The prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in a representative sample of New Zealand adults.

OBJECTIVE: This study aimed to estimate the prevalence of vegetarians, vegans and other dietary patterns that exclude some animal-source foods in New Zealand adults. We also examined socio-demographic and lifestyle correlates of these dietary patterns. DESIGN: The New Zealand Health Survey is a representative rolling cross-sectional survey of New Zealanders; data from the 2018/19 and 2019/20 waves were used for this analysis. Participants were asked if they completely excluded red meat, poultry, fish/shellfish, eggs or dairy products from their diet. SETTING: New Zealand. PARTICIPANTS: Adults, aged ≥ 15 years (n 23 292). RESULTS: The prevalence of red-meat excluders (2·89 %), pescatarians (1·40 %), vegetarians (2·04 %) and vegans (0·74 %) was low. After adjustment for socio-demographic and lifestyle factors, women (OR = 1·54, 95 % CI: 1·22, 1·95), Asian people (OR = 2·56, 95 % CI: 1·96, 4·45), people with tertiary education (OR = 1·71, 95 % CI: 1·18, 2·48) and physically active people (OR = 1·36, 95 % CI: 1·04, 1·76) were more likely to be vegetarian/vegan. Those aged ≥ 75 years (OR = 0·28, 95 % CI: 0·14, 0·53) and current smokers (OR = 0·42, 95 % CI: 0·23, 0·76) were less likely to be vegetarian/vegan. Similar associations were seen between socio-demographic and lifestyle factors and the odds of being a red-meat excluder/pescatarian. CONCLUSIONS: Approximately 93 % of New Zealand adults eat red meat and a very small number exclude all animal products from their diets. The Eating and Activity Guidelines for New Zealand adults recommend a plant-based diet with moderate amounts of animal-source foods. A comprehensive national nutrition survey would provide detailed information on the amount of red meat and other animal-source foods that the New Zealand population currently consumes.

Meat-Free Mondays in Hospital Cafés in Aotearoa, New Zealand.

Current human meat consumption levels contribute to environmental degradation and are a risk factor for non-communicable diseases. Globally, meat-reduction policy interventions are limited. Meat-Free Mondays (MFMs) is a global campaign to reduce meat consumption to improve planetary and human health. We conducted a mixed methods evaluation of MFMs at three District Health Boards (DHBs) (one not considering a MFM policy, one that had trialled MFMs and one implementing MFMs) to investigate attitudes towards MFMs and barriers and enablers to implementation. An online staff survey and eleven semi-structured interviews with food service managers, café managers and sustainability managers were conducted. Of the 194 survey participants, 51% were actively cutting back on meat, mainly for health, environmental concerns and enjoyment of plant-based dishes, and 59% were positive towards MFMs. Qualitative analysis using a general inductive approach identified four themes: (1) 'Change and choice' (impact on personal choice), (2) 'Getting it right' (product and price, food quality, health, customer retention and sales), (3) 'Human and planetary health' (hospitals as leaders in healthy, sustainable diets), (4) 'Implementation success' (communication and education). Recommendations for implementation of MFMs included seeking feedback from other DHBs, wide consultation with food service staff, cultural and dietitian food service support and providing evidence of the success of MFMs and alternatives to MFMs.

Nutrient content and cost of canned and dried legumes and plant-based meat analogues available in New Zealand supermarkets.

AIMS: Plant-based eating patterns are recommended for human and planetary health. Plant-based protein sources in supermarkets include traditional options and plant-based meat analogues. This cross-sectional survey examined the nutritional content, healthiness, cost and labelling of these products. METHODS: Nutrient content and claims on canned legumes (plain [N = 64] and flavoured [N = 25]), canned baked beans (N = 23), dried legumes (N = 21), tofu (plain [N = 8] and flavoured [N = 5]), falafels (N = 14), meat analogues (meat-free burgers [N = 11], meat-free sausages [N = 10] and 'other' meat-free products [N = 20]) were obtained from a database of packaged foods in New Zealand. Mean (SD) energy, protein, total fat, saturated fat, sodium and dietary fibre content (per 100 g) was calculated for each category. Healthiness was assessed using an estimated Health Star Rating (Rating ≥3.5 considered 'healthy'). Product data were linked with household purchasing data from the 2019 Nielsen IQ® consumer panel to calculate mean purchase price/100 g/category. The number and type of nutrition claims were compared across categories. RESULTS: The highest mean protein content was 'other' meat-free products (14.8 ± 6.9 g/100 g). Meat-free sausages had the highest sodium and saturated fat content (643 ± 148 mg/100 g, 3.7 ± 4.5 g/100 g). Overall, few meat analogues (N = 5, 12%) scored an estimated Health Star Rating ≥3.5. Dried legumes were the cheapest plant protein (mean ± SD) purchase price = NZ $0.30 ± 0.16/100 g), compared with 'other' meat-free products (purchase price = NZ $2.57 ± 0.88/100 g). The most common nutrition claims on meat analogues were about protein content. Dietary fibre claims were the most common on canned and dried legumes. CONCLUSION: Meat analogues offer convenience, however, may be less healthy and more expensive than traditional plant-based proteins. This study assists dietitians in providing accurate consumer messaging about healthy plant-based proteins.

Product promotional strategies in supermarkets and their effects on sales: A case study of breakfast cereals and drinks in New Zealand.

AIMS: To examine the frequency of promotions on breakfast cereals and drinks in a major New Zealand supermarket chain, determine the healthiness of promoted versus non-promoted products, and quantify the effects of promotions on sales. METHODS: Weekly data on product promotions and sales were collected in six Auckland supermarkets for 198 breakfast products over 12 weeks. The healthiness of products was determined using the Health Star Rating system, and the effect of promotions on sales was estimated using linear mixed models. RESULTS: On average, 47% of breakfast products in a given week were promoted using on-shelf tickets, 12% in weekly mailers, and 9% via promotional displays. The healthiness of promoted and non-promoted breakfast products was comparable. In relation to weekly sales of non-promoted products, all three promotional strategies had substantial (2 to 2.5 times higher sales) and statistically significant (P < 0.001) effects on product sales. CONCLUSION: Promotions are frequently used and effective at increasing sales. Marketing strategies focusing solely on promoting healthier products could be an important nudging strategy to improve the healthiness of supermarket food purchases.

Automated Detection of Vascular Leakage in Fluorescein Angiography - A Proof of Concept.

Purpose: The purpose of this paper was to develop a deep learning algorithm to detect retinal vascular leakage (leakage) in fluorescein angiography (FA) of patients with uveitis and use the trained algorithm to determine clinically notable leakage changes. Methods: An algorithm was trained and tested to detect leakage on a set of 200 FA images (61 patients) and evaluated on a separate 50-image test set (21 patients). The ground truth was leakage segmentation by two clinicians. The Dice Similarity Coefficient (DSC) was used to measure concordance. Results: During training, the algorithm achieved a best average DSC of 0.572 (95% confidence interval [CI] = 0.548-0.596). The trained algorithm achieved a DSC of 0.563 (95% CI = 0.543-0.582) when tested on an additional set of 50 images. The trained algorithm was then used to detect leakage on pairs of FA images from longitudinal patient visits. Longitudinal leakage follow-up showed a >2.21% change in the visible retina area covered by leakage (as detected by the algorithm) had a sensitivity and specificity of 90% (area under the curve [AUC] = 0.95) of detecting a clinically notable change compared to the gold standard, an expert clinician's assessment. Conclusions: This deep learning algorithm showed modest concordance in identifying vascular leakage compared to ground truth but was able to aid in identifying vascular FA leakage changes over time. Translational Relevance: This is a proof-of-concept study that vascular leakage can be detected in a more standardized way and that tools can be developed to help clinicians more objectively compare vascular leakage between FAs.

Practice patterns regarding regional corticosteroid treatment in noninfectious Uveitis: a survey study.

BACKGROUND: Regional corticosteroid therapy for noninfectious uveitis is well-established but usage patterns have not been studied extensively. This study aims to assess practice patterns of retina and uveitis specialists regarding their preferences on the use of local corticosteroid therapy. METHODS: A 13-question survey was developed regarding the practice patterns of regional corticosteroid use in specific situations and populations. The survey was distributed to both the American Uveitis Society and Macula Society. RESULTS: Responses from 87 ophthalmologists were analyzed. The two most commonly used drugs were the dexamethasone intravitreal implant (Ozurdex®) and posterior sub-tenon's triamcinolone (also known as posterior sub-Tenon's Kenalog, or PSTK). Regional corticosteroids were used more frequently as first-line treatment in more than half of posterior uveitis cases when compared to anterior uveitis (39.1-46.0% vs 10.3%, respectively). Respondents were more willing to use regional corticosteroids in more than half of unilateral uveitis cases than in bilateral cases (54.7% vs 18.6%, respectively). A majority of respondents (67.1%) stated that they would avoid using regional corticosteroids in patients under 8 years old. CONCLUSIONS: Our results demonstrate more frequent regional corticosteroid use in posterior segment uveitis, unilateral cases, and avoidance in younger pediatric patients. Overall, the variability in these responses highlights the need for guidelines regarding regional corticosteroid use.

Energy, Sodium, Sugar and Saturated Fat Content of New Zealand Fast-Food Products and Meal Combos in 2020.

This study aimed to benchmark the healthiness of the New Zealand (NZ) fast-food supply in 2020. There are currently no actions or policies in NZ regarding the composition, serving size and labeling of fast food. Data on serving size and nutrient content of products was collected from company websites and in-store visits to 27 fast-food chains. For each fast-food category and type of combo meal, medians and interquartile ranges were calculated for serving size and energy, sodium, total sugar, and saturated fat per serving. Nutrient contents/serving were benchmarked against the United Kingdom (UK) soft drinks levy sugar thresholds and targets for salt for away from home foods, the NZ daily intake guidelines for energy, sodium, and saturated fat, and the World Health Organization (WHO) recommendation for free sugars. Analyses were conducted for the 30.3% (n = 1772) of products with available nutrition information and for 176 meal combos. Most (n = 67; 91.8%) sugar-sweetened drinks would qualify for a UK soft drink industry levy and 47% (n = 1072) of products exceeded the relevant UK sodium target. Half of the meal combos provided at least 50.3% of the daily energy requirements and at least 88.6% of the maximum recommended intake of sodium. Fast-food products and combo meals in NZ contribute far more energy and negative nutrients to recommended daily intake targets than is optimal for good health. The NZ Government should set reformulation targets and serving size guidance to reduce the potential impact of fast- food consumption on the health of New Zealanders.

Prevalence and Types of Non-Nutritive Sweeteners in the New Zealand Food Supply, 2013 and 2019.

The widely recognized association between high sugar intakes and adverse health outcomes has increased consumer demand for products lower in sugar. This may lead to increased use of other sweeteners by the food industry. The current study investigated the prevalence and types of non-nutritive sweeteners over time (2013-2019) in New Zealand's packaged food and beverages, overall and between categories. A New Zealand database of packaged foods and beverages was used to investigate the presence of Food Standards Australia New Zealand Code-approved non-nutritive sweeteners (n = 12). Products available in 2013 (n = 12,153) and 2019 (n = 14,645) were compared. Between 2013 and 2019, the prevalence of non-nutritive sweeteners in products increased from 3% to 5%. The most common non-nutritive sweeteners in both years were acesulphame-potassium, sucralose, aspartame, and stevia, which were predominantly found in special foods (breakfast beverages and nutritional supplements), non-alcoholic beverages, dairy products, and confectionery. The prevalence of non-nutritive sweeteners is increasing over time in New Zealand's packaged foods and beverages and is likely a consequence of consumer demand for lower-sugar products. Ongoing monitoring of the prevalence and type of NNS is important to detect further increases.

Comparison of Healthiness, Labelling, and Price between Private and Branded Label Packaged Foods in New Zealand (2015-2019).

We aimed to compare New Zealand private label (PL) and branded label (BL) packaged food products in relation to their current (2019) healthiness (sodium and sugar contents, and estimated Health Star Rating (HSR) score), display of the voluntary HSR nutrition label on the package, and price. Healthiness and HSR display of products were also explored over time (2015 to 2019). Data were obtained from Nutritrack, a brand-specific food composition database. Means and proportions were compared using Student t-tests and Pearson chi-square tests, respectively. Changes over time were assessed using linear regression and chi-square tests for trends (Mantel-Haenzel tests). Altogether, 4266 PL and 19,318 BL products across 21 food categories were included. Overall, PL products in 2019 had a significantly lower mean sodium content and price, a higher proportion of products with estimated HSR ≥ 3.5/5 (48.9% vs. 38.5%) and were more likely to display the HSR on the pack compared with BL products (92.4% vs. 17.2%, respectively). However, for most food categories, no significant difference was found in mean sodium or sugar content between PL and BL products. In the period 2015-2019, there were no consistent changes in estimated HSR score, sodium or sugar contents of PL or BL products, but there was an increase in the proportion of both PL and BL products displaying HSR labels. In most food categories, there were PL options available which were similar in nutritional composition, more likely to be labelled with the HSR, and lower in cost than their branded counterparts.

Ocular adverse events in PD-1 and PD-L1 inhibitors.

BACKGROUND: Programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors can cause unique immune-related adverse effects due to non-specific immunological activation. However, less is known about adverse effects of these drugs in the eye. METHODS: Two adverse event databases were retrospectively reviewed. The two databases consisted of a routine adverse event database and a serious adverse event database of expeditiously submitted reports. Patients with any malignancy who had ocular adverse events while on PD-1/PD-L1 inhibitor treatment were included. Patients received nivolumab, pembrolizumab, atezolizumab or durvalumab alone or in combination with other anticancer agents per each trial's protocol. Databases were queried up to May 19, 2020. RESULTS: In the routine adverse event database, 272 adverse events from 213 patients were reported and in the serious adverse event reporting database, 59 ocular adverse events from 47 patients were reported. A lower estimate of the prevalance from the routine adverse event database showed 259/7727 patients on study treatment arms reporting ocular adverse events (3.3% prevalence). Excluding trials that do not report lower grade adverse events to the routine adverse event database results in a higher end estimate of 242/3255 patients on study treatment arms reporting ocular adverse events (7.4% prevalence). Ocular events occurred early after drug initiation (routine database: median 6 weeks, IQR 0-16, serious adverse events database: median 11 weeks, IQR 6-21). The median Common Terminology Criteria for Adverse Events grade was grade 1 (mild) (IQR 1-2) and grade 2 (moderate) (IQR 2-3) for the routine database and the serious adverse events database, respectively. In-depth analysis of the serious adverse event reports revealed varying degrees of clinical workup, with 30/47 patients (64%) receiving ophthalmological evaluation and 16/47 (34%) of patients having to delay or discontinue treatment. However, 16/47 (34%) patients experienced resolution and 14/47 (30%) patients experienced at least some improvement. CONCLUSIONS: This is one of the largest analyses of ocular adverse events in patients treated with PD-1/PD-L1 inhibitors in the USA. We found ocular adverse events are rare complications of PD-1/PD-L1 inhibitor therapy, can be severe enough to cause treatment discontinuation/delay, and may not always be appropriately evaluated by eye specialists. Standardized plans for ophthalmology evaluation and management of ocular toxicities are needed in studies of patients treated with PD-1/PD-L1 inhibitors.

Ocular Findings in a Patient With KAT6A Mutation.

KAT6A mutations are associated with intellectual disability, speech delays, dysmorphic facial features, and strabismus. However, detailed ocular findings of such patients have not yet been published. In this case report, the authors present a patient with a KAT6A mutation and optic nerve malformation. [J Pediatr Ophthalmol Strabismus. 2021;58(3):e9-e11.].

Which companies dominate the packaged food supply of New Zealand and how healthy are their products?

Improvement of national food supplies are an opportunity to improve a country's health. Our aim was to identify the major food companies manufacturing packaged foods and non-alcoholic beverages available in New Zealand supermarkets in 2018; to assess the healthiness of products using (1) the Health Star Rating (HSR) system, (2) Australian Dietary Guidelines classification (core/discretionary), and (3) by level of processing; to compare the healthiness of products displaying and not displaying the HSR and; to assess potential for food reformulation within selected food sub-categories. Information on packaged foods was obtained from the Nutritrack supermarket database. Companies that manufactured each food and brand were identified using company websites and the New Zealand companies register. In total, 13,506 packaged products were mapped to 1,767 brands and 1,214 companies. Based on market share of products available for sale (Euromonitor data), there were 22 dominating companies producing 31% of products and 17% of brands. Fifty-nine percent of products were classified as unhealthy (HSR <3.5/5 stars), 53% as discretionary, and 69% as ultra-processed. Products displaying the HSR on the package had a higher mean HSR ±SD than if the HSR was not displayed (3.2±1.3 versus 2.5±1.4, p = 0.000). Efforts to improve the healthiness of products should be directed to the 22 food companies dominating this market share, particularly in the core foods groups which are currently less likely to meet Heart Foundation reformulation targets (bread, breakfast cereals, cheese, canned baked beans, yoghurt). The New Zealand supermarket packaged food supply included in the Nutritrack database is dominated by a small number of companies and is mostly unhealthy. Government leadership is required to improve the healthiness of the packaged food supply and provide adequate information to consumers. This includes interventions setting reformulation targets for core food groups, setting population nutrient intake targets and mandating that the HSR is displayed on all products.

Efficacy of Cognitive Training When Translated From the Laboratory to the Real World.

INTRODUCTION: Research shows that cognitive performance and emotional well-being can be significantly strengthened. A high-performance brain training protocol, Strategic Memory Advanced Reasoning Training (SMART), was developed by cognitive neuroscientists at The University of Texas at Dallas Center for BrainHealth based on 25-plus years of scientific study. Randomized controlled trials with various populations have shown that training and use of nine "SMART" strategies for processing information can improve cognitive performance and psychological health. However, the multi-week intensive training used in the laboratory is not practical for widespread use outside the laboratory. This article examines the efficacy of SMART when translated outside the laboratory to two populations (military/veterans and law enforcement) that received SMART in condensed time frames. MATERIALS AND METHODS: In two translation studies with healthy military personnel and veterans, 425 participants received between 6 and 10 hours of SMART over 2 days. In a third translation study, 74 healthy police officers received 9 hours of SMART over 3 days. Training was conducted by clinicians who taught the nine "SMART" strategies related to three core areas-strategic attention, integrated reasoning, and innovation-to groups of up to 25 participants. In all three translation studies, cognitive performance and psychological health data were collected before and immediately following the training. In one of the military/veteran studies, psychological health data were also collected 1 and 4 months following the training. RESULTS: In both translations to military personnel and veterans, there were improvements in the complex cognitive domains of integrated reasoning (P < .0001) and innovation (P < .0001) immediately after undergoing SMART. In the translation to police officers, there were improvements in the cognitive domains of innovation (P = .02) and strategic attention (P = .005). Participants in all three translations saw statistically significant improvements in self-reported symptoms of psychological health. The improvements continued among a subset of participants who responded to the later requests for information. CONCLUSIONS: The results of translating to these two populations provide evidence supporting the efficacy of SMART delivered in an abbreviated time frame. The improvements in two major domains of cognitive function demonstrate that strategies can be taught and immediately applied by those receiving the training. The immediate psychological health improvements may be transient; however, the continued improvements in psychological health observed in a subset of the participants suggest that benefits may be sustainable even at later intervals.

Contributions of h- and Na+/K+ Pump Currents to the Generation of Episodic and Continuous Rhythmic Activities.

Developing spinal motor networks produce a diverse array of outputs, including episodic and continuous patterns of rhythmic activity. Variation in excitability state and neuromodulatory tone can facilitate transitions between episodic and continuous rhythms; however, the intrinsic mechanisms that govern these rhythms and their transitions are poorly understood. Here, we tested the capacity of a single central pattern generator (CPG) circuit with tunable properties to generate multiple outputs. To address this, we deployed a computational model composed of an inhibitory half-center oscillator (HCO). Following predictions of our computational model, we tested the contributions of key properties to the generation of an episodic rhythm produced by isolated spinal cords of the newborn mouse. The model recapitulates the diverse state-dependent rhythms evoked by dopamine. In the model, episodic bursting depended predominantly on the endogenous oscillatory properties of neurons, with Na+/K+ ATPase pump (I Pump) and hyperpolarization-activated currents (I h ) playing key roles. Modulation of either I Pump or I h produced transitions between episodic and continuous rhythms and silence. As maximal activity of I Pump decreased, the interepisode interval and period increased along with a reduction in episode duration. Decreasing maximal conductance of I h decreased episode duration and increased interepisode interval. Pharmacological manipulations of I h with ivabradine, and I Pump with ouabain or monensin in isolated spinal cords produced findings consistent with the model. Our modeling and experimental results highlight key roles of I h and I Pump in producing episodic rhythms and provide insight into mechanisms that permit a single CPG to produce multiple patterns of rhythmicity.

Seven-year trends in the availability, sugar content and serve size of single-serve non-alcoholic beverages in New Zealand: 2013-2019.

OBJECTIVE: To assess trends in relative availability, sugar content and serve size of ready-to-drink non-alcoholic beverages available for sale in supermarkets from 2013 to 2019. DESIGN: Repeat cross-sectional surveys. Data on single-serve beverages to be consumed in one sitting were obtained from an updated brand-specific food composition database. Trends in beverages availability and proportions with serve size ≤ 250 ml were assessed by χ2 tests. Sugar content trends were examined using linear regressions. The proportion of beverages exceeding the sugar threshold of the United Kingdom Soft Drinks Industry Levy (SDIL) was assessed. SETTING: New Zealand. RESULTS: From 2013 to 2019, there was (i) an increase in the availability of sugar-free/low-sugar beverages (n 25 (8·4 %) to n 75 (19·1 %); P < 0·001) and craft sugar-sweetened soft drinks (n 11 (3·7 %) to n 36 (9·2 %); P < 0·001), and a decrease in availability of fruit/vegetable juices/drinks (n 94 (31·8 %) to n 75 (19·4 %); P < 0·001); (ii) small decreases in sugar content (mean g/100 ml) of sugar-sweetened soft drinks (3·03; 95 % CI 3·77, 2·29); fruit/vegetable juices/drinks (1·08; 95 % CI 2·14, 0·01) and energy drinks (0·98; 95 % CI 1·63, 0·32) and (iii) slight reduction in the proportion of beverages with serve size ≤ 250 ml (21·6 to 18·9 %; P < 0·001). In 2019, most beverages were sugar-sweetened or had naturally occurring sugars (79·1 %) and serve size > 250 ml (81·1 %) and most sugar-sweetened beverages exceeded the SDIL lower benchmark (72·9 %). CONCLUSIONS: Most single-serve beverages available for sale in 2019 were sugary drinks with high sugar content and large serve sizes; therefore, changes made across the years were not meaningful for population's health.

The Development and Application of a Tool for Quantifying the Strength of Voluntary Actions and Commitments of Major Canadian Food Companies to Improve the Nutritional Quality of Their Products.

BACKGROUND: Canada's food supply is high in nutrients of public health concern, contributing to poor diet quality and increased noncommunicable disease risk. Food companies shape the healthfulness of the food supply, yet little is known about companies' voluntary actions and commitments concerning product (re)formulation. OBJECTIVE: This study aimed to develop and apply a tool for quantifying the strength of voluntary actions and commitments of major food companies in Canada to improve the healthfulness of their products. METHODS: Twenty-two top packaged food and beverage companies were selected based on Canadian market share. Recent actions and/or commitments to reduce energy/portion sizes, sodium, saturated fat, trans fat, and sugars were identified from company websites and public documents, verified by company representatives (where possible), and scored based on breadth of application across the product portfolio, magnitude(s) of reduction, measurability, nutritional significance, national/global applicability, and transparency using the Food Company Reformulation scoring tool. Companies offering beverages only (n = 4) were not assessed for sodium, saturated fat, or trans fat (re)formulation. RESULTS: Seventeen of 22 companies reported reductions and/or commitments concerning sodium (72.2%, n = 13/18), trans fat (61.1%, n = 11/18), sugars (59.1%, n = 13/22), saturated fat (55.6%, n = 10/18), and/or energy/portion sizes (50.0%, n = 11/22). Scores ranged from 0/155 to 122/155 for food companies (median = 49/155) and 0/65 to 42/65 for beverage companies (median = 17/65). Companies generally performed best for sodium reduction (median = 21/32; range = 0-32) and poorest for energy/portion-size reductions (median = 2/30; range = 0-24). Multinational companies had significantly higher total scores than domestic companies (P = 0.004). Higher total scores were associated with greater market shares in the beverage manufacturing sector (P = 0.04), but not packaged food (P = 0.50). CONCLUSIONS: Many of Canada's leading food companies report limited or no action to reduce nutrients of concern in their products, suggesting a need for government intervention and strengthened accountability mechanisms to encourage alignment of reformulation efforts with government and expert recommendations.

Choroidal granuloma resolution with tuberculosis treatment.

PURPOSE: To report a case of presumed ocular tuberculosis, successfully treated with anti-tubercular therapy alone. OBSERVATIONS: Resolution of a presumed tubercular choroidal granuloma occurred after initiation of 4-drug anti-tubercular therapy, without any adjunct corticosteroid treatment. CONCLUSIONS: Though corticosteroids are commonly used as adjunctive treatment for ocular tuberculosis, treatment with anti-tubercular therapy alone is possible in select patients with close follow-up.

Moving Toward Standardized Pediatric Performance Improvement Measures in Child Physical Abuse: A Modified Delphi Approach.

BACKGROUND: Limited guidance exists for pediatric trauma centers (PTCs) regarding best practice for measuring and reviewing performance improvement (PI) in the child physical abuse population. To move PTC programs toward standardized guidelines and PI practices, current practice and points of consensus among level 1 and 2 PTCs across the United States were assessed. METHODS: Utilizing a two-round, modified Delphi methodology, electronic surveys were distributed to pediatric trauma program managers and coordinators representing 125 PTCs. Survey data included demographics, coding practices, definitions, current PI measures, prevention programs, and opinions regarding key components of child physical abuse guidelines. RESULTS: In Round 1, responses were received from 90 (72%) PTCs [47 (84%) ACS-verified level 1 PTCs; 29 (73%) ACS-verified level 2 PTCs; and 14 (48%) state PTCs]. Of the respondents, 87% agreed that establishing a national consensus for child physical abuse PI is important, and 92% agreed that their institution would benefit from standardized guidelines. Although PI process varied among PTCs in terms of measures, review, and coding practices, several points of consensus were achieved. CONCLUSION: Survey results demonstrate areas of consistency and a foundation for consensus among PTCs. Results also identify areas of practice diversity that may benefit from an attempt to standardize PI across centers.

The effect of a shelf placement intervention on sales of healthier and less healthy breakfast cereals in supermarkets: A co-designed pilot study.

Supermarkets are the principal source of grocery food in many high-income countries. Choice architecture strategies show promise to improve the healthiness of food choices. A retailer-academic collaboration was formed to co-design and pilot selected commercially sustainable strategies to increase sales of healthier foods relative to less healthy foods in supermarkets. Two co-design workshops, involving supermarket corporate staff and public health nutrition academics, identified potential interventions. One intervention, more prominent shelf placement of healthier products within one category (breakfast cereals), was selected for testing. A pilot study (baseline, intervention and follow-up, 12-weeks each) was undertaken in six supermarkets (three intervention and three control) in Auckland, New Zealand. Products were ranked by nutrient levels and profile, and after accounting for the supermarkets' space management principles, healthier products were placed at adult eye level. The primary outcome was change in sales of healthier products relative to total category sales. Secondary outcomes were nutrient profile of category sales, in-store product promotions, customer perceptions, and retailer feedback. There was no difference in proportional sales of more prominently positioned healthier products between intervention (56%) and control (56%) stores during the intervention. There were no differences in the nutrient profile of category sales. A higher proportion of less healthy breakfast cereals were displayed in intervention versus control stores (57% vs 43%). Most customers surveyed supported shelf placement as a strategy (265, 88%) but noted brand preferences and price were more salient determinants of purchases. Retailers were similarly supportive but balancing profit, health/nutrition and customer satisfaction was challenging. Shelf placement alone was not an effective strategy to increase purchases of healthier breakfast cereals. This study showed co-design of a healthy eating intervention with a commercial retailer is feasible, but concurrent retail environment factors likely limited the public health impact of the intervention.

An economical solution to record and control wheel-running for group-housed mice.

BACKGROUND: The effects of exercise on brain function are widely known; however, there is a need for inexpensive, practical solutions for monitoring and metering the activity of multiple mice. NEW METHOD: A contoured running wheel that has a built-in radio-frequency identification (RFID) receiver to monitor the activity of several mice in a single cage is presented. This system is scalable , the interface is easy to use, and the wheel can be dynamically locked so that each group-housed mouse receives a set exercise regimen. RESULTS: We were able to reliably monitor three mice that were group-housed. We were able to reliably meter the amount of exercise performed by the mice using the servo-controlled lock. COMPARISON WITH EXISTING METHODS: Current methods allow a wheel to be locked when a set distance is reached. However, an issue with this method is that the set distance includes the cumulative activity of all mice in the cage so one mouse could contribute a disproportionate amount to the total distance. Our solution ensures that the wheel is locked when an individual mouse reaches the target distance, but remains unlocked for individuals that have not reached the programmed distance. CONCLUSIONS: The dynamic locking wheel (DynaLok) is designed to allow a researcher to provide individually designed exercise plans for multi-housed mice; therefore, users are able to house mice conventionally rather than in individual cages. DynaLok reduces animal housing costs, allows for new experimental exercise regimens to be developed, and is scalable and cost-effective.