Effects of Air Pollutants from Wildfires on Downwind Ecosystems: Observations, Knowledge Gaps, and Questions for Assessing Risk.

Wildfires have increased in frequency and area burned, trends expected to continue with climate change. Among other effects, fires release pollutants into the atmosphere, representing a risk to human health and downwind terrestrial and aquatic ecosystems. While human health risks are well studied, the ecological impacts to downwind ecosystems are not, and this gap may present a constraint on developing an adequate assessment of the ecological risks associated with downwind wildfire exposure. Here, we first screened the scientific literature to assess general knowledge about pathways and end points of a conceptual model linking wildfire generated pollutants and other materials to downwind ecosystems. We found a substantial body of literature on the composition of wildfire derived pollution and materials in the atmosphere and subsequent transport, yet little observational or experimental work on their effects on downwind ecological end points. This dearth of information raises many questions related to adequately assessing the ecological risk of downwind exposure, especially given increasing wildfire trends. To guide future research, we pose eight questions within the well-established US EPA ecological risk assessment paradigm that if answered would greatly improve ecological risk assessment and, ultimately, management strategies needed to reduce potential wildfire impacts.

Identifying Protective Health Behaviors on Twitter: Observational Study of Travel Advisories and Zika Virus.

BACKGROUND: An estimated 3.9 billion individuals live in a location endemic for common mosquito-borne diseases. The emergence of Zika virus in South America in 2015 marked the largest known Zika outbreak and caused hundreds of thousands of infections. Internet data have shown promise in identifying human behaviors relevant for tracking and understanding other diseases. OBJECTIVE: Using Twitter posts regarding the 2015-16 Zika virus outbreak, we sought to identify and describe considerations and self-disclosures of a specific behavior change relevant to the spread of disease-travel cancellation. If this type of behavior is identifiable in Twitter, this approach may provide an additional source of data for disease modeling. METHODS: We combined keyword filtering and machine learning classification to identify first-person reactions to Zika in 29,386 English-language tweets in the context of travel, including considerations and reports of travel cancellation. We further explored demographic, network, and linguistic characteristics of users who change their behavior compared with control groups. RESULTS: We found differences in the demographics, social networks, and linguistic patterns of 1567 individuals identified as changing or considering changing travel behavior in response to Zika as compared with a control sample of Twitter users. We found significant differences between geographic areas in the United States, significantly more discussion by women than men, and some evidence of differences in levels of exposure to Zika-related information. CONCLUSIONS: Our findings have implications for informing the ways in which public health organizations communicate with the public on social media, and the findings contribute to our understanding of the ways in which the public perceives and acts on risks of emerging infectious diseases.

A REVIEW OF WATER QUALITY RESPONSES TO AIR TEMPERATURE AND PRECIPITATION CHANGES 1: FLOW, WATER TEMPERATURE, SALTWATER INTRUSION.

Anticipated future increases in air temperature and regionally variable changes in precipitation will have direct and cascading effects on U.S. water quality. In this paper, and a companion paper by Coffey et al. (2019), we review technical literature addressing the responses of different water quality attributes to historical and potential future changes in air temperature and precipitation. The goal is to document how different attributes of water quality are sensitive to these drivers, to characterize future risk to inform management responses and to identify research needs to fill gaps in our understanding. Here we focus on potential changes in streamflow, water temperature, and salt water intrusion (SWI). Projected changes in the volume and timing of streamflow vary regionally, with general increases in northern and eastern regions of the U.S., and decreases in the southern Plains, interior Southwest and parts of the Southeast. Water temperatures have increased throughout the U.S. and are expected to continue to increase in the future, with the greatest changes in locations where high summer air temperatures occur together with low streamflow volumes. In coastal areas, especially the mid-Atlantic and Gulf coasts, SWI to rivers and aquifers could be exacerbated by sea level rise, storm surges, and altered freshwater runoff. Management responses for reducing risks to water quality should consider strategies and practices robust to a range of potential future conditions.

Integration of SWAT and HSPF for Simulation of Sediment Sources in Legacy Sediment-Impacted Agricultural Watersheds.

A total maximum daily load for the Chesapeake Bay requires reduction in pollutant load from sources within the Bay watersheds. The Conestoga River watershed has been identified as a major source of sediment load to the Bay. Upland loads of sediment from agriculture are a concern; however, a large proportion of the sediment load in the Conestoga River has been linked to scour of legacy sediment associated with historic millpond sites. Clarifying this distinction and identifying specific segments associated with upland vs. channel sources has important implications for future management. In order to address this important question, we combined the strengths of two widely accepted watershed management models - Soil and Water Assessment Tool (SWAT) for upland agricultural processes, and Hydrologic Simulation Program FORTRAN (HSPF) for instream fate and transport - to create a novel linked modeling system to predict sediment loading from critical sources in the watershed including upland and channel sources, and to aid in targeted implementation of management practices. The model indicates approximately 66% of the total sediment load is derived from instream sources, in agreement with other studies in the region and can be used to support identification of these channel source segments vs. upland source segments, further improving targeted management. The innovated linked SWAT-HSPF model implemented in this study is useful for other watersheds where both upland agriculture and instream processes are important sources of sediment load.

Combining Search, Social Media, and Traditional Data Sources to Improve Influenza Surveillance.

We present a machine learning-based methodology capable of providing real-time ("nowcast") and forecast estimates of influenza activity in the US by leveraging data from multiple data sources including: Google searches, Twitter microblogs, nearly real-time hospital visit records, and data from a participatory surveillance system. Our main contribution consists of combining multiple influenza-like illnesses (ILI) activity estimates, generated independently with each data source, into a single prediction of ILI utilizing machine learning ensemble approaches. Our methodology exploits the information in each data source and produces accurate weekly ILI predictions for up to four weeks ahead of the release of CDC's ILI reports. We evaluate the predictive ability of our ensemble approach during the 2013-2014 (retrospective) and 2014-2015 (live) flu seasons for each of the four weekly time horizons. Our ensemble approach demonstrates several advantages: (1) our ensemble method's predictions outperform every prediction using each data source independently, (2) our methodology can produce predictions one week ahead of GFT's real-time estimates with comparable accuracy, and (3) our two and three week forecast estimates have comparable accuracy to real-time predictions using an autoregressive model. Moreover, our results show that considerable insight is gained from incorporating disparate data streams, in the form of social media and crowd sourced data, into influenza predictions in all time horizons.

Terahertz-Triggered Phase Transition and Hysteresis Narrowing in a Nanoantenna Patterned Vanadium Dioxide Film.

We demonstrate that high-field terahertz (THz) pulses trigger transient insulator-to-metal transition in a nanoantenna patterned vanadium dioxide thin film. THz transmission of vanadium dioxide instantaneously decreases in the presence of strong THz fields. The transient THz absorption indicates that strong THz fields induce electronic insulator-to-metal transition without causing a structural transformation. The transient phase transition is activated on the subcycle time scale during which the THz pulse drives the electron distribution of vanadium dioxide far from equilibrium and disturb the electron correlation. The strong THz fields lower the activation energy in the insulating phase. The THz-triggered insulator-to-metal transition gives rise to hysteresis loop narrowing, while lowering the transition temperature both for heating and cooling sequences. THz nanoantennas enhance the field-induced phase transition by intensifying the field strength and improve the detection sensitivity via antenna resonance. The experimental results demonstrate a potential that plasmonic nanostructures incorporating vanadium dioxide can be the basis for ultrafast, energy-efficient electronic and photonic devices.

Social media as a sensor of air quality and public response in China.

BACKGROUND: Recent studies have demonstrated the utility of social media data sources for a wide range of public health goals, including disease surveillance, mental health trends, and health perceptions and sentiment. Most such research has focused on English-language social media for the task of disease surveillance. OBJECTIVE: We investigated the value of Chinese social media for monitoring air quality trends and related public perceptions and response. The goal was to determine if this data is suitable for learning actionable information about pollution levels and public response. METHODS: We mined a collection of 93 million messages from Sina Weibo, China's largest microblogging service. We experimented with different filters to identify messages relevant to air quality, based on keyword matching and topic modeling. We evaluated the reliability of the data filters by comparing message volume per city to air particle pollution rates obtained from the Chinese government for 74 cities. Additionally, we performed a qualitative study of the content of pollution-related messages by coding a sample of 170 messages for relevance to air quality, and whether the message included details such as a reactive behavior or a health concern. RESULTS: The volume of pollution-related messages is highly correlated with particle pollution levels, with Pearson correlation values up to .718 (n=74, P<.001). Our qualitative results found that 67.1% (114/170) of messages were relevant to air quality and of those, 78.9% (90/114) were a firsthand report. Of firsthand reports, 28% (32/90) indicated a reactive behavior and 19% (17/90) expressed a health concern. Additionally, 3 messages of 170 requested that action be taken to improve quality. CONCLUSIONS: We have found quantitatively that message volume in Sina Weibo is indicative of true particle pollution levels, and we have found qualitatively that messages contain rich details including perceptions, behaviors, and self-reported health effects. Social media data can augment existing air pollution surveillance data, especially perception and health-related data that traditionally requires expensive surveys or interviews.

Massage for mechanical neck disorders.

BACKGROUND: The prevalence of mechanical neck disorders (MND) is known to be both a hindrance to individuals and costly to society. As such, massage is widely used as a form of treatment for MND. OBJECTIVES: To assess the effects of massage on pain, function, patient satisfaction, global perceived effect, adverse effects and cost of care in adults with neck pain versus any comparison at immediate post-treatment to long-term follow-up. SEARCH METHODS: We searched The Cochrane Library (CENTRAL), MEDLINE, EMBASE, MANTIS, CINAHL, and ICL databases from date of inception to 4 Feburary 2012. SELECTION CRITERIA: Studies using random assignment were included. DATA COLLECTION AND ANALYSIS: Two review authors independently conducted citation identification, study selection, data abstraction and methodological quality assessment. Using a random-effects model, we calculated the risk ratio and standardised mean difference. MAIN RESULTS: Fifteen trials met the inclusion criteria. The overall methodology of all the trials assessed was either low or very low GRADE level. None of the trials were of strong to moderate GRADE level. The results showed very low level evidence that certain massage techniques (traditional Chinese massage, classical and modified strain/counter strain technique) may have been more effective than control or placebo treatment in improving function and tenderness. There was very low level evidence that massage may have been more beneficial than education in the short term for pain bothersomeness. Along with that, there was low level evidence that ischaemic compression and passive stretch may have been more effective in combination rather than individually for pain reduction. The clinical applicability assessment showed that only 4/15 trials adequately described the massage technique. The majority of the trials assessed outcomes at immediate post-treatment, which is not an adequate time to assess clinical change. Due to the limitations in the quality of existing studies, we were unable to make any firm statement to guide clinical practice. We noted that only four of the 15 studies reported side effects. All four studies reported post-treatment pain as a side effect and one study (Irnich 2001) showed that 22% of the participants experienced low blood pressure following treatment. AUTHORS' CONCLUSIONS: No recommendations for practice can be made at this time because the effectiveness of massage for neck pain remains uncertain.As a stand-alone treatment, massage for MND was found to provide an immediate or short-term effectiveness or both in pain and tenderness. Additionally, future research is needed in order to assess the long-term effects of treatment and treatments provided on more than one occasion.

Becoming-A Journey to Wellness: Engaging HBCU Students in Developing a Theory-Based YouTube Healthy Lifestyle Intervention.

Addressing disparities in overweight and obesity among African American college students is critical, as many of these students are heavier and gain more weight when compared with other groups. This report describes development of a theory-based YouTube series designed to improve Historically Black College and University (HBCU) student lifestyle behaviours.

Botulinum toxin for subacute/chronic neck pain.

BACKGROUND: Neck disorders are common, disabling and costly. Botulinum toxin (BoNT) intramuscular injections are often used with the intention of treating neck pain. OBJECTIVES: To systematically evaluate the literature on the treatment effectiveness of BoNT for neck pain, disability, global perceived effect and quality of life in adults with neck pain with or without associated cervicogenic headache, but excluding cervical radiculopathy and whiplash associated disorder. SEARCH STRATEGY: We searched CENTRAL, MEDLINE, AMED, Index to Chiropractic Literature, CINAHL, LILACS, and EMBASE from their origin to 20 September 2010. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials in which BoNT injections were used to treat subacute or chronic neck pain. DATA COLLECTION AND ANALYSIS: A minimum of two review authors independently selected articles, abstracted data, and assessed risk of bias, using the Cochrane Back Review Group criteria. In the absence of clinical heterogeneity, we calculated standardized mean differences (SMD) and relative risks, and performed meta-analyses using a random-effects model. The quality of the evidence and the strength of recommendations were assigned an overall grade for each outcome. MAIN RESULTS: We included nine trials (503 participants). Only BoNT type A (BoNT-A) was used in these studies.High quality evidence suggests there was little or no difference in pain between BoNT-A and saline injections at four weeks (five trials; 252 participants; SMD pooled -0.07 (95% confidence intervals (CI) -0.36 to 0.21)) and six months for chronic neck pain. Very low quality evidence indicated little or no difference in pain between BoNT-A combined with physiotherapeutic exercise and analgesics and saline injection with physiotherapeutic exercise and analgesics for patients with chronic neck pain at four weeks (two trials; 95 participants; SMD pooled 0.09 (95% CI -0.55 to 0.73)) and six months (one trial; 24 participants; SMD -0.56 (95% CI -1.39 to 0.27)). Very low quality evidence from one trial (32 participants) showed little or no difference between BoNT-A and placebo at four weeks (SMD 0.16 (95% CI -0.53 to 0.86)) and six months (SMD 0.00 (95% CI -0.69 to 0.69)) for chronic cervicogenic headache. Very low quality evidence from one trial (31 participants), showed a difference in global perceived effect favouring BoNT-A in chronic neck pain at four weeks (SMD -1.12 (95% CI: -1.89 to -0.36)). AUTHORS' CONCLUSIONS: Current evidence fails to confirm either a clinically important or a statistically significant benefit of BoNT-A injection for chronic neck pain associated with or without associated cervicogenic headache. Likewise, there was no benefit seen for disability and quality of life at four week and six months.

Recommendations for Increasing Physician Provision of Pre-Exposure Prophylaxis: Implications for Medical Student Training.

There is growing evidence that pre-exposure prophylaxis (PrEP) prevents HIV acquisition. However, in the United States, approximately only 4% of people who could benefit from PrEP are currently receiving it, and it is estimated only 1 in 5 physicians has ever prescribed PrEP. We conducted a scoping review to gain an understanding of physician-identified barriers to PrEP provision. Four overarching barriers presented in the literature: Purview Paradox, Patient Financial Constraints, Risk Compensation, and Concern for ART Resistance. Considering the physician-identified barriers, we make recommendations for how physicians and students may work to increase PrEP knowledge and competence along each stage of the PrEP cascade. We recommend adopting HIV risk assessment as a standard of care, improving physician ability to identify PrEP candidates, improving physician interest and ability in encouraging PrEP uptake, and increasing utilization of continuous care management to ensure retention and adherence to PrEP.

Comparison of Social Media, Syndromic Surveillance, and Microbiologic Acute Respiratory Infection Data: Observational Study.

BACKGROUND: Internet data can be used to improve infectious disease models. However, the representativeness and individual-level validity of internet-derived measures are largely unexplored as this requires ground truth data for study. OBJECTIVE: This study sought to identify relationships between Web-based behaviors and/or conversation topics and health status using a ground truth, survey-based dataset. METHODS: This study leveraged a unique dataset of self-reported surveys, microbiological laboratory tests, and social media data from the same individuals toward understanding the validity of individual-level constructs pertaining to influenza-like illness in social media data. Logistic regression models were used to identify illness in Twitter posts using user posting behaviors and topic model features extracted from users' tweets. RESULTS: Of 396 original study participants, only 81 met the inclusion criteria for this study. Of these participants' tweets, we identified only two instances that were related to health and occurred within 2 weeks (before or after) of a survey indicating symptoms. It was not possible to predict when participants reported symptoms using features derived from topic models (area under the curve [AUC]=0.51; P=.38), though it was possible using behavior features, albeit with a very small effect size (AUC=0.53; P≤.001). Individual symptoms were also generally not predictable either. The study sample and a random sample from Twitter are predictably different on held-out data (AUC=0.67; P≤.001), meaning that the content posted by people who participated in this study was predictably different from that posted by random Twitter users. Individuals in the random sample and the GoViral sample used Twitter with similar frequencies (similar @ mentions, number of tweets, and number of retweets; AUC=0.50; P=.19). CONCLUSIONS: To our knowledge, this is the first instance of an attempt to use a ground truth dataset to validate infectious disease observations in social media data. The lack of signal, the lack of predictability among behaviors or topics, and the demonstrated volunteer bias in the study population are important findings for the large and growing body of disease surveillance using internet-sourced data.

Curricular Interventions in Medical Schools for Assessing Adverse Childhood Experience.

Scientific evidence is accumulating about the range of adverse health, mental health, and risky behavioral sequelae across the life continuum arising from exposure to Adverse Childhood Experiences (ACEs). Research findings show a clear relationship between the number of ACEs experienced by a person during childhood and the adverse health outcomes of adulthood. The purpose of this systematic review was to assess the extent to which medical schools are teaching medical students about ACEs. Published articles were identified through searches of several databases using a combination of major and minor MeSH terms. Out of a total of 715 publications screened, 13 studies were identified that focused on medical education efforts to address ACEs. Educational interventions were conducted in a variety of formats, including lectures, perspective-taking exercises, and small group discussions. Our systematic review found little evidence to suggest that medical schools are teaching students how to address ACEs among their patients.

Zika discourse in the Americas: A multilingual topic analysis of Twitter.

This work examines Twitter discussion surrounding the 2015 outbreak of Zika, a virus that is most often mild but has been associated with serious birth defects and neurological syndromes. We introduce and analyze a collection of 3.9 million tweets mentioning Zika geolocated to North and South America, where the virus is most prevalent. Using a multilingual topic model, we automatically identify and extract the key topics of discussion across the dataset in English, Spanish, and Portuguese. We examine the variation in Twitter activity across time and location, finding that rises in activity tend to follow to major events, and geographic rates of Zika-related discussion are moderately correlated with Zika incidence (ρ = .398).

The Potential of Twitter as a Data Source for Patient Safety.

BACKGROUND: Error-reporting systems are widely regarded as critical components to improving patient safety, yet current systems do not effectively engage patients. We sought to assess Twitter as a source to gather patient perspective on errors in this feasibility study. METHODS: We included publicly accessible tweets in English from any geography. To collect patient safety tweets, we consulted a patient safety expert and constructed a set of highly relevant phrases, such as "doctor screwed up." We used Twitter's search application program interface from January to August 2012 to identify tweets that matched the set of phrases. Two researchers used criteria to independently review tweets and choose those relevant to patient safety; a third reviewer resolved discrepancies. Variables included source and sex of tweeter, source and type of error, emotional response, and mention of litigation. RESULTS: Of 1006 tweets analyzed, 839 (83%) identified the type of error: 26% of which were procedural errors, 23% were medication errors, 23% were diagnostic errors, and 14% were surgical errors. A total of 850 (84%) identified a tweet source, 90% of which were by the patient and 9% by a family member. A total of 519 (52%) identified an emotional response, 47% of which expressed anger or frustration, 21% expressed humor or sarcasm, and 14% expressed sadness or grief. Of the tweets, 6.3% mentioned an intent to pursue malpractice litigation. CONCLUSIONS: Twitter is a relevant data source to obtain the patient perspective on medical errors. Twitter may provide an opportunity for health systems and providers to identify and communicate with patients who have experienced a medical error. Further research is needed to assess the reliability of the data.

Can online self-reports assist in real-time identification of influenza vaccination uptake? A cross-sectional study of influenza vaccine-related tweets in the USA, 2013-2017.

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) spend significant time and resources to track influenza vaccination coverage each influenza season using national surveys. Emerging data from social media provide an alternative solution to surveillance at both national and local levels of influenza vaccination coverage in near real time. OBJECTIVES: This study aimed to characterise and analyse the vaccinated population from temporal, demographical and geographical perspectives using automatic classification of vaccination-related Twitter data. METHODS: In this cross-sectional study, we continuously collected tweets containing both influenza-related terms and vaccine-related terms covering four consecutive influenza seasons from 2013 to 2017. We created a machine learning classifier to identify relevant tweets, then evaluated the approach by comparing to data from the CDC's FluVaxView. We limited our analysis to tweets geolocated within the USA. RESULTS: We assessed 1 124 839 tweets. We found strong correlations of 0.799 between monthly Twitter estimates and CDC, with correlations as high as 0.950 in individual influenza seasons. We also found that our approach obtained geographical correlations of 0.387 at the US state level and 0.467 at the regional level. Finally, we found a higher level of influenza vaccine tweets among female users than male users, also consistent with the results of CDC surveys on vaccine uptake. CONCLUSION: Significant correlations between Twitter data and CDC data show the potential of using social media for vaccination surveillance. Temporal variability is captured better than geographical and demographical variability. We discuss potential paths forward for leveraging this approach.

Mechanical traction for neck pain with or without radiculopathy.

BACKGROUND: Neck pain is a frequently reported complaint of the musculoskeletal system which can be disabling and costly to society. Mechanical traction is often used as an adjunct therapy in outpatient rehabilitation. OBJECTIVES: To assess the effects of mechanical traction for neck disorders. SEARCH STRATEGY: A research librarian searched computerized bibliographic databases without language restrictions up to March 2008 for randomized controlled trials (RCTs) from the medical, chiropractic, and allied health literature. SELECTION CRITERIA: The RCTs we selected examined adults with neck disorders who received mechanical traction alone or in combination with other treatments compared to a placebo or another treatment. Our outcomes of interest were pain, function, disability, global perceived effect, patient satisfaction, and quality of life measures. DATA COLLECTION AND ANALYSIS: Two review authors with different backgrounds in medicine, physiotherapy, massage therapy and chiropractics independently conducted study selection, risk of bias assessment and data abstraction using pre-piloted forms. We resolved disagreement through consensus. MAIN RESULTS: Of the seven selected RCTs (total participants = 958), only one (N = 100) had a low risk of bias. It found no statistically significant difference (SMD -0.16: 95%CI: -0.59 to 0.27) between continuous traction and placebo traction in reducing pain or improving function for chronic neck disorders with radicular symptoms. Our review found no evidence from RCTs with a low potential for bias that clearly supports or refutes the use of either continuous or intermittent traction for neck disorders. AUTHORS' CONCLUSIONS: The current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders. Large, well conducted RCTs are needed to first determine the efficacy of traction, then the effectiveness, for individuals with neck disorders with radicular symptoms.

#Healthy Selfies: Exploration of Health Topics on Instagram.

BACKGROUND: Social media provides a complementary source of information for public health surveillance. The dominate data source for this type of monitoring is the microblogging platform Twitter, which is convenient due to the free availability of public data. Less is known about the utility of other social media platforms, despite their popularity. OBJECTIVE: This work aims to characterize the health topics that are prominently discussed in the image-sharing platform Instagram, as a step toward understanding how this data might be used for public health research. METHODS: The study uses a topic modeling approach to discover topics in a dataset of 96,426 Instagram posts containing hashtags related to health. We use a polylingual topic model, initially developed for datasets in different natural languages, to model different modalities of data: hashtags, caption words, and image tags automatically extracted using a computer vision tool. RESULTS: We identified 47 health-related topics in the data (kappa=.77), covering ten broad categories: acute illness, alternative medicine, chronic illness and pain, diet, exercise, health care & medicine, mental health, musculoskeletal health and dermatology, sleep, and substance use. The most prevalent topics were related to diet (8,293/96,426; 8.6% of posts) and exercise (7,328/96,426; 7.6% of posts). CONCLUSIONS: A large and diverse set of health topics are discussed in Instagram. The extracted image tags were generally too coarse and noisy to be used for identifying posts but were in some cases accurate for identifying images relevant to studying diet and substance use. Instagram shows potential as a source of public health information, though limitations in data collection and metadata availability may limit its use in comparison to platforms like Twitter.