Social Media Research Strategy to Understand Clinician and Public Perception of Health Care Messages.

INTRODUCTION: Despite the potential of social media to influence public health and generate insights, the process of monitoring and analyzing the dissemination of health care messages on social media has been described as difficult and in need of improvement. OBJECTIVES: The objective of this study was to describe and demonstrate a reproducible methodology for cataloging and analyzing health care-related social media comments and provide insight into how clinicians and members of the general public respond to health care messaging on social media. METHODS: We collected social media comments related to the American Dental Association's 2016 "Evidence-Based Clinical Practice Guideline for the Use of Pit-and-Fissure Sealants" between April 10, 2017, and October 31, 2017, from Facebook, Twitter, LinkedIn, Reddit, and online message boards for the New York Times, FiveThirtyEight, and Dentaltown. Using data provided in the comments, we conducted engagement analysis as well as content, network, and sentiment analysis across 8 categories. RESULTS: We collected 671 comments. Among our findings, Facebook (472 of 671) was the most popular platform among commentators; almost half of all comments (335 of 671) aligned with the recommendations of the 2016 American Dental Association sealants guideline; clinicians were more likely than the general public to like a comment that suggested an improvement to the guideline; and >75% of comments (521 of 671) were supported by anecdotal evidence. CONCLUSION: As the prevalence of anecdotes on social media suggests, the likelihood of falsehoods spreading on social media is high. Insights gleaned from the methodology described in this research could help combat the spread of such misinformation by providing disseminators of health care messaging with insight into their target audiences. Armed with this knowledge, disseminators can craft health care messages that more effectively engage clinicians and the general public. KNOWLEDGE TRANSFER STATEMENT: The methodology used in this research provides a reproducible strategy for tracking social media engagement with health care messages. Engagement results can assist future delivery of health care messages to key stakeholders and ensure better implementation and adoption of these communications.

Effect of large-scale coherent structures on turbulent convection.

We study an effect of large-scale coherent structures on global properties of turbulent convection in laboratory experiments in air flow in a rectangular chamber with aspect ratios A approximately 2 and A approximately 4 (with the Rayleigh numbers varying in the range from 5x10;{6} to 10;{8} ). The large-scale coherent structures comprise the one-cell and two-cell flow patterns. We found that a main contribution to the turbulence kinetic-energy production in turbulent convection with large-scale coherent structures is due to the nonuniform large-scale motions. Turbulence in large Rayleigh number convection with coherent structures is produced by shear rather than by buoyancy. We determined the scalings of global parameters (e.g., the production and dissipation of turbulent kinetic energy, the turbulent velocity and integral turbulent scale, the large-scale shear, etc.) of turbulent convection versus the temperature difference between the bottom and the top walls of the chamber. These scalings are in an agreement with our theoretical predictions. We demonstrated that the degree of inhomogeneity of the turbulent convection with large-scale coherent structures is small.

Mixing at the external boundary of a submerged turbulent jet.

We study experimentally and theoretically mixing at the external boundary of a submerged turbulent jet. In the experimental study we use particle image velocimetry and an image processing technique based on the analysis of the intensity of the Mie scattering to determine the spatial distribution of tracer particles. An air jet is seeded with the incense smoke particles, which are characterized by a large Schmidt number and a small Stokes number. We determine the spatial distributions of the jet fluid characterized by a high concentration of the particles and of the ambient fluid characterized by a low concentration of the tracer particles. In the data analysis we use two approaches, whereby one approach is based on the measured phase function for the study of the mixed state of two fluids. The other approach is based on the analysis of the two-point second-order correlation function of the particle number density fluctuations generated by tangling of the gradient of the mean particle number density by the turbulent velocity field. This gradient is formed at the external boundary of a submerged turbulent jet. We demonstrate that probability density function of the phase function of a jet fluid penetrating into an external flow and the two-point second-order correlation function of the particle number density do not have universal scaling and cannot be described by a power-law function. The theoretical predictions made in this study are in qualitative agreement with the obtained experimental results.

PAPP-A levels as an early marker of idiopathic preterm birth: a pilot study.

OBJECTIVE: To evaluate late PAPP-A levels as predictive of preterm birth in symptomatic women. STUDY DESIGN: Prospective cohort study of singleton gestations, 23 to 34 weeks, and symptoms of preterm labor. PAPP-A, IGF-I and IGF-III analysis were performed. Primary end point was delivery < or =7 days. Accuracy and optimally predictive PAPP-A values were based on receiver operator characteristic (ROC) curves. RESULT: In all, 26 women (51%) delivered < or =7 days post-admission (Group 1); 25 women (49%) >7 days (Group 2). Group 1 mean PAPP-A=38 000 vs 55 333 for Group 2 (P<0.04). Group 1 mean gestational age at delivery=29 weeks vs 37 weeks for Group 2 (P<0.00014). PAPP-A level < or =30,000 mU l(-1) had highest specificity (88%), sensitivity (50%), and positive predictive (81%) and negative predictive (62%) values for delivery < or =7 days. ROC area under curve=0.703. CONCLUSION: PAPP-A levels < or =30,000 mU l(-1) at admission was associated with increased risk for preterm birth < or =7 days, supporting active management and therapeutic approach in these women.

Adjunctive treatment of murine neuroblastoma with 6-hydroxydopamine and Tempol.

Currently available therapy for disseminated neuroblastoma affords only a 5-20% 5-year survival rate. We have attempted to design targeted chemotherapy for this disease by exploiting the dopamine uptake system on neuroblastoma cells. 6-Hydroxydopamine (6OHDA) is a neurotransmitter analogue, which generates cytolytic oxygen radicals in neuroblastoma cells that take it up. It is, however, predictably, systemically toxic, because of its spontaneous oxidation. Its toxicity is particularly severe in the sympathetic nervous system, because this tissue selectively concentrates dopamine and its analogues. Lowering the dose of 6OHDA below toxic levels prohibitively compromises its antitumor effect. To avoid both the systemic and sympathetic nervous system toxicity yet retain the antitumor efficacy of 6OHDA, we have used the antioxidant Tempol adjunctively with 6OHDA. Administration of Tempol (250 mg/kg, i.p.) 10 min prior to administration of toxic doses of 6OHDA (350 or 400 mg/kg, i.p.) resulted in a decrease in the mortality rate, sympathetic nervous system impairment, and activity impairment compared with those seen with 6OHDA alone. Tumor weights from mice administered saline or Tempol alone were 3.6 +/- 1.9 and 2.9 +/- 0.7 g, respectively. In contrast, mice administered Tempol followed by 6OHDA had an average tumor weight of 0.7 +/- 0.3 g. Tumor incidence was also reduced from 80-100% to 40%. Studies performed using electron spin resonance spectroscopy suggest that Tempol acts in this system by reacting directly with both the 6OHDA radical and, in the presence of iron, its oxidation product, the hydroxyl radical.

Comparative measurements of phototherapy: a practical guide.

Increasing the dose of administered phototherapy has been shown to increase the rate of bilirubin decrement up to a saturation point beyond which no further increases in bilirubin degradation are observed. This study provides irradiance measurements which can be used to interpret phototherapy dose-response and saturation data clinically and to determine an optimal phototherapy lamp combination for maximal bilirubin degradation.

Continuous versus multiple rapid infusions of indomethacin: effects on cerebral blood flow velocity.

OBJECTIVE: Therapeutic administration of indomethacin for patent ductus arteriosus (PDA) closure has been documented to decrease cerebral blood flow velocity which may be harmful to the vulnerable premature neonate. We have therefore compared the effects of administering indomethacin by rapid injection versus slow, continuous indomethacin infusion at the same total therapeutic dose on middle cerebral artery (MCA) systolic and diastolic flow velocity, resistance index, and cerebral blood flow (as reflected by the integrated area under the curve). METHODS: Premature neonates (< 1750 g) documented echocardiographically to have a PDA were randomized to receive indomethacin either by three rapid injection doses or by continuous intravenous infusion over the ensuing 36 hours, providing an equivalent total dose. Echocardiograms and transcranial color flow mapping of the MCA flow velocity were measured at baseline and serially following initiation of therapy in both groups. Effects on cerebral blood flow velocity are presented. RESULTS: Eighteen infants [rapid injection-1.2 +/- 0.3 kg (n = 9) and continuous-1.1 +/- 0.2 kg (n = 9)] were studied. In the rapid injection treated infants decreased flow velocity in the MCA as manifested by abrupt, significant decreases in systolic (to 70 +/- 8% baseline) and diastolic (to 65 +/- 13% baseline) flow velocity and area under the curve (to 60 +/- 10% of baseline) were evident by 4 minutes and progressed to 30 minutes after treatment initiation. These changes were not observed in the group treated with continuous indomethacin. Both therapeutic modalities were equally successful in closing the ductus, although the numbers are too small to definitively determine therapeutic efficacy. CONCLUSIONS: Slow, continuous infusion eliminated the decrease in cerebral flow velocity and appears to be effective in closing the PDA.

Respiratory distress syndrome of the newborn and complications of pregnancy.

A group of 412 infants with birthweights between 501 and 2,500 gm and gestational ages of 36 weeks or less were studied for the influence of both prolonged ruputre of amniotic membranes and maternal hypertension on the incidence of idiopathic respiratory distress syndrome (IRDS). The occurrence of these complications was associated with a significant decrease in the incidence of IRDS only in infants with birthweights between 1,501 and 2,500 gm (37.4% in the no complications group versus 12.8% in the complications group; P less than .01) or gestational ages of 33 to 36 weeks (35.2% in the no complications group versus 13.1% in the complications group; P less than .01). In infants with birthweights of 1,500 gm or less or gestational ages of 32 weeks or less, the specific antecedent complications of pregnancy did not alter the incidence of IRDS. Rupture of the membranes for more than 72 hours had no greater effect on the incidence of IRDS than those lasting 24 to 72 hours.

Differential effects of maternal heroin and methadone use on birthweight.

An analysis of birthweights of 337 neonates in relation to history of maternal narcotic usage was undertaken. Mean birthweight of infants born to mothers abusing heroin during the pregnancy was 2,490 gm, an effect primarily of intrauterine growth retardation. Low mean birthweight (2,615 gm) was also seen in infants born to mothers who had abused heroin only prior to this pregnancy, and mothers who had used both heroin and methadone during the pregnancy (2,535 gm). Infants born to mothers on methadone maintenance during the pregnancy had significantly higher mean birthweights (2.961 gm), but lower than the control group (3,176 gm). A highly significant relationship was observed between maternal methadone dosage in the first trimester and birthweight, i.e., the higher the dosage, the larger the infant. Heroin causes fetal growth retardation, an effect which may persist beyond the period of addiction. Methadone may promote fetal growth in a dose-related fashion after maternal use of heroin.

The association of kernicterus with bacterial infection in the newborn.

A total population of 29,395 neonates cared for in the six-year period from 1971 to 1976 was reviewed for evidence of autopsy-proven kernicterus. A total of 327 neonates died and 232 were autopsied. The only cases of kernicterus occurred in four near-term infants with antemortem proven sepsis. All four of these infants weighed more than 2,200 gm and were delivered after gestations of either 36 or 37 weeks. These cases of kernicterus occurred during a period when more aggressive management of hyperbilirubinemia in low-birth-weight infants had apparently eliminated immaturity as a predisposing factor in the development of kernicterus, uncovering bacterial infection as the major remaining etiologic co-factor.

Thomas syndrome: potter sequence with cleft lip/palate and cardiac anomalies.

Holzgreve et al. [Am J Med Genet 18:177-184, 1984] first reported on a syndrome including renal anomalies, heart defect, polydactyly, and cleft palate with other oropharyngeal anomalies. We report here on four sibs with renal adysplasia associated in two with cardiovascular malformations and cleft lip or cleft palate in two. We propose that these patients as the two siblings reported by Thomas et al. [Am J Med Genet 45:767-769, 1993] are affected with a syndrome different of the one described by Holzgreve et al. [Am J Med Genet 18:177-184, 1984] mainly because of the absence of polydactyly. Thomas syndrome is probably inherited as an autosomal recessive trait with marked variability.

Patterns of bacterial colonization of human milk.

Bacterial studies on breast milk collected by an electric suction pump from 44 postpartum mothers were conducted. All samples had bacterial growth, while 84% had organisms identical to those cultured from the mother's nipple. Colony counts varied greatly, with a median of 8700 and mean of nearly 20,000. In 30% of the milk samples, potentially pathogenic organisms were recovered. The significance of these results and collection techniques that might modify these results are discussed.

Cognitive deficits in women after childbirth.

OBJECTIVE: To test the cognitive function of parturients in the days immediately after delivery. METHODS: One hundred postpartum mothers who delivered normal full-term infants were tested on standardized neuropsychological tests--the Wechsler Logical Memory Test and the Wechsler Visual Reproduction Test. Their test results were compared with those of nonpregnant childless women, third-trimester high-risk pregnant women, and fathers of newborns. RESULTS: Postpartum women scored significantly lower than nonpregnant women on both tests on the first postpartum day. The use of intrapartum analgesia mitigated the cognitive deficit. High-risk pregnant women and fathers scored lower than nonpregnant women only on the Logical Memory Test. CONCLUSION: Objective documentation that postpartum women have transient deficits in cognitive function, particularly in memory function, can guide caretakers in the design of care plans for the postpartum lying-in period.

Pelvic cake kidney drained by single ureter.

We report a rare case of cake kidney with a single unobstructed ureter and without any other malformation.

Adrenal rest carcinoma in hilum of kidney.

Adrenocortical rests are uncommon in adults and infrequently undergo malignant changes. Most of the published cases are those of functional tumors allowing preoperative diagnosis on the basis of the resulting endocrinopathy. Most nonfunctioning tumors were found accidentally at operation or autopsy. A case is presented of a parapelvic nonfunctioning adrenocortical rest carcinoma situated in the renal hilus in a fifty-year-old woman. No such tumor has been described previously.

Trends in urolithiasis in various ethnic groups and by age, in Israel.

A survey of upper urinary tract stone composition was carried out over 8 years (1974-1982) in 1147 patients, following a previous survey (1966-1974). Trends in the development of stone formation were found. The most obvious differences were fewer pure calcium oxalate (0.75 versus 5.50%) and uric acid stones (6.11 versus 13.30%) and more mixed stones than in our previous study. In most ethnic groups urinary stones were composed of calcium oxalate/calcium phosphate. A higher prevalence of stones in Israeli-born Jews was noted, in comparison with our previous survey. Age group analysis showed this increase to be limited to the 21-50-year-old group, in contradistinction to a clear decrease in stone formation in Israeli-born Arabs and Jews under the age of 20 years.

Urine polymerase chain reaction as a screening tool for the detection of congenital cytomegalovirus infection.

OBJECTIVES: To define the incidence of congenital cytomegalovirus (CMV) infection in a defined population in Israel as diagnosed by urine polymerase chain reaction (PCR), and to assess the utility of this method for screening for congenital CMV infection. DESIGN: A convenient sample of urine specimens from asymptomatic newborns were subjected to CMV PCR. Positive results were validated by urine tube culture and by determination of serum CMV IgM antibodies. Maternal CMV IgG was determined in a representative sample of mothers. Newborns with positive urine specimens underwent full clinical evaluation. Epidemiological characteristics of the mothers were extracted from the medical records. SETTINGS: Two medical centres in Israel with different population characteristics. PATIENTS: A total of 2000 newborns (1000 in each medical centre). MAIN OUTCOME MEASURE: Presence of CMV DNA in the urine. RESULTS: Despite significant epidemiological differences between the populations in the two hospitals, the CMV seroprevalence was similar, 80.5% and 85%. Fourteen of the 2000 newborns screened (0.7%) were PCR positive. Urine culture was positive in nine of 10 specimens; IgM was positive in only two of 13 newborns with positive PCR. Eleven newborns underwent full or partial evaluation, and only one (9%) was symptomatic. CONCLUSIONS: The incidence of congenital CMV infection in the study population was 0.7%; over 90% were asymptomatic. Urinary CMV PCR is a reliable, rapid, and convenient method, and thus may serve as a screening tool for the detection of congenital CMV infection.

Biopsy proven evolution of post streptococcal glomerulonephritis to rapidly progressive glomerulonephritis of a post infectious type.

A 15 year old boy with chronic impetigo was admitted with severe acute oliguric renal failure requiring temporary dialytic treatment. Renal biopsy revealed typical diffuse and proliferative glomerulonephritis of the poststreptococcal type. Subsequently high temperature developed with flank pains at the biopsy site, concomitantly with deterioration of renal function. On exploration, a sterile perirenal hematoma was found and a wedge renal biopsy revealed crescentic rapidly progressive glomerulonephritis of the post infectious type. Deterioration to end stage renal failure occurred within a few months. Although universally accepted, biopsy proven evolution from diffuse proliferative and exudative glomerulonephritis to crescentic form of post streptococcal glomerulonephritis has been rarely reported.

Use of percutaneous nephrostomy in hydronephrosis of pregnancy.

Traditional methods of urinary diversion in pregnancy include retrograde passage of ureteral catheter or stents and operative nephrostomy. These techniques are, however, associated with the use of anesthesia, are technically difficult to perform, and may induce labor. We report the use of percutaneous nephrostomy in four pregnant patients, two with obstruction due to ureteral calculi and two with infected hydronephrosis. The procedure provided rapid relief from pain and pyosepsis, and allowed uneventful continuation of the pregnancy to full-term, with preservation of renal function.

The narcotic-dependent mother: fetal and neonatal consequences.

During the years 1971--1974, 230 infants born to drug-dependent women and 33 infants born to ex-addicts were studied. Heroin abuse declined while methadone usage increased during those years. Compared to heroin abuse, methadone maintenance treatment during pregnancy was associated with more consistent prenatal care, more normal fetal growth and reduced fetal mortality. Meconium staining of amniotic fluid was increased in the heroin and heroin-methadone groups; this was not associated, however, with an increase in meconium aspiration or a reduction in Apgar scores. Of special note was the equally severe intrauterine growth retardation of infants of former heroin addicts who were free of narcotic use during pregnancy. Neonatal withdrawal from methadone appeared to be more severe than from heroin, as judged by amount of medication required to control symptoms and duration of treatment. In all groups, central nervous system signs were the most common manifestations of withdrawal. Severity of withdrawal did not correlate with late pregnancy maternal methadone dosage. Neonatal seizures occurred in 1.5% of the heroin group and 10% of the methadone group. Discharge of an infant to a parent rather than to an alternate care-taker was more likely if the mother was enrolled in a methadone treatment program. Methadone maintenance programs appear to offer significant therapeutic benefits, balancing the untoward effects of the drug on the newborn infant.