Objectives To evaluate clinician adherence to guidelines for documentation of sexual history and screening for sexually transmitted infection (STI)/HIV during routine adolescent well visits. Secondary objectives were to determine patient and clinician factors associated with sexual history documentation and STI/HIV testing. Study design Retrospective, cross-sectional study of 1000 randomly selected 13–19 year old routine well visits at all 29 pediatric primary care practices affiliated with a children’s hospital. We evaluated frequency of documentation of sexual history and testing for gonorrhea/chlamydia (GC/CT) and HIV testing. Multivariable logistic regression was performed to identify factors associated with documentation and testing. Results Of the 1000 patient visits reviewed, 212 (21.2%; 95% CI 18.7, 23.7) had a documented sexual history, of which 45 adolescents’ (21.2%; 95% CI 15.7, 26.8) encounters were documented as being sexually active. Overall, 26 (2.6%; 95% CI 1.6, 3.6) patients were tested for GC/CT and 16 (1.6%; 95% CI 0.8, 2.4) for HIV. In multivariable analyses, factors associated with sexual history documentation included older patient age, non-Hispanic Black race/ethnicity, non-private insurance status, and care by female clinician. Factors associated with GC/CT testing included male gender, non-Hispanic Black race/ethnicity, and non-private insurance. HIV testing was more likely to be performed on older adolescents, those of non-Hispanic Black race/ethnicity, and those with non-private insurance. Conclusions Pediatric primary care clinicians infrequently document sexual histories and perform STI and HIV testing on adolescent patients. Future studies should investigate provider beliefs, clinical decision-making principles, and perceived barriers to improve the sexual health care of adolescents and evaluate interventions to increase rates of adolescent sexual health screening.

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Objective-Evaluate the effect of injection laryngoplasty (IL), medialization laryngoplasty (ML), and ML combined with arytenoid adduction (ML-AA) on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup.Methods-Measurements were recorded for eight excised canine larynges with simulated unilateral vocal fold paralysis (UVFP) before and after vocal fold injection with Cymetra. A second set of eight larynges was used to evaluate medialization laryngoplasty using a Silastic implant without and with arytenoid adduction.

Objective Evaluate the effect of vocal fold surface dehydration on mucosal wave amplitude and frequency. Study Design Controlled test-retest. Setting Larynges were mounted on an excised larynx phonation system and attached to a pseudolung in a triple-walled sound-attenuated room that eliminated background noise and maintained a stabilized room temperature and humidity level. Subjects and Methods High-speed video was recorded for eight excised canine larynges during exposure to dehumidified air at 20 cm H2O. Control trials consisted of high-speed videos recorded for two excised canine larynges during exposure to humidified air at the same pressure. Results In the majority of larynges, increased levels of dehydration were correlated with decreased amplitude and frequency. The slope of the linear regression fitted to the change in amplitude (p=0.003) as well as the percent change (p<0.001) between the initial and final trials were significantly decreased in dehydrated larynges. These measurements with respect to the change in frequency were also significantly decreased in dehydrated larynges (p<0.001; p=0.027). Conclusion Vocal fold surface dehydration caused a decrease in mucosal wave amplitude and frequency. This study provides objective, quantitative support for the mechanism of voice deterioration observed after extreme surface dehydration.

Objective/Hypothesis-The minimum airflow necessary to initiate stable vocal fold vibration, phonation threshold flow (PTF), may increase as exposure to dry air increases. A critical period of dehydration after which phonation can no longer be initiated may exist.Method-PTF data were collected for eleven excised canine larynges mounted on a bench apparatus. Trials consisted of cycles of ten seconds of phonation followed by three seconds of rest. During the experimental trials, subglottal flow of comparatively dry air was increased until phonation was initiated, and phonation was sustained for the remainder of the ten second period. The subglottal flow was then decreased until phonation ceased. No saline was applied during the dehydration trials. During the control trials, subglottal airflow was humidified and saline was applied frequently to the vocal folds.Results-PTF increased as exposure to dry air increased during the experimental trials (p = 0.010); this relationship was not statistically significant in control trials. A point existed after which phonation could not be initiated.Conclusions-Knowledge of the effect of exposure to dry air on PTF could be useful in the clinical assessment and prevention of dehydration. Further exploration of this relationship in vivo could evaluate the effectiveness of current hydration therapies and provide theoretical support for the development of new ones.