Evaluation of Simulated Shelf-Life Conditions for Food Service Applications on Chicken Tenderloins.

The objective of this study was to validate the shelf-life of marinated and frozen chicken tenderloins. Treatments were randomly assigned to the age of the tenderloins post-harvest, days aged (DA): DA4, DA5, DA6, DA7, and DA8. Microbial analyses were used to analyze the growth of aerobic, psychotropic, and lactobacilli bacteria to assess the shelf-life of bulk-packaged chicken tenderloins. Tenderloins were sampled fresh, then vacuum tumbled in a marinade. After marination, the tenderloins were sampled with the remaining tenderloins packaged and frozen (-25 °C). After freezing the chicken tenderloins were slacked in a refrigerated cooler (2.2 °C) for up to 132 h (h) and sampled at 36 h, then every 24 h following. After marination, each treatment significantly (p < 0.05) decreased in aerobic and psychotropic counts except DA4. During slacking, no treatment crossed the threshold of 106 CFU/mL (Log 6) set for this study. Though none crossed the threshold, treatments DA4, DA5, and DA6 had significant (p < 0.05) increases in aerobic bacteria after 7 days of age. The psychotropic bacteria continuously grew at each sampling period, with DA4 and DA5 surpassing the other treatments (p < 0.05) at 108 h and 132 h reaching 105 CFU/mL. Every treatment remained below the spoilage threshold, suggesting that this method of storage is suitable for chicken tenderloin shelf-life.

Impact of Packaging Film and Beef Trimmings on Ground Beef Shelf Life.

Fresh beef storage in the retail setting can be presented in a variety of packaging methods, and identifying an alternative such as vacuum packaging to current traditional methods could potentially increase shelf life and reduce meat waste. The objective of this study was to identify the influence of packaging film and lean trimming sources on fresh ground beef surface color during a simulated retail display period. There were no differences (p > 0.05) in surface color redness (a*), yellowness (b*), chroma, or hue angle regardless of packaging film or lean trimmings. However, thiobarbituric acid reactive substances (TBARS) were greater (p < 0.05) for packages containing a greater percentage of CULL beef trimmings regardless of packaging film. In addition, pH values of ground beef packages did not differ (p > 0.05) among packaging film or lean trimming blends. Visual color did not differ (p > 0.05) throughout the simulated retail display period regardless of beef trimmings or packaging film. Microbial spoilage organisms were greater (p < 0.05) after the simulated display period. These results suggest that ground beef presented in a simulated retail setting using an alternative packaging platform, such as vacuum packaging, is plausible.

A Randomized Trial Comparing Outcomes of 3 Types of Peripheral Intravenous Catheters.

BACKGROUND: There was an increase in peripheral intravenous catheter (PIVC) complications and adverse patient events after product conversion during the merger between a rural hospital and a larger hospital system. A review of the existing literature identified a gap in evidence evaluating 2 closed PIVC systems compared with an open PIVC system. PURPOSE: The purpose of the current project was to ascertain whether open or closed PIVCs are best for patients, staff, and the health care system in terms of 3 main criteria: quality, safety, and cost. METHODS: A prospective, 2-site randomized controlled trial was used to compare outcomes. RESULTS: There were no differences in the complication rates between catheter types. There was a statistically significant increase in blood leakage and a decrease in clinician satisfaction with the open-system catheter. CONCLUSIONS: Our project supports current clinical recommendation that a closed PIVC system, regardless of type, is not only safer and cost-effective but also preferred by patients and clinicians.

We Run This City: Impact of a Community-School Fitness Program on Obesity, Health, and Fitness.

INTRODUCTION: The We Run This City (WRTC) Youth Marathon Program is a community-supported, school-based fitness program designed to increase physical activity in a large, urban school district by engaging middle school youth to train 12 to 14 weeks to run or walk 1.2 miles, 6.2 miles, or 13.1 miles of the Rite Aid Cleveland Marathon. The objective of our study was to evaluate the effect of the intervention on adolescent health. METHODS: We assessed changes in obesity, health, and fitness, measured before training and postintervention, among 1,419 sixth- to eighth-grade students participating in WRTC for the first time, with particular interest in the program's effect on overweight (85th-94th body mass index percentile) or obese (≥95th percentile) students. We collected data from 2009 through 2012, and analyzed it in 2016 and 2017. Outcomes of interest were body mass index (BMI), waist-to-hip ratio (WHR), elevated blood pressure, and fitness levels evaluated by using the Progressive Aerobic Cardiovascular Endurance Run (PACER) test and the sit-to-stand test. RESULTS: We saw significant improvements overall in fitness and blood pressure. Controlling for demographics, program event, and training dosage, BMI percentile increased among normal weight participants and decreased among overweight and obese participants (P < .001). WHR increased among obese participants, whereas reductions in blood pressure among those with elevated blood pressure were associated with higher amounts of training and lower baseline BMI. CONCLUSION: Even small amounts of regular physical activity can affect the health and fitness of urban youths. School-community partnerships offer a promising approach to increasing physical activity by supporting schools and making a school-based activity inclusive, fun, and connected to the broader fitness community.

Cigar Product Modification Among High School Youth.

Introduction: Prevalence of cigar use has been increasing among youth. Research indicates that youth are modifying cigar products either by "freaking" (ie, removing the filter paper) or "blunting" (removing the tobacco and supplementing or replacing with marijuana), yet little is known about youth who engage in this behavior. Thus, this study examines demographic and concurrent substance use behaviors of youth who modify cigars. Methods: Data from the 2013 Cuyahoga County Youth Risk Behavior survey were examined (n = 16 855). The survey collected data on demographics, cigar product use, cigar modification behaviors, and current cigarette, hookah and marijuana use. Responses to cigar product use items were used to create a composite to classify youth in one of eight unique user categories. Univariate and bivariate statistics were calculated using SPSS complex samples procedures. Results: Overall, 15.2% reported current cigar product use, 11.0% reported current freaking, and 18.5% reported current blunt use; taken together, 25.3% of respondents reported any current use of a cigar product. When examined by user category, of those who endorsed any cigar product use, cigars, cigarillos, and little cigars use only was most endorsed (26.3%), followed by Blunt only (25.2%) and all three (ie, cigars, cigarillos, and little cigars, freaking, and blunting; 17.4%). Conclusion: A substantial proportion of high school youth who report using cigar products are modifying them in some way, with nearly half freaking and nearly two-thirds blunting. Given the FDA Center for Tobacco products recent extension of its regulatory authority to include cigar products, it is imperative to understand more about the prevalence of and reasons for cigar modification behaviors. Implications: Although the FDA has recently enacted regulatory authority over cigar products, little is known about cigar product modification. This is the first study to concurrently examine two unique cigar modification behaviors, "freaking" (ie, removing the filter paper) and "blunting" (removing the tobacco and supplementing or replacing with marijuana). A significant proportion of high school youth are modifying cigar products to be used as a tobacco product and as a mechanism to smoke marijuana. More research is needed to understand these behaviors to prevent and reduce the use of cigar products among youth.

Food Melt in Consumer Food Environments in Low-income Urban Neighborhoods.

OBJECTIVES: We systematically evaluated changes in availability, price, and quality of perishable food items from the beginning to the end of the month in lowincome, urban neighborhoods. METHODS: The sample included grocery stores or supermarkets in Cleveland, Ohio, within neighborhoods with >30% of population receiving food assistance. We collected data for 2 sequential months during the first and fourth weeks of each month. Two coders evaluated stores, collecting measures of availability, price, and quality for 50 items. We examined difference in number and proportion of items available at the beginning of the month (BOM) to items remaining available at the end of the month (EOM), as well as quality and price of those items. RESULTS: Across 48 stores, availability at EOM was lower than BOM; as store size increased, reduction in availability (ie, food melt) was significantly (p < .01) less pronounced. Overall, items became less expensive at the EOM whereas quality remained consistent; we noted no statistically significant differences by store type for price or quality. CONCLUSIONS: Food melt differentially affects individuals in neighborhoods without grocery stores. Findings reveal composition of food environments is dynamic rather than static, influencing food-purchasing choices among lowincome consumers.

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:: A Cross-sectional Study.

INTRODUCTION: Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them. METHODS: Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014. RESULTS: Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only. CONCLUSIONS: These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.

Individual, Parental, and Environmental Correlates of Cigar, Cigarillo, and Little Cigar Use Among Middle School Adolescents.

INTRODUCTION: Youth use of cigars, cigarillos, and little cigars (CCLC) is increasing. While correlates of cigarette smoking have been well documented, use of CCLC is not as well understood among young adolescents. This study assessed whether smoking beliefs, parenting practices, and environmental exposures were associated with CCLC use among 7th to 8th grade youth in an urban, mid-Western city. METHODS: The Cleveland Youth Risk Behavior Survey was conducted with 7th to 8th grade students in spring 2012. CCLC use was assessed by asking if students had smoked CCLC in the past 30 days. Covariates include self-reported gender, race, grade, acceptability of smoking, parental monitoring, hours of self-care, visits to corner stores, and current cigarette smoking. Bivariate and multivariate analyses were conducted to determine associations with current CCLC use. RESULTS: Overall, 14.3% of youth reported current CCLC use. Students reporting higher acceptability of smoking, lower parental monitoring, longer periods of self-care, more visits to corner stores and current cigarette smoking were more likely to report current CCLC use in both bivariate and multivariable logistic regression models. CONCLUSIONS: CCLC use is associated with multiple levels of influence, indicating that prevention of youth CCLC use must utilize a multilevel approach. Increased utilization of corner stores was associated with higher odds of CCLC use, and could indicate that youth stopping at corner stores may be exposed to increased tobacco retail advertising and tobacco products. The findings of this study have implications for FDA regulation to prevent CCLC initiation among youth. IMPLICATIONS: While correlates of cigarette smoking have been well documented, use of CCLC is not as well understood among young adolescents. This is the first study that has examined the association between individual, family, and environmental characteristics and CCLC use. The results of this study illustrate that youth attitudes, perceived parenting practices, and environmental exposure are associated with adolescent CCLC use. This is important as the tobacco control community begins to identify strategies to prevent and reduce CCLC use. The findings of this study have clear implications for FDA regulation to prevent CCLC initiation among youth.

Active Duty Women's Perceptions of Breast-Feeding Support in the Military Setting.

BACKGROUND: The purpose of this study is to evaluate the current perceptions of breast-feeding support for active duty women serving in the U.S. Armed Forces. METHODS: An online survey based on the Workplace Breastfeeding Support Scale (WBSS) was used to collect data from active duty military mothers. Data were collected and analyzed using SPSS software to evaluate active duty women's perceptions of breast-feeding support in the military. RESULTS: 318 active duty women participated in the online survey. The average WBSS scores for active duty women was 50.20 (SD = 15.75). Comparing WBSS scores and branch of service, women in the Army had significantly lower WBSS scores (M = 45.85) then women in the Air Force (M = 53.96, p < 0.001). Enlisted women had significantly lower scores (M = 47.12) than officers (M = 54.62, p < 0.001). Also noted were significantly lower scores of active duty women who were Hispanic (M = 44.30) and women who had lower levels of education (M = 46.90, p = 0.006). CONCLUSIONS: The Department of Defense may be able to improve breast-feeding rates for all active duty mothers by implementing and adhering to lactation policies and focusing support efforts for enlisted women in all branches of service.

Effectiveness of health education teachers and school nurses teaching sexually transmitted infections/human immunodeficiency virus prevention knowledge and skills in high school.

BACKGROUND: We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) curriculum, Be Proud! Be Responsible!, when taught by school nurses and health education classroom teachers within a high school curricula. METHODS: Group-randomized intervention study of 1357 ninth and tenth grade students in 10 schools. Twenty-seven facilitators (6 nurses, 21 teachers) provided programming; nurse-led classrooms were randomly assigned. RESULTS: Students taught by teachers were more likely to report their instructor to be prepared, comfortable with the material, and challenged them to think about their health than students taught by a school nurse. Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention, compared to controls. Yet, those taught by school nurses reported significant and sustained changes (up to 12 months after intervention) in attitudes, beliefs, and efficacy, whereas those taught by health education teachers reported far fewer changes, with sustained improvement in condom knowledge only. CONCLUSIONS: Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students; however, teaching the technical (eg, condom use) and interpersonal (eg, negotiation) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have.

Patient care staffing levels and facility characteristics in U.S. hemodialysis facilities.

BACKGROUND: Higher numbers of registered nurses (RNs) per patient have been associated with improved patient outcomes in acute-care facilities. Variation in and associations of patient care staffing levels and hemodialysis facility characteristics have not been examined previously. STUDY DESIGN: Cross-sectional study using Poisson regression to examine associations between patient care staffing levels and hemodialysis facility characteristics. SETTING & PARTICIPANTS: 4,800 US hemodialysis facilities in the 2009 Centers for Medicare & Medicaid (CMS) End-Stage Renal Disease Annual Facility Survey (CMS-2744 form). PREDICTORS: Facility characteristics, including profit status, freestanding status, chain affiliation, and geographic region, adjusted for facility size, capacity, functional type, and urbanicity. OUTCOMES: Patient care staffing levels, including ratios of RNs, licensed practical nurses (LPNs), patient care technicians (PCTs), composite staff (RN + LPN + PCT), social workers, and dietitians to in-center hemodialysis patients. RESULTS: After adjusting for background facility characteristics, ratios of RNs and LPNs to patients were 35% (P < 0.001) and 42% (P < 0.001) lower, respectively, but the PCT to patient ratio was 16% (P < 0.001) higher in for-profit than nonprofit facilities (rate ratios of 0.65 [95% CI, 0.63-0.68], 0.58 [95% CI, 0.51-0.65], and 1.16 [95% CI, 1.12-1.19], respectively). Regionally, compared to the Northeast, the adjusted RN to patient ratio was 14% (P < 0.001) lower in the Midwest, 25% (P < 0.001) lower in the South, and 18% (P < 0.001) lower in the West. Even after additional adjustments, the large for-profit chains had significantly lower RN and LPN to patient ratios than the largest nonprofit chain, but a significantly higher PCT to patient ratio. Overall composite staffing levels also were lower in for-profit and chain-affiliated facilities. The patterns hold when hospital-based units were excluded. LIMITATIONS: Nursing hours were not available. Two part-time staff were counted as one full-time equivalent, which may not always be accurate. CONCLUSIONS: The significant variation in patient care staffing levels and its associations with facility characteristics warrants inclusion in future large-scale hemodialysis outcomes studies. End-stage renal disease networks and hemodialysis facilities should attend to quality assurance and performance improvement initiatives that maximize licensed nurse staffing levels in hemodialysis facilities.