The Role of Media in Addressing Opioid Use Disorder: Examining Causal Attributions and Emotions as Mediators of Media Influence on Stigma and Policy Support

This study examined the influence of media on stigma and public support for policy interventions that address opioid-related problems. Data from a survey of 997 U.S. adults indicate that media exposure to opioids and relevant topics significantly influenced stigma and support for punitive and public health-oriented policies, even after direct and indirect experiences with opioid misuse were controlled for. However, differences emerged in terms of what led people to endorse each type of policy intervention. When people attributed opioid misuse to individual-oriented causes after media exposure, they were more likely to support punitive policies. When people recognized pharmaceutical-oriented causes, they tended to support public health-related policies.In addition to causal attributions, emotions (fear, anger, and sympathy) served as mediators with different effects on stigma and policy support. Although exposure to opioid-related stories positively influenced all three emotions, media influence was most likely to elicit sympathy, which was negatively associated with social stigma. However, people who felt anger tended to stigmatize individuals with opioid use disorder and not to support either of the policy interventions. The overall findings suggest that communication efforts addressing the opioid situation should find frames that reduce social stigma and encourage support for public health-related policies.

Radiation-Induced Brachial Plexopathy (RIBP) after Stereotactic Body Radiotherapy (SBRT): Pooled Analyses of Risks

PURPOSE/OBJECTIVE(S)

RIBP, with symptomatic upper extremity motor or sensory deficits, is a risk after SBRT. We herein model dosimetric factors associated with risks of RIBP of the inferior aspect of the brachial plexus following SBRT for apical lung tumors.

MATERIALS/METHODS

Literature searches (PubMed & Embase databases) were performed to identify reports published from 2000-2021, using search criteria of ["brachial plex*" and stereotactic]. From a PRISMA systematic review, studies were identified that included individual patient data on: (1) RIBP endpoints after SBRT for apical lung tumors; and (2) brachial plexus Dmax, or maximum point doses (i.e., D0.035cc or D0.03cc). These data were amenable to normal tissue complication probability (NTCP) modelling. Doses were converted using the linear-quadratic model with an alpha-beta ratio of 3 Gy. For the probit models, the parameter values were determined using the maximum likelihood method and the 95% confidence intervals (CI) were determined using the profile likelihood method. The ability of the NTCP models to distinguish patients with and without RIBP was evaluated using the area under the curve (AUC).

RESULTS

Two probit NTCP models were derived: one from 3 studies (185 patients with 192 targets and 11 events) and another from 4 studies (221 patients with 229 targets and 18 events). NTCP models (summarized in table) suggest ≈10% risks associated with brachial plexus maximum dose (Dmax) of ∼32-34 Gy in 3 fractions and ∼40-43 Gy in 5 fractions, with a clear dose response. These dose-responses with SBRT (with steep dose gradients beyond the target volume and thus only partial-irradiation of the brachial plexus) are far less steep than those reported following conventionally-fractionated or moderately-hypofractionated radiotherapy used for breast, lung and head and neck cancers (that tend to use radiotherapy fields that circumferentially irradiate the brachial plexus).

CONCLUSION

A dose-response for risk of RIBP after SBRT is observed relative to brachial plexus Dmax. The less-steep dose-response compared to that seen from conventionally-fractionated or moderately-hypofractionated radiotherapy (with large irradiated plexus volumes) suggest a possible volume dependence of RIBP risks. Future work should focus on understanding possible volume effects.

Investigating the Content of #UequalsU on Twitter

Undetectable = Untransmittable (U = U) is the scientific fact that HIV cannot be transmitted when an individual is virally suppressed. This breakthrough discovery has the potential to greatly reduce HIV stigma and its negative effects. However, U = U is not widely known. Given that Twitter has the potential to raise awareness of health issues, the purpose of this study was to analyze the content of the #UequalsU on Twitter. The results showed that mentioning sex and mentioning love were strong predictors that a tweet would be liked and retweeted. This information could help to spread the message of U = U more widely and potentially lessen HIV stigma.

Information Seeking and MSM's Beliefs about PrEP and Condoms

This study examined how frequently men who have sex with men (MSM) used a selection of sources, including news media, social media, health organizations, and dating/hookup apps, for HIV information. Additionally, the study explored the extent to which MSM's efficacy beliefs about pre-exposure prophylaxis (PrEP) and perceptions of condom importance could be predicted by the sources they used. A sample of MSM (N= 969) were surveyed online. Results showed that respondents obtained information about HIV most often from HIV organizations, LGBT organizations, and dating/hookup apps, particularly the apps Growlr, Scruff, and Grindr. Use of the app Scruff was the strongest source-based predictor of beliefs about both PrEP and condoms. Implications for health promotion are discussed.

Communication Strategies for Discussing PrEP with Men Who Have Sex with Men

HIV continues to be a pressing problem, particularly for men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a highly effective means of preventing HIV infection, but adoption of it by MSM has been sluggish. Though there are many reasons for PrEP's limited adoption, healthcare providers' lack of skill in communicating with MSM likely plays a role. This study employed in-depth interviews with MSM who have adopted PrEP to explore how effective patient-provider communication surrounding PrEP takes place. Findings revealed that healthcare providers utilized five strategies to communicate with their MSM patients about PrEP. These strategies included (1) disclosure of identity and personal information; (2) knowledge of information that may be relevant to MSM patients; (3) positivity; (4) relationship inquiries; and (5) remaining calm. Employing the strategies uncovered in this study may be useful in improving communication between healthcare providers and their MSM patients and may help to increase MSM's adoption of PrEP.

Mammalian enamel: A universal tissue and diverse source of inspiration

The natural armors and weapons of the animal kingdom are serving as inspiration in the development of next-generation engineering materials. In this pursuit, seldom considered are the variations in properties across taxa that have evolved to meet their unique functional demands. Here, teeth from six different mammalian species were acquired and categorized according to their bite force quotient (BFQ), which accounts for the allometric scaling between bite force and body size. Selected chemical, microstructural, and mechanical properties of the enamel were quantified across the enamel thickness using spectroscopy and indentation techniques. Results showed that the chemical composition of enamel was significantly (P <  0.05) different between the Low and High BFQ groups, whereas the apatite crystallinity was not. The enamel of all animals exhibited a spatial gradient in mechanical properties that was consistent when evaluated using a normalized framework. Although the elastic modulus, hardness and indentation brittleness were significantly lower in the High BFQ group, the fracture resistance of enamel was significantly higher in this group, potentially reflective of bite force requirements related to diet and predation. Enamel rod decussation was present in all teeth, but there were differences in specific microstructural features. Overall, these results highlight that the diversity of tooth enamel across species should be considered in the pursuit of nature-inspired structural materials. STATEMENT OF SIGNIFICANCE: Natural weapons are serving as inspiration in the development of next-generation engineering materials. Tooth enamel is a viable candidate, but variations in the structure and properties of enamel across taxa have not been explored. Here, teeth from six different mammalian species were categorized according to their bite force quotient (BFQ), and the enamel was compared in terms of selected chemical, microstructural, and mechanical properties. We show that specific aspects of the chemical composition and properties of the Low and High BFQ groups are unique, which appears reflective of bite forces associated with diet and predation. Overall, the results highlight that the diversity of tooth enamel across species should be considered in the pursuit of nature-inspired structural materials.

Liver stiffness assessed by shear-wave elastography declines in parallel with immunoregulatory proteins in patients with chronic HCV infection during DAA therapy

BACKGROUND

A rapid decline of liver stiffness (LS) was detected by non-invasive methods in patients with chronic hepatitis C (HCV) infection during treatment with direct-acting antivirals (DAA).

OBJECTIVE

To investigate the influence of inflammation on LS.

METHODS

We prospectively examined LS by sonographic shear-wave elastography in 217 patients during DAA therapy from treatment initiation (BL) to 12 weeks after end of therapy (SVR12). Demographic data, laboratory findings and serum levels of cytokines were determined.

RESULTS

Values of LS decreased from 1.86 m/s to 1.68 m/s (p = 0.01) which was most pronounced in patients who had F4 fibrosis at BL (3.27 m/s to 2.37 m/s; p <  0.001). Initially elevated values of aminotransferases, ferritin, IgG (p <  0.001 each) and international normalized ratio (p <  0.003) declined, thrombocyte count (p = 0.007) increased. Correlations of these laboratory parameters with BL levels of LS measurement (LSM) were most apparent in patients with F1-F3 fibrosis. Tumor necrosis factor (TNF)-α (p = 0.031), interleukin (IL)-10 (p = 0.005) and interferon y inducible protein (IP)-10 (p <  0.001) decreased in parallel with LSM under DAA therapy and corelated with BL values.

CONCLUSION

Decrease of systemic inflammatory parameters correlated with LSM under DAA therapy. We conclude that regression of LSM is attributable to the decline of inflammation rather than reflecting fibrosis.

Fluorescence Emission Triggered by Radioactive β decay in Optimized Hyperbolic Cavities

Luminescence arising from β -decay of radiotracers has garnered much interest recently as a viable in-vivo imaging technique. The emitted Cerenkov radiation can be directly detected by high sensitivity cameras or used to excite highly efficient fluorescent dyes. Here, we investigate the enhancement of visible and infrared emission driven by β -decay of radioisotopes in the presence of a hyperbolic nanocavity. By means of a transfer matrix approach, we obtain quasi-analytic expressions for the fluorescence enhancement factor at the dielectric core of the metalodielectric cavity, reporting a hundred-fold amplification in periodic structures. A particle swarm optimization of the layered shell geometry reveals that up to a ten-thousand-fold enhancement is possible thanks to the hybridization and spectral overlapping of whispering-gallery and localized-plasmon modes. Our findings may find application in nuclear-optical medical imaging, as they provide a strategy for the exploitation of highly energetic gamma rays, Cerenkov luminescence, and visible and near-infrared fluorescence through the same nanotracer.

1281. Awareness of U=U Among Gay and Bisexual Men Who Have Sex with Men

Background

The “Undetectable = Untransmittable” (“U=U”) campaign is gaining traction, but prior studies from 2012–2017 have shown that the proportion of gay and bisexual men who have sex with men (GBMSM) who are aware of or have perceived accuracy of U=U is low. We report findings from a survey administered to GBMSM in 2018 to understand whether the landscape is changing with respect to U=U message dissemination.

Methods

GBMSM were recruited on gay dating apps to complete a 96 question survey. Survey data were collected in April-August of 2018. Collected data elements included demographic information, HIV status, ART and PrEP use, and beliefs and opinions regarding HIV transmission.

Results

969 GBMSM completed the survey; of whom, 678 had analyzable data (241 had never had anal sex with a man and 54 were missing ≥1 of the variables used in the analysis). Average age was 43 years, 65% were white, 15% black, 15% white, and 15% were HIV-infected (of whom 92% were on anti-retrovirals). Of the 85% who were HIV-uninfected, 39% were on PrEP. In response to the statement that a person with an undetectable viral load cannot transmit HIV to an HIV-uninfected person, 24% strongly agreed. Among HIV-negative GBMSM, 33% of those on PrEP agreed and 12% of those not on PrEP agreed. Among those living with HIV, 42% agreed. A multivariable logistic regression was run to explain correlates of strong agreement with U=U, using the following variables: age, education, being Black, being Hispanic, relationship status, number of lifetime male sexual partners, condom use with most recent anal sex, HIV status, PrEP use, and attitudes about living with HIV. Variables associated with strong agreement with U=U were living with HIV (AOR = 1.63, P < 0.001), taking PrEP (AOR = 2.85, P < 0.001), most recent encounter’s condom use (AOR = 2.22, P = 0.003), and having positive attitudes about living with HIV (AOR= 1.93, P < 0.001). Table 1 shows percentages for each of these variables (bivariate relationships) strongly agreeing with U=U.

Conclusion

Now that U=U has been scientifically proven, the challenge is public awareness. U=U awareness seems to be improving among GBMSM, with HIV-negative GBMSM making the greatest strides. Education around U=U and PrEP efficacy may help reduce guilt around HIV transmission and alleviate HIV stigma.

Disclosures

All authors: No reported disclosures.

Stigma Communication Surrounding PrEP: The Experiences of A Sample of Men Who Have Sex With Men

HIV is a serious problem in the USA, particularly for men who have sex with men (MSM). A new means of HIV prevention, called pre-exposure prophylaxis (PrEP), has been shown to be highly effective. However, in spite of earning FDA approval, adoption of PrEP by MSM has been limited. The purpose of this study was to examine the experiences of a sample of 38 MSM who have adopted PrEP, focusing on communication with healthcare providers and social networks. In-depth interviews were used to collect data. Findings revealed that stigmatization by healthcare providers as well as stigmatization by other MSM was a relatively common experience for participants. Additionally, participants described that a high level of health literacy, health advocacy, and communication skill were necessary to adopt PrEP. Given these findings, strategies are suggested for improving MSM's healthcare and increasing rates of PrEP adoption.

"It's Like Birth Control for HIV": Communication and Stigma for Gay Men on PrEP

This study focuses on how gay men communicate about pre-exposure prophylaxis (PrEP), focusing on how they learned about PrEP, how they discussed adoption with health care providers, and to what extent they have encountered stigma on social networks. In this qualitative study, 39 gay PrEP users were interviewed about PrEP. A majority of the participants learned about PrEP via friends and potential sex partners, and a majority of the participants experienced stigma from their health care provider and from other gay men online, mainly referring to promiscuity and risks of STIs. The authors recommend that health care providers should be trained in minimizing the expression of stigmatizing attitudes and should increase their knowledge of PrEP.

Guidelines on radioiodine therapy for differentiated thyroid carcinoma

Aim: For the examination of the impact on clinical practice of the guidelines for differentiated thyroid carcinoma (DTC), treatment data from the ongoing Multicenter Study Differentiated Thyroid Carcinoma (MSDS) were analyzed. Patients, methods: Patients were randomized to adjuvant external beam radiotherapy (RTx) or no RTx in addition to standard therapy in TNM stages pT4 pN0/1/x M0/x (UICC, 5th ed. 1997). All patients were to receive the same treatment regimen consisting of thyroidectomy, ablative radioiodine therapy (RIT), and a diagnostic 131I whole-body scintigraphy (WBS) 3-4 months after RIT. Results: Of 339 eligible patients enrolled between January 2000 and March 2004, 273 could be analyzed. Guideline recommendations by the German Society for Nuclear Medicine from 1999 and 1992 were complied with within 28% and 82% with regard to the interval between surgery and RIT (4 vs. 4–6 weeks), in 33% and 84% with regard to 131I activity for RIT (1-3 vs. 1-4 GBq; ± 10%), and in 16% and 60% with regard to 131I activity for WBS (15319-300 vs. 15319-400 MBq; ± 10%). Conclusions: The 1999 guideline revision appears to have had little impact on clinical practice. Further follow-up will reveal if guideline compliance had an effect on outcomes.

PrEP on Twitter: Information, Barriers, and Stigma

On May 14, 2014 the Centers for Disease Control and Prevention (CDC) endorsed the drug Truvada as an HIV preventative, called pre-exposure prophylaxis (PrEP). PrEP has been shown to dramatically reduce the risk of HIV infection, but its rate of adoption has been slow, and discourse surrounding it has been marked by stigma and uncertainty. The purpose of this study was to investigate how PrEP was discussed on Twitter. Our analysis focused on barriers to PrEP adoption and stigmatization of PrEP users. We analyzed a random sample of 1,093 top tweets about PrEP posted to Twitter a year before and a year after the CDC's endorsement. Our results showed that tweets likely reinforced uncertainty about barriers to PrEP adoption and that users employed Twitter's functionality to counter stigmatizing narratives about PrEP. We suggest that our findings illuminate both the limitations and strengths of Twitter as a mechanism for health promotion.

Mapping in-vivo optic nerve head strains caused by intraocular and intracranial pressures

Although it is well documented that abnormal levels of either intraocular (IOP) or intracranial pressure (ICP) can lead to potentially blinding conditions, such as glaucoma and papilledema, little is known about how the pressures actually affect the eye. Even less is known about potential interplay between their effects, namely how the level of one pressure might alter the effects of the other. Our goal was to measure in-vivo the pressure-induced stretch and compression of the lamina cribrosa due to acute changes of IOP and ICP. The lamina cribrosa is a structure within the optic nerve head, in the back of the eye. It is important because it is in the lamina cribrosa that the pressure-induced deformations are believed to initiate damage to neural tissues leading to blindness. An eye of a rhesus macaque monkey was imaged in-vivo with optical coherence tomography while IOP and ICP were controlled through cannulas in the anterior chamber and lateral ventricle, respectively. The image volumes were analyzed with a newly developed digital image correlation technique. The effects of both pressures were highly localized, nonlinear and non-monotonic, with strong interactions. Pressure variations from the baseline normal levels caused substantial stretch and compression of the neural tissues in the posterior pole, sometimes exceeding 20%. Chronic exposure to such high levels of biomechanical insult would likely lead to neural tissue damage and loss of vision. Our results demonstrate the power of digital image correlation technique based on non-invasive imaging technologies to help understand how pressures induce biomechanical insults and lead to vision problems.

Uncertainty in Online U.S. News Coverage of Truvada

The purpose of this study was to analyze the frequency of incidents of uncertainty in online news articles about Truvada, a drug used to prevent HIV infection. Using a coding scheme that synthesized uncertainty research from health disciplines and communication studies, we analyzed 235 articles from the most-read United States-based news websites. Our results showed that 80.4% of articles contained at least one incident of uncertainty, that articles contained significantly more incidents of uncertainty before the Centers for Disease Control and Prevention (CDC) endorsed Truvada compared to after the CDC endorsed the drug, and that articles mentioning men who have sex with men (MSM) contained significantly more incidents of uncertainty than articles in which they were not mentioned.

Body Talk: Body Image Commentary on Queerty.com

In this study, we conducted a content analysis of 243 photographic images of men published on the gay male-oriented blog Queerty.com. We also analyzed 435 user-generated comments from a randomly selected 1-year sample. Focusing on images' body types, we found that the range of body types featured on the blog was quite narrow-the vast majority of images had very low levels of body fat and very high levels of muscularity. Users' body image-related comments typically endorsed and celebrated images; critiques of images were comparatively rare. Perspectives from objectification theory and social comparison theory suggest that the images and commentary found on the blog likely reinforce unhealthy body image in gay male communities.

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Based on the Federal Health Survey from 1998, the Augsburg heart attack registry, and the ninth coordinated population prediction, we have estimated the occurrence of heart attacks in Germany up to the year 2050. From the mere demographic perspective - regardless of medical and social influences - we can expect that the need for cardiac care will increase considerably. If we assume that the risk or the frequency of having a heart attack will remain the same, then the number of heart attacks in people aged 25 to over 90 and 35 to under 90 will increase, although the population size of these age groups will decline. The population over 75 years of age will with certainty determine the course of the incidence and prevalence of heart attacks. In addition to standardised incidence and/or prevalence rates, estimations of the absolute number of incidents and/or prevalent cases of the respective target illness have to be included in morbidity predictions in order to avoid misinterpretations.

Advances in post-mortem CT-angiography

Performing a post-mortem multidetector CT (MDCT) scan has already become routine in some institutes of forensic medicine. To better visualize the vascular system, different techniques of post-mortem CT-angiography have been explored, which can essentially be divided into partial- and whole-body angiography techniques. Probably the most frequently applied technique today is the so-called multiphase post-mortem CT-angiography (MPMCTA) a standardized method for investigating the vessels of the head, thorax and abdomen. Different studies exist, describing its use for medicolegal investigations, and its advantages as well as its artefacts and pitfalls. With the aim to investigate the performance of PMCTA and to develop and validate techniques, an international working group was created in 2012 called the "Technical Working Group Post-mortem Angiography Methods" (TWGPAM). Beyond its primary perspective, the goals of this group include creating recommendations for the indication of the investigation and for the interpretation of the images and to distribute knowledge about PMCTA. This article provides an overview about the different approaches that have been developed and tested in recent years and an update about ongoing research in this field. It will explain the technique of MPMCTA in detail and give an outline of its indications, application, advantages and limitations.