What do Australian health consumers believe about commercial advertisements and testimonials? a survey on health service advertising.

BACKGROUND: There has been little examination of consumer attitudes towards the commercial advertising of healthcare services in Australia and how marketing is used by consumers in their health decision-making. In this research, we examined how consumers reported commercial advertising helped them to understand the health services available to them and the influence that marketing had upon their choices. METHODS: A survey instrument using a Likert scale to indicate agreement or disagreement with 21 questions was developed using qualitative interviews before being distributed online within Australia. Sampling of participants was stratified by age, gender and location. The results were subjected to statistical analysis with Spearman Rank Correlation test being used for bivariate analysis. RESULTS: One thousand five hundred sixty-four complete surveys were collected. The results revealed certain consumer beliefs, for example; the title of 'Dr' was believed to indicate skill and high levels of training (81.0%), with 80.3% agreeing incorrectly that use of the title was strictly regulated. Participants reported to have a higher confidence in their own abilities (71.2%) than the public (52.8%) in assessing health advertising. The level of self-confidence increased with higher education level and decreased by age (p < 0.05). Testimonials were reported to be lacking in reliability (67.7%) and that they should not be used in healthcare in the same manner as they are used in other industries. Only 44.8% of participants reported that they felt confident to spot a review that was not written by a genuine user of a service. CONCLUSIONS: The data demonstrated that many health consumers felt that while commercial health advertising was helpful, it was also confusing, with many participants also holding mistaken beliefs around other elements of commercial health advertising. While the advertising of healthcare services might have educational effects and be superficially empowering, advertising is primarily intended to sell, not educate. This research demonstrates that there is significant potential for healthcare advertising to mislead. Future developments in regulatory health advertising policy, and the related ethical frameworks developed by professional healthcare associations, need to consider how the consumers of healthcare services might be better protected from misleading and predatory advertising practices.

The influence of sleep health on dietary intake: a systematic review and meta-analysis of intervention studies.

BACKGROUND: Poor dietary intake increases disease risk, and poor sleep influences diet. This systematic review and meta-analysis of intervention studies aimed to evaluate the effect of sleep health on dietary intake in adults. METHODS: Five online databases were used to identify studies published between 1970 and 2019. Included studies were interventions that modified sleep and reported dietary outcomes. RESULTS: Fifty four full texts were assessed and 24 publications were included. Following risk of bias appraisal, data were narratively summarised and a sub-group of studies (n = 15) was meta-analysed to determine the effect of sleep on dietary intake. One intervention modified sleep timing and 23 modified duration. Sleep duration was partially restricted (≤5.5 h night-1 ) (n = 16), totally restricted (n = 4), partially and totally restricted (n = 1), and extended (n = 2). Dietary outcomes were energy intake (n = 24), carbohydrate, fat, protein intake (n = 20), single nutrient intake (n = 5), diet quality (n = 1) and food types (n = 1). Meta-analysis indicated partial sleep restriction results in higher energy intake in intervention compared with control [standardised mean difference (SMD) = 0.37; 95% confidence interval (CI) = 0.21-0.52; P < 0.001], with a mean difference of 204 kcal (95% CI = 112-295; P < 0.001) in daily energy intake, and a higher percentage of energy from fat, protein, carbohydrate (fat: SMD = 0.33; 95% CI = 0.16-0.51; P < 0.001; protein: SMD = 0.30, 95% CI = 0.12-0.47, P = 0.001; carbohydrate: SMD = 0.22, 95% CI = 0.04-0.39, P = 0.014). CONCLUSIONS: Partial sleep restriction with duration of ≤5.5 h day-1 increases daily energy intake, as well as fat, protein and carbohydrate intake. Further research is needed to determine the relationship between other dimensions of sleep health and dietary intake.

Controlling the Structure of MoS2 Membranes via Covalent Functionalization with Molecular Spacers.

Restacked two-dimensional (2D) materials represent a new class of membranes for water-ion separations. Understanding the interplay between the 2D membrane's structure and the constituent material's surface chemistry to its ion sieving properties is crucial for further membrane development. Here, we reveal, and tune via covalent functionalization, the structure of MoS2-based membranes. We find features on both the ∼1 nm (interlayer spacing) and ∼100 nm (mesoporous voids between layers) length scales that evolve with the hydration level. The functional groups act as permanent molecular spacers, preventing local impermeability caused by irreversible restacking and promoting the uniform rehydration of the membrane. Molecular dynamics simulations show that the choice of functional group tunes the structure of water within the MoS2 channel and consequently determines the hydrated interlayer spacing. We demonstrate that MoS2 membranes functionalized with acetic acid have consistently ∼92% rejection of Na2SO4 with a flux of ∼1.5 lm-2 hr-1 bar-1.

Unusually strong hydrogen bond cooperativity in particular (H2O)20 clusters.

Drawing upon an intuitive charge-transfer-based picture of hydrogen bonding, we demonstrate that cooperativity effects acting in concert can lead to unusually strong hydrogen bonds in neutral water clusters. The structure, vibrational, and NMR properties of a (H2O)20 pentagonal dodecahedron cluster containing such a strong hydrogen bond were studied using second-order perturbation theory and density functional theory. The hydrogen bond length was found to be shorter than 2.50 Å. A large redshift of over 2000 cm-1 with respect to the isolated water molecule was predicted for the OH stretching frequency of the donor water molecule. A large downfield shift to 13.5 ppm of the isotropic part of the 1H magnetic shielding tensor together with an unusually large shielding anisotropy of 49.9 ppm was obtained. The hydrogen bond energy was calculated using symmetry-adapted perturbation theory and was found to be more than three times stronger than a typical hydrogen bond in liquid water.

Dephasing and Decoherence in Vibrational and Electronic Line Shapes.

Absorption and emission line shapes of vibrational and electronic transitions in liquids are broadened by interactions with the "bath" (in this case, the rotational and translational degrees of freedom of all the molecules in the liquid). If these degrees of freedom are treated classically, the broadening process is often known as dephasing. If, on the other hand, the bath degrees of freedom are instead treated quantum mechanically, there is additional broadening due to what is known in the chemical-physics literature as decoherence. The question addressed in this paper is the relative importance of decoherence (bath quantum effects) and dephasing. We present general developments of this subject for absorption and emission line shapes, discover several new relationships connecting classical and quantum treatments of the bath, and also consider the Stokes shift (difference in peak frequencies in absorption and emission). We next draw some general conclusions by considering a model system whose transition-frequency time-correlation function has only one bath time scale. We then consider a realistic system of the vibrational OH stretch transition of dilute HOD in liquid D2O at room temperature. For this system, we conclude that bath quantum effects are not very important, except for the Stokes shift. More generally, we argue that this is the case for many vibrational and most electronic transitions in room-temperature liquids.

IR Spectroscopy Can Reveal the Mechanism of K+ Transport in Ion Channels.

Ion channels like KcsA enable ions to move across cell membranes at near diffusion-limited rates and with very high selectivity. Various mechanisms have been proposed to explain this phenomenon. Broadly, there is disagreement among the proposed mechanisms about whether ions occupy adjacent sites in the channel during the transport process. Here, using a mixed quantum-classical approach to calculate theoretical infrared spectra, we propose a set of infrared spectroscopy experiments that can discriminate between mechanisms with and without adjacent ions. These experiments differ from previous ones in that they independently probe specific ion binding sites within the selectivity filter. When ions occupy adjacent sites in the selectivity filter, the predicted spectra are significantly redshifted relative to when ions do not occupy adjacent sites. Comparisons between theoretical and experimental peak frequencies will therefore discriminate the mechanisms.

Cross-Sectional Associations Between Dietary Antioxidant Vitamins C, E and Carotenoid Intakes and Sarcopenic Indices in Women Aged 18-79 Years.

The prevalence of sarcopenia is increasing in aging populations, so prevention is critical. Vitamins (A, C, E and carotenoids) modify skeletal muscle via protein and collagen synthesis and anti-inflammatory activities. Previous studies have not investigated intake of these vitamins in relation to sarcopenic indices in both younger and older-aged women. Indices of skeletal muscle mass (as fat-free mass (FFM) relative to body size) were measured using DXA and leg explosive power (LEP) using the Nottingham Power Rig in 2570 women aged 18-79 years. Adjusted measures of skeletal muscle were calculated according to quintiles of vitamin C, E, retinol and carotenoid intake, derived from Food Frequency Questionnaires, after stratification by age. Higher vitamin C intake was associated with significantly higher indices of FFM and LEP, (Q5-Q1 = 2.0-12.8%, P < 0.01-0.02). Intakes of total and individual carotenoids were significantly associated with indices of FFM and LEP (Q5-Q1 = 1.0-7.5%). Vitamin E was significantly associated with FFM% and FFMBMI only. In mutually adjusted analysis with vitamin C, total carotene, vitamin E and protein in the model, the strongest associations were with vitamin C. These associations were stronger in younger women (< 65 years). For the first time, our research shows higher dietary intakes of antioxidant vitamins, particularly vitamin C, is associated with higher skeletal muscle mass and power in free-living women. These findings have relevance for the treatment and prevention of frailty and sarcopenia throughout adulthood.

Machine Learning for Vibrational Spectroscopic Maps.

Maps that relate spectroscopic properties of a vibrational mode and collective solvent coordinates have proven useful in theoretical vibrational spectroscopy of condensed-phase systems. It has been realized that the predictive power of such an approach is limited and there is no clear systematic way to improve its accuracy. Here, we propose an adaptation of Δ-machine-learning methodology that goes beyond the spectroscopic maps. The machine-learning part of our approach combines Gaussian process regression used to generate the data set with an artificial neural network used to predict spectroscopic properties of interest. A specific application to the OH-stretch frequencies and transition dipoles of water is presented. Our method approximates these properties about two times more accurately than the spectroscopic-maps-only-based approach. Our results suggest that the new approach may become useful in the study of vibrational spectroscopy of condensed-phase systems.

Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation.

OBJECTIVES: The medially spherical GMK Sphere (Medacta International AG, Castel San Pietro, Switzerland) total knee arthroplasty (TKA) was previously shown to accommodate lateral rollback while pivoting around a stable medial compartment, aiming to replicate native knee kinematics in which some coronal laxity, especially laterally, is also present. We assess coronal plane kinematics of the GMK Sphere and explore the occurrence and pattern of articular separation during static and dynamic activities. METHODS: Using pulsed fluoroscopy and image matching, the coronal kinematics and articular surface separation of 16 well-functioning TKAs were studied during weight-bearing and non-weight-bearing, static, and dynamic activities. The closest distances between the modelled articular surfaces were examined with respect to knee position, and proportions of joint poses exhibiting separation were computed. RESULTS: Overall, 1717 joint poses were analyzed. At a 1.0 mm detection threshold, 37 instances of surface separation were observed in the lateral compartment and four medially (p < 0.001). Separation was activity-dependent, both laterally and medially (p < 0.001), occurring more commonly during static deep flexion in the lateral compartment, and during static rotation in the medial compartment. Lateral separation occurred more frequently than medial during kneeling (7/14 lateral vs 1/14 medial; p = 0.031) and stepping (20/1022 lateral vs 0/1022 medial; p < 0.001). Separation varied significantly between individuals during dynamic activities. CONCLUSION: No consistent association between closest distances of the articular surfaces and knee position was found during any activity. Lift-off was infrequent and depended on the activity performed and the individual knee. Lateral separation was consistent with the design rationale. Medial lift-off was rare and mostly in non-weight-bearing activities.Cite this article: S. Key, G. Scott, J.G. Stammers, M. A. R. Freeman†, V. Pinskerova, R. E. Field, J. Skinner, S. A. Banks. Does lateral lift-off occur in static and dynamic activity in a medially spherical total knee arthroplasty? A pulsed-fluoroscopic investigation. Bone Joint Res 2019;8:207-215. DOI: 10.1302/2046-3758.85.BJR-2018-0237.R1.

OH-Stretch Raman Multivariate Curve Resolution Spectroscopy of HOD/H2O Mixtures.

Recently, in an attempt to quantify the role of intermolecular OH stretching vibrational couplings in liquid water, experimental Raman spectra of HOD/H2O mixtures were analyzed using the multivariate curve resolution (Raman-MCR) algorithm. This algorithm allowed for the separation of the HOD solute-correlated spectrum from the spectrum of bulk water. The former spectrum highlights features arising from HOD itself as well as from perturbations it induces on the surrounding H2O molecules. In this work, we apply a mixed quantum-classical methodology developed in our group to simulate the isotropic Raman-MCR spectra of HOD/H2O mixtures. Our results illustrate that intermolecular coupling leads to broadening and a red shift of the OH stretching band, in good agreement with the experiment. Our theoretical analysis provides a molecular-level interpretation of Raman-MCR experiments on HOD/H2O mixtures, suggesting that perturbations affecting the OH stretching vibrational mode of HOD result from intermolecular vibrational coupling to surrounding H2O molecules extending well beyond the first solvation shell.

Analysis of the Attune tibial tray backside: A comparative retrieval study.

OBJECTIVES: The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic. METHODS: We examined 12 titanium (Ti) PFC Sigma implants, eight cobalt-chromium (CoCr) PFC Sigma implants, eight cobalt-chromium PFC Sigma rotating platform (RP) implants, and 11 Attune implants. We used a peer-reviewed digital imaging method to quantify the amount of cement attached to the backside of each tibial tray. We then measured: 1) the size of tibial tray thickness, tray projections, peripheral lips, and undercuts; and 2) surface roughness (Ra) on the backside and keel of the trays. Statistical analyses were performed to investigate differences between the two designs. RESULTS: There was no evidence of cement attachment on any of the 11 Attune trays examined. There were significant differences between Ti and CoCr PFC Sigma implants and Attune designs (p < 0.05); however, there was no significant difference between CoCr PFC Sigma RP and Attune designs (p > 0.05). There were significant differences in the design features between the investigated designs (p < 0.05). CONCLUSION: The majority of the earliest PFC Sigma designs showed evidence of cement, while all of the retrieved Attune trays and the majority of the RP PFC trays in this study had no cement attached. This may be attributable to the design differences of these implants, in particular in relation to the cement pockets. Our results may help explain a controversial aspect related to cement attachment in a recently introduced TKA design.Cite this article: A. Cerquiglini, J. Henckel, H. Hothi, P. Allen, J. Lewis, A. Eskelinen, J. Skinner, M. T. Hirschmann, A. J. Hart. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019;8:136-145. DOI: 10.1302/2046-3758.83.BJJ-2018-0102.R2.

Mid-IR spectroscopy of supercritical water: From dilute gas to dense fluid.

Mixed quantum-classical methods are commonly used to calculate infrared spectra for condensed-phase systems. These methods have been applied to study water in a range of conditions from liquid to solid to supercooled. Here, we show that these methods also predict infrared line shapes in excellent agreement with experiments in supercritical water. Specifically, we study the OD stretching mode of dilute HOD in H2O. We find no qualitative change in the spectrum upon passing through the near-critical region (Widom line) or the hydrogen-bond percolation line. At very low densities, the spectrum does change qualitatively, becoming rovibrational in character. We describe this rovibrational spectrum from the perspective of classical mechanics and provide a classical interpretation of the rovibrational line shape for both HOD and H2O. This treatment is perhaps more accessible than the conventional quantum-mechanical treatment.

Process evaluation of the midwifery initiated oral health-dental service program: perceptions of pregnant women.

BACKGROUND: Pregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery-initiated oral health dental service (MIOH-DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH-DS using the perspectives of pregnant women who participated in the trial. METHODS: A qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi-structured interviews with women who participated in the program. RESULTS: All participants were receptive of the MIOH-DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health-seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment. CONCLUSIONS: The MIOH-DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007.

OBJECTIVES: Previous studies have suggested that metal-on-metal (MoM) Pinnacle (DePuy Synthes, Warsaw, Indiana) hip arthroplasties implanted after 2006 exhibit higher failure rates. This was attributed to the production of implants with reduced diametrical clearances between their bearing surfaces, which, it was speculated, were outside manufacturing tolerances. This study aimed to better understand the performance of Pinnacle Systems manufactured before and after this event. METHODS: A total of 92 retrieved MoM Pinnacle hips were analyzed, of which 45 were implanted before 2007, and 47 from 2007 onwards. The 'pre-2007' group contained 45 implants retrieved from 21 male and 24 female patients, with a median age of 61.3 years (interquartile range (IQR) 57.1 to 65.5); the '2007 onwards' group contained 47 implants retrieved from 19 male and 28 female patients, with a median age of 61.8 years (IQR 58.5 to 67.8). The volume of material lost from their bearing and taper surfaces was measured using coordinate and roundness measuring machines. These outcomes were then compared statistically using linear regression models, adjusting for potentially confounding factors. RESULTS: There was no significant difference between the taper and bearing wear rates of the 'pre-2007' and '2007 onwards' groups (p = 0.67 and p = 0.39, respectively). Pinnacles implanted from 2007 onwards were revised after a mean time of 50 months, which was significantly earlier than the 'pre-2007' hips (96 months) (p < 0.001). A reduction in the time to revision was present year on year from 2003 to 2011. CONCLUSION: We found no difference in the wear rate of these implants based on the year of implantation. The 'pre-2007' hips had a two-fold greater time to revision than those implanted after 2007; this may be due to the increased surveillance of MoM hips following UK regulatory advice and several high-profile failures. Interestingly, we observed a decreasing trend in the mean time to revision every year from 2003 onwards.Cite this article: S. Bergiers, H. S. Hothi, J. Henckel, A. Eskelinen, J. Skinner, A. Hart. Wear performance of retrieved metal-on-metal Pinnacle hip arthroplasties implanted before and after 2007. Bone Joint Res 2018;7:595-600. DOI: 10.1302/2046-3758.711.BJR-2018-0143.R1.

Perspective: Crossing the Widom line in no man's land: Experiments, simulations, and the location of the liquid-liquid critical point in supercooled water.

The origin of liquid water's anomalous behavior continues to be a subject of interest and debate. One possible explanation is the liquid-liquid critical point hypothesis, which proposes that supercooled water separates into two distinct liquids at low temperatures and high pressures. According to this hypothesis, liquid water's anomalies can be traced back to the critical point associated with this phase separation. If such a critical point actually exists, it is located in a region of the phase diagram known as No Man's Land (NML), where it is difficult to characterize the liquid using conventional experimental techniques due to rapid crystallization. Recently, however, experimentalists have managed to explore NML near the proposed location of the Widom line (i.e., the Kanno-Angell line), thereby providing valuable information concerning the liquid-liquid critical point hypothesis. In this perspective, we analyze these experimental results, in conjunction with molecular dynamics simulations based on the E3B3 water model and discuss their implications for the validity of the liquid-liquid critical point hypothesis and the possible location of water's second critical point.

Communication: Diffusion constant in supercooled water as the Widom line is crossed in no man's land.

According to the liquid-liquid critical point (LLCP) hypothesis, there are two distinct phases of supercooled liquid water, namely, high-density liquid and low-density liquid, separated by a coexistence line that terminates in an LLCP. If the LLCP is real, it is located within No Man's Land (NML), the region of the metastable phase diagram that is difficult to access using conventional experimental techniques due to rapid homogeneous nucleation to the crystal. However, a recent ingenious experiment has enabled measurement of the diffusion constant deep inside NML. In the current communication, these recent measurements are compared, with good agreement, to the diffusion constant of E3B3 water, a classical water model that explicitly includes three-body interactions. The behavior of the diffusion constant as the system crosses the Widom line (the extension of the liquid-liquid coexistence line into the one-phase region) is analyzed to derive information about the presence and location of the LLCP. Calculations over a wide range of temperatures and pressures show that the new experimental measurements are consistent with an LLCP having a critical pressure of over 0.6 kbar.

Percolation in supercritical water: Do the Widom and percolation lines coincide?

Hydrogen bonding distinguishes water from simpler fluids. Here, we use classical molecular dynamics to study the percolation transition in the hydrogen bond network of supercritical water. We find that, contrary to some previous work, the percolation line in both the pressure-temperature and density-temperature planes does not coincide with the Widom line. This difference stems from a fundamental distinction between the Widom line, which is thermodynamic in nature, and the percolation transition, which depends only on connectivity. For example, we show that percolation-related quantities collapse onto master curves when plotted with respect to a measure of connectivity rather than thermodynamic variables. We then use the Galam-Mauger formula to understand the properties of the hydrogen bonding network. We find that the percolation transition in supercritical water can shed light on the hydrogen bonding network in room temperature liquid water.

A retrieval analysis of the Precice intramedullary limb lengthening system.

OBJECTIVES: The Precice nail is the latest intramedullary lengthening nail with excellent early outcomes. Implant complications have led to modification of the nail design. The aim of this study was to perform a retrieval study of Precice nails following lower-limb lengthening and to assess macroscopical and microscopical changes to the implants and evaluate differences following design modification, with the aim of identifying potential surgical, implant, and patient risk factors. METHODS: A total of 15 nails were retrieved from 13 patients following lower-limb lengthening. Macroscopical and microscopical surface damage to the nails were identified. Further analysis included radiology and micro-CT prior to sectioning. The internal mechanism was then analyzed with scanning electron microscopy and energy dispersive x-ray spectroscopy to identify corrosion. RESULTS: Seven male and three female patients underwent 12 femoral lengthenings. Three female patients underwent tibial lengthening. All patients obtained the desired length with no implant failure. Surface degradation was noted on the telescopic part of every nail design, less on the latest implants. Microscopical analysis confirmed fretting and pitting corrosion. Following sectioning, black debris was noted in all implants. The early designs were found to have fractured actuator pins and the pin and bearings showed evidence of corrosive debris. The latest designs showed evidence of biological deposits suggestive of fluid ingress within the nail but no corrosion. CONCLUSION: This study confirms less internal corrosion following modification, but evidence of titanium debris remains. We recommend no change to current clinical practice. However, potential reuse of the Precice nail, for secondary limb lengthening in the same patient, should be undertaken with caution.Cite this article: V. C. Panagiotopoulou, K. Davda, H. S. Hothi, J. Henckel, A. Cerquiglini, W. D. Goodier, J. Skinner, A. Hart, P. R. Calder. A retrieval analysis of the Precice intramedullary limb lengthening system. Bone Joint Res 2018;7:476-484. DOI: 10.1302/2046-3758.77.BJR-2017-0359.R1.