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

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

Transition phenomena in unstably stratified turbulent flows.

We study experimentally and theoretically the transition phenomena caused by external forcing from Rayleigh-Bénard convection with large-scale circulation (LSC) to the limiting regime of unstably stratified turbulent flow without LSC, where the temperature field behaves like a passive scalar. In the experiments we use the Rayleigh-Bénard apparatus with an additional source of turbulence produced by two oscillating grids located near the sidewalls of the chamber. When the frequency of the grid oscillations is larger than 2 Hz, the LSC in turbulent convection is destroyed, and the destruction of the LSC is accompanied by a strong change of the mean temperature distribution. However, in all regimes of the unstably stratified turbulent flow the ratio [(ℓ{x}∇{x}T)²+(ℓ{y}∇{y}T)² + (ℓ{z}∇{z}T)²]/<θ²> varies slightly (even in the range of parameters where the behavior of the temperature field is different from that of the passive scalar). Here ℓ{i} are the integral scales of turbulence along the x,y,z directions, and T and θ are the mean and fluctuating parts of the fluid temperature. At all frequencies of the grid oscillations we have detected long-term nonlinear oscillations of the mean temperature. The theoretical predictions based on the budget equations for turbulent kinetic energy, turbulent temperature fluctuations, and turbulent heat flux, are in agreement with the experimental results.

Tangling clustering of inertial particles in stably stratified turbulence.

We have predicted theoretically and detected in laboratory experiments a tangling clustering of inertial particles in a stably stratified turbulence with imposed mean vertical temperature gradient. In the stratified turbulence a spatial distribution of the mean particle number density is nonuniform due to the phenomenon of turbulent thermal diffusion, i.e., the inertial particles are accumulated in the vicinity of the minimum of the mean temperature of the surrounding fluid, and a nonzero gradient of the mean particle number density, ∇N , is formed. It causes generation of fluctuations of the particle number density by tangling of the large-scale gradient ∇N by velocity fluctuations. In addition, the mean temperature gradient ∇T produces the temperature fluctuations by tangling of the large-scale gradient ∇T by velocity fluctuations. The anisotropic temperature fluctuations contribute to the two-point correlation function of the divergence of the particle velocity field, i.e., they increase the rate of formation of the particle clusters in small scales. We have demonstrated that in the laboratory stratified turbulence this tangling clustering is much more effective than a pure inertial clustering (preferential concentration) that has been observed in isothermal turbulence. In particular, in our experiments in oscillating grid isothermal turbulence in air without imposed mean temperature gradient, the inertial clustering is very weak for solid particles with the diameter of ≈10 µm and Reynolds numbers based on turbulent length scale and rms velocity, Re=250 . In the experiments the correlation function for the inertial clustering in isothermal turbulence is much smaller than that for the tangling clustering in nonisothermal turbulence. The size of the tangling clusters is on the order of several Kolmogorov length scales. The clustering described in our study is found for inertial particles with small Stokes numbers and with the material density that is much larger than the fluid density. Our theoretical predictions are in a good agreement with the obtained experimental results.

Effect of large-scale coherent structures on turbulent convection.

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

Mixing at the external boundary of a submerged turbulent jet.

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

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

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

Post-phototherapy neonatal bilirubin rebound: a potential cause of significant hyperbilirubinaemia.

AIM: To determine the incidence of post-phototherapy neonatal plasma total bilirubin (PTB) rebound. METHODS: A prospective clinical survey was performed on 226 term and near-term neonates treated with phototherapy in the well baby nursery of the Shaare Zedek Medical Center from January 2001 to September 2002. Neonates were tested for PTB 24 hours (between 12 and 36 hours) after discontinuation of phototherapy, with additional testing as clinically indicated. The main outcome measure, significant bilirubin rebound, was defined as a post-phototherapy PTB > or =256 micromol/l. Phototherapy was not reinstituted in all cases of rebound, but rather according to clinical indications. RESULTS: A total of 30 (13.3%) neonates developed significant rebound (mean (SD) PTB 287 (27) micromol/l, upper range 351 micromol/l). Twenty two of these (73%) were retreated with phototherapy at mean PTB 296 (29) micromol/l. Multiple logistic regression analysis showed significant risk for aetiological risk factors including positive direct Coombs test (odds ratio 2.44, 95% CI 1.25 to 4.74) and gestational age <37 weeks (odds ratio 3.21, 95% CI 1.29 to 7.96). A greater number of neonates rebounded among those in whom phototherapy was commenced < or =72 hours (26/152, 17%) compared with >72 hours (4/74, 5.4%) (odds ratio 3.61, 95% CI 1.21 to 10.77). CONCLUSION: Post-phototherapy neonatal bilirubin rebound to clinically significant levels may occur, especially in cases of prematurity, direct Coombs test positivity, and those treated < or =72 hours. These risk factors should be taken into account when planning post-phototherapy follow up.

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

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

Protective effect of bilirubin in ischemia-reperfusion injury in the rat intestine.

BACKGROUND: Although bilirubin, which crosses the blood-brain barrier, can cause irreversible brain damage, it also possesses antioxidant properties that may be protective against oxidative stress. Intestinal ischemia-reperfusion (IR) injury results in cell destruction, mediated via the generation of reactive oxygen species. Although increased serum bilirubin is correlated with increased antioxidant potential in the face of hyperoxia, evidence of bilirubin-associated protective effect against IR injury remains nonspecific. We therefore sought to investigate whether hyperbilirubinemia would be protective against IR injury to the intestine. METHODS: Young adult rats were randomly assigned to one of three groups: 1) IR/control (n = 12); 2) IR/hyperbilirubinemia (n = 10), in which IR was generated while the rats were treated with a continuous infusion of bilirubin; and 3) hyperbilirubinemia controls (n = 10). Blood and intestinal tissue samples were obtained to determine serial thiobarbituric acid reducing substances (index of lipid peroxidation) and for xanthine oxidase/xanthine dehydrogenase and glutathione/glutathione disulfide ratios. Intestinal histopathology was graded from 1 (normal) to 4 (severe necrotic lesions). RESULTS: Histopathologic scoring and circulating and tissue thiobarbituric acid reducing substances were highest in the IR/control animals compared with either the IR/hyperbilirubinemics or the controls. All of these are consistent with the most severe injury in this group. Xanthine oxidase/xanthine dehydrogenase ratios were not significantly different among the groups. CONCLUSION: Hyperbilirubinemia ameliorates the extent of intestinal IR injury in our model and appears to act as an antioxidant. This study supports the concept that bilirubin possesses some beneficial properties in vivo, although no direct clinical conclusions can be drawn from these data.

Hypoglycemia and the breastfed neonate.

Healthy, full-term infants are functionally and metabolically programmed to make the transition from their intrauterine dependent environment to their extrauterine existence without the need for metabolic monitoring or interference with the natural breastfeeding process. Full-term infants are equipped with homeostatic mechanisms that preserve adequate energy substrate to the brain and other vital organs. Thermal stability and early, properly guided, frequent, exclusive breastfeeding are the keys to success. Thus, routine screening for blood glucose concentrations or feeding sugar water is not necessary and potentially counterproductive to the establishment of a healthy mother-infant dyad.

Prospective surveillance of vancomycin-resistant enterococci in a neonatal intensive care unit.

A point-prevalence study of vancomycin-resistant enterococci colonization of the gastrointestinal tract in an Israeli hospital revealed that 14.7% of the 320 inpatients were colonized. Vancomycin-resistant enterococci colonization was detected in most departments except the neonatal intensive care unit. Hence, a prospective longitudinal study of the prevalence of vancomycin-resistant enterococci colonization in the neonatal intensive care unit was conducted. A rectal swab was obtained from every newborn on admission to the neonatal intensive care unit and once weekly thereafter until the patient was discharged. Enterococci were isolated and tested for susceptibility to vancomycin. A total of 84 neonates were enrolled and monitored on average for 3 weeks (SD +/- 3.9, range 1-20 weeks). Mean gestational age was 35.7 weeks (SD +/- 3.9, range 25-42 weeks), and mean birth weight was 2.4 kg (SD +/- 0.9, range 0.45-4.1 kg). Most patients had one or more of the known risk factors associated with colonization with vancomycin-resistant enterococci. Eighty percent of the patients received antibiotics during the study, and 14.3% received vancomycin. The median duration of vancomycin treatment was 12.5 days (SD +/- 16.8, range 5-55 days). Fifty-one of 84 (61%) patients acquired enterococci sensitive to vancomycin during the study period, but no newborn had vancomycin-resistant enterococci. Possible explanations for this finding may be physical isolation of the neonatal intensive care unit from the rest of the hospital, intrinsic differences in the bowel milieu of this age group and the lack of exposure to food and other environmental sources of vancomycin-resistant enterococci from the community.

Effectiveness of primiparae and multiparae at soothing their newborn infants.

To examine the effectiveness of new parents at soothing their infants, the authors filmed primiparae (20 mothers, 20 fathers) and, for comparison, multiparae (25 mothers, 25 fathers) during an interaction with their crying 2- to 3-day-old infants. Data were derived from loudness ratings of the infants' distress signals and by measuring the time it took parents to quiet their infants. In addition, specific parental behaviors were coded by microanalysis. From these data, measures of soothing effectiveness and behavioral profiles were derived. Data analyses showed that most primiparae were effective at soothing their infants' cries and that there were no parity effects on measures of soothing effectiveness. However, mothers, regardless of parity, were more effective at quieting their infants than were fathers, and there were significant differences in mothers' and fathers' caregiving behaviors. These data suggest that primiparae are effective at quickly soothing their newborns and that their skill, as measured, does not depend on parenting experience. Moreover, the data point to significant differences in mothers' and fathers' competence at quieting their newborns whether or not they are experienced at parenting.

The nature of the mother's tie to her infant: maternal bonding under conditions of proximity, separation, and potential loss.

Attachment has generally been examined from the infant's perspective. We focused on mothers' post-partum thoughts and behaviors. Guided by an ethological approach, maternal bonding was examined under conditions of proximity, separation, and potential loss. Ninety-one mothers were interviewed: mothers of full-term infants who maintained continuous proximity to the infant, mothers of healthy premature infants who were separated from the infant, and mothers of very low birthweight infants who experienced potential loss and prolonged separation. Mothers of term infants reported medium-to-high levels of preoccupations with thoughts of infant safety and well-being. Preoccupations increased with separation (Group 2) and significantly decreased with impending loss (Group 3). Attachment behaviors and representations were the highest among mothers of term infants and declined linearly with the duration of mother-infant separation. Maternal trait anxiety and depression were related respectively to higher levels of preoccupations and reduced attachment behaviors and representations, independent of the infant medical condition and mother-child separation. Discussion focused on the comparability of maternal and infant attachment in relation to the neurobiological system underlying bond formation.

Amelioration of ischemia-reperfusion injury in rat intestine by pentoxifylline-mediated inhibition of xanthine oxidase.

BACKGROUND: Intestinal ischemia-reperfusion (IR) injury results in cell destruction, which may be mediated by the generation of reactive oxygen species, potentially toxic metabolites of xanthine oxidase. Pentoxifylline (PTX) possesses a variety of biochemical and antioxidant properties that can improve capillary flow and tissue oxygenation. Because of these combined effects, it has been hypothesized that pentoxifylline would protect against intestinal IR. METHODS: Young adult rats were randomly assigned to one of four experimental groups: IR/Placebo (n = 12) in which superior and inferior mesenteric arteries were clamped for 45 minutes and then reopened; IR/PTX (n = 11) in which IR was induced as in the Placebo group, but with 25 mg/kg PTX at 0, 30, and 60 minutes; No IR/Placebo (n = 12); and No IR/PTX (n = 6) in which placebo and PTX were applied with no IR. Blood and intestinal samples were taken for serial thiobarbituric acid-reducing substances (TBARS; index of lipid peroxidation), for xanthine oxidase-xanthine dehydrogenase ratios, glutathione, myeloperoxidase, and histopathology. RESULTS: Animals in the IR/PTX group had lower TBARS and the least severe histopathologic injury. Xanthine oxidasexanthine dehydrogenase ratios were elevated only in IR/ Placebo (0.67+/-0.22 vs. 0.45+/-0.14 in IR/PTX; 0.42+/-0.22 in No IR/Placebo; and 0.40+/-0.11 in No IR/PTX; p = 0.0009). Reduced glutathione was diminished in IR/PTX animals (38.9 +/-1.35 vs. 46.1+/-7.0 in IR/Placebo; 41.1+/-2.5 in No IR/ Placebo; 43.6+/-1.0 in No IR/PTX; p = 0.048). No differences were recorded in myeloperoxidase levels among groups. CONCLUSIONS: Pentoxifylline ameliorates histopathologic signs of injury and decreases lipid peroxidation (TBARS). Normal xanthine oxidase-xanthine dehydrogenase ratios in the treated compared with IR-only animals imply that the protective effect of PTX is at least partially mediated through inhibition of xanthine oxidase.

Indomethacin tocolysis increases postnatal patent ductus arteriosus severity.

UNLABELLED: Postnatally, therapeutic indomethacin administration is usually effective in mediating patent ductus arteriosus (PDA) constriction in premature infants. There are infants, however, who remain resistant to indomethacin and require more aggressive surgical intervention to facilitate ductal closure. Indomethacin tocolysis has been reported to increase the incidence of persistent PDA in premature infants. It was our impression that infants exposed to antenatal indomethacin not only suffered from an increased incidence of PDA, but that they were more symptomatic from PDA and that for them, PDA was more resistant to medical closure. It is this observation that we sought to examine in this study. METHODS: Medical records of all mothers and premature neonates with birth weight

Grandmultiparity. Is it a perinatal risk?

Increased parity is more common in lower-socioeconomic groups. Additionally, GMPs tend to be older. It is for these reasons that there is a tendency for an increased incidence of antenatal complications, such as hypertension and diabetes, among GMP mothers. It appears that the previous conflicting reports on the effect of high parity on perinatal outcome can be related to differences in the socioeconomic conditions of the parturient population under examination. Previous evidence of the unfavorable influence on perinatal outcome of high parity might have been biased by patient selection, because high parity is often inversely linked to social class. Our recent studies of the Israeli maternal population plus comparable reports from other countries allow us to conclude that GMP is not always a great cause for concern in an economically stable and healthy population that has access to high-quality medical care. As such, the term dangerous multipara should be removed from the medical literature and the focus of concern should shift to the organization and the delivery of quality medical services.

Intervention programs for premature infants. How and do they affect development?

Over the past 30 years, a variety of intervention programs for the enhancement of the neurodevelopmental status of premature infants have been implemented with confusing outcomes. In addition, diametrically different forms of therapy that rest on contrasting theories have led, paradoxically, to similar results. This article systematically examines and analyses the various modes of therapy and their underlying theoretical mechanisms. Skin-to-skin contact (kangaroo care) is suggested as the intervention that most logically meshes the premature infant's need to develop state regulation while facilitating sequential sensory development and promoting mother-infant attachment.

Prevention of neonatal group B streptococcal infections. Is there a rational prevention strategy?

Clinicians, both obstetric and pediatric, are currently faced with the need to choose treatment strategies to reduce the persistent high incidence of early-onset GBS neonatal disease without being equipped with adequate data to choose conclusively which of the proposed strategies is ideal. There is an urgent need for well-designed prospective randomized trials comparing the various prevention protocols so as to resolve conclusively the controversy. The ultimate prevention strategy may well be a successful maternal immunization program.

Supernumerary umbilical vein resulting in a four-vessel umbilical cord.

The birth of an infant with increased number of umbilical veins is a rare event and has been previously reported to be associated with a high incidence of major congenital anomalies. This report documents a normal infant with two umbilical veins resulting in a four vessel cord. A male infant (third of triplet pregnancy resulting from multiple zygote implantation) was born at 30 weeks' gestation weighing 1320 g.Two umbilical veins and two umbilical arteries were noted on cannulation and X ray. Physical examination and cranial, abdominal, and cardiac ultrasound exam were normal. One-year follow-up was normal. The birth of infant with a four-vessel cord mandates comprehensive workup for associated anomalies but this case indicates that such a finding is not always ominous.