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This study aims to investigate how reported comprehension of the Medicare programme and its prescription drug benefits is associated with cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors.This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking and obesity) (n = 2821). A survey-weighted logistic model was used to examine associations between perceived difficulty of understanding the Medicare programme and its prescription drug benefits and CRN, controlling for beneficiaries' demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved.Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare programme and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare programme (OR = 1.50; 95% CI = 1.11-2.04; p = 0.009) and its prescription drug benefits (OR = 2.01; 95% CI = 1.52-2.66; p 0.001). Similar results were obtained for the subgroups with obesity, hypertension or hyperlipidemia.Perceived difficulty of understanding the Medicare Programme and its prescription drug benefits is associated with CRN among Medicare beneficiaries with CVD risk factors, especially those with obesity, hypertension or hyperlipidemia. Monitoring and enhancing Medicare beneficiaries' overall understanding of the Medicare programme may reduce CRN.

Background Understanding factors that influence healthy or unhealthy eating can inform intervention strategies. This study ascertained whether and how unintentional exposure to food and nutrition information influenced healthy eating concerns. The study tested body comparison, body satisfaction, and body mass index as three mechanisms that potentially link food information encounter, commonly known as information scanning, to healthy eating concerns. Methods A sample of 440 online participants (mean age = 29.15 years) was used to investigate: (1) how unintentional exposure to food and nutrition information, i.e., information encounter (IE), affects healthy eating concerns (HEC); (2) how the effect of IE on HEC is mediated by body comparison (BC); (3) how the paths of the mediation model are moderated by body satisfaction (BS) or body mass index (BMI). Results The findings show a positive and sizable total effect of IE on HEC – a whole-scale increase in information encounter is associated with a substantial increase in healthy eating concerns by 15 percentage points (bp = 0.150). BC is found to mediate the effect of IE on HEC in an all-positive complementary mediation. Both the indirect and the direct-and-remainder paths show sizable effects. The mediated path contributes about 20% of the total effect between IE and HEC (cp = 20%), while the direct-and-remainder path contributes the rest (cp = 80%). BS was found to moderate the relationship between IE and BC, the first leg of the mediation. The moderation effect is large – the effect of IE on BC is much smaller on the highly and the moderately satisfied than on the lowly satisfied (slope differential bp = -.60). BMI was found to moderate the direct-and-remainder effect of IE on HEC, controlling BC. That is, the effect of IE on HEC, after filtering out the mediated effect through BC, is much larger for those with high or low BMI than those with healthy BMI (slope differential bp = .32). Conclusions Exposure, even if unintentional, to food and nutrition information is an important predictor of HEC. BC, BS, and BMI are important factors that help to explain the process through which information affects behaviors.

This study explored consumers' perspectives on self-monitoring, a common feature in behavioral interventions that helps inform consumers' progress and answer their questions, to learn what outcome metrics matter to consumers and whether self-selection of these metrics leads to greater engagement (i.e., compliance, satisfaction) in self-monitoring than monitoring only default options.In a proof-of-concept randomized trial, 48 adult participants were randomly assigned to "clinician-determined monitoring" or "clinician + self-determined monitoring" conditions. Before starting monitoring, all participants shared outcomes that would matter to them in a mobile intervention for binge eating and weight management. Then, for 3 weeks, participants in the "clinician-determined" condition monitored their weight and binge-eating episodes, and participants in the "clinician + self-determined" condition monitored these and another metric of their choosing. After, satisfaction and compliance were assessed.Participants identified 116 metrics, grouped into 12 themes, that mattered to them. During monitoring, participants in the "clinician + self-determined" condition monitored 41 metrics. Surprisingly, participants in the "clinician-determined" condition also monitored metrics besides weight and binge eating. This resulted in a failure of our experimental manipulation, which represents a significant limitation of this research. No significant differences emerged in satisfaction or compliance between conditions.Although our proof-of-concept trial yielded null quantitative results, findings also suggested binge eating and weight management interventions may benefit from including an individually customizable monitoring option in addition to default metrics, warranting testing in future research.Examining consumers' self-monitoring preferences for a mobile intervention for binge eating and weight management revealed a variety of metrics that matter to consumers, although binge eating and weight were still most valued. Findings from our proof-of-concept trial suggest design implications of encouraging an individually customizable monitoring option, in addition to default metrics, which needs to be tested in future research over a longer period and during actual mobile intervention delivery.

Companies often use aesthetics or salient visual attributes to differentiate their products from those of their competitors and to appeal to customers. However, consumers may make unfavorable inferences about highly aesthetic products due to concerns about the products’ functionality. To address the issue of how retailers can most effectively engage in the deployment and promotion of product aesthetics, the present research proposes that consumers will respond more favorably (i.e., enhanced choice of product, enhanced product and advertisement evaluations, and a heightened willingness to pay) to a highly aesthetic product when they are in an abstract, rather than a concrete, mindset. Five studies using multiple product categories and applying various mindset manipulations provide convergent evidence to support the proposed hypothesis. The findings hold true for utilitarian, but not hedonic, products, and the focus of attention on product functionality accounts for the results. With the insight that the mindset consumers are in is critical in determining their response to highly aesthetics products, retailers can capitalize on selected situations in which to promote product aesthetics.

BACKGROUND Individuals’ perception of medication drug safety affects their adherence to their drug regime and through adherence to their health. China is among the countries with the largest number of medical drug consumers. Chinese citizens are facing a complex drug market that contains a variety of both traditional Chinese (TCM) and western medicine; meanwhile, the continuing safety scandals considerably impaired public confidence in medication drug. However, attention paid to their drug safety perception is few. OBJECTIVE Our study aims to answer a series of questions concerning drug safety perceptions in the Chinese context. We examined Chinese citizens' general drug safety perceptions and explored concerns about several frequently used drugs. Questions on how health information exposure and personal healthcare experience affect drug safety perceptions will be answered, and persons’ reliance on information sources in the drug safety crisis will be ascertained. METHODS Data from HINTS-China 2017 contains 3090 adults. The dataset was weighted before inferential analysis due to the overrepresentation of female respondents. We applied multiple linear regressions to examine the relations between drug safety perception and media exposure as well as personal healthcare experience. Respondents’ choice of unsafe drugs and information sources to rely on in drug safety crises were displayed in descriptive statistics. RESULTS Chinese people generally do not believe the current drug safety situation is satisfying and do not think it has improved in recent years. Their strong concerns are also reflected in their distrust in the safety antibiotics and vaccines. Exposure to Internet health information was negatively associated with drug safety perception (Drug safety quo: β = -.149, p < .001; drug safety amelioration (β = -.065, p= .042). However tradition media exposure was positively correlated (Drug safety quo: β = 121, p < .001; drug safety amelioration β = .107, p < .001). Satisfaction with health care services positively linked to safety perception (Drug safety quo: β = .271, p < .001; drug safety amelioration β = .182, p < .001). Physicians were considered the most reliable group in drug safety incidents. CONCLUSIONS Chinese citizens’ concerns about drug safety were accompanied by strong distrust in antibiotics and vaccines. Several determinants of safety perceptions were identified including internet health information exposure, traditional media health information exposure and personal healthcare experiences. New insights into the role of physicians were added to the literature by showing the firmest reliance on health information from physicians in drug safety incidents.

BACKGROUND People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. OBJECTIVE The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. METHODS A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. RESULTS Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. CONCLUSIONS In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals’ intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

Background Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. Methods A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. Results Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. Conclusions Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.

Background People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. Objective The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. Methods A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. Results Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. Conclusions In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals’ intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.

Background People’s potentials to seek health information can be affected by their social context, such as their social networks and the resources provided through those social networks. In the past decades, the concept of social capital has been widely used in the health realm to indicate people’s social context. However, not many such studies were conducted in China. Chinese society has its special quality that many Western societies lack: people traditionally render strong value to family relations and rely heavily on strong social ties in their social life. Therefore, the purpose of this study was to examine the association between different types of social capital and health information-seeking behavior (HISB) in the Chinese context. The different types of social capital were primarily bonding and bridging, as well as cognitive and structural ones. Methods Our analysis is based on a total of 3090 cases taken from the Health Information National Trends Survey (HINTS) – China, 2017. Dataset was weighted due to the overrepresentation of female respondents and hierarchical multiple regression analyses as well as binary logistic regression tests were operated to examine the associations between people’s social capital and their HISB. Results Some aspects of social capital emerged as positive predictors of HISB: information support (standing in for the cognitive component of social capital) promoted health information seeking, organization memberships (standing in for the structural component) encouraged cancer information seeking, and both the use of the internet and of traditional media for gaining health information were positively linked with bridging networks and organization memberships. Bonding networks (structural component) were not correlated with any other of the key variables and emotional support (cognitive social capital) was consistently associated with all health information-seeking indicators negatively. Conclusions Social capital demonstrated significant and complex relationships with HISB in China. Structural social capital generally encouraged HISB in China, especially the bridging aspects including bridging networks and organization memberships. On the other hand, emotional support as cognitive social capital damaged people’s initiatives in seeking health-related information.

BACKGROUND The prevalence of psychosocial distress is increasing worldwide, which impacts people’s dietary behaviors and habits. Preparing and cooking food may facilitate the mitigation of psychosocial distress during epidemic-related quarantines. Emotional self-efficacy (ESE) measures various aspects of perceiving and understanding emotions and helping others modulate their emotions. ESE affects dietary behaviors and habits and mediates the relationship between socioeconomic status (SES) and diet-related behavior. OBJECTIVE This study attempts to identify whether the predictor variable, socioeconomic status, and the criterion variable, dietary quality, form a linear relationship. The statistical association between SES and dietary quality may be higher when considering ESE than when it is not considered. METHODS A questionnaire survey was designed to evaluate the impact of ESE on food-related behavior and that of SES on dietary quality. Adults from Mainland China participated in a web-based survey from April to June 2020. Factor analysis was used to report the survey results and item reliability. Multiple linear regression was performed to identify the association between ESE and dietary behavior, and further analytics analyzed how socioeconomic factors affected the dietary quality of those who were influenced by food advertising promotion (FAP). RESULTS The data derived from 441 responses showed that the ESE scale exhibited satisfactory internal consistency and predictive validity for Chinese individuals. The COVID-19 pandemic significantly decreased the food-consumption level, particularly in the case of salty snacks and alcoholic beverages. The respondents who reported a higher SES tended to have a higher ESE level than those with a lower SES. ESE mediated the relationship between SES and dietary quality (β=-.019, P CONCLUSIONS The relationship between SES and food consumption with regard to dietary quality is stronger for people who encounter environmental influences. ESE is a well-established tool for evaluating how people cope with negative emotions. The findings support the mediating impact of ESE on the conditional process linking SES to dietary quality, which provides further insights about the dynamic process of psychological constructs in behavioral outcomes. This study highlights that the lockdown imposed to contain an infectious agent affected people’s dietary behaviors and habits and advocates for organized nutritional support during future epidemic-related quarantines.

RATIONALE, AIMS, AND OBJECTIVES: This study aims to investigate how reported comprehension of the Medicare program and its prescription drug benefits affects cost-related medication nonadherence (CRN) among Medicare beneficiaries with cardiovascular disease (CVD) risk factors. METHODS: This cross-sectional study used the 2017 Medicare Current Beneficiary Survey Public Use File data and included Medicare beneficiaries aged ≥ 65 years who reported having at least one CVD risk factor (i.e., hypertension, hyperlipidemia, diabetes, smoking, and obesity) (n=2,821). A survey-weighted logistic model was used to examine associations between lack of difficulty understanding the Medicare program and its prescription drug benefits and CRN, controlling for beneficiaries’ demographic (e.g., age) and clinical characteristics (e.g, comorbidities). This study further analyzed five subgroups based on the type of CVD risk factors involved. RESULTS: Among Medicare beneficiaries with CVD risk factors, 14.4% reported CRN. Medicare beneficiaries with CVD risk factors who reported difficulty understanding the overall Medicare program and its prescription drug benefits were more likely to report CRN, compared to those who reported easy understanding of the overall Medicare program (OR=1.49; 95% CI=1.09, 2.04; p

Background: The city-wide COVID-19 lockdown has resulted in psychological anguish, which may have an impact on dietary consumption. This study’s dual goals are to show how Chinese food consumption was altered before and after the lockdown, and to examine the nutrient density for the psychologically affected group. Methods: A cross-sectional study involving 652 people from Mainland China, Taiwan, and Macao was conducted with the aid of a web-based questionnaire. Sociodemographic characteristics, related environmental factors, nutrient consumption, food recommendations, and psychological distress were all measured. 516 trustworthy data revealed that two nutrient-poor foods were consumed less frequently during the lockdown than they were before to the COVID-19 outbreak (i.e., salty snacks and alcoholic beverages). People who endured high levels of psychological distress in particular tended to consume more. Particularly, those who experienced high levels of psychological distress had a tendency to consume far more alcohol than people who only experienced low levels of stress. Comparing the time before the COVID-19 to the present, there has statistically been an increase in the frequency of family members recommending diets. According to research, by food advice, individuals who experience psychological distress should consume more nutrient-dense foods (78.7%) than nutrient-poor ones (61.9%). Thus, food advice plays a role in mediating the relationship between psychological distress and dietary decisions for nutrient-rich (b = 0.186, p < 0.001) or nutrient-poor (b = 0.187, p < 0.001) food groups. This study provides insights for lowering psychological distress through dietary consumption, where the exact mechanisms underlying these connections have not been thoroughly elucidated. It encourages nutrition research by recommending practical nutrition education from family and environmental activities. Chronic psychological anguish may have a crucial relationship to secure access to food and a balanced diet. Along with nutrition instruction, it is critical to develop skills in interventions such as food procurement and culinary knowledge.

INTRODUCTION AND OBJECTIVE:Radical cystectomy (RC) has 30-day and 90-day re-admission rates of over 15% and 20% respectively. The majority of complications are infection and bowel-related. Modern B...

PURPOSE: Rapid sequence intubation (RSI) in trauma patients is common; however, the induction agents used have been debated. We determined which induction medications were used most frequently for adult trauma RSIs and their associations with hemodynamics and outcomes. We hypothesized that etomidate is the most commonly used induction agent and has similar outcomes to other induction agents. METHODS: This retrospective review at two U.S. level I trauma centers evaluated adult trauma patients undergoing RSI within 24h of admission, between 01/01/2016 and 12/31/2017. We compared patient characteristics and outcomes by induction agent. Comparisons on the primary outcome of in-hospital mortality and secondary outcomes of peri-intubation hypotension, hospital and ICU length of stay (LOS), ventilator days, and complications used logistic regression or negative binomial regression. Regression models adjusted for hospital site, age, patient severity measures, and intubation location. RESULTS: Among 1303 trauma patients undergoing RSI within 24h of admission, 948 (73%) were intubated in the emergency department (ED) and 325 (25%) in the operating room (OR). The most common induction agents were etomidate (68%), propofol (17%), and ketamine (11%). In-hospital mortality was highest in the etomidate group (25.5%), followed by ketamine (17%), and propofol (1.8%). CONCLUSION: Etomidate was most commonly used in ED intubations; propofol was most used in the OR. Compared to propofol, patients induced with etomidate had higher mortality and complication rates. Findings should be interpreted with caution given limited generalizability and residual confounding by indication.

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual’s dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.

BACKGROUND Ongoing rumors and fake news regarding food fraud, adulteration, and contamination are highly visible. Health risk information circulating through media and interpersonal communication channels has made health crisis an important research agenda. OBJECTIVE This study explored the issue of food fraud and the effect of misinformation. Further, it assessed whether and how these issues have provided evidence-based interventions for food handlers and regulators to mitigate fraud misinformation. METHODS The Health Information National Trends Survey (HINTS) was adopted for a collaborative study in China, after which a cross-sectional survey with door-to-door interviews was performed. Participants from Beijing and Hefei were selected using multistage sampling of adults in May 2017. Based on 4 government surveillance reports on food rumors and safety incidents, a descriptive analysis, correlation analysis, and analysis of variance were performed on the data. RESULTS A total of 3090 results were gathered and analyzed. Among the respondents, 83.6% (2584/3090) heard at least one food rumor. Learning about food fraud was correlated with interpersonal connections (eg, doctors or health specialists) for accessing food health information. Overall, Chinese citizens with a higher level of interpersonal connection were more likely to be concerned about food incidents with a statistical difference (PPPP=.006). The respondents in Beijing were confronted more frequently by food rumors (range 346-1253) than those in Hefei (range 155-946). The urban dwellers in Beijing and their rural counterparts in Hefei also differed in terms of perceiving different levels of food risks from different media sources. The food rumor narratives that examined the conspiracy belief showed that social media played more important roles in influencing attitudes against misinformation for users in Hefei than in Beijing. CONCLUSIONS This study shows that consumers have to be on guard against not only fake food, but also spreading fake information and rumors, as well as conspiracy beliefs involving fake food. This study focused on characterizing media sources, types of food fraud misinformation, and risk perceptions of food safety, which mix urgency and suspicion, and attempted to provide evidence-based interventions for risk management guidance, with the hypothesis of significant correlations between media types and sources, and consumer exposure and perception levels of food rumors and risks.

A 63-year-old male with a history of hiatal hernia presented with one day of hematemesis and acute peritonitis. Computed tomographic imaging revealed perigastric pneumoperitoneum concerning perforated viscus. Exploratory laparotomy revealed a Type III hiatal hernia with a perforated posterior gastric ulcer, which was reduced and repaired. This report describes a case of acute abdomen secondary to hiatal hernia, a rare presentation of hiatal hernia, along with its surgical management and postoperative care.

Background: Peanut introduction guidelines have undergone significant reversal since 2001 from recommending delayed introduction to rescinding the recommendations in 2008 to actively recommending early introduction of peanut between 4 and 11 months of age in high-risk infants in 2015. This qualitative study aims to explore pediatrician beliefs, practices, facilitators, and barriers regarding peanut introduction and testing. Methods: General pediatricians from academic, private, large group, and underserved practices in Northern California underwent individual semi-structured interviews in 2017. We asked about experiences surrounding infant peanut introduction, strategies for staying up-to-date with current recommendations, and barriers and facilitators to the new peanut introduction and testing recommendations. The data were coded, and using grounded theory methodology, a conceptual framework was developed around early peanut introduction and testing in infants. Results: Eighteen general pediatricians participated. We identified barriers that may contribute to pediatrician reluctance to recommending early peanut introduction or testing including lack of awareness, lack of agreement, lack of resources, and lack of outcome expectancy. A framework was created that suggests that pediatricians need to be knowledgeable about new recommendations, agree with the recommendations, have resources to carry out the counseling and testing, and have buy-in from the parents in order for successful uptake of peanut introduction guidelines. Conclusion: Recommending early peanut introduction or testing causes significant apprehension in some pediatricians, and there are many barriers to following recent early peanut introduction recommendations. A potential limitation of the study is that it was conducted right after the addendum guidelines were changed, leaving the possibility that attitudes and practices may have evolved since 2017. It is still likely that a multifaceted approach that addresses primary care provider guideline awareness, limited primary care resources for education and testing, and includes support and collaboration from subspecialty practices is more likely to lead to improved early peanut introduction uptake.

Introduction: Weight loss apps to date have not directly addressed binge eating. To inform the design of a new mobile behavioral intervention that addresses binge eating and weight management, we applied user-centered design methods to qualitatively assess how target intervention consumers experience these conditions in their day-to-day lives.Methods: The participants were 22 adults with self-reported obesity (body mass index ≥30) and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating. The participants completed a digital diary study, which is a user-centered design technique for capturing individuals' day-to-day experiences in relevant contexts. Qualitative data describing the participants' experiences with binge eating and obesity were analyzed using thematic analysis. The results were then used to create personas (i.e., character archetypes of different intervention consumers).Results: The participants described triggers for binge eating and indicated that binge eating and excess weight negatively impact their mental health, physical health, and quality of life. The resulting personas reflected five different struggles individuals with these health problems experience in managing their binge eating and weight.Conclusions: Individuals with binge eating and obesity have varying precipitants of problematic eating as well as varying motivations for and challenges to behavior change. To meet the needs of all who seek intervention, an ideal intervention design will account for variations in these factors and be relevant to diverse experiences. Insights from the diary study and resulting personas will inform the next phases of the user-centered design process of iteratively designing prototypes and testing the intervention in practice.

Background Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions.

Purpose:This article aims to determine preferences and demographics for listeners of an ophthalmology podcast, since podcasts are gaining favor for medical education.Methods:The present study used a cross-sectional, online survey as well as Podtrac, Inc and Squarespace, Inc platform analytics to examine perceived educational usefulness of podcasts for listeners.Results:Quarterly episode downloads increased from 684 in first-quarter 2017 to 16 016 in third-quarter 2018. A total of 102 participants completed the survey: 82 (80.4%) men and 68 (66.7%) retina attending physicians or fellows. Most respondents listened to “stay up to date” or “learn more about the field of retina” (67; 65.7% each). Most respondents agreed that podcasts are useful for medical education and result in changes in practice, but not that podcasts have surpassed traditional educational methods. For respondents, there was no difference in perceived usefulness between podcasts and peer-reviewed journals, textbooks, continuing medical education lectures, or national conferences; these did not differ with respondent listening histories.Conclusions:Podcasts are valuable adjuncts for distributing clinically relevant material.

To develop a method for T2 mapping of the entire tibiotalar/hindfoot articular surfaces and to examine regional T2 variation in asymptomatic volunteers, establishing necessary methods for future T2 mapping work in patients with ankle/hindfoot injury.Twenty-six asymptomatic volunteers (11 female/13 male, aged 23-64 years in final analysis) underwent sagittal T2 mapping. Tibiotalar and hindfoot cartilage surfaces were segmented by two raters. The tibiotalar joint cartilage was divided into subregions to assess T2 variation across the joint. The articular surface and subregion mean T2 values were compared using Tukey post hoc pairwise comparisons to test for statistical significance.Mean ankle/hindfoot cartilage T2 ranged from 37 ± 3 to 47 ± 7 ms. Tibial plafond mean T2 was significantly different from the middle and posterior subtalar cartilage T2 (both articular surface comparisons resulted in P .05). Talar dome mean T2 was significantly different from the posterior calcaneal-side and talar-side subtalar cartilage, and middle calcaneal-side subtalar cartilage (P .05 for all comparisons). Tibial plafond middle versus lateral, anterior versus middle, middle versus posterior, and anterior versus posterior subregion T2 values were significantly different (P .05 for all comparisons). Talar dome medial versus middle, middle versus lateral, anterior versus middle, and middle versus posterior subregion T2 values were significantly different (P .05 for all comparisons). Ankle/hindfoot joint cartilage T2 mapping and segmentation was found to be feasible for all cartilage surfaces except the anterior subtalar joint facet. Mean T2 differed significantly between ankle/hindfoot joint and subregion cartilage in asymptomatic volunteers.

The COVID-19 outbreak has caused significant stress in our lives, which potentially increases frustration, fear, and resentful emotions. Managing stress is complex, but helps to alleviate negative psychological effects. In order to understand how the public coped with stress during the COVID-19 pandemic, we used Macao as a case study and collected 104,827 COVID-19 related posts from Facebook through data mining, from 1 January to 31 December 2020. Divominer, a big-data analysis tool supported by computational algorithm, was employed to identify themes and facilitate machine coding and analysis. A total of 60,875 positive messages were identified, with 24,790 covering positive psychological themes, such as “anti-epidemic”, “solidarity”, “hope”, “gratitude”, “optimism”, and “grit”. Messages that mentioned “anti-epidemic”, “solidarity”, and “hope” were the most prevalent, while different crisis stages, key themes and media elements had various impacts on public involvement. To the best of our knowledge, this is the first-ever study in the Chinese context that uses social media to clarify the awareness of solidarity. Positive messages are needed to empower social media users to shoulder their shared responsibility to tackle the crisis. The findings provide insights into users’ needs for improving their subjective well-being to mitigate the negative psychological impact of the pandemic.

A 49-year-old man flight attendant with a past medical history of Roux-en-Y bypass and massive weight loss 18 months prior was referred for surgical management of a superficial temporal artery aneurysm. Imaging confirmed the diagnosis. Intraoperatively a 1 cm fusiform aneurysm was identified with numerous feeding side branch vessels. The aneurysm was suture ligated and excised in toto with pathologic analysis showing involvement of all vessel layers. This case highlights a rare true aneurysm of the superficial temporal artery and aberrant anatomy of multiple side branches feeding the aneurysm and complicating dissection and excision.

Mild cognitive impairment (MCI) impacts approximately 20% of older adults, with many also experiencing sleep disorders, such as insomnia. Given the relationship between sleep and dementia, addressing sleep issues may offer an opportunity to treat reversible causes. There are two primary treatments for insomnia: behavioral-based (cognitive behavioral therapy for insomnia, CBT-I) and pharmacological interventions. Although CBT-I is recommended as first-line treatment for insomnia in older adults, sedative-hypnotics are more likely to be recommended than non-pharmacological treatments given their convenience and accessibility. However, there are significant concerns in prescribing medications to patients with MCI. To explore this disconnect, we reviewed insomnia treatments in older adults with MCI studies and current guidelines of pharmacological therapy. First, we reviewed studies presenting non-pharmacological treatment of insomnia in older adults with MCI. Although the search yielded over 4,000 non-duplicate titles, only one article presented data on non-pharmacological treatment of insomnia in MCI. The literature covering comorbid insomnia, CBT-I, and MCI is sparse. In contrast to review of non-pharmacological studies, studies on the pharmacological treatment of insomnia in older adults were ample. Finally, we reviewed international guidelines for pharmacological treatment of insomnia in cognitive disorders. More widely used pharmacological interventions show short-term effectiveness with problems of recurrence, ineffectiveness in inadvertent or purposeful chronic use, and adverse side effects. Despite evidence regarding adverse consequences, pharmacological treatment of insomnia remains the most common treatment for insomnia. Reflecting on age-related changes in older adults, particularly those with MCI, inappropriate or mismanagement of medication can lead to unnecessary complications. Further research examining effective behavioral-based sleep management options in older adults with cognitive impairment is needed with exploration of improved sleep on cognitive function.

Decline of protein quality control in neurons contributes to age-related neurodegenerative disorders caused by misfolded proteins. 4E-BP1 is a key node in the regulation of protein synthesis, as activated 4E-BP1 represses global protein translation. Overexpression of 4E-BP1 mediates the benefits of dietary restriction and can counter metabolic stress, and 4E-BP1 disinhibition on mTORC1 repression may be neuroprotective; however, whether 4E-BP1 overexpression is neuroprotective in mammalian neurons is yet to be fully explored. To address this question, we generated 4E-BP1-overexpressing transgenic mice and confirmed marked reductions in protein translation in 4E-BP1-overexpressing primary neurons. After documenting that 4E-BP1-overexpressing neurons are resistant to proteotoxic stress elicited by brefeldin A treatment, we exposed primary neurons to three different Parkinson's disease (PD)-linked toxins (rotenone, maneb, or paraquat) and documented significant protection in neurons from newborn male and female4E-BP1-OEtransgenic mice. We observed 4E-BP1-dependent upregulation of genes encoding proteins that comprise the mitochondrial unfolded protein response, and noted 4E-BP1 overexpression required activation of the mitochondrial unfolded protein response for neuroprotection against rotenone toxicity. We also tested whether 4E-BP1 could prevent α-synuclein neurotoxicity by treating 4E-BP1-overexpressing primary neurons with α-synuclein preformed fibrils, and we observed marked reductions in α-synuclein aggregation and neurotoxicity, thus validating that 4E-BP1 is a powerful suppressor of PD-linked pathogenic insults. Our results indicate that increasing 4E-BP1 expression or enhancing 4E-BP1 activation can robustly induce the mitochondrial unfolded protein response and thus could be an appealing strategy for treating a variety of neurodegenerative diseases, including especially PD.SIGNIFICANCE STATEMENTIn neurodegenerative disease, misfolded proteins accumulate and overwhelm normal systems of homeostasis and quality control. One mechanism for improving protein quality control is to reduce protein translation. Here we investigated whether neuronal overexpression of 4E-BP1, a key repressor of protein translation, can protect against misfolded protein stress and toxicities linked to Parkinson's disease, and found that 4E-BP1 overexpression prevented cell death in neurons treated with brefeldin A, rotenone, maneb, paraquat, or preformed fibrils of α-synuclein. When we sought the basis for 4E-BP1 neuroprotection, we discovered that 4E-BP1 activation promoted the mitochondrial unfolded protein response. Our findings highlight 4E-BP1 as a therapeutic target in neurodegenerative disease and underscore the importance of the mitochondrial unfolded protein response in neuroprotection against various insults.

Background Information about a new coronavirus emerged in 2019 and rapidly spread around the world, gaining significant public attention and attracting negative bias. The use of stigmatizing language for the purpose of blaming sparked a debate. Objective This study aims to identify social stigma and negative sentiment toward the blameworthy agents in social communities. Methods We enabled a tailored text-mining platform to identify data in their natural settings by retrieving and filtering online sources, and constructed vocabularies and learning word representations from natural language processing for deductive analysis along with the research theme. The data sources comprised of ten news websites, eleven discussion forums, one social network, and two principal media sharing networks in Taiwan. A synthesis of news and social networking analytics was present from December 30, 2019, to March 31, 2020. Results We collated over 1.07 million Chinese texts. Almost two-thirds of the texts on COVID-19 came from news services (n=683,887, 63.68%), followed by Facebook (n=297,823, 27.73%), discussion forums (n=62,119, 5.78%), and Instagram and YouTube (n=30,154, 2.81%). Our data showed that online news served as a hotbed for negativity and for driving emotional social posts. Online information regarding COVID-19 associated it with China—and a specific city within China through references to the “Wuhan pneumonia”—potentially encouraging xenophobia. The adoption of this problematic moniker had a high frequency, despite the World Health Organization guideline to avoid biased perceptions and ethnic discrimination. Social stigma is disclosed through negatively valenced responses, which are associated with the most blamed targets. Conclusions Our sample is sufficiently representative of a community because it contains a broad range of mainstream online media. Stigmatizing language linked to the COVID-19 pandemic shows a lack of civic responsibility that encourages bias, hostility, and discrimination. Frequently used stigmatizing terms were deemed offensive, and they might have contributed to recent backlashes against China by directing blame and encouraging xenophobia. The implications ranging from health risk communication to stigma mitigation and xenophobia concerns amid the COVID-19 outbreak are emphasized. Understanding the nomenclature and biased terms employed in relation to the COVID-19 outbreak is paramount. We propose solidarity with communication professionals in combating the COVID-19 outbreak and the infodemic. Finding solutions to curb the spread of virus bias, stigma, and discrimination is imperative.

Background The incidence of major surgery is on the rise globally, and more than 20% of patients are readmitted to hospital following discharge from hospital. During their hospital stay, patients are monitored for early detection of clinical deterioration, which includes regularly measuring physiological parameters such as blood pressure, heart rate, respiratory rate, temperature, and pulse oximetry. This monitoring ceases upon hospital discharge, as patients are deemed clinically stable. Monitoring after discharge is relevant to detect adverse events occurring in the home setting and can be made possible through the development of digital technologies and mobile networks. Smartwatches and other technological devices allow patients to self-measure physiological parameters in the home setting, and Bluetooth connectivity can facilitate the automatic collection and transfer of this data to a secure server with minimal input from the patient. Objective This paper presents the protocol for the DREAMPath (Domiciliary Recovery After Medicalization Pathway) study, which aims to measure compliance with a multidevice remote monitoring kit after discharge from hospital following major surgery. Methods DREAMPath is a single-center, prospective, observational, cohort study, comprising 30 patients undergoing major intracavity surgery. The primary outcome is to assess patient compliance with wearable and interactive smart technology in the first 30 days following discharge from hospital after major surgery. Secondary outcomes will explore the relation between unplanned health care events and physiological data collected in the study, as well as to explore a similar relationship with daily patient-reported outcome measures (Quality of Recovery–15 score). Secondary outcomes will be analyzed using appropriate regression methods. Cardiopulmonary exercise testing data will also be collected to assess correlations with wearable device data. Results Recruitment was halted due to COVID-19 restrictions and will progress once research staff are back from redeployment. We expect that the study will be completed in the first quarter of 2022. Conclusions Digital health solutions have been recently made possible due to technological advances, but urgency in rollout has been expedited due to COVID-19. The DREAMPath study will inform readers about the feasibility of remote monitoring for a patient group that is at an increased risk of acute deterioration. Trial Registration ISRCTN Registry ISRCTN62293620; https://www.isrctn.com/ISRCTN62293620 International Registered Report Identifier (IRRID) DERR1-10.2196/30638

A 70-year-old edentulous male presented with bilateral mandible and left midface fractures following an assault. Imaging confirmed fractures and showed mandible thickness greater than 20 millimeters. The patient was treated by open reduction internal fixation with miniplates via an intra-oral approach and recovered without deficit. While miniplate fixation and an intra-oral approach is typically reserved for the dentulous patient, this case illustrates that in select edentulous patients with sufficient bone thickness and amenable midface fractures this technique may be successfully utilized.

Background and study aims The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option. However, current literature on the performance of non-physicians in endoscopy is limited. The aim of this study was to assess the quality of colonoscopy performed by three gastrointestinal fellowship-trained nurse practitioners (NPs). Methods This was a retrospective study performed at a single tertiary academic medical center. Colonoscopies performed by three gastrointestinal-specialized NPs after having completed training of at least 140 supervised colonoscopies were reviewed for analysis. Inclusion criteria were patients undergoing colonoscopy for colorectal cancer screening purposes. Outcomes included colonoscopy quality indicators as defined by the American Society for Gastrointestinal Endoscopy/American College of Gastroenterology Taskforce (ASGE/ACG) Taskforce. Results The study included 1,012 subjects (mean age 56.2 years, female 51.5 %, African American 73.9 %) who underwent screening colonoscopies by three NPs. Cecal intubation was successful in 997 subjects (98.5 %). Mean adenoma detection rate was 35.6 %. Mean withdrawal time was 18.9 minutes. There were no adverse events including colonic perforations or delayed post-polypectomy bleeding. Conclusions Three fellowship-trained NPs in colonoscopy in the United States satisfied the quality indicators proposed by the ASGE/ACG Task force, demonstrating that adequately trained NPs can perform colonoscopy safely and effectively. With the demand for colonoscopy exceeding the supply, non-physicians could be part of the solution to meet the demands for CRC screening.

A 59-year-old male presented with recurrent mucoepidermoid carcinoma of the mandible. A resection with immediate free fibula flap reconstruction was done. The osteocutaneous free fibula flap relies on the peroneal artery and its distal perforators. Variant patterns necessitate consideration of the challenging to dissect proximal myocutaneous perforator raised on a single or double anastomosis, depending on origin. Even in cases of flap salvage, the fibula flap remains a reliable flap. This case describes a fibula flap with a sole proximal myocutaneous perforator identified during dissection despite a normal preoperative Doppler.

BACKGROUND Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. OBJECTIVE This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. METHODS A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. RESULTS Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. CONCLUSIONS Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions.

As non-communicable diseases (NCDs) are now well recognized as the leading cause of mortality among adult populations worldwide, they are also increasingly the focus of media coverage. As such, the objective of this study is to describe the framing of NCDs in the coverage of newspapers, with the understanding that it says something about the society producing it. Automatic content analysis was employed to examine disease topics, risks, and cost consequences, thus providing lay people with a chance of learning the etiology of NCDs and information available for fighting diseases. The result of the computational method identified a total of 152,810 news articles with one of the seven supra-categories of NCDs. The category of metabolic diseases was covered most frequently in the past ten years. Three health risks received ample attention in all 11 newspapers: stress burden, tobacco use, and genetic predispositions. The results evidenced how media framed risk information of illnesses would distort the way in which diseases were selected, interpreted, and the outcome communicated. Future research building on our findings can further examine whether news framing affects the way the readers perceive and prevent NCDs.

Previous studies indicated that television (TV) advertising is associated with higher rates of obesity. The rate of obesity and overweight continues to rise in mainland China, bringing into question whether TV advertising to young audiences might be partly to blame. This study investigated messaging delivered through TV advertisements regarding healthy and unhealthy foodstuffs. A total of 42 major food brands and 480 advertisements were analysed for content in this study. The results showed that the majority of TV spots advertised products with poor nutritional content and had a potential to mislead audiences concerning products’ actual nutritional value. The tactics of repetition and appeals of premium offerings on food brands have a potential to influence the purchase intentions. Additional qualitative observation involving the social bond, social context and cultural factors pertaining to mood alterations were highlighted. The discussion addressed product attributes reflected by culture and the implicit messages of marketing claims may increase the risk of obesity. Thus, public health policymakers and researchers were encouraged to act urgently to evaluate the obesity risks of unhealthy food advertised in the media and to support healthy foods.

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients&rsquo, combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals&rsquo, sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users&rsquo, characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources.

For respondents to this cross-sectional survey, traditional educational media remained the most important for clinical learning. However, podcasts were particularly useful for a subset of the surveyed population, and their influence will likely continue increasing.

Raising the question of what and how metabolic syndrome is covered through the renowned online press, hence, this study attempted to determine the ways in which the newspapers selects chronic diseases and how the syndrome informs the public of causation and adverse outcome. Web-based news platforms from four leading newspapers in mainland China were sampled for machine computational analysis. Two prominent metabolic diseases, its causation and causal inference were identified in a total of 16,005 articles in the past 10 years. Descriptive statistics is reported while a word cloud displays the entire news content as a graphical representation of word frequency with recurring expressions. A dendograms was summarized to provide a richer context to interpret association between metabolic syndrome and causal inference to verify if misinformation was spread through the renowned online press. Results indicate that news stories tend to provide equivocal descriptions of metabolic disease burden while implying explicitly that alcohol, tobacco, or genes might be the main cause of adverse outcomes for metabolic syndrome. This study emphasized the importance of taxonomy of coding, causal assessments of news stories to inform debates on addressing causal inferences, message design, and unique frames in the media content. It concludes with limitation of datamining and directions for future research.

User-centered design methods aim to increase intervention engagement by focusing on consumers’ needs and preferences. We conducted a needs assessment (the first step in user-centered design) via a digital diary study to understand how individuals with recurrent binge eating (≥12 episodes in 3 months) and obesity (BMI≥30 kg/m(2)) manage these problems in their day-to-day lives and the approaches they use to change their behavior. Specifically, we applied the Behavior Change Technique (BCT)-Taxonomy to characterize which standardized BCTs individuals use to change binge eating and health-related behaviors and their motivations to use them, to inform the design of a mobile intervention. We analyzed qualitative data from 22 adults (64% female, 32% White) who submitted 176 diary entries. For each entry, we coded the BCTs used, motivation for use, and whether the BCT(s) were perceived as beneficial for behavior change. Across participants, investigators identified 50 of the 93 standardized BCTs (54%). Each participant used an average of 12 (SD = 4) BCTs, most commonly Behavior Substitution (72.3%), Distraction (68.2%), Goal Setting (Behavior) (63.6%), Action Planning (59.1%) and Adding Objects to the Environment (59.1%). More BCTs were coded as beneficial (49%) versus detrimental (24%) or neutral (27%). Techniques were most commonly motivated by preventing binge eating (95.5%), losing weight (95.5%), reducing unhealthy food choices (90.9%), or managing stress (59.1%). Results help inform how interventions could be designed to support consumers in changing binge eating and weight-related behaviors, although such designs would need to be tested for their impact on engagement and outcomes.

Background: Inferior angle of scapula fractures (IAS) are rare injuries that result from the periscapular shoulder muscles avulsing the inferior scapula tip. The aim of this study was to investigate the mechanisms of injury, investigations and treatment outcomes, as currently only case reports are available to guide management. Methods: Computered tomography (CT) images were reviewed to identify patients with an IAS fracture. Case notes were reviewed, and patients contacted to gather data relating to the injury, treatment and outcome. Results: Fourteen fractures were identified on CT. Five were missed on the initial radiograph. High energy fractures had an average age of 47.6 years, 90% were male. Low energy fractures had a mean age of 83.6 years 75% were female. All undisplaced fractures had a satisfactory outcome treated non-operatively. Three of six displaced fractures reported an unsatisfactory outcome with non-operative treatment. Subsequent surgical fixation resulted in resolution of symptoms. Conclusions: Inferior angle of scapula fractures are a rare injury that can result from high or low energy trauma. They are easy to miss on plain radiographs. Identification is important as displaced fractures can do poorly when treated non-operatively, but symptoms resolve with surgical fixation. Undisplaced fracture has a satisfactory outcome when treated non-operatively. Evidence: Level IV.

Background: Several studies have shown the relationship between poorer clinical outcomes of arthroscopic femoroacetabular impingement syndrome surgery and focal chondral defects or global chondromalacia/osteoarthritis. Although recent studies described good outcomes after the conjunctive application of synovial mesenchymal stem cells (MSCs), none demonstrated the application of synovial MSCs for cartilaginous hip injuries. Purpose: To compare the characteristics of MSCs derived from the paralabral synovium and the cotyloid fossa synovium and determine which is the better source. Study Design: Controlled laboratory study. Methods: Synovium was harvested from 2 locations of the hip—paralabral and cotyloid fossa—from 18 donors. The number of cells, colony-forming units, viability, and differentiation capacities of adipose, bone, and cartilage were collected and compared between groups. In addition, real-time polymerase chain reaction was used to assess the differentiation capacity of adipose, bone, and cartilage tissue from both samples. Results: The number of colonies and yield obtained at passage 0 of synovium from the cotyloid fossa was significantly higher than that of the paralabral synovium ( P < .01). In adipogenesis experiments, the frequency of detecting oil red O–positive colonies was significantly higher in the cotyloid fossa than in the paralabral synovium ( P < .05). In osteogenesis experiments, the frequency of von Kossa and alkaline phosphatase positive colonies was higher in the cotyloid fossa synovium than in the paralabral synovium ( P < .05). In chondrogenic experiments, the chondrogenic pellet culture and the gene expressions of COL2a1 and SOX9 were higher in the cotyloid fossa synovium than in the paralabral synovium ( P < .05). Conclusion: MSCs from the cotyloid fossa synovium have higher proliferation and differentiation potential than do those from the paralabral synovium and are therefore a better source. Clinical Relevance: Synovial cells from the cotyloid fossa synovium of patients with femoroacetabular impingement syndrome are more robust in vitro, suggesting that MSCs from this source may be strongly considered for stem cell therapy.

Understanding patrons’ repurchase intentions is a key area of focus for marketers, given its effect on survival and growth in competitive environments. Four types of relationships based on patron’s satisfaction, product preference, product involvement, induced emotions and repurchasing intention were modelled to illustrate how current consumption influenced the repurchase intentions of performing arts patrons. An empirical study on an East Asian traditional culture performance from 671 patrons was conducted by using structural equation modelling (SEM) techniques. The result indicated that patrons’ satisfaction was not the most direct determinant of their own repurchase intention, as initially theorized. Instead, patron preferences and involvement are the most proximal predictors of repurchase intent. Performing arts represent a leisure market sector that provides educational, entertainment and experiential services. Arts marketers can identify the factors that influence the patrons’ repurchase responses to improve their’ inherently experiential offerings. This study represents a sophisticated nature of the relationship with theatre patrons and offers theoretical and practical mediating attributes for arts marketing managers to consider in communication.

Background The fact that the number of individuals with obesity has increased worldwide calls into question media efforts for informing the public. This study attempts to determine the ways in which the mainstream digital news covers the etiology of obesity and diseases associated with the burden of obesity. Objective The dual objectives of this study are to obtain an understanding of what the news reports on obesity and to explore meaning in data by extending the preconceived grounded theory. Methods The 10 years of news text from 2010 to 2019 compared the development of obesity-related coverage and its potential impact on its perception in Mainland China, Hong Kong, and Taiwan. Digital news stories on obesity along with affliction and inferences in 9 Chinese mainstream newspapers were sampled. An automatic content analysis tool, DiVoMiner was proposed. This computer-aided platform is designed to organize and filter large sets of data on the basis of the patterns of word occurrence and term discovery. Another programming language, Python 3, was used to explore connections and patterns created by the aggregated interactions. Results A total of 30,968 news stories were identified with increasing attention since 2016. The highest intensity of newspaper coverage of obesity communication was observed in Taiwan. Overall, a stronger focus on 2 shared causative attributes of obesity is on stress (n=4483, 33.0%) and tobacco use (n=3148, 23.2%). The burdens of obesity and cardiovascular diseases are implied to be the most, despite the aggregated interaction of edge centrality showing the highest link between the “cancer” and obesity. This study goes beyond traditional journalism studies by extending the framework of computational and customizable web-based text analysis. This could set a norm for researchers and practitioners who work on data projects largely for an innovative attempt. Conclusions Similar to previous studies, the discourse between the obesity epidemic and personal afflictions is the most emphasized approach. Our study also indicates that the inclination of blaming personal attributes for health afflictions potentially limits social and governmental responsibility for addressing this issue.