bluuebunny/crossref_metadata_2025_split huggingface dataset:
High and Stable Human Immunodeficiency Virus Prevalence Among Transwomen With Low Income Recruited With Respondent-driven Sampling, San Francisco, 2010–2016
Authors: Raymond Henry F. , Wilson Erin C. , Packer Tracey , Ick Theresa , Lin Jess , McFarland Willi 
Published: September 2018

Background
Studies have documented high human immunodeficiency virus (HIV) prevalence among transwomen in the United States; however, to our knowledge, no studies have documented trends in HIV prevalence in this population.

Methods
We used respondent-driven sampling to sample transwomen in San Francisco for 3 HIV prevalence and behavioral surveys in 2010, 2013, and 2016. Our analysis of point estimates and trends were weighted for the sampling method.

Results
Human immunodeficiency virus prevalence by serological testing in the survey was 38.8% (95% confidence interval [CI], 32.4–45.2), 33.7% (95% CI, 25.9–41.5), and 31.6% (95% CI, 12.2–38.1) in 2010, 2013, and 2016, respectively. Disparities in higher HIV prevalence by black, Latino, and Asian race/ethnicity and lower education level persisted through 2016.

Conclusions
Based on a statistical test for trend, HIV prevalence among transwomen has remained high and stable from 2010 to 2016. Human immunodeficiency virus infection is still highest at 31.6% compared to any other group in San Francisco. We also observed that older transwomen had significantly higher odds of living with HIV than younger women over the last 2 waves of data collection. Taken together, these trends suggest that there is declining incidence of new HIV infections among low-income transwomen in San Francisco. Moreover, among transwomen, HIV disproportionately affects transwomen of color.
Prevalence of Seizures in Pediatric Extracorporeal Membrane Oxygenation Patients as Measured by Continuous Electroencephalography
Authors: Okochi Shunpei , Shakoor Aqsa , Barton Sunjay , Zenilman Ariela R. , Street Cherease , Streltsova Svetlana , Cheung Eva W. , Middlesworth William , Bain Jennifer M. 
Published: September 2018

Objectives:
Standards for neuromonitoring during extracorporeal membrane oxygenation support do not currently exist, and there is wide variability in practice. We present our institutional experience at an academic children’s hospital since establishment of a continuous electroencephalography monitoring protocol for extracorporeal membrane oxygenation patients.

Design:
Retrospective, single-center study.

Setting:
Neonatal ICU and PICU in an urban, quaternary care center.

Patients:
All neonatal and pediatric patients requiring extracorporeal membrane oxygenation.

Interventions:
None.

Measurements and Main Results:
During the study period, 70 patients were cannulated for extracorporeal membrane oxygenation and had continuous electroencephalography monitoring for greater than 24 hours. Electroencephalographic seizures were observed in 16 of 70 patients (23%), including five patients (7%) who were in status epilepticus. Among patients with continuous electroencephalography seizures, nine (56%) had subclinical nonconvulsive status epilepticus and eight (50%) had seizures in the initial 24 hours of extracorporeal membrane oxygenation support. Survival to hospital discharge was significantly greater for extracorporeal membrane oxygenation patients without seizures (74% vs 44%; p = 0.02).

Conclusions:
Seizures occur in a significant proportion of pediatric and neonatal extracorporeal membrane oxygenation patients, frequently in the initial 24 hours after extracorporeal membrane oxygenation cannulation. Because seizures are associated with significantly decreased survival, neuromonitoring early in the extracorporeal membrane oxygenation course is important and useful. Further studies are needed to correlate electroencephalography findings with neurologic outcome.
Development and Implementation of a Bedside Peripherally Inserted Central Catheter Service in a PICU*
Authors: Conlon Thomas W. , Himebauch Adam S. , Cahill Anne Marie , Kraus Blair M. , Madu Chinonyerem R. , Weber Mark D. , Czajka Carol A. , Baker Ruby L. , Brinkley Torron M. , Washington Melanie D. , Frey Anne Marie , Nelson Eileen M. , Jefferies Cara T. , Woods-Hill Charlotte Z. , Wolfe Heather A. , Davis Daniela H. 
Published: September 2018

Objectives:
To create a bedside peripherally inserted central catheter service to increase placement of bedside peripherally inserted central catheter in PICU patients.

Design:
Two-phase observational, pre-post design.

Setting:
Single-center quaternary noncardiac PICU.

Patients:
All patients admitted to the PICU.

Interventions:
From June 1, 2015, to May 31, 2017, a bedside peripherally inserted central catheter service team was created (phase I) and expanded (phase II) as part of a quality improvement initiative. A multidisciplinary team developed a PICU peripherally inserted central catheter evaluation tool to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process, and balancing metrics were evaluated.

Measurements and Main Results:
Bedside peripherally inserted central catheter service placed 130 of 493 peripherally inserted central catheter (26%) resulting in 2,447 hospital central catheter days. A shift in bedside peripherally inserted central catheter centerline proportion occurred during both phases. Median time from order to catheter placement was reduced for peripherally inserted central catheters placed by bedside peripherally inserted central catheter service compared with placement in interventional radiology (6 hr [interquartile range, 2–23 hr] vs 34 hr [interquartile range, 19–61 hr]; p < 0.001). Successful access was achieved by bedside peripherally inserted central catheter service providers in 96% of patients with central tip position in 97%. Bedside peripherally inserted central catheter service central line-associated bloodstream infection and venous thromboembolism rates were similar to rates for peripherally inserted central catheters placed in interventional radiology (all central line-associated bloodstream infection, 1.23 vs 2.18; p = 0.37 and venous thromboembolism, 1.63 vs 1.57; p = 0.91). Peripherally inserted central catheters in PICU patients had reduced in-hospital venous thromboembolism rate compared with PICU temporary catheter in PICU rate (1.59 vs 5.36; p < 0.001).

Conclusions:
Bedside peripherally inserted central catheter service implementation increased bedside peripherally inserted central catheter placement and employed a patient-centered and timely process. Balancing metrics including central line-associated bloodstream infection and venous thromboembolism rates were not significantly different between peripherally inserted central catheters placed by bedside peripherally inserted central catheter service and those placed in interventional radiology.
Left-Sided Appendicitis
Authors: Cramer Natan , Coombs Carmen 
Published: September 2018

Abstract
Classic appendicitis is a common condition easily diagnosed by emergency care providers. However, atypical cases represent a diagnostic challenge and can contribute to increased morbidity from a delay in definitive care. It is important to recognize that atypical presentations have an increased risk for underlying anatomic variants, which may require additional imaging as part of management. We present a case of a 13-year-old previously healthy adolescent boy with acute onset of left-sided abdominal pain who was found to have appendicitis in the setting of underlying malrotation.
Acupuncture as a Nonpharmacologic Treatment for Pain in a Pediatric Emergency Department
Authors: Tsai Shiu-Lin , Reynoso Elena , Shin Da Wi , Tsung James W. 
Published: September 2018

Objectives
With epidemic opioid deaths and abuse in the United States, government agencies recommend nonpharmacological treatments for pain. However nonopioid treatment options for moderate to severe pain in the pediatric emergency department (PED) are limited. Acupuncture has been shown to be effective for pain. The objective of this study was to evaluate the feasibility of using traditional acupuncture (TA) and battlefield acupuncture (BFA) in the treatment of pain in the PED.

Methods
A pediatric cohort treated with acupuncture for pain in an urban PED was assessed. All subjects received TA or BFA as treatment, and pre/postacupuncture pain scores, feedback, and adverse events were assessed. The primary outcome was a change in pain score.

Results
Twelve patients received BFA, and 13 received TA for these pain conditions: headaches, sciatica, paraphimosis, torticollis, joint pains (knee, shoulder, jaw), sprains (foot, wrist, thumb), dysmenorrhea, otitis externa, sickle cell, and muscle knot. The mean ± SD pain score change, 5.8 ± 2.5 (P < 0.05; 95% confidence interval, 4.9–7.0), was clinically and statistically significant. Over 90% of subjects reported significant improvement or resolution of pain; 96% were satisfied with pain relief and would receive acupuncture again. Two adverse events were noted: one patient reported dizziness, and another, a tinge of blood at 1 of 90 needled points.

Conclusions
This study suggests that acupuncture is a potential nonpharmacologic therapeutic option for acute pain management in the PED.
Pediatric Intraosseous Access Performed by Emergency Department Nurses Using Semiautomatic Devices
Authors: Feldman Oren , Nasrallah Najib , Bitterman Yuval , Shavit Roni , Marom Dana , Rapaport Zofia , Kabesa Shauli , Benacon Michael , Shavit Itai 
Published: September 2018

Background
No study has examined the performance of emergency department (ED) nurses in establishing intraosseous access (IO) access. This study aimed to evaluate ED nurses' success rate in establishing pediatric IO access using semiautomatic devices.

Methods
A randomized crossover simulation study was conducted. The success rates of ED nurses were compared with those of paramedics with similar years of experience. The study instruments were the new spring-loaded injector (NIO) and the battery power drill (EZ-IO). Uncooked piglets' bones were used as the study model. All attempts were filmed by a video camera. Successful placement was defined as the visualization of flow from the marrow cavity. Participants recorded their ranking of the “ease of use” of each device.

Results
No differences in 1-attempt success rate was found between nurses and paramedics (27/34 [79.4%] vs 25/30 [83.3%], P = 0.68). Nurses and paramedics had similar success rates with the 2 semiautomatic IO devices (12/17 vs 12/15 with the spring-loaded injector, P = 0.69, and 15/17 vs 13/15 with the battery power drill, P = 0.9). The number of failed attempts and the causes for failure were equally distributed between nurses and paramedics. Median ease-of-use Likert-scale scores of the spring-loaded injector and the battery power drill were 4 (interquartile range [IQR] = 3–4) and 5 (IQR = 5–5) (P < 0.04) for the nurses and 5 (IQR = 4–5) and 5 (IQR = 4–5) (P = 0.44) for the paramedics, respectively.

Conclusions
Emergency department nurses and paramedics had a similarly high insertion success rates on a pediatric bone model. This pilot study suggests that ED nurses can successfully perform this procedure.
Multidisciplinary, In Situ Simulation Improves Experienced Caregiver Confidence With High-Risk Pediatric Emergencies
Authors: Cristallo Tara , Walters Michelle , Scanlan James , Doten Ian , Demeter Theresa , Colvin David 
Published: September 2018

Objectives
Emergency department (ED) caregivers have reported feeling uncomfortable performing emergency pediatric procedures, likely because of either a lack of training or infrequent exposure to these events. To address these gaps, ongoing education for experienced ED caregivers must aim to improve caregiver confidence with high-risk, low-volume pediatric emergency care. This study used multidisciplinary, in situ simulations to facilitate improved caregiver confidence when treating pediatric emergencies in an ED setting.

Methods
Two-hour pediatric code blue simulations were held in 7 EDs throughout the Seattle, Washington, metropolitan area. Questionnaire data were collected from 353 simulation participants (60% nurses, 19.5% ED technicians, 14% ED physicians; median team size = 5) via pre simulation and post simulation surveys assessing confidence and understanding regarding interventions/treatments, standard protocols, culture of safety behavior, and team members' roles/responsibilities. Paired t tests were used to analyze changes in self-reported confidence.

Results
Confidence improved across all questions (37%–57% of participants reported good/complete confidence pre simulation, improving 94%–98% post simulation; P < 0.00001 for all). Participants cited learning equipment location/use (37%), hands-on practice (32%), and discussion (22%) as the most helpful aspects of the simulations. Identified changes to practice made post simulation included more effective communication (18%) and utilization of a pediatric emergency drug sheet (13%).

Conclusions
Multidisciplinary, in situ simulation improves experienced ED caregivers' confidence with pediatric emergencies in an ED setting. These findings suggest that investment in simulation-based education may improve clinical care and quality and safety improvement plans for the treatment of pediatric emergencies in general EDs.
Harnessing Social Media to Advance Research in Plastic Surgery
Authors: Timberlake Andrew T. , Wu Robin T. , Cabrejo Raysa , Gabrick Kyle , Persing John A. 
Published: September 2018

Background:
Social media have transformed plastic surgery, intersecting patient education, provider marketing, and academic interactions across the globe. Despite this, social media are seldom used in research. The authors sought to understand the primary incentives and deterrents for patient participation in research efforts.

Methods:
Facebook groups for craniosynostosis families were identified; the largest two had 11,000 and 7200 members. Facebook group administrators were asked to post an open invitation to enroll in the authors’ study. Interested participants contacted study personnel directly. Materials and written/video instructions were provided for collecting genetic specimens. Participants completed a follow-up survey to assess satisfaction. The authors subsequently conducted virtual neurocognitive sessions for functional assessment.

Results:
Three hundred thirty-one of 384 genetic study participants (86 percent) were recruited by means of social media. Three hundred forty-three of 472 mailed packages (73 percent) were returned. Novel mutations identified explained craniosynostosis in 10 percent of participants. One hundred ninety-five families completed the follow-up survey. One hundred percent and 95 percent reported that the written and video instructions were helpful, respectively. The most frequently cited obstacles barring participation in research studies was travel to the study site (63 percent), significantly more than indirect monetary costs (p = 0.007), information confidentiality (p < 0.001), time required to participate (p < 0.001), and invasive study procedures (p < 0.001). Ninety-nine percent preferred participating in a study from home rather than a research center. Follow-up neurocognitive studies are ongoing.

Conclusions:
With proper planning, participation in social media–based research is easy, cost-effective, and time conscious. Requiring travel to a research facility is the factor most likely to deter families from contributing to research. The results emphasize the unrealized potential of social media for advancing research in plastic surgery.
Inferior External Pudendal Artery Anastomosis: Additional Approach to Prevent Skin Necrosis in Replanted Penis
Authors: Lohasammakul Suphalerk , Turbpaiboon Chairat , Ratanalekha Rosarin , Ungprasert Patompong , Yodrabum Nutcha 
Published: September 2018

Background:
Microsurgical anastomosis of the dorsal artery of the penis either with or without anastomosis of the cavernosal artery is the preferred technique for penile replantation. However, postoperative penile skin necrosis is commonly reported with this technique. This study aimed to characterize the anatomy of the vascular supply of the penis pertinent to penile replantation surgery and to report a successful case of penile replantation without postoperative necrosis using anastomosis of the inferior external pudendal artery.

Methods:
The authors dissected 15 penises of fresh cadavers under acrylic dye injection by means of the inferior external pudendal and dorsal arteries of the penis to identify vascular anastomoses between arteries supplying the penis and to measure other parameters of the arteries.

Results:
Mean diameters at the base of the penis of the inferior external pudendal, dorsal, and cavernosal arteries were 0.94, 1.43, and 0.80 mm, respectively. Penile skin is mainly supplied by the inferior external pudendal artery under three patterns with anastomoses across the midline. Preputial skin receives additional blood supply from perforators of the dorsal artery without visible anastomosis between the perforators and the inferior external pudendal artery. Deep structures receive blood supply from the dorsal, cavernosal, and urethral arteries, with visible anastomoses between the arteries. In a patient with amputated penis, the inferior external pudendal artery diameter was 0.7 mm, which was sufficient for microsurgical anastomosis. No postoperative necrosis developed, and patency of the inferior external pudendal artery was confirmed with duplex ultrasound.

Conclusion:
The diameter of the inferior external pudendal artery at the base and midshaft of the penis is sufficiently large for microsurgical anastomosis, and additional vascular anastomosis of at least one inferior external pudendal artery may help to prevent postoperative penile skin necrosis.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, V.
Immediate Implant-Based Breast Reconstruction with Acellular Dermal Matrix: A Comparison of Sterile and Aseptic AlloDerm in 2039 Consecutive Cases
Authors: Parikh Rajiv P. , Brown Gabriella M. , Sharma Ketan , Yan Yan , Myckatyn Terence M. 
Published: September 2018

Background:
Sterile ready-to-use acellular dermal matrix, introduced as an alternative to aseptic freeze-dried acellular dermal matrix for implant-based breast reconstruction, has been investigated in a limited number of studies. This study compared outcomes in implant-based breast reconstruction with ready-to-use and freeze-dried acellular dermal matrix.

Methods:
The authors analyzed patients undergoing implant-based breast reconstruction with either freeze-dried or ready-to-use acellular dermal matrix, including demographics, clinical variables, and outcomes. An a priori power analysis was performed and logistic regression modeling was used to quantify the effect of acellular dermal matrix on outcomes while controlling for potential confounders.

Results:
A total of 1285 consecutive patients undergoing 2039 immediate prosthetic breast reconstructions constituted the population: 612 (n = 910 breasts) with freeze-dried matrix and 673 (n = 1129 breasts) with ready-to-use acellular dermal matrix. The freeze-dried matrix cohort had a significantly higher rate of explantation compared with the ready-to-use matrix cohort (18.0 percent versus 12.0 percent; p = 0.0036), but surgical-site infection, wound dehiscence, mastectomy flap necrosis, seroma, and hematoma did not differ significantly between groups. On multivariate regression, patients undergoing reconstruction with freeze-dried matrix, compared to ready-to-use matrix, did not have higher odds of experiencing surgical-site infections (OR, 1.064; p = 0.7455), but did have higher odds of explantation (OR, 1.570; p = 0.0161). Tobacco use (OR, 2.809; p = 0.0002) and body mass index (OR, 1.054; p < 0.0001) were also independent predictors of explantation.

Conclusion:
Immediate implant-based breast reconstruction with sterile ready-to-use acellular dermal matrix has a comparable overall safety profile and a lower rate of prosthetic explantations compared with aseptic freeze-dried acellular dermal matrix.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, III.
The Constriction Arm Band Deformity in Brachioplasty Patients: Characterization and Incidence Using a Prospective Registry
Authors: Chen Wendy , James Isaac B. , Gusenoff Jeffrey A. , Rubin J. Peter 
Published: September 2018

Background:
Demand for brachioplasty in the United States has seen a dramatic increase, from 338 procedures in 2000 to 17,860 in 2016. In this article, the authors present their series of arm band deformities not yet described in the literature.

Methods:
This is a retrospective review of massive weight loss patients undergoing brachioplasty at their institution from 2000 to 2016. Preoperative and postoperative photographs were reviewed. Descriptive statistics and t test were used.

Results:
One hundred seventy-two patients underwent brachioplasty, and 25 patients (15 percent) were identified with the deformity. Twenty-four (96 percent) were women, with an average age of 60 years (range, 36 to 85 years) and a mean body mass index of 34 kg/m2 at the time of surgery (average, 2 years since gastric bypass; mean delta body mass index, 22 kg/m2). The bands were generally single bands (100 percent) found bilaterally (68 percent) in the distal third (74 percent) of the upper arm and exacerbated (50 percent) by brachioplasty. The average specimen weighed 1005 g. The authors found that arm banding was associated with a higher current body mass index, but not with a maximum body mass index or delta body mass index.

Conclusions:
For massive weight loss patients, arm band deformity is a challenging problem that can be exacerbated by brachioplasty. It can be identified preoperatively to aid in counseling. The authors found patients with a higher current body mass index to be at a higher risk for the arm band deformity after brachioplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, IV.
Breast Implant Engineering and Performance
Authors: Mohebali Khashayar , Wixtrom Roger N. 
Published: September 2018

Summary:
The engineering of breast implants for both augmentation and reconstruction is centered on facilitating optimal aesthetic results pleasing to the patient, while minimizing both short- and long-term complications. Some of the key individual design elements that have been the primary focus over time have included gel cohesivity, shell thickness, shell surface, and implant gel fill. A review of these separate elements points to the potential benefits of increased focus on a combined overall performance perspective for engineering of new implants as exemplified in the recently introduced MemoryGel Xtra Breast Implants. Such an approach is expected to provide an improved and expanded range of options to facilitate obtaining desired aesthetic outcomes and long-term clinical performance.