Background

Use of social media is becoming ubiquitous, and disease-related communities are forming online, including communities of interest around diabetes.

Objective

Our objective was to examine diabetes-related participation on Twitter by describing the frequency and timing of diabetes-related tweets, the geography of tweets, and the types of participants over a 2-year sample of 10% of all tweets.

Methods

We identified tweets with diabetes-related search terms and hashtags in a dataset of 29.6 billion tweets for the years 2013 and 2014 and extracted the text, time, location, retweet, and user information. We assessed the frequencies of tweets used across different search terms and hashtags by month and day of week and, for tweets that provided location information, by country. We also performed these analyses for a subset of tweets that used the hashtag #dsma, a social media advocacy community focused on diabetes. Random samples of user profiles in the 2 groups were also drawn and reviewed to understand the types of stakeholders participating online.

Results

We found 1,368,575 diabetes-related tweets based on diabetes-related terms and hashtags. There was a seasonality to tweets; a higher proportion occurred during the month of November, which is when World Diabetes Day occurs. The subset of tweets with the #dsma were most frequent on Thursdays (coordinated universal time), which is consistent with the timing of a weekly chat organized by this online community. Approximately 2% of tweets carried geolocation information and were most prominent in the United States (on the east and west coasts), followed by Indonesia and the United Kingdom. For the user profiles randomly selected among overall tweets, we could not identify a relationship to diabetes for the majority of users; for the profiles using the #dsma hashtag, we found that patients with type 1 diabetes and their caregivers represented the largest proportion of individuals.

Conclusions

Twitter is increasingly becoming a space for online conversations about diabetes. Further qualitative and quantitative content analysis is needed to understand the nature and purpose of these conversations.

Background

National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive.

Aims

The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity.

Method

At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated.

Results

Student perceptions of mistreatment were not statistically correlated with individual's responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it "harsh" to be called incompetent during rounds (p < 0.0005).

Conclusion

This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.

Objective

Salsalate treatment has well-known effects on improving glycemia, and the objective of this study was to examine whether the mechanism of this effect was related to changes in adipose tissue.

Methods

A randomized double-blind and placebo-controlled trial in obese Hispanics (18-35 years) was conducted. The intervention consisted of 4 g day(-1) of salsalate (n = 11) versus placebo (n = 13) for 4 weeks. Outcome measures included glycemia, adiposity, ectopic fat, and adipose tissue gene expression and inflammation.

Results

In those receiving salsalate, plasma fasting glucose decreased by 3.4% (P < 0.01), free fatty acids decreased by 42.5% (P = 0.06), and adiponectin increased by 27.7% (P < 0.01). Salsalate increased insulin AUC by 38% (P = 0.01) and HOMA-B by 47.2% (P < 0.01) while estimates of insulin sensitivity/resistance were unaffected. These metabolic improvements occurred without changes in total, abdominal, visceral, or liver fat. Plasma markers of inflammation/immune activation were unchanged following salsalate. Salsalate had no effects on adipose tissue including adipocyte size, presence of crown-like structures, or gene expression of adipokines, immune cell markers, or cytokines downstream of NF-κB with the exception of downregulation of IL-1β (P < 0.01).

Conclusions

Findings suggest that metabolic improvements in response to salsalate occurred without alterations in adiposity, ectopic fat, or adipose tissue gene expression and inflammation.

Multimodal analgesia pathways have been shown to reduce opioid use and side effects in surgical patients. A quality improvement initiative was implemented to increase the use of multimodal analgesia in adult patients presenting for general anaesthesia at an academic tertiary care centre. The aim of this study was to increase adoption of a perioperative multimodal analgesia protocol across a broad population of surgical patients. The use of multimodal analgesia was tracked as a process metric. Our primary outcome was opioid use normalised to oral morphine equivalents (OME) intraoperatively, in the postanaesthesia care unit (PACU), and 48 hours postoperatively. Pain scores and use of antiemetics were measured as balancing metrics. We conducted a quality improvement study of a multimodal analgesia protocol implemented for adult (≥18 and≤70) non-transplant patients undergoing general anaesthesia (≥180 min). Components of multimodal analgesia were defined as (1) preoperative analgesic medication (acetaminophen, celecoxib, diclofenac, gabapentin), (2) regional anaesthesia (peripheral nerve block or catheter, epidural catheter or spinal) or (3) intraoperative analgesic medication (ketamine, ketorolac, lidocaine infusion, magnesium, acetaminophen, dexamethasone ≥8 mg, dexmedetomidine). We compared opioid use, pain scores and antiemetic use for patients 1 year before (baseline group-1 July 2018 to 30 June 2019) and 1 year after (implementation group-1 July 2019 to 30 June 2020) project implementation. Use of multimodal analgesia improved from 53.9% in the baseline group to 67.5% in the implementation group (p<0.001). There was no significant difference in intraoperative OME use before and after implementation (β0=44.0, β2=0.52, p=0.875). OME decreased after the project implementation in the PACU (β0=34.4, β2=-3.88, p<0.001) and 48 hours postoperatively (β0=184.9, β2=-22.59, p<0.001), while pain scores during those time points were similar. A perioperative pragmatic multimodal analgesic intervention was associated with reduced OME use in the PACU and 48 hours postoperatively.

During late March and April of 1999 the University of Wyoming's King Air research aircraft measured atmospheric concentrations of NO, O3, peroxyacetyl nitrate (PAN), CO, CH4, VOCs, aerosols, and J(NO2) off the west coast of the United States. During 14 flights, measurements were made between 39°-48° N latitude, 125°-129° W longitude, and at altitudes from 0-8 km. These flights were part of the Photochemical Ozone Budget of the Eastern North Pacific Atmosphere (PHOBEA) experiment, which included both ground-based and airborne measurements. Flights were scheduled when meteorological conditions minimized the impact of local pollution sources. The resulting measurements were segregated by air mass source region as indicated by back isentropic trajectory analysis. The chemical composition of marine air masses whose 5-day back isentropic trajectories originated north of 40° N latitude or west of 180° W longitude (WNW) differed significantly from marine air masses whose 5-day back isentropic trajectories originated south of 40° N latitude and east of 180° W longitude (SW). Trajectory and chemical analyses indicated that the majority of all encountered air masses, both WNW and SW, likely originated from the northwestern Pacific and have characteristics of emissions from the East Asian continental region. However, air masses with WNW back trajectories contained higher mixing ratios of NO, NOx, O3, PAN, CO, CH4, various VOC pollution tracers, and aerosol number concentration, compared to those air masses with SW back trajectories. Calculations of air mass age using two separate methods, photochemical and back trajectory, are consistent with transport from the northwestern Pacific in 8-10 days for air masses with WNW back trajectories and 16-20 days for air masses with SW back trajectories. Correlations, trajectory analysis, and comparisons with measurements made in the northwestern Pacific during NASA's Pacific Exploritory Mission-West Phase B (PEM-West B) experiment in 1994 are used to investigate the data. These analyses provide evidence that anthropogenically influenced air masses from the northwestern Pacific affect the overall chemical composition of the northeastern Pacific troposphere. Copyright 2001 by the American Geophysical Union.

Anthropogenically-impacted environments offer the opportunity to discover novel microbial species and metabolisms, which may be undetectable in natural systems. Here, a combined metagenomic and geochemical study in Base Mine Lake, Alberta, Canada, which is the only oil sands end pit lake to date, revealed that nitrification was performed by members from Nitrosomonadaceae, Chloroflexi and unclassified Gammaproteobacteria "MBAE14." While Nitrosomonadaceae and Chloroflexi groups were relatively abundant in the upper oxygenated zones, MBAE14 dominated the hypoxic hypolimnetic zones (approximately 30% of total microbial communities); MBAE14 was not detected in the underlying anoxic tailings. Replication rate analyses indicate that MBAE14 grew in metalimnetic and hypolimnetic water cap regions, most actively at the metalimnetic, ammonia/oxygen transition zone consistent with it putatively conducting nitrification. Detailed genomic analyses of MBAE14 evidenced both ammonia oxidation and denitrification into dinitrogen capabilities. However, the absence of known CO₂-fixation genes suggests a heterotrophic denitrifying metabolism. Functional marker genes of ammonia oxidation (amo and hao) in the MBAE14 genome are homologous with those conserved in autotrophic nitrifiers, but not with those of known heterotrophic nitrifiers. We propose that this novel MBAE14 inhabits the specific ammonia-rich, oxygen and labile organic matter-limited conditions occurring in Base Mine Lake which selectively favors mixotrophic coupled nitrifier denitrification metabolism. Our results highlight the opportunities to better constrain biogeochemical cycles from the application of metagenomics to engineered systems associated with extractive resource sectors.

Canister sampling for the determination of atmospheric mixing ratios of nonmethane hydrocarbons (NMHCs), selected halocarbons, and methyl nitrate was conducted aboard the National Center for Atmospheric Research (NCAR) C-130 aircraft over the Pacific and Southern Oceans as part of the First Aerosol Characterization Experiment (ACE 1) during November and December 1995. A latitudinal profile, flown from 76°N to 60°S, revealed latitudinal gradients for most trace gases. NMHC and halocarbon gases with predominantly anthropogenic sources, including ethane, ethyne, and tetrachloroethene, exhibited significantly higher mixing ratios in the northern hemisphere at all altitudes. Methyl chloride exhibited its lowest mixing ratios at the highest northern hemisphere latitudes, and the distributions of methyl nitrate and methyl iodide were consistent with tropical and subtropical oceanic sources. Layers containing continental air characteristic of aged biomass burning emissions were observed above about 3 km over the remote southern Pacific and near New Zealand between approximately 19°S and 43°S. These plumes originated from the west, possibly from fires in southern Africa. The month-long intensive investigation of the clean marine southern midlatitude troposphere south of Australia revealed decreases in the mixing ratios of ethane, ethyne, propane, and tetrachloroethene, consistent with their seasonal mixing ratio cycle. By contrast, increases in the average marine boundary layer concentrations of methyl iodide, methyl nitrate, and dimethyl sulfide (DMS) were observed as the season progressed to summer conditions. These increases were most appreciable in the region south of 44°S over Southern Ocean waters characterized as subantarctic and polar, indicating a seasonal increase in oceanic productivity for these gases. Copyright 1999 by the American Geophysical Union.

Purpose

The inability to intraoperatively distinguish primary tumor, as well as lymphatic spread, increases the probability of positive surgical margins, tumor recurrence, and surgical toxicity. The goal of this study was to develop a tumor-specific optical probe for real-time fluorescence-guided surgery.

Experimental design

A humanized antibody fragment against PSCA (A11 minibody, A11 Mb) was conjugated with a near-infrared fluorophore, IRDye800CW. The integrity and binding of the probe to PSCA were confirmed by gel electrophoresis, size-exclusion chromatography, and flow cytometry, respectively. The ability of the probe to detect tumor-infiltrated lymph nodes and metastatic lesions was evaluated in 2 xenograft models, as well as in transgenic mice expressing human PSCA (hPSCA). An invasive intramuscular model was utilized to evaluate the efficacy of the A11 Mb-IRDye800CW-guided surgery.

Results

A11 Mb was successfully conjugated with IRDye800CW and retained specific binding to PSCA. In vivo imaging showed maximal signal-to-background ratios at 48 hours. The A11 Mb-IRDye800CW specifically detected PSCA-positive primary tumors, tumor-infiltrated lymph nodes, and distant metastases with high contrast. Fluorescence guidance facilitated more complete tumor resection, reduced tumor recurrence, and improved overall survival, compared with conventional white light surgery. The probe successfully identified primary orthotopic tumors and metastatic lesions in hPSCA transgenic mice.

Conclusions

Real-time fluorescence image-guided surgery with A11 Mb-IRDye800CW enabled detection of lymph node metastases and positive surgical margins, facilitated more complete tumor removal, and improved survival, compared with white light surgery. These results may be translatable into clinical practice to improve surgical and patient outcomes.