18 (N=2000, Mage=11.37, 47.2% female, 74.9% White), and a youth self-report sample aged 12-18 (N=754, Mage=14.33, 49.6% female, 75.3% White). Both samples were representative of the U.S. population on key demographics, and the self-report sample consisted entirely of children whose parents also participated in the parent sample, thus creating parent-child dyads. Internal consistency was evaluated using Cronbach's alpha and McDonald's Omega. Cross-informant agreement was assessed with Intraclass Correlation Coefficient (ICC; two-way model, absolute agreement, single unit) and Bland-Altman plots. Age-dependent norms of each sex were established with Generalized Additive Models for Location, Scale, and Shape (GAMLSS), with 5th-95th percentile curves and reference tables provided. Results: Parent- and self-report PDS demonstrated acceptable-to-good internal consistency (Cronbach's alpha: 0.78-0.89; McDonald's omega: 0.79-0.90). Among the 754 parent-youth dyads, excellent cross-informant agreement was observed for both sexes (ICC(2,1)=0.88). Parents' and children's PDS total scores did not differ significantly for boys; for girls, parents rated pubertal development on average 0.13 points lower than children's self-report. Regardless of informants, PDS scores increased nonlinearly with age and exhibited sex-specific developmental patterns. Girls showed earlier pubertal onset, faster progression, and greater convergence toward pubertal completion by late adolescence. Discussion: The PDS demonstrated strong psychometrics in national samples, supporting its utility in the general pediatric population. The national norms provide empirical benchmarks for PDS score interpretation, strengthening its value as a broad estimation of pubertal status and a pre-screening tool for identifying early or delayed puberty.

OBJECTIVE This study investigates the long-term impacts of childhood exposure to voiding cystourethrogram (VCUG), a diagnostic procedure for vesicoureteral reflux. Primary outcomes include long-term health outcomes, mental health disorders, healthcare avoidance, and participation in risky behaviors compared to a control group. METHODS A 9-month retrospective cohort study was conducted with adults who received most of their medical care in the U.S. Respondents self-reported health metrics, behaviors, and outcomes via a 20-minute survey. Respondents were divided into two groups: those who remembered undergoing at least one VCUG in childhood (VCUG group), and those who did not (control group). RESULTS Of 334 respondents, 204 (61%) were in the VCUG group (mean age: 29, 70% female) and 130 (39%) were controls (mean age: 34, 70% female). Notable findings include: 47% of VCUG respondents were diagnosed with depression compared to 27% of controls. 15% of female-born VCUG respondents reported they would never visit a gynecologist compared to 2% of controls. 34% of VCUG respondents smoked regularly compared to 5% of controls, and 11% of VCUG respondents regularly missed work compared to 1% of controls. These findings highlight the need for further research and clinical consideration of VCUG's long-term consequences. CONCLUSIONS This study suggests that the effects of childhood VCUG extend into adulthood. Our findings underscore the need to reassess informed consent protocols and consider full-scale studies to minimize bias.

In a loudness-matching paradigm, a reduction in the loudness of sounds with bandwidths less than one-half octave compared to a tone of equal sound pressure level has been observed previously for five-tone complexes at 60 dB SPL centered at 1 kHz. Here, this loudness-reduction phenomenon is explored using band-limited noise across wide ranges of frequency and level. Additionally, these measurements are simulated by a model of loudness judgement based on neural ensemble averaging (NEA), which serves as a proxy for central auditory signal processing. Multi-frequency equal-loudness contours (ELC) were measured for each of the adult participants (N=100) with pure-tone average (PTA) thresholds that ranged from normal to moderate hearing loss using a categorical-loudness-scaling (CLS) paradigm. Presentation level and center frequency of the test stimuli were determined on each trial according to a Bayesian adaptive algorithm, which enabled multi-frequency ELC estimation within about five minutes of testing. Three separate test conditions differed by stimulus type: (1) pure-tone, (2) quarter-octave noise and (3) octave noise. For comparison, loudness judgements for all three stimulus types were also simulated by the NEA model, which comprised a nonlinear, active, time-domain cochlear model with an appended stage of neural spike generation. Mid-bandwidth loudness reduction was observed to be greatest at moderate stimulus levels and frequencies near 1 kHz. This feature was approximated by the NEA model, which suggests involvement of an early stage of the central auditory system in the formation of loudness judgements.

Introduction The aim of this study was to determine the annual age- and sex-specific prevalence of gender-affirming hormone and puberty blocker use among young people with a gender incongruence (GI) diagnosis in Norway. Methods We integrated data from multiple Norwegian national registers to perform a nationwide register-based study of individuals with known sex assigned at birth who were born in the period 1975-2017 and resident in Norway for all or part of the period 2008-2022. We first calculated the annual age- and sex-specific incidence of GI diagnoses in the population. Then, we calculated the annual age- and sex-specific prevalence of androgen, estrogen, and puberty blocker use among individuals with a GI diagnosis who were under age 25 (for androgens and estrogens) or 18 (for puberty blockers) in the year that they collected the prescription. Results The incidence of GI diagnoses has increased among youth in Norway, most notably since 2015 and with the largest increase among teens assigned female at birth. The prevalence of feminizing and masculinizing hormone therapy has increased in this period as well, but mainly among the oldest teens and young adults. The prevalence of puberty suppression is mostly low but has also increased since 2015, especially in recent years among teens assigned male at birth. Conclusion The prevalence of gender-affirming hormone and puberty blocker use has increased among transgender youth in Norway, concurrently with an increase in the incidence of GI diagnoses.

Bubble continuous positive airway pressure (bCPAP) is a low-cost respiratory support device that has demonstrated different outcomes for children with severe pneumonia in different settings. Some differences in outcomes may be attributable to implementation factors (e.g., patient monitoring and feeding practices). We aimed to characterize bCPAP reach, implementation fidelity, and safety outcomes for children with severe pneumonia in Pakistan. We conducted a prospective cohort study at Aga Khan University Hospital and Abbasi Shaheed Hospital from February through May 2025. We enrolled children 1-59 months who met WHO criteria for severe pneumonia within 24 hours of presentation to the emergency department. Participants were followed daily via chart review, caregiver survey, and physical exam through discharge, transfer, or death. We reported the proportion of children receiving bCPAP ("reach") and constructed a mixed-effects, multinomial logistic regression model with robust standard errors to report: fidelity (child location in a highly monitored area, continuous monitoring, avoidance of unplanned disruptions to bCPAP, and avoidance of oral feeding); safety (aspiration events and pneumothorax); bCPAP failure (death, respiratory support escalation, or leaving against medical advice); and in-hospital mortality. Of 165 children with severe pneumonia, 88 (53%) received bCPAP over 141 bCPAP days. The average predicted probabilities (95% CI) of our fidelity measures were: 85% (78-92%) for location in a highly monitored area; 56% (51-60%) for continuous monitoring; 66% (57-75%) for continuous bCPAP without disruptions; 46% (36-55%) for avoidance of oral feeding while on bCPAP. Among children receiving bCPAP, 9 (10%) experienced an aspiration event, 1 (2.2%) experienced a pneumothorax; 19 (22%) experienced bCPAP treatment failure. One child (1.1%) died; 6 (6.8%) required respiratory support escalation; 14 (16%) left against medical advice. We identified several gaps in bCPAP reach and fidelity. These may be modifiable by individual-and team-targeted strategies to reduce bCPAP-related complications and pneumonia-related child deaths.

Markerless motion capture has emerged as a potential substitute for traditional marker-based systems, offering scalable, non-invasive acquisition of human movement. Despite increasing adoption in research and sports applications, its clinical utility for children with complex gait patterns remains an open question. To address this gap, simultaneous marker-based and markerless data were collected in 202 pediatric children (12.1 {+/-} 3.9 years). Marker-based kinematics were processed using the Shriners Children's Gait Model (SCGM), while markerless outputs were computed using Theia3D with identical Cardan sequences. Agreement between systems was evaluated using statistical parametric mapping (SPM), root-mean-square error (RMSE), and a gait pattern classification based on the plantarflexor-knee extension index. Markerless output systematically underestimated pelvic tilt, hip rotation, and knee rotation and demonstrated reduced between-subject variance in the transverse plane. SPM revealed widespread waveform differences, although most were of negligible effect, especially in the sagittal plane. Mean sagittal-plane RMSEs were < 5{degrees} for the knee and ankle and < 8{degrees} for the pelvis and hip. Coronal-plane deviations were < 7{degrees}, whereas transverse-plane errors exceeded 10{degrees}. RMSE increased significantly with body mass index and use of a walker (p < 0.001). Agreement in sagittal-plane gait classification was moderate between systems ({kappa} = 0.60; 67% overall concordance). These results indicate that markerless motion capture is suitable for analyses emphasizing sagittal deviations but remains limited for applications requiring precise axial or frontal-plane estimation. Future work should address algorithmic underestimation of transverse motion and evaluate markerless performance across increasing severity of gait deviation.

BackgroundPatient radiation exposure in diagnostic radiology is an important concern for radiation protection and patient safety. Monitoring radiation dose levels during radiographic examinations is essential to ensure compliance with diagnostic reference levels (DRLs) and to optimize radiological practices. ObjectiveThe aim of this study was to evaluate patient radiation dose during conventional lumbar spine radiography and compare the obtained values with diagnostic reference levels. MethodsA descriptive cross-sectional multicenter study was conducted in four hospitals in the Sous Massa region, Morocco, between April and June 2017. Data were collected from 142 patients undergoing lumbar spine radiography examinations and from 20 radiology technicians. Exposure parameters including tube voltage, tube current, exposure time, focus-to-film distance, and field size were recorded. Entrance surface dose (ESD) was estimated using MICADO software, and dose area product (DAP) values were subsequently calculated. The 75th percentile values were determined and compared with diagnostic reference levels. ResultsThe regional 75th percentile ESD values were 5.33 mGy for the anteroposterior projection and 7.38 mGy for the lateral projection. Corresponding DAP values were 1840.9 mGy.cm2 and 2783.65 mGy.cm2, respectively. All obtained values were below the diagnostic reference levels used for comparison. However, variations between hospitals were observed, likely due to differences in imaging protocols and equipment. ConclusionRadiation doses associated with lumbar spine radiography in the evaluated hospitals were within acceptable limits according to diagnostic reference levels. Continuous monitoring of patient radiation exposure and optimization of radiographic techniques remain essential to ensure effective radiation protection.