Search

STUDY DESIGN.: Institutional review board-approved, prospective, multicenter, comparative study. OBJECTIVE.: To assess the accuracy and utility of a computer-assisted fluoroscopic navigation method for percutaneous placement of lumbar pedicle screws compared with conventional fluoroscopic placement. SUMMARY OF BACKGROUND DATA.: Recent reports indicate that cortical breaches during percutaneous pedicle screw placement can exceed 15%. Computed tomography (CT)- and fluoroscopy-based navigation systems may facilitate increased placement accuracy with reduced radiation exposure and operative times. METHODS.: Patients were alternately assigned to either the Guidance or Control group. The Guidance group underwent lumbar pedicle screw placement using the oblique visualization technique and computer-assisted fluoroscopic navigation. The Control group underwent lumbar pedicle screw placement per standard percutaneous technique aided by fluoroscopy alone. Baseline demographics, visual analog scale (VAS) pain scores, and American Spinal Injury Association scores were obtained preoperatively and in the immediate postoperative period. Fluoroscopy times and guidewire insertion times were recorded intraoperatively. All postoperative CT scans were reviewed by an independent spine surgeon to grade screw placement accuracy. RESULTS.: Forty-two patients (210 screws) were assigned to the Guidance group and 34 patients (152 screws) were assigned to the Control group. Use of Guidance resulted in reduced average fluoroscopy usage per pedicle [6.6 sec (SD = 5.1) vs. 9.6 sec (SD 6.2), P < 0.001] and more expedient placement of guidewires per pedicle [3.65 min (SD = 2.31) vs. 4.43 min (SD = 2.56), P = 0.003]. The Guidance group experienced less than half of the breach rate of the Control group (3.0% vs. 7.2%, P = 0.055) and reduced breach magnitudes. None of the breaches resulted in a corresponding neurological deficit or required revision. All patient-reported outcomes were significantly improved after surgery and there were no significant differences in average postoperative VAS scores between treatment groups. CONCLUSION.: Use of Guidance reduces fluoroscopy and insertion times with increased accuracy compared with conventional fluoroscopic methods of percutaneous pedicle screw insertion. [ABSTRACT FROM AUTHOR]

Background: Seeking and obtaining effective health care for Long COVID remains a challenge in the USA. Women have particularly been impacted, as they are both at higher risk of developing Long COVID and of facing gendered barriers to having symptoms acknowledged. Long COVID clinics, which provide multidisciplinary and coordinated care, have emerged as a potential solution. To date, however, there has been little examination of U.S. patient experiences with Long COVID clinics and how patients may or may not have come to access care at a Long COVID clinic., Methods: We conducted semi-structured interviews with 30 U.S. women aged 18 or older who had experienced Long COVID symptoms for at least 3 months, who had not been hospitalized for acute COVID-19, and who had seen at least one medical provider about their symptoms. Participants were asked about experiences seeking medical care for Long COVID. Long COVID clinic-related responses were analyzed using qualitative framework analysis to identify key themes in experiences with Long COVID clinics., Results: Of the 30 women, 43.3% (n = 13) had been seen at a Long COVID clinic or by a provider affiliated with a Long COVID clinic and 30.0% (n = 9) had explored or attempted to see a Long COVID clinic but had not been seen at time of interview. Participants expressed five key themes concerning their experiences with seeking care from Long COVID clinics: (1) Access to clinics remains an issue, (2) Clinics are not a one stop shop, (3) Not all clinic providers have sufficient Long COVID knowledge, (4) Clinics can offer validation and care, and (5) Treatment options are critical and urgent., Conclusions: While the potential for Long COVID clinics is significant, findings indicate that ongoing barriers to care and challenges related to quality and coordination of care hamper that potential and contribute to distress among women seeking Long COVID care. Since Long COVID clinics are uniquely positioned and framed as being the place to go to manage complex symptoms, it is critical to patient wellbeing that they be properly resourced to provide a level of care that complies with emerging best practices., (© 2024. The Author(s).)

Introduction: Effective August 2018, the U.S. Food and Drug Administration (FDA) required that nicotine addiction warnings be placed on ads for nicotine containing e-liquids. As per FDA comments, this provision pertains to visual ads communicated via social media, raising questions about compliance within the large e-liquid promotion community on Instagram., Aims and Methods: This study examines use of warnings on promotional Instagram posts before and after provisions took effect on August 10, 2018. Netlytic was used to gather a sample of 500 promotional #eliquid and #ejuice posts from: May 2017, October 2017, March 2018, August 2018, and September 2018. The 1500 prewarning and 1000 postwarning posts were coded using content analysis. Changes in products and marketing strategies were also considered. Post volume was tracked monthly between May 2017 and February 2020., Results: In the prewarning period, nicotine warning statements were absent on all posts. Following August 10, 2018, FDA compliant warnings were present on 13.6% of posts. Among US-based posts, 36.4% used the warnings, with warnings more common on posts made by e-liquid brands (52.3%) and posts promoting e-liquids with nicotine (40.0%). Promotional strategies and products did not significantly change. The share of posts made by US Instagram users decreased by 11%, although total post volume continued to grow., Conclusions: Many e-liquid promotion posts on Instagram remained noncompliant with nicotine warnings after FDA provisions took effect. The large volume of international users also limited the impact of FDA-mandated warnings on the social media environment., Implications: Further guidance and enforcement are needed to ensure that US e-liquid marketers on visual social media platforms adhere to current provisions, particularly for individual social media users who are sponsored by industry. The inherently global span of social media also indicates the importance of a shared approach to marketing regulations. Further work is needed to assess enforcement strategies viable for the social media environment., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: With the growing popularity of refillable e-cigarettes and recent FDA regulatory action on e-liquid warning labels, e-liquids are an increasingly important area of study. At present, however, little is known about how e-liquids are marketed. This study examined e-liquid marketing on the visual social media platform Instagram, on which users have created significant amounts of e-cigarette related content., Methods: A systematic, random sample of Instagram posts with either #eliquid or #ejuice was collected from the Instagram API during one week in May 2017 and in October 2017 using the Netlytic application. A final sample of 1000 posts was analyzed using qualitative content analysis to discern e-liquid themes, claims, promotions, and products promoted., Results: Of the 1000 posts, 61.1% promoted e-liquid. These posts were most frequently made by vape shops and ambassadors/representatives. Almost 80% of promotional posts featured a flavored e-liquid. Posts focused largely on e-liquids tasting good (35.4%) or being cool/edgy (19.0%). Many posts made use of Instagram's visual nature to share creative label designs. Just over a third of posts made some claim about e-liquid benefits or quality, with smokeless tobacco claims being most common. Although posts most commonly originated from the United States, posts made from Indonesia and the United Kingdom were also common., Conclusions: E-liquid marketing on Instagram emphasizes positive experiences, personalization, and aspirational identities rather than explicit health and cessation claims. Appeal to youth is a significant concern based both on marketing strategies and the demographics of Instagram users., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: With the growing popularity of social media, corporate marketers are increasingly launching hashtag campaigns to encourage consumers to create branded user-generated content on their behalves. If successful, these campaigns may expand the reach of harmful marketing messages and capitalize on peer-effects among adolescents. To shed light on these novel corporate campaigns, we performed a case study of the user-generated Instagram content created in response to a hashtag campaign promoting the quick-service restaurant Kentucky Fried Chicken (KFC)., Methods: We performed a content analysis of one week's worth of user-generated Instagram posts created with the hashtag #HowDoYouKFC between 24 April 2015-1 May 2015. Posts were coded to discern: (a) relevance to KFC as a brand and/or food; (b) themes in the post, (c) the content of images/videos, and (d) overall sentiment toward KFC. Posts that were deleted or made private during the study period were removed. Descriptive statistics were calculated to discern trends in post content., Results: Instagram users created 196 posts with #HowDoYouKFC during the study period. After removing irrelevant and deleted/private posts, analysis of the 128 remaining user-generated posts revealed that 45% of posts were explicitly positive toward KFC and 39% lacked a specific stance or emotion related to KFC. Of the posts, 55% depicted KFC chicken and 65% included depictions of the brand hashtag on food packaging., Conclusions: Findings indicate that corporations are successfully converting individual social media users into positive advertisers for harmful products. Novel efforts are needed to counter corporate user-generated content campaigns., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

Background: The growth of social networking services has enabled the sharing of electronic cigarette opinions and experiences via user-generated content., Objectives: This exploratory study analyzed electronic cigarette content found on the visual social networking service, Instagram, in order to highlight public health challenges created by this content and support understanding of electronic cigarette promotion and usage., Methods: A qualitative content analysis was performed on Instagram posts made with the hashtags #ecig or #vape in October 2014. Images, text, and hashtags from 85 posts (43 #ecig, 42 #vape) were analyzed. In addition, the total number of posts made with eight key electronic cigarette hashtags was recorded at four points between March 2014 and October 2015., Results: The total number of #vape posts on Instagram grew by 4,163,274 during the study period, while #ecig posts increased by 741,916. Of the posts examined in-depth, corporate users made up over half of posts. No posts were critical of electronic cigarettes. Few mentioned electronic cigarettes in the context of health benefits. No posts included major brands, and mod style electronic cigarettes were mentioned or depicted in over half of posts. A majority of posts included hashtags expressing vaping identity and community. In addition, users mentioned novel practices such as sub-ohming. Conclusions/Importance: Instagram users in our sample characterized electronic cigarettes primarily as novel devices rather than equivalents to cigarettes. Further, hashtag communities and identities appear to be forming around vaping. Future research should consider the public health implications of these hashtags, as well as novel electronic cigarette practices.

Small-vessel disease or cerebral microangiopathy is a common finding in elderly people leading finally to subcortical ischemic vascular dementia. Because cerebral microangiopathy impairs vascular reactivity and affects mainly the frontal lobes, we hypothesized that brain activation decreases during an event-related color-word matching Stroop task. 12 patients suffering from cerebral microangiopathy were compared with 12 age-matched controls. As an imaging method we applied functional near-infrared spectroscopy, because it is particularly sensitive to the microvasculature. The Stroop task led to activations in the lateral prefrontal cortex. Generally, the amplitude of the hemodynamic response was reduced in patients in tight correlation with behavioral slowing during the Stroop task and with neuropsychological deficits, namely attentional and executive dysfunction. Interestingly, patients showed an early deoxygenation of blood right after stimulation onset, and a delay of the hemodynamic response. Whereas the amplitude of the hemodynamic response is reduced in the frontal lobes also with normal aging, data suggest that impairments of neurovascular coupling are specific for cerebral microangiopathy. In summary, our findings indicate frontal dysfunction and impairments of neurovascular coupling in cerebral microangiopathy.