bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Predictors of Chlamydia, Gonorrhea and Trichomonas Among a Prospective Cohort of Cisgender Female Sex Workers in Baltimore, Maryland
Authors: Park Ju Nyeong , Gaydos Charlotte A. , White Rebecca Hamilton , Decker Michele R. , Footer Katherine H.A. , Galai Noya , Silberzahn Bradley E. , Riegger Katelyn , Morris Miles , Huettner Steve S. , Allen Sean T. , Sherman Susan G. 
Published: November 2019

Background
Cisgender female sex workers (CFSWs) have elevated rates of sexually transmitted infections (STI) yet are underrepresented in targeted programming and research in the United States. We examined the prevalence, incidence and predictors of chlamydia, gonorrhea, and trichomonas infection among CFSW.

Methods
Two hundred fifty street-based CFSWs were recruited into a prospective observational cohort in Baltimore, Maryland using targeted sampling in 2016 to 2017 and completed surveys and STI testing at baseline, 3, 6, 9, and 12 months. Cox proportional hazards regression was used to model the predictors of STI.

Results
Mean age was 36 years, and 66.5% of respondents were white. Baseline prevalence of chlamydia, gonorrhea, trichomonas was 10.5%, 12.6%, and 48.5%, respectively. The incidence of chlamydia, gonorrhea, and trichomonas was 14.3, 19.3, 69.1 per 100 person-years. Over one year of observation, past year sex work initiation predicted both chlamydia incidence (adjusted hazard ratio [aHR], 2.7; 95% confidence interval [CI], 1.3–6.0) and gonorrhea incidence (aHR, 1.7; 95% CI, 1.0–2.8). Client sexual violence predicted gonorrhea incidence (aHR, 2.9; 95% CI, 1.2–7.1) and having female sexual partners predicted trichomonas incidence (aHR, 3.4; 95% CI, 1.3–8.5). Having a usual health care provider (aHR, 0.6; 95% CI, 0.5–0.7) was inversely associated with trichomonas.

Conclusions
In this study of urban US street-based CFSW, interpersonal and structural factors differentially predicted STIs, and infection rates remained elevated through follow-up despite regular testing, notification, and treatment referral. Focused and multifaceted interventions for sex workers and their sexual partners are urgently needed.
Two Distinct Gonorrhea Trends and Risk Factors Among Women in Australia
Authors: Whitford Kate , Callander Denton , Smith Lucy Watchirs , Guy Rebecca , Kong Marlene , Ward James , Donovan Basil , McManus Hamish , Bell Stephen , McGregor Skye , Menon Arun , Russell Darren , O'Connor Catherine C. 
Published: November 2019

Background
In recent years, gonorrhea notifications have increased in women in Australia and other countries. We measured trends over time and risk factors among Australian Aboriginal and Torres Strait Islander (“Aboriginal”) and non-Aboriginal women.

Methods
We conducted a cross-sectional analysis of data from 41 sexual health clinics. Gonorrhea positivity at each patient's first visit (first-test positivity) during the period 2009 to 2016 was calculated. Univariate and multivariate analyses assessed risk factors for first-test positivity in Aboriginal and non-Aboriginal women.

Results
Gonorrhea positivity decreased among Aboriginal women (7.1% in 2009 to 5.2% in 2016, P < 0.001) and increased among non-Aboriginal women (0.6%–2.9%, P < 0.001). Among Aboriginal women, first-test positivity was independently associated with living in a regional or remote area (adjusted odds ratio [aOR], 4.29; 95% confidence interval [CI], 2.52–7.31; P < 0.01) and chlamydia infection (aOR, 4.20; 95% CI,3.22–5.47; P < 0.01). Among non-Aboriginal women, first-test positivity was independently associated with greater socioeconomic disadvantage (second quartile: aOR, 1.68 [95% CI, 1.31–2.16; P < 0.01]; third quartile: aOR, 1.54 [95% CI, 1.25–1.89; P < 0.01]) compared with least disadvantaged quartile: recent sex work (aOR, 1.69; 95% CI, 1.37–2.08; P < 0.01), recent injecting drug use (aOR, 1.85; 95% CI, 1.34–2.57; P < 0.01), and chlamydia infection (aOR, 2.35; 95% CI, 1.90–2.91; P < 0.01). For non-Aboriginal women, being aged 16 to 19 years (aOR, 0.62; 95% CI, 0.49–0.80; P < 0.01) compared with those ≥30 years was a protective factor.

Conclusions
These findings highlight 2 different epidemics and risk factors for Aboriginal and non-Aboriginal women, which can inform appropriate health promotion and clinical strategies.
Health Care Access and Service Use Among Behavioral Risk Factor Surveillance System Respondents Engaging in High-Risk Sexual Behaviors, 2016
Authors: Cuffe Kendra Michelle , Coor Alexandra , Hogben Matthew , Pearson William S. 
Published: November 2019

Introduction
Access to health care services such as screening, testing, and treatment of sexually transmitted diseases is vital for those who engage in high-risk behaviors. Studies examining the relationship between high-risk behaviors and health care access and utilization are crucial for determining whether persons at risk are receiving appropriate health services.

Methods
We examined 2016 data from the Behavioral Risk Factor Surveillance System. Our study population included persons aged 18 to 65 years. χ2 and logistic regression analyses were used to examine relationships between high-risk behaviors including drug use and high-risk sexual behaviors, and access to and utilization of health care services.

Results
Among our study population, 6.2% engaged in a high-risk behavior in the past year. Those engaging in high-risk behaviors were more likely to have no health insurance coverage (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.34), have no personal health care provider (OR, 1.14; 95% CI, 1.06–1.21), have foregone care because of cost (OR 1.54; 95% CI, 1.42–1.65), or have had no routine check-up in the past 2 years (OR 1.16; 95% CI, 1.09–1.25).

Conclusions
Those who engaged in high-risk behaviors had poorer health care access and utilization outcomes. Future studies should incorporate the relationships between changes in behaviors, health care access and utilization, and resulting sexually transmitted disease morbidity.
Clear and Single Binocular Vision in Near 3D Displays
Authors: McCormack Glen L. , Hogan Katherine M. 
Published: November 2019

SIGNIFICANCE
Accommodation/convergence mismatch induced by 3D displays can cause discomfort symptoms such as those induced by accommodation/convergence mismatch in clinical vergence testing. We found that the limits of clear and single vision during vergence tests are very different between 3D and clinical tests. Clinical vergences should not be used as substitutes for measures of vergences in 3D displays.

PURPOSE
The purposes of this study were to determine whether the limits of clear and single binocular vision derived from phoropter prism vergence tests match the limits measured in a 3D display and to determine whether vergence mode, smooth versus jump, affected those limits in the 3D display.

METHODS
We tested the phoropter prism vergence limits of clear and single vision at 40 cm in 47 binocular young adults. In separate sessions, we tested, in a 3D display, the analogous 40-cm vergence limits for smooth vergence and jump vergence. The 3D fixation target was a Maltese cross whose visual angle changed congruently with target disparity.

RESULTS
Our mean phoropter vergence blur and break values were similar to those reported in previous studies. The mean smooth divergence limit was less in the 3D display (9.8Δ) than in the phoropter (12.8Δ). Most smooth convergence limits were much larger in the 3D display than in the phoropter, reaching the 35Δ limit of the 3D display without blur or diplopia in 24 subjects. Mean jump vergence limits were significantly smaller than smooth vergence limits in the 3D display.

CONCLUSIONS
The limits of clear and single binocular vision derived from phoropter vergence tests were not a good approximation of the analogous limits in our 3D display.
The Unique and Misunderstood Wound Ballistics in the John F. Kennedy Assassination
Authors: Haag Lucien C. 
Published: November 2019

Abstract
President Kennedy sustained 2 gunshot wounds on November 22, 1963, in Dallas, Texas, while riding in the right-rear seat of the presidential limousine. The convertible top was down, and no special ballistic protection for the occupants was present.
The ballistic events in the assassination and subsequent ballistic evidence were not fully understood then and continue to be misunderstood and often misrepresented today. These facts are largely the consequence of the very uncommon wound ballistic properties of the 6.5-mm Carcano bullets associated with the President's gunshot wounds and the visual responses of the President to his 2 gunshot wounds so often viewed in the 8-mm Zapruder film.
An understanding of the wound ballistic characteristics associated with the John F. Kennedy assassination also applies to certain contemporary bullets. Such an understanding could assist forensic pathologists in future cases in evaluating and correctly interpreting gunshot wounds associated with these types of bullets.
Postmortem Tryptase Level in 120 Consecutive Nonanaphylactic Deaths
Authors: Garland Jack , Philcox Winston , McCarthy Sinead , Mathew Suneeth , Hensby-Bennett Sarah , Ondrushka Benjamin , Woydt Lina , Da Broi Ugo , Palmiere Cristian , Lam Leo , Ahn Yeri , Olds Kelly , Glenn Charley , Morrow Paul , Kesha Kilak , Stables Simon , Tse Rexson 
Published: November 2019

AbstractPostmortem tryptase is a useful biochemical test to aid the diagnosis of anaphylaxis. Multiple perimortem and postmortem factors have been documented to cause an elevation in postmortem tryptase level. One factor that was recently recognized to have an impact on postmortem tryptase level is correct sampling technique. A recent study recommended aspirating blood samples from a clamped femoral/external iliac vein to be used for reliable postmortem tryptase analysis. This study sampled 120 consecutive nonanaphylactic deaths in which all the peripheral bloods were sampled as recommended. Postmortem interval, resuscitation, different nonanaphylactic causes of death, sex, and age did not show any statistical significant relation to postmortem tryptase level in Studentttest, Pearson correlation, and univariate and multivariate analyses. The mean (SD) postmortem tryptase level was 8.4 (5.2) μg/L (minimum, 1.0 μg/L; maximum, 36.1 μg/L; median, 7.3 μg/L). Using nonparametric methods, the postmortem tryptase reference range in nonanaphylactic death was established as <23 μg/L (97.5th percentile).
Improving Bronchiolitis Care in Outpatient Settings Across a Health Care System
Authors: Tejedor-Sojo Javier , Chan K. Ning , Bailey Martha , Williams Abby , Killgore Maggie , Gillard Laura , Campo Mary , Hua Hannah , Jain Shabnam 
Published: November 2019

Objective
This study aimed (1) to reduce use of ineffective testing and therapies in children with bronchiolitis across outpatient settings in a large pediatric health care system and (2) to assess the cost impact and sustainability of these initiatives.

Methods
We designed a system-wide quality improvement project for patients with bronchiolitis seen in 3 emergency departments (EDs) and 5 urgent care (UC) centers. Interventions included development of a best-practice guideline and education of all clinicians (physicians, nurses, and respiratory therapists), ongoing performance feedback for physicians, and a small physician financial incentive. Measures evaluated included use of chest x-ray (CXR), albuterol, viral testing, and direct (variable) costs. Data were tracked using statistical process control charts.

Results
For 3 bronchiolitis seasons, albuterol use decreased from 54% to 16% in UC and from 45% to 16% in ED. Chest x-ray usage decreased from 29% to 9% in UC and from 21% to 12% in the ED. Viral testing in UC decreased from 18% to 2%. Cost of care was reduced by $283,384 within our system in the first 2 seasons following guideline implementation. Improvements beginning in the first bronchiolitis season were sustained and strengthened in the second and third seasons. Admissions from the ED and admissions after return to the ED within 48 hours of initial discharge did not change.

Conclusion
A system-wide quality improvement project involving multiple outpatient care settings reduced the use of ineffective therapies and interventions in patients with bronchiolitis and resulted in significant cost savings. Improvements in care were sustained for 3 bronchiolitis seasons.
Acute Cannabis Toxicity
Authors: Wong Kei U. , Baum Carl R. 
Published: November 2019

Abstract
The change in legal status of cannabis (the botanical species Cannabis sativa, commonly known as marijuana) in the United States has had significant impact on pediatric drug exposures. In states with decriminalization of recreational and medicinal use of cannabis, emergency department visits and poison control center calls for unintentional pediatric cannabis intoxication are on the rise in the last few decades. Exploratory or unintentional ingestions of cannabis-containing products (as opposed to those derived from synthetic cannabinoids, which may mimic the structure and/or function of cannabis, but are not the focus of this article) can lead to significant pediatric toxicity, including encephalopathy, coma, and respiratory depression. With the increasing magnitude of the public health implications of widespread cannabis use, clinicians who care for pediatric patients routinely must be adept in the recognition, evaluation, management, and counseling of unintentional cannabis exposure.
Ingested Foreign Body Imaging Using Point-of-Care Ultrasonography
Authors: Kozaci Nalan , Avci Mustafa , Pinarbasili Tansu , Dönertaş Eda , Karaca Adeviyye 
Published: November 2019

Abstract
The ingestion of foreign bodies is a common problem in the pediatric population. Emergent treatment of ingested foreign bodies is dependent on the type of foreign body ingested, patient symptoms, timing of ingestion, and the location of the foreign body. Although X-ray and computed tomography are the imaging techniques used most often to assess for foreign bodies, ultrasonography, which lacks ionizing radiation, may also be useful. This case series describes 8 cases of gastrointestinal tract foreign bodies and the utility of point-of-care ultrasonography for their real-time evaluation.
Variability of Steady State Oral Baclofen Prescribing Practices in Pediatric Patients With Cerebral Palsy
Authors: McLaughlin Matthew J. , Ratnasingam Denesh , McGhee Emily 
Published: November 2019

Abstract
The aim of the study was to identify oral baclofen dosing variability at steady state based on weight and Gross Motor Function Classification System level using a retrospective cross-sectional study design. The medical records of 500 pediatric aged patients (age 1–21 yrs) were reviewed to obtain 144 pediatric patients who met inclusion criteria. One-way analysis of variance tests revealed increasing mean doses in baclofen (in milligram per kilogram) with higher Gross Motor Function Classification System levels (P = 0.001). Post hoc Tukey analysis showed patients with higher ambulatory ability (Gross Motor Function Classification System I–II) received a lower total daily dosage than did patients with less ambulatory ability (Gross Motor Function Classification System III–V). A moderate correlation was observed with increasing oral baclofen dose as weight increased (r = 0.43, P < 0.0001). Because of the variability in dosing between Gross Motor Function Classification System levels, prescribing oral baclofen for pediatric patients with cerebral palsy may not follow the traditional model of weight-based dosing seen in other pediatric conditions.
Effects of Upper Limb Loss or Absence and Prosthesis Use on Postural Control of Standing Balance
Authors: Major Matthew J. , Stine Rebecca , Shirvaikar Tara , Gard Steven A. 
Published: November 2019

Objective
Persons with upper limb loss or absence experience a high prevalence of falls. Although upper limb prostheses help perform upper limb tasks, fall likelihood increases by six times with prosthesis use. The effects of upper limb loss or absence and prosthesis use on postural control are poorly documented.

Design
Static posturography characterized postural control of standing balance between persons with unilateral upper limb loss or absence not wearing a prosthesis and wearing either a customary prosthesis or prosthesis that matched the mass, inertia, and length of their sound limb. Able-bodied controls were also compared to persons with unilateral upper limb loss or absence not wearing a prosthesis. Center-of-pressure anterior-posterior range, medial-lateral range, and sway area, as well as weight-bearing symmetry, were measured.

Results
Persons with upper limb loss or absence display greater standing postural sway than controls. Although wearing a prosthesis improved weight-bearing symmetry, this condition increased postural sway, which was pronounced in the medial-lateral direction.

Conclusions
The presence of upper limb loss or absence increased postural control demands than able-bodied individuals as reflected in greater postural sway, which was further exacerbated with the use of prosthesis. Results suggest that upper limb loss or absence and prosthesis use may affect the internal models that guide motor commands to maintain body center-of-mass position equilibrium. The relatively greater postural control demands might help explain the increase fall prevalence in this patient group.
Active Video Games as an Adjunct to Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease
Authors: Wang Ya-Qing , Liu Xin , Ma Rui-Chen , Yin Ying-Ying , Yang Zhuo , Cao Hui-Ping , Xie Jiao 
Published: November 2019

Objective
This review aimed to investigate the effectiveness of active video games as an adjunct to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease.

Design
All entries to the following databases were searched up until April 3, 2019: PubMed, Embase Ovid, the Cochrane Central Register of Randomized Controlled Trials, Web of Science, Wanfang, Weipu, and Chinese National Knowledge Infrastructure databases.

Results
A total of seven articles (three randomized controlled trials and four quasi-experimental studies) with 249 patients were included. Active video games can increase the 6-min walk distance by 30.9 meters on average. Four studies assessed quality of life and showed significant improvement. Four studies have reported that patients with chronic obstructive pulmonary disease found active video games to be enjoyable. Patient adherence was assessed in two studies and showed high adherence with active video games. No adverse events related to active video games were reported.

Conclusions
The review demonstrated that active video games as an adjunct to pulmonary rehabilitation of patients with chronic obstructive pulmonary disease may prove to be useful and enjoyable. Additional studies should explore the differences between different types of active video games in order to create more effective game interventions for pulmonary rehabilitation.
Economics of Lymphovenous Bypass
Authors: Head Linden K. , Momtazi Moein 
Published: November 2019

Background:
The objective of this study was to compare the economic impact of complete decongestive therapy and lymphovenous bypass in the management of upper extremity lymphedema.

Methods:
Economics were modeled for a patient with breast cancer–related lymphedema undergoing three different clinical pathways: (1) complete decongestive therapy alone; (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy; or (3) lymphovenous bypass requiring ongoing complete decongestive therapy. Activity-based cost analysis identified costs incurred with complete decongestive therapy and lymphovenous bypass. Costs were retrieved from supplier price lists, physician fee schedules, lymphedema therapists, and literature reviews. The net present value of all costs incurred for each clinical pathway were calculated.

Results:
The estimated net present value of all costs for a patient with breast cancer–related lymphedema undergoing treatment were as follows: (1) complete decongestive therapy alone ($30,400); (2) lymphovenous bypass no longer requiring ongoing complete decongestive therapy ($15,000); or (3) lymphovenous bypass requiring ongoing complete decongestive therapy ($42,100). The expected net present value of all costs for lymphovenous bypass was $26,800, which was comparable to that of complete decongestive therapy alone. Sensitivity analysis demonstrated that the expected net present value of lymphovenous bypass was dependent on the patient’s life expectancy, number of bypass anastomoses, and likelihood of discontinuing complete decongestive therapy.

Conclusions:
Lymphedema has substantial ongoing costs irrespective of the treatment modality. The cost of lymphovenous bypass appears comparable to that of complete decongestive therapy alone—the surgical costs of lymphovenous bypass are offset by the savings from discontinued ongoing therapy. Despite its limitations as a theoretical economic model, this study provides insight into the potential economic impact of lymphovenous bypass.
Forehead Fat Grafting: Asian Facial Contouring and Augmentation
Authors: Li Xin , Kubiak Carrie A. , Yang Xiaoning , Kemp Stephen W. P. , Cederna Paul S. , Ma Jiguang 
Published: November 2019

Background:
Aesthetic facial contouring procedures, particularly forehead augmentation, continue to increase in popularity in the Asian population. However, there are very few reports in the literature specifically examining the long-term outcomes of forehead fat grafting. In the present study, the authors aimed to objectively evaluate the efficacy of autologous forehead fat grafting through evaluation of facial proportions and patient-reported outcomes.

Methods:
Patients who underwent autologous fat grafting for forehead contouring procedures between July of 2011 and June of 2017 were recruited for participation in the study. Patient demographic and clinical variables were collected preoperatively and postoperatively. Facial proportion analysis was collected and compared from preoperative and postoperative photographs. Satisfaction with outcome was assessed by the patient, the surgeon, and a layperson postoperatively. A related-samples Wilcoxon signed rank test was used for statistical analysis.

Results:
Postoperative outcomes were evaluated in a total of 24 patients who underwent forehead autologous fat-grafting procedures. The average postoperative follow-up was 8.1 months. There were no intraoperative or postoperative complications. More than 50 percent of the postoperative results were evaluated as “satisfactory” by all three groups (i.e., patient, surgeon, and layperson) in terms of aesthetic contouring. Average forehead projection increased 0.24 U (ratio of horizontal distance from midforehead plane to cornea plane/cornea diameter) after one round of fat grafting (p = 0.01). Seven patients (29.2 percent) required more than a single round of fat grafting to achieve optimal results.

Conclusions:
Autologous fat grafting remains a viable option for forehead contouring and augmentation. The findings of this study demonstrate that the operation is effective and offers stable satisfactory results after long-term follow-up.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.