Circadian time series proteomics reveals daily dynamics in cartilage physiology.

OBJECTIVE: Cartilage in joints such as the hip and knee experiences repeated phases of heavy loading and low load recovery during the 24-h day/night cycle. Our previous work has shown 24 h rhythmic changes in gene expression at transcript level between night and day in wild type mouse cartilage which is lost in a circadian clock knock-out mouse model. However, it remains unknown to what extent circadian rhythms also regulate protein level gene expression in this matrix rich tissue. METHODS: We investigated daily changes of protein abundance in mouse femoral head articular cartilage by performing a 48-h time-series LC-MS/MS analysis. RESULTS: Out of the 1,177 proteins we identified across all time points, 145 proteins showed rhythmic changes in their abundance within the femoral head cartilage. Among these were molecules that have been implicated in key cartilage functions, including CTGF, MATN1, PAI-1 and PLOD1 & 2. Pathway analysis revealed that protein synthesis, cytoskeleton and glucose metabolism exhibited time-of-day dependent functions. Analysis of published cartilage proteomics datasets revealed that a significant portion of rhythmic proteins were dysregulated in osteoarthritis and/or ageing. CONCLUSIONS: Our circadian proteomics study reveals that articular cartilage is a much more dynamic tissue than previously thought, with chondrocytes driving circadian rhythms not only in gene transcription but also in protein abundance. Our results clearly call for the consideration of circadian timing mechanisms not only in cartilage biology, but also in the pathogenesis, treatment strategies and biomarker detection in osteoarthritis.

Perceived healthiness of food items and the traffic light front of pack nutrition labelling: choice-based conjoint analysis and cross-sectional survey.

BACKGROUND: Although traffic light labelling (TLL) is designed to aid the selection of healthier choices, consumers often have to make trade-offs between (un)desirable attributes. With the current emphasis of public health on sugar reduction, the present study aimed to investigate the relative influence of sugar on the perceived healthiness of products. METHODS: A choice-based conjoint analysis (CBC) survey was designed to assess the relative importance of the macronutrients commonly used in TLL, as well as the rescaled utilities of three attribute levels (red, amber and green), which involved 858 participants aged ≥18 years, who were recruited from the general population of Nottingham. An additional cross-sectional online survey was completed by another 901 participants to assess public knowledge about the intake recommendations underpinning the TLL. RESULTS: Usable data for CBC analysis showed that, when deciding upon the healthiness of items, sugar was significantly the most important macronutrient (mean 0.34, 95% confidence interval = 0.32-0.35) among the 641 participants. Red labelling was significantly more influential than green across macronutrients. In the substudy, 13.3% of participants correctly identify the maximum recommended intake of free sugars. Moreover, 42.8% of the total sample could not identify whether the sugar information on TLL refers to the total or free sugar content. CONCLUSIONS: Despite a lack of knowledge about the recommendations underpinning the TLL criteria, decisions made by participants concerning the healthfulness of food products were significantly influenced by sugar content. TLL appears to guide consumer beliefs in the absence of deep knowledge. The dominance of sugar in decision making is unsurprising in the current public health climate.

"Fat is really a four-letter word": Exploring weight-related communication best practices in children with and without disabilities and their caregivers.

BACKGROUND: Health care professionals play a critical role in preventing and managing childhood obesity, but the American Academy of Pediatrics recently stressed the importance of using sensitive and nonstigmatizing language when discussing weight with children and families. Although barriers to weight-related discussions are well known, there are few evidence-based recommendations around communication best practices. Disability populations in particular have previously been excluded from work in this area. The objectives were to present the findings of a recent scoping review to children with and without disabilities and their caregivers for their reactions; and to explore the experiences and perceptions of the children and their caregivers regarding weight-related communication best practices. METHODS: Focus group and individual interviews were conducted with 7-18-year olds with and without disabilities and their caregivers. The interview guide was created using findings from a recent scoping review of weight-related communication best practices. Inductive thematic analysis was employed. RESULTS: Eighteen children (9 boys; 7 children with disabilities) and 21 caregivers (17 mothers, 1 step-father, 3 other caregivers) participated in 8 focus group and 7 individual interviews. Preferred communication strategies were similar across those with and without disabilities, although caregivers of children with autism spectrum disorder endorsed more concrete approaches. Discussions emphasizing growth and health were preferred over weight and size. Strengths-based, solution-focused approaches for weight conversations were endorsed, although had not been widely experienced. CONCLUSION: Perceptions of weight-related communication were similar across stakeholder groups, regardless of children's disability or weight status. Participants generally agreed with the scoping review recommendations, suggesting that they apply broadly across different settings and populations; however, tailoring them to specific circumstances is critical. Empirical evaluations are still required to examine the influence of weight-related communication on clinically important outcomes, including behaviour change and family engagement in care.

Factors associated with universal infant free school meal take up and refusal in a multicultural urban community.

BACKGROUND: Universal infant free school meals (UIFSM) were introduced in September 2014 and are available to all key stage 1 (4-7 years) children attending state-maintained infant and primary schools in England. The present study aimed to investigate the school-based factors, child and family socio-demographic characteristics, and parental beliefs associated with UIFSM take up in an urban community. METHODS: A cross-sectional questionnaire survey was completed in October to November 2015, amongst parents whose children attended eligible schools in Leicester, England. A questionnaire about school meals was also completed by each school. RESULTS: Parents reported their child did not take (non-UIFSM, n = 159) or took (UIFSM, n = 517) a UIFSM on most days. The non-UIFSM group were more likely to be White-British, have a higher socio-economic status, have English as a first language, and involve their child in the decision over whether or not to take UIFSM, compared to the UIFSM group. Cluster analysis revealed that non-UIFSM parents were either concerned over quality of meals and what/how much their child ate, concerned only by what/how much their child ate or whether their child did not like the food provided. Two subsets of parents in the UIFSM group were either very positive about UIFSM or appeared to take meals because they were free. Schools used a variety of measures to increase and maintain UIFSM take up. CONCLUSIONS: Parents like to have control over what their child eats at school and children need to enjoy their school meals. Using a range of interventions to target subsets of parents may help local authorities, schools and caterers to increase UIFSM take up.

Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants.

BACKGROUND: A better understanding of the nutritional status of infants who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is key to improving population health, particularly in sub-Saharan Africa. METHODS: A cross-sectional study compared the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants residing in representative selected districts in Botswana during their first 1000 days of life. Four hundred and thirteen infants (37.3% HIV-exposed), aged 6-24 months, attending routine child health clinics, were recruited. Anthropometric, 24-h dietary intake and socio-demographic data was collected. Anthropometric Z-scores were calculated using 2006 World Health Organization growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression. RESULTS: Overall, the prevalences of stunting, wasting and being underweight were 10.4%, 11.9% and 10.2%, respectively. HEU infants were more likely to be underweight (15.6% versus 6.9%), (P < 0.01) and stunted (15.6% versus 7.3%), (P < 0.05) but not wasted (P = 0.14) than HUU infants. HEU infants tended to be formula fed (82.5%), whereas HUU infants tended to breastfeed (94%) for the first 6 months (P < 0.001). Significant predictors of nutritional status were HIV exposure, birthweight, birth length, APGAR (appearance, pulse, grimace, activity and respiration) score and mother/caregiver's education with little influence of socio-economic status. CONCLUSIONS: HEU infants aged 6-24 months had worse nutritional status compared to HUU infants. Low birthweight was the main predictor of undernutrition in this population. Optimisation of infant nutritional status should focus on improving birthweight. In addition, specific interventions should target HEU infants aiming to eliminate growth disparity between HEU and HUU infants.

Setting targets leads to greater long-term weight losses and 'unrealistic' targets increase the effect in a large community-based commercial weight management group.

BACKGROUND: Setting personal targets is an important behavioural component in weight management programmes. Normal practice is to encourage 'realistic' weight loss, although the underlying evidence base for this is limited and controversial. The present study investigates the effect of number and size of weight-loss targets on long-term weight loss in a large community sample of adults. METHODS: Weight change, attendance and target weight data for all new UK members, joining from January to March 2012, were extracted from a commercial slimming organisation's electronic database. RESULTS: Of the 35 380 members who had weight data available at 12 months after joining, 69.1% (n = 24 447) had a starting body mass index (BMI) ≥30 kg m-2 . Their mean (SD) weight loss was 12.9% (7.8%) and, for both sexes, weight loss at 12 months was greater for those who set targets (P < 0.001). Those that set ≥4 targets achieved the greatest loss (P < 0.001). The odds ratio for weight loss ≥10% at 12 months was 10.3 (95% confidence interval = 9.7-11.1, P < 0.001) where targets had been set compared to none. At the highest quintile of target size, the size of the first target explained 47.2% (P < 0.001) of the variance in weight loss achieved at 12 months. The mean (SD) BMI reduction in those with a target >25% was 7.6 (4.0) kg m-2 . A higher percentage of obese members did not set targets (P < 0.001) compared to those with a BMI <30 kg m-2 . CONCLUSIONS: Much of the variance in weight loss achieved in this population was explained by the number of targets set and the size of the first target. Although obese people were less likely to set targets, doing so increased the likelihood of achieving clinically significant weight loss and, for some 'unrealistic' targets, improved the results.

Assessing communication skills in dietetic consultations: the development of the reliable and valid DIET-COMMS tool.

BACKGROUND: There is an increasing emphasis on the development of communication skills for dietitians but few evidence-based assessment tools available. The present study aimed to develop a dietetic-specific, short, reliable and valid assessment tool for measuring communication skills in patient consultations: DIET-COMMS. METHODS: A literature review and feedback from 15 qualified dietitians were used to establish face and content validity during the development of DIET-COMMS. In total, 113 dietetic students and qualified dietitians were video-recorded undertaking mock consultations, assessed using DIET-COMMS by the lead author, and used to establish intra-rater reliability, as well as construct and predictive validity. Twenty recorded consultations were reassessed by nine qualified dietitians to assess inter-rater reliability: eight of these assessors were interviewed to determine user evaluation. RESULTS: Significant improvements in DIET-COMMS scores were achieved as students and qualified staff progressed through their training and gained experience, demonstrating construct validity, and also by qualified staff attending a training course, indicating predictive validity (P < 0.05). An acceptable level of intra-rater reliability (rs  = 0.90) and a moderate level of inter-rater reliability (r = 0.49) were demonstrated. Interviews identified many positive features and possible uses for DIET-COMMS in both pre- and post-registration settings. The need for assessor training was emphasised and how readily qualified dietitians would accept assessment of skills in practice was questioned. DISCUSSION: DIET-COMMS is a short, user-friendly, reliable and valid tool for measuring communication skills in patient consultations with both pre- and post-registration dietitians. Additional work is required to develop a training package for assessors and to identify how DIET-COMMS assessment can acceptably be incorporated into practice.

Weight bias among UK trainee dietitians, doctors, nurses and nutritionists.

BACKGROUND: Trainee dietitians, nutritionists, nurses and doctors will direct the future of obesity treatment and prevention. To do so effectively, they must be willing and able to engage empathically with overweight and obese people. The present study aimed to assess weight bias among UK trainee healthcare professionals and to investigate the factors predicting weight bias, both static and potentially modifiable. METHODS: A self-completed questionnaire collected data on demographics, weight and height, the Fat Phobia Scale (F-scale), and the Beliefs about Obese People (BOAP) scale from 1130 students. RESULTS: Overall, participants demonstrated significant levels of fat phobia [F-scale score mean (SD) = 3.8 (0.5)]. Only 1.4% of participants could be said to have expressed 'positive or neutral attitudes' (i.e. achieved a F-scale score ≤ 2.5). Hierarchical multiple regression revealed that lower fat phobia (as measured by the F-scale) was uniquely predicted by a higher self-reported body mass index, being on the Nursing BSc course and a stronger perception that obesity is not under a person's control (as measured by the BOAP scale). CONCLUSIONS: There are unacceptable levels of weight bias among UK students training to become nurses, doctors, nutritionists and dietitians. The results of the present study suggest that a promising approach for future interventions would be the provision of balanced education about the controllability of obesity, focusing upon genetic and environmental factors, as well as diet and exercise.

Human temporomandibular joint and myofascial pain biochemical profiles: a case-control study.

Neurobiological mechanisms of human musculoskeletal pain are poorly understood. This case-control study tested the hypothesis that biomarkers within temporomandibular muscle and joint disorders (TMJD) subjects' masseter muscles or temporomandibular joint (TMJ) synovial fluid correlate with plasma biomarker concentrations. Fifty subjects were recruited and categorized into TMJD cases (n=23) and pain-free controls (n=27) at the University of Minnesota School of Dentistry. Prior to specimen collection, pain intensity and pressure pain threshold masseter muscles and the TMJs were assessed. We collected venous blood; biopsied masseter muscle; and sampled TMJ synovial fluid on the subjects' side of maximum pain intensity. We assayed these tissues for the presence of nerve growth factor (NGF), bradykinin (BK), leukotreine B(4) (LTB(4) ) and prostaglandin E(2) (PGE(2) ), F(2) -isoprostane (F(2) I) and substance P (SP). The data was analyzed using Spearman Correlation Coefficients. We found that only plasma concentrations of bradykinin statistically correlated with synovial fluid concentrations (ρ=-0·48, P=0·005), but no association was found between pain intensities. The data suggests that biomarkers used to assess TMJD need to be acquired in a site-specific manner. We also discovered that F(2) I concentrations were associated with muscle pain intensity and muscle pressure pain threshold (PTT) (ß=0·4, 95%CI: 0·03-0·8) and joint PPT (ß=0·4, 95%CI: 0·07-0·8) suggesting that muscle oxidative stress is involved in myofascial pain and that F(2) -I may be a biomarker for myofascial pain.

Facilitating grant proposal writing in health behaviors for university faculty: a descriptive study.

Grant proposal writing in the behavioral sciences is important for fiscal reasons and scientific reasons at many universities. This report describes a grant proposal-writing seminar series provided to University faculty (N = 20) and explores factors facilitating and impeding writing. Summary statistics are provided for quantitative data. Free responses were sorted by independent raters into meaningful categories. As a consequence of the training, 45% planned to submit within 18 months; 80% of grant proposals targeted NIH. At 1-year follow-up, 40% actually submitted grants. Factors impeding grant proposal writing included competing professional demands; factors facilitating writing included regularly scheduled feedback on written proposal sections and access to expert collaborators. Obtaining grants generates financial resources, facilitates training experiences, and vastly contributes to the growth and dissemination of the knowledge base in an area.

Qualitative research in nutrition and dietetics: data collection issues.

The wide scope of qualitative enquiry presents the researcher with a number of choices regarding data collection and sampling. Selecting data collection and sampling techniques can therefore be somewhat daunting, particularly because, often, there is no single, universally accepted 'correct' option. Appropriate research methods are, however, crucial to ensure high-quality research. This review, the second in the series, provides an overview of the principal techniques of data collection and sampling that may be used for qualitative research in nutrition and dietetics. In addition, it describes a process for choosing appropriate data collection and sampling methods that considers the extent to which they provide data that answers the research question(s) and are compatible with the philosophical assumptions about ontology, epistemology and methodology that underpin the overall design of a study. Finally, it discusses the central role that the researcher plays in qualitative data collection and encourages researchers to acknowledge and reflect upon their impact on the data. Other reviews in this series provide a model for embarking on a qualitative research project in nutrition and dietetics, an overview of the principal techniques of data analysis and quality assessment of this kind of research, and some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.

Qualitative research in nutrition and dietetics: assessing quality.

In recent years, qualitative research has become much more widely used in healthcare settings and undoubtedly has much to offer nutrition and dietetics. Its value is, however, still sometimes called into question and, for those unfamiliar with qualitative approaches, it can be difficult to grasp what distinguishes 'good' qualitative research from that which has been less rigorously conceived and conducted. This review, the fourth in the series, aims to highlight some of the key scientific debates around the quality criteria that can be applied to qualitative research, and offers some flexible guidelines that may be used both in producing and assessing qualitative health research, including studies in nutrition and dietetics. Other reviews in this series provide a model for embarking on a qualitative research project in nutrition and dietetics, an overview of the principal techniques of data collection, sampling and analysis and some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.

Qualitative research in nutrition and dietetics: data analysis issues.

Although much of the analysis conducted in qualitative research falls within the broad church of thematic analysis, the wide scope of qualitative enquiry presents the researcher with a number of choices regarding data analysis techniques. This review, the third in the series, provides an overview of a number of techniques and practical steps that can be taken to provide some structure and focus to the intellectual work of thematic analysis in nutrition and dietetics. Because appropriate research methods are crucial to ensure high-quality research, it also describes a process for choosing appropriate analytical methods that considers the extent to which they help answer the research question(s) and are compatible with the philosophical assumptions about ontology, epistemology and methodology that underpin the overall design of a study. Other reviews in this series provide a model for embarking on a qualitative research project in nutrition and dietetics, an overview of the principal techniques of data collection, sampling and quality assessment of this kind of research and some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.

Qualitative research in nutrition and dietetics: getting started.

Qualitative research is well placed to answer complex questions about food-related behaviour because it investigates how and why individuals act in certain ways. The field of qualitative health research is undoubtedly gaining momentum and, increasingly, there is a recognition that it should be a vital part of the decision-making processes that direct the development of health policy and practice. Much of the guidance available, however, is difficult to navigate for those new to 'qualitative research', and there is little discussion of qualitative research issues specifically in relation to nutrition and dietetics. This review, the first in a series, outlines the field of qualitative enquiry, its potential usefulness in nutrition and dietetics, and how to embark upon this type of research. Furthermore, it describes a process to guide high-quality qualitative research in this area that proceeds from the research question(s) and considers the key philosophical assumptions about ontology, epistemology and methodology that underpin the overall design of a study. Other reviews in this series provide an overview of the principal techniques of data collection and sampling, data analysis, and quality assessment of qualitative work, and provide some practical advice relevant to nutrition and dietetics, along with glossaries of key terms.

Demonstration of the fuzzy surface coat of rat intestinal microvilli by freeze-etching.

In freeze-etch replicas of epithelial cells of rat rectum, the fuzzy surface coat is composed of discrete filaments which are aligned in parallel with each other and with the long axes of the microvilli.

A Climatic Freshening of the Deep Atlantic North of 50{degrees}N over the Past 20 Years.

Observations made in summer 1981 show a significant and widespread decrease in salinity, averaging 0.02 per mil, in deep waters of the subpolar North Atlantic over the past two decades. This implies a relatively rapid response of deep water formation to climatic perturbation.

Communication skills for behaviour change in dietetic consultations.

BACKGROUND: Both the UK's National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health-related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. METHODS: In October 2007, a cross-sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free-text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre- and post-registration level. RESULTS: There were 1158 respondents; a response rate of 19.3%. Ninety-eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post-registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post-registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. CONCLUSIONS: This study has explored an important and under-researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post-registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.

Speculations on the molecular structure of eumelanin.

Eumelanin is the polymeric black pigment commonly found in hair and skin. Its chemical intractability, to all but vigorous oxidizing agents, has hindered satisfactory understanding of its molecular structure. It is well-established that the immediate precursor to polymerization, indole-5,6-quinone (IQ), is biosynthesized from the amino acid tyrosine. Current views are that the polymer consists of single bond connections between random indole and degraded indole units. In this paper, an alternative chemical scheme for the polymerization of IQ is proposed based upon the original suggestion by Horner in 1949 that a Diels-Alder (D-A) reaction might be involved. The proposed basic chemical scheme for eumelanin formation is that D-A addition occurs specifically between the 2- and 3-positions of one IQ molecule and the 7- and 4- positions respectively of a second IQ molecule, that the ensuing diketo bridge is oxidized to carboxyl groups and that, by decarboxylation and aromatization, a fused indole dimer is produced. It is envisaged that, by further D-A addition of more IQ molecules, oligomers of greater molecular mass are produced. Calculations based on published bond lengths and angles for the indole nucleus show that oligomeric units containing a total of up to 11 fused indoles could be packed into a flat circular disc of 20 A diameter. The discs of the extensively conjugated polymer are envisaged to be stacked above each other by pi-pi interaction and with a spacing of 3.4 A to produce cylindrical units, the mass density of which is calculated to be 1.54 gm cm(-3); approximating with actual physical measurements. The size and shape of the predicted cylinders are in concordance with those observed in atomic force microscope investigations of eumelanin proto-particles. The model is also in agreement with published experimental data that 2/3rds of the carbon dioxide liberated during eumelanin formation derives from positions 5- and 6- of the IQ molecule.

Passive functional mapping of receptive language areas using electrocorticographic signals.

OBJECTIVE: To validate the use of passive functional mapping using electrocorticographic (ECoG) broadband gamma signals for identifying receptive language cortex. METHODS: We mapped language function in 23 patients using ECoG and using electrical cortical stimulation (ECS) in a subset of 15 subjects. RESULTS: The qualitative comparison between cortical sites identified by ECoG and ECS show a high concordance. A quantitative comparison indicates a high level of sensitivity (95%) and a lower level of specificity (59%). Detailed analysis reveals that 82% of all cortical sites identified by ECoG were within one contact of a site identified by ECS. CONCLUSIONS: These results show that passive functional mapping reliably localizes receptive language areas, and that there is a substantial concordance between the ECoG- and ECS-based methods. They also point to a more refined understanding of the differences between ECoG- and ECS-based mappings. This refined understanding helps to clarify the instances in which the two methods disagree and can explain why neurosurgical practice has established the concept of a "safety margin." SIGNIFICANCE: Passive functional mapping using ECoG signals provides a fast, robust, and reliable method for identifying receptive language areas without many of the risks and limitations associated with ECS.

Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.

For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.