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Our objectives were to explore attitudes regarding food retail policy and government regulation among managers of small food stores and examine whether manager views changed due to the 2014 Minneapolis Staple Foods Ordinance, a city policy requiring retailers to stock specific healthy products.
Manager interviewer-administered surveys were used to assess views on food retail policy four times from 2014 to 2017. We examined baseline views across manager and store and neighbourhood characteristics using cross-sectional regression analyses and examined changes over time using mixed regression models. In 2017, open-ended survey questions asked about manager insights on the Minneapolis Staple Foods Ordinance.
Minneapolis, MN, where the ordinance was enacted, and St. Paul, MN, a control community, USA.
Managers from 147 small food retail stores.
At baseline, 48 % of managers were likely to support a policy requiring stores to stock healthy foods/beverages, 67·5 % of managers were likely to support voluntary programmes to help retailers stock healthy foods and 23·7 % agreed government regulation of business is good/necessary. There was a significant increase in overall support for food retail policies and voluntary programmes from 2014 to 2017 (P < 0·01); however, neither increase differed by city, suggesting no differential impact from the ordinance. Minneapolis store managers reported some challenges with ordinance compliance and offered suggestions for how local government could provide support.
Findings suggest that managers of small food retail stores are becoming increasingly amenable to healthy food policies; yet, challenges need to be addressed to ensure healthy food is available to all customers.
Intensive care at a psychiatric intensive care unit (PICU) traditionally includes the treatment of severely ill psychiatric patients with suicidal or violent behavior .
A chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese PICU between 2008–2009.
Psychopharmacotherapy and the rate of electroconvulsive therapy (ECT) in these patients is reported here.
87% of patients were treated with antipsychotics: 44% with quetiapine (447.7 ± 421 mg), 32% with risperidone (4.3 ± 2.3 mg), 25% with olanzapine (16.9 ± 7.5 mg), 20% with haloperidol (10.5 ± 5.4 mg), 16% with aripiprazole (15 ± 8.4 mg), 6% clozapine (416.7 ± 147.2 mg) and 3% ziprasidone (120 ± 56.6 mg). 36% of patients received treatment with mood stabilizers: 15% with valproic acid, 8% with lamotrigine, 6% with lithium, 4% with pregabaline, 3% with topiramate, 2% with gabapentine and 2% with oxcarbazepine. In 49% of patients antidepressants were prescribed: in 23% selective serotonin reuptake inhibitors, in 12% selective dual acting reuptake inhibitors, in 5% tricyclic antidepressants and in 33% other antidepressants (mostly trazodone or mirtazapine). 84% of patients were treated with benzodiazepines (30.3 ± 22.4 mg diazepam equivalents), in 17% the opioid nalbuphin was applied. Intravenous psychopharmacotherapy was used in 31% of cases. 10% of patients received ECT.
Psychotropic compounds with sedative properties are frequently used at the Viennese PICU. However, the dosages for antipsychotics do not appear to be higher than on normal psychiatric wards.
Psychiatric intensive care is supposed to offer treatment and to hold patients with psychiatric illness, if they pose a threat to themselves or to others. Besides treating the underlying psychiatric diagnoses, it is also necessary to take care of severe somatic comorbidity, which is often impeded by patients’ limited ability to cooperate. Treatment often requires the administration of sedative medication and occasionally the use of medical restraints. Involuntary commitment, involuntary treatment and the usage of physical restraints is regulated by national mental health laws. Medical professionals working in the field of psychiatric intensive care must have expert knowledge in the fields of psychopharmacology and intensive care medicine. Treatment concepts should be aimed to provide optimized care for psychiatric inpatients in a potentially life-threatening phase of their illness. This article outlines current clinical practice at the psychiatric intensive care unit of the Medical University of Vienna (Austria). Furthermore, we present diagnoses, diagnostic procedures and specific treatments of a sample of 100 consecutive inpatients treated in the years 2008 and 2009 at this ward.
Psychiatric disorders per se or treatment resistance can cause life-threatening conditions. More than 25 years have passed since the term “psychiatric intensive care unit” (PICU) was introduced in the United Kingdom. This system is comprised of security units for psychiatric patients with suicidal or violent behaviour, providing a locked environment with more resources regarding personnel and care. The PICU concept at the Department of Psychiatry and Psychotherapy in Vienna, Austria, represents a progress towards optimal care of patients with serious psychiatric illnesses who also have critical somatic illnesses. One third of the patients are transferred from inpatient facilities of medical departments such as internal medicine, emergency medicine, trauma surgery or anesthesiology. Our PICU is dedicated to somatically, critically ill patients who have psychiatric symptoms (e.g., agition, aggression, impulsivity, delusions, catatonia, confusion, reduced consciousness, impaired self-reliance) complicating recovery from their critical, somatic condition. Generally, the dosages for antipsychotics are not higher than those at normal psychiatric wards. Benzodiazepine dosages of about 30mg diazepam equivalents per day are frequently used. In the years 2008 and 2009, 10% of all patients at the Viennese PICU were treated with electroconvulsive therapy. Delirium requires immediate therapy of underlying intracerebral pathologies, extracerebral illnesses or toxic features. Involuntary commitment, physical restraints and urinary catheterization were applied in approximately 50% of the patients, nasogastric tube or central venous catheter in 20%. In every case, intensive care nursing, monitoring of vital functions and specific experience at the interface between psychiatry and somatic medicine are required.
Psychiatric intensive care is supposed to offer treatment and to hold patients with psychiatric illness, if they pose a threat to themselves or to others.
A chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese psychiatric intensive care unit (PICU) in the years 2008 and 2009. Clinical key features and the distribution of mental disorders (according to ICD-10) in these patients are reported here.
The mean duration of stay was 18.9 ± 14.8 days. 52% of patients were admitted involuntarily. 18% suffered from organic mental disorder (12% from delirium), 20% were diagnosed with mental disorders due to psychoactive substance use (9% alcohol dependency, 6% benzodiazepine dependency, 5% multiple drug use), 16% had a diagnosis of schizophrenia, 10% of schizoaffective disorder and 5% of transient psychotic disorder. 20% suffered from recurrent depressive disorder, 15% from bipolar affective disorder and 3% from a single depressive episode. 8% fulfilled diagnostic criteria of a neurotic, stress-related or somatoform disorder. 12% had eating disorders, 9% had personality disorders and 1% was diagnosed with mental retardation. Only 15% of patients had a first episode of psychiatric illness. 4% were admitted after an accident and 21% after a suicide attempt (45% poisoning, 25% jumping from height, 20% cutting/piercing with sharp object, 5% vehicular impact, 5% self-immolation).
All major psychiatric diagnoses can be found at the Viennese PICU, either if patients are in a life-threatening condition, or if additional somatic illnesses require intensive care management.
Risperidone-ISM is a new long-acting intramuscular formulation intended to achieve sustained plasma concentrations over 4 weeks without oral supplementation. The clinical efficacy to risperidone has been associated with 65–80% occupancy of dopamine D2 receptor (D2RO) and a mean Cmax between 7.5 ng/mL and 80 ng/mL.
Use a population PK/PD model to predict the PK and the D2RO for Risperidone-ISM in schizophrenic patients and to characterize the relationship among doses, in order to guide dose selection for a future Phase-III trial.
A population PK/PD analysis for Risperidone-ISM using Monolix software was conducted based on 6641 plasma samples from two Phase-I studies (17 healthy subjects and 31 schizophrenic subjects, respectively) and 1 Phase-II study (60 schizophrenic subjects). Simulations were subsequently undertaken predicting the steady state PK and D2RO after multiple Risperidone-ISM doses administered every 28 days for 12 weeks.
Doses of 75 and 100 mg, administered either in gluteal or deltoid muscle, were predicted to result in median Cmax and Ctrough that stayed between 7.5 ng/mL and 80 ng/mL. At steady state 75 mg and 100 mg dose (gluteal) achieved a D2RO average [min–max] of 70.8% [61.4–80.4] and 74.3% [66.2–82.1], respectively; a 75-mg and 100-mg dose (deltoid) achieved a D2RO average [min–max] of 69.3% [56.5–80.3] and 73.0% [61.8–82.1], respectively. The model estimated that the 65% D2RO occurs within first 8 h after treatment.
Simulations were carried out supporting doses of 75 mg and 100 mg Risperidone-ISM to show the greatest efficacy and safety potential to be assessed in the future Phase-III trial.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
We examined differences in consumer-level characteristics and structural resources and capabilities of small and non-traditional food retailers (i.e. corner stores, gas-marts, pharmacies, dollar stores) by racial segregation of store neighbourhood and corporate status (corporate/franchise- v. independently owned).
Observational store assessments and manager surveys were used to examine availability-, affordability- and marketing-related characteristics experienced by consumers as well as store resources (e.g. access to distributors) and perceived capabilities for healthful changes (e.g. reduce pricing on healthy foods). Cross-sectional regression analyses of store and manager data based on neighbourhood segregation and store corporate status were conducted.
Small and non-traditional food stores in Minneapolis and St. Paul, MN, USA.
One hundred and thirty-nine stores; seventy-eight managers.
Several consumer- and structural-level differences occurred by corporate status, independent of residential segregation. Compared with independently owned stores, corporate/franchise-owned stores were more likely to: not offer fresh produce; when offered, receive produce via direct delivery and charge higher prices; promote unhealthier consumer purchases; and have managers that perceived greater difficulty in making healthful changes (P≤0·05). Only two significant differences were identified by residential racial segregation. Stores in predominantly people of colour communities (<30 % non-Hispanic White) had less availability of fresh fruit and less promotion of unhealthy impulse buys relative to stores in predominantly White communities (P≤0·05).
Corporate status appears to be a relevant determinant of the consumer-level food environment of small and non-traditional stores. Policies and interventions aimed at making these settings healthier may need to consider multiple social determinants to enable successful implementation.
The current mixed-methods study explored qualitative accounts of prior childhood experiences and current contextual factors around family meals across three quantitatively informed categories of family meal frequency patterns from adolescence to parenthood: (i) ‘maintainers’ of family meals across generations; (ii) ‘starters’ of family meals in the next generation; and (iii) ‘inconsistent’ family meal patterns across generations.
Quantitative survey data collected as part of the first (1998–1999) and fourth (2015–2016) waves of the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study and qualitative interviews conducted with a subset (n 40) of Project EAT parent participants in 2016–2017.
Surveys were completed in school (Wave 1) and online (Wave 4); qualitative interviews were completed in-person or over the telephone.
Parents of children of pre-school age (n 40) who had also completed Project EAT surveys at Wave 1 and Wave 4.
Findings revealed salient variation within each overarching theme around family meal influences (‘early childhood experiences’, ‘influence of partner’, ‘household skills’ and ‘family priorities’) across the three intergenerational family meal patterns, in which ‘maintainers’ had numerous influences that supported the practice of family meals; ‘starters’ experienced some supports and some challenges; and ‘inconsistents’ experienced many barriers to making family meals a regular practice.
Family meal interventions should address differences in cooking and planning skills, aim to reach all adults in the home, and seek to help parents who did not eat family meals as a child develop an understanding of how and why they might start this tradition with their family.
Background: This work proposes a hypothetical model that integrates human factors (e.g. inherent ability and acquired expertise) and task factors (e.g. pre-procedural data, visual and haptic information) to better understand the hand ergonomics adaptation needed for optimal safety and efficiency during simulated brain tumor resections. Methods: Hand ergonomics of neurosurgeons, residents and medical students were assessed during simulated brain tumors resection on the NeuroVR virtual reality neurosurgical simulation platform. Spatial distribution of time expended, force applied, and tumor volume removed, and other metrics were analyzed in each tumor quadrant (Q1 to Q4). Results: Significant differences were observed between the most favorable hand ergonomics condition (Q2) and the unfavorable hand ergonomics condition (Q4). Neurosurgeons applied more total force, more mean force, and removed less tumor per unit of force applied in Q4. However, total volume removed was not significant between the two quadrants indicating hand ergonomics adaptation in order to maximize tumor removal. In comparison, hand ergonomics of medical students remained unchanged in all quadrants, indicating a learning phenomenon. Conclusions: Neurosurgeons are more capable of adapting their hand ergonomics during simulated brain tumor resections. Our proposed hypothetical model integrates our findings with the literature and highlights the importance of experience in the acquisition of adaptive hand ergonomics.
Hulless oats are of interest as an alternative to corn and wheat in organic poultry diets because they offer potential to enhance agrobiodiversity and produce locally grown feeds both within and outside of corn-growing regions. Hulless oats are easily certified GM-free and have demonstrated nutritional value for poultry. A feeding study was carried out to examine: (i) the effects of substituting corn, wheat or a fraction of each with hulless oats in organic layer diets, and (ii) the importance of oat variety in feed performance. Productivity and economic implications in the context of current organic markets were explored. Experimental diets included an oat-free control, Oat + corn, Oat + wheat and Oat + corn + wheat, each of which was formulated with three hulless oat varieties, AC Gwen, Paul and Streaker. All but the control diet included oats at 200 g kg−1. Three hundred Hy-Line Brown hens were individually caged and allocated to diets in groups of 10 in a completely randomized design with three replicates per diet. Experimental diets were fed between 24 and 32 weeks of age during which time hen health, egg production and egg quality indicators were monitored. Results indicated that hulless oats had no negative effects on hen health and productivity. On the basis of current organic feed ingredient prices and an estimated cost of USD 533 mt−1 for production of oats in the study region, oat containing diets were more expensive than the oat-free control. In an evaluation of revenue based on current market prices for organic eggs, the additional cost was completely offset by larger egg sizes of hens on oat containing diets. There were no major differences associated with oat variety.
Bovine embryos produced in vivo and in vitro differ with respect to molecular profiles, including epigenetic marks and gene expression profiles. This study investigated the CpG methylation status in bovine testis satellite I (BTS) and Bos taurus alpha satellite I (BTαS) DNA sequences, and concomitantly the relative abundance of transcripts, critically involved in DNA methylation (DNMT1 and DNMT3A), growth and development (IGF2R) and pluripotency (POU5F1) in Bos indicus embryos produced in vitro or in vivo. Results revealed that methylation of BTS were higher (P < 0.05) in embryos produced in vitro compared with their in vivo produced counterparts, while the methylation status of BTαS was similar in both groups. There were no significant differences in transcript abundance for DNMT3A, IGF2R and POU5F1 between blastocysts produced in vivo and in vitro. However, a significantly lower amount of DNMT1 transcripts was found in the in vitro cultured embryos (P < 0.05) compared with their in vivo derived counterparts. In conclusion, this study reported only minor changes in the expression of developmentally important genes and satellite DNA methylation related to the in vitro embryo production system.
Background: Current selection methods for neurosurgical residents lack objective measurements of psychomotor performance. This pilot study was designed to answer three questions: 1) What are the differences in bimanual psychomotor performance among neurosurgical residency applicants using the NeuroVR (formerly NeuroTouch) neurosurgical simulator? 2) Are there exceptionally skilled medical student applicants? 3) Does previous surgical exposure influence surgical performance? Methods: Medical students attending neurosurgery residency interviews at McGill University were asked to participate. Participants were instructed to remove 3 simulated brain tumors. Validated tier 1, tier 2, and advanced tier 2 metrics were utilized to assess bimanual psychomotor performance. Demographic data included weeks of neurosurgical elective and prior operative exposure. Results: Sixteen of 17 neurosurgical applicants (94%) participated. Performances clustered in definable top, middle, and bottom groups with significant differences for all metrics. Increased time spent playing music, increase applicant self-evaluated technical skills, high self-ratings of confidence and increased skin closures statistically influenced performance on univariate analysis. A trend for both self-rated increased operating room confidence and increased weeks of neurosurgical exposure to increase blood loss was seen in multivariate analysis. Conclusions: Simulation technology identifies neurosurgical residency applicants at the extremes of technical ability and extrinsic and intrinsic applicant factors appear to influence performance.
Background: Virtual reality simulators allow development of novel methods to analyze neurosurgical performance. Force pyramids provide visual and spatial analysis of 3 dimensional force application by any instrument used during simulated tumor resection. This study was designed to answer three questions: 1) Do study groups have distinct force pyramids? 2) Do handedness and ergonomics influence force pyramid structure? 3) Are force pyramids dependent on visual and haptic characteristics of simulated tumors? Methods: NeuroVR (formerly NeuroTouch), a virtual reality simulator, continually assessed simulated ultrasonic aspirator force application of neurosurgeon, resident and medical student groups during resection of 18 simulated brain tumors with different visual and haptic characteristics. Results: Sixteen neurosurgeons, 15 residents and 84 medical students participated. Neurosurgeon, resident and medical students groups displayed easily distinguishable 3 dimensional ‘force pyramid fingerprints’. Neurosurgeons had the lowest force pyramids, indicating application of the lowest forces, followed by resident and medical student groups. Handedness, ergonomics, visual and haptic tumor characteristics resulted in distinct well-defined 3 dimensional force pyramid patterns. Conclusions: ‘Force pyramid fingerprints’ provide 3 dimensional spatial assessment displays of instrument force application during simulated tumor resections. Neurosurgeon force utilization and ergonomics data form a basis for understanding and modulating resident force application and improving patient safety during tumor resection.
Biological electron transfers often occur between metal-containing cofactors that are separated by very large molecular distances. Employing photosensitizer-modified iron and copper proteins, we have shown that single-step electron tunneling can occur on nanosecond to microsecond timescales at distances between 15 and 20 Å. We also have shown that charge transport can occur over even longer distances by hole hopping (multistep tunneling) through intervening tyrosines and tryptophans. In this perspective, we advance the hypothesis that such hole hopping through Tyr/Trp chains could protect oxygenase, dioxygenase, and peroxidase enzymes from oxidative damage. In support of this view, by examining the structures of P450 (CYP102A) and 2OG-Fe (TauD) enzymes, we have identified candidate Tyr/Trp chains that could transfer holes from uncoupled high-potential intermediates to reductants in contact with protein surface sites.
The most fundamental characteristic of a physical system can often be deduced from its behaviour under discrete symmetry transformations, such as time reversal, parity and chirality. Here, we review some of the basic symmetry properties of the relativistic quantum theories for free electrons in (
)- and (
)-dimensional spacetime. Additional flavour degrees of freedom are necessary to properly define symmetry operations in (
) dimensions, and are generally present in physical realizations of such systems, for example in single sheets of graphite. We find that there exist two possibilities for defining any flavour-coupling discrete symmetry operation of the two-flavour (
)-dimensional Dirac theory. Some physical implications of this previously unnoticed duplicity are discussed.
Background: NeuroTouch simulator provides the potential to determine performance metrics, but validation and easily utilized software are essential before implementation of this platform into neurosurgical training. Objectives: Evaluate and validate neurosurgical performance metrics for simulated brain tumors resection. Develop software and a global web based system to allow utilization of these metrics. Methods: The bimanual resection of 8 simulated brain tumors with differing complexity was evaluated. Software was developed to automatically generate all the metrics from NeuroTouch data output including: blood loss, tumor percentage resected, total brain volume removed, maximum and sum of forces utilized, efficiency index, ultrasonic aspirator path length index (UAPLI), coordination index and ultrasonic aspirator bimanual forces ratio (UABFR). Six neurosurgeons and 12 residents were evaluated. Results: Resident performance was significantly more impaired than neurosurgeon by increasing tumor complexity. Significant differences were found between neurosurgeons, senior, and junior residents on efficiency index and UAPLI. UABFR outlined significant differences between senior and junior residents. Coordination index demonstrated significant differences between junior residents and neurosurgeons. Conclusions: Utilizing metrics employed the NeuroTouch platform differentiated novice from expert performance. Software was developed for metrics and will be made available online for all NeuroTouch users allowing global comparison of neurosurgical performance.
Background: The availability of virtual reality (VR) surgical simulators affords the opportunity to assess the influence of stress on neurosurgical operative performance in a controlled laboratory environment. This study sought to examine the effect of a stressful VR neurosurgical task on the subjective anxiety ratings of participants with varying levels of surgical expertise. Methods: Twenty four participants comprised of six staff neurosurgeons, six senior neurosurgical residents (PGY4-6), six junior neurosurgical residents (PGY1-3), and six senior medical students took part in a bimanual VR tumor removal task with a component of sudden uncontrollable intra-operative bleeding. State Trait Anxiety Inventory (STAI) questionnaires were completed immediately pre and post the stress stimulus. The STAI questionnaire consisted of six items (calm, tense, upset, relaxed, content and worried) measured on a Likert scale. Results: Significant increases in subjective anxiety ratings were noted in junior residents (p=0.005) and medical students (p=0.025) while no significant changes were observed for staff and senior neurosurgical residents. Conclusions: Staff and senior residents more effectively mitigate stress compared to junior colleagues in a VR operative environment. Further physiological correlates are needed to determine whether this increased anxiety is paralleled by physiological arousal and altered surgical performance.