Assessing the quality and reliability of patient information regarding aesthetic fat grafting on YouTube.

PURPOSE: Patients increasingly consult social media regarding aesthetic surgery. Given the popularity of fat transfer operations, this study assesses the quality and reliability of patient information available on YouTube regarding aesthetic fat grafting. METHODS: The terms "fat grafting" and "fat transfer" were searched on YouTube with respect to the terms "face", "breast", "buttock", and "Brazilian butt lift". Filtered by view count, the top 20 unique, English language, aesthetic surgery-related videos for each search combination were reviewed by three independent reviewers for demographic and descriptive characteristics. Videos were rated for information reliability and quality using the modified DISCERN (MD) tool (1 = low, 5 = high) and global quality scale (GQS) (1 = poor, 5 = excellent). RESULTS: Out of 80 total videos, 76% were authored by physicians and 24% by laypersons. The overall mean MD score was 1.5 and the mean GQS was 2.6. Videos authored by physicians outscored those by non-medical authors (MD: 1.6 vs. 1.3; GQS 2.7 vs. 2.2). Board-certified plastic surgeon videos (N = 30) scored higher on both the MD (1.7 vs 1.3) and GQS (3.1 vs 2.2) than those of non-medical authors. On the contrary, videos by laypersons and non-plastic surgeons had 40% more views, twice as many "likes" and nearly double as many subscribers. CONCLUSION: The overall quality of information presented in aesthetic fat grafting procedures videos on YouTube is low and from unreliable sources. Surgeons should educate patients regarding potentially inaccurate information, and professional societies should disseminate high-quality media.

A look at racial and socioeconomic disparities in post-mastectomy breast reconstruction at a midwestern academic hospital.

Purpose of this study was to assess likelihood of undergoing breast reconstruction based on race, socioeconomic status, insurance, and distance from the hospital. Patients with public insurance were less likely to undergo reconstruction than patients with private insurance (OR = 2.99, p < 0.001). White patients were more likely to undergo reconstruction (OR = 0.62, p = 0.02). Patients who lived 10-20 miles and 20-40 miles from UCMC were more likely to undergo reconstruction (OR = 1.93, p = 0.01; OR = 3.06, p < 0.001). White patients and patients with private insurance are disproportionately undergoing breast reconstruction after mastectomy.

Hand and Upper Extremity Infections in Intravenous Drug Users: Epidemiology and Predictors of Outcomes.

PURPOSE: Injectable drug use (IDU) is a national epidemic, public health problem, and common cause of hand and upper extremity (UE) infections. This study assesses the epidemiology of the IDU patient population presenting to a Midwestern academic medical center emergency department (ED) and examines predictors influencing morbidity and outcomes. METHODS: A retrospective review was performed using International Classification of Diseases, Ninth Revision (ICD-9) codes to identify all adult patients presenting to the ED with hand/UE infections, with and without concurrent IDU diagnoses, over a period of 2.5 years. Demographics and clinical factors were examined utilizing bivariate and multivariable analyses to identify predictors of outcomes, including not completing outpatient follow-up and leaving against medical advice (AMA). RESULTS: A total of 1,482 patients with 1,754 ED visits for hand/UE infections were identified, including 308 patients with IDU-acquired infections (396 visits) and 1,174 patients with non-IDU infections (1,358 visits). Psychiatric comorbidities and hepatitis C were common in the IDU group (51% and 39%, respectively), and 31% of IDU patients were uninsured. Heroin use was identified in 96% of visits. The IDU infections were more likely to have surgical intervention than those in non-IDU patients (16% vs 6%), and a longer mean length hospital stay (2.4 vs 0.9 days). The IDU patients were more likely than non-IDU patients to leave AMA. In multivariable analysis, IDU, psychiatric comorbidity, and insurance status were independent predictors (P < .05) for leaving AMA. CONCLUSIONS: In the setting of a national epidemic, hand/UE infections due to IDU are a common problem seen by hand surgeons. This study characterizes the growing IDU patient population at an urban academic medical center, examining the largest cohort of these patients to date. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic IV.

Direct measurement of planar flow rate in an excised canine larynx model.

OBJECTIVES/HYPOTHESIS: During phonation, skewing of the glottal flow waveform (Q) refers to a phenomenon that occurs when the flow decelerates more rapidly than it accelerates. This skewing is clinically important because it increases the glottal efficiency, which is defined by the acoustic intensity (sound pressure level) divided by the subglottal pressure. Current theoretical models predict that the only mechanism to cause skewing of Q involves changes in the vocal tract inertance. The purpose of the current work is to show that other factors at the vocal fold level can also cause skewing of Q and to determine if the acoustic intensity is correlated with maximum flow declination rate. STUDY DESIGN: Basic science. METHODS: Intraglottal geometry and velocity measurements were taken in five canine larynges at the mid-membranous plane using 2-dimensional particle imaging velocimetry (PIV). The flow rate at the glottal exit was computed from the PIV measurements for low, medium, and high subglottal pressures. RESULTS: Vortices form in the superior aspect of the divergent glottis during closing. These vortices produce negative pressure that increases both the maximum value of Q and the rapid deceleration of the flow. The skewing of the flow rate is increased as the intraglottal vortices are increased by increasing the subglottal pressure. The increase in the acoustic intensity is highly correlated with certain properties of the flow rate waveform, such as maximum flow rate. CONCLUSION: Flow skewing and the acoustic intensity can be increased by increasing the intraglottal vortices. LEVEL OF EVIDENCE: N/A.

Characterization of the vocal fold vertical stiffness in a canine model.

OBJECTIVES/HYPOTHESIS: Characterizing the vertical stiffness gradient that exists between the superior and inferior aspects of the medial surface of the vocal fold. Characterization of this stiffness gradient could elucidate the mechanism behind the divergent glottal shape observed during closing. STUDY DESIGN: Basic science. METHODS: Indentation testing of the folds was done in a canine model. Stress-strain curves are generated using a customized load-cell and the differential Young's modulus is calculated as a function of strain. RESULTS: Results from 11 larynges show that stress increases as a function of strain more rapidly in the inferior aspect of the fold. The calculations for local Young's modulus show that at high strain values, a stiffness gradient is formed between the superior and inferior aspects of the fold. CONCLUSIONS: For small strain values, which are observed at low subglottal pressures, the stiffness of the tissue is similar in both the superior and inferior aspects of the vocal fold. Consequently, the lateral force that is applied by the glottal flow at both aspects results in almost identical displacements, yielding no divergence angle. Conversely, at higher strain values, which are measured in high subglottal pressure, the inferior aspect of the vocal fold is much stiffer than the superior edge; thus, any lateral force that is applied at both aspects will result in a much greater displacement of the superior edge, yielding a large divergence angle. The increased stiffness observed at the inferior edge could be due to the proximity of the conus elasticus.