Evaluation of Flour Safety Messages on Commercially Available Packages: An Eye-Tracking Study.

Wheat flour and baking mix have been associated with foodborne outbreaks and recalls, yet many consumers are unaware of the repercussions of consuming raw flour products. The objective of this study was to evaluate the accessibility of flour safety messages on commercially available packages and to identify consumer barriers to processing these messages. Eye-tracking technology was used to track the eye movements of 47 participants to assess their time to fixation (TTF) on the flour safety messages on 10 commercial packages. Notifications that were longer than one sentence were considered "long" messages, while notifications that consisted of only one sentence were considered short (S1-S5 and L1-L5). Only two participants (4.3%) found messages on all 10 packages. Highly accessible messages did not result in a high preference of presentation among participants. Most of the participants (98%) found the message on the S4 package, which correlated with the lowest TTF of 7.08 s. However, only 15% of those who found the S4 message chose it as their preferred message. Many participants who were interviewed said that they preferred messages that identified the reasoning for the warnings. They also preferred the messages that were well separated from other content on the package. Flour safety messages on the current packages are not effective to convey information and change consumer behavior. More science-based messaging strategies need to be developed to provide guidance for flour safety communication.

Clinical Predictors of Failed Medical Treatment in Patients with Tubo-ovarian Abscess: External Validation of a Recently Published Risk Score.

STUDY OBJECTIVE: To assess the external validity of a recently published clinical risk score estimating the risk of failed medical treatment in patients with tubo-ovarian abscess (TOA) based on 4 clinical variables on admission. DESIGN: The probability of failed medical treatment predicted from the reference risk score was compared with the observed rates in a retrospective cohort of patients with TOA. Results were assessed using rigorous methods for clinical prediction models. SETTING: Safety-net teaching hospital system in Houston, Texas. PATIENTS: One hundred and sixty nine consecutive patients admitted with TOA between 2011 and 2018 were included. Some were treated conservatively with intravenous antibiotic agents; others required a drainage procedure. INTERVENTION: Electronic health records were reviewed and the 4 clinical predictors of failed conservative treatment were captured (age, white blood cell count on admission, abscess size, and presence of bilateral abscess). A clinical risk score was calculated for each patient. The prediction model was created using the risk score in a multivariate logistic regression. Then the calibration, discrimination, and accuracy of the model were evaluated to perform the external validation analysis. MEASUREMENTS AND MAIN RESULTS: Among 169 eligible patients, 50.2% were successfully treated with intravenous antibiotic agents and 49.8% needed abscess drainage. Patients undergoing drainage were more likely to be older, be diabetic, to present with elevated white blood cell count and fever, and to have a larger abscess size on univariate analysis. Among the 4 known predictors of drainage, abscess size was found to be the strongest. Significant difference in clinical characteristics was noted between our cohort and the reference cohort, and the model needed recalibration to adjust for these differences. The area under the receiver operating characteristic curve was 0.77 (0.71-0.84) indicating good discrimination. The Brier score was favorable (0.19) and the observed and predicted rates were similar ranging across different risk scores. CONCLUSIONS: Our results provide external validation of a simple clinical risk score predicting failed medical treatment in patients with TOA.

Food Handling Practices in the Era of COVID-19: A Mixed-Method Longitudinal Needs Assessment of Consumers in the United States.

ABSTRACT: At present, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been shown to be transmitted through food. Even so, the coronavirus disease 2019 (COVID-19) pandemic has changed how consumers view food and food safety. This study assessed consumer food safety practices during the COVID-19 pandemic using (i) surveys and (ii) online focus group discussions. From April to August 2020, five waves of surveys were distributed to an online U.S. consumer panel and screened to include only primary food preparers and grocery shoppers. The online focus groups were conducted via WebEx from May to July 2020. Focus group participants were recruited from the first wave of survey respondents. Both survey respondents and focus group participants reported higher levels of hand washing in response to the pandemic. However, survey participants' anticipated levels of hand washing after the pandemic decreased; some focus group participants noted that human nature "kicking in" could lead to lower levels of hand hygiene practice. For each of the 5 months, the surveys reported increased produce washing, both with water only and with water plus soap. Most focus group participants mentioned using water to wash their produce, but some reported using soap and even vinegar to "kill" the virus. Since consumers were worried that SARS-CoV-2 could survive on food, they started to mishandle food to address these concerns. However, this study also reported an increase in food thermometer use during the pandemic. Social determinants like gender, income, education, and age may have also influenced changes in levels of practice throughout the pandemic. The COVID-19 pandemic drove consumers to practice proper and improper food safety practices, which may or may not continue after the pandemic. This study's findings provide timely information to guide future food safety education and communication during health crises and pandemics.

Exploring Food Safety Messages in an Era of COVID-19: Analysis of YouTube Video Content.

ABSTRACT: Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not a proven foodborne pathogen, the COVID-19 pandemic has put the food system on alert, and food safety has been identified as an important pillar in mitigating the crisis. Therefore, an understanding of how popular media are used as a vital disseminator of food safety and health information for the public is more important than ever. YouTube deserves particular attention as one of the most highly trafficked Web sites on the Internet, especially because YouTube has been blamed during the pandemic for spreading misleading or untrustworthy information that contradicts validated information. This study was conducted to evaluate the food safety information and practices circulating on YouTube during the COVID-19 pandemic and the alignment of these practices with recommendations from government agencies. A search for videos on YouTube was conducted using the key words "food and COVID-19," "food safety and COVID-19," and "groceries and COVID-19." After applying a series of inclusive and exclusive criteria, 85 videos from the United States and Canada were evaluated. More than half (69%) of the videos presented hand washing procedures, 26% showed kitchen disinfection, and most (86%) showed take-out food or grocery store practices. Multiple produce washing procedures were also shown throughout videos. Food was not considered hazardous in 39% of the videos, but 24% mentioned that food packaging is potentially hazardous. Most videos cited government agencies and had a host or guest who was a health care professional, professor, or expert. Three videos were not aligned with a government agency's guideline or information cited; two were presented by a health care professional. These findings reveal the need to develop educational interventions that increase YouTube video host and guest awareness of social media use as a tool for food safety dissemination and the need to provide trustworthy information.

Consumer risk perception and trusted sources of food safety information during the COVID-19 pandemic.

Risk perceptions and trusted sources of information may have influenced consumer food handling practices during the COVID-19 pandemic. This study used a mixed-method qualitative-quantitative approach to assess consumer risk perception and trusted sources of food safety information during the pandemic. From April to August of 2020, five waves of online surveys (N = 3,584, with a minimum of 700 per month) were distributed to a U.S. consumer panel, which included only primary food preparers and grocery shoppers. The online focus groups recruited participants (N = 43) from the first wave of survey respondents and were conducted via Webex from May to July 2020. Topics covered in both studies focused on food safety risk perceptions and trusted sources of information during the pandemic. Trusted sources of information included government agencies, healthcare professionals, scientists, and social media. Throughout the longitudinal study, survey respondents and focus group participants perceived a higher risk of getting COVID-19 from people than from food. Survey respondents believed that handwashing could protect them more from COVID-19 than from foodborne illnesses. Many focus group participants practiced handwashing to prevent them from contracting COVID-19 from food items. Both survey respondents and focus group participants trusted the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and healthcare professionals for COVID-19 and food safety information. Focus group participants trusted these entities because they provide information that is "scientifically proven." Survey data for all five months reported social media to be the least-trusted source of both COVID-19 and food safety information. Focus group participants agreed that social media has "misinformation." The findings suggest that increased risk perception may have caused consumers to adopt good hand hygiene. However, consumers may not be connecting such practices to food safety. Food safety educators can use this time of heightened risk perception to connect COVID-19 and food safety practices. Trusted entities of information also need to be aware of their impact on consumer behavior and provide consumers with proper food safety information.

Risk of Foodborne Illness from Pet Food: Assessing Pet Owners' Knowledge, Behavior, and Risk Perception.

Pet food has been identified as a source of pathogenic bacteria, including Salmonella and Escherichia coli. A recent outbreak linked to Salmonella -contaminated pet treats infected over 150 people in the United States. The mechanism by which contaminated pet food leads to human illness has not been explicated. Pet owners' food safety knowledge and their pet food handling practices have not been reported. This study evaluated pet owners' food safety knowledge and pet-food handling practices through an online consumer survey. The survey consists of 62 questions and assesses (1) owners' food safety knowledge and pet-food handling practices; (2) owners' interaction with pets; (3) owners' risk perception related to their own health, their children's health, and their pets' health. The survey was pilot-tested among 59 pet owners before distribution to a national consumer panel, managed by Qualtrics XM. All participants (n=1,040) were dog and/or cat owners in the United States. Almost all pet owners interacted with their pets (93%) and most cuddled, allowed their pets to lick them, and slept with their pets. Less than one-third of pet owners washed their hands with soap after interacting with their pets. Over half (58%) the owners reported washing their hands after feeding their pets. Most pet owners fed their pets dry pet food and dry pet treats. Some fed their pets raw meat or raw animal product (RAP) diets because they believed these diets to be beneficial to their pet's overall health. Many owners (78%) were unaware of pet food recalls or outbreaks associated with foodborne pathogens. Less than 25% considered dry pet foods and treats as a potential source of foodborne pathogens. The findings of this study indicated the need for consumer education about pet food handling. The data collected can assist in developing more accurate risk assessment models and consumer education related to pet food handling.

Predictive Model of Listeria monocytogenes Growth in Queso Fresco.

Listeria monocytogenes is a hardy psychrotrophic pathogen that has been linked to several cheese-related outbreaks in the United States, including a recent outbreak in which a fresh cheese (queso fresco) was implicated. The purpose of this study was to develop primary, secondary, and tertiary predictive models for the growth of L. monocytogenes in queso fresco and to validate these models using nonisothermal time and temperature profiles. A mixture of five strains of L. monocytogenes was used to inoculate pasteurized whole milk to prepare queso fresco. Ten grams of each fresh cheese sample was vacuum packaged and stored at 4, 10, 15, 20, 25, and 30°C. From samples at each storage temperature, subsamples were removed at various times and diluted in 0.1% peptone water, and bacteria were enumerated on Listeria selective agar. Growth data from each temperature were fitted using the Baranyi model as the primary model and the Ratkowsky model as the secondary model. Models were then validated using nonisothermal conditions. The Baranyi model was fitted to the isothermal growth data with acceptable goodness of fit statistics (R2 = 0.928; root mean square error = 0.317). The Ratkowsky square root model was fitted to the specific growth rates at different temperatures (R2 = 0.975). The tertiary model developed from these models was validated using the growth data with two nonisothermal time and temperature profiles (4 to 20°C for 19 days and 15 to 30°C for 11 days). Data for these two profiles were compared with the model prediction using an acceptable prediction zone analysis; >70% of the growth observations were within the acceptable prediction zone (between -1.0 and 0.5 log CFU/g). The model developed in this study will be useful for estimating the growth of L. monocytogenes in queso fresco. These predictions will help in estimation of the risk of listeriosis from queso fresco under extended storage and temperature abuse conditions.

Age estimation by cemental annulation rings.

CONTEXT: Tooth plays a pivotal role in the identification of a person when all other remains are ruined by natural or unnatural causes. Dental evidence can contribute to age estimation in forensic dentistry. Estimating the age of an individual with the help of a tooth for identification proves beneficial. Alternating light and dark bands seen on the cementum have been shown to be proportionate to the age of the patient in number. This was done to evaluate the cementum annulation in age determination. AIMS: This study aimed to determine the age of an individual using tooth cementum annulation. MATERIALS AND METHODS: In this study, twenty extracted teeth were collected and all the clinical details of the patient such as age, sex, and chief complaint were recorded. The collected teeth was preserved in formalin overnight and then washed under tap water before they were sectioned. The area selected for counting was observed under 10 × objective of light microscope, and photomicrographs were taken for the counting of the lines. At the time of analysis, the age of the patient was not disclosed to the observer. STATISTICAL ANALYSIS USED: Student's t-test was used for statistical analysis. RESULTS: This study showed the correlation between the actual age of the individual and the estimated age using tooth cementum annulation method and showed significant statistical value. CONCLUSION: Incremental lines found in cementum can be used for age estimation in forensic dentistry.