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BackgroundResearch suggests that direct exposure to suicidal behaviors and acts of self-harm through social media may increase suicidality through imitation and modeling, particularly in more vulnerable populations. One example of a social media phenomenon that demonstrates how self-harming behavior could potentially be propagated is the blue whale challenge. In this challenge, adolescents and young adults are encouraged to engage in self-harm and eventually kill themselves. ObjectiveThis paper aimed to investigate the way individuals portray the blue whale challenge on social media, with an emphasis on factors that could pose a risk to vulnerable populations. MethodsWe first used a thematic analysis approach to code 60 publicly posted YouTube videos, 1112 comments on those videos, and 150 Twitter posts that explicitly referenced the blue whale challenge. We then deductively coded the YouTube videos based on the Suicide Prevention Resource Center (SPRC) safe messaging guidelines as a metric for the contagion risk associated with each video. ResultsThe thematic analysis revealed that social media users post about the blue whale challenge to raise awareness and discourage participation, express sorrow for the participants, criticize the participants, or describe a relevant experience. The deductive coding of the YouTube videos showed that most of the videos violated at least 50% of the SPRC safe and effective messaging guidelines. ConclusionsThese posts might have the problematic effect of normalizing the blue whale challenge through repeated exposure, modeling, and reinforcement of self-harming and suicidal behaviors, especially among vulnerable populations such as adolescents. More effort is needed to educate social media users and content generators on safe messaging guidelines and factors that encourage versus discourage contagion effects.

Objective: Intracranial EEG can identify epilepsy‐related networks in patients with focal epilepsy; however, the association between network organization and post‐surgical seizure outcomes remains unclear. Hubness serves as a critical metric to assess network organization by identifying brain regions that are highly influential to other regions. In this study, we tested the hypothesis that favorable post‐operative seizure outcomes are associated with the surgical removal of interictal network hubs, measured by the novel metric "Resection‐Hub Alignment Degree (RHAD)." Methods: We analyzed Phase II interictal intracranial EEG from 69 patients with epilepsy who were seizure‐free (n = 45) and non–seizure‐free (n = 24) 1 year post‐operatively. Connectivity matrices were constructed from intracranial EEG recordings using imaginary coherence in various frequency bands, and centrality metrics were applied to identify network hubs. The RHAD metric quantified the congruence between hubs and resected/ablated areas. We used a logistic regression model, incorporating other clinical factors, and evaluated the association of this alignment regarding post‐surgical seizure outcomes. Results: There was a significant difference in RHAD in fast gamma (80–200 Hz) interictal network between patients with favorable and unfavorable surgical outcomes (p =.025). This finding remained similar across network definitions (i.e., channel‐based or region‐based network) and centrality measurements (Eigenvector, Closeness, and PageRank). The alignment between surgically removed areas and other commonly used clinical quantitative measures (seizure‐onset zone, irritative zone, high‐frequency oscillations zone) did not reveal significant differences in post‐operative outcomes. This finding suggests that the hubness measurement may offer better predictive performance and finer‐grained network analysis. In addition, the RHAD metric showed explanatory validity both alone (area under the curve [AUC] =.66) and in combination with surgical therapy type (resection vs ablation, AUC =.71). Significance: Our findings underscore the role of network hub surgical removal, measured through the RHAD metric of interictal intracranial EEG high gamma networks, in enhancing our understanding of seizure outcomes in epilepsy surgery. [ABSTRACT FROM AUTHOR]

Background: Dispatcher assistance can help to save lives during layperson cardiopulmonary resuscitation during cardiac arrest. The aim of this study was to investigate the influence of different camera positions on the evaluation of cardiopulmonary resuscitation performance during video-assisted cardiopulmonary resuscitation. Methods: For this randomized, controlled simulation trial, seven video sequences of cardiopulmonary resuscitation performance were recorded from three different camera positions: side, foot and head position. Video sequences showed either correct cardiopulmonary resuscitation performance or one of the six typical errors: low and high compression rate, superficial and increased compression depth, wrong hand position or incomplete release. Video sequences with different cardiopulmonary resuscitation performances and camera positions were randomly combined such that each evaluator was presented seven individual combinations of cardiopulmonary resuscitation and camera position and evaluated each cardiopulmonary resuscitation performance once. A total of 46 paramedics and 47 emergency physicians evaluated seven video sequences of cardiopulmonary resuscitation performance from different camera positions. The primary hypothesis was that there are differences in accuracy of correct assessment/error recognition depending on camera perspective. Generalized linear multi-level analyses assuming a binomial distribution and a logit link were employed to account for the dependency between each evaluator's seven ratings. Results: Of 651 video sequences, cardiopulmonary resuscitation performance was evaluable in 96.8% and correctly evaluated in 74.5% over all camera positions. Cardiopulmonary resuscitation performance was classified correctly from a side perspective in 81.3%, from a foot perspective in 68.8% and from a head perspective in 73.6%, revealing a significant difference in error recognition depending on the camera perspective (p =.01). Correct cardiopulmonary resuscitation was mistakenly evaluated to be false in 46.2% over all perspectives. Conclusions: Participants were able to recognize significantly more mistakes when the camera was located on the opposite side of the cardiopulmonary resuscitation provider. Foot position should be avoided in order to enable the dispatcher the best possible view to evaluating cardiopulmonary resuscitation quality. [ABSTRACT FROM AUTHOR]

Background: In this observational study, patient-reported outcomes and short-term clinical outcome parameters in patients with colorectal cancer were studied 12 months after the start of treatment. Outcomes were also compared across German Certified Colorectal Cancer Centers. Methods: Data were collected from 4239 patients with colorectal cancer who had undergone elective tumor resection in one of 102 colorectal cancer centers and had responded to a quality-of-life questionnaire before treatment (EORTC QLQ-C30 and -CR29). 3142 (74.1%) of these patients completed a post-treatment questionnaire 12 months later. Correlation analyses were calculated and case-mix adjusted comparisons across centers were made for selected patient-reported outcomes, anastomotic insufficiency, and 30-day mortality. Results: At 12 months, mild improvements were seen in mean quality-of-life scores (66 vs. 62 points), constipation (16 vs. 19), and abdominal pain (15 vs. 17). Worsening was seen in physical function (75 vs. 82) and pain (22 vs. 19). Better patient-reported outcomes at 12 months were associated with better scores before treatment. Better results in at least three of the five scores were associated with male sex, higher educational level, higher age, and private health insurance. Major worsening of fecal incontinence was seen among patients with rectal cancer without a stoma. The largest differences across centers were found with respect to physical function. Anastomotic insufficiency was found in 4.3% of colon cancer patients and 8.2% of rectal cancer patients. 1.9% of patients died within 30 days after their resection. Conclusion: Clinicians can use these findings to identify patients at higher risk for poorer patient-reported outcomes. The differences among cancer centers that were found imply that measures for quality improvement would be desirable. [ABSTRACT FROM AUTHOR]