Dietary assessment can be based on pattern recognition rather than recall.

Diet is the leading predictor of health status, including all-cause mortality, in the modern world, yet is rarely measured; whereas virtually every adult in a developed country knows their approximate blood pressure, hardly any knows their objective diet quality. Leading authorities have called for the inclusion of nutrition in every electronic health record as one of the many remedial steps required to give dietary quality the routine attention it warrants. Existing tools to capture dietary intake are based on either real-time journaling or recall. Journaling, or logging, is time and labor intensive. Recall is notoriously unreliable, as humans are notably bad at remembering detail. Even allowing for the challenge of recall, these dietary intake methods are labor and time intensive, and require analysis at the n-of-1 level. We hypothesize that dietary intake assessment can be "reverse engineered"-predicating assessment on the recognition of fully formed dietary patterns-rather than endeavoring to assemble such a representation one food, meal, dish, or day at a time. This pattern recognition-based method offers potential advantages over existing methods, including speed, efficiency, cost, and applicability. We have developed and provisionally tested such a system, and the results thus far support our hypothesis. We are convinced that leveraging pattern recognition to make dietary assessment quick, user-friendly, economical, and scalable can allow for the conversion of dietary quality into a universally measured and routinely managed vital sign. In this paper, we present the supporting case.

Two outbreaks of campylobacteriosis associated with the consumption of raw cows' milk.

The present paper summarises the investigation of two different outbreaks of milk-associated Campylobacter enteritis in the Netherlands. In 2005, after a school trip to a dairy farm, 22 out of a group of 34 children developed diarrhoeal illness and Campylobacterjejuni was cultured from the stool samples of 11 of the cases. The illness was found to be epidemiologically associated with drinking raw milk during the farm visit; 86% of the cases could be explained by drinking raw milk. C.jejuni was also isolated from three of 10 faecal samples from dairy cattle collected at the farm. The human isolates and C.jejuni isolates from one of these three samples of cattle faeces revealed identical restriction patterns by both pulsed-field gel electrophoresis (PFGE) and flagellin (fla) typing by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Both epidemiological and bacteriological evidence implicated contaminated raw milk as the vehicle of transmission, though C.jejuni was not isolated from the bulk tank milk or the milk filter collected during the farm investigation. In 2007, an outbreak of enteritis was notified among people who had attended a lunch at a dairy farm where bulk tank milk was served. Of the 19 persons who had consumed raw milk, 16 (84%) had become ill. Of the persons who did not drink the raw milk, none became ill. A significant association was found between tasting the raw milk and being ill (risk difference=0.84, p=0.0011). C.jejuni was cultured from four of seven cases who had submitted a stool specimen. C. jejuni was also isolated from a sample of bulk tank milk and the isolate had an identical flaA PCR-RFLP genotype to isolates obtained from patients. Also in this outbreak both the epidemiological and bacteriological findings support raw milk as the vehicle for the enteritis. These two outbreaks highlight the health risks associated with the consumption of raw milk. As long as legislation allows the sale and distribution of untreated milk these risks will continue. Therefore, consumers need to be continuously informed about the dangers inherent in consuming unpasteurised milk or products made from raw milk. Farmers need to be strongly discouraged from serving raw milk to their visitors.

The frequency of JAK2 exon 12 mutations in idiopathic erythrocytosis patients with low serum erythropoietin levels.

BACKGROUND AND OBJECTIVES: Idiopathic erythrocytosis (IE) is characterized by erythrocytosis in the absence of megakaryocytic or granulocytic hyperplasia, and is associated with variable serum erythropoietin (Epo) levels. Most patients with IE lack the JAK2 V617F mutation that occurs in the majority of polycythemia vera patients. Four novel JAK2 mutant alleles have recently been described in patients with V617F-negative myeloproliferative disorders presenting with erythrocytosis. The aims of this study were to assess the prevalence of JAK2 exon 12 mutations in IE patients, and to determine the associated clinicopathological features. DESIGN AND METHODS: A cohort of 58 IE patients with low to normal serum Epo levels and no known causative mutation were identified from 181 individuals diagnosed with IE. Patients' DNA samples were screened for the presence of a JAK2 exon 12 mutation by allele-specific polymerase chain reaction and sequencing. Bone marrow trephines were examined for morphological abnormalities and the erythroid activity assessed immunohistochemically. RESULTS: Eight mutation-positive cases were identified, including one with a previously undescribed mutant JAK2 exon 12 allele and another with biallelic involvement. The hematologic features of mutation-positive and mutation-negative patients were similar, although Epo-hypersensitive erythroid progenitors occurred exclusively in patients with an exon 12 mutation (p=0.0002; n=15). Patients' bone marrows were moderately hypercellular, as the result of erythroid hyperplasia, and several had mild megakaryocyte atypia. INTERPRETATION AND CONCLUSIONS: JAK2 exon 12 mutations were detected in 27% of patients with low serum Epo levels, all of whom had Epo-independent erythroid progenitors. Consequently, IE patients presenting with either of these features should be tested for the presence of a JAK2 mutation.

Multiple Mycobacterium tuberculosis infections in an HIV-infected patient.

Mycobacterial colonies of two different morphologies were isolated from one sputum sample of a HIV-positive patient. One morphological type was resistant to streptomycin (STR) and susceptible to isoniazid (INH), while the other isolate with different colony morphology was resistant to both of these anti-TB drugs. A mycobacterial isolate of one pus from a lymph node sample was resistant to these two anti-TB drugs, while the other isolate from another pus sample was resistant to STR but susceptible INH. IS6110 RFLP based finger printing revealed that the HIV-positive patient was infected with different strains of Mycobacterium tuberculosis. A subculture of isolates on solid medium is useful to examine mixed infection.

Characterization of Mycobacterium africanum subtype I among cows in a dairy farm in Bangladesh using spoligotyping.

Acid-fast bacilli (AFB) were detected in the autopsy lung tissue homogenate samples of four cows (variety Frisian cross) in a dairy farm in Bangladesh. Histopathological examination of the lung tissue demonstrated prominent granulomas, caseating necrosis and calcification indicative of tuberculosis (TB) infection. Mycobacteria could not be cultured from the tissue homogenate samples by Lowenstein-Jensen based conventional culture method though AFB were evident by Ziehl-Neelsen (ZN) staining of the smears of tissue homogenate and in paraffin embedded tissue slices. Spoligotyping performed on DNA extracts of paraffin embedded lung tissue samples confirmed the AFB as a member of the M. tuberculosis complex (MTBC) with a pattern assigned to M. africanum subtype I. This characterization by spoligotyping was confirmed by subjecting M. africanum subtype I isolates from other parts of the world to an alternative identification method based on DNA polymorphism in the gyrB gene (Hain Life Science, GmbH, Nehren, Germany). Since M. africanum is believed to be a human pathogen, general infection in cattle may be a public health threat. The presence of these bacteria in the animal reservoir most likely originated from a caretaker.

The incidence of the JAK2 V617F mutation in patients with idiopathic erythrocytosis.

Sixty-three patients with erythrocytosis exhibiting a range of erythropoietin levels were screened for the JAK2 V617F mutation. One patient (1.6%) was found to have this mutation, and has remained stable for 9 years, suggesting that the JAK2 V617F mutation is rare in patients with idiopathic erythrocytosis.

Novel uses for recombinant erythropoietin therapy in unlicensed indications.

Clinical uses for recombinant human erythropoietin (rHuEPO) therapy continue to expand. Initial use was in anaemia associated with end-stage renal disease, but more recently there have been many reports of the benefits of erythropoietin in other clinical situations such as cancer-related anaemia. Recombinant erythropoietin reduces the need for blood transfusion and hence exposure to donor blood products as well as improving quality of life. We report four patients who were transfusion dependent, none of whom had licensed indications for the use of recombinant erythropoietin. Two patients had microangiopathic haemolytic anaemia secondary to mechanical valve haemolysis and were unsuitable for any further cardiac intervention. One patient had anaemia of chronic disease and anti-Vel red cell antibodies, making compatible blood transfusions difficult to obtain. The fourth patient had primary thrombocythaemia and developed transfusion-dependent anaemia secondary to myelosuppressive agents. All four patients had a relative deficiency in endogenous erythropoietin levels ranging between 7 and 41 IU/l. After commencing recombinant erythropoietin therapy, all had a response in haemoglobin of at least 1 g/dl with an overall improvement in their quality of life. We conclude that rHuEPO is a very convenient and useful form of treatment in transfusion-dependent anaemia and in some cases beyond the licensed indications.

Reproducibility of brain ADC histograms.

The aim of this study was to assess the effect of differences in acquisition technique on whole-brain apparent diffusion coefficient (ADC) histogram parameters, as well as to assess scan-rescan reproducibility. Diffusion-weighted imaging (DWI) was performed in 7 healthy subjects with b-values 0-800, 0-1000, and 0-1500 s/mm(2) and fluid-attenuated inversion recovery (FLAIR) DWI with b-values 0-1000 s/mm(2). All sequences were repeated with and without repositioning. The peak location, peak height, and mean ADC of the ADC histograms and mean ADC of a region of interest (ROI) in the white matter were compared using paired-sample t tests. Scan-rescan reproducibility was assessed using paired-sample t tests, and repeatability coefficients were reported. With increasing maximum b-values, ADC histograms shifted to lower values, with an increase in peak height ( p<0.01). With FLAIR DWI, the ADC histogram shifted to lower values with a significantly higher, narrower peak ( p<0.01), although the ROI mean ADC showed no significant differences. For scan-rescan reproducibility, no significant differences were observed. Different DWI pulse sequences give rise to different ADC histograms. With a given pulse sequence, however, ADC histogram analysis is a robust and reproducible technique. Using FLAIR DWI, the partial-voluming effect of cerebrospinal fluid, and thus its confounding effect on histogram analyses, can be reduced.

Effects of debittering on grapefruit juice acceptance.

This study was conducted to assess the acceptance of grapefruit juice which has undergone a debittering process. The sensory effect of debittering and the sensory attributes of sourness, sweetness, bitterness, and aftertaste were appraised, and the correlation between chemical and sensory analyses of the debittered juice were identified. The effect of added grapefruit flavor on perception of sweetness and sourness was statistically significant. Both the level of bitterness and storage duration of grapefruit were shown to influence the way judges perceived bitterness and sweetness. Storage study showed no difference in aftertaste, which may increase consumers buying interest in debittered juice with a high level of bitterness (450 ppm).

Methodological issues regarding eating behavior of high-risk adolescents.

Teens exist in multiple environments that offer a variety of foods and a range in nutrient intakes. Currently used dietary data-collection methods may not be contemporary and encompass the real world of today's youth. If we consider respondent capability when we design our dietary assessment methods, then we can increase accuracy and reduce errors in our data. Our methodological challenge is to improve collection methods and to: Focus on the teen and his or her respective environments, Develop environment-specific probes within food records, recalls, checklists, and frequencies, Inbed safeguards to assure impartial reporting when surrogate respondents-for example, parents or school food service staff-are queried, Differentiate between foods "as offered or available at the home or school" versus foods as actually selected and eaten, Tease out the influence of peers and older siblings on food choices versus selections based on personal choice or cost, Employ cooperative education in the classroom so teens will feel comfortable with spontaneous interviews by unfamiliar people, Train students in dietary recordkeeping procedures by incorporating assessment activities into the classroom instruction. In conclusion, the teen lives in multiple environments that influence his or her food and nutrient intake. To increase validity, reliability, and our confidence in the dietary data about teens, we must acknowledge these microenvironments and evolve our methods. The process must be evolutionary not revolutionary like the lives of many teens. The result will be an increased accuracy in both defining actual nutrient intakes and exploring the role foods and nutrients have in the overall health or nutrient deficit teens face.

Environmental influences on methods used to collect dietary data from children.

When collecting dietary data on children, confidence about responses is required. Children exist in multienvironments in their everyday lives, eg, the personal, school, home, peer, medical care, media, food industry, and fast-food facility environments. These macroenvironments influence the format and type of data-collection methods used to interview today's youth. Researchers should identify the influence of each environment on the child's eating pattern and nutrient intake, explore the pros and cons of various data-collection methods amid these environments, and determine unresolved methodological issues to stimulate future research. Standardized protocols for interviewing children, exclusion criteria for surrogate responses, and currency of nutrient data for new food products available to children are needed. Redefining our methods by understanding the macroenvironments of youth can create a dietary methodology for the 21st century--an evolutionary method that builds on past research and incorporates current technology and societal changes.

A food frequency questionnaire for adolescents: defining eating patterns.

A self-administered food frequency questionnaire (FFQ) was developed to indicate weekly consumption of 64 foods. Reliability, validity, and usefulness of the tool to define a protein eating pattern were determined. Adolescents (N = 1,108) completed the FFQ during the Bogalusa Heart Study. Two-hour and 2-week reliability measures demonstrated consistency of intake of specific foods. Frequency of foods obtained from seven consecutive 24-hour recalls was compared with frequency obtained from the FFQ. A mean 50% agreement for both frequency and quantity of food intake was observed. Geometric means showed differences in mean number of protein foods by age of adolescent but the only significant difference was for beef intake of 15-year-olds. White children reported more servings of beef, cheese, and vegetables with meat than did black children. Black children reported more servings of eggs, luncheon meat, pork, poultry, and total protein than did white children. Boys reported a greater frequency of total protein foods, specifically, eggs, milk, and poultry, than did girls. Significant correlations were noted between low-density-lipoprotein cholesterol and intake of eggs and luncheon meat. We were able to quantitate the reliability and validity of the FFQ and to use it to explore the association of specific eating patterns with cardiovascular disease risk.

Fat and cholesterol avoidance among Mexican-American and Anglo preschool children and parents.

Is a fat-avoidance scale a useful tool for monitoring and tracking dietary fat selections of adults and children? Using a seven-point scale, we addressed this question with 341 preschool children and 421 of their parents participating in a longitudinal study of childhood behaviors in San Diego County, California. Milk type and cooking fat reported in the fat-avoidance scale was compared with data reported in a 24-hour food intake record. An overall 86% agreement for milk type and a 78% agreement for cooking fat were noted. Anglo preschoolers (n = 143) had significantly greater mean scores for fat and cholesterol avoidance than did Mexican-American preschoolers (n = 198). Anglo, but not Mexican-American, women avoided fat and cholesterol more often than did their male counterparts. A significantly higher sum score was noted for Anglo men and women and Mexican-American men as education increased. These findings indicate that the fat-avoidance scale has a relative validity compared with a 1-day food record, that fat avoidance can be measured, that differences can be noted in a biethnic sample of children and adults, and that the scale has potential for monitoring success in achieving a lower fat and cholesterol intake.

Nutritional therapy for hyperlipidemia and obesity: office treatment integrating the roles of the physician and the registered dietitian.

Clinical therapy for hyperlipidemia and obesity mandates dietary changes. The rationale for modification of specific dietary components becomes more impressive with each decade, as research and epidemiologic studies continue. Treatment modalities should be based on lipid patterns and lipid aberrations. Intervention methods should become practical and behaviorally motivating for patients. The environment must be receptive, with sophisticated interaction between the physician and registered dietitian. Third party reimbursement trends should be considered, but should not deter nutrition care services essential for medical management of the individual with heart disease.

Sodium, potassium, calcium, magnesium, and phosphorus intakes of infants and children: Bogalusa Heart Study.

Electrolyte and mineral intakes assessed by 24-hour dietary recall were examined for race and sex differences in cohorts of infants and school-age children at 6 months and at 1, 2, 3, 4, 10, 13, 15, and 17 years. A fourfold increase in sodium intake occurred from 6 months to 4 years, and potassium intake doubled. Sodium increased from 0.88 gm at 6 months to 3.21 gm at 4 years and 3.67 gm by 17 years; a slight increase for potassium was noted from 4 to 17 years for boys. Calcium intake was relatively constant from 6 months to 17 years. Boys had higher intakes of sodium and sodium per kilogram body weight than did girls. Black children at 2, 3, and 4 years had significantly higher sodium, potassium, calcium, phosphorus, and magnesium expressed as total intake and per kilogram body weight than white children did. At 6 months, 66% of the infants exceeded the National Research Council's recommended range for sodium. At 1 to 10 years, 90% to 100% and at 13 to 17 years, 60% to 65% exceeded the recommended range. In contrast, 58% to 77% of preschool children and only 5% to 20% of school-age children surpassed the recommended potassium range. Fifty percent to 70% of children more than 10 years old achieved the recommended range for potassium. Approximately half of the children 6 months through 4 years of age met the Recommended Dietary Allowance (RDA) for calcium. Sixty percent to 80% of adolescents ingested less than two-thirds the RDA. Girls had lower intakes than did boys.(ABSTRACT TRUNCATED AT 250 WORDS)

Caffeine intakes of children from a biracial population: the Bogalusa Heart Study.

To investigate caffeine intake patterns in children, dietary intakes were examined for a biracial sample of 1,284 infants and children. Twenty-four-hour dietary recalls were completed by parents of children aged 6 months and repeated at ages 1, 2, 3, and 4 years; children 10 years old served as their own respondents and were surveyed at ages 13, 15, and 17 years. The sample was 60% white and 40% black. Additional cohorts of 10-year-olds (no. = 686) were studied for temporal trend. Whites consumed significantly more caffeine than blacks as early as 1 year and persisted at a higher intake level from 2 to 17 years. This trend continued whether intake was measured in total milligrams, milligrams per 1,000 kcal, or milligrams per kilogram body weight. Significant sex differences in caffeine intakes per 1,000 kcal occurred among 15- and 17-year-olds (girls greater than boys). Peak periods of consumption occurred at ages 2, 3, 13, and 17. Snacks contributed large quantities of caffeine, particularly for 10-year-olds. Most frequent sources of caffeine were regular carbonated beverages, chocolate-containing foods, and tea. Mean intakes of caffeine for 10-year-olds were consistent from 1973 to 1982. Those observations document caffeine intakes beginning early in life.