Considerations for the Identification and Conveyance of Clinical Pathology Findings in Preclinical Toxicity Studies: Results From the 9th ESTP International Expert Workshop.

The European Society of Toxicologic Pathology (ESTP) organized a panel of 24 international experts from many fields of toxicologic clinical pathology (e.g., industry, academia, and regulatory) that came together in 2021 to align the use of terminology to convey the importance of clinical pathology findings in preclinical toxicity studies. An additional goal consisted of how to identify important findings in standard and nonstandard clinical pathology associated endpoints. This manuscript summarizes the information and opinions discussed and shared at the ninth ESTP International Expert Workshop, April 5 to 6, 2022. In addition to terminology usage, the workshop considered topics related to the identification and conveyance of the importance of test item-related findings. These topics included sources of variability, comparators, statistics, reporting, correlations to other study data, nonstandard biomarkers, indirect/secondary findings, and an overall weight-of-evidence approach.

Harmonization of three different accelerometers to classify the 24 h activity cycle.

Increasing interest in measuring key components of the 24 h activity cycle (24-HAC) [sleep, sedentary behavior (SED), light physical activity (LPA), and moderate to vigorous physical activity (MVPA)] has led to a need for better methods. Single wrist-worn accelerometers and different self-report instruments can assess the 24-HAC but may not accurately classify time spent in the different components or be subject to recall errors.Objective. To overcome these limitations, the current study harmonized output from multiple complimentary research grade accelerometers and assessed the feasibility and logistical challenges of this approach.Approach. Participants (n= 108) wore an: (a) ActiGraph GT9X on the wrist, (b) activPAL3 on the thigh, and (c) ActiGraph GT3X+ on the hip for 7-10 d to capture the 24-HAC. Participant compliance with the measurement protocol was compared across devices and an algorithm was developed to harmonize data from the accelerometers. The resulting 24-HAC estimates were described within and across days.Main results. Usable data for each device was obtained from 94.3% to 96.7% of participants and 89.4% provided usable data from all three devices. Compliance with wear instructions ranged from 70.7% of days for the GT3X+ to 93.2% of days for the activPAL3. Harmonized estimates indicated that, on average, university students spent 34% of the 24 h day sleeping, 41% sedentary, 21% in LPA, and 4% in MVPA. These behaviors varied substantially by time of day and day of the week.Significance. It is feasible to use three accelerometers in combination to derive a harmonized estimate the 24-HAC. The use of multiple accelerometers can minimize gaps in 24-HAC data however, factors such as additional research costs, and higher participant and investigator burden, should also be considered.

Methods and measures in food service food safety research: A review of the published literature.

Purpose: Food handlers working in food service establishments need to perform appropriate and consistent food safety practices to ensure that the prepared food is safe for consumers to eat, as a failure to do so may lead to foodborne illness. It is important to have an in-depth understanding of food handler food safety behaviour in the food service sector to design targeted educational interventions and approaches to safeguard consumers. The purpose of this review is to provide insight to the existing body of research regarding food handler food safety in the food service sector, and to identify future research needs in terms of methods and measures. Methods: This study is a review of published food safety research studies (n = 118) focusing on food handlers in the food service sector conducted between 2001 and 2021. Data were collated regarding the methods used and the measures assessed in published studies to identify the gaps in current knowledge related to food safety in food service. Findings: The majority of studies were conducted in the United States (29%), Brazil (17%) and United Kingdom (7%). A large proportion were carried out in restaurants (70%). Less than a third of studies (28%) relied on a mixed method approach for data collection; and only 12% of studies assessed a combination of cognitive and behavioural measures. Observation was used in only 29% of studies. A lack of observational data detailing food safety practices such as handwashing, temperature control, separation and cleaning was determined. Significance: Such findings indicate a greater need for mixed method approach in future food safety research. It is recommended that the understanding of food handler food safety performance is best obtained through a combined assessment of cognitive and behavioural measures with subsequent triangulation of findings to reduce bias and to obtain reliable results.

Dietetics Student Perceptions of Food Safety Communication to Vulnerable Populations: An International Study.

Registered dietitians can play an important role in delivering food safety information to vulnerable population groups. Although dietetic students are reported to perceive food safety to be important for vulnerable population groups, little is known regarding their attitudes toward their role in the delivery of food safety information. Therefore, the purpose of this study was to determine and evaluate the perceptions of dietetic students regarding their role in food safety communication to vulnerable populations from three international institutions. A total of 208 dietetics students participated in the study from Columbus, Ohio, USA (n = 100), Cardiff, Wales, UK (n = 78), and Beirut, Lebanon (n = 30). Predominantly, the students in this study had positive attitudes toward the importance of food safety for vulnerable groups, although more students from Lebanon were skeptical that vulnerable patients were more susceptible to foodborne infections than the general populations (p < 0.001). Data indicated confidence and understanding of food safety principles and a willingness to learn more about food safety for these groups, however, some students in the UK (30%) and USA (31%) were not confident that they could effectively communicate food safety to vulnerable patients. Based on the findings in this and previous studies, adjustments are recommended to the requirements for food safety knowledge among dietetic students to include food safety counseling competency.

Inclusion of Food Safety Information in Home-delivered U.K. Meal-kit Recipes.

Home-delivered meal-kit recipe boxes provide consumers with fresh, measured ingredients requiring storage, preparation, and cooking by following a recipe card.Previous literature has suggested that including food safety information within recipes may positively impact behavior. Therefore, there is a need to better understand what food safety information is included on the meal-kit recipe cards. Content analysis was performed on U.K. meal-kit provider recipe cards (n = 359) obtained using citizen science methods. Although 46% of recipes referred to handwashing at the start of recipe preparation, these stated 'wash hands' with no further advice regarding hand hygiene, and half (48%) did not refer to handwashing during recipe preparation. Most recipes included produce (99%) and referred to washing fruit and vegetables (88%). For meal-kits that provided animal proteins (n = 332), 50% referred to storing ingredients in the fridge, and only one recipe referred to recommended temperatures (≤5°C). Where applicable (n = 346), food safety advice to prevent cross-contamination was present in 51% of recipes.Statements concerning cooking adequacy of animal proteins (n = 1306) included subjective cooking guidance, with 35% referring to visual assessment of color and 26% cooking duration. For best practice food safety guidance, two recipes referred to end-point temperature, and one stated to use a temperature probe. While all meal-kit providers provided some food safety-related information in reviewed recipes, information was often not sufficient to inform consumers about food safety risk-reducing behaviors in the domestic setting. Observational research is needed to understand consumer engagement with how food safety information in meal-kit recipes impacts the behavior of consumers.

Diet Quality Outcomes of a Cooperative Extension Diabetes Prevention Program.

OBJECTIVE: The effectiveness of the National Diabetes Prevention Program (DPP) in improving diet quality (DQ) in community settings is largely unknown. This study aimed to evaluate the DQ changes of Extension DPP participants. METHODS: A single-group, repeated-measures design was used to evaluate an Extension-implemented DPP using the PreventT2 curriculum. Participants were overweight adults with or at high risk for prediabetes (n = 88). Weight and DQ (Healthy Eating Index-2015, Dietary Screener Questionnaire) were evaluated using mixed-effects regression. RESULTS: There was no change in the Healthy Eating Index-2015 total score. Predicted fiber, fruit, and vegetable intake increased (P < 0.05) but remained below recommendations. CONCLUSIONS AND IMPLICATIONS: Clinically meaningful DQ changes of Extension DPP participants were limited. The effect of the DPP on DQ in Extension and other implementation settings should be evaluated through randomized controlled trials. Diabetes Prevention Program curriculum revisions that include more specific dietary goals and educational tools may promote greater DQ changes in DPP participants.

Depressive symptoms, but not moderate-to-vigorous physical activity, impacts sexual well-being and menopause-specific quality of life in middle-aged women.

Inadequate physical activity (PA), unhealthy weight status, prevalence of chronic conditions, and psychosocial distress are common in middle-aged women and are linked to reductions in well-being and quality of life. However, their potential interactive effects, specifically on sexual well-being and menopause-specific quality of life (MENQOL), have not been well characterized in postmenopausal women. PURPOSE: To determine if moderate-to-vigorous physical activity (MVPA) and adiposity (%Fat) influence sexual well-being and MENQOL outcomes, controlling for health status (chronic conditions; medications) and psychosocial well-being (depressive symptoms; perceived stress), in postmenopausal women. Postmenopausal women (n = 68, 58.6 ± 3.4 yr, 80.9 percent married/partnered, 51.5 percent overweight/obese, nonsmoking) were recruited through e-mail advertisements and flyers placed throughout the community. Participants were scheduled for two laboratory visits 7-10 days apart where they were objectively assessed for MVPA with accelerometers (in the interim), adiposity via dual-energy X-ray absorptiometry (DXA), and self-report questionnaires to determine health status, depressive symptoms, perceived stress, sexual well-being, and MENQOL. Lower MVPA and higher %Fat were associated with lower physical domain MENQOL (both r = .27, p < .05); health status and psychosocial well-being were not associated (all p > .05). Hierarchical regression analyses revealed 1) greater number of chronic conditions and medications, and depressive symptoms scores predicted less favorable sexual well-being, independent of MVPA and %Fat (standardized ß range =.22-.56, all p < .05), 2) depression was most consistently associated with MENQOL (models p ≤ .001), and 3) greater adiposity augmented the negative influence of depression on the physical domain of MENQOL (ß = .40. p = .002). CONCLUSIONS: PA may influence sexual well-being and MENQOL indirectly through positive impacts on adiposity, chronic conditions, and depressive symptoms in middle-aged postmenopausal women, a sector of the population often afflicted with compromised sexual well-being.

Effect of power training on rate of torque development and spatiotemporal gait parameters post stroke.

BACKGROUND: Maximizing independence and function post-stroke are two common therapy goals. Rate of torque development in lower-extremity muscles was recently reported to be associated with walking speed; however, trainability and subsequent effect on gait is unknown. This study aimed to determine effect of power training on paretic and non-paretic limb torque parameters, spatiotemporal gait parameters, and walking speed in chronic stroke survivors. METHODS: Individuals with chronic stroke (n = 22; 7 females; 62.7 ± 8.8 yrs) completed 24 progressive power-training sessions over 8 weeks with pre and post assessments. Knee extensor strength was assessed via dynamometry with torque parameters measured from maximal voluntary isometric contractions. Gait speed and spatiotemporal gait parameters were assessed via an instrumented gait mat, and a 6-min walk test was performed. FINDINGS: Rate of torque development at 200 ms and peak torque improved 58.6% and 14.1%, respectively, in the quadricep of the paretic limb (p < 0.05); conversely the non-paretic limb was unchanged. On average, self-selected walking speed, fastest-comfortable walking speed, and 6-min walk test improved 21.7%, 21.1%, and 19.5%, respectively (all p < 0.05). Change in torque development at 100 ms in the quadricep of the non-paretic limb was positively associated with improvements in self-selected and fastest-comfortable walking speeds (both r = 0.70, p < 0.05) and 6-min walk (r = 0.78, p < 0.001). INTERPRETATIONS: These findings suggest power training may be an effective intervention for improving torque development in the quadricep of the paretic limb in individuals with chronic stroke. Further research to explore utility and mechanistic aspects of force development for gait function in chronic stroke survivors is warranted.

Implementation of the Diabetes Prevention Program in Georgia Cooperative Extension According to RE-AIM and the Consolidated Framework for Implementation Research.

Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes.

Weight Loss and Exercise Effects on Rate of Torque Development and Physical Function in Overweight Older Women.

Exercise training (EX) and weight loss (WL) improve lower extremity physical function (LEPF) in older overweight women; however, effects on rate of torque development (RTD) are unknown. This study aimed to determine the effects of WL + EX or WL alone on RTD, and relatedly LEPF, in overweight older women. Leg strength was assessed using isokinetic dynamometry, and RTD was calculated (RTD200 = RTD at 200 ms, RTDPeak = peak RTD, T2P = time to 1st peak). LEPF was determined via clinical functional tasks. Women (n = 44, 69.1 ± 3.6 years, 30.6 ± 4.3 kg/m2) completed a 6-month trial in EX + WL or WL groups with similar weight loss (-9.8 ± 4.2%, p > .95). EX + WL had greater improvements in (a) most LEPF tasks (p < .001) and (b) RTD200, compared with WL (36% vs. -16%, p = .031); no other RTD parameters differed. Changes in RTD parameters and LEPF were not related (all p > .05). RTD is responsive to EX but is not associated with LEPF in older women.

Differences in physical activity and perceived benefits and barriers to physical activity between LGBTQ + and non-LGBTQ + college students.

ObjectiveTo compare physical activity (PA) behaviors and perceived benefits and barriers among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ + college students. Participants: Participants were 406 college students. Methods: Surveys assessed PA behaviors and perceptions of PA among college students. Multivariate ANOVA assessed differences in PA behaviors and perceptions of PA. Results: LGBTQ + students (n = 71) engaged in 17% less aerobic PA and 42% less resistance training than their counterparts (n = 335; both p < .05). LGBTQ + students reported 6.5% lower total Exercise Benefits and Barriers Scale scores and 13.3% higher Barriers Scale scores (both p < .05). Conclusions: LGBTQ + college students are at higher risk of not meeting PA guidelines than non-LGBTQ + students. More perceived barriers and fewer perceived benefits to PA may contribute to this disparity. Identification of LGBTQ+-specific barriers to PA among college students is needed to inform programming to increase PA among this at-risk community.

Physical activity and perceived benefits, but not barriers, to exercise differ by sex and school year among college students.

Objective: To assess whether sex or school year influence physical activity and exercise (PA/EX) behaviors and perceived benefits and barriers of PA/EX among college students. Participants: Participants were 862 (78% female; 20.1 ± 1.4 years) college students. Methods: The International Physical Activity Questionnaire, Exercise Benefits and Barriers Scale, and resistance training (RT) questions were completed online. Results: Factorial ANOVA (sex x year) determined no significant interaction effects of sex and school year in behaviors or perceived benefits and barriers (all p > .05). Males reported higher levels of PA/EX and RT than females (p < .05) with no differences by school year (p = .34). Benefits Scale scores and some of its subscales were higher for males and first-year students compared to females and third- and fourth-year students (all p < .05). Conclusion: PA/EX promotion programs may need to be tailored differently based on sex and school year.

Identifying support mechanisms to overcome barriers to food safety scheme certification in the food and drink manufacturing industry in Wales, UK.

Obtaining food safety certification is essential for food manufacturers. Potential barriers to obtaining certification are complex, interrelated and broadly relate to, 'knowledge and skills', 'time, cost and resources', and 'communication and access to information'. This study aimed to explore requirements for support to enable food manufacturers in Wales to overcome identified barriers. Food manufacturers (n = 37) participated in group discussions (n = 2) and completed online-questionnaires (n = 29). Support mechanisms, perceived necessary to obtain food safety certification included; funding for training and audit-fees, support for implementing food safety scheme documentation, on-site support through mentoring/coaching and pre-audits. Findings identify the need for a food safety scheme certification support package pathway incorporating online, off-site, on-site and financial support to assist food and drink manufacturers obtain third-party food safety certification. Such assistance would support three critical areas. Findings may inform development of support mechanisms to increase uptake of food safety certification and accelerate food-sector growth.

A case study of food handler hand hygiene compliance in high-care and high-risk food manufacturing environments using covert-observation.

Observation of behaviour is superior to cognitive data, which does not equate to behaviour. Covert-observation is seldom used in food manufacturing to assess behaviour. In this case study, closed-circuit-television footage (15 h) in a business were reviewed to assess hand hygiene compliance using an electronic-checklist. Hand hygiene attempts were observed prior to entering high-risk (cake/pie)(n= 47) and high-care (sandwich/salad)(n= 153) production areas. Business hand hygiene protocol required handwashing durations ≥ 20 s. Observed durations ranged 1-71 s, <96% of attempts were <20 s. Significantly longer durations were observed when food handlers were in the presence of others (12 s) than when alone (9 s). Although <99% utilised soap, only 56-69% wetted hands first. Failure to rub all parts of hands was commonplace (<87%) and 24-35% failed to apply sanitiser after drying. Consequently, >98% of observed attempts before entering production areas did not comply with the protocol. Observed non-compliant practices may have implications for food safety in manufacturing.

Sex-specific correlates of metabolic syndrome risk in college-aged young adults.

Objective: To identify the sex-specific prevalence of metabolic syndrome (MetS) risk factors and their physiological, psychosocial, and behavioral correlates in a college-aged population. Participants and methods: Cross-sectional assessment of MetS risk factors and potential correlates occurred in 379 first-year students (aged 18.34 ± 0.49 years, 67.3% female). Multivariable linear regression assessed the relationships between potential correlates and continuous MetS risk scores, derived from principal component analysis. Results: MetS risk factors were present in 58.4% of females and 68.5% of males, with 2.4% and 3.2% having defined MetS. In females, percent body fat (ß = 0.46, p < 0.001), stress (ß = 0.12, p = 0.031), % kcal from sugar (ß = 0.18, p = 0.001), and moderate-to-vigorous physical activity (ß=-0.12, p = 0.036) were associated with risk score. Whereas, correlates in males included percent body fat (ß = 0.54, p < 0.001), C-reactive protein (ß = 0.15, p = 0.045), and AUDIT alcohol consumption score (ß = 0.15, p = 0.033). Conclusion: The sex-specific prevalence of MetS risk factors and correlates suggest that primary prevention strategies on college campuses should also follow a sex-specific approach.

Assessing Existing Food Safety Resources with United Kingdom-Based Chemotherapy Patients and Family Caregivers for Future Learning Purposes.

ABSTRACT: Because the incidence of foodborne infection is more prevalent among cancer patients and the domestic kitchen is a contributor to foodborne infection, appropriate domestic food safety practices are needed to safeguard this at-risk population. Although patients are aware of the increased risk of infection, previous self-reported data indicate potential food safety malpractices among patients and family caregivers, thus suggesting the need for targeted food safety information. However, existing United Kingdom resources provide inconsistent and insufficient food safety information. Involvement of intended end users in the cocreation of interventions increases potential effectiveness. Qualitative data were collated from in-depth interviews and a focus group with United Kingdom chemotherapy patients and family caregivers (n = 35) to determine perceptions and preferences for food safety information by evaluating existing food safety resources from international providers (n = 12). Although participants liked digital interventions (e.g., Web sites and videos), traditional paper-based leaflets were perceived as the most beneficial because they could be referred to on repeated occasions. Despite the drawbacks associated with some resources, combining approaches in a multiresource intervention was favored by patients and family caregivers. Ensuring patients are not overwhelmed with excessive information was important. Short, logical, engaging, educational, and entertaining information to evoke an interest in the topic was preferred. Utilization of graphics to supplement descriptive information may enhance comprehensibility. Interventions need to be appropriate for patients and caregivers, and delivery by trusted health care professionals may enhance the credibility of the message. Preferred approaches to facilitate targeted food safety communication were identified, and these findings can be utilized to cocreate targeted food safety interventions for chemotherapy patients and family caregivers.

Awareness and Attitudes of Student Dietitians in Lebanon, UK and USA towards Food Safety.

Allied health professionals such as dietitians can play a critical role in providing food safety advice to vulnerable consumers. To maximize food-related health and wellbeing, food needs to be safe and nutritious; consequently, food safety is referred to in international curricula for the training of dietitians. The purpose of this study was to explore the awareness and attitudes of student dietitians from three international institutions towards food safety. A total of 207 student dietitians participated in the study from Columbus, OH, USA (n = 99), Cardiff, Wales, UK (n = 78) and Beirut, Lebanon (n = 30). Completion of the study established that the students in three dietetic training programs lacked awareness of key food safety concepts. Close to half (43%) were not familiar with Campylobacter, with the USA students being significantly less knowledgeable (p < 0.001) with 58% being unaware of the pathogen. Understanding of safe handling of leftovers was the lowest for the students in all institutions; only 46% described appropriate reheating practices, with significantly lower (p < 0.001) understanding in Lebanon (28%). The students reported a good understanding of vulnerable populations and perceived food safety to be important for these groups. However, the knowledge of certain high-risk foods was lacking. For instance, 69% of students thought that fresh squeezed juices and smoothies made with raw fruits and vegetables were safe for vulnerable patients, with the UK students being the least familiar with this risk (16%). This is the first study of its kind to take an international perspective of student dietitian food safety awareness and attitudes; the findings are important to dietetic food safety educators and recommendations are made to further explore the interpretation of food safety requirements in international dietetic curricula. Future studies should extend student dietetic research to address attitudes, self-efficacy and the overall readiness to deliver food safety advice to the patients and the community.

Raw Meat-Based Pet Feeding and Food Safety: Netnography Study of Pet Owner Comments and Review of Manufacturers' Information Provision.

ABSTRACT: Feeding raw meat to domestic pets is a popular practice. Because of the potential food safety implications associated with handling raw meat, concerns about pet owner health have increased. For this study, a netnographic content analysis approach was used to analyze posts from Pet Forums Community online archives related to raw meat-based feeding and food safety (n = 308). United Kingdom manufacturer and supplier Web sites (n = 33) were reviewed for provision of food safety information related to raw meat-based pet feeding. The data were analyzed using a qualitative thematic approach and quantitative methods. Pet owner forum comments indicated potential malpractices and indifference toward possible food safety hazards when preparing raw meat-based pet food. Many were risk aware but indicated confusion regarding appropriate food safety practices. Although emotional concern about the safety of pets and children was expressed, contracting a foodborne disease was not perceived as a personal risk. In addition, the review identified that most (61%) manufacturer and supplier Web sites failed to provide food safety instructions or warnings to pet owners regarding raw meat-based pet food. Information was inconsistent and varied across sources. The most comprehensive sources of information were provided by manufacturers approved by the United Kingdom Pet Food Manufacturers' Association. This is the first netnography study to explore pet owner online reports and the provision of food safety information related to raw pet feeding. Findings suggest pet owners may not fully appreciate the potential risks associated with raw meat-based pet feeding. Consequently, there is a need for credible and consistent strategies to inform pet owners about potential implications associated with feeding raw meat to pets, as well as about safe food handling practices.