Toward the redesign of nutrition delivery.

In the facilitation of widespread access to low-cost, good tasting food, the global food system has relied on the use of fat, sugar, chemical processing aids and plastics, among other elements potentially detrimental to human health and the environment. This contrasts starkly with the strategies of natural nutrition delivery systems. Rich in vitamins, minerals, and other substances of functional benefit to human health, natural delivery systems, such as fruits and vegetables, retain their physical and chemical stability in a range of conditions over relatively long times through protective skins and shells that can either be eaten or degrade rapidly and fully in nature. Frequently natural foods can be delivered in small (even extremely small) portions, as with berries, insects, plankton and krill, permitting portion control and the rapid and efficient delivery of functional nutrition in inherently mobile circumstances. These and other qualities, which have insured the sustainable and healthy nourishment of animals and humans for at least tens of thousands of years, are often absent from today's man-made food and beverage delivery systems. With growing awareness of the liabilities to maintaining the food system of today, efforts are now underway to redesign nutrition delivery so as to provide the contemporary benefits of global access while retrieving the health and environmental benefits associated with natural delivery systems. We review these here, with special attention to recently commercialized nutritional delivery systems emerging from the drug delivery field aimed at reducing waste in food and beverage (nutritional aerosols) and eliminating waste in food and beverage packaging (edible skins). We briefly discuss the potential ramifications to how we will eat tomorrow.

Surgical interest and surgical match for third-year students: results of a prospective multivariate longitudinal cohort study.

BACKGROUND: Numerous factors have been linked to surgical career choice, including the quality of third-year surgical clerkship. The vast majority of studies also selectively evaluate one or only a few variables that link to surgical career choice, so relative impact cannot be assessed. This study simultaneously evaluates the majority of variables linked to surgical career choice in previous research so that the relative contributions of each of these variables with respect to surgical career choice can be determined. STUDY DESIGN: Surveys before, during, and after the third-year surgical clerkship included student demographics, background, and values (eg, importance of money, controllable lifestyle), and student reactions to the third-year surgical clerkship. The dependent variables in this study included interest in surgery at the beginning and end of the clerkship and matching into a surgical residency. RESULTS: Both univariate and multivariate analyses generally supported findings in the literature, but the strengths of these associations reported previously might not have been accurate. In this study, the surgical resident match odds ratio for students starting the clerkship already knowing they wanted to be a surgeon was 22.46; the next highest associations were 4.65 and 3.37, which corresponded to earlier exposure to a surgical specialty and earlier exposure to general surgery, respectively. Differences in career choice for general surgeons and surgical specialists were also explored. CONCLUSIONS: Although the experience of the clerkship is related to career choice, the largest impact of the clerkship is for those already interested in a surgical career. Interest in a surgical career largely develops before the third-year clerkship. Implications of the results for recruiting greater numbers of students into surgical careers are discussed.