Co-Design of a Weekly Meal Box for Neurological Conditions: Findings From Consumer and Healthcare Provider Collaborative Workshops.

BackgroundCooking and consuming a homemade meal is associated with health benefits. Home-delivered meal boxes can support families in cooking this fresh meal. The current study aimed to gain a deeper understanding of the determinants of meal box use, and of the perceived impact on meal practices of parents with younger (i.e., aged 6–12 years) and older children (i.e., 13–18 years).MethodsFour focus groups were conducted (n = 19); two with parents of younger children, and two with parents of older children. A semi-structured interview guide was developed and interviews were recorded and transcribed. Reflexive thematic analysis was performed using NVivo 1.4.ResultsMost parents mentioned practical reasons like saving time and money, as well as inspiration, as reasons to choose a home-delivered meal box. Also, tastiness and menu variation were often mentioned as determining factors by both parent groups. However, a few parents stated to stop using the meal boxes because of returning menus or too small portion sizes. Meal box providers were chosen based on the price, the freshness and the quality of the products. Moreover, positive effects on parents’ perceived cooking skills and knowledge were reported. Also, some parents mentioned positively changed attitudes towards vegetarian dishes. Lastly, parents reported healthier eating due to more appropriate portion sizes and more vegetables. A prominent difference between parent groups was that older children played a role in continuing the use of meal boxes, and helped to prepare the meals (contrary to younger children).ConclusionsHome-delivered meal boxes might be promising to enhance families’ meal practices. This study could inform social marketeers and health promotors to adopt an optimal strategy to reach families.

Household food waste is determined by a complex set of routinized behaviors, and disruption of these routines may allow for a decrease in this vast amount of food waste. The current study examines such a disruption of household routines: the meal box. The potential of meal boxes to diminish different types of household food waste is investigated for the first time, across different countries. After providing a framework comparing the effects of different types of meals on food waste, we subsequently examine the effects of subscription-based food supply (i.e., meal boxes) on total meal waste as well as on the different types of food waste: preparation, cooking, and plate waste. Our dataset contains 8747 meal observations from 955 households in six countries. Results from a Bayesian multilevel hurdle-lognormal model with random intercept show that, overall, meal boxes reduce total meal waste in comparison to traditionally cooked dinners (38% reduction). Meal boxes especially lower the occurrence and amount of pan-and-pot food that is wasted (i.e., cooking waste), and also lower the amount of meal preparation waste, yet lead to a higher occurrence of both preparation and plate waste compared to traditional meals. This shows how differences between meals affect household food waste, something that has received little prior research attention. Furthermore, whereas most prior research has focused on overall household food waste, our study illustrates that distinguishing between different types of household food waste can provide important new insights.

People with neurological conditions may face barriers to meal preparation. Culinary nutrition interventions aim to facilitate the building of knowledge and skills for meal preparation. This scoping review aims to map the available evidence for culinary nutrition interventions for people with neurological conditions and evaluate the quality of these interventions based on program design, delivery and evaluation. After a systematic search of online databases (MEDLINE, CINAHL, Embase, Scopus and Proquest) and reference lists, a total of ten publications describing nine interventions were included. Most interventions were designed for people with stroke and/or Transient Ischemic Attack (n = 3) and Multiple Sclerosis (n = 3); others were for traumatic brain injury (n = 1), mild dementia (n = 1) and Parkinson's Disease (n = 1). Overall, the included culinary nutrition interventions had good program delivery (inclusion of motivational experiences, delivered by appropriate health providers) but needed improvements in program design (lack of consumer engagement and neurological symptom accommodations) and evaluation (lack of complete process, outcome and impact evaluations). In conclusion, the evidence base for culinary nutrition interventions for people with neurological conditions remains sparse. To bridge the gap between theory and practice, it is important to consider the following aspects in culinary nutrition intervention planning/improvement: (I) the involvement of consumers; (II) the accommodation/tailoring for post-condition effects; and (III) the coverage of all disease-specific culinary nutrition aspects.

To develop a core outcome set (COS) for evaluating gastrostomy/gastrojejunostomy tube impact in children with neurological impairment. Healthcare providers/researchers and caregivers rated the importance of candidate outcomes on a 5-point Likert scale. Outcomes rated 'somewhat important' or 'very important' by most (≥85%) respondents were voted on during a consensus meeting. Outcomes that reached consensus for inclusion were ratified and assigned to Outcome Measures in Rheumatology filter core areas. The COS was validated in a separate group of caregivers. Twelve outcomes were selected from 120 candidate outcomes to form the COS. These included five 'Life Impact' outcomes, three 'Pathophysiological Manifestations' outcomes, two 'Resource Use' outcomes, one 'Growth and Development' outcome, and one 'Death' outcome. We developed an evidence-informed and consensus-based COS for use in studies of gastrostomy/gastrojejunostomy tube feeding in children with neurological impairment. Implementation of this COS will help reduce heterogeneity between studies and facilitate evidence-based decision-making. Caregivers, healthcare providers, and researchers ranked the importance of 120 outcomes. Twelve core outcomes were identified as essential to measure in future clinical research studies.

Accurate, clinically meaningful outcome measures that are responsive to change are essential for selecting interventions and assessing their effects. Little guidance exists on the selection and administration of neurological impairment tests in children with a neurological condition. Clinicians therefore frequently modify adult assessments for use in children, yet the literature is inconsistent. This study aims to establish consensus on neurological conditions most likely to require neurological impairment test in pediatrics and the barriers, enablers, and modifications perceived to enhance test reliability. Over a 2-round modified Delphi study, a panel of experts (n=24) identified neurological conditions perceived to typically require pediatric neurological testing and the modifications to address barriers/enablers to testing. Experts comprised physical therapists with evidence of advanced training or research in pediatrics. Using a 6-point Likert scale (6=strongly agree, 5=agree, 4=somewhat agree, 3=somewhat disagree, 2=disagree, 1=strongly disagree), experts rated statements from existing literature. Thematic analyses were conducted on responses to open-ended questions. A priori consensus was pre-set at 65% agreement/disagreement. Median, mode, and interquartile ranges estimated perceived importance. Cessation was pre-determined by non-consensus items <10% and panel fatigue. Experts reached consensus on 107/112 (96%) items, including identifying 25/26 (96%) neurological conditions they perceived to require routine neurological testing. Experts strongly agreed with high importance that appropriately trained, experienced therapists are less variable when testing children. Communication modifications were perceived as most important. High levels of consensus support the use of lower limb neurological testing in a range of pediatric neurological conditions. Trained clinicians should document modifications such as visual aid use. Using recommended modifications could encourage consistency among clinicians. This is the first study to our knowledge to identify the barriers and enablers to pediatric neurological testing. Barriers and enablers were partially addressed through suggested modifications. Further rigorous examination of these modifications is required to support their use. This study supports that clinicians should adapt their communication for children and young people with neurological problems to include visual aids and equipment demonstration.

Minority children living in under-resourced communities are at the greatest risk for obesity and poor diet quality. Child involvement in meal preparation may be a helpful strategy to improve diet quality. This paper explores minority children’s perspectives regarding this. Eighteen children participated in a mixed methods study (online surveys, telephone interviews). Descriptive statistics were calculated for child demographic and psychosocial factors. Thematic analysis was used to code and analyze the interviews. Most children reported having cooking experience (83%) and cooking with family (94%) and exhibited high cooking self-efficacy (21.8 ± 2.9) and positive cooking attitudes (25.7 ± 4.4). Children reported helping with meal preparation (50%) and grocery shopping (41%) sometimes. The qualitative data further supported the results obtained from the children’s psychosocial factors. Most children noted the importance of learning to cook with an emphasis on life skills. Children also shared their level of involvement in cooking and grocery shopping. Most children reported using technology when cooking to find demonstration videos and recipes. These findings highlight that minority children participate in meal preparation and grocery shopping. Their perspectives are important for the development of nutrition education programs to achieve equitable dietary outcomes in minority families living in under-resourced communities.

A variety of complications associated with cancer may adversely affect the spine and musculoskeletal system, resulting in physical impairment, pain, or both. Dysfunction may arise because of tissue injury at the primary site of disease; from metastatic lesions and paraneoplastic syndromes; or as the result of treatment and bed rest. This study evaluated 50 patients seen in consultation by the Rehabilitation Service at Memorial Sloan-Kettering Cancer Center (28 retrospective, 22 prospective). Patients were evaluated for functional problems resulting from their disease or therapy. Patients were noted to have an average of 1.74 physical impairments. Thirteen (26%) patients had only one identifiable problem adversely affecting function. Fifty-four percent of patients were found to have two physical impairments. Ten patients (20%) had three or more such abnormalities. The mean Karnofsky score, a measure commonly used in assessing cancer patient function, at initial evaluation was 46.6 (standard deviation (SD) 12.05). The most frequently encountered problem limiting function was deconditioning (56%); 36% of patients had central nervous system dysfunction; 28% had peripheral neurologic disease; 22% of patients were found to have bone metastasis. Additionally, pain was present in 44% of all patients. These results suggest that it is common for cancer patients who are referred for physiatric evaluation to have more than one functional problem, and that deconditioning, neurological, and skeletal abnormalities are common causes of impairment in cancer patients.Cancer is a significant cause of morbidity and mortality in the United States.1 It is a disease process which is inherently destructive, both at the primary site as well as areas to which it may spread. Additionally, remote effects of cancer, such as paraneoplastic syndromes, may result in further compromise of the patient. Antineoplastic therapies such as chemotherapy, radiotherapy, and surgery are also potentially injurious to native tissues and organ systems. The deleterious effects of these direct and indirect consequences of cancer, whether affecting the musculoskeletal, nervous, cardiovascular, or pulmonary systems, may result in functional impairment and disability. Therefore, it is not surprising to find a high prevalence of disabilities among cancer patients.2,3Significant functional impairment has been noted by previous authors.2,3 A variety of organ systems may be either primarily or secondarily involved, including the spine and musculoskeletal systems. These authors have demonstrated a high prevalence of functional deficits in cancer patients. Additionally, they noted that the majority of cancer patients with disabilities can be successfully treated by physical medicine intervention. The principal impediments preventing patients from obtaining optimal rehabilitation, as determined by these authors were: primary care physicians' inability to recognize functional impairment; and a lack of understanding by these same physicians in rehabilitation principles.2The scope of musculoskeletal and neurological impairments, as well as the number of functionally compromising problems faced by the individual patient is less well known. The object of this survey was to evaluate a series of cancer patients, seen in consultation by a rehabilitation medicine service, for musculoskeletal, neurologic, and other relevant impairments.

BACKGROUND Neurological disorders affect approximately 3 billion people globally, yet clinical trial success is often hindered by poorly chosen outcome measures, impacting trial design, compliance, and interpretation. Core Outcome Sets (COS) have emerged over the past 25 years as standardized tools to enhance outcome selection, ensuring comparability across studies and reflecting the priorities of both researchers and patients. Despite the success of COS initiatives in other fields, their development in neurology remains limited, leaving many trialists without disease-specific guidance. Given common themes across neurological COS, a unified framework—a ‘COS of COS’—could support outcome selection where no disease-specific COS exists. OBJECTIVE This study (COS-Neuro) uses Artificial Intelligence (AI) to analyse existing COS, identifying shared outcome domains to develop a thematic framework, streamlining COS creation and improving neurological trial design. METHODS COS-Neuro was developed using AI-assisted thematic framework analysis, followed by expert review. A modified 6-step thematic analysis was used without pre-determined codes: 1. Dataset Gathering – Data from the COMET database was collected and COS domains for neurological diseases were coded. 2. Prompt Design &amp; Testing – LLMs (ChatGPT 3.5, Google Gemini 1.5 Flash, Meta Llama-2-70b) were trialled, and prompts refined based on responses. 3. Thematic Analysis – LLMs categorised domains into core areas. 4. Human Refinement – Experts reviewed LLM-generated core areas and selected the most appropriate for interpretation. 5. Clinical Validation – Experts validated domains, core areas, and concepts. This streamlined approach integrated AI with expert oversight to develop a standardised COS framework for neurological disorders. RESULTS With the assistance of LLMs, particularly ChatGPT, a robust conceptual framework for COS in neurological disorders was developed based on the existing 112 COS. Adapting OMERACT model, 4 concepts, 13 core areas and 75 domains were finalised following consensus of clinicians. CONCLUSIONS COS-Neuro establishes AI-assisted recommendations for COS in neurological disorders. This project provides a foundation for future COS research and a reference for trials lacking established COS. It also sets a precedent for AI-assisted qualitative analysis in medicine, with the successful adaptation of OMERACT highlighting its scalability for ‘COS of COS’ development across specialties.

In this paper, we develop a novel method for integrating system thinking into architectural design by mapping its processes in a standard process modeling language. We structured a decision-support framework using process mapping workflows to incorporate sustainable building materials and resource-based design decisions into the architectural practice. We turned to other disciplines' knowledgebases, such as Business Information Technology (BIT), to develop a workflow for the Design-Bid-Build project delivery method (DBB). Mapping both current and the proposed design processes, including their activities, workflow, and decision nodes, was critical in defining roles, flow of information, and subsequent decisions. In this study, we utilized a qualitative methodology to capture the required knowledge from industry experts in resource-based design and then integrated our findings into a set of process maps to support the materials decisions by the architectural project team. This study establishes a system of information exchange to support the growth of the newly emerging industry of reuse stores and vendors. Through numerous interviews and knowledge capturing sessions with industry experts from the building material reuse industry that acknowledged an absence of a "system of information exchange." It is through this study that an overall system of information exchange will connect the links between the reuse industry and the AEC industry. The primary outcome of this study is a structured process for design with resource reuse. This process will redefine the DBB traditional design process by introducing new procedures, define information exchange and identify key decisions within the proposed processes, define responsibilities and identify key stakeholders. The author conducted an extensive multi-year knowledge capturing process with constructive feedback from the industry experts.

Background para sport will be divided into a group determined by the type and level of disability of an athlete; impairment classification in the International Paralympic Committee (IPC) is divided into visual, physical, and intellectual impairment. Athletes with impairments increase the risk of events in para-sports. Purpose: The aim was to determine if there is a relationship between impairment classification and the incidence of injury in para-sport athletes. Method: The research is a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data search follows the databases Google Scholar, PubMed, and Scopus using keywords and Boolean search in searching for literature. Result: 10 studies were obtained with publication years between 2016-2022, of which 1 study included reports of injury incidence in athletes with visual, physical, and intellectual impairment, three studies included reports of injury incidence in athletes with visual impairment and physical impairment, three studies included reports of injury incidence in athletes with visual impairment only, and three studies included reports of injury incidence in athletes with physical impairment only. Injury rates in athletes with visual impairment, where the highest population was 267 of elite judokas participating in the IBSA 2018 world judo, 19.1% were injured. Conclusion: This study showed variation in injury incidence based on impairment classification in para-sport athletes, with a high prevalence in athletes with a limb deficiency, neurological impairment, and visual impairment.

Industrialised Building System (IBS) has been considered a construction method to accelerate the development of the construction industry in attempt to boost the economic growth of Malaysia. With the slow uptake of IBS method in Malaysian construction industry, Building Information Modelling (BIM) technology was introduced as an IBS catalyst to improve IBSprocess in term of its productivity and efficacy. However, the advantages of BIM implementation are not fully acquired in IBS industry. Therefore, there is a need to investigate the issues encountered when BIM is implemented in IBS design and production process in Malaysia. The preliminary study adopted the concurrent triangulation mixed method approach where both semi-structured interview and qualitative survey are used as research technique. Four semi-structured interviews were conducted as qualitative survey with the industry experts who have more than 5 years of experience in both IBS and BIM fields to gain insight into the issues of BIM implementation in both IBS design and production process. The quantitative survey Likert scale of agreed level was indicated by the respondents simultaneously while investigating the issues of BIM implementation in IBS design and production process during the interview. The interview data was collected and analysed by measuring mean agreed level to issues of BIM implementation in IBS design and production process and identifying the most significant issues of BIM implementation in IBS process across responses from interview using excel tool and content analysis. The results showed that the most significant issues are encountered when BIM is implemented in IBS design process rather than in IBS production process. The most significant issue is the lack of early collaboration among IBS players in the beginning of IBS design stage in a BIM project. In addition, the lack of knowledge and understanding on IBS design and installation among the project stakeholder, especially consultants in the BIM integrated projects leads to the increase of IBS design time and causes the late confirmation of informed decision of the IBS component design. It can further affect the productivity of IBS production process. Therefore, the issues of BIM implementation in IBS design process should be tackled early to improve the BIM implementation in IBS industry in Malaysia.

Parents' child feeding practices are influenced not only by family but also by a broader circle of networks, including online groups. Peer‐to‐peer platforms such as Facebook groups facilitate a learning environment and may influence the transmission of user‐generated content into practice. These digital data not only benefit participants but also offer new opportunities for researchers to study related phenomena. Therefore, this study employs thematic content analysis to investigate peer‐exchanging discourse conveyed in Facebook peer‐support groups in children's diets in Thailand. To identify the area of interest, we classified and quantified the initial posts and investigated the relationship between initial posts' contents and community engagement. Thematic analysis was used to qualitatively describe the peer‐exchanging content that responded to the initial posts. Of the five approved Facebook groups, 200 initial posts with their 1964 comments were extracted anonymously. Results revealed that Facebook groups devoted to diets for children have become a platform for Thai parents to seek informational and emotional support. The top‐ranked initial posts were related to requesting knowledge and skills about age‐appropriate food and meal preparation. Parents have also expressed anxiety about feeding and tension related to food fussiness which created the need for emotional support. Age‐appropriate feeding, homemade baby foods, concerns about food seasonings and food allergy awareness were observable within online groups. However, a shift from traditional child feeding practices to new ideas created cultural gaps which lead to arguments in some families. Understanding these views would help guide to address parental concerns better.

About 70% of African-Americans are currently overweight. Among these overweight individuals, 40% are adults aged 20 years and older. Such high incidence of overweight cases in African-Americans raises the question: does this population have a taste preference for dietary fat? The objective of this study was to determine if dietary fat preference depends on taste sensitivity in young African-American adults. Fifty-seven African-Americans aged 18 to 21 voluntarily participated in the study. Two types of commonly consumed food, lasagna and macaroni and cheese, were used. Each food type had two versions prepared with identical ingredients and cooking methods, except for total fat content (reduced-fat versus regular-fat). Demographic data, food consumption frequency, correct identification, and taste preference were collected and analyzed using the Student t-test, Chi-Square, and Pearson correlation tests at the 5% significance level. Results revealed a significant correlation between dietary preference and ability to identify fattier food samples (p < 0.05). The majority of participants (79%) that correctly identified reduced-fat or regular-fat containing food types preferred the regular-fat-containing version (p < 0.05). Gender, but not BMI, was significantly related to identification of different fat-containing food products. The finding provides valuable information about food preferences and eating habits of African-American young adults, and such information could be useful for nutrition education or dietary intervention in the future.

Integrated practice delivery methods and its affiliated Building Information Modeling software enrich stakeholder collaboration. The shared knowledge resource functionalities and the real-time simultaneous collaborative attributes optimize the design interaction amongst industry experts. This may not be the case when novices collaborate on a group design project in a university setting. University novices do not have the individual intellectual capacity to communicate design ideas in the same way as industry experts. An artifact analysis on the intervention of BIM reveals that design education lacks a critical reflection and an approach that addresses how students with novice prerequisite knowledge should collaborate in the BIM domain. The hallmarks of best practices are provided to ground a collaborative design methodology.

BackgroundPersons with neurological conditions and their families face a number of challenges with the provision of health and community-based services. The purpose of this study was to understand the existing health and community service needs and gaps in care and to use this information to develop a model to specify factors and processes that may improve the quality of care and health and well-being for persons with neurological conditions.MethodsWe conducted semi-structured interviews with health care professionals, community-based non-health care professionals working with individuals with neurological conditions, and policy makers –from the Ministries of Health, Community and Social Services, Transportation and Education– across Canada. We used a purposive sampling and snowballing approach to obtain maximum variation across professions, sector and geography (provinces and territories, rural and urban). Data analysis was an iterative, constant comparative process involving descriptive and interpretive analyses and was initially guided by the components of the Expanded Chronic Care Model.ResultsA total of 180 individuals completed the interviews: 39% (n = 70) health care professionals, 47% (n = 85) community-based non-health care professionals, and 14% (n = 25) policy makers. Based on the data we developed the Chronic Care Model for Neurological Conditions (CCM-NC). The major needs/gaps are represented by the following themes: acceptance and openness to neurological conditions, evidence informed policy, investments and funding, supported transitions, caregiver support, and life enhancing resources (education, employment, housing and transportation), knowledge and awareness of neurological conditions and availability and access to health services. The model maintains that intersectoral collaboration across the health system, community and policy components is needed. It recognizes that attitudes, policies, enhanced community integration and health system changes are needed to develop activated patients and families, proactive service delivery teams, a person-centred health system and healthy public policy for persons with neurological conditions.ConclusionThe CCM-NC will generate debate and discussion about the actions needed in each of the model components to enable people with neurological conditions to sustain healthier lives. Next steps include validating the model with persons with neurological conditions, in and outside of the Canadian context and developing and evaluating interventions to test the model.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-409) contains supplementary material, which is available to authorized users.