Journal articles on the topic 'Demographic entrapment'

Introduction Entrapment neuropathies of upper limbs such as carpal tunnel and cubital tunnel syndromes are common in the general population. Identification of entrapment neuropathies of upper limbs in patients with multiple sclerosis can be clinically challenging as signs and symptoms could be attributed to multiple sclerosis. People at later stages of multiple sclerosis use mobility aids and wheelchairs. Weakness of hands in this cohort due to entrapment neuropathies could adversely affect their mobility and independence. Methods This was a retrospective review of records of patients with multiple sclerosis referred for clinical neurophysiological studies with clinical suspicion of upper limb entrapment neuropathies over a 10-year period. We collected demographic details, clinical features, clinical neurophysiological data and details of aids and appliances used for mobility. Results Among 71 patients, 38 (53.5%) patients had at least one entrapment neuropathy of upper limb confirmed by clinical neurophysiological studies. Twelve (31%) patients had median nerve entrapment, 20 (53%) had ulnar nerve entrapment and six (16%) had both. Risk of ulnar nerve entrapment was significantly higher in patients using a powered wheelchair (odds ratio 5.7, 95% confidence interval (1.7–18.7, p = 0.0037). Discussion Entrapment neuropathies should be considered in patients with multiple sclerosis reporting sensory and motor symptoms of hands.

Abstract The article presents a few of the demographic transformations in Romania in the period after the fall of the communist regime in 1989, when the new social circumstances, along with legal changes, had an undeniable effect on the manifestation of the demographic phenomena and thus on the volume and the structure of the population. The present article summarizes and also describes the transformations, with a few attempts at explaining them, without, however, aligning to any major theory that attempts to explain what has happened and to predict what will come next. In order to avoid entrapment within an enclosed discursive universe, there will be references to the situation of other countries, mainly in the geographical area of Romania and, more widely, in the European Union. The demographic phenomena that are analysed individually are fertility and mortality, which have a direct impact on the natural growth of the population. There are only a few suggestions on transnational migration in the section devoted to the changes of the population. Last, but not least, the text is a critical analysis of some of the official demographic statistics put forward by the National Institute of Statistics and even by EUROSTAT – data that is questionable or outright false and risks misleading the reader that is less familiar with the demographic situation of Romania.

Several studies have emphasized the heterogeneity of fibromyalgia patients. Furthermore, fibromyalgia patients are considered a high-risk suicide group. The ideation-to-action framework proposes a set of transdiagnostic psychological factors involved in the development of suicidal ideation. The present study aims to explore the existence of different subgroups according to their vulnerability to suicidal ideation through these transdiagnostic psychological variables and a set of variables typically associated with fibromyalgia. In this cross-sectional study, 151 fibromyalgia patients were assessed through the Revised Fibromyalgia Impact Questionnaire, Beck Depression Inventory-II, Plutchik Suicide Risk Scale, Interpersonal Needs Questionnaire, Defeat Scale, Entrapment Scale, Psychache Scale, and Beck Hopelessness Scale. A K-means cluster analysis identified two clusters, one (45.70%) according to a low vulnerability, and a second (54.30%) with a high vulnerability to suicidal ideation. These clusters showed statistically significant differences in suicidal ideation and suicide risk. However, no differences were observed in most socio-demographic variables. In conclusion, fibromyalgia patients who present a clinical condition characterized by a moderate-high degree of physical dysfunction, overall disease impact and intensity of fibromyalgia-associated symptoms, along with a high degree of perceived burdensomeness, thwarted belongingness, defeat, entrapment, psychological pain and hopelessness, form a homogeneous group at high risk for suicidal ideation.

Since September 11, 2001, the U.S. government and police departments across the United States, most notably the New York City Police Department, have been collecting intelligence targeting Muslim American communities. The controversial surveillance practices include the use of confidential informants, undercover operations, and entrapment, and infringing upon civil rights and civil liberties in the name of national security. A decade before 9/11, however, the Federal Bureau of Investigation (FBI) conducted the same practices against a completely different demographic – Christian Right militants, through a program called PATCON, short for Patriot Conspiracy. Building upon the concept of surveillance as social sorting (Lyon 2013) and surveillance and terrorism (Monahan 2013), This article will compare the history of surveillance tactics used by the FBI against Christian Right militants and those used by the NYPD against non-militant Muslim Americans, and assess their implications in the context of civil rights, leaving a legacy of mistrust between these respective groups and the federal government that further undermines the national security interests of the United States.

Introduction High resolution ultrasonography (US) has been used for diagnosis and evaluation of entrapment peripheral neuropathy. Ulnar neuropathy at the elbow (UNE) is the second most common focal entrapment neuropathy. The ulnar nerve tends to move to the anteromedial side and sometimes subluxates or dislocates over the medial epicondyle as the elbow is flexed. Dislocation of the ulnar nerve during elbow flexion may contribute to friction injury. We aimed to investigate the effects which the dislocation of ulnar nerve at the elbow could have on the electrophysiologic pathology of UNE. Materials We retrospectively reviewed 71 arms of UNE. The demographic data, electrodiagnosis findings and US findings of ulnar nerve were analyzed. We classified the electrodiagnosis findings of UNE into three pathologic types; demyelinating, sensory axonal loss, and mixed sensorimotor axonal loss. The arms were grouped into non-dislocation, partial dislocation, and complete dislocation groups according to the findings of nerve dislocation in US examination. We compared the electrodiagnosis findings, ulnar nerve cross sectional areas in US and electrodiagnosis pathology types among the groups. Results A total of 18 (25.3%) arms showed partial dislocation, and 15 (21.1%) arms showed complete dislocation of ulnar nerve in US. In the comparison of electrodiagnosis findings, the partial and complete dislocation groups showed significantly slower conduction velocities and lower amplitudes than non-dislocation group in motor conduction study. In the sensory conduction study, the conduction velocity was significantly slower in partial dislocation group and the amplitude was significantly lower in complete dislocation group than non-dislocation group. In the comparison of US findings, patients in partial and complete dislocation groups showed significantly larger cross sectional areas of the ulnar nerve. The comparison of electrodiagnosis pathologic types among the groups revealed that there were significantly larger proportions of the axonal loss (sensory axonal loss or mixed sensorimotor axonal loss) in partial and complete dislocation groups than non-dislocation group. Conclusion The ulnar nerve dislocation could influence on the more severe damage of the ulnar nerve in patients with UNE. It might be important to evaluate the dislocation of the ulnar nerve using US in diagnosing ulnar neuropathy for predicting the prognosis and determining the treatment direction of UNE.

Background. Breech presentation is associated with increased rates of maternal and perinatal morbidity regardless of mode of delivery. After the results of Term Breech Trial, most of the countries adopted the protocol of cesarean section for term breech delivery because of which breech vaginal delivery is becoming rare. The aim of this study is to evaluate short-term maternal and perinatal outcomes of breech vaginal delivery at a tertiary care hospital in Nepal. Methods. A retrospective review of case records of all women who had vaginal breech delivery from April 13, 2016, to April 12, 2018, was conducted, over a period of two years. Available demographic variables, obstetric characteristics, details of labor, postpartum complications, and perinatal complications were recorded and analyzed. Results. Out of 21,768 cases of deliveries during the study period, the incidence of term breech deliveries was 528 (2.4%) among which the mode of only 84 (17.8%) deliveries was vaginal. Most of the deliveries were unplanned and were conducted because emergency cesarean section could not be performed. Three (3.6%) women had postpartum hemorrhage, and four (4.8%) had entrapment of aftercoming head, two of them requiring Dührssen incisions. Adverse perinatal outcomes were seen in 23.8% of such deliveries with <7 APGAR score at 5 minutes in 20.2%, neonatal admission in 17.7%, and perinatal mortality in 8.3%. The perinatal mortality was significantly associated with birthweight less than 2500 grams as compared to birthweight ≥2500 grams (21.1% versus 4.6%; P = 0.043 ). Conclusion. The perinatal outcomes for vaginal breech delivery are grave with our existing health facilities, especially when the deliveries are not well planned.

Few studies have reported on polonium-210, a decay breakdown product of radon-222 and lead-210, in human lungs and there has been no study in patients with suspected lung cancer. The main aim of this “Polonium in vivo” study was to evaluate polonium-210 radioactivity in bronchopulmonary systems of smoker, ex-smoker and never smoker patients with suspected lung cancer. Alpha-spectrometric analyses were performed on bronchial lavage (BL) fluids from two Italian hospitals in 2013–2016. Socio-demographic, smoking, occupational and spirometric characteristics, lung cancer confirmation and histologic type and radon-222 concentration in patients’ homes were collected. Seventy BL samples from never (n = 13), former (n = 35) and current smokers (n = 22) were analyzed; polonium-210 was detected in all samples from current and former smokers and in 54% of samples from never smokers (p < 0.001; median values: 1.20, 1.43 and 0.40 mBq, respectively). Polonium-210 levels were significantly higher in COPD versus no COPD patients (median value: 3.60 vs. 0.97 mBq; p = 0.007); former and current smokers, without and with COPD, had significantly increased polonium-210 levels (p = 0.012); 96% of confirmed versus 69% of non-confirmed lung cancer patients recorded detectable polonium-210 levels (p = 0.018). A polonium-210 detectable activity was measured in BL samples from all current and former smokers. Polonium-210 in the lungs could be the result of lead-210 entrapment, which, with its half-life of 22 years, could provide a continuous emission of alpha radioactivity, even many years after quitting, thus proposing a possible explanation for the onset of lung cancer, particularly in former smokers.

✓ Pain following suspected nerve injury was comprehensively evaluated with detailed examination including history', neurological evaluation, electrodiagnostic studies, quantitative sensory testing, thermography, anesthetic agents, and sympathetic nerve blocks. Forty-two surgically treated patients fell into four discrete groups: Group 1 patients had distal sensory neuromas treated by excision of the neuroma and reimplantation of the proximal nerve into muscle or bone marrow; Group 2 patients had suspected distal sensory neuromas in which the involved nerve was sectioned proximal to the injury site and reimplanted; Group 3 patients had proximal in-continuity neuromas of major sensorimotor nerves treated by external neurolysis; and Group 4 patients had proximal major sensorimotor nerve injuries at points of anatomical entrapment treated by external neurolysis and transposition, if possible. Patient follow-up monitoring from 2 to 32 months (average 11 months) was possible in 40 (95%) of 42 patients. Surgical success was defined as 50% or greater improvement in pain using the Visual Analog Scale or pain relief subjectively rated as either good or excellent, without postoperative narcotic usage. Overall, 16 (40%) of 40 patients met those criteria. Success rates varied as follows: 44% in 18 Group 1 patients, 40% in 10 Group 2 patients, 0% in five Group 3 patients, and 57% in seven Group 4 patients. Twelve (30%) of 40 patients were employed both pre- and postoperatively. It is concluded that: 1) neuroma excision, neurectomy, and nerve release for injury-related pain of peripheral nerve origin yield substantial subjective improvement in a minority of patients; 2) external neurolysis of proximal mixed nerves is ineffective in relieving pain; 3) surgically proving the existence of a neuroma with confirmed excision may be preferable; 4) traumatic neuroma pain is only partly due to a peripheral source; 5) demographic and neurological variables do not predict success; 6) the presence of a discrete nerve syndrome and mechanical hyperalgesia modestly predict pain relief; 7) ongoing litigation is the strongest predictor of failure; and 8) change in work status is not a likely outcome.

BackgroundTrapdoor fracture is a special type of orbital blowout fracture. Although early surgery is recommended, there still remain some patients delayed by various reasons. In this study, we analysed the clinical characteristics of delayed paediatric patients, especially those with different levels of ocular motility restriction before surgery.MethodsThirty patients (3 to 14 years old) who underwent delayed surgery for trapdoor fractures between January 2008 and September 2016 were enrolled. Their demographics, causes of injury and delay, clinical features, imaging data and follow-up information were collected.ResultsMuscular entrapment was found in 17 patients (group A) and soft-tissue entrapment in 13 patients (group B). 12 (7 in group A) presented with severe motility restriction and 18 (10 in group A) with mild restriction before surgery. 41.7% with severe restriction recovered after surgery, compared with 83.3% with mild restriction. Four (23.7%) in group A (all with severe restriction) and six (46.2%) in group B (half with severe restriction) presented with persistent diplopia.ConclusionsLong recovery time and a high percentage of persistent diplopia are the main problems of delayed trapdoor fracture in children. A prompt surgery within 48 hours is strongly recommended in patients with muscular entrapment even if an urgent treatment is hard to achieve. So are patients with soft-tissue entrapment and significant motility restriction. In the other patients without such indications, even though some recovery might be possible in the long term, a prompt surgery right after diagnosis is still preferable regardless of the entrapped contents.

Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. Of the 14 patients, three (21%) were diagnosed with a Spigelian hernia confirmed by imaging. The remaining patients were eventually diagnosed with abdominal cutaneous nerve entrapment syndrome (ACNES). The average delay in diagnosis was 4 years with patients with ACNES suffering twice as long with chronic pain. Patients with a Spigelian hernia and ACNES had different demographics and presenting complaints. Physical examination findings were nondiagnostic. Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.

Background The prevalence of depression in sexually transmitted infections (STIs) patients is much higher than general public. However, studies focusing on comprehensive psychosocial effects on depression among STIs patients are limited. This study aimed to examine association of multiple psychosocial syndemic conditions with depression among STIs patients in Shanghai, China. Methods We conducted a cross-sectional study and recruited 910 STIs patients from Shanghai Skin Disease Hospital. Participants self-reported their demographics and themselves completed the scales of depression, self-esteem, loneliness, social support, entrapment, defeat and interpersonal needs. Logistic regressions were performed to detect the possible contributing psychosocial factors for depression and to verify the syndemic conditions of psychosocial problems. Results Of the STIs patient sample, the prevalence of depression was 17.9%. Multivariable analysis showed low-level self-esteem (odds ratio [ORm]: 2.18, 95% CI [1.19–4.00]) and social support (ORm: 2.18, 95% CI [1.37–3.46]), high-level entrapment (ORm: 6.31, 95% CI [3.75–10.62]) and defeat (ORm: 2.60, 95% CI [1.51–4.48]) increased the risk of depression. Psychosocial syndemic conditions magnified effect in fusing depression (adjusted odds ratio [AOR]: 11.94, 95% CI [7.70–18.53]). Participants with more than 4 psychosocial problems were about 22 times more likely to have depression (AOR: 22.12, 95% CI [13.19–37.09]). Conclusions The psychosocial problems syndemic magnifying the risk of depression was confirmed and psychosocial interventions to prevent depression is needed among STIs patients.

Abstract BACKGROUND: Compressive neuropathy of the ulnar nerve at the elbow, or cubital tunnel syndrome (CuTS), is the second most common entrapment neuropathy of the upper extremity after carpal tunnel syndrome. While several studies have reported risk factors and outcomes for select populations (mostly surgical), it is difficult to interpret these data without an accurate measure of CuTS disease burden in the general population. OBJECTIVE: To estimate the incidence of CuTS among US health plan enrollees, using a large administrative health care claims database comprised of individuals from all 50 states. METHODS: An administrative database of commercial insurance beneficiaries was queried for diagnosis and treatment of CuTS over a 6-yr period. We examined subsequent claims to determine frequency of subsequent surgical treatment. Descriptive statistics were used to determine the association of incident cases and surgical treatment with age and gender. RESULTS: The estimated adjusted incidence rate of CuTS is 30.0 per 100 000 person-years. Of the 53 401 identified new cases within this cohort from 2006 to 2012, 41.3% were treated surgically. Incident cases were identified more frequently in men than in women (31.2 vs 28.8 cases per 100 000 person-years), though we observed more cases in women than in men below 50 yr of age (20.9 vs 19.5 cases per 100 000 person-years). Overall, incident cases increase with age in both men and women. In addition to incident cases being more common with increasing age, the percentage of cases treated surgically also increases with age (surgery in 34.4% of cases in the 18-30 yr group vs 48.8% of cases in the 60-65 yr group). CONCLUSION: The purpose of this study was to estimate the incidence of CuTS among US health plan enrollees. This is the largest published study on the incidence of CuTS, and the first to look at a US population. The overall adjusted incidence of CuTS was 30.0 per 100 000 person-years. Of patients who developed CuTS, 41.3% were treated surgically during the study period. Our results corroborate previously reported literature suggesting incidence increases significantly with age, with a slightly higher incidence in males. A high percentage of people who were diagnosed with CuTS and ended up receiving surgical intervention (41.3%) were older males. These results may aid practitioners in providing some basic prognostic information to patients who develop CuTS.

Category: Trauma Introduction/Purpose: There is increasing interest on how to best manage displaced intraarticular calcaneal fractures (DIACF). Intramedullary locking devices (ILDs) have recently been advocated since the technique adopts a minimally invasive approach which may minimise complications and therefore improve outcomes. We reviewed the literature of commercially available devices to identify their characteristics, efficacy and safety. Methods: Medline, Scopus and EMBASE databases were searched to identify studies reporting use of ILDs for treating DIACF. A PRISMA checklist was used to sort eligible studies. Technical notes and biomechanical studies were first reviewed. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. Results: Thirteen studies investigated two devices (Calcanail; C-Nail). Four technical notes described how to use these devices and three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Seven clinical studies (302 feet, 289 patients) demonstrated satisfactory clinical (AOFAS, VAS) and radiographic (Bohler’s angle, Gissane angle, Goldzak index, posterior facet step-off) outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications; soft tissue issues were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in 4-6% of cases. Four (57%) studies were authored by implant designers and in 5 (71%) relevant conflict of interest were disclosed. Mean CMS was 61 (moderate quality). Conclusion: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications including infection and wound breakdown are less frequent than after open lateral approaches. The quality of evidence provided so far is only moderate and biased by potential conflict of interest, raising concerns about the generalisability of results.

Background:Carpal tunnel syndrome(CTS) is the most common form of entrapment neuropathies,caused by compression of the median nerve in the carpal tunnel at the wrist. But there is no gold standard technique for diagnosing CTS. Electrodiagnostic studies (EDS) are generally used but have some limitations. Recent years, magnetic resonance imaging(MRI) and ultrasonography(US) have facilitated the diagnosis of CTS. The median nerve cross section area(CSA) measured by US or MRI has been found to be associated with CTS[1]][2].CTS is usually idiopatic but it can be seen more in some disease. Psoriatic arthritis(PsA) occurs in up to 30% of people with psoriasis and can have serious debilitating effects on the peripheral joints, spine, tendon insertions, and fingers[3]. Because of arthritis, steroid use and flexor tenosynovitis play an important role in the pathogenesis of CTS, we think that CTS can be seen more in PsA patients.Objectives:We aimed to investigate the CTS in PsA patients with EDS, US and MRI than compare them with healthy controls.Methods:68 people, including 39 PsA (according to CASPAR criteria) and 28 healthy volunteers were included in study within 1 year. EDS, US and MRI were performed within maximum 2 weeks, and measurements were made by different doctors who were blind to other measurments. EDS was started with median and ulnar nerve motor conduction study than continued with sensory conduction studies. CTS diagnose was made according to the routine laboratory standards. The CSA measurement was made from the inner border of the hyperechoic ring around median nerve by using continuous tracing method at psiform bone level. US examinations were performed with a high frequency linear transducer (4-14 MHz), MRI examinations were performed on a 3-T imaging system. The statistical analyses were performed with Statistical Package for the Social Science Program Version 22. Descriptive statistics, T tests, chi-square test, Pearson correlation test were used.Results:No statifically significant difference was found between the groups for demographic characteristics. 12 (30.76%) of 39 PsA patients had CTS, whereas CTS was not detected in the control group(p= 0.001). US and MRI show larger CSA in PsA patients compared to the healthy control group(9,49 ± 3,00 mm2 vs 8,30 ±1,73mm2 p=0,005, 11,24 ± 3,41mm2 vs 9,35 ± 1,81mm2 p<0,001); in patients with CTS compared to others(11,63 mm2 ± 3,25 vs 8,60 ± 2,26mm2 p=0,002, 13,37 ± 3,37 mm2 vs 9,90 ± 1,58mm2 p<0,001) and in PsA patients which have CTS compared to PsA patients with normal EDS(11,63 ± 3,25 mm2 vs 8,87 ± 2,64 mm2 p=0,001, 13,37 ± 3,37 mm2 vs 10,52 ±3,15 mm2 p=0,003). When the CSA compared PsA patients which have normal EDS and healthy volunteers; US (8,87 ± 2,64 vs 8,30 ±1,73 p=0,180) and MRI (10,52 ±3,15 vs 9,35 ± 1,81 p=0,026) show larger CSA in PsA patients. But differance isn’t statistically significant for US measurments. The Pearson correlation coefficient between MRI and US measurements of the CSA was 0.85 (P<0,001).Conclusion:CTS is more common in patients with PsA. The relationship between CTS diagnosed by EDS and CSA measured by US or MRI was observed in both PsA patients and all participants. Diagnosis can be supported by US or MRI in patients who can not undergo EDS or who do not accept EDS. For PsA patients, cut off values obtained from normal people should not be used. The limitations of our study were that our CTS population was small and most of them was mild. We think that this study will be the precursor of CTS studies in PsA patients.References:[1]M. S. Cartwright et al., “Evidence-based guideline: Neuromuscular ultrasound for the diagnosis of carpal tunnel syndrome,” Muscle and Nerve, vol. 46, no. 2, pp. 287–293, Aug. 2012.[2]M. Ikeda, M. Okada, M. Toyama, T. Uemura, K. Takamatsu, and H. Nakamura, “Comparison of median nerve cross-sectional area on 3-T MRI in patients with carpal tunnel syndrome,” Orthopedics, vol. 40, no. 1, pp. e77–e81, Jan. 2017.[3]C. T. Ritchlin, R. A. Colbert, and D. D. Gladman, “Psoriatic Arthritis,” N. Engl. J. Med., vol. 376, no. 10, pp. 957–970, Mar. 2017.Disclosure of Interests:None declared.

Carpal Tunnel Syndrome (CTS) is a common medical condition that results in numbness, pain and tingling in the arm and constitutes about 90% of neuropathy entrapments. The condition arises when the median nerve in the arm is compressed. CTS can degenerate rapidly to cause nerve damage. The effects of CTS on medical practitioners can be serious given the speculation that the condition is work-related. Consequently, this study seeks to establish the prevalence and knowledge of CTS among dental practitioners in the city of Riyadh. In doing so, the research attempts to find relationships between CTS and workload and the experience of the dental practitioners. The study takes the model of sectional study that targets dental practitioners specifically in the city of Riyadh. The researchers recruited 190 dentists and used google forms to collect data from the respondents. The questions in the survey related to symptoms of the condition and the related demographics. The study found a significant comparison of the prevalence and knowledge of CTS among various subgroups. Daily patient exposure and work experience were some of the underlying features discovered in the study. Dentists with more work experience demonstrated significant knowledge on the condition and registered an equally high prevalence of pain associated with CST. The findings of the research show a direct correlation between workload, work experience, and CST.

A survey of 715 Holstein dairy farms in Pennsylvania was used to construct demographics for the average Holstein dairy farm. The average Holstein dairy farm was composed of 69 lactating cows; 11 nonlactating, pregnant cows; 44 heifers; and 18 calves. Milk production averaged 27.3 kg (60.0 lb). Crop area averaged 73.6 ha. Milk production, crop area and type, average county yields, and herd animal groups were used to construct a typical feeding program for these farms. Typical rations were constructed for six feeding groups (three milk production groups, one nonlactating group, two heifer groups) to meet milk production, pregnancy, and growth requirements. Rations were constructed based on three forage qualities (excellent, average, and poor) typically observed on Pennsylvania dairy farms. Data for animal description (milk production, body weight, growth, and pregnancy status) and ration components and amounts consumed for each animal group were input into the excretion model of the Dairy Nutrient Planner computer program (DNP). Excretion of fecal N and dry matter (DM), urinary N, and total P and K were produced for each animal group and used to assess potential volatile losses of N. Work at the Marshak Dairy, New Bolton Center, indicates the majority of urinary N is rapidly lost as ammonia from dairy facilities. Based on this observation, the losses of N as ammonia were estimated to be 4.63, 4.62, and 4.28�tonne/year for the farm with excellent, average, and poor quality forages, respectively. Volatile losses of N may be reduced most by controlling levels of urea in urine. Urinary N may be reduced through dietary manipulation of protein and carbohydrate sources. Conversion of urea to ammonia may be reduced by altering the pH of barn floors and gutters. Entrapment of ammonia may be accomplished by acidification of manure slurry. Atmospheric ammonia contributes to acid rain, eutrophication of estuaries and lakes, and particulate air pollution. Reduction of ammonia emissions from dairy barns can significantly reduce atmospheric pollution and improve air and water quality.

OBJECTIVELiquid embolic agents have revolutionized endovascular management of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs). Nonetheless, since 2005, the US FDA has received more than 100 reports of microcatheter breakage or entrapment related to Onyx embolization, including 9 deaths. In 2014, the Apollo detachable-tip microcatheter became the first of its kind available in the US. Since then, few reports on its safety have been published.METHODSThe authors conducted a retrospective review of endovascular cases by searching the patient databases at 2 tertiary cerebrovascular centers (Barrow Neurological Institute and University of Pittsburgh Medical Center). Patients who underwent endovascular embolization of an AVM or AVF using the Apollo microcatheter were identified. Patient demographics and lesion characteristics were collected. The authors analyzed Apollo-specific endovascular variables, such as number of microcatheterizations, sessions, and pedicles embolized; microcatheter tip detachment status; obliteration rate; and endovascular- and microcatheter-related morbidity and mortality.RESULTSFrom July 2014 to October 2016, a total of 177 embolizations using the Apollo microcatheter were performed in 61 patients (mean age 40.3 years). The most frequent presentation was hemorrhage (22/61, 36.1%). Most lesions were AVMs (51/61, 83.6%; mean diameter 30.6 mm). The mean Spetzler-Martin grade was 2.4. Thirty-nine (76.5%) of 51 patients with AVMs underwent resection. Microcatheterization was successful in 172 pedicles. Most patients (50/61, 82%) underwent a single embolization session. The mean number of pedicles per session was 2.5 (range 1–7). Onyx-18 was used in 103 (59.9%), N-butyl cyanoacrylate (NBCA) in 44 (25.6%), and Onyx-34 in 25 (14.5%) of the 172 embolizations. In 45.9% (28/61) of the patients, lesion obliteration of 75% or greater was achieved. Tip detachment occurred in 19.2% (33/172) of microcatheters. Fifty-three (86.9%) of the 61 patients who underwent embolization with the Apollo microcatheter had good functional outcomes (modified Rankin Scale score 0–2). No unintended microcatheter fractures or related morbidity was observed. One patient died of intraprocedural complications unrelated to microcatheter selection. In the univariate analysis, microcatheter tip detachment (p = 0.12), single embolized pedicles (p = 0.12), and smaller AVM nidus diameter (p = 0.17) correlated positively with high obliteration rates (> 90%). In the multivariate analysis, microcatheter tip detachment was the only independent variable associated with high obliteration rates (OR 9.5; p = 0.03).CONCLUSIONSThe use of the Apollo detachable-tip microcatheter for embolization of AVMs and AVFs is associated with high rates of successful catheterization and obliteration and low rates of morbidity and mortality. The microcatheter was retrieved in all cases, even after prolonged injections in distal branch pedicles, often with significant reflux. This study represents the largest case series on the application of the Apollo microcatheter for neurointerventional procedures.

Abstract Background Percutaneous needle electrolysis is a technique of invasive physical therapy which is increasingly used by physical therapists in their clinical practice. However, to date, no studies have analyzed the presence of adverse effects.The aim of the present study was to evaluate the incidence of adverse effects and the associated impact of the application of ultrasound-guided percutaneous needle electrolysis in disorders of the neuro-musculoskeletal system. Material and Method A prospective case series study was performed over a period of six months at the Sannus Clinic center (Madrid). A sample of patients was identified and recruited, and follow-up was performed up to six months after discharge. Initial information was collected regarding demographic data (age and sex) and clinical data (affected structure, area, type of pain and process associated to the pathology). During each of the sessions performed, percutaneous needle electrolysis was applied in an isolated manner and data were gathered on the treatment received, as well as the presence of any adverse effects. An adverse effect was considered as being any incident related with the application of percutaneous needle electrolysis which caused any damage, as perceived by both the patient and the physical therapist who applied the treatment. The type of adverse effect was recorded (pain, bleeding, hematoma, post-intervention vegetative reactions [sweating, pallor, abdominal discomfort], syncope, skin lesions, damage to organs, nerve lesions, pneumothorax, metal allergy), the moment these appeared (during application, after application, days after the application), its severity (transitory (<48h), reversible (resolved at discharge), irreversible), its impact (did not require any specific intervention, required an additional specific physical therapy intervention, required intervention from medical staff (without hospitalization), and cause (insufficient skill with the technique, malpractice, inappropriate protocol). The adverse effects were classified as mild or severe depending on whether or not an intervention was required. Results 214 patients (60.7% men; 39.3% women) received a total of 772 sessions, the mean number (and standard deviation) of sessions was 3.6 (1.1). The totality of patients treated with ultrasound-guided percutaneous electrolysis received more than one session, according to the methodology described by Valera & Minaya. The main reasons for consultation were tendinous pathologies (70.5%), muscle pathologies (11.7%), ligaments (6.5%), joint capsule-synovia (5.6%), nerve entrapments (4.2%) and others (1.4%). Degenerative processes were more common than acute inflammatory processes. The greatest incidence was in the lower limbs. Degenerative processes were significantly more frequent than tendinous problems. During the 772 sessions of ultrasound-guided percutaneous needle electrolysis, the most common adverse effects were pain during the intervention (96.1%) and in the days following treatment (71.1%), as well as mild vasovagal responses post-intervention (80.1%). One syncope was recorded (0.13%). All the effects were transitory and without impact. No hematomas were detected in the days after a mild bleeding, when this occurred (9.3%). Interventions were performed on the thorax in 1.5% of the procedures, close to organs (0.5%) or close to peripheral nerves (4.2%) without any adverse effect. In the 6-week follow-up after discharge no adverse effects were detected. Conclusions Percutaneous needle electrolysis is a safe technique. The adverse effects provoked by the application of percutaneous needle electrolysis are mild, transitory, without impact on the person's health and following a homogenous pattern. The pain and the mild vasovagal response associated with the intervention are frequent and inherent to the stimulus generated by the needling and the electric current employed.

PurposeThe paper aims to analyze the coverage of health insurance and its correlates in the north-eastern region of India.Design/methodology/approachThe study accessed the raw data of the National Family Health Survey (NFHS-4) (2015–16), which was an extensive, multiround survey conducted in a representative sample of households throughout India, which included socioeconomic, demographic and information on coverage of health insurance of any member of the household. The multivariate analysis of logistic regression was adopted to find the correlates of health insurance for all the eight (8) north-eastern states of India.FindingsThe results observed that among the north-eastern states, the coverage of health insurance was highest in Arunachal Pradesh (59%) followed by Tripura (58%), Mizoram (47%) surpassing the all India level of 27%, whereas the lowest was in Manipur (4%) followed by Nagaland (6%) and Assam (10%). The multivariate analysis of logistic regression found that the socioeconomic and demographic factors, households with a bank account and below poverty line (BPL) cardholders played a significant role in the coverage of health insurance in the north-eastern states of India.Research limitations/implicationsThe study focuses only on the coverage and correlates of health insurance. Further evaluation studies on each scheme of the social health insurance are needed for proper assessment of the health insurance schemes in the region.Practical implicationsThere has been evidence around the world (South Korea, Taiwan and Thailand) that health insurance could be a protective shield from the entrapment into poverty due to high health expenditure. The NFHS-4 put up the finding that in the north-eastern part of India, the coverage of health insurance had been low. This implied that the region could fall into poverty due to high medical expenses on health. Taking account of multiple health insurance providers, risk pooling and consolidation of health insurance providers have become the need of the hour.Originality/valueThe study is different from other studies of health insurance since it covered all the eight (8) north-eastern states of India, which are ethnically, culturally and historically distinct from the rest of India in general and within the region and states in particular and examines the impact of each of the independent variables with the dependent variables. The study has shown that the variation in health insurance coverage associated with socioeconomic and other household-level demographic attributes (although not very strong).

BACKGROUND: Piriformis syndrome (PS) is the common entrapment neuropathy causing buttock pain. Patients are conventionally treated with lifestyle modification, exercise, non-steroidal anti-inflammatory drugs, corticosteroid or botulinum toxin injections. However, some patients may not respond to these conventional treatment methods. Platelet rich plasma (PRP) injection has been shown to be beneficial in various muscular injuries, but its effects have not yet been investigated in PS. OBJECTIVE: The aim of this study was to explore the effect of PRP on pain and functional status in patients with PS, and to identify any correlations between clinical changes and demographic features. METHODS: A total of 60 patients with PS were randomly separated into two groups (PRP and control groups). All patients received one session of either PRP or saline injection performed under ultrasound guidance. The pain was measured with a visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were noted at three intervals in both groups: before treatment, 1 week after treatment and 1 month after treatment. RESULTS: The VAS and ODI scores were improved in both groups. The improvement was more obvious in the PRP group in the first week, and the results were similar for both groups when measured 1 month after the treatment. CONCLUSION: Ultrasound-guided PRP injection provided greater improvements in both pain and functional status in patients with PS, starting in the early period after treatment. A repeat injection might be needed for a long-term effect.

Abstract Background Evidence-based theoretical models outlining the pathways to the development of suicidal ideation may inform treatment. The current research draws from the Interpersonal Theory of Suicide (IPT) and the Integrated Motivational-Volitional (IMV) Model of suicidal behaviour and aims to test the interaction between perceived burdensomeness and thwarted belongingness as proposed by the IPT model, and the defeat-entrapment pathway as proposed by the IMV model, in the prediction of suicidal ideation at 12-month follow-up. Methods The Scottish Wellbeing Study is a nationally representative prospective study of young people aged 18–34 years (n = 3508) from across Scotland, who completed a baseline interview and a 12-month follow-up (n = 2420). The core factors from both the IPT (perceived burdensomeness and thwarted belongingness) and the IMV model (defeat, internal and external entrapment) were measured alongside demographics, depressive symptoms and suicidal ideation at baseline. At 12-month follow-up, suicidal ideation was assessed again. Results In multiple regression analysis perceived burdensomeness and internal entrapment, with baseline suicidal ideation, predicted 12-month suicidal ideation. No support for the interaction between perceived burdensomeness and thwarted belongingness in predicting 12-month suicidal ideation was found. However, there was evidence that internal, but not external, entrapment mediated the relationship between defeat and 12-month suicidal ideation, but no support was found for the moderation of burdensomeness and belongingness on the entrapment to suicidal ideation pathway. Conclusions The current findings highlight the importance of targeting perceived burdensomeness and internal entrapment to reduce the likelihood that suicidal ideation emerges in at risk individuals.

Study Design: Retrospective chart review of pediatric and globe injuries associated with orbital fractures.ObjectiveOur study seeks to examine these injuries and their association with orbital fractures at our trauma center to gain a better understanding of how to approach pediatric patients with orbital fractures. Methods: A retrospective review of all facial fractures in pediatric patients at an urban level 1 trauma center was performed for the years 2002 to 2014. Patient demographics were collected, as well as orbital fracture location, mechanism of injury, concomitant injuries, ophthalmologic documentation, imaging, and perioperative records. Results: One hundred sixteen pediatric patients over a 12-year period sustained an orbital fracture. The orbital floor was the most commonly fractured orbital bone in our series (60%). Thirty-four (30%) of the pediatric patients with orbital fractures had documented periorbital and/or globe injuries at the time of presentation. The most common periorbital injury was entrapment related to orbital floor fractures. Significant eyelid lacerations were present in seven patients, with five of these patients had canalicular injuries and two had canthal malposition. Five pediatric patients presented with traumatic optic neuropathy. Two patients had ruptured globes requiring enucleation. Conclusions: Periorbital soft tissue and globe injuries associated with orbital fractures occurs in a substantial number of pediatric patients. There are no guidelines for treatment of these type of injuries in the pediatric population. Further research should be performed to better understand the appropriate management of periorbital injuries in conjunction with surgical management of the orbital fractures

Introduction I am on the phone with a journalist discussing my research into anti-vaccination. As the conversation winds up, they ask a question I have come to expect: "how big do you think this is?" My answer is usually some version of the following: that we have no way of knowing. I and my fellow researchers can only see the information that is public or in the sunlight. How anti-vaccination information spreads through private networks is dark to us. It is private and necessarily so. This means that we cannot track how these conversations spread in the private or parochial spaces of Facebook, nor can we consider how they might extend into other modes of mediated communication. Modern communication is a complex and multiplatform accomplishment. Consider this: I am texting with my friend, I send her a selfie, in the same moment I hear a notification, she has DMed me a relevant Instagram post via that app. I move to Instagram and share another post in response; we continue our text message conversation there. Later in the day, I message her on Facebook Messenger while participating in a mutual WhatsApp group chat. The next day we Skype, and while we talk, we send links back and forth, which in hindsight are as clear as hieroglyphics before the Rosetta stone. I comment on her Twitter post, and we publicly converse back and forth briefly while other people like our posts. None of these instances are discrete conversational events, even though they occur on different platforms. They are iterations on the same themes, and the archival properties of social media and private messaging apps mean that neither of you forgets where you left off. The conversation slides not only between platforms and contexts but in and out of visibility. Digitally mediated conversation hums in the background of daily life (boring meetings, long commutes and bad dates) and expands our understanding of the temporal and sequential limits of conversation. In this article, I will explore digitally-mediated cross-platform conversation as a problem in two parts, and how we can understand it as part of the 'dark social'. Specifically, I want to draw attention to how 'dark' online spaces are part of our everyday communicative practices and are not necessarily synonymous with the illicit, illegal, or deviant. I argue that the private conversations we have online are also part of the dark social web, insofar as they are hidden from the public eye. When I think of dark social spaces, I think of what lies beneath the surface of murky waters, what hides behind in backstage areas, and the moments between platforms. In contrast, 'light' (or public) social spaces are often perceived as siloed. The boundaries between these platforms are artificially clean and do not appear to leak into other spaces. This article explores the dark and shadowed spaces of online conversation and considers how we might approach them as researchers. Conversations occur in the backchannels of social media platforms, in private messaging functions that are necessarily invisible to the researcher's gaze. These spaces are distinct from the social media activity analysed by Marwick and boyd. Their research examining teens' privacy strategies on social media highlights how social media posts that multiple audiences may view often hold encoded meanings. Social media posts are a distinct and separate category of activity from meditated conversations that occur one to one, or in smaller group chat settings. Second is the disjunction between social media platforms. Users spread their activity across any number of social media platforms, according to social and personal logics. However, these movements are difficult to capture; it is difficult to see in the dark. Platforms are not hermeneutically sealed off from each other, or the broader web. I argue that understanding how conversation moves between platforms and in the backstage spaces of platforms are two parts of the same dark social puzzle. Conversation Online Digital media have changed how we maintain our social connections across time and space. Social media environments offer new possibilities for communication and engagement as well as new avenues for control. Calls and texts can be ignored, and our phones are often used as shields. Busying ourselves with them can help us avoid unwanted face-to-face conversations. There are a number of critiques regarding the pressure of always-on contact, and a growing body of research that examines how users negotiate these demands. By examining group messaging, Mannell highlights how the boundaries of these chats are porous and flexible and mark a distinct communicative break from previous forms of mobile messaging, which were largely didactic. The advent of group chats has also led to an increasing complication of conversation boundaries. One group chat may have several strands of conversation sporadically re-engaged with over time. Manell's examination of group chats empirically illustrates the complexity of digitally-mediated conversations as they move across private, parochial, and public spaces in a way that is not necessarily temporally linear. Further research highlights the networked nature of digitally mediated interpersonal communication and how conversations sprawl across multiple platforms (Burchell). Couldry (16, 17) describes this complex web as the media manifold. This concept encompasses the networked platforms that comprise it and refers to its embeddedness in daily life. As we no longer “log on” to the internet to send and receive email, the manifold is both everywhere and nowhere; so too are our conversations. Gershon has described the ways we navigate the communicative affordances of these platforms as “media ideologies" which are the "beliefs, attitudes, and strategies about the media they [individuals] use" (391). Media ideologies also contain implicit assumptions about which platforms are best for delivering which kinds of messages. Similarly, Burchell argues that the relational ordering of available media technologies is "highly idiosyncratic" (418). Burchell contends that this idiosyncratic ordering is interdependent and relational, and that norms about what to do when are both assumed by individuals and learnt in their engagement with others (418). The influence of others allows us to adjust our practices, or as Burchell argues, "to attune and regulate one's own conduct … and facilitate engagement despite the diverse media practices of others" (418). In this model, individuals are constantly learning and renegotiating norms of conversation on a case by case, platform by platform basis. However, I argue that it is more illuminating to consider how we have collectively developed an implicit and unconscious set of norms and signals that govern our (collective) conduct, as digitally mediated conversation has become embedded in our daily lives. This is not to say that everyone has the same conversational skill level, but rather that we have developed a common toolbox for understanding the ebb and flow of digitally mediated conversations across platforms. However, these norms are implicit, and we only have a partial understanding of how they are socially achieved in digitally-mediated conversation. What Lies Beneath Most of what we do online is assumed not to be publicly visible. While companies like Facebook trace us across the web and peer into every nook and cranny of our private use patterns, researchers have remained focussed on what lies above in the light, not below, in the dark. This has meant an overwhelming focus on single platform studies that rely on the massification of data as a default measure for analysing sentiment and behaviour online. Sociologically, we know that what occurs in dark social spaces, or backstage, is just as important to social life as what happens in front of an audience (Goffman). Goffman's research uses the metaphor of the theatre to analyse how social life is accomplished as a performance. He highlights that (darkened) backstage spaces are those where we can relax, drop our front, and reveal parts of our (social) self that may be unpalatable to a broader audience. Simply, the public data accessible to researchers on social media are “trace data”, or “trace conversation”, from the places where conversations briefly leave (public) footprints and can be tracked and traced before vanishing again. Alternatively, we can visualise internet researchers as swabbing door handles for trace evidence, attempting to assemble a narrative out of a left-behind thread or a stray fingerprint. These public utterances, often scraped through API access, are only small parts of the richness of online conversation. Conversations weave across multiple platforms, yet single platforms are focussed on, bracketing off their leaky edges in favour of certainty. We know the social rules of platforms, but less about the rules between platforms, and in their darker spaces. Conversations briefly emerge into the light, only to disappear again. Without understanding how conversation is achieved and how it expands and contracts and weaves in and out of the present, we are only ever guessing about the social dynamics of mediated conversation as they shift between light, dark, and shadow spaces. Small things can cast large shadows; something that looms large may be deceptively small. Online they could be sociality distorted by disinformation campaigns or swarms of social bots. Capturing the Unseen: An Ethnomethodological Approach Not all data are measurable, computable, and controllable. There is uncertainty beyond what computational logics can achieve. Nooks and crannies of sociality exist beyond the purview of computable data. This suggests that we can apply pre-digital social research methods to capture these “below the surface” conversations and understand their logics. Sociologists have long understood that conversation is a social accomplishment. In the 1960s, sociologist Harvey Sacks developed conversation analysis as an ethnomethodological technique that seeks to understand how social life is accomplished in day-to-day conversation and micro-interactions. Conversation analysis is a detailed and systematic account of how naturally-occurring talk is socially ordered, and has been applied across a number of social contexts, including news interviews, judicial settings, suicide prevention hotlines, therapy sessions, as well as regular phone conversations (Kitzinger and Frith). Conversation analysis focusses on fine-grained detail, all of the little patterns of speech that make up a conversation; for example, the pauses, interruptions, self-corrections, false starts, and over-speaking. Often these too are hidden features of conversation, understood implicitly, but hovering on the edges of our social knowledge. One of the most interesting uses of conversational analysis is to understand refusal, that is, how we say 'no' as a social action. This body of research turns common-sense social knowledge – that saying no is socially difficult – into a systemic schema of social action. For instance, acceptance is easy to achieve; saying yes typically happens quickly and without hesitation. Acceptances are not qualified; a straightforward 'yes' is sufficient (Kitzinger and Frith). However, refusals are much more socially complex. Refusal is usually accomplished by apologies, compliments, and other palliative strategies that seek to cushion the blow of refusals. They are delayed and indirect conversational routes, indicating their status as a dispreferred social action, necessitating their accompaniment by excuses or explanations (Kitzinger and Frith). Research by Kitzinger and Frith, examining how women refuse sexual advances, illustrates that we all have a stock of common-sense knowledge about how refusals are typically achieved, which persists across various social contexts, including in our intimate relationships. Conversation analysis shows us how conversation is achieved and how we understand each other. To date, conversation analysis techniques have been applied to spoken conversation but not yet extended into text-based mediated conversation. I argue that we could apply insights from conversation analysis to understand the rules that govern digitally mediated conversation, how conversation moves in the spaces between platforms, and the rules that govern its emergence into public visibility. What rules shape the success of mediated communication? How can we understand it as a social achievement? When conversation analysis walks into the dark room it can be like turning on the light. How can we apply conversation analysis, usually concerned with the hidden aspects of plainly visible talk, to conversation in dark social spaces, across platforms and in private back channels? There is evidence that the norms of refusal, as highlighted by conversation analysis, are persistent across platforms, including in people's private digitally-mediated conversations. One of the ways in which we can identify these norms in action is by examining technology resistance. Relational communication via mobile device is pervasive (Hall and Baym). The concentration of digitally-mediated communication into smartphones means that conversational norms are constantly renegotiated, alongside expectations of relationship maintenance in voluntary social relationships like friendship (Hall and Baym). Mannell also explains that technology resistance can include lying by text message when explaining non-availability. These small, habitual, and often automatic lies are categorised as “butler lies” and are a polite way of achieving refusal in digitally mediated conversations that are analogous to how refusal is accomplished in face-to-face conversation. Refusals, rejections, and, by extension, unavailability appear to be accompanied by the palliative actions that help us achieve refusal in face-to-face conversation. Mannell identifies strategies such as “feeling ill” to explain non-availability without hurting others' feelings. Insights from conversation analysis suggest that on balance, it is likely that all parties involved in both the furnishing and acceptance of a butler lie understand that these are polite fabrications, much like the refusals in verbal conversation. Because of their invisibility, it is easy to assume that conversations in the dark social are chaotic and disorganised. However, there are tantalising hints that the reverse is true. Instead of arguing that individuals construct conversational norms on a case by case, platform by platform basis, I suggest that we now have a stock of common-sense social knowledge that we also apply to cross-platform mediated communication. In the spaces where gaps in this knowledge exist, Szabla and Blommaert argue that actors use existing norms of interactions and can navigate a range of interaction events even in online environments where we would expect to see a degree of context collapse and interactional disorganisation. Techniques of Detection How do we see in the dark? Some nascent research suggests a way forward that will help us understand the rhythms of cross-platform mediated conversation. Apps have been used to track participants' messaging and calling activities (Birnholtz, Davison, and Li). This research found a number of patterns that signal a user's attention or inattention, including response times and linguistic clues. Similarly, not-for-profit newsroom The Markup built a Facebook inspector called the citizen browser, a "standalone desktop application that was distributed to a panel of more than 1000 paid participants" (Mattu et al.). The application works by being connected to a participant's Facebook account and periodically capturing data from their Facebook feeds. The data is automatically deidentified but is still linked to the demographic information that participants provide about themselves, such as gender, race, location, and age. Applications like these point to how researchers might reliably collect interaction data from Facebook to glimpse into the hidden networks and interactions that drive conversation. User-focussed data collection methods also help us, as researchers, to sever our reliance on API access. API-reliant research is dependent on the largesse of social media companies for continued access and encourages research on the macro at the micro's expense. After all, social media and other digital platforms are partly constituted by the social acts of their users. Without speech acts that constitute mediated conversation, liking, sharing GIFs, and links, as well as the gaps and silences, digital platforms cease to exist. Digital platforms are not just archives of “big data”, but rather they are collections of speech and records of how our common-sense knowledge about how to communicate has stretched and expanded beyond face-to-face contexts. A Problem of Bots Ethnomethodological approaches have been critiqued as focussing too much on the small details of conversation, on nit-picking small details, and thus, as unable to comment on macro social issues of oppression and inequality (Kitzinger and Frith 311). However, understanding digitally-mediated conversation through the lens of talk-as-human-interaction may help us untangle our most pressing social problems across digital platforms. Extensive research examines platforms such as Twitter for “inauthentic” behaviour, primarily identifying which accounts are bots. Bots accounts are programmed Twitter accounts (for example) that automatically tweet information on political or contentious issues, while mimicking genuine engagement. Bots can reply to direct messages too; they converse with us as they are programmed to act as “humanly” as possible. Despite this, there are patterns of behaviour and engagement that distinguish programmed bot accounts, and a number of platforms are dedicated to their detection. However, bots are becoming increasingly sophisticated and better able to mimic “real” human engagement online. But there is as yet no systematic framework regarding what “real” digitally mediated conversation looks like. An ethnomethodological approach to understanding this would better equip platforms to understand inauthentic activity. As Yang and colleagues succinctly state, "a supervised machine learning tool is only as good as the data used for its training … even the most advanced [bot detection] algorithms will fail with outdated training datasets" (8). On the flipside, organisations are using chat bots to deliver cognitive behavioural therapy and assist people in moments of psychological distress. But the bots do not feel human; they reply instantly to any message sent. Some require responses in the form of emojis. The basis of therapy is talk. Understanding more accurately how naturally-occurring talk functions in online spaces could create more sensitive and genuinely therapeutic tools. Conclusion It is easy to forget that social media have largely mainstreamed over the last decade; in this decade, crucial social norms about how we converse online have developed. These norms allow us to navigate our conversations, with intimate friends and strangers alike across platforms, both in and out of public view, in ways that are often temporally non-sequential. Dark social spaces are a matter of intense marketing interest. Advertising firm Disruptive Advertising identified the very spaces that are the focus of this article as “dark social”: messaging apps, direct messaging, and native mobile apps facilitate user activity that is "not as easily controlled nor tracked". Dark social traffic continues to grow, yet our understanding of why, how, and for whom trails behind. To make sense of our social world, which is increasingly indistinguishable from online activity, we need to examine the spaces between and behind platforms, and how they co-mingle. Where are the spaces where the affordances of multiple platforms and technologies scrape against each other in uncomfortable ways? How do users achieve intelligible conversation not just because of affordances, but despite them? Focussing on micro-sociological encounters and conversations may also help us understand what could build a healthy online ecosystem. How are consensus and agreement achieved online? What are the persistent speech acts (or text acts) that signal when consensus is achieved? To begin where I started, to understand the scope and power of anti-vaccination sentiment, we need to understand how it is shared and discussed in dark social spaces, in messaging applications, and other backchannel spaces. Taking an ethnomethodological approach to these conversational interactions could also help us determine how misinformation is refused, accepted, and negotiated in mediated conversation. Focussing on “dark conversation” will help us more richly understand our social world and add much needed insight into some of our pressing social problems. References Burchell, Kenzie. 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