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To examine the feasibility of using social media to assess the consumer nutrition environment by comparing sentiment expressed in Yelp reviews with information obtained from a direct observation audit instrument for grocery stores.
Trained raters used the Nutrition Environment Measures Survey in Stores (NEMS-S) in 100 grocery stores from July 2015 to March 2016. Yelp reviews were available for sixty-nine of these stores and were retrieved in February 2017 using the Yelp Application Program Interface. A sentiment analysis was conducted to quantify the perceptions of the consumer nutrition environment in the review text. Pearson correlation coefficients (ρ) were used to compare NEMS-S scores with Yelp review text on food availability, quality, price and shopping experience.
Detroit, Michigan, USA.
Yelp reviews contained more comments about food availability and the overall shopping experience than food price and food quality. Negative sentiment about food prices in Yelp review text and the number of dollar signs on Yelp were positively correlated with observed food prices in stores (ρ=0·413 and 0·462, respectively). Stores with greater food availability were rated as more expensive on Yelp. Other aspects of the food store environment (e.g. overall quality and shopping experience) were captured only in Yelp.
While Yelp cannot replace in-person audits for collecting detailed information on the availability, quality and cost of specific food items, Yelp holds promise as a cost-effective means to gather information on the overall cost, quality and experience of food stores, which may be relevant for nutrition outcomes.
Parasites can exert strong effects on population to ecosystem level processes, but data on parasites are limited for many global regions, especially tropical marine systems. Characterizing parasite diversity and distributions are the first steps towards understanding the potential impacts of parasites. The Panama Canal serves as an interesting location to examine tropical parasite diversity and distribution, as it is a conduit between two oceans and a hub for international trade. We examined metazoan and protistan parasites associated with ten oyster species collected from both Panamanian coasts, including the Panama Canal and Bocas del Toro. We found multiple metazoan taxa (pea crabs, Stylochus spp., Urastoma cyrinae). Our molecular screening for protistan parasites detected four species of Perkinsus (Perkinsus marinus, Perkinsus chesapeaki, Perkinsus olseni, Perkinsus beihaiensis) and several haplosporidians, including two genera (Minchinia, Haplosporidium). Species richness was higher for the protistan parasites than for the metazoans, with haplosporidian richness being higher than Perkinsus richness. Perkinsus species were the most frequently detected and most geographically widespread among parasite groups. Parasite richness and overlap differed between regions, locations and oyster hosts. These results have important implications for tropical parasite richness and the dispersal of parasites due to shipping associated with the Panama Canal.
There is now expert consensus that directly observing the work of trainee therapists vs. relying upon self-report of sessions, is critical to providing the accurate feedback required to attain a range of competencies. In spite of this expert consensus however, and the broadly positive attitudes towards video review among supervisees, video feedback methods remain under-utilized in clinical supervision. This paper outlines some of the weaknesses that affect feedback based solely on self-report methods, before introducing some of the specific benefits that video feedback methods can offer the training and supervision context. It is argued that video feedback methods fit seamlessly into CBT supervision providing direct, accessible, effective, efficient and accurate observation of the learning situation, and optimizing the chances for accurate self-reflections and planning further improvements in performance. To demonstrate the utility of video feedback techniques to CBT supervision, two specific video feedback techniques are introduced and described: the Give-me-5 technique and the I-spy technique. Case examples of CBT supervision using the two techniques are provided and explored, and guidance as to the supervision contexts in which each of the two techniques are suitable, individually, and in tandem, are outlined. Finally, best practice guidelines for the use of video feedback techniques in supervision are outlined.
The incidence of recreational water-associated outbreaks in the United States has significantly increased, driven, at least in part, by outbreaks both caused by Cryptosporidium and associated with treated recreational water venues. Because of the parasite's extreme chlorine tolerance, transmission can occur even in well-maintained treated recreational water venues (e.g. pools) and a focal cryptosporidiosis outbreak can evolve into a community-wide outbreak associated with multiple recreational water venues and settings (e.g. childcare facilities). In August 2004 in Auglaize County, Ohio, multiple cryptosporidiosis cases were identified and anecdotally linked to pool A. Within 5 days of the first case being reported, pool A was hyperchlorinated to achieve 99·9% Cryptosporidium inactivition. A case-control study was launched to epidemiologically ascertain the outbreak source 11 days later. A total of 150 confirmed and probable cases were identified; the temporal distribution of illness onset was peaked, indicating a point-source exposure. Cryptosporidiosis was significantly associated with swimming in pool A (matched odds ratio 121·7, 95% confidence interval 27·4–∞) but not with another venue or setting. The findings of this investigation suggest that proactive implementation of control measures, when increased Cryptosporidium transmission is detected but before an outbreak source is epidemiologically ascertained, might prevent a focal cryptosporidiosis outbreak from evolving into a community-wide outbreak.
We analyzed a 10-year stroke administrative dataset to examine trends in admissions, mortality, and discharge destination in Canada.
We conducted an analysis of hospital administrative data from April 1st 2003 to March 31st 2013 from the Canadian Institute of Health Information’s Discharge Abstract Database. Ten-year trends for population-based age- and sex-standardized admission rates were calculated. We reviewed 10-year trends in absolute stroke admissions for differences between provinces and age groups. Stroke 30-day in-hospital mortality rates were calculated and adjusted for sex, age, stroke type and comorbidities. We documented changes in discharge location for ischemic and hemorrhagic stroke patients discharged from acute care.
The rate of hospital admissions has declined from 140.2 to 117.5 (per 100,000 people). The number of absolute stroke admissions within provinces increased in Alberta and British Columbia (21.7% and 16.2% respectively). The proportion of stroke patients aged 40-69 years old increased by 4.8% (p<0.0001) over the 10 years, whereas the proportion aged over 70 decreased by 4.9% (p<0.0001). Risk-adjusted 30-day in-hospital mortality decreased from: 18.5% to 14.9% for all strokes; 15.2% to 12.1% for ischemic strokes; 35.6% to 29.7% for intracerebral hemorrhage; and 25.1% to 18.0% for subarachnoid hemorrhage. The absolute increase in patients requiring inpatient and outpatient support increased by 4% (p<0.0001).
The rate of admissions for stroke is decreasing but there is an increase in stroke admissions for younger patients. In-hospital mortality is decreasing; fewer patients are going directly home without services and more are requiring support services.
This article is an executive summary of a report from the Centers for Disease Control and Prevention Ventilator-Associated Pneumonia Surveillance Definition Working Group, entitled “Developing a new, national approach to surveillance for ventilator-associated events” and published in Critical Care Medicine. The full report provides a comprehensive description of the Working Group process and outcome.
In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1).
The “chronic cerebrospinal venous insufficiency” or “CCSVI” hypothesis, namely that multiple sclerosis (MS) is caused by abnormalities in the azygous and internal jugular veins with subsequent alterations in venous hemodynamics in the central nervous system, has been a dominant topic in MS care in Canada over the past year. Although there is no methodologically rigorous evidence to support this hypothesis presently, a considerable number of MS patients have undergone endovascular CCSVI procedures. Such procedures include angioplasty or stent placement in jugular and azygous veins. The safety and efficacy of these procedures is unknown, but not without risk.
Chart and patient review of five patients with confirmed MS followed in Calgary were undertaken after patients came to medical attention by referral or admission secondary to complications believed to be associated with CCSVI procedures.
Complications upon investigation and review included internal jugular vein stent thrombosis, cerebral sinovenous thrombosis, stent migration, cranial nerve injury and injury associated with venous catheterization.
As the debate about CCSVI and its relationship to MS continues, the complications and risks associated with venous stenting and angioplasty in jugular and azygous veins are becoming clearer. As increasing numbers of MS patients are seeking such procedures, these five cases represent the beginning of a wave of complications for which standardized care guidelines do not exist. Our experience and that of our colleagues will be used to develop guidelines and strategies to monitor and manage these patients as their numbers increase.
Sydney M. Evans, Professor of Radiation Oncology, University of Pennsylvania, Philadelphia, PA,
Robert Bristow, Associate Professor, Department of Radiation Oncology and Medical Biophysics, Princess Margaret Hospital, Toronto, Ontario, Canada,
Robert Gatenby, Professor of Radiology and Applied Mathematics, University of Arizona, Tucson, AZ,
Mary J. Hendrix, Professor, Northwestern University Feinberg School of Medicine, Chicago, IL,
Richard Hill, Professor, Department of Medical Biophysics and Radiation Oncology, University of Toronto, Princess Margaret Hospital, Toronto, Ontario, Canada,
William M.-F. Lee, Associate Professor of Medicine, Department of Medicine, Hematology/Oncology Division, University of Pennsylvania, Philadelphia, PA
“The science of today is the technology of tomorrow.”
Interventional radiology (IR) techniques play an important role in cancer therapy by accessing and treating tumors via image-guided methods. These methods involve both local and regional therapies, with thermal ablative technology comprising the former and intra-arterial embolization with radioactive particles the latter. Combined with systemic chemotherapy, these techniques result in increased patient survival. A more recent approach for cancer therapy involves the use of drugs that specifically target molecular, biological or physiological processes. Examples of such targets include epithelial growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), protein kinases, hypoxia inducible factor (HIF), cell cycle checkpoints, apoptosis, hypoxia and angiogenesis. Drugs specific to each of these targets are currently available or are in development; some of these agents may be applicable to interventional delivery. The purpose of this chapter is to review important aspects of tumor biology that may be targeted via an interventional approach.
The clinical behavior of a tumor results from a complex set of interactions between neoplastic and non-neoplastic cells, blood vessels, blood and interstitial fluids using intercellular communication. These interactions define the tumor microenvironment, which continues to be extensively studied because there is evidence that it substantially influences tumor behavior and patient outcome (1, 2). This chapter begins with a review of the components and clinical/biological effects of hypoxia, pH, and glucose, discussed by Evans and Gatenby.
Efficient and reliable assessments of cognitive treatment effects are essential for the comparative evaluation of procognitive effects of pharmacologic therapies. Yet, no studies have addressed the sensitivity and efficiency with which neurocognitive batteries evaluate cognitive abilities before and after treatment. Participants were primarily first episode schizophrenia patients who completed baseline (n = 367) and 12-week (n = 219) assessments with the BACS (Brief Assessment of Cognition in Schizophrenia) and CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness) neuropsychological batteries in a clinical trial comparing olanzapine, quetiapine, and risperidone. Exploratory factor analysis revealed that performance on both batteries was characterized by a single factor of generalized cognitive deficit for both baseline performance and cognitive change after treatment. Both batteries estimated similar levels of change following treatment, although the BACS battery required half the administration time. Because a unitary factor characterized baseline cognitive abilities in early psychosis as well as cognitive change after treatment with atypical antipsychotic medications, short batteries such as the BACS may efficiently provide sufficient assessment of procognitive treatment effects with antipsychotic medications. Assessment of cognitive effects of adjunctive therapies targeting specific cognitive domains or impairments may require more extensive testing of the domains targeted to maximize sensitivity for detecting specific predicted cognitive outcomes. (JINS, 2008, 14, 209–221.)Presented in part at the annual International Neuropsychology Society meeting in Portland, OR, February 2007; and the 2007 International Congress for Schizophrenia Research in Colorado Springs, CO.
Development of transgenic triticale as a platform for novel bio-industrial
products is predicated on an environmental biosafety assessment that
quantifies the potential risks associated with its release. Pollen-mediated
gene flow to related species and conventional triticale varieties is one
pathway for transgene movement. A tier 1 quantification of triticale
hybridization was conducted by emasculating and hand pollinating flowers
under greenhouse conditions. Approximately 2000 manual pollinations were
conducted for each cross and its reciprocal between two triticale genotypes:
a modern triticale cultivar (AC Alta) and primary triticale (89TT108), and
common wheat, durum wheat and rye. The frequency of outcrossing, hybrid seed
appearance and weight, and F1 emergence and fertility were recorded.
Outcrossing, F1 emergence and fertility rates were high from crosses
between triticale genotypes. Outcrossing in inter-specific crosses was
influenced by the species, and the genotype and gender of the triticale
parent. In crosses to common and durum wheat where triticale was the male
parent, outcrossing was ≥73.0% and ≥69.5%, respectively, but ≤23.9% and ≤3.0% when triticale was the female parent. Overall, outcrossing with
rye was lower than with common and durum wheat. F1 hybrid emergence was
greater when triticale was the female parent. With the exception of a single
seed, all wheat-triticale F1 hybrid seeds were non-viable when
triticale was the male parent in the cross. Only seven durum wheat-triticale
F1 hybrids emerged from 163 seeds sown, and all were produced with
triticale 89TT108 as female parent. With rye, 8 F1 hybrids emerged from
38 seeds sown, and all were produced from crosses to AC Alta; five with AC
Alta as the female parent and three as the male. Interspecific F1
hybrids were self-sterile, with the exception of those produced in crosses
between common wheat and triticale where triticale was the female parent.
Tier 2 hybridization quantification will be conducted under field
Accuracy of intracranial magnetic resonance angiography (MRA) and reliability of interpretation are not well established compared to conventional selective catheter angiography. The purpose of this study was to determine the accuracy of MRA in evaluation of intracranial vessels in acute stroke and transient ischemic attack (TIA) patients.
Twenty-nine patients (seven females, 22 males; median age 53) with acute stroke or TIA were enrolled into the study. All patients underwent both MRA using a 3 T clinical magnet and conventional angiography within 48 hours. Median time between MRA and angiography was 263 minutes. Conventional angiography preceded MRA in 15 cases. Fourteen patients received thrombolysis during MRA or angiography. National Institutes of Health Stroke Scale scores were obtained prior to the MR exam. One neuroradiologist rated all conventional angiograms, which were used as gold standard. Five observers, blinded to conventional angiography results and all clinical information except symptom side, rated the MR angiograms. Kappa statistics were used to assess reliability; contingency tables were used to assess accuracy of non-enhanced and enhanced MRA.
Two hundred and fifty two intracranial vessels were assessed. Agreement between raters was good for both non-enhanced (k=0.50) and gadolinium-enhanced (k=0.46) images. There were a total of 26 vessels occluded by DSA. Overall, the non-enhanced MRA showed sensitivity of 84.2% (95% CI 60.4-96.6) and specificity of 84.6% (95% CI 78.6-89.4). The enhanced MRA showed sensitivity of 69.2 (95% CI 38.6-90.9) and specificity of 73.6 (95% CI 65.5-80.7).
Magnetic resonance angiography is a good non-invasive screening tool for assessing intracranial vessel status in acute ischemic stroke. Angiography remains the gold standard for definitive assessment of the intracranial circulation.
This article examines early colonial Kaqchikel
Maya notions of the self, souls, and the heart. By integrating
ethnohistorical data and contemporary ethnographic observations,
we show that Kaqchikeles viewed the self as contingent
on a dynamic balance of cosmic forces acting on the individual.
The ways in which these forces are seen to effect one's
state of being are documented through an extensive discussion
of Kaqchikel metaphors of the heart and soul. We conclude
by noting the importance of understanding processes of
continuity (as well as change) in cultural constructions
and argue for the continued utility of such approaches
in ethnohistorical research.
We present an analysis of wide-field, far-ultraviolet images of the LMC and SMC obtained by the Ultraviolet Imaging Telescope. The photometric catalog of over 37,000 stars allows us to make large-scale, statistical studies of massive star formation in OB associations and in the field population. Our results show that: (1) the most probable slope for the initial mass function (IMF) of field stars is Γ = −1.80, slightly steeper than the Salpeter slope; and (2) there doesn't seem to be a single, unique IMF slope for stars in OB associations, with a range of values from Γ = −1.0 to −2.0. We also analyze the stellar vs. diffuse UV flux, and the population of OB star candidates in the field.
The Chajoma were a major Late Postclassic polity in highland Guatemala. Referred to as the Akajal or Akul in the Annals of the Cakchiquels and Popol Vuh, their territory previously has not been fully defined. Based on a small group of sixteenth-century documents preserved in the records of a later litigation, it is now possible to identify the origins of the Chajoma, approximate the time of their arrival in their new territory, and define the extent of their territory. Combined with information on archaeological sites associated with this occupation, we can provisionally characterize the polity's composition and estimate its population.
As the role of paramedics evolves, evaluation of their ability to accomplish an expanded scope of practice is necessary. The objective of this study was to determine whether specially trained paramedics can monitor and treat patients appropriately during interfacility transports that traditionally have required the use of supplemental, hospital-based personnel.
A paramedic-staffed mobile intensive care unit was developed as a cooperative program between Huron Valley Ambulance and the Washtenaw/Livingston County Medical Control Authority. This prospective observational study involved 111 patients requiring interfacility transport, conveyed by a paramedic-staffed mobile intensive care unit. A change in the Acute Physiologic and Chronic Health Evaluation (APACHE II) score components of mean arterial pressure, heart rate, and respiratory rate at the beginning and end of the transport was used to evaluate the ability of the paramedics to accomplish the transfer appropriately.
APACHE II scares increased in 20 patients, decreased in 16, and were unchanged in 75. The mean value for the change in APACHE score was 0.11 (95% confidence interval: −0.11−0.33).
Specially trained paramedics can monitor and treat patients appropriately during interfacility transfers that traditionally would have required supplementation with additional hospital staff.