A Revised Model of Trust in Internet-Based Health Information and Advice: Cross-Sectional Questionnaire Study.

BACKGROUND: The internet continues to offer new forms of support for health decision making. Government, charity, and commercial websites increasingly offer a platform for shared personal health experiences, and these are just some of the opportunities that have arisen in a largely unregulated arena. Understanding how people trust and act on this information has always been an important issue and remains so, particularly as the design practices of health websites continue to evolve and raise further concerns regarding their trustworthiness. OBJECTIVE: The aim of this study was to identify the key factors influencing US and UK citizens' trust and intention to act on advice found on health websites and to understand the role of patient experiences. METHODS: A total of 1123 users took part in an online survey (625 from the United States and 498 from the United Kingdom). They were asked to recall their previous visit to a health website. The online survey consisted of an updated general Web trust questionnaire to account for personal experiences plus questions assessing key factors associated with trust in health websites (information corroboration and coping perception) and intention to act. We performed principal component analysis (PCA), then explored the relationship between the factor structure and outcomes by testing the fit to the sampled data using structural equation modeling (SEM). We also explored the model fit across US and UK populations. RESULTS: PCA of the general Web trust questionnaire revealed 4 trust factors: (1) personal experiences, (2) credibility and impartiality, (3) privacy, and (4) familiarity. In the final SEM model, trust was found to have a significant direct effect on intention to act (beta=.59; P<.001), and of the trust factors, only credibility and impartiality had a significant direct effect on trust (beta=.79; P<.001). The impact of personal experiences on trust was mediated through information corroboration (beta=.06; P=.04). Variables specific to electronic health (eHealth; information corroboration and coping) were found to substantially improve the model fit, and differences in information corroboration were found between US and UK samples. The final model accounting for all factors achieved a good fit (goodness-of-fit index [0.95], adjusted goodness-of-fit index [0.93], root mean square error of approximation [0.50], and comparative fit index [0.98]) and explained 65% of the variance in trust and 41% of the variance in intention to act. CONCLUSIONS: Credibility and impartiality continue to be key predictors of trust in eHealth websites. Websites with patient experiences can positively influence trust but only if users first corroborate the information through other sources. The need for corroboration was weaker in the United Kingdom, where website familiarity reduced the need to check information elsewhere. These findings are discussed in relation to existing trust models, patient experiences, and health literacy.

The Management of Iatrogenic Obstructive Sleep Apnoea Syndrome Following Bimaxillary Surgery in a Patient with Cleft Lip and Palate.

A 26-year-old man presented with a 6-year history of severe obstructive sleep apnoea syndrome followed a bimaxillary osteotomy procedure for a class III skeletal pattern. The patient was born with a unilateral cleft lip and palate and underwent primary lip and palate repair and later a pharyngeal flap for severe velopharyngeal insufficiency. Surgical management of obstructive sleep apnoea syndrome with conventional osteotomy, in cleft lip and palate patients, is a difficult problem. Distraction osteogenesis may provide a safer alternative. The authors describe and discuss the indications and the technical challenge of a multistage treatment protocol with distraction osteogenesis.

Craniofacial diversity across Danionins and the effects of TH status on craniofacial morphology of two Danio species.

The model zebrafish ( Danio rerio ) belongs to the Danioninae subfamily with a range of informative phenotypes. However, the craniofacial diversity across the subfamily is not fully described. To better understand craniofacial phenotypes across Danioninae we used microCT and 3D geometric morphometrics to capture skull shapes from nine species. The Danio species examined showed largely similar skull shapes, although D. aesculapii , the sister species to D. rerio showed a unique morphology. Two non- Danio species examined, Chela dadiburjori and Devario aequipinnatus showed distinct skull morphologies unique from those of other species examined. Thyroid hormone regulates skeletal development and remodeling, and we asked if changes in developmental thyroid hormone metabolism could underlie some of the craniofacial diversity across Danioninae. We reared two Danio species under altered thyroid profiles, finding that hypothyroid individuals from both species showed corresponding morphological shifts in skull shape. Hypothyroid Danios showed skull morphologies closer to that of Chela and unlike any of the examined wild-type Danio species. We provide an examination of the evolved craniofacial diversity across Danioninae, and demonstrate that alterations to thyroid hormone have the capacity to create unique skull phenotypes.

Collecting and sharing self-generated health and lifestyle data: Understanding barriers for people living with long-term health conditions - a survey study.

Background: The growing popularity of collecting self-generated health and lifestyle data presents a valuable opportunity to develop our understanding of long-term health conditions and improve care. Barriers remain to the effective sharing of health and lifestyle data by those living with long-term health conditions which include beliefs around concepts of Trust, Identity, Privacy and Security, experiences of stigma, perceptions of risk and information sensitivity. Method: We surveyed 250 UK adults who reported living with a range of long-term health conditions. We recorded data to assess self-reported behaviours, experiences, attitudes and motivations relevant to sharing self-generated health and lifestyle data. We also asked participants about their beliefs about Trust, Identity, Privacy and Security, stigma, and perceptions of risk and information sensitivity regarding their health and lifestyle data. Results: Three-quarters of our sample reported recording information about their health and lifestyle on a daily basis. However, two-thirds reported never or rarely sharing this information with others. Trust, Identity, Privacy and Security concerns were considered to be 'very important' by those with long-term health conditions when deciding whether or not to share self-generated health and lifestyle data with others, with security concerns considered most important. Of those living with a long-term health condition, 58% reported experiencing stigma associated with their condition. The greatest perceived risk from sharing with others was the potential for future harm to their social relationships. Conclusions: Our findings suggest that, in order for health professionals and researchers to benefit from the increased prevalence of self-generated health and lifestyle data, more can be done to address security concerns and to understand perceived risks associated with data sharing. Digital platforms aimed at facilitating the sharing of self-generated health and lifestyle data may look to highlight security features, enable users to control the sharing of certain information types, and emphasise the practical benefits to users of sharing health and lifestyle data with others.

The impact of IoT security labelling on consumer product choice and willingness to pay.

The Internet of Things (IoT) brings internet connectivity to everyday electronic devices (e.g. security cameras and smart TVs) to improve their functionality and efficiency. However, serious security and privacy concerns have been raised about the IoT which impact upon consumer trust and purchasing. Moreover, devices vary considerably in terms of the security they provide, and it is difficult for consumers to differentiate between more and less secure devices. One proposal to address this is for devices to carry a security label to help consumers navigate the market and know which devices to trust, and to encourage manufacturers to improve security. Using a discrete choice experiment, we estimate the potential impact of such labels on participant's purchase decision making, along with device functionality and price. With the exception of a label that implied weak security, participants were significantly more likely to select a device that carried a label than one that did not. While they were generally willing to pay the most for premium functionality, for two of the labels tested, they were prepared to pay the same for security and functionality. Qualitative responses suggested that participants would use a label to inform purchasing decisions, and that the labels did not generate a false sense of security. Our findings suggest that the use of a security label represents a policy option that could influence behaviour and that should be seriously considered.

Microsurgical Reconstruction of the Jaws Using Vascularised Free Flap Technique in Patients with Medication-Related Osteonecrosis: A Systematic Review.

BACKGROUND: Osteonecrosis of the jaw (ONJ) has been reported to be associated with patients receiving primarily bisphosphonate (BP) therapies. However, lately it has been documented that other medications, such as RANK ligand inhibitor (denosumab) and antiangiogenic drug, can cause ONJ. Micro-osseous-vascular reconstruction of the jaws in patients affected by medication-related osteonecrosis of the jaw represents a viable option of treatment for patients affected by stage III of the disease. However, there are still considerable doubts about the success of this procedure in the short, medium, and long term. MATERIAL AND METHODS: A multidatabase (PubMed/MEDLINE, EMBASE, and CENTRAL) systematic search was performed. Any type of studies considering human patients treated with antiresorptive and antiangiogenic drugs was considered. The aim of the research is to primarily understand the success rate of micro-osseous-vascular reconstruction in the short, medium, and long period of time. This review has also the goal of better understanding any perioperative and postoperative complications resulting from the use of the reconstruction techniques. RESULTS: Eighteen studies resulted eligible for the study. Fibula free flap is the most commonly utilised vascularised free flap reconstruction technique (80.76%). Ten out of eighteen studies reported no complications. Recurrence of osteonecrosis was registered in five cases (6.41%) after free flap reconstruction. The overall free flap success rate was 96.16%. CONCLUSIONS: Based on the limited data available in literature (Level 4 of the Oxford Evidence-based medicine scale), micro-osseous-vascular reconstruction of the jaws represents a valid treatment in patients with bisphosphonate-related osteonecrosis at stage III of the disease. However, additional data based on a larger cohort of patients are necessary to justify this type of intervention in patient affected by MRONJ.

Rejuvenation of the ageing upper lip and nose with suspension lifting.

There are growing number of patients attending aesthetic consultations and requesting the rejuvenation of ageing upper lips. Often these patients also have nasal tip ptosis. There are a number of direct and indirect upper lip lifting procedures. We describe a novel technique, which combines upper lip and nasal tip rejuvenation through hidden incisions and the use of suspension micro-screws.

A systematic review of soft-to-hard tissue ratios in orthognathic surgery. Part III: Double jaw surgery procedures.

OBJECTIVE: The aim was to determine the soft-to-hard tissue ratios in profile view in bimaxillary orthognathic surgical corrections. MATERIAL AND METHODS: A systematic review of studies published in different languages was performed by searching the Medline, Embase, Cochrane Library, Lilacs, Scopus, and Science Direct databases up to August 2015. Additional studies were identified by reference analyses. The methodological quality was evaluated using the instrument developed by the Effective Public Health Practice Project and the Level of Evidence using the Level of Evidence scale from the Oxford Centre for Evidence-based Medicine. RESULTS: The search identified 16 articles; one of which was included from the manual reference search. The analysis of bias revealed weak methodological quality for all the studies included (LOE IV). The studies were retrospective and presented widely varying ratios. In sagittal movements Sn:ANS showed consistency in the evaluations with 60%-90% ratios in five articles. Pn:A presented 66%-90% when V-Y suturing is executed and Ls:U1 ratio was 60%-100% in 6 articles. In vertical direction, poor data are available, considering Sn:A between 54% and 91% in 3 articles and Ls:U1 between 66% and 97% in 3 articles. The Mla-to-point B ratio in sagittal movements was 100% in six articles and Pg-to-sPg demonstrated a relationship between 90% and 100% in 8 articles. CONCLUSION: Soft-to-hard tissue ratios varied greatly in literature. The results for the mentolabial angle and soft Pogonion changes were apparently more uniform. The low LOE of the studies prevented a more in-depth analysis.

Personality and Social Framing in Privacy Decision-Making: A Study on Cookie Acceptance.

Despite their best intentions, people struggle with the realities of privacy protection and will often sacrifice privacy for convenience in their online activities. Individuals show systematic, personality dependent differences in their privacy decision making, which makes it interesting for those who seek to design 'nudges' designed to manipulate privacy behaviors. We explore such effects in a cookie decision task. Two hundred and ninety participants were given an incidental website review task that masked the true aim of the study. At the task outset, they were asked whether they wanted to accept a cookie in a message that either contained a social framing 'nudge' (they were told that either a majority or a minority of users like themselves had accepted the cookie) or contained no information about social norms (control). At the end of the task, participants were asked to complete a range of personality assessments (impulsivity, risk-taking, willingness to self-disclose and sociability). We found social framing to be an effective behavioral nudge, reducing cookie acceptance in the minority social norm condition. Further, we found personality effects in that those scoring highly on risk-taking and impulsivity were significantly more likely to accept the cookie. Finally, we found that the application of a social nudge could attenuate the personality effects of impulsivity and risk-taking. We explore the implications for those working in the privacy-by-design space.

Do you mind if I vape? Immediate effects of electronic cigarettes on perfusion in buccal mucosal tissue--a pilot study.

The association between smoking and postoperative complications is compounded in patients who have oral and maxillofacial operations by an additional local effect, and patients often continue to smoke after operation despite advice to stop. Recent studies have suggested that nicotine may reduce inflammation and improve angiogenesis, so topical application may be beneficial for smokers. The electronic cigarette is increasing in popularity and more patients ask whether they can vape after operation. We investigated the effect of electronic cigarettes (of which half contained nicotine and half did not) on blood flow in the buccal mucosa in 10 volunteers immediately after vaping. Smokers were excluded as this was considered an additional variable in a small pilot study and our Trust has a no-smoking policy. After vaping for 5 minutes, capillary blood flow was measured in the buccal mucosa at 5-minute intervals using a laser Doppler probe, and the results were expressed as arbitrary perfusion units. There was a wide variation in results and a small but significant rise (p=0.008) as a result of nicotine vaping, but these fell to the same levels as before within 30 minutes. Electronic cigarettes may have an effect on blood flow to the oral mucosa, although further studies are needed to show whether they improve healing time after operation. Additional work is also needed to compare them with cigarettes.

Contemporary use of imaging modalities in neck mass evaluation.

The effective and efficient management of a patient with a neck mass in a 1-stop clinic requires a collaborative and harmonious partnership among surgeon, radiologist, and pathologist. In this article, theoretic and practical issues are addressed to optimize patient care when prescribing, planning, performing, and interpreting imaging for neck disease.

Management of early stage cutaneous Merkel cell carcinoma of the head and neck.

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer of neuroendocrine origin. As a result, few large studies have been published, and we know of even fewer on disease of the head and neck alone. The most appropriate way to manage patients with early local disease and no sign of metastases neck is controversial. We reviewed management of early cutaneous MCC of the head and neck in 8 hospitals in the United Kingdom over 12 years between 1999 and 2011 (the largest head and neck series in Europe to date), and identified 39 patients (19 men and 20 women) with early disease according to a well recognised classification. A total of 24 patients had stage Ia disease, 11 had stage Ib disease, and 4 were unclassified. Five of those with stage Ia disease developed regional metastases and 7 with stage Ib disease developed regional recurrence. The 2-year overall survival for stage Ia and Ib disease was 62% and 27%, respectively. Our study shows that prognosis is poor after conservative surgical management of stage I disease. Management of the neck is still controversial, and a meta-analysis of all the published data is needed to establish best practice statistically.

Delayed presentation of a swallowed partial denture.

We report a unique case of a young patient who accidentally swallowed his partial denture and alarmingly only presented to our ear, nose and throat (ENT) department 4 weeks later despite several previous presentations to primary and secondary care. The partial denture was successfully removed under general anaesthetic using direct laryngoscopy following admission. He was discharged on a normal diet 6 days later after oesophageal perforation was excluded using a contrast swallow.