Quantitative effects of formulation and process parameters on the structure of food emulsions stabilized with an unrefined by-product powder: A statistical approach

Apple pomace powder is a sustainable food ingredient, but its more complex composition compared to commonly purified ingredients could curb its valorization. This study assesses how physicochemical properties, formulation and process factors influence the physical properties of the emulsion. The two main objectives were to: 1) unravel the structuring and stabilizing mechanisms of such complex systems and 2) account for interactions between various parameters instead of studying them separately. Thirty-one experimental samples were formulated to produce a variety of microstructures with droplet diameters ranging from 28 to 105 µm, textures with viscosity ranging from 135 to 2,490 mPa.s at 50 s-1 and stabilities. Using multicriteria selection of effects revealed that the concentration of the powder and the size of solid particles are the main levers for tailoring the structure-function relationships of the emulsions. Solid particles play a key role in both structuring and stabilizing the emulsions. Process parameters have an impact on the emulsification step by modifying the adsorption rate of solid particles. In conclusion, modelling advanced our understanding of stabilizing mechanisms of the emulsions produced by apple pomace and will enable efficient knowledge transfer for industrial applications.

Lip color diversity: An intricate study

BACKGROUND

Lip investigations and characterizations in the literature are less prevalent than for skin, particularly on the topic of color diversity. However, as the consumer demand increases for a nude lip makeup result, that is, shades close to the bare lip color, the identification and modification of lip color is essential for the cosmetic industry.

OBJECTIVE

The objective was to highlight lip color diversity among three ethnicities (Caucasian, African and Hispanic), through the use of a spectral color measurement device especially adapted to the lip area, and to consider lip color ethnic specificities and overlaps.

MATERIALS AND METHODS

The inferior natural lip color was measured with a full-face hyperspectral imaging system, SpectraFace (Newtone Technologies, Lyon, France), on 410 healthy women aged 19 to 68 (Caucasian French, Caucasian American, African American, and Hispanic American women). A hierarchical ascending classification, was deployed to determine clusters based on the lip colorimetric parameters along two strategies to identify the best statistical analysis to preserve the lip color diversity.

RESULTS

Lip color is a continuous color space, with great intra-ethnic and inter-ethnic diversity, especially for African American women in terms of chroma and lightness. Among the two strategies of data analysis, our two-step statistical clustering analysis yielded 11 groups (i.e., 11 lip tones), revealing an accurate representation of the scope of diversity, but also of the overlaps.

CONCLUSION

The 11 lip tones/colors could potentially serve as target shades for the development of a more diverse and inclusive range of lip cosmetics, such as nude lipsticks.

Effect of perceptive enrichment on the efficiency of simulated contexts: Comparing virtual reality and immersive room settings

This study was designed within the methodological framework of sensory and consumer sciences, where conventionally internal and external validity are approached separately (e.g. CLT vs HUT). Here is explored the added value of new immersive strategies, such as virtual reality, on their ability to achieve both: internal and external validity. This article presents a comparative study between different experimental setups, involving more than 270 consumers. Two different immersive setups were appraised, simulating the consumption episode 'eating a sandwich for lunch in a park': a context room (N = 57) and a VR environment (N = 55). We added two control conditions: a real park in summer (N = 56) and scenario-only in sensory booths (duplicated condition, N1 = 59, N2 = 52). A set of sandwiches were evaluated in a between-participants design, with one duplicated recipe for a reliability assessment. Participants evaluated samples on hedonic criteria and closed the experiment with a questionnaire measuring their level of immersion. After classification of the questionnaire variables, seven underlying dimensions were identified, with significant differences between conditions on the credibility of the environment and the scenario. As expected, with strong external validity, the simulated environments were more immersive than the conventional booth with scenario and less immersive than a real-life environment. Although the immersive conditions did not stand out from the other conditions on the product evaluation performance, all the conditions revealed a high level of internal validity. Mean scores and rankings of the products, participants' repeatability and discriminatory power remained comparable to the real park environment indices.

Putting Medicare Spending for COVID-19 Into Perspective

Tsai and colleagues used Medicare claims data to examine the characteristics and medical spending of older adults diagnosed with COVID-19 from April through December 2020. The editorialists discuss how the study sheds light on COVID-19's effect on medical care and lays the groundwork for future research.

To keep or not to keep? Sorting out leftovers from a refrigerator

Most literature on food waste shows that food that ends up in the garbage can is often no longer considered as enjoyable, or even as edible. In this paper, we decided to focus on assessments of whether leftover food is still considered as worth eating, to provide a better understanding of the production of domestic food waste. We constructed a pluridisciplinary approach, combining sensory analysis and sociology. The first part was conducted in a test kitchen under controlled conditions: 50 participants had to sort out and decide to keep or to throw away different types of refrigerated leftovers. The second part used in-depth interviews with half of these participants (N = 25) to explore their food habits and perceptions and handling of leftovers at home. The first section of the paper presents the theoretical framework of the study, which is grounded in practice theory. Then we detail the methodology and the results. We show that sorting out leftovers is a process mobilizing embodied knowledge and resulting from domestic practices implemented to avoid waste, such as storing or reusing leftovers. In the discussion, we analyze the sorting of refrigerated food products as a compound practice, situated at the intersection of provisioning, cooking, meal organization, and judgment of taste (Warde, 2013). Using this theoretical framework enables us to understand the heterogeneity observed in the outcome of the sorting process as the result of its weak degree of regulation. The sorting out practice is thus consistent with different modes of engagement such as food waste prevention, health maintenance, or providing enjoyable family meals. We conclude by providing suggestions of policy recommendations regarding domestic refrigeration, food storage, and assessment practices.

Critical review of sensory texture descriptors: From pureed to transitional foods for dysphagia patients

Dysphagic people need to change their diet to avoid pain or risk of choking. For example, they can eat texture modified foods (including pureed and transitional foods, that is, food that start with one texture and change into another because of moisture or heating). Simple testing methods proposed by the IDDSI initiative can be performed to characterize texture modified food but these methods are not always relevant for understanding oral texture and mouthfeel properties. Sensory characterization is essential to develop or optimize a food product and to meet consumer's expectations and needs especially for dysphagic persons. However, sensory methods and texture descriptors are complex to target and evaluate for different severity of dysphagia. Sensory texture descriptors can be determined by different methods and assessed in different ways. This review is useful for listing the sensory methods used to generate sensory descriptors to characterize the oral texture of cereal and pureed foods. We found that 55% of the reviewed publications used specific oral texture descriptors and that 17 descriptors could be identified as the most used and relevant for all the products studied (sticky), for pureed (e.g., cohesiveness, floury, and soft) and for cereal-based foods (e.g., hard, fatty, and crispy). These results should be considered to facilitate the choice of sensory texture descriptors in future studies on pureed and transitional foods such as cereal-based foods according to the IDDSI level. This review also demonstrates that it is difficult to find a consensus between studies using different evaluation methods for the same descriptor.

P14.79 Randomized phase II trial of Tumor Treating Fields plus radiation therapy plus temozolomide compared to radiation therapy plus temozolomide in patients with newly diagnosed glioblastoma

BACKGROUND

In last decade, there were numerous attempts to improve the outcome of patients with glioblastoma (GBM), but even after maximal surgical resection, radiation therapy (RT) and temozolomide (TMZ), followed by maintenance TMZ for 6 months the median OS is 14.6 months. In the EF-14 Phase III trial, the addition of Tumor Treating Fields (TTFields) at 200 kHz to maintenance TMZ increased the median OS to 20.9 months, compared with 16.0 months with maintenance TMZ alone (HR, 0.63; 95% CI, 0.53–0.76; p<0.001). Based on these results, the currently accepted standard of care for newly diagnosed GBM (ndGBM) is surgical resection if safely feasible, followed by RT with concomitant TMZ, and then followed by maintenance TMZ in combination with TTFields. Preclinical investigations have shown a radio-sensitizing effect of TTFields on glioma cells, suggesting synergistic effects between TTFields and radiotherapy. In a pilot study of 10 patients with ndGBM, we demonstrated that there was no increased treatment-related toxicity when TTFields were given in combination with RT/TMZ. The only TTFields-related adverse event was skin toxicity below the arrays. Preliminary progression free survival (PFS) data was encouraging. Based on the results of the pilot study, we designed this prospective, randomized Phase II study to further investigate if the addition of TTFields TMZ/RT treatment in ndGBM patients improves treatment efficacy and delays disease progression.

MATERIAL AND METHODS

Following debulking surgery or biopsy, 60 adult patients (≥18 years) with histologically confirmed GBM, KPS≥70 and life expectancy of at least 3 months will be randomized 1:1 to either a) RT with concomitant TMZ and TTFields (200 kHz) for 6 weeks followed by up to 6 months of maintenance TMZ in combination with TTFields (experimental arm) up to 24 months; or b) RT with concomitant TMZ alone followed by maintenance TMZ in combination with TTFields (control arm). Exclusion criteria: patients with early progressive disease, significant comorbidities precluding maintenance RT or TMZ or patients with an implanted electronic device. The primary endpoint is progression free survival at 12 months (PFS12). Treatment with TTFields will be continued until second progression or 24 months (the earlier of the two). All patients will be followed for survival. Grading and severity of all adverse events will be recorded using CTCAE V5.0. The sample size of 60 patients provides 80% power with a two-sided alpha level of 0.05 to detect a PFS12 of 46.5% with RT/TMZ/TTFields compared to 29.4% with RT/TMZ followed, respectively, by maintenance TMZ/TTFields (calculated from the RT/TMZ followed by maintenance TMZ/TTFields arm of the EF-14 trial). It is forecasted to take 24 months to fully recruit. Follow-up will continue for >12 months from recruitment of the last patient.

P14.71 Tumor Treating Fields combined with radiotherapy and temozolomide for newly diagnosed glioblastoma: final safety and efficacy results from a pilot study

BACKGROUND

Tumor Treating Fields (TTFields) are a non-invasive, loco-regional, anti-mitotic treatment consisting of low intensity alternating electric fields. The combination of TTFields with maintenance temozolomide significantly improved survival versus temozolomide alone in the phase 3 EF-14 study in newly diagnosed glioblastoma (ndGBM). In preclinical studies, TTFields increased the number of glioma cells undergoing cellular death following radiotherapy (RT) by inhibiting DNA damage repair, suggesting a radio-sensitizing effect of TTFields. This pilot study is the first to evaluate the safety and feasibility of administering TTFields concomitant to RT and TMZ in ndGBM patients.

MATERIAL AND METHODS

Patients diagnosed with ndGBM were treated with TTFields/RT/TMZ followed by maintenance TMZ and TTFields for up to 24 months. TTFields (200kHz) were delivered for >18 hours/day while the transducer arrays were removed during delivery of RT. TMZ was administered at a dose of 75 mg/m2/daily for 6 weeks and RT at a total dose of 60 Gy. The primary endpoint was safety of the combined TTFields/RT/TMZ; secondary endpoints included progression-free survival (PFS), overall survival (OS) and toxicity. Adverse events (AEs) were graded according to CTCAE V4.0.

RESULTS

10 ndGBM patients that recovered from maximal debulking surgery or biopsy were enrolled at a single center in Israel between April and December 2017. Five patients (50%) had undergone gross total resection while the rest had biopsy only. Eight of the patients were male, median age was 59, median KPS was 80 and median dose of RT was 60 Gy. Six patients (60%) reported at least one AE. The most common AE was TTFields-related skin toxicity, reported in four patients (40%), all of which were grade 1–2 in severity. Two patients reported serious AEs (seizures and general deterioration) that were considered unrelated to TTFields. Median PFS with RT/TMZ/TTFields was 10.5 months. Median OS has not yet been reached.

CONCLUSION

The proportion of patients with TTFields-related skin toxicity was similar to that reported in ndGBM patients in the randomized Phase III study (52%), where patients started TTFields at least 4 weeks after RT. No other TTFields-related toxicities were reported and there were no increase in RT- or TMZ-related toxicities as a result of combining TTFields with RT in addition to TMZ. Based on the safety and preliminary efficacy results of this pilot study, a phase II randomized study has been initiated to investigate the efficacy of concomitant RT/TMZ/TTFields in 60 ndGBM patients.

The Arc Of History Bends Toward Coverage: Health Policy At A Crossroads

There is a formidable historical arc to health care policy: Every modern US president has sought to expand coverage. Democrats eagerly placed the issue on the agenda. Republicans vociferously opposed Democratic proposals but countered with creative ways to expand coverage on their own terms. Democrats eventually absorbed elements of the latest Republican plan-which Republicans, in turn, attacked, and the cycle began anew. The dynamic interaction between the parties slowly, often haphazardly, expanded health insurance as each sought to extend coverage in its own way. We speculate about whether the recent Republican efforts to repeal the Affordable Care Act constitute a sharp break with the past, perhaps because opposition to government, exacerbated by racial anxieties, has changed the Republican calculus. Alternatively, there are still some reasons to conclude that the arc of health policy continues to bend toward increasing coverage.

Academic Medical Centers and High-Need, High-Cost Patients: A Call to Action

Health care delivery systems, including academic medical centers (AMCs), are increasingly focused on improving care for vulnerable, high-need, high-cost patients, in part because value-based payment models offer the promise of financial returns, or the avoidance of losses, for doing so. AMCs and other providers that have participated in Medicare and Medicaid demonstrations and value-based payment programs have important insights to offer about the features of successful and promising programs for high-need, high-cost patients. As more AMCs embrace value-based payment, they may have greater flexibility to provide services that address the medical and nonmedical needs of clinically complex patients and thereby reduce avoidable health care utilization. AMCs have many opportunities to create high-performing health systems, establish operational evidence for how to transform delivery systems, and train the next generation of providers to better address the care of high-need, high-cost individuals.

Effect of Bread Crumb and Crust Structure on the in Vivo Release of Volatiles and the Dynamics of Aroma Perception

This study examined the effects of bread crumb and crust structure on volatile release and aroma perception during oral processing. French baguettes with different crumb structures were procured from a supermarket or local bakeries (n = 6) or produced in the laboratory via par baking (n = 3). Eight study participants consumed crumb-only and crumb-and-crust samples, and the resulting volatile release was measured in vivo using proton transfer reaction-mass spectrometry. A statistical model was then used to examine the contributions of volatile compounds to target ion production (i.e., crumb or crust markers). Utilizing the three laboratory-produced breads, chewing behavior and aroma perception were measured via electromyography and the temporal dominance of sensations method, respectively. The results revealed that the initial levels of crumb markers as well as crumb firmness affected the crumb markers release. Crust markers were released more quickly than crumb markers, leading to different perception dynamics.

How Medicaid Enrollees Fare Compared with Privately Insured and Uninsured Adults: Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016

ISSUE: The number of Americans insured by Medicaid has climbed to more than 70 million, with an estimated 12 million gaining coverage under the Affordable Care Act’s Medicaid expansion. Still, some policymakers have questioned whether Medicaid coverage actually improves access to care, quality of care, or financial protection. GOALS: To compare the experiences of working-age adults who were either: covered all year by private employer or individual insurance; covered by Medicaid for the full year; or uninsured for some time during the year. METHOD: Analysis of the Commonwealth Fund Biennial Health Insurance Survey, 2016. FINDINGS AND CONCLUSIONS: The level of access to health care that Medicaid coverage provides is comparable to that afforded by private insurance. Adults with Medicaid coverage reported better care experiences than those who had been uninsured during the year. Medicaid enrollees have fewer problems paying medical bills than either the privately insured or the uninsured.