Metabolic Diversity in Human Non-Small Cell Lung Cancer Cells.

Intermediary metabolism in cancer cells is regulated by diverse cell-autonomous processes, including signal transduction and gene expression patterns, arising from specific oncogenotypes and cell lineages. Although it is well established that metabolic reprogramming is a hallmark of cancer, we lack a full view of the diversity of metabolic programs in cancer cells and an unbiased assessment of the associations between metabolic pathway preferences and other cell-autonomous processes. Here, we quantified metabolic features, mostly from the 13C enrichment of molecules from central carbon metabolism, in over 80 non-small cell lung cancer (NSCLC) cell lines cultured under identical conditions. Because these cell lines were extensively annotated for oncogenotype, gene expression, protein expression, and therapeutic sensitivity, the resulting database enables the user to uncover new relationships between metabolism and these orthogonal processes.

Does Organizational Messaging Make a Difference? Investigating Themes and Language Style in Twitter Discourse and Engagement by Mental Health Organizations.

The present study investigated the latent topics and language styles present in mental health organizational discourse on Twitter. The researchers sought to analyze identifying the prevalence of and language used in social support messaging in tweets about mental health care, the overarching topics regarding mental health care, and predicted that tweets with higher engagement will have increased frequency of words with positively valenced emotion and cognitive processing. A GSDMM was run to uncover latent themes that emerged in a data set of 326.9k tweets and 7.2 m words about organizational discussions of mental health. A generalized linear model using the Poisson distribution was used to assess the role of engagement, positive emotion, and cognitive processing. The study found support for both positive emotion and cognitive processing as statistically significant predictors of engagement. Directions for research include the development of health message strategies, policy needs, and online interventions.

Social Media as Risk-Attenuation and Misinformation-Amplification Station: How Social Media Interaction Affects Misperceptions about COVID-19.

This study addresses how social media interaction affects misperceptions about COVID-19 via risk perceptions thereof and whether political orientation moderates the relationship. Using original two-wave panel survey data (N = 679), this study reveals that social media interaction increases misperception directly, as well as indirectly by reducing the extent of risk perception. The extent of risk perception is found to be a negative predictor of misperception. The deleterious role of social media interaction on misperception is pronounced across groups of conservatives and liberals, but in different ways. Although the effects of social media interaction on the level of misperception are observed in both conservatives and liberals, this relationship is particularly salient among conservatives. Furthermore, whereas conservatives consistently show low levels of risk perception toward COVID-19 regardless of how much they interact with others on social media, the more liberals interact on social media, the less likely they are to perceive COVID-19-related risks. The findings expand our understanding of the role of interaction behaviors on social media in forming risk perceptions and misperceptions on the politicized COVID-19 pandemic.

Communication Expressed on the COVID-19 Subreddit in the Midst of a Global Pandemic.

The manner in which scientific information related to the COVID-19 pandemic has been shared and discussed in similar venues has, to date, been largely neglected. Considering the role that such discourse plays in knowledge sharing and knowledge production, it is essential to understand such communication processes as they relate to global health crises like the COVID-19 pandemic. The current study examines communication expressed by participants in the r/COVID19 subreddit, a community that facilitates scientific discussion of the ongoing coronavirus pandemic. A computational content analysis was performed to identify the primary themes of users' communication on r/COVID19, while stepwise segmented regression was used to assess identify longitudinal changes in the volume of user contributions. Findings showed that while conversations were centered on scientific conversations, they were catalyzed by sociological and political developments rather than scientific breakthroughs. Future studies should examine the effects of pandemic-related communities on lurkers, the effects of visibility on scientific and medical contributions, and the implications of pseudonymity and ambiguous credentials in a community addressing a volatile health and scientific topic.

Oral Healthcare Implications of Dedicated Online Communities: A Computational Content Analysis of the r/Dentistry Subreddit.

The current study explores communication expressed by participants in a subreddit surrounding oral health care, moderated by dentists and dental hygienists. The corpus was analyzed through Leximancer, a computer-assisted program used for computational content analyses of large data sets. Users' personal disclosures about ongoing dental concerns, advice about others' self-care, and the role of interpersonal communication with and among health care providers emerged as dominant themes. The findings suggest that online communities may serve an important role that dentists are unable to fill in their limited interactions with individual patients. Such interaction spaces may therefore offer a fertile environment for future interventions to promote beneficial practices and achieve positive health-related outcomes.

"Sharing Hope and Healing": A Culturally Tailored Social Media Campaign to Promote Living Kidney Donation and Transplantation Among Native Americans.

In this article, the authors discuss a community-based participatory research (CBPR)-driven and culturally tailored social media campaign to promote living kidney donation and transplantation (LKDT) serving Native American communities, who are disproportionately burdened by kidney failure. The effort represents a collaboration among researchers, tribal leaders and community members, medical centers, and other stakeholders to facilitate health promotion related to LKDT among the broader Native American community. Campaign objectives were collaboratively established by the researchers and stakeholders, and the campaign approach and materials were likewise developed in consultation with the community. The results indicated that the use of success stories about LKDT within campaign materials was a statistically significant predictors of heightened campaign engagement (p = .003, ß = .223). Recommendations are offered for partnering with tribal communities and other stakeholders, as well as for building tailored health promotion strategies.

Native Americans' Memorable Conversations About Living Kidney Donation and Transplant.

Living kidney donation and transplant (LKDT) offers a path of hope for patients on indefinite dialysis treatment. However, identification of a living donor can be challenging; initiating these conversations is difficult. Our study analyzes memorable conversations about LKDT that occurred in response to an LKDT campaign targeted to Native Americans. Our analysis of n = 28 memorable conversations revealed that the campaign prompted conversations and increased communication efficacy about LKDT. Based on these findings, we suggest that campaign designers utilize narratives within campaigns to model communication self-efficacy and then analyze the content of postcampaign conversations as an indicator of campaign effectiveness.

Statewide assessment of surgical outcomes and the acute care surgery model.

BACKGROUND: The acute care surgery (ACS) model has been widely implemented with single institution studies demonstrating improved outcomes. Recent multicenter studies have raised questions about the economics and efficacy of ACS. This study compares traditional and ACS outcomes across an entire state. METHODS: A retrospective review of Virginia's Health Information administrative database was completed. Adults admitted with appendicitis or cholecystitis between 2008 and 2014 were included. Hospital administration was contacted to determine surgical model. To compare patient characteristics, t-test and chi-square analyses were used. Total charges and length of stay (LOS) differences between ACS and traditional were examined using generalized linear models, whereas logistic regression was used for the presence of complications and 30-day mortality. RESULTS: Overall, the ACS model showed an increased proportion of uninsured patients with a higher rate of comorbidities. In the appendicitis subgroup, (n = 22,011; ACS n = 1993), ACS patients had higher total charges ($30,060 versus $28,460, P = 0.013), longer LOS (3.31 versus 2.92 d, P < 0.001), and higher chance of complications (odds ratio [OR] = 1.2, P = 0.016) and mortality (OR = 2.4, P = 0.029). After adjustment for comorbidities and insurance, mortality was no longer significantly different. In the cholecystitis group (n = 6936; ACS n = 777), ACS patients had a longer LOS (4.55 versus 4.13 d; P = 0.009) without significant differences in mortality, complications, or cost. There were no significant differences after adjustment for patient characteristics. CONCLUSIONS: ACS patients in Virginia have a higher rate of medical comorbidities and uninsured status, with slightly worse outcomes than the traditional model for appendicitis. Further studies to determine which patients benefit the most from ACS are warranted.

Online Social Support for Participants of Crohn's and Ulcerative Colitis Groups.

Thousands of people affected by or caring for someone affected by Crohn's disease or ulcerative colitis participate in online social support groups today. The diseases, which are often discussed in conjunction due to being similar in nature, have no cure and yet affect over 1 million people in the United States alone. There is a need for health communication scholarship to examine the nature of the messages in Crohn's and UC groups, which can lend insight into the unique struggles and psychosocial benefits that members gain from group participation. To develop an in-depth understanding of social support exchanges on these groups, 2000 posts within a 2-year period were randomly selected and content analyzed. Using a taxonomy of social support, several categories and subcategories of social support emerged. Results showed that informational support (41.1%) and emotional support (36.1%) were most frequently exchanged, followed by esteem support (14.3%) and network support (14.2%). Data suggested that several exchanges, such as symptom management and remission, experiences of extraintestinal manifestations, and relational support, may be contextually unique due to the variety of symptoms and treatments unique to Crohn's and UC. Recommendations are provided for researchers to collaborate with health practitioners and educators, including developing interventions and patient-centered practices to better serve patients and caregivers of Crohn's and UC. Further avenues for research in social support are also recommended.

eHealth Literacy and Health Behaviors Affecting Modern College Students: A Pilot Study of Issues Identified by the American College Health Association.

BACKGROUND: The eHealth Literacy Scale (eHEALS) has been widely adopted by researchers to understand how eHealth literacy can be put into context. eHealth researchers need to know how to promote positive health behavior changes across college students, given the importance of the Internet to acquire and use health information. The American College Health Association identified a set of key health issues that affect college students today. By understanding how eHEALS might be related to college students' maintenance of their health and their use of online health resources, researchers will be provided with a better understanding of eHealth literacy and its pragmatic implications for health campaigns and future interventions. OBJECTIVE: The goal of the study was to examine what eHEALS reveals about college student health behaviors identified by the American College Health Association. To understand college student current health maintenance and their intentions to maintain their health and use online resources, the theory of planned behavior was used as the theoretical framework for the study. METHODS: Data were collected via a survey of 422 college students that included the eHEALS measure and questions about health issues based on the recommendations of the American College Health Association. These questions asked about college student current health, subsequent use of online health resources, and their intention to maintain their health and make use of such resources in the future. RESULTS: eHEALS was positively and significantly associated with all 8 areas of health issues identified by the American College Health Association for college student current maintenance of health and use of online health resources and for future intention of health maintenance and use of online resources. Key issues that emerged with eHealth literacy were maintaining safe sex practices and seeking out related information, seeking out information on an exercise regime, information on vaccinations, and maintaining a balanced diet. CONCLUSIONS: These results suggest several areas that may be targeted for future health campaigns toward college students. In addition, eHEALS was found to be a useful instrument for college students in the United States. Lastly, these results point to a need to deliver targeted information to college students, particularly since eHEALS captures literacy based on positively phrased items.

Challenges in Media Attention toward COVID-19-Preventive Behaviors: Dual Roles of Threat and Perceived Capability for Information Systems and Health Care.

Based on the extended parallel process model, this study investigated the relationship between young adults' media exposure to COVID-19 and their adoption of protective behaviors. This study surveyed 141 college students and found that increased risk perceptions led to greater intentions to engage in COVID-19-preventive behaviors and that these intentions were mediated by normative beliefs. There was no significant difference in risk perceptions between traditional media and social media. The results showed that college students took precautions against COVID-19 because they perceived themselves to be both vulnerable and capable.

Type of Prior Operation Does Not Predict Surgical Intervention for Small Bowel Obstruction.

Background: Patients with prior abdominal surgeries are at higher risk for intra-abdominal adhesive tissue formation and subsequently higher risk for small bowel obstruction (SBO).Purpose: In this study, we investigated whether surgical intervention for SBO was more likely following specific types of abdominal surgeries.Research Design: With retrospective chart review, we pooled data from 799 patients, ages 18 to 89, admitted with SBO between 2012 and 2019. Patients were evaluated based on whether they underwent surgery or were managed conservatively. They were further compared with regard to past surgical history by way of type of abdominal surgery (or surgeries) undergone prior to admission.Results: Of the 799 patients admitted for SBO, 206 underwent surgical intervention while 593 were managed nonoperatively. There was no significant difference in number of prior surgeries (2.07 ± 1.56 vs 2.36 ± 2.11, P = .07) or in number of comorbidities (2.39 ± 1.97 vs 2.65 ± 1.93, P = .09) for surgical vs non-surgical intervention. Additionally, of the operations evaluated, no specific type of abdominal surgery predicted need for surgical intervention in the setting of SBO. However, for both surgical and non-surgical intervention following SBO, pelvic surgery was the most common type of prior abdominal surgery (45% vs 43%). There are significantly more female pelvic surgeries in both the operative (91.4% vs 8.6%, P < .0001) and nonoperative groups (89.9% vs 10.2%, P < .0001).Conclusion: Ultimately, no specific type of prior operation predicted the need for surgical intervention in the setting of SBO.

Indications for Readmission for Small Bowel Obstruction: A Comparison of Medical vs Surgical Service Admission.

Small bowel obstruction (SBO) impacts the health care system and patient quality of life. Previously, we evaluated differences between medical and surgical admissions in the management of SBO. This study investigates indications for readmission based on original admission to medical (MS) or surgical services (SS). A retrospective chart review was performed for 799 patients aged 18 to 89 admitted between 2012 and 2019 with a diagnosis of SBO. Patient characteristics examined included length of stay (LOS), prior abdominal operations, prior SBO, use of small bowel follow through imaging, operative intervention, mortality, and 30-day readmission. There was no difference in readmission rates in patients originally admitted to MS or SS (13.2% vs 12.7%, P = .86). Patients admitted to SS were more likely to be readmitted for recurrent SBO (39% vs 8.6%, P = .006). Patients admitted to MS were more likely to be readmitted for other reasons (73.9% v. 40.2%, P = .004). In the MS cohort, 30.4% (7 patients) had surgery during their initial admission for SBO, and none of those patients were readmitted for recurrent SBO (rSBO). In the SS cohort, 23% had surgery during their initial admission and 31.6% were readmitted for rSBO (P = .002). Patients admitted to SS were more likely to be readmitted for rSBO and to require surgery. Patients admitted to MS were more likely to be readmitted for other reasons. None of the MS patients who had surgery were readmitted for SBO. 31.6% of SS patients who had surgery were readmitted for SBO.

Outcomes of Small Bowel Obstructions by Admitting Specialty and Hospital Type.

BACKGROUND: Small bowel obstructions (SBOs) account for a significant burden on the health care system. Should the ongoing trend of regionalizing medicine extend to these patients? We investigated if there is a benefit to admitting SBOs to larger teaching hospitals and to surgical services. METHODS: We performed a retrospective chart review of 505 patients admitted to a Sentara Facility between 2012 and 2019 with a diagnosis of SBO. Patients between the ages of 18 and 89 were included. Patients were excluded if they required emergent operation. Outcomes were evaluated based on patient's admission either to a teaching or community hospital as well as the admitting service's specialty. RESULTS: Of 505 patients admitted with a SBO, 351 (69.5%) were admitted to a teaching hospital. 392 (77.6%) patients were admitted to a surgical service. The average length of stay (LOS) (4 vs 7 days, P < .0001) and cost ($18,069.79 vs $26,458.20, P < .0001) were lower at teaching hospitals. The same trends in LOS (4 vs 7 days, P < .0001) and cost ($18,265.10 vs $29 944.82, P < .0001) were seen with surgical services. The 30-day readmission rate was higher in teaching hospitals (18.2% vs 11%, P = .0429), and no difference was seen in operative rate or mortality. DISCUSSION: These data would suggest that there is a benefit to admitting SBO patients to larger teaching hospitals and to surgical services with regard to LOS and cost, suggesting that these patients might benefit from treatment at centers with emergency general surgery (EGS) Services.

Patient and provider perception of home blood pressure monitoring kits.

BACKGROUND: Pregnant patients of racial/ethnic minorities have higher preeclampsia rates. Home blood pressure monitoring (HBPM) has been investigated for disparity reduction. Smaller studies showed patients find HBPM to be a helpful intervention postpartum. Further investigation is needed to define the role of HPBM in an at-risk and diverse population antepartum. OBJECTIVE: To assess patient perception of HBPM among diverse patients at high risk of disease development. STUDY DESIGN: Prospective study conducted from April 2020-September 2021. HBPM kits were advertised and interested parties across the United States responded. Cuff Kits were then distributed to participating providers. Providers distributed the kits to patients meeting high-risk criteria for disease development, prioritizing those of racial/ethnic minorities. Surveys were distributed quarterly to providers and patients to assess HBPM perception. RESULTS: 2910 Cuff Kits were distributed to patients at 179 sites in 14 states. Of those, 1160 were distributed to Black patients, 1045 to White patients, and 500 to Hispanic patients. 117 patients completed surveys, with most patients finding Cuff Kits "very valuable" or "valuable" (68.4% and 19.7%, respectively). Most providers (73.4%) felt the Cuff Kits influenced patient care. CONCLUSIONS: Most patients receiving Cuff Kits reported a beneficial impact on disease understanding and most belonged to racial/ethnic groups at higher risk of adverse outcomes. Providers found HBPM had a beneficial impact on care. Though more research is needed to illustrate the impact of HBPM on outcomes, this study suggests that among racial/ethnic minorities and those at the high risk, HBPM is a well-received intervention.

Diatrizoate (Gastrograffin®) Small Bowel Follow Through for Small Bowel Obstructions: Timing and Outcomes.

INTRODUCTION: The advent of the Gastrograffin® small bowel follow through (G-SBFT) has resulted in a decreased rate of operative intervention of small bowel obstructions (SBO); however, there is no data to suggest when G-SBFT should be performed. METHODS: We retrospectively reviewed 548 patients, admitted to 1 of 9 hospitals with a diagnosis of SBO. Patients were divided into two categories with regards to timing of G-SBFT: before (early) or after (late) 48 hours from admission. Primary outcomes were length of stay (LOS) and total cost. Secondary outcomes were operative interventions and mortality. RESULTS: Of the reviewed patients, 71% had the G-SBFT ordered early. Comparing early versus late, there were no differences in patient characteristics with regards to age, sex, or BMI. There was a significant difference between LOS (4 vs 8 days, P < 0.05) and total cost ($17,056.19 vs $33,292.00, P < 0.05). There was no difference in mortality (1.3% vs 2.6%, P = 0.239) or 30-day readmission rates (15.6% vs 15.9%, P = 0.509). Patients in the early group underwent fewer operations (20.7% vs 31.9%, P = 0.05). DISCUSSION: Patients that had a G-SBFT ordered early had a decreased LOS, total cost, and operative intervention. This suggests there is a benefit to ordering G-SBFT earlier in the hospital stay to reduce the overall disease burden, and that it is safe to do so with regards to mortality and readmissions. We therefore recommend ordering a G-SBFT within 48 hours to reduce LOS, cost, and need for an operation.

Finding the Invisible Leader: When A Priori Opinion Leader Identification is Impossible.

Opinion leaders are increasingly recruited to diffuse information, attitudes, and behaviors to serve communication campaigns. However, this has historically required opinion leader identification before launching the campaign. A priori identification is impossible in many contexts, such as when addressing unfamiliar topics or insular communities. The authors introduce a two-stage campaign approach that resolves this problem, and a public health campaign is used to demonstrate it. This approach is applicable to a wider variety of contexts than traditional a priori opinion leader identification.

The impact of the 80-hour work week on appropriate resident case coverage.

BACKGROUND: On July 1, 2003, the Accreditation Council for Graduate Medical Education (ACGME) required restriction of resident duty hours. Surgical programs were concerned about an expected decrease in operative experience. In our previous study, resident case coverage remained constant with the institution of the restricted duty hours. Several years later, we hypothesized that the level of resident coverage would be less appropriate. MATERIALS AND METHODS: A retrospective study was performed of elective cases scheduled for an academic general surgery practice over three time periods: 1 y prior to institution of restricted duty hours; 1 y later; 3 y later. Data collected included procedure performed, number of attending surgeons and residents present, and resident level. Resident level was defined as appropriate if it matched or exceeded the complexity of the procedure. RESULTS: From July 2002 to June 2003, 890 records of 1278 scheduled cases were available for review. From July 2004 to June 2005, 961 records of 1182 cases were available. From July 2006 to June 2007, 1029 of 1171 records were available. Case coverage was the same or better in the latest time period overall and for each resident level. An appropriate level resident was available for senior level cases similarly during all periods. During the last period, junior and intermediate level cases were more often covered by a resident at the appropriate level of training. CONCLUSIONS: The restricted duty hours have not negatively affected resident case coverage. The level of resident available for operative cases has remained constant for senior level cases. Junior and intermediate level cases were more often covered by an appropriate level resident.

The incidence of benign and malignant neoplasia presenting as acute appendicitis.

Acute appendicitis remains the most common surgical emergency encountered by the general surgeon. It is most often secondary to lymphoid hyperplasia, however it can also result from obstruction of the appendiceal lumen by a mass. We sought to review our experience with neoplasia presenting as appendicitis. We retrospectively reviewed all patients admitted with the diagnosis of appendicitis to our Acute Care Surgery Service from July 1, 2007 to June 30, 2009. Patient demographics, duration of symptoms, lab findings, computed tomography findings, and pathology were all analyzed. Over the 2-year period, 141 patients underwent urgent appendectomy. Ten patients (7.1%) were diagnosed with neoplasia on final pathology, including four women and six men with a mean age of 46.9 years and mean duration of symptoms of 12.6 days. Final pathology revealed four colonic adenocarcinoma; three mucinous tumors; one carcinoid; one endometrioma; and one patient had a combination of a mucinous cystadenoma, a carcinoid tumor, and endometriosis of the appendix. Six patients had concurrent appendicitis. Colonic and appendiceal neoplasia are not unusual etiologies of appendicitis. These patients tend to present at an older age and with longer duration of symptoms.

Readmission after emergency general surgery.

BACKGROUND: Readmission rates are an important metric because they enable an evaluation of care and affect Medicare funding. This study evaluates factors contributing to readmission after emergency general surgery. METHODS: The Virginia Health Information database was used to identify patients who had undergone the most common emergency general surgery procedures from 1/2011-6/2016. Analyses were performed for 30 and 90-day readmission. RESULTS: 121,223 records met initial inclusion criteria and 54,372 remained after exclusions. In 30 days there were 5050 readmissions and 7896 readmissions in 90 days. Factors significant in contributing to 30-day readmission were length of stay, discharge location, and several comorbidities. For 90-day readmission the same factors were significant with the addition of urgent vs emergency admission and insurance status as well as additional comorbidities. Discharge to rehab, SNF, or with home healthcare had particularly high rates of 90 day readmission. CONCLUSIONS: We identified factors that contribute to readmission after emergency general surgery providing targets for future interventions. Improved follow up for patients discharged with rehab or home health needs is our next step.