Crowd-Sourced Focus Groups on Twitter: 140 Characters of Research Insight

Researchers have traditionally relied on in-person focus groups to test and obtain feedback regarding behavioral and technology-based interventions for specific disease processes. An increasing generation of engaged and connected patients turn to Twitter, a popular microblogging service, to discuss health related topics. Regularly scheduled Twitter-based chats (tweetchats) can potentially function as an additional source of input and information from a diverse, global group of engaged participants. We report the first use of a “tweetchat focus group” to explore data collection issues using this methodology. The speed at which tweetchat conversations occur, coupled with the ability to pursue multiple streams of conversation both in real time and in a delayed fashion, make tweetchat data collection particularly challenging. We discuss important considerations and preparation that should be undertaken by the researchers prior to initiating a tweetchat focus group, consider facilitation challenges and issues of confidentiality.

Real-Time Mobile Detection of Drug Use with Wearable Biosensors: A Pilot Study

While reliable detection of illicit drug use is paramount to the field of addiction, current methods involving self-report and urine drug screens have substantial limitations that hinder their utility. Wearable biosensors may fill a void by providing valuable objective data regarding the timing and contexts of drug use. This is a preliminary observational study of four emergency department patients receiving parenteral opioids and one individual using cocaine in a natural environment. A portable biosensor was placed on the inner wrist of each subject, to continuously measure electrodermal activity (EDA), skin temperature, and acceleration. Data were continuously recorded for at least 5 min prior to drug administration, during administration, and for at least 30 min afterward. Overall trends in biophysiometric parameters were assessed. Injection of opioids and cocaine use were associated with rises in EDA. Cocaine injection was also associated with a decrease in skin temperature. Opioid tolerance appeared to be associated with a blunted physiologic response as measured by the biosensor. Laterality may be an important factor, as magnitude of response varied between dominant and nondominant wrists in a single patient with bilateral wrist measurements. Changes in EDA and skin temperature are temporally associated with intravenous administration of opioids and cocaine; the intensity of response, however, may vary depending on history and extent of prior use.University of Massachusetts Medical School. Department of Emergency MedicineNational Institute on Drug AbuseNational Institutes of Health (U.S.) (Grant R01DA033769-01

Insights into Adolescent Online Conflict through Qualitative Analysis of Online Messages

Given adolescents’ widespread use of online messaging and social media, as well as the prevalence of cyberbullying, analyzing adolescents’ online message-based communication topics and patterns is relevant to public health. To better describe conflict in adolescent online communication, this paper analyzes patterns of conflict in a dataset of adolescent online messages. We describe a qualitative methodology for analyzing these complex data, to expand understanding of adolescents’ online conversations, and to identify how best to categorize conflict within online media datasets. In this study, 14,239 messages from 20 adolescents in the Northeast United States (of which 1,911 were coded) were analyzed using thematic analysis. Several distinct kinds of conflict and responses were identified. Conflict was either direct or indirect, serious or non-serious; it most often was indirect and serious, referenced either insults or romantic contacts, and was frequently related to in-person fights. Coding relied on understanding both textual contexts and referents

Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa

Background: Clinical trials undertaken by industrialized nations in undeveloped nations pose several critical ethical dilemmas. One key potential problem concerns misunderstandings of the consent process by participants. Though other reports have begun to explore this area, needs remain to identify specific areas of misunderstanding. Purpose: To identify deficits in comprehension during consent processes in Mali, West Africa. Methods: After obtaining informed consent for participation for a malaria vaccine trial being conducted in two West African villages, we administered to participants a nine-item questionnaire testing their understanding of information relevant for their consent. After testing their ability to understand a multiple choice format, 78 of 100 subjects were administered the questionnaire in one village and 85 of 100 in the other. Results: Participants had difficulty comprehending several concepts relevant to informed consent: 90% of respondents did not understand withdrawal criterion, 93% did not understand the existence of study side effects, and 74% did not understand that they were enrolled in an investigation as opposed to receiving therapy. The response rate and percentage of correct answers was generally much higher in the village nearer an urban center than the more rural village. The percent of correct answers exceeded 50% for five questions in the urban village and for only two question in the more rural setting. Limitations: Potential limitations of this study are relating to translation, cultural differences in the notion of informed consent, staff differences between each village, the proportion who could not understand the survey instrument and the fact that the study explored participants’ understanding of the consent process but did not observe the process itself. Conclusions: This study illustrates potential areas of miscomprehension in the consent process in a developing country. The degree of miscomprehension found in this study appeared to be more than that found in similar studies conducted in industrialized nations. Despite efforts to obtain truly informed consent, several factors make it more challenging in the developing world. This research highlights the need for more comprehensive studies of consent in developing countries. Such studies may eventually aid investigators in identifying, targeting and addressing specific areas of miscomprehension and thereby improve the informed consent process in the developing world

Unconditional care in academic emergency departments

Recent news stories have explicitly stated that patients with symptoms of COVID-19 were "turned away" from emergency departments. This commentary addresses these serious allegations, with an attempt to provide the perspective of academic emergency departments (EDs) around the Nation. The overarching point we wish to make is that academic EDs never deny emergency care to any person