Let Them Eat Cake? A Historical Analysis of FDA's Decision to Approve Aspartame

That sugar occupies a cherished role in the human diet hardly needs mention. After all, nearly 2,500 tastebuds located at the tip of the human tongue are dedicated to the pursuit of sweetness. The first recorded mention of sugar, a description of a crown of glistening sugar crystals, dates back to a sacred Hindu text from 800 B.C. Of course, the sumptuous deserts and candies which fulfill our sugar cravings come at a high caloric cost, a cost which has become less and less affordable to the growing millions who seek to watch their weight. As far back as the mid 1800's, people recognized the tension between the desire to eat delicious foods, and the often contravening desire to eat healthfully. It is not surprising, therefore, that the intersection of the dietary movement with the human sweet tooth would eventually lead to a demand for low calorie artificial sweeteners

Community Health Improvement and the Community Psychology Competencies

Community health improvement initiatives are strongly influenced by the local context in which they take place. Community coalitions of diverse stakeholders are expected to determine the needs of their population of interest, select an appropriate strategy, implement with quality, and evaluate for effectiveness. Many public health initiatives look toward behavioral scientists with experience in collaborating with community members. The competencies that community psychologists possess make them particularly useful contributors in these initiatives, especially when the projects explicitly focus on increasing health equity. This paper describes how community psychologists can contribute to community health improvement work by sharing our experiences in the Spreading Community Accelerators through Learning and Evaluation (SCALE) initiative funded by the Robert Wood Johnson Foundation. As part of SCALE, community coalitions are expected to develop appropriate aims and corresponding driver diagrams as well as implement quality improvement projects to help reach those aims. We demonstrate how community psychologists operationalize SCALE by working with communities of color in three distinct settings with different contextual factors: the Proviso Partners for Health (Chicago, IL), Boston Medical Center’s Vital Village Network (Boston, MA), and the San Gabriel Valley Healthy Cities Collaborative (Los Angeles, CA). We also describe how community psychologists contribute to the formative evaluation of the entire SCALE project. We note that specific community psychology competencies are applicable across diverse settings in community health improvement work. Consequently, community psychologists can contribute significantly to improving community health and advancing health equity

Community Health Improvement and the Community Psychology Competencies

Community health improvement initiatives are strongly influenced by the local context in which they take place. Community coalitions of diverse stakeholders are expected to determine the needs of their population of interest, select an appropriate strategy, implement with quality, and evaluate for effectiveness. Many public health initiatives look toward behavioral scientists with experience in collaborating with community members. The competencies that community psychologists possess make them particularly useful contributors in these initiatives, especially when the projects explicitly focus on increasing health equity. This paper describes how community psychologists can contribute to community health improvement work by sharing our experiences in the Spreading Community Accelerators through Learning and Evaluation (SCALE) initiative funded by the Robert Wood Johnson Foundation. As part of SCALE, community coalitions are expected to develop appropriate aims and corresponding driver diagrams as well as implement quality improvement projects to help reach those aims. We demonstrate how community psychologists operationalize SCALE by working with communities of color in three distinct settings with different contextual factors: the Proviso Partners for Health (Chicago, IL), Boston Medical Center’s Vital Village Network (Boston, MA), and the San Gabriel Valley Healthy Cities Collaborative (Los Angeles, CA). We also describe how community psychologists contribute to the formative evaluation of the entire SCALE project. We note that specific community psychology competencies are applicable across diverse settings in community health improvement work. Consequently, community psychologists can contribute significantly to improving community health and advancing health equity

Digital Mammography and Breast Tomosynthesis Performance in Women with a Personal History of Breast Cancer, 2007-2016

Background Since 2007, digital mammography and digital breast tomosynthesis (DBT) replaced screen-film mammography. Whether these technologic advances have improved diagnostic performance has, to the knowledge of the authors, not yet been established. Purpose To evaluate the performance and outcomes of surveillance mammography (digital mammography and DBT) performed from 2007 to 2016 in women with a personal history of breast cancer and compare with data from 1996 to 2007 and the performance of digital mammography screening benchmarks. Materials and Methods In this observational cohort study, five Breast Cancer Surveillance Consortium registries provided prospectively collected mammography data linked with tumor registry and pathologic outcomes. This study identified asymptomatic women with American Joint Committee on Cancer anatomic stages 0-III primary breast cancer who underwent surveillance mammography from 2007 to 2016. The primary outcome was a second breast cancer diagnosis within 1 year of mammography. Performance measures included the recall rate, cancer detection rate, interval cancer rate, positive predictive value of biopsy recommendation, sensitivity, and specificity. Results Among 32 331 women who underwent 117 971 surveillance mammographic examinations (112 269 digital mammographic examinations and 5702 DBT examinations), the mean age at initial diagnosis was 59 years ± 12 (standard deviation). Of 1418 second breast cancers diagnosed, 998 were surveillance-detected cancers and 420 were interval cancers. The recall rate was 8.8% (10 365 of 117 971; 95% CI: 8.6%, 9.0%), the cancer detection rate was 8.5 per 1000 examinations (998 of 117 971; 95% CI: 8.0, 9.0), the interval cancer rate was 3.6 per 1000 examinations (420 of 117 971; 95% CI: 3.2, 3.9), the positive predictive value of biopsy recommendation was 31.0% (998 of 3220; 95% CI: 29.4%, 32.7%), the sensitivity was 70.4% (998 of 1418; 95% CI: 67.9%, 72.7%), and the specificity was 98.1% (114 331 of 116 553; 95% CI: 98.0%, 98.2%). Compared with previously published studies, interval cancer rate was comparable with rates from 1996 to 2007 in women with a personal history of breast cancer and was higher than the published digital mammography screening benchmarks. Conclusion In transitioning from screen-film to digital mammography and digital breast tomosynthesis, surveillance mammography performance demonstrated minimal improvement over time and remained inferior to the performance of screening mammography benchmarks. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Moy and Gao in this issu

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Situation assessment in aircrews: A taxonomy for organizing cue-based information

The content of situation assessment is explored to develop an understanding of the cues that pilots process when constructing a mental representation of a situation. Tools for cognitive task analysis were used to elicit information from 46 military pilots from five different aircraft communities about critical cues that contribute to the development and maintenance of situation assessment. The results were used to develop a taxonomy of cues that are critical in the process of situation assessment

Geographic analysis of latent tuberculosis screening: A health system approach.

BackgroundNovel approaches are required to better focus latent tuberculosis infection (LTBI) efforts in low-prevalence regions. Geographic information systems, used within large health systems, may provide one such approach.MethodsA retrospective, cross-sectional design was used to integrate US Census and Duke Health System data between January 1, 2010 and October 31, 2017 and examine the relationships between LTBI screening and population tuberculosis risk (assessed using the surrogate measure of proportion of persons born in tuberculosis-endemic regions) by census tract.ResultsThe median proportion of Duke patients screened per census tract was 0.01 (range 0-0.1, interquartile range 0.01-0.03). The proportion of Duke patients screened within a census tract significantly but weakly correlated with the population risk. Furthermore, patients residing in census tracts with higher population tuberculosis risk were more likely to be screened with TST than with an IGRA (pConclusionThe weak correlation between patient proportion screened for LTBI and our surrogate marker of population tuberculosis risk suggests that LTBI screening efforts should be better targeted. This type of geography-based analysis may serve as an easily obtainable benchmark for LTBI screening in health systems with low tuberculosis prevalence