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A major point of debate in the study of the Internet and politics is the extent to which social media platforms encourage citizens to inhabit online “bubbles” or “echo chambers,” exposed primarily to ideologically congenial political information. To investigate this question, we link a representative survey of Americans with data from respondents’ public Twitter accounts (N = 1,496). We then quantify the ideological distributions of users’ online political and media environments by merging validated estimates of user ideology with the full set of accounts followed by our survey respondents (N = 642,345) and the available tweets posted by those accounts (N ~ 1.2 billion). We study the extent to which liberals and conservatives encounter counter-attitudinal messages in two distinct ways: (a) by the accounts they follow and (b) by the tweets they receive from those accounts, either directly or indirectly (via retweets). More than a third of respondents do not follow any media sources, but among those who do, we find a substantial amount of overlap (51%) in the ideological distributions of accounts followed by users on opposite ends of the political spectrum. At the same time, however, we find asymmetries in individuals’ willingness to venture into cross-cutting spaces, with conservatives more likely to follow media and political accounts classified as left-leaning than the reverse. Finally, we argue that such choices are likely tempered by online news watching behavior.

of delusion. My husband Sir, was halfway mad- Sir, and at the last only recall a pipe-smoke kiss that look and I knew: Eli, Eli, it is finished.

Introduction The STOP-Bang Questionnaire is a validated instrument to assess an individual’s risk for obstructive sleep apnea (OSA). The prevalence of OSA is estimated at 20% in the US with only 20% of those individuals properly diagnosed. Dentists are being asked to screen and refer patients at high risk for OSA for definitive diagnosis and treatment. The aim of this study was to determine whether patients in a dental school student clinic who were identified as high-risk for OSA, were referred for evaluation of OSA. Methods All new patients over the age of 18 admitted to The Ohio State University - College of Dentistry complete an “Adult Medical History Form”. Included in this study were 21,312 patients admitted between July 2017 and March 2020. Data were extracted from the history form to determine the STOP-Bang Score for all patients: age, sex, BMI, self-reported snoring-, stopped breathing/choking/gasping while sleeping-, high blood pressure-, neck size over 17” (males) or 16” (females)-, and tiredness. Each positive response is a point, for a maximum of 8 points possible. Additionally, any previous diagnosis of sleep apnea, and the patient’s history of referrals were extracted from the health record. According to clinic policy, if the patient did not have a previous diagnosis for OSA noted in the health history, and scored 5 or more on the STOP-Bang Questionnaire, they should receive a referral for an evaluation for OSA. Notes and referral forms were reviewed to determine if the appropriate referrals occurred for patients at high risk without a previous diagnosis. Results Of the 21,312 patients screened; 1098 (5.2%) screened high-risk for OSA, of which 398 had no previous diagnosis of OSA. Of these 398 patients, none (0%) had referrals for further evaluation for OSA. Conclusion The rate of appropriate referrals from a student dental clinic with an electronic health record was unacceptably low. Continued education and changes to the electronic health record are needed to ensure those at high-risk for OSA are appropriately referred and managed. Support (if any):