Impact of animal origin of milk, processing technology, type of product, and price on the Boursin cheese choice process: Insights of a discrete choice experiment and eye tracking.

Boursin is a versatile semisoft cheese that can be made with different types of milk. While widely distributed in the European and North American markets, Boursin is produced to a limited extent in Brazil despite its commercial potential. This scenario encourages consumer-oriented product development studies by facilitating data collection with less bias and fewer product preconceptions, thus favoring the investigation of technological aspects of commercial interest. This study evaluates Brazilians' perceptions regarding different versions of Boursin cheese, with the aim of gaining a better understanding of the factors related to choosing cheese. Four attributes related to cheese production were evaluated at three different levels using two discrete choice experiments: one with eye tracking (n = 20) and another without (n = 312). These attributes included "type of processing" (evaluating pasteurization, ohmic heating, and preparation with raw milk), "animal origin of milk" (cow, goat, or buffalo milk), "type of product" (traditional, light, and lactose-free versions), and "price" (10.99, 13.99, and 16.99 BRL). Information regarding processing with ohmic heating did not affect the probability of Boursin being chosen, suggesting that consumers are open to using this emerging technology in Boursin cheese. However, information on being made with goat, buffalo, and raw milk negatively impacted the probability of choice, along with the price of 16.99 BRL. The frequency of cheese consumption and the level of health concerns also affected the probability of choosing the product. PRACTICAL APPLICATION: Identifying the relationship between extrinsic attributes presented on the Boursin cheese label and the consumer's choice process can aid the communication process with the target audience and reveal how some technological issues of interest to manufacturers are perceived. This study indicates how information regarding the animal origin of the milk (cow, goat, and buffalo), the type of processing (pasteurization, ohmic heating, and raw milk), the version of the product (traditional, light, and lactose-free), and the price affect the consumer choice process. The results provide insights that can be applied to product processing and designing labels.

Consumers' attitudes of high-intensity ultrasound in Minas Frescal cheese processing: An innovative approach with text highlighting technique.

Due to the intense competition in the sector, the dairy market maintains a constant search for innovations. Thus, new technologies are incorporated, and new products are constantly launched, increasing the range of consumer options. In this way, the understanding of consumers' motivations, attitudes, and behaviors in the moments of choice, purchase, and consumption are important for the academic public and food industries. This study used the Text Highlighting methodology to assess Brazilian consumers' explicit attitudes towards using high-intensity ultrasound technology in Minas Frescal cheese processing. In the task, consumers were asked to highlight in a text the terms they "liked" or "disliked" about using high-intensity ultrasound in the Minas Frescal cheese processing. A seven-point Likert scale was also used to assess consumers' attitudinal statements. A high engagement of consumers with the Text Highlighting methodology could be observed (43.8-92.3% of text highlighting), which suggests good intuitiveness of the technique. Including information about the benefits of the emerging technology in the product, mainly on sensory and nutritional properties, may increase positive consumer perception, as it promotes the consumers to express their value judgment in the form of "liked". At the same time, the harms of the traditional processing technique prompted consumers to express their value judgment in the "disliked" highlights. It was observed that information should be in a simple and direct language, as technical terminology in the text did not have a positive effect. The categorizing of consumers according to the sentimental score showed that consumers are still reticent to use emerging technologies in Minas Frescal cheese processing. Consumers' attitudinal statements demonstrated that consumers perceive high-intensity ultrasound as a positive idea and safety technology for Minas Frescal cheese processing. Still, they are not willing to pay premium prices. In conclusion, Text Highlighting produced valuable insights that can be used in communication strategies with Minas Frescal cheese consumers.

Free comment as a valuable approach to characterize and identify the drivers of liking of high-protein flavored milk drink submitted to ohmic heating.

Flavored milk drink is a popular dairy product traditionally processed by pasteurization, which is a safe and robust process. Still, it can imply a greater energy expenditure and a more significant sensorial alteration. Ohmic heating (OH) has been proposed as an alternative to dairy processing, including flavored milk drink. However, its impact on sensory characteristics needs to be evidenced. This study used Free Comment, an underexplored methodology in sensory studies, to characterize five samples of high-protein vanilla-flavored milk drink: PAST (conventional pasteurization 72 °C/15 s); OH6 (ohmic heating at 5.22 V/cm); OH8 (ohmic heating at 6.96 V/cm); OH10 (ohmic heating at 8.70 V/cm), and OH12 (ohmic heating at 10.43 V/cm). Free Comment raised similar descriptors to those found in studies that used more consolidated descriptive methods. The employed statistical approach allowed observation that pasteurization and OH treatment have different effects on the sensory profile of products, and the electrical field strength of OH also has a significant impact. PAST was slightly to moderately negatively associated with "acid taste," "fresh milk taste," "smoothness," "sweet taste," "vanilla flavor," "vanilla aroma," "viscous," and "white color." On the other hand, OH processing with more intense electric fields (OH10 and OH12) produced flavored milk drinks strongly associated with the "in natura" milk descriptors ("fresh milk aroma" and "fresh milk taste"). Furthermore, the products were characterized by the descriptors "homogeneous," "sweet aroma," "sweet taste," "vanilla aroma," "white color," "vanilla taste," and "smoothness." In parallel, less intense electric fields (OH6 and OH8) produced samples more associated with a bitter taste, viscosity, and lumps presence. Sweet taste and fresh milk taste were the drivers of liking. In conclusion, OH with more intense electric fields (OH10 and OH12) was promising in flavored milk drink processing. Furthermore, the free comment was a valuable approach to characterize and identify the drivers of liking of high-protein flavored milk drink submitted to OH.

Retrospective assessment of rapid outbreak investigation for gastrointestinal diseases using only cases and background exposure data.

For outbreaks of gastrointestinal disease, rapid identification of the source is crucial to enable public health intervention and prevent further cases. Outbreak investigation comprises analyses of exposure information from cases and, if required, undertaking analytical epidemiological studies. Hypothesis generation has been reliant on empirical knowledge of exposures historically associated with a given pathogen. Epidemiology studies are resource-intensive and prone to bias, one of the reasons being the difficulties in recruiting appropriate controls. For this paper, the information from cases was compared against pre-defined background exposure information. As exemplars, three past outbreaks were used, one of common and two of rare exposures. Information from historical case trawling questionnaires was used to define background exposure having removed any exposures implicated with the outbreak. The case-background approach showed good sensitivity and specificity, identifying correctly all outbreak-related exposures. One additional exposure related to a retailer was identified and four food items where all cases had been exposed. In conclusion, the case-background method, a development of the case-case design, can be used to assist with hypothesis generation or when a case-control study may not be possible to carry out.

Online market research panel members as controls in case-control studies to investigate gastrointestinal disease outbreaks: early experiences and lessons learnt from the UK.

Established methods of recruiting population controls for case-control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case-control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.

An outbreak of Shiga toxin-producing Escherichia coli O157:H7 associated with contaminated salad leaves: epidemiological, genomic and food trace back investigations.

In August 2015, Public Health England detected an outbreak of Shiga toxin-producing Escherichia coli (STEC) serotype O157:H7 caused by contaminated salad leaves in a mixed leaf prepacked salad product from a national retailer. The implicated leaves were cultivated at five different farms and the zoonotic source of the outbreak strain was not determined. In March 2016, additional isolates from new cases were identified that shared a recent common ancestor with the outbreak strain. A case-case study involving the cases identified in 2016 revealed that ovine exposures were associated with illness (n = 16; AOR 8·24; 95% CI 1·55-39·74). By mapping the recent movement of sheep and lambs across the United Kingdom, epidemiological links were established between the cases reporting ovine exposures. Given the close phylogenetic relationship between the outbreak strain and the isolates from cases with ovine exposures, it is plausible that ovine faeces may have contaminated the salad leaves via untreated irrigation water or run-off from fields nearby. Timely and targeted veterinary and environmental sampling should be considered during foodborne outbreaks of STEC, particularly where ready to eat vegetables and salads are implicated.

Dynamic profiling of different ready-to-drink fermented dairy products: A comparative study using Temporal Check-All-That-Apply (TCATA), Temporal Dominance of Sensations (TDS) and Progressive Profile (PP).

Despite the several differences in ingredients, processes and nutritional values, dairy foods as yogurts, fermented milks and milk beverages are widely accepted worldwide, and although they have their sensory profiling normally covered by descriptive analyses, the temporal perception involved during the consumption are rarely considered. In this sense, the present work aimed to assess the dynamic sensory profile of three categories of fermented dairy products using different temporal methodologies: Temporal Dominance of Sensations (TDS), Progressive Profiling (PP), Temporal CATA (TCATA), and compare the results obtained. The findings showed that the different sensory characteristics among the products are basically related to their commercial identity. Regarding the methods, all of them collected the variations between samples with great correlation between data. In addition, to detect differences in intensities, TCATA showed to be the most sensitive method in detecting textural changes. When using PP, a balanced experimental design considering the number of attributes, time intervals, and food matrix must be weighed. The findings are of interest to guide sensory and consumer practitioners involved in the dairy production to formulate/reformulate their products and help them choosing the most suitable dynamic method to temporally evaluate them.

Consumers' perceptions toward 3 different fermented dairy products: Insights from focus groups, word association, and projective mapping.

Yogurts, fermented milk beverages, and fermented milks have great similarity and are widely accepted by Brazilian population, but the factors that influence their choice and consumption are unknown. In this sense, the present study aimed to identify the main aspects involved in consumers' perception of 3 different products, comparing the findings by using the 2 fast qualitative methods, word association and projective mapping, and a standard method, focus group. The tasks were performed by different participants through graphic stimuli (word association and projective mapping) and focus interviews (focus group). Results showed that all the 3 methodologies identified numerous intrinsic and extrinsic factors that influence the consumer choices regarding fermented dairy products. Major dimensions were closely related to the sensory aspects, emotional factors, perception of benefits, and composition, among others. It is noteworthy that the stimuli related to fermented milk beverages evoked rejecting responses, possibly due to the dissociation between information and consumers' expectation. Although minor differences were observed between the number and type of dimensions that were obtained, similar conclusions can be drawn from all 3 sensory methods, which shows the relevance of qualitative and projective methods for investigation of consumers' perception. These findings can help dairy companies to provide subsidies and guidelines for the reformulation of their products, marketing strategies, and improvement in the communication between producers and consumers from different fermented dairy products.

Consumer-based product characterization using Pivot Profile, Projective Mapping and Check-all-that-apply (CATA): A comparative case with Greek yogurt samples.

Product characterization has been a primary concern for the food industry, and methodologies based on consumers' perceptions have become popular and widely used by industries to replace classical methods. Although there are several studies on other methods, the potential of reference-based one such as Pivot Profile is still little explored. Therefore, the aims of this study were to characterize Greek yogurt samples according to consumers' perceptions using three different methodologies: Pivot Profile (PP), Check-all-that-apply (CATA), and Projective Mapping (PM), and to assess which method is easier for consumers to describe products. The rapid methodologies assessed were equally effective in characterizing the different samples; however, some drawbacks evidenced in the study can help in targeting and choosing the best method to perform the sensory characterization. Pivot Profile showed some advantages, bypassing some limitations presented by the other methods. In addition, its experimental versatility also allows for broad applications evidencing the PP technique as a promising tool for routine use. Some implications of using it were also discussed. We suggest the supplemental use of Multidimensional Alignment (MDA) as it shows more accurately the correlations between attributes and samples, especially in the case of PP data.

Whole genome sequencing improved case ascertainment in an outbreak of Shiga toxin-producing Escherichia coli O157 associated with raw drinking milk.

Five cases of STEC O157 phage type (PT) 21/28 reported consumption of raw cows' drinking milk (RDM) produced at a dairy farm in the South West of England. STEC O157 PT21/28 was isolated from faecal specimens from milking cows on the implicated farm. Whole genome sequencing (WGS) showed that human and cattle isolates were the same strain. Further analysis of WGS data confirmed that sequences of isolates from an additional four cases (who did not report consumption of RDM when first questioned) fell within the same five single nucleotide polymorphism cluster as the initial five cases epidemiologically linked to the consumption of RDM. These four additional cases identified by WGS were investigated further and were, ultimately, associated with the implicated farm. The RDM outbreak strain encoded stx2a, which is associated with increased pathogenicity and severity of symptoms. Further epidemiological analysis showed that 70% of isolates within a wider cluster containing the outbreak strain were from cases residing in, or linked to, the same geographical region of England. During this RDM outbreak, use of WGS improved case ascertainment and provided insights into the evolution of a highly pathogenic clade of STEC O157 PT21/28 stx2a associated with the South West of England.

Novel and successful free comments method for sensory characterization of chocolate ice cream: A comparative study between pivot profile and comment analysis.

Rapid sensory profiling methods have gained space in the sensory evaluation field. Techniques using direct analysis of the terms generated by consumers are considered easy to perform, without specific training requirements, thus improving knowledge about consumer perceptions on various products. This study aimed to determine the sensory profile of different commercial samples of chocolate ice cream, labeled as conventional and light or diet, using the "comment analysis" and "pivot profile" methods, based on consumers' perceptions. In the comment analysis task, consumers responded to 2 separate open questions describing the sensory attributes they liked or disliked in each sample. In the pivot profile method, samples were served in pairs (consisting of a coded sample and pivot), and consumers indicated the higher and lower intensity attributes in the target sample compared with the pivot. We observed that both methods were able to characterize the different chocolate ice cream samples using consumer perception, with high correlation results and configurational similarity (regression vector coefficient=0.917) between them. However, it is worth emphasizing that comment analysis is performed intuitively by consumers, whereas the pivot profile method showed high analytical and discriminative power even using consumers, proving to be a promising technique for routine application when classical descriptive methods cannot be used.

A multi-country Salmonella Enteritidis phage type 14b outbreak associated with eggs from a German producer: 'near real-time' application of whole genome sequencing and food chain investigations, United Kingdom, May to September 2014.

We report an outbreak of Salmonella Enteritidis phage type 14b (PT14b) in the United Kingdom (UK) between May and September 2014 where Public Health England launched an investigation to identify the source of infection and implement control measures. During the same period, outbreaks caused by a Salmonella Enteritidis strain with a specific multilocus variable-number tandem repeat analysis (MLVA) profile occurred in other European Union Member States. Isolates from a number of persons affected by the UK outbreak, who had initially been tested by MLVA also shared this particular profile. Cases were defined as any person infected with S. Enteritidis PT14b, resident in England or Wales and without history of travel outside of this geographical area during the incubation period, reported from 1 June 2014 onwards, with a MLVA profile of 2­11­9-7­4-3­2-8­9 or a single locus variant thereof. In total, 287 cases met the definition. Food traceback investigations in the UK and other affected European countries linked the outbreaks to chicken eggs from a German company. We undertook whole genome sequencing of isolates from UK and European cases, implicated UK premises, and German eggs: isolates were highly similar. Combined with food traceback information, this confirmed that the UK outbreak was also linked to a German producer.

The epidemiology, microbiology and clinical impact of Shiga toxin-producing Escherichia coli in England, 2009-2012.

Between 1 January 2009 and 31 December 2012 in England, a total of 3717 cases were reported with evidence of Shiga toxin-producing E. coli (STEC) infection, and the crude incidence of STEC infection was 1·80/100 000 person-years. Incidence was highest in children aged 1-4 years (7·63/100 000 person-years). Females had a higher incidence of STEC than males [rate ratio (RR) 1·24, P < 0·001], and white ethnic groups had a higher incidence than non-white ethnic groups (RR 1·43, P < 0·001). Progression to haemolytic uraemic syndrome (HUS) was more frequent in females and children. Non-O157 STEC strains were associated with higher hospitalization and HUS rates than O157 STEC strains. In STEC O157 cases, phage type (PT) 21/28, predominantly indigenously acquired, was also associated with more severe disease than other PTs, as were strains encoding stx2 genes. Incidence of STEC was over four times higher in people residing in rural areas than urban areas (RR 4·39, P < 0·001). Exposure to livestock and/or their faeces was reported twice as often in cases living in rural areas than urban areas (P < 0·001). Environmental/animal contact remains an important risk factor for STEC transmission and is a significant driver in the burden of sporadic STEC infection. The most commonly detected STEC serogroup in England was O157. However, a bias in testing methods results in an unquantifiable under-ascertainment of non-O157 STEC infections. Implementation of PCR-based diagnostic methods designed to detect all STEC, to address this diagnostic deficit, is therefore important.

Growth hormone deficiency after childhood bone marrow transplantation with total body irradiation: interaction with adiposity and age.

OBJECTIVE: Bone marrow transplantation with total body irradiation (BMT/TBI) has adverse effects on growth, growth hormone status and adiposity. We investigated the GH-IGF-I axis in relation to adiposity. DESIGN: Cross-sectional case control study. PATIENTS: BMT/TBI survivors (n = 22) and short stature control participants (n = 19), all GH-naïve or off GH treatment >3 months. MEASUREMENTS: Auxology, DEXA scans and GH-IGF-I axis investigation: (i) 12-h overnight GH profiles; (ii) insulin tolerance test (ITT); and (iii) IGF-I generation test. ANALYSIS: auto-deconvolution of GH profile data and comparison of quantitative parameters using ANOVA. RESULTS: Eighty-two percent of BMT/TBI survivors had growth hormone deficiency (GHD) using ITT. GH profile area-under-the-curve (GH-AUC) was reduced in BMT/TBI survivors vs short stature control participants [geometric mean (range) 209 (21-825) vs 428 (64-1400) mcg/l/12 h, respectively, P = 0·007]. GHD was more marked in those who had additional cranial irradiation (CRT) [ITT peak 1·4 (0·2-3·0) vs TBI only 4·1 (1·1-14·8) mcg/l, P = 0·036]. GHD was more marked at the end of growth in BMT/TBI survivors vs short stature control participants (GH-AUC 551 (64-2474) vs 1369 (192-4197) mcg/l/12 h, respectively, P = 0·011) and more prevalent (9/11 vs 1/9, respectively, P = 0·005). GH profile data were consistent with ITT results in 80% of participants. IGF-I generation tests were normal. BMT/TBI survivors still demonstrated lower GH levels after adjustment for adiposity (fat-adjusted mean difference for GH-AUC 90·9 mcg/l/12 h, P = 0·025). CONCLUSIONS: GHD was more prevalent in BMT/TBI survivors than expected for the CRT dose in TBI, worsened with time and persisted into adulthood. GHD could not be explained by adiposity. There was no evidence of GH neurosecretory dysfunction or resistance after BMT/TBI.

Computerised physician order entry-related medication errors: analysis of reported errors and vulnerability testing of current systems.

IMPORTANCE: Medication computerised provider order entry (CPOE) has been shown to decrease errors and is being widely adopted. However, CPOE also has potential for introducing or contributing to errors. OBJECTIVES: The objectives of this study are to (a) analyse medication error reports where CPOE was reported as a 'contributing cause' and (b) develop 'use cases' based on these reports to test vulnerability of current CPOE systems to these errors. METHODS: A review of medication errors reported to United States Pharmacopeia MEDMARX reporting system was made, and a taxonomy was developed for CPOE-related errors. For each error we evaluated what went wrong and why and identified potential prevention strategies and recurring error scenarios. These scenarios were then used to test vulnerability of leading CPOE systems, asking typical users to enter these erroneous orders to assess the degree to which these problematic orders could be entered. RESULTS: Between 2003 and 2010, 1.04 million medication errors were reported to MEDMARX, of which 63 040 were reported as CPOE related. A review of 10 060 CPOE-related cases was used to derive 101 codes describing what went wrong, 67 codes describing reasons why errors occurred, 73 codes describing potential prevention strategies and 21 codes describing recurring error scenarios. Ability to enter these erroneous order scenarios was tested on 13 CPOE systems at 16 sites. Overall, 298 (79.5%) of the erroneous orders were able to be entered including 100 (28.0%) being 'easily' placed, another 101 (28.3%) with only minor workarounds and no warnings. CONCLUSIONS AND RELEVANCE: Medication error reports provide valuable information for understanding CPOE-related errors. Reports were useful for developing taxonomy and identifying recurring errors to which current CPOE systems are vulnerable. Enhanced monitoring, reporting and testing of CPOE systems are important to improve CPOE safety.

Pregnancy-associated listeriosis in England and Wales.

Listeriosis is a rare but severe foodborne disease with low morbidity and high case-fatality rates. Pregnant women, unborn and newborn babies are among the high-risk groups for listeriosis. We examined listeriosis cases reported to the enhanced surveillance system in England and Wales from 1990 to 2010 to identify risk factors influencing outcome. Cases were defined as pregnancy-associated if Listeria monocytogenes was isolated from a pregnant woman or newborn infants aged <28 days. Of the 3088 cases reported, pregnancy-associated listeriosis accounted for 462 (15%) cases and 315 cases resulted in a live birth. Several factors were identified as affecting the severity and outcome of listeriosis in pregnancy in both mother and child including: presence or absence of maternal symptoms, gestational age at onset of symptoms, and clinical presentation in the infant (meningitis or septicaemia). Deprivation, ethnicity and molecular serotype had no effect on outcome.

Measurement of hip range of flexion-extension and straight-leg raising.

We believe there is a degree of inaccuracy in the usual methods of evaluation of range at the hip in the sagittal plane, ie, flexion-extension. We describe a simple method of measuring more accurately the range of hip flexion-extension, presuming such ranges of motion should relate to the anatomic position of the pelvis. We used this technique for the measurement of flexion and extension of the left hip in a cohort of 200 healthy individuals; we found a wide range of both flexion (80 degrees-140 degrees ) and extension (5 degrees-40 degrees ). Especially with respect to extension, we believe more conventional methods underestimate the ranges of motion. As a corollary to this study, we suggest some reappraisal of the straight-leg-raising test by which pain from nerve root tension can be distinguished from a source of pain arising locally in intervertebral joints for mechanical reasons or from the hip itself. We recommend the method described as being useful in the consulting office.