Applying the theoretical domains framework and behavior change wheel to inform interventions for food and food-related waste audits in hospital foodservices

BackgroundCompleting aggregate food and food-related waste audits in hospital foodservices is an intense practice, however they can demonstrate problem areas that require attention to reduce waste. Identifying interventions to facilitate and improve the implementation of these audits can be guided by behavior change science. The aims of this study were to use behavior change theories and frameworks to (1) describe the drivers of behavior to complete food and food-related waste audits and (2) identify possible interventions that support the implementation and uptake of these audits.MethodsPurposive sampling was used to recruit participants from hospitals in Victoria, Australia who worked in their foodservice system. Semi-structured interviews sought knowledge of participant’s perceived barriers and enablers to completing food and food-related waste audits. Deductive analysis using the Theoretical Domains Framework (TDF) and Capability Opportunity Motivation Behavior theory (COM-B) identified dominant drivers of behavior. TDF domains were then matched to their corresponding intervention functions according to the Behavior Change Wheel framework (BCW) to identify relevant strategies that may support audit implementation.ResultsData from 20 interviews found the dominant COM-B constructs (TDF domains) were psychological capability (knowledge, skills), physical opportunity (environmental context and resources), and reflective motivation (social/professional role and identity, beliefs about capabilities). These dominant domains come from narratives that participants shared about foodservice staffs’ lack of knowledge, labor, time, and the hospital avoiding responsibility for audit completion. Corresponding intervention functions that could have the most potential for implementing waste audits were education, training, environmental restructuring, modeling, and enablement. Participants’ shared perspectives of audit enablers resembled these: for example, obtaining staff buy-in, reinforcing behavior through incentives and installing an audit champion.ConclusionTo transition toward regular food and food-related waste auditing practices in hospital foodservices these findings may help identify practice and policy change that delivers standardized auditing activities to encourage long term behavior change. Interventions to support audit completion should address each behavioral construct and relevant domain, as individual hospital sites will experience unique contextual factors and expectations influencing audit outcomes. A co-design process that includes staff and stakeholders of hospital foodservices is recommended to enable engagement and practical solutions to audit implementation

Vaping Associated Lung Injury Requiring Bilateral Lung Transplant in an Adolescent

Purpose: E-cigarette, or vaping, product use associated lung injury (EVALI) is a newly recognized entity that is being reported with increasing frequency in the literature and mainstream press. The aim of this case report is to radiographically illustrate the fairly rapid progression of a severe case of EVALI that ultimately required a successful bilateral lung transplant, and to describe a unique histopathology correlation. Case Report: Our patient is a 16-year-old, previously healthy male with a two year history of vaping who presented to an outside hospital for dyspnea and nonproductive cough. He was initially treated with antibiotics for community acquired pneumonia. Initial contrast-enhanced CT of the chest demonstrated subtle bilateral but right lower lobe predominant centrilobular nodules, ground glass opacities (GGO) and mild septal thickening. Bronchial alveolar lavage, microbiology studies and autoimmune panel were negative for an infectious or autoimmune etiology. Repeat chest CT only five days later following clinical deterioration demonstrated a dramatic worsening of bilateral nodular airspace opacities, septal thickening, GGO and dependent diffuse consolidations. Pneumomediastinum and mild bronchiectasis were also present. Our patient’s condition continued to decline requiring intubation and subsequent ECMO support. He was transferred to our tertiary care center for bilateral lung transplant. Histopathology of the explanted lungs described predominant acute necrotizing and granulomatous bronchopneumonia with areas of organizing pneumonia. Discussion: The Centers for Disease Control and Prevention currently considers EVALI a diagnosis of exclusion with a confirmed case requiring the use of an e-cigarette 90 days before symptom onset, pulmonary infiltrates on chest imaging, absence of pulmonary infection and no other plausible diagnoses. Various imaging patterns of EVALI have been reported including hypersensitivity pneumonitis, diffuse alveolar hemorrhage, acute eosinophilic pneumonia and lipoid pneumonia, among others. This case demonstrates progression of a severe case of EVALI requiring bilateral lung transplant in an adolescent. Acute necrotizing and granulomatous bronchopneumonia were the predominant histologic features in our patient and have not previously been described in association with EVALI. It is important to consider EVALI in adolescents with a history of e-cigarette use who have a negative infectious and autoimmune work up presenting with severe respiratory symptoms and patterns of lung injury on chest imaging. As the popularity of these inhalational products evolves, radiologists must be informed of the emerging radiographic appearances of EVALI.https://scholarlycommons.henryford.com/merf2020caserpt/1101/thumbnail.jp

Exosomal Composition, Biogenesis and Profiling using Point-of-Care Diagnostics - Implications for Cardiovascular Disease

Arteriosclerosis is an important age-dependent disease that encompasses atherosclerosis, in-stent restenosis (ISR), pulmonary hypertension, autologous bypass grafting and transplant arteriosclerosis. Endothelial dysfunction and the proliferation of vascular smooth muscle cell (vSMC)-like cells is a critical event in the pathology of arteriosclerotic disease leading to intimal-medial thickening (IMT), lipid retention and vessel remodelling. An important aspect in guiding clinical decision-making is the detection of biomarkers of subclinical arteriosclerosis and early cardiovascular risk. Crucially, relevant biomarkers need to be good indicators of injury which change in their circulating concentrations or structure, signalling functional disturbances. Extracellular vesicles (EVs) are nanosized membraneous vesicles secreted by cells that contain numerous bioactive molecules and act as a means of intercellular communication between different cell populations to maintain tissue homeostasis, gene regulation in recipient cells and the adaptive response to stress. This review will focus on the emerging field of EV research in cardiovascular disease (CVD) and discuss how key EV signatures in liquid biopsies may act as early pathological indicators of adaptive lesion formation and arteriosclerotic disease progression. EV profiling has the potential to provide important clinical information to complement current cardiovascular diagnostic platforms that indicate or predict myocardial injury. Finally, the development of fitting devices to enable rapid and/or high-throughput exosomal analysis that require adapted processing procedures will be evaluate

Influence of team rating on running performance in elite Gaelic football

It is currently unknown how team rating influences running performance in Gaelic football. Global positioning system technologies were used to quantify match-running performance within 5 elite Gaelic football teams over a period of 5 years (2012-2016). In total 780 player data sets were collected over 95 matches. Running performance variables included total distance, high-speed distance (≥17 km·h), and the percentage of high-speed distance. Team ratings were determined objectively using the Elo rating system for Gaelic football. Reference team rating had trivial effects on total distance (p = 0.011, partial η = 0.008) and high-speed distance (p = 0.011, partial η = 0.008). Opposition team rating had small effects on total distance (p = 0.005, partial η = 0.016) and high-speed distance (p = 0.001, partial η = 0.020). Top-tier teams cover greater total distances and high-speed distance than lower tier teams. Players cover considerably less total distance and high-speed distance against tier-3 and tier-4 teams. Tier-1 players ran a significantly higher percentage of distance at high speed than players who played for tier-2 teams (p = 0.020). The competitive advantage of top-tier Gaelic football teams is closely linked with their ability to demonstrate a higher physical intensity than lower tier teams

The influence of match outcome on running performance in elite Gaelic football

Introduction: Match outcome has been linked to running performance in many sports; however, the association has not yet been examined in Gaelic football. Methods: GPS technologies (4-Hz, VX Sport, Lower Hutt, New Zealand) were used with 5 elite Gaelic football teams over a period of 5 years (2012–2016), amounting to 95 matches. In total, 780 full match data sets were collected. Game movements were divided into total distance and high-speed distance (≥17 km h−1). Match outcomes were divided into big losses (≥6 points), small losses (≤5points), draws, small wins (≤5 points) and big wins (≥6 points). Results: Team (P ≤ 0.001), playing position (P ≤ 0.001) and match outcome (P ≤ 0.034) had a significant effect on total and high-speed distance. In the first (P = 0.008) and second (P = 0.002) quarters of games players ran significantly less high-speed distance in big losses in comparison to draws. In the fourth quarter, players ran significantly less high-speed distance in big losses than in draws (P = 0.001), small wins (P = 0.044) and big wins (P = 0.011). Conclusion: The current study confirms that running performance is a contributing factor to match outcome in Gaelic football. Coaches should be aware how contextual factors can influence running performance

A conserved protein, BcmA, mediates motility, biofilm formation, and host colonisation in Adherent Invasive Escherichia coli

Adherent Invasive Escherichia coli (AIEC) is a non-diarrhoeagenic intestinal E. coli pathotype associated with Crohn’s Disease. AIEC pathogenesis is characterised by biofilm formation, adhesion to and invasion of intestinal epithelial cells, and intracellular replication within epithelial cells and macrophages. Here, we identify and characterise a protein in the prototypical AIEC strain LF82 which is required for efficient biofilm formation and dispersal – LF82_p314. LF82 ΔLF82_314 have defective swimming and swarming motility, indicating LF82_p314 is important for flagellar-mediated motility, and thus surface colonisation and biofilm dispersal. Flagellar morphology and chemotaxis in liquid appear unaffected by deletion of LF82_314, suggesting LF82_p314 does not elicit an effect on flagella biogenesis or environmental sensing. Flagellar motility has been implicated in AIEC virulence, therefore we assessed the role of LF82_p314 in host colonisation using a Caenorhabditis elegans model. We found that LF82 ΔLF82_314 have an impaired ability to colonise the C. elegans compared to wild-type LF82. Phylogenetic analysis showed that LF82_314 is conserved in several major enterobacterial pathogens, and suggests the gene may have been acquired horizontally in several genera. Our data suggests LF82_p314 may be a novel component in the flagellar motility pathway and is a novel determinant of AIEC colonisation. Our findings have potential implications not only for the pathogenesis of Crohn’s Disease, but also for the course of infection in several major bacterial pathogens. We propose a new designation for LF82_314, biofilm coupled to motility A, or bcmA

Difficulties in recruitment for a randomized controlled trial involving hysterosalpingography

BACKGROUND: The usefulness of hysterosalpingography (HSG) as routine investigation in the fertility work-up prior to laparoscopy and dye had been assessed in a randomized controlled trial. Recruiting subjects to the study was more difficult than anticipated. The objective of this study was to explore possible reasons for non-participation in the trial. METHODS: All newly referred subfertile women admitted to the Reproductive Medicine Clinic of Leiden University Medical Centre between 1 April 1997 and 31 December 1999, were eligible for the study. The reasons for non-participation were evaluated by scrutinizing the medical records. RESULTS: Out of 759 women, a total of 127 (17%) agreed to participate in the trial. The most important reason for non-participation was because of exclusion criteria (73%). Other reasons were inattentive clinicians (3%) and patient-associated reasons (24%). Patient refusal and indecisiveness to enroll in the study were the most common patient-associated reasons. The most frequently stated reason for trial refusal was reluctance to undergo laparoscopy and dye mainly due to issues related to anesthesia and scheduling of procedure. CONCLUSION: Almost three-quarters of recruitment difficulties in this study were due to unavoidable reasons. To overcome the remaining avoidable reasons for non-participation, attention should be paid to appropriate instruction of the study protocol to the participating doctors and to provide adequate information, in layman's terms, to the patients. Reminding patients by notes or telephone calls for attending the clinic are helpful. It may be contingent upon tracing the reasons of clinicians and patients for non-participation to improve enrollment during a trial

Novel real-time PCR species identification assays for British and Irish bats and their application to a non-invasive survey of bat roosts in Ireland

Detection and monitoring of extant bat populations are crucial for conservation success. Non-invasive genetic analysis of bat droppings collected at roosts could be very useful in this respect as a rapid, cost‐efficient monitoring tool. We developed species‐specific real-time PCR assays for 18 British and Irish bat species to enable non‐invasive, large‐scale distribution monitoring, which were then applied to a field survey in Ireland. One hundred and sixty-four DNA samples were collected from 95 bat roosts, of which 73% of samples were identified to species, and the resident bat species were identified at 89% of roosts. However, identification success varied between roost types, ranging from 22% for underground sites to 92% for bat boxes. This panel of DNA tests will be especially useful in cases where roosts contain multiple species, where the number of bats present is small, or bats are otherwise difficult to directly observe. The methodology could be applied to the surveillance of proposed development sites, post development mitigation measures, distribution surveys, bat box schemes and the evaluation of agri-environmental bat box schemes