Comparison of Social Media Utilization Among Vascular Surgeons, Interventional Cardiologists, and Interventional Radiologists at Academic Training Institutions.

BACKGROUND: Social media platforms, especially Twitter, are increasingly utilized across medical practice, education, and research. However, little is known about differences in social media use among physicians of varying specialties and its impact on recruitment of trainees. Our objective was to describe differences in social media use among vascular interventional proceduralists at academic training institutions. METHODS: We identified institutions with training programs in vascular surgery (VS), interventional radiology (IR), and interventional cardiology (IC). Faculty providers were identified in each specialty at these institutions. A standardized search was used to identify non-anonymous social media profiles on Facebook, Instagram, and Twitter in September 2019. Influencers were defined as physicians with more than 1,000 Twitter followers. Follow ratio was defined as the number of followers divided by the number of accounts followed. Between-specialty differences were analyzed. RESULTS: A total of 1,330 providers (n = 454 VS, n=451 IR, n = 425 IC) were identified across 47 institutions in 27 states. Across all physicians, a minority of providers utilize social media (Facebook: 24.9%, n = 331; Instagram: 10.8%, n = 143; Twitter: 18.0%, n = 240). VS were significantly more likely to use Instagram (P = 0.001) but there was not a significant difference in utilization of Facebook and Twitter. Among Twitter users, VS had fewer followers on average (median 178, inter-quartile range [IQR] 39-555) than IR (median 272, IQR 50-793, P = 0.26) and IC (median 286, IQR 71-1257, P = 0.052). IC were most likely to be influencers (30.9%, n = 25) followed by IR (17.9%, n = 15) and VS (10.7%, n = 8, P = 0.006). On average, interventional cardiologists had the highest follow ratio (mean 4.9 ± 7.1) compared to interventional radiologists (mean 3.2 ± 5.5) and vascular surgeons (mean 2.5 ± 3.3, P < 0.001). CONCLUSION: A minority of academic vascular interventional proceduralists utilize social media in a non-anonymous manner. On Twitter, interventional cardiologists are most likely to be influencers based on number of followers and, on average, have the highest follow ratio. Vascular surgeons could potentially benefit from pursuing greater influence and visibility on social media as a means to recruit trainees.

Online Ratings for Vascular Interventional Proceduralists Vary by Physician Specialty.

BACKGROUND: Multiple specialties offer vascular interventional care, creating potential competition for referrals and procedures. At the same time, patient/consumer ratings have become more impactful for physicians who perform vascular procedures. We hypothesized that there are differences in online ratings based on specialty. METHODS: We used official program lists from the Association for Graduate Medical Education to identify institutions with training programs in integrated vascular surgery (VS), integrated interventional radiology (IR), and interventional cardiology (IC). Faculty providers were identified in each specialty at these institutions. A standardized search was performed to collect online ratings from Vitals.com, Healthgrades.com, and Google.com as well as from online demographics. Between specialty differences were analyzed using chi-squared and analysis of variance tests as appropriate. Multivariable linear regression was used to identify factors associated with review volume and star rating. RESULTS: A total of 1,330 providers (n = 454 VS, n = 451 IR, n = 425 IC) were identified across 47 institutions in 27 states. VS (55.5%-69.4%) and IC (63.8%-71.1%) providers were significantly more likely to have reviews than IR (28.6%-48.8%) providers across all online platforms (P < 0.001 for all websites). Across all platforms, IC providers were rated significantly higher than VS and IR providers. Multivariable regression showed that provider specialty and additional time in practice were associated with higher review volume. In addition to specialty, review volume was associated with star rating as those physicians with more reviews tended to have a higher rating. CONCLUSIONS: On average, vascular surgeons have more reviews and are more highly rated than interventional radiologists but tend to have fewer reviews and lower ratings than interventional cardiologists. VS providers may benefit from encouraging patients to file online reviews, especially in competitive markets.

Translating coding lists in administrative claims-based research for cardiovascular procedures.

BACKGROUND: To effectively use administrative claims for healthcare research, clinical events must be inferred from coding data according to validated algorithms. In October 2015, the United States transitioned from the International Classification of Diseases Ninth Revision (ICD-9) to the Tenth Revision (ICD-10). We describe our method to derive new ICD-10 codes for outcomes after vascular procedures from our prior, validated ICD-9 codes. METHODS: We began with validated ICD-9 coding lists known to represent outcomes after lower extremity revascularization, thoracic aortic endograft placement, abdominal aortic aneurysm reintervention, and carotid revascularization. We used the publicly available general equivalence mapping tools to derive corresponding ICD-10 codes for each of the ICD-9 codes in our current lists. The resulting lists were then manually reviewed by multiple authors to ensure clinical relevance for appropriate event detection. Clinically nonrelevant and duplicated codes were removed. RESULTS: A total of 475 ICD-9 codes were translated to ICD-10 with a 98-fold increase (n = 46,630) in the total number of codes. Overall, we found that 77% of codes (n = 35,833) were either duplicated or not clinically relevant upon manual review. For example, for thoracic aortic endograft placement, 97 ICD-9 codes mapped to 14,661 ICD-10 codes in total. A total of 890 codes were removed as duplicates and 9035 codes were removed during manual clinical review. The resultant, reviewed list contained 4736 ICD-10 codes representing a 49-fold increase from the initial ICD-9 list. Findings were similar across the other procedures studied. CONCLUSIONS: ICD-10 has expanded the number of codes necessary to describe outcomes after vascular procedures. More than 75% of the codes obtained using the general equivalence mapping database were either duplicated or not clinically relevant. Manual review of codes by researchers with clinical knowledge of the procedures is imperative.

Patient information sources when facing repair of abdominal aortic aneurysm.

OBJECTIVE: Shared medical decision making is most important when there are competing options for repair such as in treatment of abdominal aortic aneurysm (AAA). We sought to understand the sources of patients' pre-existing knowledge about AAA to better inform treating physicians about patients' needs for preoperative counseling. METHODS: We performed a multicenter survey of patients facing AAA repair at 20 Veterans Affairs hospitals across the United States as part of the Preferences for Open Versus Endovascular Repair of AAA study. A validated survey instrument was administered to examine the sources of information available and commonly used by patients to learn about their repair options. The survey was administered by study personnel before the patient had any interaction with the vascular surgeon because survey data were collected before the vascular clinic visit. RESULTS: Preliminary analysis of data from 99 patients showed that our cohort was primarily male (99%) and elderly (mean age 73 years). Patients commonly had a history of hypertension (86%), prior myocardial infarction (32%), diabetes (32%), and were overweight (58%). Patients arrived at their surgeon's office appointment with limited information. A majority of patients (52%) reported that they had not talked to their primary care physician at all about their options for AAA repair, and one-half (50%) reported that their view of the different surgical options had not been influenced by anyone. Slightly less than one-half of patients reported that they did not receive any information about open surgical aneurysm repair and endovascular aortic aneurysm repair (41% and 37%, respectively). Few patients indicated using the internet as their main source of information about open surgical aneurysm repair and endovascular aortic aneurysm repair (10% and 11%, respectively). CONCLUSIONS: Patients are commonly referred for AAA repair having little to no information regarding AAA pathology or repair options. Fewer than one in five patients searched the internet or had accessed other sources of information on their own. Most vascular surgeons should assume that patients will present to their first vascular surgery appointment with minimal understanding of the treatment options available to them.

Quality of optical diagnosis of diminutive polyps and associated factors.

BACKGROUND AND AIMS: The aim of the study was to identify endoscopist-related and procedural factors that may be associated with the quality of optical diagnosis of diminutive polyps using narrow-band imaging (NBI). METHODS: All subjects who participated in a randomized trial on cap-assisted colonoscopy were eligible for the current study. Optical polyp diagnosis was an a priori outcome of the initial trial. Ten participating endoscopists used NBI to assess all of the diagnosed polyps as adenomatous or non-adenomatous in real-time and provided a degree of diagnostic certainty. The main outcome measures were quality benchmarks of optical diagnosis (negative predictive value [NPV] for diminutive rectosigmoid adenomas, agreement with pathology-based surveillance interval) and assessment of endoscopist-related and procedural factors potentially associated with the quality of optical diagnosis. RESULTS: A total of 1650 polyps were found in 607 patients, with 1311 polyps (79 %) being diminutive, of which 672 (53 %) were adenomatous. The NPV of optical diagnosis for rectosigmoid adenomas was 95 %. The optical diagnosis-based surveillance interval agreed with the pathology-based recommendation in 93 % of patients. Prior experience with image-enhanced endoscopy had no effect on optical diagnosis. Low and high adenoma detectors were not different in achieving the quality benchmarks. Cap-assisted colonoscopy was not associated with quality of optical diagnosis. Quality metrics of optical diagnosis remained similar during the first and second half of the study period. CONCLUSION: High quality optical diagnosis of diminutive polyps can be achieved and sustained by endoscopists previously inexperienced in this practice with minimal training. None of the examined factors appear to affect the quality of optical diagnosis; particularly, endoscopists' adenoma detection was not associated with optical diagnosis.

Cap-assisted colonoscopy and detection of Adenomatous Polyps (CAP) study: a randomized trial.

BACKGROUND AND STUDY AIM: Cap-assisted colonoscopy has improved adenoma detection in some but not other studies. Most previous studies have been limited by small sample sizes and few participating endoscopists. The aim of the current study was to evaluate whether cap-assisted colonoscopy improves adenoma detection in a two-center, multi-endoscopist, randomized trial. PATIENTS AND METHODS: Consecutive patients who presented for an elective colonoscopy were randomized to cap-assisted colonoscopy (4-mm cap) or standard colonoscopy performed by one of 10 experienced endoscopists. Primary outcome measures were mean number of adenomas per patient and adenoma detection rate (ADR). Secondary outcomes included procedural measures and endoscopist variation; a logistic regression model was employed to examine predictors of increased detection with cap use. RESULTS: A total of 1113 patients (64 % male, mean age 62 years) were randomized to cap-assisted (n = 561) or standard (n = 552) colonoscopy. The mean number of adenomas detected per patient in the cap-assisted and standard groups was similar (0.89 vs. 0.82; P = 0.432), as was the ADR (42 % vs. 40 %; P = 0.452). Cap-assisted colonoscopy achieved a faster cecal intubation time (4.9 vs. 5.8 minutes; P < 0.001), a similar cecal intubation rate (99 % vs. 98 %; P = 0.326), and a higher terminal ileum intubation rate (93 % vs. 89 %; P < 0.028). Cap-assisted colonoscopy resulted in a 20 % increase in ADR for some endoscopists and in a 15 % decrease for others. Individual preference for the cap was an independent predictor of increased adenoma detection in adjusted analysis (P < 0.001), whereas baseline low adenoma detection was not. CONCLUSION: Although the efficiency of cecal and terminal ileum intubation was slightly improved by cap-assisted colonoscopy, adenoma detection was not. Cap-assisted colonoscopy may be beneficial for selected endoscopists. TRIAL REGISTRATION: clinicalTrials.gov (NCT01935180).

Proximal Motives of Sexual Arousal, Power, and Relationship for Sexual Aggression: Supporting the Millennial Shift.

We examined three proximal motives for sexual aggression (sexual persistence after a turn down): sexual arousal, power, and relationship. The MTurk sample consisted of 264 adults: 92 Millennial men (35%), 51 Millennial women (19%), 82 Gen X men (31%) and 39 Gen X women (15%). The motive data, measured by the Sexual Aggression Motive Assessment (SAMA), were unanalyzed data extracted from the authors' previous study of the Millennial shift, a phenomenon in which Millennial women, as compared to older generation women, showed higher levels of sexual aggression, while Millennial men, in comparison to older generation men, demonstrated lower levels of sexual aggression. For all respondents combined, the most chosen motive category was sexual arousal (95%), followed by relationship (49%), and then by power (18%) with 50% choosing two or more motive categories. Providing conceptual support for the Millennial shift, significantly more Millennial women than Gen X women chose motives of sexual arousal and power as reasons for perpetrating sexual aggression. An important finding for the relationship motive is that substantial numbers of both men and women engaged in sexual aggression because they felt that having sex would make the person like them.

Outcomes of Arterial Bypass With the Human Acellular Vessel for Chronic Limb-Threatening Ischemia Performed Under the FDA Expanded Access Program.

OBJECTIVE: To report outcomes of the human acellular vessel (HAV) implanted for limb salvage through the Food and Drug Administration (FDA) Expanded Access Program for patients with chronic limb-threatening ischemia with no autologous conduit. METHODS: The HAV is a bioengineered vascular conduit designed with human vascular smooth muscle cells. The product is under regulatory study. From April 2019 to November 2021, the HAV was implanted in 14 patients (12 men; mean age, 62±14 years) at 3 US centers. Each case was performed with a single-use investigational new drug Expanded Access Program issued by the FDA. Institutional review board approval was obtained; technical and clinical outcomes were analyzed. RESULTS: A single 6-mm-diameter (40-cm-long) HAV was implanted in 9 patients; 5 patients required 2 HAVs sewn together as a composite. Technical success was 100%. Median follow-up was 12 (range, 1 to 41) months. Primary and secondary patency rates were 72% and 81% at 12 months; assisted primary patency was attained in 4 patients. Amputation-free survival was 93% at 6 months and 77% at 12 months. All patients with a patent HAV experienced clinical improvement with no HAV-related infections or adverse events. There were 4 deaths in the cohort, late mortality unrelated to the HAV. CONCLUSION: The HAV is a safe and effective "off-the-shelf" biologic conduit. This experience from the FDA Expanded Access Program in this population with few alternative limb salvage options will help guide regulatory deliberations for patients with lower extremity ischemia and no autologous bypass conduit options.

Awareness of Preeclampsia among Antenatal Clinic Attendees in Northwestern Nigeria.

Background Preeclampsia (PE) is among the five main causes of maternal mortality in low resource countries. This study was designed to assess PE awareness and its socioeconomic determinants among antenatal clinic attendees in northwestern Nigeria. Methods Two hundred twenty-one antenatal clinic attendees in northwestern Nigeria were selected through systematic random sampling for this quantitative study. Women who were 9 months pregnant and had consented to participate were included; those with chronic illnesses such as diabetes mellitus were excluded. Data on respondents' sociodemographic variables, and PE awareness were collected using a validated questionnaire. Associations between variables were tested using chi-square test and multiple regression analysis. Results Ninety-one percent of respondents were aged 20 to 40 years, 53.9% were multiparous, 27% had no or low level of formal education, and 52% had attended antenatal care (ANC) at least four times in the index pregnancy. Only 37% ( N = 83) were aware of PE. Women with formal education were 3.8 times more likely (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.4-10.3) to be aware of PE compared with those with no formal education ( p < 0.05). Also, women who experienced hypertension in their previous pregnancies were 2.8 times more likely (OR = 2.8, 95% CI = 1.37-5.71) to be aware of PE than those women who had not ( p < 0.05). Conclusion There was a low level of PE awareness among pregnant women in this study; being formally educated and having had hypertension in a previous pregnancy were positively associated with PE awareness. PE education should be part of ANC.

The Human Acellular Vessel (HAV) as a vascular conduit for infrainguinal arterial bypass.

Autologous vein is the optimal conduit for peripheral arterial bypass surgery, a standard recently highlighted by findings from the BEST-CLI trial. The Human Acellular Vessel is a novel biologic conduit produced using regenerative medicine technologies with structural and mechanical properties like a human blood vessel. Not yet approved by the United States Food and Drug Administration, the Human Acellular Vessel is being studied as an alternative bypass conduit in patients with peripheral arterial disease, vascular injury, and those in need of arteriovenous access for hemodialysis. This report describes and illustrates the technical aspects of intraoperative handling specific to the use of this new and innovative technology.

Constructing masculinity in response to women's sexual advances.

Drawing on 20 in-depth interviews with men who reported unwanted sexual experiences with women as adults, this article addresses how masculinity informs their lived experiences of this type of contact. One of the main themes that emerged from this research was that participants constructed masculinity by engaging in sexual gatekeeping or setting limits on women's sexual advances. Whereas sexual gatekeeping has been perceived as a passive role for women, it may be entirely agentic for men. That is, sexual gatekeeping played a vital role in preserving the gender dichotomy that informed the traditional sexual script for our participants. Since it is consistent with masculinity to take a proactive role in heterosexual sex, a man's perceived sexual objectification by an initiative woman can be experienced as a violation. In order to regain their proactive role, male participants set limitations on women's sexual advances.

Why not the University of New Orleans? Social disorganization and sexual violence among internally displaced women of Hurricane Katrina.

Researchers have reported that natural disasters lead to an increase in sexual violence against women and this is echoed by the current situation in Haiti. This is a social pattern throughout the world during periods of war, as well as natural disasters such as tsunamis, famine, and hurricanes. This article examines the prevalence of sexual violence experienced by women students at the University of New Orleans (UNO) before and after Hurricane Katrina using the CORE Alcohol and Drug Survey. Two hundred and thirty seven women participated in the pre-Katrina study and 215 women participated in the post-Katrina study. We hypothesized that, due to the trauma of this disaster, there would be a higher prevalence of sexual aggression against women after Katrina than there was before Katrina. Our analyses yielded no significant differences in any of the measures of sexual violence toward women (nine CORE survey items) pre to post Katrina, so our hypothesis was not supported. We suggest that social organization and cultural attenuation--often indicators of sexual assault in FEMA Greenfield communities--were mitigated by social cohesion found on the UNO campus post-Katrina.

Generation by Gender Differences in Use of Sexual Aggression: A Replication of the Millennial Shift.

Adult perpetration rates of sexual aggression (defined as: acts in which an individual uses verbal pressure, arousal techniques, coercion, alcohol or drugs, or force to have sexual contact with someone against his or her will) were compared among an MTurk sample of 341 Baby Boom-GenX men, 356 Baby Boom-GenX women, 465 Millennial men, and 309 Millennial women (Mdn age = 30). Logistic regression analyses revealed a significant generation by gender interaction effect for use of six behaviors: pressured or forced sexual outcomes (PFSOs) without sexual intercourse; PFSOs with sexual intercourse, any tactic of post-refusal sexual persistence (PRSP), and PRSP tactic sets related to arousal, emotional coercion, and intoxication. No interaction effect was found for the PRSP tactic set of physical force. Follow-up analyses revealed that for four measures (any PRSP, PRSP sets for arousal, emotional coercion, and intoxication), Baby Boom-GenX men had significantly higher rates of sexual aggression than same-generation women, but Millennial men and women had statistically similar rates. This outcome replicated a pattern termed the Millennial Shift which we detected in earlier work. We suggest that the Millennial Shift involves higher sexual aggression rates reported by Millennial women compared to older generation women, in conjunction with lower rates reported by Millennial men compared to older generation men. We speculate that the Millennial Shift reflects changes in the traditional sexual script.

Assessment of dental faculty, staff, and students on knowledge of health effects associated with tobacco use.

OBJECTIVES: This study examined the knowledge of the health effects associated with tobacco use among dental school faculty, staff, and students. METHODS: A 30-item survey instrument was pilot-tested to ensure content validity prior to implementation. A total of 724 surveys were distributed through campus mail. RESULTS: A total of 344 (47.51%) survey instruments were returned. 71.8 percent of respondents reported using tobacco sometime during their life, 21.8 percent had smoked at least one cigarette a day for the past 30 days, but only 8.4 percent considered themselves to be smokers. Of the 71.8% reported using tobacco sometime during their lifetime, 49.7 percent reported being very confident about their ability to quit using tobacco, 32.6 percent reported that it would be unlikely for their tobacco use to result in negative health effects, and 31.7 percent reported that they were not worried about negative health effects associated with tobacco use. CONCLUSIONS: This study reveals a lack of knowledge of dental school faculty, staff, and students on the negative personal health effects associated with tobacco use.

An examination of sexual strategies used by urban Southern and rural Midwestern university women.

The purposes of this study were (a) to determine whether women's use of persuasion, non-physical coercion, and physical force strategies to obtain sex from a man varied between U.S. women from an urban Southern and rural Midwestern university and (b) to determine if sexual behavior history and early courtship behavior affected the use of these strategies (or not using any strategy). Women from the Midwest and the South did not differ in their use of sexual strategies. There were, however other variables that accounted for differences in women's use of sexual strategies. Women who used persuasion strategies had fewer lifetime sexual partners than women who used any other strategy. Women who used physical force strategies reported a lower age at first intercourse and more early courtship behaviors than all others. Overall, the results indicated that sexual strategies are related to sexual behavior history and early courtship behaviors rather than cultural setting or demographics.

Social, legal, and institutional context of heterosexual aggression by college women.

This review concerns women's heterosexual aggression. Social context considers prevalence and incidence, gender roles and social norms, reactions to receiving aggression, and alcohol and drugs. Legal context focuses on state law and institutional context focuses on college and university codes of conduct. Primary findings: women engage in the full range of sexually aggressive behaviors attributed to men; the language of many legal codes place women's heterosexually aggressive behaviors below the threshold for rape even when it involves physical force or the use of a weapon; many men, similar to many women, do not report receiving sexual aggression and may not define themselves as victims; regardless of reporting status or self-perception, some men do suffer physical and psychological symptoms as a result of receiving sexual aggression from women; and women's heterosexual aggression may be more socially acceptable than men's.

Tactics of sexual coercion: when men and women won't take no for an answer.

We investigated women's and men's reports of experiencing and using tactics of postrefusal sexual persistence, defined as persistent attempts to have sexual contact with someone who has already refused. Participants were 275 men and 381 women at Midwestern and Southern universities. More women (78%) than men (58%) reported having been subjected to such tactics since age 16; this difference was significant for the categories of sexual arousal, emotional manipulation and lies, and intoxication, and for two tactics within the physical force category (physical restraint and threats of harm). More men (40%) than women (26%) reported having used such tactics; this difference was significant for the sexual arousal, emotional manipulation and lies, and intoxication categories. We present participants' written descriptions of their experiences.