Publications by authors named "Neal Shah"

61 Publications

Characterizing Self-Reported Tobacco, Vaping, and Marijuana-Related Tweets Geolocated for California College Campuses.

Front Public Health 2021 13;9:628812. Epub 2021 Apr 13.

Department of Anesthesiology, San Diego School of Medicine, University of California, San Diego, San Diego, CA, United States.

College-aged youth are active on social media yet smoking-related social media engagement in these populations has not been thoroughly investigated. We sought to conduct an exploratory infoveillance study focused on geolocated data to characterize smoking-related tweets originating from California 4-year colleges on Twitter. Tweets from 2015 to 2019 with geospatial coordinates in CA college campuses containing smoking-related keywords were collected from the Twitter API stream and manually annotated for discussions about smoking product type, sentiment, and behavior. Out of all tweets detected with smoking-related behavior, 46.7% related to tobacco use, 50.0% to marijuana, and 7.3% to vaping. Of these tweets, 46.1% reported first-person use or second-hand observation of smoking behavior. Out of 962 tweets with user sentiment, the majority (67.6%) were positive, ranging from 55.0% for California State University, Long Beach to 95.8% for California State University, Los Angeles. We detected reporting of first- and second-hand smoking behavior on CA college campuses representing possible violation of campus smoking bans. The majority of tweets expressed positive sentiment about smoking behaviors, though there was appreciable variability between college campuses. This suggests that anti-smoking outreach should be tailored to the unique student populations of these college communities. Among tweets about smoking from California colleges, high levels of positive sentiment suggest that the campus climate may be less receptive to anti-smoking messages or adherence to campus smoking bans. Further research should investigate the degree to which this varies by campuses over time and following implementation of bans including validating using other sources of data.
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http://dx.doi.org/10.3389/fpubh.2021.628812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076505PMC
April 2021

Online marketing practices of regenerative medicine clinics in US-Mexico border region: a web surveillance study.

Stem Cell Res Ther 2021 Mar 18;12(1):189. Epub 2021 Mar 18.

Department of Healthcare Research and Policy, UC San Diego - Extension, 8950 Villa La Jolla Drive Suite A124, San Diego, CA, 92037, USA.

Introduction: The potential of regenerative medicine to improve human health has led to the rapid expansion of stem cell clinics throughout the world with varying levels of regulation and oversight. This has led to a market ripe for stem cell tourism, with Tijuana, Mexico, as a major destination. In this study, we characterize the online marketing, intervention details, pricing of services, and assess potential safety risks through web surveillance of regenerative medicine clinics marketing services in Tijuana.

Methods: We conducted structured online search queries from March to April 2019 using 296 search terms in English and Spanish on two search engines (Google and Bing) to identify websites engaged in direct-to-consumer advertising of regenerative medicine services. We performed content analysis to characterize three categories of interest: online presence, tokens of scientific legitimacy, and intervention details.

Results: Our structured online searches resulted in 110 unique websites located in Tijuana corresponding to 76 confirmed locations. These clinics' online presence consisted of direct-to-consumer advertising mainly through a dedicated website (94.5%) or Facebook page (65.5%). The vast majority of these websites (99.1%) did not mention any affiliation to an academic institutions or other overt tokens of scientific legitimacy. Most clinics claimed autologous tissue was the source of treatments (67.3%) and generally did not specify route of administration. Additionally, of the Tijuana clinics identified, 13 claimed licensing, though only 1 matched with available licensing information.

Conclusions: Regenerative medicine clinics in Tijuana have a significant online presence using direct-to-consumer advertising to attract stem-cell tourism clientele in a bustling border region between Mexico and the USA. This study adds to existing literature evidencing the unregulated nature of online stem cell offerings and provides further evidence of the need for regulatory harmonization, particularly to address stem cell services being offered online across borders.
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http://dx.doi.org/10.1186/s13287-021-02254-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977255PMC
March 2021

Engaging Medical Students in the Virtual, Socially Distant Era of the Covid-19 Pandemic: Online Radiology Resources Worth Exploring.

Acad Radiol 2021 05 2;28(5):733-736. Epub 2021 Feb 2.

Brigham and Women's Hospital, Boston, Massachusetts, Department of Radiology, Boston, Massachusetts.

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http://dx.doi.org/10.1016/j.acra.2021.01.021DOI Listing
May 2021

Doxycycline Induced Severe Acute Pancreatitis: A Rare Finding To A Common Medication.

BMJ Case Rep 2021 Feb 5;14(2). Epub 2021 Feb 5.

Department of Gastroenterology and Hepatology, NYU Langone Hospital - Long Island, Mineola, New York, USA.

Doxycycline is a commonly prescribed antibiotic with growing evidence suggesting a possible linkage with drug-induced acute pancreatitis. We present an elderly female presenting with severe acute pancreatitis likely secondary to doxycycline therapy after thorough investigation. We reviewed the evidence linking doxycycline-inducing acute pancreatitis and signs and symptoms for severe disease. Early recognition and intervention are critical for positive patient outcomes.
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http://dx.doi.org/10.1136/bcr-2020-239640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871261PMC
February 2021

Automated abstraction of myocardial perfusion imaging reports using natural language processing.

J Nucl Cardiol 2021 Jan 20. Epub 2021 Jan 20.

Department of Cardiovascular Medicine, Westchester Medical Center, 100 Woods Road, Valhalla, NY, 10595, USA.

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http://dx.doi.org/10.1007/s12350-020-02507-4DOI Listing
January 2021

Superior Vena Cava Syndrome.

JACC Cardiovasc Interv 2020 12;13(24):2896-2910

Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, Pennsylvania, USA. Electronic address:

Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. There is a paucity of data and societal guidelines with regard to the management of SVC syndrome. This paper aims to update the practicing interventionalists with the contemporary and the evolving therapeutic approach to SVC syndrome. In addition, the review will focus on endovascular techniques, including catheter-directed thrombolysis, angioplasty, and stenting, and their associated complications.
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http://dx.doi.org/10.1016/j.jcin.2020.08.038DOI Listing
December 2020

First Bite Syndrome Relief With Trigeminal Nerve Branch Block and Ablation: A Case Report.

A A Pract 2020 Nov;14(13):e01329

From the *Pain Medicine, Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, Florida †Pain Medicine, Neurology Service, James A. Haley Veterans' Hospital, Tampa, Florida ‡Interventional Pain Service, Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.

First bite syndrome (FBS) is intense facial pain at the first bite of each meal. Currently, no guidelines exist for treating FBS, although botulinum toxin injection has shown benefit. We describe a case of right-sided FBS and painful trigeminal neuropathy, in which FBS resolved for 2 weeks using maxillary and mandibular nerve block and radiofrequency nerve thermal ablation (RFA). Our treatment may have disrupted somatic sensory input from the parotid carried by the auriculotemporal nerve or lesioned the otic ganglion resulting in decreased parasympathetic hyperactivation. Further studies are warranted to evaluate the use of this procedure for FBS.
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http://dx.doi.org/10.1213/XAA.0000000000001329DOI Listing
November 2020

Characterizing Weibo Social Media Posts From Wuhan, China During the Early Stages of the COVID-19 Pandemic: Qualitative Content Analysis.

JMIR Public Health Surveill 2020 12 7;6(4):e24125. Epub 2020 Dec 7.

Department of Healthcare Research and Policy, University of California, San Diego - Extension, La Jolla, CA, United States.

Background: The COVID-19 pandemic has reached 40 million confirmed cases worldwide. Given its rapid progression, it is important to examine its origins to better understand how people's knowledge, attitudes, and reactions have evolved over time. One method is to use data mining of social media conversations related to information exposure and self-reported user experiences.

Objective: This study aims to characterize the knowledge, attitudes, and behaviors of social media users located at the initial epicenter of the outbreak by analyzing data from the Sina Weibo platform in Chinese.

Methods: We used web scraping to collect public Weibo posts from December 31, 2019, to January 20, 2020, from users located in Wuhan City that contained COVID-19-related keywords. We then manually annotated all posts using an inductive content coding approach to identify specific information sources and key themes including news and knowledge about the outbreak, public sentiment, and public reaction to control and response measures.

Results: We identified 10,159 COVID-19 posts from 8703 unique Weibo users. Among our three parent classification areas, 67.22% (n=6829) included news and knowledge posts, 69.72% (n=7083) included public sentiment, and 47.87% (n=4863) included public reaction and self-reported behavior. Many of these themes were expressed concurrently in the same Weibo post. Subtopics for news and knowledge posts followed four distinct timelines and evidenced an escalation of the outbreak's seriousness as more information became available. Public sentiment primarily focused on expressions of anxiety, though some expressions of anger and even positive sentiment were also detected. Public reaction included both protective and elevated health risk behavior.

Conclusions: Between the announcement of pneumonia and respiratory illness of unknown origin in late December 2019 and the discovery of human-to-human transmission on January 20, 2020, we observed a high volume of public anxiety and confusion about COVID-19, including different reactions to the news by users, negative sentiment after being exposed to information, and public reaction that translated to self-reported behavior. These findings provide early insight into changing knowledge, attitudes, and behaviors about COVID-19, and have the potential to inform future outbreak communication, response, and policy making in China and beyond.
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http://dx.doi.org/10.2196/24125DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722484PMC
December 2020

Pulsed Radiofrequency Ablation: An Alternative Treatment Modality for Radiation-Induced Brachial Plexopathy.

Pain Med 2021 Mar;22(3):749-753

Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Radiation therapy is used as a form of treatment for various neoplastic diseases. There are many potential adverse effects of this therapy, including radiation-induced neurotoxicity. Radiation-induced brachial plexopathy (RIBP) may occur due to the fibrosis of neural and perineural soft tissues, leading to ischemic damage of the axons and Schwann cells. The dose of radiation exceeds 55 Gy in many patients who develop symptoms [1]. Current incidence in the United States is 1-2%, and RIBP is most commonly seen in patients who have undergone treatment for breast cancer, lung cancer, or lymphoma [1-3]. Common symptoms include numbness, paresthesia, dysesthesia, and occasional numbness of the arm. Pain is present in the shoulder and proximal arm and is typically mild to moderate in severity. Diagnosis is often made based on clinical presentation and evaluation of imaging to rule out concurrent malignant etiologies of the brachial plexus. Current recommended treatment includes physical therapy and medical management with anticonvulsants, tricyclic antidepressants, and selective serotonin-norepinephrine reuptake inhibitors.
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http://dx.doi.org/10.1093/pm/pnaa382DOI Listing
March 2021

CT Coronary Angiography Fractional Flow Reserve: New Advances in the Diagnosis and Treatment of Coronary Artery Disease.

Curr Probl Diagn Radiol 2020 Sep 24. Epub 2020 Sep 24.

University Hospitals Cleveland Medical Center/Case Western Reserve University, Department of Radiology, Cleveland, OH.

Coronary artery disease (CAD) remains the most common cardiovascular disease, accounting for 6% of all Emergency Department visits and 27% of all Emergency Department hospitalizations. Invasive coronary angiography with fractional flow reserve (FFR) remains the gold standard to assess for hemodynamically stenosis in CAD patients. However, for low- and intermediate-risk patients, noninvasive modalities have started to gain favor as patients with stable CAD who received optimal medical therapy did as well as patients who underwent percutaneous coronary intervention. This led to the incorporation of FFR. cCTA provides good spatial resolution for evaluating stenosis. FFR provides additional information regarding whether the stenosis is hemodynamically significant. FFR is the ratio of maximum blood flow in a stenotic artery to the maximum blood flow through that artery without stenosis. Computational fluid dynamics involved in FFR is based on Navier-Stokes equations, allowing the assessment of pressure and flow across coronary arteries. Limitations do exist with FFR which includes false-positive results due to step artifact and left ventricular hypertrophy, as well as manual segmentation and ostial stenosis, which can cause false-negative results. However, there are improvements on the horizon including artificial intelligence-driven computation of FFR and the utilization of virtual stenting for surgical planning. The purpose of this review is to describe the clinical validation, underlying mechanism, and implementation of FFR.
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http://dx.doi.org/10.1067/j.cpradiol.2020.09.006DOI Listing
September 2020

Dear Medical Students: It's Time to Join the #Twitterverse.

J Am Coll Radiol 2021 Feb 31;18(2):309-311. Epub 2020 Aug 31.

Department of Radiology, Mount Auburn Hospital, Cambridge, Massachusetts.

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http://dx.doi.org/10.1016/j.jacr.2020.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458052PMC
February 2021

Characterization of Pediatric Breast Abscesses and Optimal Treatment: A Retrospective Analysis.

J Surg Res 2021 01 25;257:195-202. Epub 2020 Aug 25.

Department of Surgery, Children's Mercy Kansas City, Kansas City, Missouri. Electronic address:

Background: Literature on pediatric breast abscesses is sparse; therefore, treatment is based on adult literature which has shifted from incision and drainage (I&D) to needle aspiration. However, children may require different treatment due to different risk factors and the presence of a developing breast bud. We sought to characterize pediatric breast abscesses and compare outcomes.

Materials And Methods: A retrospective review of patients presenting with a primary breast abscess from January 2008 to December 2018 was conducted. Primary outcome was persistent disease. Antibiotic utilization, treatment required, and risk factors for abscess and recurrence were also assessed. A follow-up survey regarding scarring, deformity, and further procedures was administered. Fisher's exact and Kruskal-Wallis tests for group comparisons and multivariable regression to determine associations with recurrence were performed.

Results: Ninety-six patients were included. The median age was 12.8 y [IQR 4.9, 14.3], 81% were women, and 51% were African-American. Most commonly, patients were treated with antibiotics alone (47%), followed by I&D (27%), and aspiration (26%). Twelve patients (13%) had persistent disease. There was no difference in demographic or clinical characteristics between those with persistent disease and those who responded to initial treatment. The success rates of primary treatment were 80% with antibiotics alone, 90% with aspiration, and 96% with I&D (P = 0.35). The median time to follow-up survey was 6.5 y [IQR 4.4, 8.5]. Four patients who underwent I&D initially reported significant scarring.

Conclusions: Treatment modality was not associated with persistent disease. A trial of antibiotics alone may be considered to minimize the risk of breast bud damage and adverse cosmetic outcomes with invasive intervention.
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http://dx.doi.org/10.1016/j.jss.2020.07.014DOI Listing
January 2021

Identification and characterization of tweets related to the 2015 Indiana HIV outbreak: A retrospective infoveillance study.

PLoS One 2020 26;15(8):e0235150. Epub 2020 Aug 26.

Global Health Policy Institute, San Diego, CA, United States of America.

Introduction: From late 2014 through 2015, Scott County, Indiana faced an HIV outbreak triggered by opioid abuse and transition to injection drug use. Investigating the origins, risk factors, and responses related to this outbreak is critical to inform future surveillance, interventions, and policymaking. In response, this retrospective infoveillance study identifies and characterizes user-generated messages related to opioid abuse, heroin injection drug use, and HIV status using natural language processing (NLP) among Twitter users in Indiana during the period of this HIV outbreak.

Materials And Methods: Our study consisted of two phases: data collection and processing, and data analysis. We collected Indiana geolocated tweets from the public Twitter API using Amazon Web Services EC2 instances filtered for geocoded messages in the immediate pre and post period of the outbreak. In the data analysis phase we applied an unsupervised machine learning approach using NLP called the Biterm Topic Model (BTM) to identify tweets related to opioid, heroin/injection, and HIV behavior and then examined these messages for HIV risk-related topics that could be associated with the outbreak.

Results: More than 10 million geocoded tweets occurring in Indiana during the immediate pre and post period of the outbreak were collected for analysis. Using BTM, we identified 1350 tweets thought to be relevant to the outbreak and then confirmed 358 tweets using human annotation. The most prevalent themes identified were tweets related to self-reported abuse of illicit and prescription drugs, opioid use disorder, self-reported HIV status, and public sentiment regarding the outbreak. Geospatial analysis found that these messages clustered in population dense areas outside of the outbreak, including Indianapolis and neighboring Clark County.

Discussion: This infoveillance study characterized the social media conversations of communities in Indiana in the pre and post period of the 2015 HIV outbreak. Behavioral themes detected reflect discussion about risk factors related to HIV transmission stemming from opioid and heroin abuse for priority populations, and also help identify community attitudes that could have motivated or detracted the use of HIV prevention methods, along with helping identify factors that can impede access to prevention services.

Conclusions: Infoveillance approaches, such as the analysis conducted in this study, represent a possibly strategy to detect "signal" of the emergence of risk factors associated with an outbreak though may be limited in their scope and generalizability. Our results, in conjunction with other forms of public health surveillance, can leverage the growing ubiquity of social media platforms to better detect opioid-related HIV risk knowledge, attitudes and behavior, as well as inform future prevention efforts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235150PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449407PMC
September 2020

Big Data, Natural Language Processing, and Deep Learning to Detect and Characterize Illicit COVID-19 Product Sales: Infoveillance Study on Twitter and Instagram.

JMIR Public Health Surveill 2020 08 25;6(3):e20794. Epub 2020 Aug 25.

Global Health Policy and Data Institute, San Diego, CA, United States.

Background: The coronavirus disease (COVID-19) pandemic is perhaps the greatest global health challenge of the last century. Accompanying this pandemic is a parallel "infodemic," including the online marketing and sale of unapproved, illegal, and counterfeit COVID-19 health products including testing kits, treatments, and other questionable "cures." Enabling the proliferation of this content is the growing ubiquity of internet-based technologies, including popular social media platforms that now have billions of global users.

Objective: This study aims to collect, analyze, identify, and enable reporting of suspected fake, counterfeit, and unapproved COVID-19-related health care products from Twitter and Instagram.

Methods: This study is conducted in two phases beginning with the collection of COVID-19-related Twitter and Instagram posts using a combination of web scraping on Instagram and filtering the public streaming Twitter application programming interface for keywords associated with suspect marketing and sale of COVID-19 products. The second phase involved data analysis using natural language processing (NLP) and deep learning to identify potential sellers that were then manually annotated for characteristics of interest. We also visualized illegal selling posts on a customized data dashboard to enable public health intelligence.

Results: We collected a total of 6,029,323 tweets and 204,597 Instagram posts filtered for terms associated with suspect marketing and sale of COVID-19 health products from March to April for Twitter and February to May for Instagram. After applying our NLP and deep learning approaches, we identified 1271 tweets and 596 Instagram posts associated with questionable sales of COVID-19-related products. Generally, product introduction came in two waves, with the first consisting of questionable immunity-boosting treatments and a second involving suspect testing kits. We also detected a low volume of pharmaceuticals that have not been approved for COVID-19 treatment. Other major themes detected included products offered in different languages, various claims of product credibility, completely unsubstantiated products, unapproved testing modalities, and different payment and seller contact methods.

Conclusions: Results from this study provide initial insight into one front of the "infodemic" fight against COVID-19 by characterizing what types of health products, selling claims, and types of sellers were active on two popular social media platforms at earlier stages of the pandemic. This cybercrime challenge is likely to continue as the pandemic progresses and more people seek access to COVID-19 testing and treatment. This data intelligence can help public health agencies, regulatory authorities, legitimate manufacturers, and technology platforms better remove and prevent this content from harming the public.
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http://dx.doi.org/10.2196/20794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451110PMC
August 2020

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season.

Acad Radiol 2020 09 7;27(9):1294-1297. Epub 2020 Jul 7.

Mount Auburn Hospital, Department of Radiology, Cambridge, Massachusetts.

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http://dx.doi.org/10.1016/j.acra.2020.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340060PMC
September 2020

Contemporary nationwide trends and in-hospital outcomes of adjunctive stenting in patients undergoing catheter-directed thrombolysis for proximal deep venous thrombosis.

J Vasc Surg Venous Lymphat Disord 2021 01 6;9(1):62-72.e1. Epub 2020 Jun 6.

Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, Pa. Electronic address:

Objective: Outflow venous stenting as an adjunct to catheter-directed thrombolysis (CDT) is performed to prevent recurrent thrombosis and to reduce the risk of post-thrombotic syndrome. Historical data show that stenting improves outcomes of surgical thrombectomy in patients with iliofemoral deep venous thrombosis (DVT), and recent observational data suggest that stenting improves long-term outcomes of CDT. However, the impact of stenting during CDT on acute safety outcomes is unknown. We sought to investigate the contemporary trends, safety outcomes, and resource utilization of adjunctive stent placement in patients undergoing CDT.

Methods: Patients with proximal lower extremity and caval DVT were identified within the National Inpatient Sample from January 2005 to December 2013. From this data set, we stratified our patients into three groups: patients who received CDT alone, patients who received CDT plus angioplasty, and patients who received CDT plus angioplasty with stenting. We used an inverse probability treatment weighting algorithm to create three weighted cohorts. Cochran-Armitage test was used to evaluate the trends of stent placement among patients treated with CDT. The primary outcome was a composite end point of all-cause mortality, gastrointestinal bleed, or intracranial hemorrhage.

Results: A total of 138,049 patients were discharged with a principal diagnosis of proximal and caval DVT; 7097 of these patients received CDT (5.1%). From this group, 2854 (40.2%) were treated with CDT alone, 2311 (32.6%) received adjunctive angioplasty alone, and 1932 (27.2%) received adjunctive angioplasty and stent. Adjunctive stenting had a significantly lower rate of primary composite outcome compared with CDT alone (2.7% vs 3.8%; P = .04). Stent placement was associated with a similar length of stay compared with angioplasty and CDT alone groups (6.8 vs 6.9 vs 7.1 days, respectively; P = .94) and higher in-hospital charges ($115,164.01 ± $76,985.31 vs $98,089.82 ± $72,921.94 vs $80,441.63 ± $74,024.98; P < .001).

Conclusions: This nationwide study suggests that one in four patients undergoing CDT is treated with adjunctive stent placement in the United States. This observational study showed that adjunctive stenting does not adversely affect the acute safety outcomes of CDT; however, it was associated with increased hospital charges.
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http://dx.doi.org/10.1016/j.jvsv.2020.04.034DOI Listing
January 2021

Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study.

JMIR Public Health Surveill 2020 06 8;6(2):e19509. Epub 2020 Jun 8.

Department of Anesthesiology and Division of Global Public Health and Infectious Diseases, School of Medicine, University of California San Diego, La Jolla, CA, United States.

Background: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries.

Objective: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach.

Methods: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics.

Results: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States.

Conclusions: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity.
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http://dx.doi.org/10.2196/19509DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282475PMC
June 2020

Characterising communities impacted by the 2015 Indiana HIV outbreak: A big data analysis of social media messages associated with HIV and substance abuse.

Drug Alcohol Rev 2020 11 13;39(7):908-913. Epub 2020 May 13.

Global Health Policy Institute, San Diego, USA.

Introduction And Aims: Infoveillance approaches (i.e. surveillance methods using online content) that leverage big data can provide new insights about infectious disease outbreaks and substance use disorder topics. We assessed social media messages about HIV, opioid use and injection drug use in order to understand how unstructured data can prepare public health practitioners for response to future outbreaks.

Design And Methods: We conducted an retrospective analysis of Twitter messages during the 2015 HIV Indiana outbreak using machine learning, statistical and geospatial analysis to examine the transition between opioid prescription drug abuse to heroin injection use and finally HIV transmission risk, and to test possible associations with disease burden and demographic variables in Indiana and Marion County. Tweets from October 2014 to June 2015 were compared to disease burden at the county level for Indiana, and classification of census blocks by presence of relevant messages was done at the census block level for Marion County. Marion County was used as it exhibited the highest total count of Tweets.

Results: 257 messages about substance abuse and HIV were significantly related to HIV rates (P < 0.001) and opioid-related hospitalisations (P = 0.037). Using 157 characteristics from the American Community Survey, a linear classifier was computed with an appreciable correlation (r = 0.49) to risk-related social media messages from Marion County.

Discussion And Conclusions: Communities appear to communicate online in response to disease burden. Classification produced an accurate equation to model census block risk based on census data, allowing for high-dimensional estimation of risk for blocks with sparse populations.
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http://dx.doi.org/10.1111/dar.13091DOI Listing
November 2020

Biological nitrogen fixation in maize: optimizing nitrogenase expression in a root-associated diazotroph.

J Exp Bot 2020 07;71(15):4591-4603

Pivot Bio, Inc., Berkeley, CA, USA.

Plants depend upon beneficial interactions between roots and root-associated microorganisms for growth promotion, disease suppression, and nutrient availability. This includes the ability of free-living diazotrophic bacteria to supply nitrogen, an ecological role that has been long underappreciated in modern agriculture for efficient crop production systems. Long-term ecological studies in legume-rhizobia interactions have shown that elevated nitrogen inputs can lead to the evolution of less cooperative nitrogen-fixing mutualists. Here we describe how reprogramming the genetic regulation of nitrogen fixation and assimilation in a novel root-associated diazotroph can restore ammonium production in the presence of exogenous nitrogen inputs. We isolated a strain of the plant-associated proteobacterium Kosakonia sacchari from corn roots, characterized its nitrogen regulatory network, and targeted key nodes for gene editing to optimize nitrogen fixation in corn. While the wild-type strain exhibits repression of nitrogen fixation in conditions replete with bioavailable nitrogen, such as fertilized greenhouse and field experiments, remodeled strains show elevated levels in the rhizosphere of corn in the greenhouse and field even in the presence of exogenous nitrogen. Such strains could be used in commercial applications to supply fixed nitrogen to cereal crops.
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http://dx.doi.org/10.1093/jxb/eraa176DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382387PMC
July 2020

Drug resistance occurred in a newly characterized preclinical model of lung cancer brain metastasis.

BMC Cancer 2020 Apr 7;20(1):292. Epub 2020 Apr 7.

Department of Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, 108 Biomedical Drive, Morgantown, WV, 26506, USA.

Background: Cancer metastasis and drug resistance have traditionally been studied separately, though these two lethal pathological phenomena almost always occur concurrently. Brain metastasis occurs in a large proportion of lung cancer patients (~ 30%). Once diagnosed, patients have a poor prognosis surviving typically less than 1 year due to lack of treatment efficacy.

Methods: Human metastatic lung cancer cells (PC-9-Br) were injected into the left cardiac ventricle of female athymic nude mice. Brain lesions were allowed to grow for 21 days, animals were then randomized into treatment groups and treated until presentation of neurological symptoms or when moribund. Prior to tissue collection mice were injected with Oregon Green and C-Aminoisobutyric acid followed by an indocyanine green vascular washout. Tracer accumulation was determined by quantitative fluorescent microscopy and quantitative autoradiography. Survival was tracked and tumor burden was monitored via bioluminescent imaging. Extent of mutation differences and acquired resistance was measured in-vitro through half-maximal inhibitory assays and qRT-PCR analysis.

Results: A PC-9 brain seeking line (PC-9-Br) was established. Mice inoculated with PC-9-Br resulted in a decreased survival time compared with mice inoculated with parental PC-9. Non-targeted chemotherapy with cisplatin and etoposide (51.5 days) significantly prolonged survival of PC-9-Br brain metastases in mice compared to vehicle control (42 days) or cisplatin and pemetrexed (45 days). Further in-vivo imaging showed greater tumor vasculature in mice treated with cisplatin and etoposide compared to non-tumor regions, which was not observed in mice treated with vehicle or cisplatin and pemetrexed. More importantly, PC-9-Br showed significant resistance to gefitinib by in-vitro MTT assays (IC50 > 2.5 μM at 48 h and 0.1 μM at 72 h) compared with parental PC-9 (IC50: 0.75 μM at 48 h and 0.027 μM at 72 h). Further studies on the molecular mechanisms of gefitinib resistance revealed that EGFR and phospho-EGFR were significantly decreased in PC-9-Br compared with PC-9. Expression of E-cadherin and vimentin did not show EMT in PC-9-Br compared with parental PC-9, and PC-9-Br had neither a T790M mutation nor amplifications of MET and HER2 compared with parental PC-9.

Conclusion: Our study demonstrated that brain metastases of lung cancer cells may independently prompt drug resistance without drug treatment.
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http://dx.doi.org/10.1186/s12885-020-06808-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137432PMC
April 2020

A Patient with an Intradural Tumor: An Unexpected Finding.

Cureus 2020 Mar 23;12(3):e7376. Epub 2020 Mar 23.

Anesthesia and Interventional Pain Management, H. Lee Moffitt Cancer Center and Research Institute, Tampa, USA.

Chronic back pain patients may require escalating doses of systemic opioids. In refractory cases, implantation of an intrathecal drug delivery system (IDDS) may provide effective relief of pain and improve overall function. This system infuses opioid directly into the cerebrospinal fluid via a catheter. While efficacious, it can be associated with complications, one of the most severe being the formation of a catheter-tip granuloma that can lead to permanent neurological deficits. We present a case of a 38-year-old male with an IDDS for pain related to retroperitoneal fibrosis, who began developing worsening back pain along with new-onset lower extremity weakness. A catheter-tip granuloma was suspected, and the patient was advised to obtain emergent spine imaging. He was non-compliant until the point of becoming wheelchair bound, whereupon imaging was finally obtained. Magnetic resonance imaging revealed an intradural mass causing spinal cord compression. After emergent surgical resection, pathology revealed a malignant tumor. Any patient with IDDS and escalating pain levels or new neurological deficits needs urgent neuroimaging to rule out catheter-tip granuloma. However, as this case demonstrates, the differential diagnosis should remain broad and always include neoplasm or abscess.
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http://dx.doi.org/10.7759/cureus.7376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093916PMC
March 2020

Reply to: Comment on "Preemptive purse-string suture: A novel technique to minimize bleeding risk".

J Am Acad Dermatol 2020 06 7;82(6):e261. Epub 2020 Mar 7.

Department of Dermatology, West Virginia University, Morgantown. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.03.005DOI Listing
June 2020

The gut microbiome and psycho-cognitive traits.

Prog Mol Biol Transl Sci 2020 3;176:123-140. Epub 2020 Oct 3.

NYU Long Island School of Medicine, Mineola, NY, United States. Electronic address:

The idea that trillions of bacteria inhabit our gut is somewhat unnerving, yet these bacteria may have a greater influence on our behavior than previously thought. Accumulating data strongly suggest that these gut commensal organisms have a strong inter-relationship with our brain and behavior, including cognitive function, mood, and personality. In this chapter, we discuss the role of the gut microbiome in the development of human personality, mood and mood disorders, and cognition, with a particular emphasis on the current consensus and controversies in the literature surrounding the behavioral effects of bioactive metabolites, microbial ratio shifts, and neurotransmitter synthesis facilitated by the microbiome.
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http://dx.doi.org/10.1016/bs.pmbts.2020.08.014DOI Listing
October 2020

In Hospital Outcomes of Total Hip Arthroplasty in the Medicaid Population.

J Surg Orthop Adv 2019 ;28(4):281-284

University of Illinois at Chicago College of Medicine, Department of Orthopaedics, Chicago, Illinois.

Total hip arthroplasty (THA) is one of the most common orthopaedic procedures. This study's purpose was to evaluate national trends, patient demographics and hospital outcomes for Medicaid patients who underwent a primary THA. The National Hospital Discharge Survey (NHDS) database was queried for patients undergoing THA from 2001-2010. Patients were stratified into two groups based on insurance. We found from 2001-2005, Medicaid accounted for 2.38% of all THA performed, increasing insignificantly to 2.61% between 2006-2010. The Medicaid group was younger (50.3 vs. 65.6 years, p < 0.01). Length of stay was longer for the Medicaid group (4.6 vs. 4.0 days, p < 0.01). Medicaid patients were more likely to be discharged home (53.7% vs. 47.2%, p < 0.01) and less likely to be discharged to rehabilitation facilities (24.4% vs. 29.0%, p < 0.05). In conclusion, we discovered that the rate of Medicaid insurance in patients undergoing primary THA was stable through 2010, prior to the Affordable Care Act. We found Medicaid THA patients had longer length of stay, despite being a mean 15 years younger than the non-Medicaid cohort. Medicaid insurance status should be factored into risk adjustment models to avoid creating additional disincentive to treat the Medicaid population. (Journal of Surgical Orthopaedic Advances 28(4):281-284, 2019).
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January 2020

An Interdisciplinary Review of Surgical Data Recording Technology Features and Legal Considerations.

Surg Innov 2020 Apr 6;27(2):220-228. Epub 2019 Dec 6.

University of California San Diego, School of Medicine, La Jolla, CA, USA.

Surgical data recording technology has great promise to generate patient safety and quality data that can be utilized to potentially reduce medical errors. Variations of these systems aim to improve surgical technique, develop better training simulation, and promote adverse event investigation similar to the aims of black box technology utilized in other industries. However, many unknowns remain for surgical data recording utilization in operating rooms and clinical settings in the United States. This includes the need to appropriately design systems so they collect meaningful and useful data that can be discussed by surgical team members in an open and safe environment to optimize clinical care processes. In order to better understand the clinical and regulatory environment for surgical data recording systems, we conducted an interdisciplinary review to identify key technology approaches, and assess legal and regulatory implications associated with this potentially disruptive technology. We found technology ranging from audio and visual data, to systems utilizing mobile applications, and kinematic data capture. The data collected present legal questions over ownership of information and privacy, along with regulatory issues at the federal and state levels. The benefits of these data should be balanced with the need to develop appropriate policies and regulations that protect the interests of both clinicians and patients in order to encourage further innovation and better realize the potential of surgical data recording technology to improve clinical decision making and patient safety outcomes.
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http://dx.doi.org/10.1177/1553350619891379DOI Listing
April 2020

Cervical Spinal Cord Stimulator Lead Migration and Transection Adjacent to the Foramen Magnum: A Case Report.

Pain Pract 2020 06 20;20(5):534-538. Epub 2019 Dec 20.

Interventional Pain Service, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, U.S.A.

Background: Spinal cord stimulation (SCS) is a relatively safe therapy for the treatment of pain but has the potential for several complications, including lead migration and breakage. While instances of lead breakage and electrode shearing have been described, there are no reported cases of stimulator lead transection and migration to the foramen magnum.

Aims: We describe the case of a 53-year-old woman who reported that her cervical spinal cord stimulator was no longer functioning after a traumatic fall.

Case: Fluoroscopy of the neck revealed that one of the MRI conditional leads had migrated cephalad, and the distal aspect appeared to be transected. This was confirmed by computerized tomography, which showed a transected portion of the lead in the epidural space, just inferior to the posterior aspect of the foramen magnum. An SCS device revision was performed to replace the lead, but the distal transected tip was left in place in the epidural space adjacent to the foramen magnum to avoid complications of retrieval.

Discussion/conclusion: Given the location of the transected portion of the lead, we recommended avoiding MRI imaging. In addition, we advised the patient that a repeat x-ray may be necessary if she has increased neck pain or any other concerning symptoms. In this report, we discuss the known complications with SCS, as well as management of a retained lead fragment.
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http://dx.doi.org/10.1111/papr.12865DOI Listing
June 2020

Pre-emptive purse-string suture: A novel technique to minimize bleeding risk.

J Am Acad Dermatol 2020 Mar 19;82(3):e85-e86. Epub 2019 Oct 19.

Department of Dermatology, West Virginia University, 64 Medical Center Dr, Morgantown, West Virginia. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2019.10.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453940PMC
March 2020

Improving CNS Delivery to Brain Metastases by Blood-Tumor Barrier Disruption.

Trends Cancer 2019 08 20;5(8):495-505. Epub 2019 Jul 20.

Department of Pharmaceutical Sciences, School of Pharmacy, West Virginia University HSC, Morgantown, West Virginia 26506, USA. Electronic address:

Brain metastases encompass nearly 80% of all intracranial tumors. A late stage diagnosis confers a poor prognosis, with patients typically surviving less than 2 years. Poor survival can be equated to limited effective treatment modalities. One reason for the failure rates is the presence of the blood-brain barrier (BBB) and blood-tumor barrier (BTB) that limit the access of potentially effective chemotherapeutics to metastatic lesions. Strategies to overcome these barriers include new small molecule entities capable of crossing into the brain parenchyma, novel formulations of existing chemotherapies, and disruptive techniques. Here, we review BBB physiology and BTB pathophysiology. Additionally, we review the limitations of routinely practiced therapies and three current methods being explored for BBB/BTB disruption for improved delivery of chemotherapy to brain tumors.
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http://dx.doi.org/10.1016/j.trecan.2019.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703178PMC
August 2019

The Bleeding Bowel: A Rare Case of Neurofibromatosis Type 1-associated Gastrointestinal Stromal Tumor in a Young Male.

Cureus 2019 Jun 10;11(6):e4868. Epub 2019 Jun 10.

Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.

Individuals with neurofibromatosis type 1 are much more likely to develop gastrointestinal stromal tumors than those without this condition. The median age for patients with neurofibromatosis type 1-associated gastrointestinal stromal tumors is approximately 65 years. We present a case of a young male with a history of neurofibromatosis type 1 who presented with symptomatic anemia and melena and was ultimately found to have a gastrointestinal stromal tumor.
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http://dx.doi.org/10.7759/cureus.4868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6687427PMC
June 2019

Surgical Data Recording Technology: A Solution to Address Medical Errors?

Ann Surg 2020 03;271(3):431-433

Global Health Policy Institute, San Diego, CA.

: Reducing preventable medical errors remains a universal goal, yet implementing effective solutions remains a challenge. The development of surgical data recording technology shows promise to generate robust qualitative and quantitative data in the surgical theater. These data can allow physicians and their teams to capture specific sources of error and implement corrective interventions. Surgical data recording technology encompasses rudimentary data tabulation on notecards, to integrated audio-video systems containing cameras, microphones, and sensors, capturing and synthesizing intraoperative, environmental, and instrumentation information, along with devices tailored to robotic surgical systems. There is growing interest in the implementation of such technology in medical centers, particularly in the United States, Canada, and Europe, but existing medicolegal and regulatory challenges necessitate further research and clinical assessment in order for this technology to facilitate improved surgical patient safety.
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http://dx.doi.org/10.1097/SLA.0000000000003510DOI Listing
March 2020