Analysis of polycaprolactone scaffolds fabricated via precision extrusion deposition for control of craniofacial tissue mineralization.

OBJECTIVES: Recurrence of cranial bone fusion following surgical resection in craniosynostosis patients commonly requires additional surgical procedures. Surgical implantation of engineered 3D scaffolds that control tissue mineralization could be utilized to diminish recurrence of fusion. This study investigated the ability of composite scaffolds to control tissue mineralization when cultured in vitro. SETTING AND SAMPLE POPULATION: Precision-engineered scaffolds with calvarial cells were cultured in vitro at the Department of Orthodontics and Pediatric Dentistry, University of Michigan. MATERIAL & METHODS: Polycaprolactone (PCL) scaffolds were fabricated using a novel precision extrusion deposition technique. Polyethylene glycol (PEG) hydrogel was coated onto select scaffolds to inhibit mineralization. MC3T3E1(C4) calvarial cells were cultured with scaffolds in media containing ascorbate and phosphate to promote osteoblast differentiation and mineralization. Scaffolds were assayed for osteoblast differentiation by alkaline phosphatase assay. Scaffolds were assayed for mineralization by nano-computed tomography (nano-CT) and by von Kossa staining of histologic sections. RESULTS: MC3T3E1(C4) cells differentiated into osteoblasts and formed mineral when cultured on uncoated PCL scaffolds. MC3T3E1(C4) cells were significantly diminished in their ability to differentiate into osteoblasts when cultured on hydrogel-coated scaffold. CONCLUSION: Results of this study indicate that this novel printing technology can be used to fabricate 3D scaffolds to promote and inhibit tissue mineralization in a region-specific manner. Future studies are needed to establish utility of such scaffolds in vivo.

Choosing the best method to estimate the energy density of a population using food purchase data.

BACKGROUND: Energy density (ED) is a measure of the energy content of a food component or diet relative to a standard unit of weight. Widespread variation in ED assessment methodologies exist. The present study aimed to explore the feasibility of calculating the ED of the Scottish diet using UK food purchase survey data and to identify the most appropriate method for calculating ED for use in the development of a Scottish Dietary Goal that captures any socioeconomic differences. METHODS: Energy density was calculated using five different methods [food; food and milk; food, milk and energy containing (non-alcoholic) beverages; food, milk and all non-alcoholic beverages; and all food and beverages]. ED of the Scottish diet was estimated for each of the ED methods and data were examined by deprivation category. RESULTS: Mean ED varied from 409 to 847 kJ 100 g(-1) depending on the method used. ED values calculated from food (847 kJ 100 g(-1) ) and food and milk (718 kJ 100 g(-1) ) were most comparable to other published data, with the latter being a more accurate reflection of all food consumed. For these two methods, there was a significant gradient between the most and least deprived quintiles (892-807 and 737-696 kJ 100 g(-1) for food and food and milk, respectively). CONCLUSIONS: Because the World Cancer Research Fund recommendations are based on ED from food and milk, it was considered prudent to use this method for policy purposes and for future monitoring work of the Scottish Diet to ensure consistency of reporting and comparability with other published studies.

Validity and reliability of a short questionnaire for assessing the impact of cooking skills interventions.

BACKGROUND: Food skills programmes are widely used as a means to improve confidence in food preparation, the use of basic food skills and food selections amongst low income communities. However, the impact of such interventions are rarely evaluated as a result of a lack of validated assessment tools appropriate for use within this target group. METHODS: A two-page questionnaire utilising a closed-question format was designed based on key domains known to be influenced by cooking skills programmes. Content validity was assessed by a panel of public health experts and face validity by individuals, typical of those who may attend cooking skills classes. Internal and repeat reliability were assessed with groups of adults attending community-based classes. The feasibility of using the tool in community settings was also assessed. RESULTS: The draft questionnaire was amended as appropriate subsequent to content and face validity testing. Cronbach's alpha for confidence and knowledge sections was 0.86 and 0.84, respectively, indicating good internal consistency. Spearman correlation coefficients for repeat reliability testing between time 1 and time 2 for each item were in the range 0.46-0.91 (all significant at P < 0.001), indicating that the questionnaire elicited stable responses for repeated use. Feasibility testing highlighted the need for detailed instructions for course tutors on how to distribute and check questionnaires for completion. CONCLUSIONS: This tool provides a standardised method of evaluating cooking skills interventions that could be utilised in the development and evaluation of multicentre cooking skills interventions.

Supporting postpartum weight loss in women living in deprived communities: design implications for a randomised control trial.

BACKGROUND/OBJECTIVES: Pregnancy is a life stage where excess weight gain may occur and the postpartum period is often characterised by weight retention. The aim of the current study was to evaluate the feasibility of undertaking a randomised controlled trial of a weight loss intervention (WeighWell) in postpartum women living in areas of social disadvantage. SUBJECTS/METHODS: The study aimed to recruit 60 women who were not pregnant, 6-18 months postpartum with a body mass index >25 kg/m(2) living in areas of deprivation within Tayside, UK. Recruitment strategies focused on visits to community groups; writing directly to postpartum women living in areas of deprivation and primary care teams who covered the most deprived 15% of the population and advertising in community settings. The 12-week intervention used motivational interviewing techniques to promote an energy deficit diet and increased physical activity, delivered by three face-to-face consultations plus three structured telephone calls. RESULTS: Of 142 women screened, 63 were eligible and 52 (83%) were recruited and randomised to an intervention (n=29) or comparison group (n=23). Over the 12-week intervention, body weight changed significantly by -1.6 ± 2.0 kg in the intervention group compared with +0.2 ± 2.2 kg in the comparison group, indicating the potential efficacy of the intervention. Loss to follow-up was 24% in the intervention group and 39% for the comparison group. CONCLUSIONS: The findings support the development of a definitive trial that embraces personalised recruitment strategies and the development of approaches to improve retention over a clinically relevant intervention period.

Estimation of portion size in children's dietary assessment: lessons learnt.

BACKGROUND/OBJECTIVES: Assessing the dietary intake of young children is challenging. In any 1 day, children may have several carers responsible for providing them with their dietary requirements, and once children reach school age, traditional methods such as weighing all items consumed become impractical. As an alternative to weighed records, food portion size assessment tools are available to assist subjects in estimating the amounts of foods consumed. Existing food photographs designed for use with adults and based on adult portion sizes have been found to be inappropriate for use with children. This article presents a review and summary of a body of work carried out to improve the estimation of portion sizes consumed by children. METHODS: Feasibility work was undertaken to determine the accuracy and precision of three portion size assessment tools; food photographs, food models and a computer-based Interactive Portion Size Assessment System (IPSAS). These tools were based on portion sizes served to children during the National Diet and Nutrition Survey. As children often do not consume all of the food served to them, smaller portions were included in each tool for estimation of leftovers. The tools covered 22 foods, which children commonly consume. Children were served known amounts of each food and leftovers were recorded. They were then asked to estimate both the amount of food that they were served and the amount of any food leftover. RESULTS: Children were found to estimate food portion size with an accuracy approaching that of adults using both the food photographs and IPSAS. CONCLUSIONS: Further development is underway to increase the number of food photographs and to develop IPSAS to cover a much wider range of foods and to validate the use of these tools in a 'real life' setting.

Increasing antioxidant intake from fruits and vegetables: practical strategies for the Scottish population.

BACKGROUND: Increasing intakes of dietary antioxidants may help to reduce oxidative damage caused by free radicals and provide protection against the progression of a number of chronic diseases. The present study aimed to estimate the antioxidant intake from fruits and vegetables in the UK and Scottish population and to examine consumption models to identify potential strategies to optimize antioxidant intake from these foods. METHODS: This was a retrospective study of cross-sectional data on fruit and vegetable intake in relation to antioxidant intake. Antioxidant capacity of individual fruits and vegetables was determined by the ferric reducing antioxidant power assay and data on quantity and frequency of consumption of fruits and vegetables determined from National Diet and Nutrition Survey 2000-2001. RESULTS: Mean antioxidant intake in UK population from fruits and vegetables varied by region. In the Scottish sample (n = 123), mean antioxidant intake was estimated at 680 +/- 689 micromol day(-1) with 92% subjects consuming <400 g of fruits and vegetables per day. Consumption data showed that strawberries, apples, orange citrus fruits, purple broccoli and cauliflower were the top five sources of antioxidants from fruits and vegetables in the Scottish population. CONCLUSIONS: Appropriate selection of fruits and vegetables would help to achieve a higher antioxidant intake with the potential to produce significant health benefits.

Children's estimates of food portion size: the development and evaluation of three portion size assessment tools for use with children.

A number of methods have been developed to assist subjects in providing an estimate of portion size but their application in improving portion size estimation by children has not been investigated systematically. The aim was to develop portion size assessment tools for use with children and to assess the accuracy of children's estimates of portion size using the tools. The tools were food photographs, food models and an interactive portion size assessment system (IPSAS). Children (n 201), aged 4-16 years, were supplied with known quantities of food to eat, in school. Food leftovers were weighed. Children estimated the amount of each food using each tool, 24 h after consuming the food. The age-specific portion sizes represented were based on portion sizes consumed by children in a national survey. Significant differences were found between the accuracy of estimates using the three tools. Children of all ages performed well using the IPSAS and food photographs. The accuracy and precision of estimates made using the food models were poor. For all tools, estimates of the amount of food served were more accurate than estimates of the amount consumed. Issues relating to reporting of foods left over which impact on estimates of the amounts of foods actually consumed require further study. The IPSAS has shown potential for assessment of dietary intake with children. Before practical application in assessment of dietary intake of children the tool would need to be expanded to cover a wider range of foods and to be validated in a 'real-life' situation.

Children's estimates of food portion size: the effect of timing of dietary interview on the accuracy of children's portion size estimates.

For food intakes to be converted into nutrient intakes a measure or estimate of the amount of food consumed is required. A number of methods have been developed to assist subjects in providing an estimate of portion size. Children's ability to use perception, conceptualisation and memory skills to estimate food portion size has not been investigated systematically. The aim of the present study was to test the effect of the timing of a dietary interview on the accuracy of estimates of food portion sizes made by children, using food photographs, food models and an interactive portion size assessment system, developed for use with children and based on portion sizes of foods consumed by children. Children (n 108) aged 4-14 years were supplied with known quantities of foods and asked to estimate the portion size of each food using each of the three portion size assessment tools. Interviews took place (a) with the food in view, (b) just after the child had eaten the food or (c) 24 h after the child had eaten the food. There were no significant differences in children's ability to estimate food portion size (either as served or as eaten) with timing of interview. That is, children were as accurate in their estimates of portion size 24 h after consuming the food as when the food was in view. Under these conditions many children were able to estimate food portion size utilising perception, conceptualisation and memory skills.

Factors that affect the food choices made by girls and young women, from minority ethnic groups, living in the UK.

BACKGROUND: Lower birth weight, often found in infants from minority ethnic groups, may be partly because of the disproportionate representation of ethnic minority groups in low-income areas. To develop an intervention, to improve the nutritional intake of young women from populations at risk of low-birth-weight babies, which would be culturally sensitive and well received by the intended recipients, a community development approach was used to investigate factors that might influence food choice and the nutritional intake of girls and young women from ethnic minority groups. METHODS: Focus group discussions were conducted across the UK, to explore factors that might affect the food choices of girls and young women of African and South Asian decent. The data was analysed using deductive content analysis (Qual. Soc. Res., 1, 2000, 1). Discussions were around the broad themes of buying and preparing food, eating food and dietary changes, and ideas for an intervention to improve diet. RESULTS: The focus group discussions indicated that all the communities took time, price, health and availability into consideration when making food purchases. The groups were also quite similar in their use of 'Western' foods which tended to be of the fast food variety. These foods were used when there was not enough time to prepare a 'traditional' meal. CONCLUSION: Many issues that affect the food choice of people who move to the UK are common within different ethnic groups. The idea of a practical intervention based on improving cooking skills was popular with all the groups.

Reliability of a modified Gartland classification of supracondylar humerus fractures.

Fracture-classification systems are used to recommend treatment and predict outcomes. In this study, a modified Gartland classification system of supracondylar humerus fractures in children was assessed for intraobserver and interobserver variability. Five observers classified radiographs of 50 consecutive children with extension supracondylar humerus fractures on three separate occasions. After a 2-week interval, 90% of fractures were classified the same on both readings, with and intraobserver kappa value of 0.84. After a 36-week interval, 89% of the fractures were classified the same, with a kappa value of 0.81. Interobserver reliability was evaluated by pairwise comparison among observers, resulting in an overall kappa value of 0.74. The reliability of the Gartland classification for supracondylar humerus fractures in children is better than that published for other fracture-classification systems. However, 10% of the time, a second reading by the same observer is different. This makes treatment recommendations based only on fracture type imprecise.

Laser Doppler flowmetry during open reduction for developmental dysplasia of the hip.

Laser Doppler flowmetry was used intraoperatively to monitor femoral head perfusion during open reduction of 13 congenital hip dislocations in 11 patients. Laser Doppler determinations ranged from 12 to 400 mV before reduction and 30 to 300 mV after reduction. Three patients had magnitude changes in excess of 50%. One had increased perfusion, and two had decreased blood flow. Avascular necrosis of the hip occurred in one patient that was not predicted by laser Doppler flowmetry. Femoral head perfusion measured 175 mV for the dislocated hip and 180 mV after reduction of the femoral head and completion of the pelvic osteotomy. The authors conclude that laser Doppler flowmetry is not a reliable method for monitoring femoral head perfusion during open reduction of the hip for developmental hip dysplasia.

Lichen myxedematosus treated with chlorambucil.

BACKGROUND: Chemotherapy with various alkylating agents has been reported to be successful in the treatment of lichen myxedematosus. However, serious toxicities have accompanied such use. OBJECTIVE: To report a case of treatment of lichen myxedematosus with chlorambucil. RESULT: There was a favorable response using chlorambucil as an alternative therapeutic agent.