Factors associated with eating rate: a systematic review and narrative synthesis informed by socio-ecological model.

Accumulating evidence shows associations between rapid eating and overweight. Modifying eating rate might be a potential weight management strategy without imposing additional dietary restrictions. A comprehensive understanding of factors associated with eating speed will help with designing effective interventions. The aim of this review was to synthesise the current state of knowledge on the factors associated with eating rate. The socio-ecological model (SEM) was utilised to scaffold the identified factors. A comprehensive literature search of eleven databases was conducted to identify factors associated with eating rate. The 104 studies that met the inclusion criteria were heterogeneous in design and methods of eating rate measurement. We identified thirty-nine factors that were independently linked to eating speed and mapped them onto the individual, social and environmental levels of the SEM. The majority of the reported factors pertained to the individual characteristics (n = 20) including demographics, cognitive/psychological factors and habitual food oral processing behaviours. Social factors (n = 11) included eating companions, social and cultural norms, and family structure. Environmental factors (n = 8) included food texture and presentation, methods of consumption or background sounds. Measures of body weight, food form and characteristics, food oral processing behaviours and gender, age and ethnicity were the most researched and consistent factors associated with eating rate. A number of other novel and underresearched factors emerged, but these require replication and further research. We highlight directions for further research in this space and potential evidence-based candidates for interventions targeting eating rate.

A Universal Chelation-Induced Selective Demetallization Strategy for Bioceramic Nanosheets (BCene).

The emergence of nanosheet materials like graphene and phosphorene, which are created by breaking the interlayer van der Waals force, has revolutionized multiple fields. Layered inorganic materials are ubiquitous in materials like bioceramics, semiconductors, superconductors, etc. However, the strong interlayer covalent or ionic bonding in these crystals makes it difficult to fabricate nanosheets from them. In this study, we present a simple technique to produce nanosheets from layered crystals by selectively exfoliating their interlayer metal atoms using the metal-chelation reaction. As a proof of concept, we successfully produced bioceramic nanosheets (BCene) by extracting Ca layers from Akermanite (AKT). The 3D-printed BCene scaffolds exhibited superior mechanical strength and in vitro bioactivity compared to the scaffolds made from AKT nanopowders. Our findings demonstrate the outstanding potential of BCene nanosheets in tissue engineering. Additionally, the selective demetallization technique for nanosheet production could be applied to other inorganic layered crystals to optimize their performance.

Nanocomposite bioinks for 3D bioprinting.

Three-dimensional (3D) bioprinting is an advanced technology to fabricate artificial 3D tissue constructs containing cells and hydrogels for tissue engineering and regenerative medicine. Nanocomposite reinforcement endows hydrogels with superior properties and tailored functionalities. A broad range of nanomaterials, including silicon-based, ceramic-based, cellulose-based, metal-based, and carbon-based nanomaterials, have been incorporated into hydrogel networks with encapsulated cells for improved performances. This review emphasizes the recent developments of cell-laden nanocomposite bioinks for 3D bioprinting, focusing on their reinforcement effects and mechanisms, including viscosity, shear-thinning property, printability, mechanical properties, structural integrity, and biocompatibility. The cell-material interactions are discussed to elaborate on the underlying mechanisms between the cells and the nanomaterials. The biomedical applications of cell-laden nanocomposite bioinks are summarized with a focus on bone and cartilage tissue engineering. Finally, the limitations and challenges of current cell-laden nanocomposite bioinks are identified. The prospects are concluded in designing multi-component bioinks with multi-functionality for various biomedical applications. STATEMENT OF SIGNIFICANCE: 3D bioprinting, an emerging technology of additive manufacturing, has been one of the most innovative tools for tissue engineering and regenerative medicine. Recent developments of cell-laden nanocomposite bioinks for 3D bioprinting, and cell-materials interactions are the subject of this review paper. The reinforcement effects and mechanisms of nanocomposites on viscosity, printability and biocompatibility of bioinks and 3D printed scaffolds are addressed mainly for bone and cartilage tissue engineering. It provides detailed information for further designing and optimizing multi-component bioinks with multi-functionality for specialized biomedical applications.

A First Reported Adjustable Breast Volume Simulator for Teaching Oncoplastic Surgery Marking: Adjustable Breast Oncoplastic Surgery Simulator.

BACKGROUND: The current simulators for teaching oncoplastic surgery marking are available in a fixed size for each model. This is not an accurate reflection of the variety of patient's breast volumes in reality and may limit the teaching to certain techniques associated with the particular breast ptosis/size. DEVICE DESCRIPTION: This is the first reported simulator with varying breast volumes/ptosis in a single model for teaching oncoplastic surgery marking, known as Adjustable Breast Oncoplastic Surgery Simulator (ABOSS). Adjustable Breast Oncoplastic Surgery Simulator was created using 3D printing. PRELIMINARY RESULTS: Adjustable Breast Oncoplastic Surgery Simulator could simulate the breast in appearance and texture. It is inexpensive and allows the practice of various markings based on the different breast volumes/ptosis in a single model. It also allows for the practice of the marking needed in asymmetric breasts to correct the asymmetry. CURRENT STATUS: Plans for commercialisation were made.

Machine Learning-Guided Prediction of Central Anterior Chamber Depth Using Slit Lamp Images from a Portable Smartphone Device.

There is currently no objective portable screening modality for narrow angles in the community. In this prospective, single-centre image validation study, we used machine learning on slit lamp images taken with a portable smartphone device (MIDAS) to predict the central anterior chamber depth (ACD) of phakic patients with undilated pupils. Patients 60 years or older with no history of laser or intraocular surgery were recruited. Slit lamp images were taken with MIDAS, followed by anterior segment optical coherence tomography (ASOCT; Casia SS-1000, Tomey, Nagoya, Japan). After manual annotation of the anatomical landmarks of the slit lamp photos, machine learning was applied after image processing and feature extraction to predict the ACD. These values were then compared with those acquired from the ASOCT. Sixty-six eyes (right = 39, 59.1%) were included for analysis. The predicted ACD values formed a strong positive correlation with the measured ACD values from ASOCT (R2 = 0.91 for training data and R2 = 0.73 for test data). This study suggests the possibility of estimating central ACD using slit lamp images taken from portable devices.

Design and Multicenter Clinical Validation of a 3-Dimensionally Printed Nasopharyngeal Swab for SARS-CoV-2 Testing.

Importance: Three-dimensionally printed nasopharyngeal swabs (3DP swabs) have been used to mitigate swab shortages during the coronavirus disease 2019 (COVID-19) pandemic. Clinical validation for diagnostic accuracy and consistency, as well as patient acceptability, is crucial to evaluate the swab's performance. Objective: To determine the accuracy and acceptability of the 3DP swab for identifying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Design, Setting, and Participants: A diagnostic study was conducted from May to July 2020 at 2 tertiary care centers in Singapore with different reference swabs (FLOQSwab [COPAN Diagnostics] or Dacron swab [Deltalab]) and swab processing techniques (wet or dry) to evaluate the performance of the 3DP swab compared with traditional, standard-of-care nasopharyngeal swabs used in health care institutions. The participants were patients with COVID-19 in the first 2 weeks of illness and controls with acute respiratory illness with negative test results for SARS-CoV-2. Paired nasopharyngeal swabs were obtained from the same nostril and tested for SARS-CoV-2 by reverse-transcriptase polymerase chain reaction. The sequence of swabs was randomized based on odd and even participant numbers. Main Outcomes and Measures: Primary outcome measures were overall agreement (OA), positive percentage agreement (PPA), and negative percentage agreement of the 3DP swab compared with reference swabs. Secondary outcome measures were the correlation of cycle threshold (Ct) values of both swabs. Results: The mean (SD) age of participants was 45.4 (13.1) years, and most participants were men (87 of 89 [97.8%]), in keeping with the epidemiology of the COVID-19 pandemic in Singapore. A total of 79 patients with COVID-19 and 10 controls were recruited. Among the patients with COVID-19, the overall agreement and PPA of the 3DP swab was 91.1% and 93.5%, respectively, compared with reference swabs. The PPA was 100% for patients with COVID-19 who were tested within the first week of illness. All controls tested negative. The reverse-transcriptase polymerase chain reaction Ct values for the ORF1ab and E-gene targets showed a strong correlation (intraclass correlations coefficient, 0.869-0.920) between the 3DP and reference swab on independent testing at each institution despite differences in sample processing. Discordant results for both gene targets were observed only at high Ct values. Conclusions and Relevance: In this diagnostic study of 79 patients with COVID-19 and 10 controls, the 3DP swab performed accurately and consistently across health care institutions and could help mitigate strained resources in the escalating COVID-19 pandemic.

The Effect of Patient Education and Telemedicine Reminders on Adherence to Eye Drops for Glaucoma.

PURPOSE: To determine the improvement in patient adherence to topical ocular hypotensive therapy by introducing a personalized illustrated medication reference chart and telereminder. DESIGN: Prospective randomized controlled clinical trial. PARTICIPANTS: Fifty-nine patients with glaucoma who were using at least 3 or more eye drops were recruited from the ophthalmology clinic at the National University Hospital of Singapore. METHODS: Participants were randomized into 3 groups: control, reference chart only, and reference chart with telereminder. They completed a survey on demographics, barriers to glaucoma medication adherence, and self-adherence (measured by the Morisky adherence scale) before and 6 weeks after intervention. Logistic regression analysis was performed on the barriers that contribute to nonadherence and paired t tests were conducted for the preimplementation and postimplementation effects of intervention on adherence score. MAIN OUTCOME MEASURES: Changes in mean adherence score based on the Morisky adherence scale before and after intervention in participants from all 3 groups. RESULTS: In our study, 71% of participants who were nonadherent to medications had multiple barriers to adherence, with lack of self-efficacy and forgetfulness being the most common factors. Only the reference chart with telereminder group showed a statistically significant increase in mean adherence score, from 7.18 to 7.69 (P = 0.047). CONCLUSIONS: Adherence to medication in chronic diseases like glaucoma is an important healthcare issue to address. Most of these patients have poor adherence because of multiple factors, and hence interventions aimed at improving adherence should be multifaceted to target these barriers.

The use of a 3D-printed prosthesis in a Great Hornbill (Buceros bicornis) with squamous cell carcinoma of the casque.

The advent of new technologies in medical imaging and 3D printing in recent years has made customization of surgical tools and implants more accessible, revolutionizing many surgical fields. In many human diseases, these implants have led to superior surgical outcomes and greatly improved patients' quality of life. Thus, it is of great interest to apply these technologies to the treatment of animal diseases. In this study, we report the use of computed tomography (CT) and 3D printing for the treatment of a Great Hornbill at Jurong Bird Park that was diagnosed with squamous cell carcinoma of the casque. A 3D printed prosthesis that perfectly fitted the subject was implanted to replace its resected casque. The subject exhibited natural eating behaviour with no post-operative complications. Using this case as an example, the positive outcomes suggest a great potential in applying these technologies to the treatment of other wildlife diseases.

A composite 3D printed model of the midcarpal joint.

Three-dimensional (3D) printing has recently been developed as a resource for teaching human anatomy through the accurate reproduction of anatomical specimens. Using a composite 3D printed model with the incorporation of metal and magnets, we were able to demonstrate and analyse movements at the midcarpal joint during the 'dart thrower's motion', which is an important motion in daily activities involving the use of the hand. The hand component with the distal row of carpal bones was subjected to flexion and extension at the midcarpal joint and observed for simultaneous abduction/adduction. Notable adduction was observed in the flexed position as compared to the extended position. Moreover, while the primary movements at the midcarpal joint were taking place in the medial part of the joint, the lateral part of the joint (which is ellipsoid) served to accommodate the arc of movement. We suggest that such composite 3D printed models are useful teaching tools for enhancing the understanding of complex joint movements.

The Effects of a Functional Three-dimensional (3D) Printed Knee Joint Simulator in Improving Anatomical Spatial Knowledge.

In recent decades, three-dimensional (3D) printing as an emerging technology, has been utilized for imparting human anatomy knowledge. However, most 3D printed models are rigid anatomical replicas that are unable to represent dynamic spatial relationships between different anatomical structures. In this study, the data obtained from a computed tomography (CT) scan of a normal knee joint were used to design and fabricate a functional knee joint simulator for anatomical education. Utility of the 3D printed simulator was evaluated in comparison with traditional didactic learning in first-year medical students (n = 35), so as to understand how the functional 3D simulator could assist in their learning of human anatomy. The outcome measure was a quiz comprising 11 multiple choice questions based on locking and unlocking of the knee joint. Students in the simulation group (mean score = 85.03%, ±SD 10.13%) performed significantly better than those in the didactic learning group, P < 0.05 (mean score = 70.71%, ±SD 15.13%), which was substantiated by large effect size, as shown by a Cohen's d value of 1.14. In terms of learning outcome, female students who used 3D printed simulators as learning aids achieved greater improvement in their quiz scores as compared to male students in the same group. However, after correcting for the modality of instruction, the sex of the students did not have a significant influence on the learning outcome. This randomized study has demonstrated that the 3D printed simulator is beneficial for anatomical education and can help in enriching students' learning experience.

Virtual breast oncoplastic surgery simulator (VBOSS): A novel training tool in breast surgery.

Virtual simulators have been employed for the teaching of breast surgery. However, there remains no virtual simulator for the training of oncoplastic breast conserving surgery. This is the first known report of virtual simulator for oncoplastic breast conserving surgery training, to the best of our knowledge.

An exploratory study of ageing women's perception on access to health informatics via a mobile phone-based intervention.

OBJECTIVE: This is an exploratory study examining the perceived attitudes and readiness of women aged 50 years or older on adopting a mobile phone-based intervention named as Infohealth in Singapore. METHOD: Infohealth is designed as a health informatics to tailor personalized healthcare advice for the well-being for women - very little is known about the acceptability level of self-care technology, especially the older among the female population. To explore participants' perceptions and acceptance, a telephone survey was developed from concepts identified from various user acceptance theories and models. Correlation was used to identify significant dependent variables while partial least square and boot-strapping procedures were used to estimate the significance of the path coefficients. RESULTS: Analysis supports the validity and reliability of the 27-item research model consisting of 8 constructs. 700 women aged 50years and older responded to the survey. Findings show the extent of ageing women's existing dependency on others for help, regard for close ones whom they care for, opinion from family and friends, and guarding the health of people who are important for them do not directly affect the intention of using Infohealth, but are rather mediated by perceived usefulness. This study validated some ageing-specific and female-posited variables to suggest as main constructs in future innovation adoption studies about older women. Technological anxiety and perceived physical condition both have no direct relationship with perceived ease of use and usefulness, lifestyle and intention to use. CONCLUSION: Findings reinforced the significant roles of perceived usefulness and perceived ease of use, compatibility, and subjective norm in predicting the adoption intention of Infohealth among ageing women. More extensive statistical analysis is needed to discover more interesting findings while qualitative analysis can help to detect humanistic design opportunities.

A study on Singaporean women's acceptance of using mobile phones to seek health information.

OBJECTIVE: This paper is an exploratory study that investigates Singaporean women's acceptance of using mobile phones to seek health information. METHOD: A mobile web containing health topics was developed to track Singaporean women's actual use of their mobile phones to seek health information. A survey questionnaire measured variables hypothesized to predict Behavioural Intention. The survey responses were then matched to the data collected on actual use. Correlation analysis and hierarchical regression were used to analyze the data collected. RESULTS: Findings revealed that Perceived Usefulness and Self-efficacy positively predicted the intention to use mobile phones to seek health information. The study also confirmed the presence of an intention-behaviour gap among participants. The conversion of intention to actual behaviour hinges on technical concerns and design factors. Prior experiences with health information seeking reinforced women's evaluations of the usefulness of the mobile web application and helped them to feel more self-efficacious about using their mobile phones to seek health information. Using mobile phones to seek health information was found to be complementary to online health information seeking and can be regarded as an alternative source to the internet for seeking health information. CONCLUSION: This study contributes to the existing literature by applying the Technology Acceptance Model (TAM) in the context of mobile health information seeking, for which there has been a lack of studies, and demonstrated that the inclusion of additional variables can enhance TAM's predictive power. The empirical presence of an intention-behaviour gap calls for future research to investigate the reasons behind the gap. Finally, the findings from this study can serve as input to promote women's use of mobile phones for better self-management of health.