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Objective: The true incidence and risk factors for secondary bacterial infections in coronavirus disease 2019 (COVID-19) remains poorly understood. Knowledge of risk factors for secondary infections in hospitalized patients with COVID-19 is necessary to optimally guide selective use of empiric antimicrobial therapy. Design: Single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 from April 15, 2020, through June 30, 2021. Setting: Academic quaternary-care referral center in Portland, Oregon. Patients: The study included patients who were 18 years or older with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR test up to 10 days prior to admission. Methods: Secondary infections were identified based on clinical, radiographic, and microbiologic data. Logistic regression was used to identify risk factors for secondary infection. We also assessed mortality, length of stay, and empiric antibiotics among those with and without secondary infections. Results: We identified 118 patients for inclusion; 31 (26.3%) had either culture-proven or possible secondary infections among hospitalized patients with COVID-19. Mortality was higher among patients with secondary infections (35.5%) compared to those without secondary infection (4.6%). Empiric antibiotic use on admission was high in both the secondary and no secondary infection groups at 71.0% and 48.3%, respectively. Conclusions: The incidence of secondary bacterial infection was moderate among hospitalized patients with COVID-19. However, a higher proportion of patients received empiric antibiotics regardless of an identifiable secondary infection. Transfer from an outside hospital, baseline immunosuppressant use, and corticosteroid treatment were independent risk factors for secondary infection. Additional studies are needed to validate risk factors and best guide antimicrobial stewardship efforts.

Untested psychosocial or economic factors mediate associations between perceived discrimination and suboptimal antihypertensive therapy. This study included 2 waves of data from Health and Retirement Study participants with self-reported hypertension (n = 8,557, 75% non-Hispanic White, 15% non-Hispanic Black, and 10% Hispanic/Latino) over 4 years (baselines of 2008 and 2010, United States). Our primary exposures were frequency of experiencing discrimination, in everyday life or across 7 lifetime circumstances. Candidate mediators were self-reported depressive symptoms, subjective social standing, and household wealth. We evaluated with causal mediation methods the interactive and mediating associations between each discrimination measure and reported antihypertensive use at the subsequent wave. In unmediated analyses, everyday (odds ratio (OR) = 0.86, 95% confidence interval (CI): 0.78, 0.95) and lifetime (OR = 0.91, 95% CI: 0.85, 0.98) discrimination were associated with a lower likelihood of antihypertensive use. Discrimination was associated with lower wealth, greater depressive symptoms, and decreased subjective social standing. Estimates for associations due to neither interaction nor mediation resembled unmediated associations for most discrimination-mediator combinations. Lifetime discrimination was indirectly associated with reduced antihypertensive use via depressive symptomatology (OR = 0.99, 95% CI: 0.98, 1.00). In conclusion, the impact of lifetime discrimination on the underuse of antihypertensive therapy appears partially mediated by depressive symptoms.

Antibiotics are among the most commonly prescribed medications, and there is evidence to guide the optimal use of these agents for most situations encountered in clinical medicine, including for both treatment and prophylaxis. Nevertheless, clinicians routinely prescribe antibiotics in ways that diverge from this evidence, such as prescribing them when not indicated, for durations longer than necessary, or selecting broad-spectrum antibiotics when a narrower-spectrum agent would suffice.1,2 This overuse of antibiotics contributes to the public health crisis of antibiotic resistance while exposing patients to potential antibiotic-related harms.

Background Antibiotic therapy is a known risk factor for Clostridioides difficile infection (CDI) and evidence suggests the magnitude of risk varies by spectrum of antibiotic activity and days of therapy (DOT). We quantified the risk of hospital-associated (HA) CDI associated with antibiotic therapy considering spectrum of activity and DOT. Methods We performed a retrospective cohort study of adult (≥18 years) inpatient encounters at a 576-bed academic medical center in Portland, OR between January 2018 and February 2020. We excluded patients with hospital stays under 4 days and those known to have recurrent (CDI in the previous 12 weeks) or community-acquired (CDI diagnosis within first 3 days of hospitalization) CDI. The primary exposure of antibiotic utilization was measured using the Antibiotic Spectrum Index (ASI), where spectrum-based weights are applied to each agent and DOT over the time at risk, summed over the encounter, and divided by the number of antibiotic days. The primary outcome was HA-CDI. We estimated the independent association between aggregate ASI and HA-CDI using multivariable logistic regression. Results Among 37,629 inpatient encounters, 68% patients received at least one antibiotic. We identified 159 cases of non-recurrent HA-CDI, which corresponds to 4.8 cases per 10,000 patient-days. Compared to those without HA-CDI, those with HA-CDI had a greater median number of distinct antibiotics prescribed (4 vs 1), greater median days of antibiotic therapy (22 vs 2), a greater median time at-risk (9 vs 6 days), and greater median Elixhauser Comorbidity Index (9 vs 4) (Kruskal-Wallis p-value < 0.0001 for all comparisons). There were no significant differences by age or sex. Patients with HA-CDI had a greater mean ASI per antibiotic day than those without (5.2 vs 3.2, Student’s t-test p < 0.0001). After adjusting for time at-risk and Elixhauser Comorbidity Index, each one-unit of ASI per antibiotic day was associated with 1.29 times increased odds of developing HA-CDI (Odds Ratio = 1.29, 95% Confidence Interval: 1.21 to 1.37). Conclusion The Antibiotic Spectrum Index was strongly associated with HA-CDI. ASI may be a useful tool for quantifying the risk of CDI according to the specific antibiotic therapy received among hospitalized patients. Disclosures All Authors: No reported disclosures.

INTRODUCTION: Antibiotics and opioids are targeted by public health and stewardship communities for reductions in prescribing across the country. This study evaluates trends and factors associated with outpatient prescribing by dental and medical providers in a large integrated health system. METHODS: This was a cross-sectional study of national dental and medical outpatient visits from Department of Veterans Affairs facilities in 2015–2017; analyzed in 2019–2020. Antibiotic and opioid prescribing rates were assessed by provider and facility characteristics. Multivariable Poisson regression adjusted for repeated measures by provider was used to assess the independent association between facility and provider characteristics and rate of prescribing. RESULTS: Over the study period, 4,625,840 antibiotic and 10,380,809 opioid prescriptions were identified for 115,625,890 visits. Physicians prescribed most antibiotics (67%). Dentists prescribed 6% of antibiotics but had the highest per-visit antibiotic prescribing rate, compared with medical providers (6.75 vs 3.90 prescriptions/100 visits, p

Exposure to air can cause amine solutions in CANada Deuterium Uranium (CANDU) reactor secondary coolant circuit feed tanks to absorb carbon dioxide (CO2). Likewise, carbon dioxide can be absorbed d...

In this study, we map the legal work seven U.S. digital consultancies and public relations firms undertook across social media and digital platforms of behalf of four foreign governments. We find t...

To more fully understand the belief gap hypothesis, this study examines the effect of political identity, education, and partisan media consumption on the formation of attitudes and false beliefs. Using a two-wave, nationally representative online survey of the U.S., we assess people’s attitudes and beliefs toward climate change, on the one hand, and Syrian refugees, on the other. Building on previous studies, we demonstrate that the effect of one’s political identity on attitudes and false beliefs is contingent upon education, which appears to widen the belief gap in consort with political identity.

Aim With the reported incidence of Frey's syndrome as high as 59%, the significant morbidity experienced by patients post parotidectomy has resulted in a range of treatment options being proposed with variable outcomes. The lack of consensus has resulted in patients being offered a wide range of treatments with varying success. While fat grafting remains a treatment for contour deformity correction, there is emerging evidence to suggest its effectiveness as a treatment for Frey's syndrome, warranting further investigation. This systematic review aims to evaluate the efficacy of fat grafting as a treatment for Frey's syndrome post parotidectomy. Method A systematic review was conducted as per PRISMA guidelines, with all articles from MEDLINE, Embase, Web of Science, Ovid, Scopus, and Cochrane screened by two independent reviewers using discreet inclusion and exclusion criteria followed by in depth full-text reviews. Results 116 papers were screened with 16 meeting the inclusion criteria (13.8%) totalling 785 patients, with multiple outcome measures for assessing Frey's syndrome. Fat grafting was shown to significantly reduce the incidence of Frey's syndrome in patients having undergone both superficial and total parotidectomies, with 15 studies (93.8%) finding a significant reduction in its incidence post treatment. Conclusions With low donor site morbidity, biocompatibility, ease of use, low cost to perform and high patient satisfaction, the systematic review of the evidence supports the use of fat grafting post parotidectomy as an effective treatment for Frey's syndrome. Further research to determine the long-term outcome would inform its suitability as a first line treatment.

Aim The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training. Method A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020. Results Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity. Conclusions Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.

High prescribers of antibiotics and opioids are an important target for stewardship interventions. The goal of this study was to assess the association between high antibiotic and high opioid prescribing by provider type.A national cross-sectional study.2015-2017 Department of Veterans Affairs (VA) electronic health record data.Prescribers were identified as dentists (2017: n = 1346) and medical providers (physicians n = 23,072; advanced practice providers [APP] n = 7705; and other providers [pharmacists/chiropractors] n = 3674) (2017: n = 34,451).High prescribing was defined as being in the top 25% of visit-based rates of antibiotic or opioid prescribing (number of prescriptions/number of dental or medical visits). Multivariable random effects logistic regression with clustering by facility was used to assess the adjusted association between high antibiotic and opioid prescribing.Medical providers prescribed 4,348,670 antibiotic and 10,256,706 opioid prescriptions; dentists prescribed 277,170 antibiotic and 124,103 opioid prescriptions. Among all high prescribers of antibiotics, 40% were also high prescribers of opioids as compared to 18% of those who were not high antibiotic prescribers (p 0.0001). High prescribing of antibiotics was associated with high prescribing of opioids in medical providers (adjusted odds ratio [aOR] = 2.87, 95% confidence interval [CI] = 2.72-3.04) and dentists (aOR = 8.40, 95% CI 6.00-11.76). Older provider age, specific US geographic regions, and lower VA facility complexity and rurality were also associated with high opioid prescribing by medical providers. In dentists, younger provider age, male gender, specific regions of the United States, and lower number of dentists in a facility were associated with high opioid prescribing. At the facility level, high dental prescribers of antibiotics or opioids were not at the same facilities as high medical prescribers, respectively (p 0.0001).High antibiotic prescribing was associated with high opioid prescribing. Thus, stewardship interventions targeting both medication classes may have higher impact to efficiently reduce prescribing of medications with high public health impact. Provider-targeted interventions are needed to improve antibiotic and opioid prescribing in both dentists and medical providers.

Objective:Transmission of SARS-CoV-2 has significant implications for hospital infection prevention and control, discharge management, and public health. We reviewed available literature to reach an evidenced-based consensus on the expected duration of viral shedding.Design:We queried 4 scholarly repositories and search engines for studies reporting SARS-CoV-2 viral shedding dynamics by PCR and/or culture available through September 8, 2020. We calculated the pooled median duration of viral RNA shedding from respiratory and fecal sources.Results:The review included 77 studies on SARS-CoV-2. All studies reported PCR-based testing and 12 also included viral culture data. Among 28 studies, the overall pooled median duration of RNA shedding from respiratory sources was 18.4 days (95% CI, 15.5–21.3; I2 = 98.87%; P < .01). When stratified by disease severity, the pooled median duration of viral RNA shedding from respiratory sources was 19.8 days (95% CI, 16.2–23.5; I2 = 96.42%; P < .01) among severely ill patients and 17.2 days (95% CI, 14.0–20.5; I2 = 95.64%; P < .01) in mild-to-moderate illness. Viral RNA was detected up to 92 days after symptom onset. Viable virus was isolated by culture from −6 to 20 days relative to symptom onset.Conclusions:SARS-COV-2 RNA shedding can be prolonged, yet high heterogeneity exists. Detection of viral RNA may not correlate with infectivity since available viral culture data suggests shorter durations of shedding of viable virus. Additional data are needed to determine the duration of shedding of viable virus and the implications for risk of transmission.

Opioids are overprescribed in the outpatient dental setting. Therefore, opportunities exist for opioid stewardship.The purpose of this pilot study was to test the feasibility of an academic detailing (AD) intervention to promote appropriate prescribing of opioids in outpatient dentistry.We implemented an AD intervention targeting management of acute oral pain in a Midwestern Veterans Affairs outpatient dental facility. The intervention targeted dentists who actively prescribed opioids at the time of the study. The pilot study tested feasibility, adoption, and acceptance of the AD campaign. Visit-based prescribing rates were obtained from the Veterans Health Administration's Corporate Data Warehouse for baseline and postintervention using difference-in-differences analyses to detect potential changes in health service outcomes.Results indicate moderate levels of feasibility through participation rates (n = 5, 55.5%) and high levels of organizational readiness for change (average of 88.6% agree to strongly agree). Furthermore, fidelity of the AD intervention was high. Adoption measures show moderate indication of motivation to change, and trends suggest that participating dentists decreased their visit-based opioid prescribing rates (P0.05).The intervention demonstrated feasibility with some indications of adoption of intervention techniques and decrease in opioid prescribing. We further recommend working closely with frontline providers to gather feedback and buy-in before scaling and implementing the AD campaign.

Background: Systematic evaluation of neighborhood factors which capture an array of characteristics -analogous to genome-wide-association studies- may identify important patterns in spatial determinants of blood pressure control. Methods: Our sample included Health and Retirement Study participants (N=13180; 58% women, 13% non-Hispanic Black, 4% Hispanic/Latino) with at least one sphygmomanometer reading taken between 2006 and 2016. Our main study outcome was at least one hypertensive blood pressure measurement over the study period. Participants were randomly assigned to either a training or test dataset. Using generalized estimating equations, we summarized multivariable associations between each of 51 standardized American Community Survey sociodemographic, housing, and income-related census tract variables (2005-09) and the period prevalence of measured hypertension. We adjusted for individual factors and accounted for multiple comparisons in the training set using the Simes significance test. Neighborhood-based factors that revealed statistically significant associations (Simes-adjusted p-value Results: Thirty-two percent (4218 out of 13180) of participants had at least one hypertensive sphygmomanometer reading between 2006 and 2016. In the training set, two of the 51 census-tract level variables were independently associated with period prevalence of hypertension. In the full sample, we observed a lower likelihood of prevalent hypertension (OR: 0.95; 95% CI: 0.92, 0.99) among participants residing in a census tract with recent (since 2000) in-migration. A higher proportion of relatively recent (since 2000) renters in the census tract was associated with a lower hypertension prevalence (OR: 0.95; 95% CI: 0.91, 0.98). When stratified by racial/ethnic designation, these patterns were apparent among Non-Hispanic White and to some extent Hispanic/Latino but not Non-Hispanic Black participants. However, differences were not statistically significant by race or ethnicity. Conclusion: In conclusion, relatively more recent relocation to an area appears to be modestly associated with reduced prevalence of hypertension. These findings support possible differential cardiovascular health impacts of gentrification. Further investigation is needed to confirm these findings.

In this matched case–control study, we sought to determined the association between probiotic use and invasive infections caused by typical probiotic organisms. The odds of probiotic use in cases were 127 times the odds of probiotic use in controls (95% CI, 6.21–2600). Further research into these rare but severe complications is needed.

INTRODUCTION: Evidence suggests that United States (US) dentists excessively prescribe opioids. There are limited national data on recent trends in opioid prescribing by US dentists. This study examined trends of opioid prescribing by general dentists and dental specialists in the US from 2012–2019. METHODS: Dispensed prescriptions for oral opioid analgesics written by dentists were identified in the IQVIA Longitudinal Prescription Dataset from January 2012 through December 2019. Autoregressive integrated moving average and joinpoint regression models described monthly population-based prescribing rates (prescriptions [Rx]/100,000 persons), dentist-based prescribing rates (Rx/1,000 dentists), and opioid dosages (mean daily morphine milligram equivalents [MME/day]). All analyses were performed in 2020. RESULTS: Over the eight years, dentists prescribed >87.2 million opioid prescriptions. Population- and dentist-based prescribing rates declined monthly by −1.97 Rx/100,000 persons (95% confidence intervals [CI] −9.98, −0.97) and −39.12 Rx/1,000 dentists (95%CI −58.63, −17.65), respectively. Opioid dosages declined monthly by −0.08MME/day (95%CI −0.13,−0.04). Joinpoint regression identified four time-points (February 2016, May 2017, December 2018, and March 2019) at which monthly prescribing rate trends were often decreasing in greater magnitude compared to the prior time-segment. CONCLUSION: Following national trends, dentists became more conservative in prescribing opioids. Greater magnitude of decline occurred post-2016, following the implementation of strategies aimed to further regulate opioid prescribing. Understanding factors that influence prescribing trends can aid in development of tailored resources to encourage and support dentists’ conservative approach to prescribing opioids.

Objective:To determine prophylaxis appropriateness by Veterans’ Affairs (VA) dentists.Design:A cross-sectional study of dental visits, 2015–2019.Methods:Antibiotics within 7 days before a visit in the absence of an oral infection were included. Appropriate antibiotic prophylaxis was defined as visits with gingival manipulation and further delineated into narrow and broad definitions based on comorbidities. The primary analysis applied a narrow definition of appropriate prophylaxis: cardiac conditions at the highest risk of an adverse outcome from endocarditis. The secondary analysis included a broader definition: cardiac or immunocompromising condition or tooth extractions and/or implants. Multivariable log-linear Poisson generalized estimating equation regression was used to assess the association between covariates and unnecessary prophylaxis prescriptions.Results:In total, 358,078 visits were associated with 369,102 antibiotics. The median prescription duration was 7 days (IQR, 7–10); only 6.5% were prescribed for 1 day. With the narrow definition, 15% of prophylaxis prescriptions were appropriate, which increased to 72% with the broader definition. Prophylaxis inconsistent with guidelines increased over time. For the narrow definition, Black (vs White) race, Latine (vs non-Latine) ethnicity, and visits located in the West census region were associated with unnecessary prophylaxis. Variables associated with a lower risk were older age, prosthetic joints, immunocompromising condition, and rural location.Conclusions:Of every 6 antibiotic prophylaxis prescriptions, 5 were inconsistent with guidelines. Improving prophylaxis appropriateness and shortening duration may have substantial implications for stewardship. Guidelines should state whether antibiotic prophylaxis is indicated for extractions, implants, and immunocompromised patients.

CE Information Activity Available Online: To access the article and evaluation online, go to https://www.highmarksce.com/mscare. Target Audience: The target audience for this activity is physicians, advanced practice clinicians, nursing professionals, pharmacists, and other health care providers involved in the management of patients with multiple sclerosis (MS). Learning Objectives: Recognize the frequency of utilization of non-DMT medications by MS patients and integrate questions about their use into patient history. Characterize and be mindful of the out-of-pocket cost burden of DMT and non-DMT medication use in patients with MS. Accreditation Statement: In support of improving patient care, this activity has been planned and implemented by The Consortium of Multiple Sclerosis Centers (CMSC) and Intellisphere, LLC. CMSC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team. This activity was planned by and for the health care team, and learners will receive 0.5 Interprofessional Continuing Education (IPCE) credit for learning and change. For Physicians: The Consortium of Multiple Sclerosis Centers designates this journal-based activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. For Nurses: This activity is awarded 0.5 contact hours of nursing continuing professional development (NCPD) (0.5 of these credits are in the area of pharmacology). For Pharmacists: This knowledge-based activity (UAN JA4008165-9999-22-020-H01-P) qualifies for 0.5 contact hours (0.05 CEUs) of continuing pharmacy education credit. For Physician Assistants: The Consortium of Multiple Sclerosis Centers has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.5 AAPA Category 1 CME credits. Approval is valid until April 1, 2023. PAs should only claim credit commensurate with the extent of their participation. It is the policy of the Consortium of Multiple Sclerosis Centers to mitigate all relevant financial disclosures from planners, faculty, and other persons that can affect the content of this CE activity. For this activity, all relevant disclosures have been mitigated. Disclosures: Francois Bethoux, MD, editor in chief of the International Journal of MS Care (IJMSC), has served as Physician Planner for this activity. He has disclosed no relevant financial relationships. Alissa Mary Willis, MD, Associate Editor of IJMSC, has disclosed no relevant financial relationships. Daniel Hartung, PharmD, MPH, consults for the National Multiple Sclerosis Society and Sandoz Pharmaceuticals. Leorah Freeman, MD, PhD, has served as a consultant for Genentech, Celgene/Bristol Myers Squibb, EMD Serono, TG Therapeutics, and Novartis; and has received grant/program support from EMD Serono and Genentech. The staff at IJMSC, CMSC, and Intellisphere, LLC who are in a position to influence content have disclosed no relevant financial relationships. Laurie Scudder, DNP, NP, Continuing Education Director CMSC, has served as a planner and reviewer for this activity. She has disclosed no relevant financial relationships. Method of Participation: Release Date: April 1, 2022; Valid for Credit through: April 1, 2023 In order to receive CE credit, participants must: (1) Review the continuing education information, including learning objectives and author disclosures.(2) Study the educational content.(3) Complete the evaluation, which is available at https://www.highmarksce.com/mscare. Statements of Credit are awarded upon successful completion of the evaluation. There is no fee to participate in this activity. Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not approved by the FDA. The CMSC and Intellisphere, LLC do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the CMSC or Intellisphere, LLC. Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any medications, diagnostic procedures, or treatments discussed in this publication should not be used by clinicians or other health care professionals without first evaluating their patients’ conditions, considering possible contraindications or risks, reviewing any applicable manufacturer’s product information, and comparing any therapeutic approach with the recommendations of other authorities.

Nonopioid analgesics are more effective for most oral pain, but data suggest that dental prescribing of opioids is excessive. This study evaluates the extent to which opioids exceed recommendations and the characteristics associated with opioid overprescribing by Veterans Health Administration dentists.This was a national cross-sectional study of Veterans' dental visits from 2015 to 2018. Overprescribing was defined per national guidelines as120 morphine milligram equivalents (primary outcome). The association of dental visit and patient demographic and medical characteristics was modeled with overprescribing (defined as120 morphine milligram equivalents) using Poisson regression with clustering by facility and patient. A secondary analysis assessed opioid prescriptions3 days' supply. The dates of analysis were January 2020‒May 2021.Of the 196,595 visits, 28.7% exceeded 120 morphine milligram equivalents. Friday visits and people with chronic oral pain or substance misuse were associated with a higher prevalence of overprescribing. Women, older Veterans, and Black and Latinx Veterans were less likely to be overprescribed than men, younger Veterans, and White Veterans, respectively. Routine dental visits had a higher prevalence of opioid overprescribing than invasive visits. Opioid overprescribing decreased over time. White Veterans were more likely to receive oxycodone and hydrocodone, whereas people of Black race and Latinx ethnicity were more likely to receive codeine and tramadol. In the secondary analysis, 68.5% of opioid prescriptions exceeded a 3-day supply.Nearly 1 in 3 opioids prescribed by Veterans Health Administration dentists exceed guidelines. Prescribing higher potency and quantities of opioids, especially on Fridays and to certain demographic groups, should be addressed as part of dental opioid stewardship programs.

For most of the twentieth century, public opinion was nearly analogous with polling. Enter social media, which has upended the social, technical, and communication contingencies upon which public opinion is constructed. This study documents how political professionals turn to social media to understand the public, charting important implications for the practice of campaigning as well as the study of public opinion itself. An analysis of in-depth interviews with 13 professionals from 2016 US presidential campaigns details how they use social media to understand and represent public opinion. I map these uses of social media onto a theoretical model, accounting for quantitative and qualitative measurement, for instrumental and symbolic purposes. Campaigns’ use of social media data to infer and symbolize public opinion is a new development in the relationship between campaigns and supporters. These new tools and symbols of public opinion are shaped by campaigns and drive press coverage (McGregor 2019), highlighting the hybrid logic of the political media system (Chadwick 2017). The model I present brings much-needed attention to qualitative data, a novel aspect of social media in understanding public opinion. The use of social media data to understand the public, for all its problems of representativeness, may provide a retort to long-standing criticisms of surveys—specifically that surveys do not reveal hierarchical, social, or public aspects of opinion formation (Blumer 1948; Herbst 1998; Cramer 2016). This model highlights a need to explicate what can—and cannot—be understood about public opinion via social media.