An evaluation of recommendation algorithms for online recipe portals

Better models of food preferences are required to realise the oft touted potential of food recommenders to aid with the obesity crisis. Many of the food recommender evaluations in the literature have been performed with small convenience samples, which limits our conidence in the generalisability of the results. In this work we test a range of collaborative iltering (CF) and content-based (CB) recommenders on a large dataset crawled from the web consisting of naturalistic user interaction data over a 15 year period. The results reveal strengths and limitations of diferent approaches. While CF approaches consistently outperform CB approaches when testing on the complete dataset, our experiments show that to improve on CF methods require a large number of users (> 637 when sampling randomly). Moreover the results show diferent facets of recipe content to ofer utility. In particular one of the strongest content related features was a measure of health derived from guidelines from the UK Food Safety Agency. This inding underlines the challenges we face as a community to develop recommender algorithms, which improve the healthfulness of the food people choose to eat.publishedVersio

Cerebral palsy in Mulago hospital, Uganda : comorbidity, diagnosis and cultural adaptation of an assessment tool

Background and aim: Cerebral palsy (CP) is the most common form of chronic motor disability that begins in early childhood and persists throughout life. The clinical features, including motor function, comorbidities and nutritional status, have not been investigated in Uganda. In addition, no assessment tool to measure functional skill development and the level of independence performance in activities of daily living has been developed for these children. The overall aim of this thesis was to describe the neurological, anthropometric and brain imaging findings of Ugandan children with CP and to develop a culturally relevant assessment tool for measuring their functional performance. Methods and participants: Five cross sectional studies (I-V) were carried out at the Mulago National Referral Hospital in Kampala and in varied rural and urban districts within Uganda. Three studies were conducted at the health facility (I-III), while two were conducted in the community (IV-V). Study I investigated the clinical types, motor function and comorbidities of children with CP. In Study II, this same cohort had their anthropometric measurements taken, as well as information about their clinical, feeding and perinatal history to determine their nutritional status and associated factors. Study III, performed on a sub sample of the original cohort, investigated the brain computed tomography (CT) scans and associated features. In Study IV, the Pediatric Evaluation Disability Inventory (PEDI) was translated and cross-culturally adapted to the Ugandan environment to create the PEDI-UG instrument. The psychometric properties of the new PEDI-UG instrument was validated in Study V. Results: Bilateral spastic CP was the main clinical subtype (45%). Severe gross and fine motor function levels were more common in the bilateral spastic and dyskinetic CP subtypes. Signs of learning disability (75%) and epilepsy (45%) were the most common comorbidities. Speech and language impairments were associated with bilateral spastic CP and severe gross and fine motor dysfunction (Study I). More than half (52%) of the children with CP were malnourished, with being underweight (42%) presented as the most common form. Malnutrition was associated more with children 5 years of age or older, and those with a history of complications during the neonatal period (Study II). The distribution of brain image patterns differed from that seen in high income countries with more primary grey matter injuries (PGMI) (44%) and normal scans (31%) and very few primary white matter injuries (4%). PGMI were more common in children with a history of hospital admission following birth (Study III). In the culturally adapted PEDI-UG, overall 178 of the original 197 PEDI items (90%) were retained, with a number of modifications in the remaining items, to create the final 185-item PEDI-UG. (Study IV). Most activities of the culturally adapted PEDI UG (95%) showed acceptable fit to the Rasch model. In addition, the caregiver assistant rating scale was changed from a six-point to four-point rating scale (Study V). Conclusions: There was a large proportion of severely affected children with CP in this cohort, with frequent malnutrition and more PGMI. These results suggest a different etiology of CP in infants born full-term between sub-Saharan Africa and high-income countries. Our findings could imply a higher occurrence of birth asphyxia, postnatally acquired infections or other varied insults around the last trimester period which may possibly benefit from improved emergency obstetric and postnatal care. The culturally adapted PEDI-UG instrument with a four categories caregiver assistant rating scale is appropriate, providing a valid measure of the functional performance of typically developing children from the age of 6 months to 7.5 years in Uganda and other similar African contexts

Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1:a multicentre, single-blind, randomised trial

Background: Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. Methods: We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep–wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10–14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0–100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. Findings: Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI −0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (−2·02, −4·02 to −0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. Interpretation: Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. Funding: The European Union Seventh Framework Programme

The Cholesterol Factor: Balancing Accuracy and Health in Recipe Recommendation Through a Nutrient-Specific Metric

Whereas many food recommender systems optimize for users’ preferences, health is another but often overlooked objective. This paper aims to recommend relevant recipes that avoid nutrients that contribute to high levels of cholesterol, such as saturated fat and sugar. We introduce a novel metric called ‘The Cholesterol Factor’, based on nutritional guidelines from the Norwegian Directorate of Health, that can balance accuracy and health through linear re-weighting in post-filtering. We tested popular recommender approaches by evaluating a recipe dataset from AllRecipes.com, in which a CF-based SVD method outperformed content-based and hybrid methods. Although we found that increasing the healthiness of a recommended recipe set came at the cost of Precision and Recall metrics, only putting little weight (10-15%) on our Cholesterol Factor can significantly improve the healthiness of a recommendation set with minimal accuracy losses.publishedVersio

Exploring the effects of natural language justifications in food recommender systems

Users of food recommender systems typically prefer popular recipes, which tend to be unhealthy. To encourage users to select healthier recommendations by making more informed food decisions, we introduce a methodology to generate and present a natural language justification that emphasizes the nutritional content, or health risks and benefits of recommended recipes. We designed a framework that takes a user and two food recommendations as input and produces an automatically generated natural language justification as output, which is based on the user’s characteristics and the recipes’ features. In doing so, we implemented and evaluated eight different justification strategies through two different justification styles (e.g., comparing each recipe’s food features) in an online user study (N = 503). We compared user food choices for two personalized recommendation approaches, popularity-based vs our health-aware algorithm, and evaluated the impact of presenting natural language justifications. We showed that comparative justifications styles are effective in supporting choices for our healthy-aware recommendations, confirming the impact of our methodology on food choices

Exploring the effects of natural language justifications in food recommender systems

Users of food recommender systems typically prefer popular recipes, which tend to be unhealthy. To encourage users to select healthier recommendations by making more informed food decisions, we introduce a methodology to generate and present a natural language justification that emphasizes the nutritional content, or health risks and benefits of recommended recipes. We designed a framework that takes a user and two food recommendations as input and produces an automatically generated natural language justification as output, which is based on the user's characteristics and the recipes' features. In doing so, we implemented and evaluated eight different justification strategies through two different justification styles (e.g., comparing each recipe's food features) in an online user study (N = 503). We compared user food choices for two personalized recommendation approaches, popularity-based vs our health-aware algorithm, and evaluated the impact of presenting natural language justifications. We showed that comparative justifications styles are effective in supporting choices for our healthy-aware recommendations, confirming the impact of our methodology on food choices

HEALTH DISPARITIES ACROSS FUNCITONAL DISABILITY GROUPS

Background: People with disabilities experience higher rates of chronic disease and poor health status compared to those without disability. People with disabilities do not participate in community health programs to the same degree as those without disability due to social, programmatic, and environmental barriers. The Community Health Inclusion Index (CHII) is a community health assessment tool which evaluates the degree to which community-level health promoting opportunities to promote nutrition and physical activity are inclusive and accessible to people with disabilities. The CHII assess barriers to inclusion across five domains: build environment, equipment, program/services, staff, and policies. Objective: The purpose of this study was to use the CHII to assess the inclusiveness and accessibility of nine San Antonio senior centers which provide nutrition and physical activity programs to local seniors and identify the barriers and facilitators to inclusion of seniors with disabilities. Methods: Assessment of CHII survey items related to the built environment and equipment was conducted through an observational audit of the nine senior centers. Survey items under the domains of program and services, staff, and policies were completed through interviews with a City leadership and community organizations which provide services to people with disabilities. Pilot data on the usability and feasibility of the CHII survey tools were collected. Results: The top barriers to inclusion included a lack of health promotion materials available in accessible formats, lack of accessible equipment in healthcare exam rooms, and neighborhood characteristics that make travel to the sites on foot unappealing. Top facilitators to inclusion included a robust nutrition and transportation program available at no cost to qualifying seniors, accessible site layouts, and an organization and community willingness to identify and improve inclusion and accessibility for people with disability in the San Antonio. Conclusion: San Antonio senior centers provide an array of services with the majority being inclusive of seniors with disabilities. Partnerships with local transit, food bank, and YMCA/YWCA organizations help ensure nutrition and physical activity programs are inclusive and accessible to local seniors. Future considerations include adding questions to assess leisure/recreational activities. Future initiatives to improve accessibility and make health-promoting opportunities more inclusive of people with disabilities should use an established framework such as Guidelines, Recommendations, Adaptions Including Disabilities (GRAIDs)

The development and validation of a quality of life assessment instrument for cancer patients in South Africa

A thesis submitted to the Faculty of Health Sciences. University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, 2016Background: Quality of life (QoL) of cancer patients has been well researched, but not necessarily from the perspective of the patient and not in third world countries. Total care of cancer patients should encompass all aspects of the person, such as physical-, psychological- and social aspects, existential wellbeing and spirituality, in order to ensure optimal QoL. The purpose of the study was to explore QoL from the perspective of the cancer patient who accesses public health care services in South Africa for treatment and to develop and validate an appropriate patient-directed assessment instrument. Method: The study was conducted in two phases. In Phase 1 assessment of QoL was done by means of in-depth qualitative interviews. Open coding and template analysis was conducted \during data analysis and the applicable domains of QoL were identified. In Phase 2 an appropriate QoL assessment instrument was developed for cancer patients in South Africa. The Rasch Measurement Model was utilized for the validation of the instrument. Results: The domains of QoL identified by the cancer patients were: physical, psychosocial, financial, spiritual, existential and emotional. When compared with the domains included in available QoL assessment instruments such as the World Health Organization Quality of Life Instrument (shortened version) (WHOQOL-BREF), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy General (FACT-G), the domains identified by cancer patients in South Africa were not fully addressed by these instruments. Significance of results: Culture, psychosocial status, financial aspects and spirituality play a major role in QoL of South African patients, as indicated by this study as well as a previous study on QoL of palliative patients from a resource-poor community in South Africa. These aspects of QoL are not addressed by the most commonly used assessment instruments. The importance of the utilization of an instrument which addresses all the appropriate domains of QoL is highlighted by the study.MT201