Trends in Trans Fatty Acids Reformulations of US Supermarket and Brand-Name Foods From 2007 Through 2011

Introduction: Although some US food manufacturers have reduced trans fatty acids (TFA) in their products, it is unknown how much TFA is being reduced, whether pace of reformulation has changed over time, or whether reformulations vary by food type or manufacturer. Methods: In 2007, we identified 360 brand-name products in major US supermarkets that contained 0.5 g TFA or more per serving. In 2008, 2010, and 2011, product labels were re-examined to determine TFA content; ingredients lists were also examined in 2011 for partially hydrogenated vegetable oils (PHVO). We assessed changes in TFA content among the 270 products sold in all years between 2007 and 2011 and conducted sensitivity analyses on the 90 products discontinued after 2007. Results: By 2011, 178 (66%) of the 270 products had reduced TFA content. Most reformulated products (146 of 178, 82%) reduced TFA to less than 0.5 g per serving, although half of these 146 still contained PHVO. Among all 270 products, mean TFA content decreased 49% between 2007 and 2011, from 1.9 to 0.9 g per serving. Yet, mean TFA reduction slowed over time, from 30.3% (2007–2008) to 12.1% (2008–2010) to 3.4% (2010–2011) (P value for trend < .001). This slowing pace was due to both fewer reformulations among TFA-containing products at start of each period and smaller TFA reductions among reformulated products. Reformulations also varied substantially by both food category and manufacturer, with some eliminating or nearly eliminating TFA and others showing no significant changes. Sensitivity analyses were similar to main findings. Conclusions: Some US products and food manufacturers have made progress in reducing TFA, but substantial variation exists by food type and by parent company, and overall progress has significantly slowed over time. Because TFA consumption is harmful even at low levels, our results emphasize the need for continued efforts toward reformulating or discontinuing foods to eliminate PHVO

Effects of Saturated Fat, Polyunsaturated Fat, Monounsaturated Fat, and Carbohydrate on Glucose-Insulin Homeostasis: A Systematic Review and Meta-analysis of Randomised Controlled Feeding Trials.

BACKGROUND: Effects of major dietary macronutrients on glucose-insulin homeostasis remain controversial and may vary by the clinical measures examined. We aimed to assess how saturated fat (SFA), monounsaturated fat (MUFA), polyunsaturated fat (PUFA), and carbohydrate affect key metrics of glucose-insulin homeostasis. METHODS AND FINDINGS: We systematically searched multiple databases (PubMed, EMBASE, OVID, BIOSIS, Web-of-Knowledge, CAB, CINAHL, Cochrane Library, SIGLE, Faculty1000) for randomised controlled feeding trials published by 26 Nov 2015 that tested effects of macronutrient intake on blood glucose, insulin, HbA1c, insulin sensitivity, and insulin secretion in adults aged ≥18 years. We excluded trials with non-isocaloric comparisons and trials providing dietary advice or supplements rather than meals. Studies were reviewed and data extracted independently in duplicate. Among 6,124 abstracts, 102 trials, including 239 diet arms and 4,220 adults, met eligibility requirements. Using multiple-treatment meta-regression, we estimated dose-response effects of isocaloric replacements between SFA, MUFA, PUFA, and carbohydrate, adjusted for protein, trans fat, and dietary fibre. Replacing 5% energy from carbohydrate with SFA had no significant effect on fasting glucose (+0.02 mmol/L, 95% CI = -0.01, +0.04; n trials = 99), but lowered fasting insulin (-1.1 pmol/L; -1.7, -0.5; n = 90). Replacing carbohydrate with MUFA lowered HbA1c (-0.09%; -0.12, -0.05; n = 23), 2 h post-challenge insulin (-20.3 pmol/L; -32.2, -8.4; n = 11), and homeostasis model assessment for insulin resistance (HOMA-IR) (-2.4%; -4.6, -0.3; n = 30). Replacing carbohydrate with PUFA significantly lowered HbA1c (-0.11%; -0.17, -0.05) and fasting insulin (-1.6 pmol/L; -2.8, -0.4). Replacing SFA with PUFA significantly lowered glucose, HbA1c, C-peptide, and HOMA. Based on gold-standard acute insulin response in ten trials, PUFA significantly improved insulin secretion capacity (+0.5 pmol/L/min; 0.2, 0.8) whether replacing carbohydrate, SFA, or even MUFA. No significant effects of any macronutrient replacements were observed for 2 h post-challenge glucose or insulin sensitivity (minimal-model index). Limitations included a small number of trials for some outcomes and potential issues of blinding, compliance, generalisability, heterogeneity due to unmeasured factors, and publication bias. CONCLUSIONS: This meta-analysis of randomised controlled feeding trials provides evidence that dietary macronutrients have diverse effects on glucose-insulin homeostasis. In comparison to carbohydrate, SFA, or MUFA, most consistent favourable effects were seen with PUFA, which was linked to improved glycaemia, insulin resistance, and insulin secretion capacity.Dr Imamura received support from the Medical Research Council Epidemiology Unit Core Support (MC_UU_12015/5). Dr Mozaffarian received funding from The National Institute of Health in the United States (R01 HL085710).This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pmed.100208

Exploring parent and student engagement in school self-evaluation in four European countries

The purpose of this paper, which is part of a three-year EU Erasmus+-funded study titled 'Distributed Evaluation and Planning in Schools' (DEAPS), is to provide an analysis of policies, structures, processes, supports and barriers that exist to enable or inhibit the involvement of students and parents in school evaluation in four European countries (Belgium, Ireland, Portugal and Turkey). Document analysis was used for this study and some 348 peer-reviewed articles, and 28 national and transnational policy documents were included in the analysis. Based on this review it would be reasonable to suggest that the student/parent voice agenda around evaluation in schools remains, by and large, aspirational. It is extolled in policy but in practice is mainly tokenistic with very little evidence of impact on the work of schools. In light of this, it is argued that government and school-level policies and strategies need to be reconsidered to enhance students' and parents' engagement in school evaluation. As a first step, significant further empirical research on the limitations on and conditions necessary for stakeholder voice in education is required

Thermal performance comparison of different sun tracking configurations

Parabolic trough collector (PTC) is one of the most widespread solar concentration technologies and represents the biggest share of the CSP market; it is currently used in various applications, such as electricity generation, heat production for industrial processes, water desalination in arid regions and industrial cooling. The current paper provides a synopsis of the commonly used sun trackers and investigates the impact of various sun tracking modes on thermal performance of a parabolic trough collector. Two sun-tracking configurations, full automatic and semi-automatic, and a stationary one have numerically been investigated. The simulation results have shown that, under the system conditions (design, operating and weather), the PTC's performance depends strongly on the kind of sun tracking technique and on how this technique is exploited. Furthermore, the current study has proven that there are some optimal semi-automatic configurations that are more efficient than one-axis sun tracking systems. The comparison of the mathematical model used in this paper with the thermal profile of some experimental data available in the literature has shown a good agreement with a remarkably low relative error (2.93%)

Trends in Thrombolysis and Thrombectomy Use in Patients With Ischemic Stroke and Cancer

Background To determine how intravenous thrombolysis (IV‐tPA) and mechanical thrombectomy (MT) use has changed in patients with acute ischemic stroke (AIS) with cancer (AIS‐C) compared with patients with AIS and noncancer (AIS‐NC) in the United States since publication of pivotal MT trials. Methods All primary AIS‐NC and AIS‐C admissions (weighted N=5 748 357) were identified from the 2007 to 2019 Nationwide Inpatient Sample. Joinpoint and multivariable‐adjusted models with interaction terms were used to compare the rate of change in IV‐tPA and MT use between AIS‐C and AIS‐NC. Results From 2007 to 2019, 4.4% of AIS admissions had active cancer. Overall IV‐tPA use in AIS‐C (6.4%) was lower than that of AIS‐NC (8.5%) (P<0.001) but use differed by cancer subtype (hematologic, 7.2%; metastatic, 4.2%). IV‐tPA use increased over time in all cancers, but analysis of status‐by‐time interaction revealed that the pace of increase was slower in metastatic compared with AIS‐NC admissions (rate ratio, 0.98; P=0.015) per year. In contrast, MT use in AIS‐C (2.2%) was greater than that of AIS‐NC (1.9%), but use was highest in metastatic (2.5%) and lowest in hematologic cancers (1.6%) (P values for all pairwise comparisons <0.001). MT use increased at a faster pace in metastatic AIS‐C (rate ratio, 1.06; P=0.001)/year compared with AIS‐NC. In‐hospital all‐cause mortality in AIS‐NC was 4.2% compared with 8.2% in AIS‐C (P<0.001). Mortality declined over time in all cancer groups, but the pace of decline was faster in solid and metastatic AIS‐C compared with AIS‐NC (P values <0.01). Conclusions Use of IV‐tPA and MT has increased in AIS‐C over the past decade. Contrary to prior studies, the current frequency and pace of increase in MT use is greater in metastatic AIS‐C compared with AIS‐NC. Future studies are needed to determine whether AIS‐C are more predisposed to large‐vessel occlusion

Alcohol withdrawal is associated with poorer outcome in acute ischemic stroke

To determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes. All adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS. Of the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time ( for trend 50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11-1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost ( < 0.001). AW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients

Abstract TP121: National Patterns of Carotid Revascularization in the Pre- and Post- Crest Era

Background: The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients (pts) 70 yo. The aim of this study was to evaluate national patterns in CAS performance in pts >70yo in the pre- (2007-2010) and post-CREST (2011-2013) era. Methods: Adults requiring CAS or CEA were identified from the 2007-2013 Nationwide Inpatient Sample (NIS) using International Classification of Disease (ICD-9) codes. We estimated the proportion of CAS performed in all age groups and used multivariate models adjusted for clinical and hospital factors to compare odds of receiving CAS in the pre- to post-CREST era. Results: We identified 839,357 weighted cases of CAS and CEA from the NIS. 15.7% of CAS and 8.4% of CEA were performed in symptomatic pts. CAS increased in all age groups over time (figure 1). Proportion of >70yo receiving CAS increased from 11.9% in the pre- to 13.9% in the post-CREST era (p=0.004). In multivariate models, odds of receiving CAS as opposed to CEA increased by 15% in all pts >70yo in the post-CREST compared to the pre-CREST period (OR 1.15, 95%CI 1.10-1.19, p70yo, while female sex (OR 0.92, 95%CI =0.89-0.97), smoking (OR 0.84, 95%CI 0.79-0.90) and weekend admission (OR 0.78, 95%CI 0.70-0.86) were negatively associated with odds of CAS. Conclusion: Rates of CAS increased in the post- compared to pre-CREST era in pts >70yo including asymptomatic women. Despite the concerns of higher periprocedural complications with CAS in elderly pts, the results of CREST have not influenced clinical revascularization practice in pts >70yo

National Patterns of Carotid Revascularization Before and After the Carotid Revascularization Endarterectomy vs Stenting Trial (CREST)

The Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients younger than 70 years and carotid endarterectomy (CEA) in those older than 70 years. It is unknown how the result of CREST has influenced carotid revascularization choices in the United States. To evaluate national patterns in CAS performance in patients older than 70 years in the post-CREST (2011-2014) compared with the pre-CREST (2007-2010) era. All adults older than 70 years undergoing carotid revascularization in the United States from 2007 to 2014 were retrospectively identified from the 2007-2014 National Inpatient Sample using International Classification of Disease, Ninth Revision procedural codes. From 61 324 882 unweighted hospitalizations contained in the 2007-2014 National Inpatient Sample, 494 733 weighted carotid revascularization admissions in adults older than 70 years were identified using International Classification of Disease, Ninth Revision procedural codes. The proportion of CAS performed in all age groups over time was estimated and multivariable-adjusted models were used to compare the odds of receiving CAS in the pre-CREST with those in the post-CREST era in adults older than 70 years. A total of 41.8% of all patients were women, and mean (SE) age at presentation was 78.1 (0.03) years. A total of 16.3% of CAS and 10.1% of CEA procedures were performed in patients with symptomatic stenosis. The proportion of patients older than 70 years receiving CAS increased from 11.9% in the pre-CREST to 13.8% in the post-CREST era (P = .005). In multivariable models, the odds of receiving CAS increased by 13% in all patients older than 70 years in the post-CREST compared with the pre-CREST period (odds ratio [OR], 1.13, 95% CI, 1.00-1.28, P = .04), including symptomatic women (OR, 1.31, 1.05-1.65, P = .02). Symptomatic stenosis (OR 1.39; 95% CI, 1.27-1.52; P < .001), congestive heart failure (OR, 1.48; 95% CI, 1.35-1.63; P < .001), and peripheral vascular disease (OR, 1.35; 95% CI, 1.27-1.43; P < .001) were associated with higher odds of CAS; comorbid hypertension (OR, 0.70; 95% CI, 0.66-0.74; P < .001), smoking (OR, 0.84; 95% CI, 0.78-0.91; P < .001), and weekend admission (OR, 0.77; 95% CI, 0.68-0.88; P < .001) were negatively associated with the odds of CAS. Despite concerns for higher periprocedural complications with CAS in elderly patients, the odds of CAS increased in the post-CREST compared with pre-CREST era in patients older than 70 years, including symptomatic women