Characterization and Comparison of the Utilization of Facebook Groups Between Public Medical Professionals and Technical Communities to Facilitate Idea Sharing and Crowdsourcing During the COVID-19 Pandemic: Cross-sectional Observational Study.

BACKGROUND: Strict social distancing measures owing to the COVID-19 pandemic have led people to rely more heavily on social media, such as Facebook groups, as a means of communication and information sharing. Multiple Facebook groups have been formed by medical professionals, laypeople, and engineering or technical groups to discuss current issues and possible solutions to the current medical crisis. OBJECTIVE: This study aimed to characterize Facebook groups formed by laypersons, medical professionals, and technical professionals, with specific focus on information dissemination and requests for crowdsourcing. METHODS: Facebook was queried for user-created groups with the keywords "COVID," "Coronavirus," and "SARS-CoV-2" at a single time point on March 31, 2020. The characteristics of each group were recorded, including language, privacy settings, security requirements to attain membership, and membership type. For each membership type, the group with the greatest number of members was selected, and in each of these groups, the top 100 posts were identified using Facebook's algorithm. Each post was categorized and characterized (evidence-based, crowd-sourced, and whether the poster self-identified). STATA (version 13 SE, Stata Corp) was used for statistical analysis. RESULTS: Our search yielded 257 COVID-19-related Facebook groups. Majority of the groups (n=229, 89%) were for laypersons, 26 (10%) were for medical professionals, and only 2 (1%) were for technical professionals. The number of members was significantly greater in medical groups (21,215, SD 35,040) than in layperson groups (7623, SD 19,480) (P<.01). Medical groups were significantly more likely to require security checks to attain membership (81% vs 43%; P<.001) and less likely to be public (3 vs 123; P<.001) than layperson groups. Medical groups had the highest user engagement, averaging 502 (SD 633) reactions (P<.01) and 224 (SD 311) comments (P<.01) per post. Medical professionals were more likely to use the Facebook groups for education and information sharing, including academic posts (P<.001), idea sharing (P=.003), resource sharing (P=.02) and professional opinions (P<.001), and requesting for crowdsourcing (P=.003). Layperson groups were more likely to share news (P<.001), humor and motivation (P<.001), and layperson opinions (P<.001). There was no significant difference in the number of evidence-based posts among the groups (P=.10). CONCLUSIONS: Medical professionals utilize Facebook groups as a forum to facilitate collective intelligence (CI) and are more likely to use Facebook groups for education and information sharing, including academic posts, idea sharing, resource sharing, and professional opinions, which highlights the power of social media to facilitate CI across geographic distances. Layperson groups were more likely to share news, humor, and motivation, which suggests the utilization of Facebook groups to provide comedic relief as a coping mechanism. Further investigations are necessary to study Facebook groups' roles in facilitating CI, crowdsourcing, education, and community-building.

Suicidality After Burn Injuries: A Systematic Review.

Burn survivors may be at increased risk for suicide due to the nature of their injury and psychiatric comorbidities. The purpose of this review is to assess the evidence as to the prevalence of suicidal ideations and behaviors (attempts and completed suicides) in burn survivors as well as evaluate risk and protective factors. PubMed, EMBASE, CINAHL, Cochrane, PsycINFO, and Web Science databases were searched using search terms regarding suicide, suicidality, and burn. Fourteen full-text manuscripts and two published abstracts were included in the review. Overall, burn survivors demonstrate elevated suicidal ideations and a higher lifetime prevalence of suicide attempts compared to the general population. There is mixed evidence as to rates of completed suicide postburn injury, though rates appear to be relatively low. Risk factors include pain at discharge, perceived level of disfigurement, premorbid psychiatric comorbidities, and past suicide attempts. Results of this systematic review shed light on the scarcity of data on rates of suicidality among burn survivors, which is surprising given the multiple risk factors burn survivors possess including chronic pain, sleep disturbances, history of substance abuse, posttraumatic stress disorder, social isolation, and depression which are linked to suicidality in the general population. Suicide risk screening should be included as an integral part of burn survivors' care, and more research is needed to better understand the magnitude of this phenomenon and offer targeted interventions to vulnerable individuals.

Pediatric Safety Restraint Use in Motor Vehicle Crashes at a Level I Safety-Net Trauma Center.

BACKGROUND: Adherence to child passenger safety recommendations is essential to prevent death and injury in children involved in motor vehicle crashes. Parents may not undertake the proper safety measures, which can lead to increase injury. METHODS: A safety net, level I trauma center's database was used to identify admitted children (age<15 y/o) involved in motor vehicle crashes over a 2-y period to investigate safety restraint device use and compliance with state recommendations. Variables evaluated were crash characteristics, presence and method of passenger restraint, demographics, Glasgow Coma Scale, and Injury Severity Score. Excluded were patients where restraint characteristics could not be identified and those discharged from the trauma center. RESULTS: Eighty patients met inclusion criteria. Thirty-two (40%) children were unrestrained. Safety restraint device was noted in 48 (60%) children with 13 (27.1%) patients improperly restrained. The most common method of improper restraint (6, 46.2%) was traveling in the front seat before the age state law recommends. With respect to proper, improper, and no restraint, age (7.31 ± 14.26, 5.76 ± 3.24, P = 0.36), female sex (17, 8, 13, P = 0.32), low-income status (14, 5, 24, P = 0.28), and race (P = 0.08) did not differ between the groups. The unrestrained children had statistically lower initial Glasgow Coma Scale and higher Injury Severity Score and were more often involved in high-risk mechanism of Injury motor vehicle crashes. CONCLUSIONS: Despite recommendations and regulations regarding child passenger safety measures, there are a significant number of children that remain suboptimally restrained who are admitted to a safety-net trauma center. Further research is needed to understand the barriers to increase the compliance with recommendations along with targeted educational campaigns in low-compliance populations.

Scientists' warning to humanity on the freshwater biodiversity crisis.

Freshwater ecosystems provide irreplaceable services for both nature and society. The quality and quantity of freshwater affect biogeochemical processes and ecological dynamics that determine biodiversity, ecosystem productivity, and human health and welfare at local, regional and global scales. Freshwater ecosystems and their associated riparian habitats are amongst the most biologically diverse on Earth, and have inestimable economic, health, cultural, scientific and educational values. Yet human impacts to lakes, rivers, streams, wetlands and groundwater are dramatically reducing biodiversity and robbing critical natural resources and services from current and future generations. Freshwater biodiversity is declining rapidly on every continent and in every major river basin on Earth, and this degradation is occurring more rapidly than in terrestrial ecosystems. Currently, about one third of all global freshwater discharges pass through human agricultural, industrial or urban infrastructure. About one fifth of the Earth's arable land is now already equipped for irrigation, including all the most productive lands, and this proportion is projected to surpass one third by midcentury to feed the rapidly expanding populations of humans and commensal species, especially poultry and ruminant livestock. Less than one fifth of the world's preindustrial freshwater wetlands remain, and this proportion is projected to decline to under one tenth by midcentury, with imminent threats from water transfer megaprojects in Brazil and India, and coastal wetland drainage megaprojects in China. The Living Planet Index for freshwater vertebrate populations has declined to just one third that of 1970, and is projected to sink below one fifth by midcentury. A linear model of global economic expansion yields the chilling prediction that human utilization of critical freshwater resources will approach one half of the Earth's total capacity by midcentury. Although the magnitude and growth of the human freshwater footprint are greater than is generally understood by policy makers, the news media, or the general public, slowing and reversing dramatic losses of freshwater species and ecosystems is still possible. We recommend a set of urgent policy actions that promote clean water, conserve watershed services, and restore freshwater ecosystems and their vital services. Effective management of freshwater resources and ecosystems must be ranked amongst humanity's highest priorities.

Hemosiderotic Dermatofibroma: A Rare and Atypical Variant Capable of Clinically Resembling Melanoma.

A dermatofibroma (DF) is a common, benign tumor composed of fibroblastic and histiocytic cells. DF presents clinically with several different reported variants. One rare variant is hemosiderotic DF (HDF), which is made up of small blood vessels and hemosiderin deposits. HDF can be indistinguishable, clinically, from melanoma, making the use of other pathological tools crucial in the diagnosis. We report the case of a 25-year-old male medical student from the Caribbean who presented to our clinic with a single asymptomatic pigmented cystic lesion on his left posterior calf. The cystic lesion was excised surgically. Histopathology examination of the excised mass revealed a moderately cellular, poorly demarcated, dermal, fibrohistiocytic proliferation. Pathology consultation confirmed a diagnosis of HDF.

Closing the gaps for animal seed dispersal: Separating the effects of habitat loss on dispersal distances and seed aggregation.

Habitat loss can alter animal movements and disrupt animal seed dispersal mutualisms; however, its effects on spatial patterns of seed dispersal are not well understood. To explore the effects of habitat loss on seed dispersal distances and seed dispersion (aggregation), we created a spatially explicit, individual-based model of an animal dispersing seeds (SEADS-Spatially Explicit Animal Dispersal of Seeds) in a theoretical landscape of 0%-90% habitat loss based on three animal traits: movement distance, gut retention time, and time between movements. Our model design had three objectives: to determine the effects of (1) animal traits and (2) habitat loss on seed dispersal distances and dispersion and (3) determine how animal traits could mitigate the negative effects of habitat loss on these variables. SEADS results revealed a complex interaction involving all animal traits and habitat loss on dispersal distances and dispersion, driven by a novel underlying mechanism of fragment entrapment. Unexpectedly, intermediate habitat loss could increase dispersal distances and dispersion relative to low and high habitat loss for some combinations of animal traits. At intermediate habitat loss, movement between patches was common, and increased dispersal distances and dispersion compared to continuous habitats because animals did not stop in spaces between fragments. However, movement between patches was reduced at higher habitat loss as animals became trapped in fragments, often near the parent plant, and dispersed seeds in aggregated patterns. As movement distance increased, low time between movements and high gut retention time combinations permitted more movement to adjacent patches than other combinations of animal traits. Because habitat loss affects movement in a nonlinear fashion under some conditions, future empirical tests would benefit from comparisons across landscapes with more than two levels of fragmentation.

Coordinated Dispersal and Pre-Isthmian Assembly of the Central American Ichthyofauna.

We document patterns of coordinated dispersal over evolutionary time frames in heroine cichlids and poeciliine live-bearers, the two most species-rich clades of freshwater fishes in the Caribbean basin. Observed dispersal rate (DO) values were estimated from time-calibrated molecular phylogenies in Lagrange+, a modified version of the ML-based parametric biogeographic program Lagrange. DO is measured in units of "wallaces" (wa) as the number of biogeographic range-expansion events per million years. DO estimates were generated on a dynamic paleogeographic landscape of five areas over three time intervals from Upper Cretaceous to Recent. Expected dispersal rate (DE) values were generated from alternative paleogeographic models, with dispersal rates proportional to target area and source-river discharge volume, and inversely proportional to paleogeographic distance. Correlations between DO and DE were used to assess the relative contributions of these three biogeographic parameters. DO estimates imply a persistent dispersal corridor across the Eastern (Antillean) margin of the Caribbean plate, under the influence of prevailing and perennial riverine discharge vectors such as the Proto-Orinoco-Amazon river. Ancestral area estimation places the earliest colonizations of the Greater Antilles and Central America during the Paleocene-Eocene (ca. 58-45 Ma), potentially during the existence of an incomplete Paleogene Arc (∼59 Ma) or Lesser Antilles Arc (∼45 Ma), but predating the GAARlandia land bridge (∼34-33 Ma). Paleogeographic distance is the single best predictor of DO. The Western (Central American) plate margin did not serve as a dispersal corridor until the Late Neogene (12-0 Ma), and contributed relatively little to the formation of modern distributions.

Barrier Displacement on a Neutral Landscape: Toward a Theory of Continental Biogeography.

Macroevolutionary theory posits three processes leading to lineage diversification and the formation of regional biotas: dispersal (species geographic range expansion), speciation (species lineage splitting), and extinction (species lineage termination). The Theory of Island Biogeography (TIB) predicts species richness values using just two of these processes; dispersal and extinction. Yet most species on Earth live on continents or continental shelves, and the dynamics of evolutionary diversification at regional and continental scales are qualitatively different from those that govern the formation of species richness on biogeographic islands. Certain geomorphological processes operating perennially on continental platforms displace barriers to gene flow and organismal dispersal, and affect all three terms of macroevolutionary diversification. For example, uplift of a dissected landscape and river capture both merge and separate portions of adjacent areas, allowing dispersal and larger geographic ranges, vicariant speciation and smaller geographic ranges, and extinction when range sizes are subdivided below a minimum persistence threshold. The TIB also does not predict many biogeographic and phylogenetic patterns widely observed in continentally distributed taxa, including: (i) power function-like species-area relationships; (ii) log-normal distribution of species geographic range sizes, in which most species have restricted ranges (are endemic) and few species have broad ranges (are cosmopolitan); (iii) mid-domain effects with more species toward the geographic center, and more early-branching, species-poor clades toward the geographic periphery; (iv) exponential rates of net diversification with log-linear accumulation of lineages through geological time; and (v) power function-like relationships between species-richness and clade diversity, in which most clades are species-poor and few clades are species-rich. Current theory does not provide a robust mechanistic framework to connect these seemingly disparate patterns. Here we present SEAMLESS (Spatially Explicit Area Model of Landscape Evolution by SimulationS) that generates clade diversification by moving geographic barriers on a continuous, neutral landscape. SEAMLESS is a neutral Landscape Evolution Model (LEM) that treats species and barriers as functionally equivalent with respect to model parameters. SEAMLESS differs from other model-based biogeographic methods (e.g., Lagrange, GeoSSE, BayArea, and BioGeoBEARS) by modeling properties of dispersal barriers rather than areas, and by modeling the evolution of species lineages on a continuous landscape, rather than the evolution of geographic ranges along branches of a phylogeny. SEAMLESS shows how dispersal is required to maintain species richness and avoid clade-wide extinction, demonstrates that ancestral range size does not predict species richness, and provides a unified explanation for the suite of commonly observed biogeographic and phylogenetic patterns listed above. SEAMLESS explains how a simple barrier-displacement mechanism affects lineage diversification under neutral conditions, and is advanced here toward the formulation of a general theory of continental biogeography. [Diversification, extinction, geodispersal, macroevolution, river capture, vicariance.].

Unusual Manifestation of Superior Mesenteric Artery Syndrome in a Female Patient: A Case Presentation.

Superior mesenteric artery (SMA) syndrome is a rare clinical entity. We report a female patient presenting with abdominopelvic pain and diagnosed with superior mesenteric artery syndrome. Direct venography revealed a large ovarian varix that was treated with hysterectomy and unilateral oophorectomy. SMA syndrome can have many presentations often with small bowel obstruction. Obstruction of only the ovarian vein with resultant ovarian varix is an unusual presentation.

The effect of intermittent preventive treatment on anti-malarial drug resistance spread in areas with population movement.

BACKGROUND: The use of intermittent preventive treatment in pregnant women (IPTp), children (IPTc) and infant (IPTi) is an increasingly popular preventive strategy aimed at reducing malaria risk in these vulnerable groups. Studies to understand how this preventive intervention can affect the spread of anti-malarial drug resistance are important especially when there is human movement between neighbouring low and high transmission areas. Because the same drug is sometimes utilized for IPTi and for symptomatic malaria treatment, distinguishing their individual roles on accelerating the spread of drug resistant malaria, with or without human movement, may be difficult to isolate experimentally or by analysing data. A theoretical framework, as presented here, is thus relevant as the role of IPTi on accelerating the spread of drug resistance can be isolated in individual populations and when the populations are interconnected and interact. METHODS: A previously published model is expanded to include human movement between neighbouring high and low transmission areas, with focus placed on the malaria parasites. Parasite fitness functions, determined by how many humans the parasites can infect, are used to investigate how fast resistance can spread within the neighbouring communities linked by movement, when the populations are at endemic equilibrium. RESULTS: Model simulations indicate that population movement results in resistance spreading fastest in high transmission areas, and the more complete the anti-malarial resistance the faster the resistant parasite will tend to spread through a population. Moreover, the demography of infection in low transmission areas tends to change to reflect the demography of high transmission areas. Additionally, when regions are strongly connected the rate of spread of partially resistant parasites (R1) relative to drug sensitive parasites (RS), and fully resistant parasites (R2) relative to partially resistant parasites (R1) tend to behave the same in both populations, as should be expected. CONCLUSIONS: In fighting anti-malarial drug resistance, different drug resistance monitoring and management policies are needed when the area in question is an isolated high or low transmission area, or when it is close and interacting with a neighbouring high or low transmission area, with human movement between them.

Molecular evolutionary signatures reveal the role of host ecological dynamics in viral disease emergence and spread.

RNA viruses account for numerous emerging and perennial infectious diseases, and are characterized by rapid rates of molecular evolution. The ecological dynamics of most emerging RNA viruses are still poorly understood and difficult to ascertain. The availability of genome sequence data for many RNA viruses, in principle, could be used to infer ecological dynamics if changes in population numbers produced a lasting signature within the pattern of genome evolution. As a result, the rapidly emerging phylogeographic structure of a pathogen, shaped by the rise and fall in the number of infections and their spatial distribution, could be used as a surrogate for direct ecological assessments. Based on rabies virus as our example, we use a model combining ecological and evolutionary processes to test whether variation in the rate of host movement results in predictive diagnostic patterns of pathogen genetic structure. We identify several linearizable relationships between host dispersal rate and measures of phylogenetic structure suggesting genetic information can be used to directly infer ecological process. We also find phylogenetic structure may be more revealing than demography for certain ecological processes. Our approach extends the reach of current analytic frameworks for infectious disease dynamics by linking phylogeography back to underlying ecological processes.

Strong seasonality produces spatial asynchrony in the outbreak of infectious diseases.

Models for infectious diseases usually assume a fixed demographic structure. Yet, a disease can spread over a region encountering different local demographic variations that may significantly alter local dynamics. Spatial heterogeneity in the resulting dynamics can lead to important differences in the design of surveillance and control strategies. We illustrate this by exploring the north-south gradient in the seasonal demography of raccoon rabies over the eastern USA. We find that the greater variance in the timing of spring births characteristic of southern populations can lead to the spatial synchronization of southern epidemics, while the narrow birth-pulse associated with northern populations can lead to an irregular patchwork of epidemics. These results indicate that surveillance in the southern states can be reduced relative to northern locations without loss of detection ability. This approach could yield significant savings in vaccination programmes. The importance of seasonality in many widely distributed diseases indicates that our findings will find applications beyond raccoon rabies.

Optimal control of a rabies epidemic model with a birth pulse.

A system of ordinary differential equations describes the population dynamics of a rabies epidemic in raccoons. The model accounts for the dynamics of a vaccine, including loss of vaccine due to animal consumption and loss from factors other than racoon uptake. A control method to reduce the spread of disease is introduced through temporal distribution of vaccine packets. This work incorporates the effect of the seasonal birth pulse in the racoon population and the attendant increase in new-borns which are susceptible to the diseases, analysing the impact of the timing and length of this pulse on the optimal distribution of vaccine packets. The optimization criterion is to minimize the number of infected raccoons while minimizing the cost of distributing the vaccine. Using an optimal control setting, numerical results illustrate strategies for distributing the vaccine depending on the timing of the infection outbreak with respect to the birth pulse.

Testing the robustness of management decisions to uncertainty: Everglades restoration scenarios.

To effectively manage large natural reserves, resource managers must prepare for future contingencies while balancing the often conflicting priorities of different stakeholders. To deal with these issues, managers routinely employ models to project the response of ecosystems to different scenarios that represent alternative management plans or environmental forecasts. Scenario analysis is often used to rank such alternatives to aid the decision making process. However, model projections are subject to uncertainty in assumptions about model structure, parameter values, environmental inputs, and subcomponent interactions. We introduce an approach for testing the robustness of model-based management decisions to the uncertainty inherent in complex ecological models and their inputs. We use relative assessment to quantify the relative impacts of uncertainty on scenario ranking. To illustrate our approach we consider uncertainty in parameter values and uncertainty in input data, with specific examples drawn from the Florida Everglades restoration project. Our examples focus on two alternative 30-year hydrologic management plans that were ranked according to their overall impacts on wildlife habitat potential. We tested the assumption that varying the parameter settings and inputs of habitat index models does not change the rank order of the hydrologic plans. We compared the average projected index of habitat potential for four endemic species and two wading-bird guilds to rank the plans, accounting for variations in parameter settings and water level inputs associated with hypothetical future climates. Indices of habitat potential were based on projections from spatially explicit models that are closely tied to hydrology. For the American alligator, the rank order of the hydrologic plans was unaffected by substantial variation in model parameters. By contrast, simulated major shifts in water levels led to reversals in the ranks of the hydrologic plans in 24.1-30.6% of the projections for the wading bird guilds and several individual species. By exposing the differential effects of uncertainty, relative assessment can help resource managers assess the robustness of scenario choice in model-based policy decisions.