Primary Perspectives in Meme Utilization as a Digital Driver for Medical Community Engagement and Education Mobilization: Pre-Post Study.

BACKGROUND: Memes have gone "viral," gaining increasing prominence as an effective communications strategy based on their unique ability to engage, educate, and mobilize target audiences in a call to action through a cost-efficient and culturally relevant approach. Within the medical community in particular, visual media has evolved as a means to influence clinical knowledge transfer. To this end, the GetWaivered (GW) project has leveraged memes as part of a behavioral economics toolkit to address one of the most critical public health emergencies of our time-the 20-year opioid epidemic. As part of a multidimensional digital awareness campaign to increase Drug Enforcement Administration (DEA)-X waiver course registration, GW investigated the results of meme usage in terms of impressions, website traffic, and ultimately user acquisition, as determined by web-based training enrollment and attendance outcomes. OBJECTIVE: The objective of this study was to determine the efficacy of implementing humor-based promotional content versus the traditional educational model, and how the translation of the increase in engagement would increase the participant count and website traffic for GW's remote DEA-X waiver training. METHODS: The approach to this study was based on 2 time frames (pre- and postcampaign). During April-July 2021, we developed a campaign via advertisements on Facebook, Twitter, Instagram, and the GW website to expand outreach. These memes targeted medical professionals with the ability to prescribe buprenorphine. The time frame of this campaign measured engagement metrics and compared values to preceding months (January-March 2021) for our GetWaivered website and social media pages, which translated to registrants for our remote DEA-X waiver training. RESULTS: By the end of July 2021, a total of 9598 individuals had visited the GW website. There was an average of 79.3 visitors per day, with the lowest number of daily visitors being 0 and the highest being 575. CONCLUSIONS: The use of memes may provide a medium for social media engagement (likes, comments, and shares) while influencing viewers to pursue a proposed action, such as e-training registration.

Review of Vaginal Approaches to Apical Prolapse Repair.

PURPOSE OF REVIEW: To review recent literature and provide up-to-date knowledge on new and important findings in vaginal approaches to apical prolapse surgery. RECENT FINDINGS: Overall prolapse recurrence rates following transvaginal apical prolapse repair range from 13.7 to 70.3% in medium- to long-term follow-up, while reoperation rates for prolapse recurrence are lower, ranging from 1 to 35%. Subjective prolapse symptoms remain improved despite increasing anatomic failure rates over time. The majority of studies demonstrated improvement in prolapse-related symptoms and quality of life in over 80% of patients 2-3 years after transvaginal repair, with similar outcomes with and without uterine preservation. Contemporary studies continue to demonstrate the safety of transvaginal native tissue repair with most adverse events occurring within the first 2 years. Transvaginal apical prolapse repair is safe and effective. It is associated with long-term improvement in prolapse-related symptoms and quality of life despite increasing rates of prolapse recurrence over time. Subjective outcomes do not correlate with anatomic outcomes.

Analyzing opioid-use disorder websites in the United States: An optimized website usability study.

Background: As the United States continues to tackle the opioid epidemic, it is imperative for digital healthcare organizations to provide Internet users with accurate and accessible online resources so that they can make informed decisions with regards to their health. Objective: The primary objectives were to adapt and modify a previously established usability methodology from literature, apply this modified methodology in order to perform usability analysis of opioid-use-disorder (OUD)-related websites, and make important recommendations that OUD-related digital health organizations may utilize to improve their online presence. Methods: A list of 208 websites (later refined) was generated for usability testing using a modified Google Search methodology. Four keywords were chosen and used in the search: "DEA-X Waiver Training", "opioid-use-disorder (OUD) Initiatives", "Buprenorphine Assisted Treatment", and "Opioid-Use Disorder Websites". Usability analysis was performed concurrently with optimization of the methodology. OUD websites were analyzed and scored on several usability categories established by previous literature. Results: "DEA-X Waiver Training" yielded websites that scored the highest average in "Accessibility" (0.84), while "Opioid-Use Disorder Websites" yielded websites that scored the highest average in "Content Quality" (0.67). "Buprenorphine Assisted Treatment" yielded websites that scored the highest average across "Marketing" (0.52), "Technology" (0.89), "General Usability" (0.69), and "Overall Usability" (0.68). "Technology" and "Marketing" were the highest and lowest scoring usability categories, respectively. T-test analysis revealed that each usability, except "Marketing" had a pair of one or more keywords that were significantly different with a p-value that was equal to or less than 0.05. Conclusions: Based on the study findings, we recommend that digital organizations in the OUD space should improve their "General Usability" score by making their websites easier to find online. Doing so, may allow users, especially individuals in the OUD space, to discover accurate information that they are seeking. Based on the study findings, we also made important recommendations that OUD-related digital organizations may utilize in order to improve website usability as well as overall reach.

Macrophage Reprogramming and Cancer Therapeutics: Role of iNOS-Derived NO.

Nitric oxide and its production by iNOS is an established mechanism critical to tumor promotion or suppression. Macrophages have important roles in immunity, development, and progression of cancer and have a controversial role in pro- and antitumoral effects. The tumor microenvironment consists of tumor-associated macrophages (TAM), among other cell types that influence the fate of the growing tumor. Depending on the microenvironment and various cues, macrophages polarize into a continuum represented by the M1-like pro-inflammatory phenotype or the anti-inflammatory M2-like phenotype; these two are predominant, while there are subsets and intermediates. Manipulating their plasticity through programming or reprogramming of M2-like to M1-like phenotypes presents the opportunity to maximize tumoricidal defenses. The dual role of iNOS-derived NO also influences TAM activity by repolarization to tumoricidal M1-type phenotype. Regulatory pathways and immunomodulation achieve this through miRNA that may inhibit the immunosuppressive tumor microenvironment. This review summarizes the classical physiology of macrophages and polarization, iNOS activities, and evidence towards TAM reprogramming with current information in glioblastoma and melanoma models, and the immunomodulatory and therapeutic options using iNOS or NO-dependent strategies.

Get waivered remote: Nationwide, remote DEA-x waiver course in response to COVID-19.

PROBLEM: As of 2020, less than 5% of physicians in the United States have a drug enforcement administration-X waiver to prescribe buprenorphine. The coronavirus-2019 pandemic restricted in-person gatherings, including traditional drug enforcement administration-X waiver courses. As a result, in-person conferences have needed to adopt remote formats. Many programs identified a gap between educational delivery and the faculty skills required to deliver content remotely. APPROACH: To address the need for high-quality remote learning, Get Waivered designed and implemented a novel experience for clinicians, called Get Waivered Remote. An educational session was live-streamed via Zoom™. To foster interactivity, like in-person didactic conferences, participants were polled to facilitate discussion among presenters, learners, and facilitators during the broadcast. OUTCOMES: The RE-AIM framework was used for evaluation. Our program had a Reach encompassing 814 users that participated during the live-streamed event; Effectiveness with 73.79% reporting being somewhat familiar or very familiar with the practice of opioid dependency treatment with approved buprenorphine medications; Adoption with 95.15% reporting a favorable experience and 92.23% reporting it was similar or more enjoyable than their usual teaching; Implementation with 450 messages sent by 281 users to engage with presenters and other learners via Zoom chat in real time. NEXT STEPS: Get Waivered Remote provides a proof-of-concept that a broadcast with a concurrent, interactive remote learning platform is feasible, low cost, and simple to execute. Further study is required to assess the ability of our group to maintain this innovation and also to measure its impact on the treatment of opioid use disorder.