Publications by authors named "Allison Brown"

136 Publications

Development and validation of an enzyme immunoassay for detection and quantification of SARS-CoV-2 salivary IgA and IgG.

medRxiv 2021 Sep 7. Epub 2021 Sep 7.

Oral fluids offer a non-invasive sampling method for the detection of antibodies. Quantification of IgA and IgG antibodies in saliva allows studies of the mucosal and systemic immune response after natural infection or vaccination. We developed and validated an enzyme immunoassay (EIA) to detect and quantify salivary IgA and IgG antibodies against the prefusion-stabilized form of the SARS-CoV-2 spike protein. Normalization against total antibody isotype was performed to account for specimen differences, such as collection time and sample volume. Saliva samples collected from 187 SARS-CoV-2 confirmed cases enrolled in 2 cohorts and 373 pre-pandemic saliva samples were tested. The sensitivity of both EIAs was high (IgA: 95.5%; IgG: 89.7%) without compromising specificity (IgA: 99%; IgG: 97%). No cross reactivity with seasonal coronaviruses was observed. The limit of detection for SARS-CoV-2 salivary IgA and IgG assays were 1.98 ng/mL and 0.30 ng/mL, respectively. Salivary IgA and IgG antibodies were detected earlier in patients with mild COVID-19 symptoms than in severe cases. However, severe cases showed higher salivary antibody titers than those with a mild infection. Salivary IgA titers quickly decreased after 6 weeks in mild cases but remained detectable until at least week 10 in severe cases. Salivary IgG titers remained high for all patients, regardless of disease severity. In conclusion, EIAs for both IgA and IgG had high specificity and sensitivity for the confirmation of current or recent SARS-CoV-2 infections and evaluation of the IgA and IgG immune response.
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http://dx.doi.org/10.1101/2021.09.03.21263078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8437314PMC
September 2021

Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018.

JAC Antimicrob Resist 2021 Sep 4;3(3):dlab137. Epub 2021 Sep 4.

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.

Background: Historically, United States' carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: , , and (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread.

Objectives: From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE.

Methods: State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene ( , , , , or ) was detected.

Results: SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. spp. was the most common CP-LCG; the proportion of that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than .

Conclusions: Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
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http://dx.doi.org/10.1093/jacamr/dlab137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417453PMC
September 2021

Minimalist revision and description of 403 new species in 11 subfamilies of Costa Rican braconid parasitoid wasps, including host records for 219 species.

Zookeys 2021 2;1013:1-665. Epub 2021 Feb 2.

Division of Entomology, PO Box 37012 12. National Museum of Natural History E515 MRC127, Washington, DC 20013-7012, USA Natural History Museum of Los Angeles County Los Angeles United States of America.

Three new genera are described: (Proteropinae), (Rogadinae), and (Rogadinae). Keys are given for the New World genera of the following braconid subfamilies: Agathidinae, Braconinae, Cheloninae, Homolobinae, Hormiinae, Ichneutinae, Macrocentrinae, Orgilinae, Proteropinae, Rhysipolinae, and Rogadinae. In these subfamilies 416 species are described or redescribed. Most of the species have been reared and all but 13 are new to science. A consensus sequence of the COI barcodes possessed by each species is employed to diagnose the species, and this approach is justified in the introduction. Most descriptions consist of a lateral or dorsal image of the holotype, a diagnostic COI consensus barcode, the Barcode Index Number (BIN) code with a link to the Barcode of Life Database (BOLD), and the holotype specimen information required by the International Code of Zoological Nomenclature. The following species are treated and those lacking authorship are newly described here with authorship attributable to Sharkey except for the new species of Macrocentrinae which are by Sharkey & van Achterberg: AGATHIDINAE: , , , , (Cameron, 1905), , , , , , , , Sharkey, 1990, (Cameron, 1887), Sharkey, 1990, , . BRACONINAE: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . CHELONINAE: , Shimbori & Shaw, 2019, Shimbori & Shaw, 2019, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . HOMOLOBINAE: , , , , . HORMIINAE: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . ICHNEUTINAE: , , , , . MACROCENTRINAE: , , (Muesebeck, 1938), , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . ORGILINAE: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , . PROTEROPINAE: Sharkey & Wharton, 1994, , , . RHYSIPOLINAE: , . ROGADINAE: , , , , , , , , , , , , , , , , , , , , , , , , Shimbori & Shaw, 2020, , , Shimbori & Shaw, 2020, , , , , , , , , , , , , , , , , , , , , , , , Quicke sp. nov., , , , , , , , , , , , , , , , , , , , , , , , , , Valerio, 2015, , , , , , , , , , , , , , , Quicke, 1996. Quicke, 1996. The following new combinations are proposed: (Ashmead), new combination for Ashmead, 1894; (Enderlein), new combination for Enderlein, 1920; (Ashmead), new combination for Ashmead, 1894; (Bortoni and Penteado-Dias) new combination for Bortoni and Penteado-Dias, 2015; (Bortoni and Penteado-Dias) new combination for Bortoni and Penteado-Dias, 2015; (Cameron) new combination for Cameron, 1905. (Enderlein), new combination for Enderlein, 1920. (Enderlein) new combination for Enderlein, 1920. Finally, Sharkey, 1998 is synonymized with Cameron, 1905; Enderlein, 1920 is synonymized with Viereck, 1911; Enderlein, 1920 is synonymized with (Enderlein, 1920); and Enderlein,1920 is synonymized with (Fabricius, 1804). (originally described as Fabricius, 1804).
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http://dx.doi.org/10.3897/zookeys.1013.55600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8390796PMC
February 2021

Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey.

J Antimicrob Chemother 2021 Sep 2. Epub 2021 Sep 2.

Robert Koch Institute, WHO Collaborating Center for Emerging Infections and Biological Threats, Berlin, Germany.

Objectives: The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control.

Methods: From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed.

Results: Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19.

Conclusions: This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.
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http://dx.doi.org/10.1093/jac/dkab300DOI Listing
September 2021

Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012-2019.

Emerg Infect Dis 2021 ;27(9):2475-2479

Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012-April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation.
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http://dx.doi.org/10.3201/eid2709.210456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8386808PMC
August 2021

Repeated Antigen Testing Among SARS-CoV-2-Positive Nursing Home Residents.

Infect Control Hosp Epidemiol 2021 Aug 20:1-10. Epub 2021 Aug 20.

COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Repeated antigen testing of 12 SARS-CoV-2-positive nursing home residents using Abbott BinaxNOW™ identified 9/9 (100%) culture-positive specimens up to 6 days after initial positive test. Antigen positivity lasted 2-24 days. Antigen positivity might last beyond the infectious period, but was reliable in residents with evidence of early infection.
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http://dx.doi.org/10.1017/ice.2021.370DOI Listing
August 2021

Absence of SARS-CoV-2 infections among patients with end-stage renal disease following facility-wide testing in four outpatient hemodialysis facilities.

Am J Infect Control 2021 Aug 8. Epub 2021 Aug 8.

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Facility-wide testing performed at 4 outpatient hemodialysis facilities in the absence of an outbreak or escalating community incidence did not identify new SARS-CoV-2 infections and illustrated key logistical considerations essential to successful implementation of SARS-CoV-2 screening. Facilities could consider prioritizing facility-wide SARS-CoV-2 testing during suspicion of an outbreak in the facility or escalating community spread without robust infection control strategies in place. Being prepared to address operational considerations will enhance implementation of facility-wide testing in the outpatient dialysis setting.
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http://dx.doi.org/10.1016/j.ajic.2021.07.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349431PMC
August 2021

Two sides of the same coin: Quality improvement and program evaluation in health professions education.

J Eval Clin Pract 2021 Jul 22. Epub 2021 Jul 22.

Department of Family Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.

Health professions education is in constant pursuit of new ways of teaching and assessment in order to improve the training of healthcare professionals. Educators are often challenged with designing, implementing, and evaluating programs in the context of their professional practice, particularly those in response to dynamic and emerging social needs. This article explores the synergies and intersections of two approaches-quality improvement and program evaluation-and the potential utility of their combinations within our field to design, evaluate, and most importantly, improve educational programming. We argue that the inclusion of established quality improvement frameworks within program evaluation provides a proven mechanism for driving change, can optimize programming within the multi-contextual education systems, and, ultimately, that these two approaches are complementary to one another. These combinations hold great promise for optimizing programming in alignment with social missions, where it has been difficult for institutions worldwide to generate and capture evidence of social accountability.
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http://dx.doi.org/10.1111/jep.13598DOI Listing
July 2021

Using quality improvement to advance health professions education.

Clin Teach 2021 Jul 14. Epub 2021 Jul 14.

Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1111/tct.13397DOI Listing
July 2021

Exploring the impact of the COVID-19 pandemic on medical learner wellness: a needs assessment for the development of learner wellness interventions.

Can Med Educ J 2021 Jun 30;12(3):54-69. Epub 2021 Jun 30.

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.

Background: On March 11, 2020 the World Health Organization declared the novel coronavirus SARS-CoV-2 disease (COVID-19) a global pandemic. We sought to understand impact of COVID-19 on learner wellness at a large tertiary care academic institution to inform the future development of learner wellness interventions during the COVID-19 pandemic.

Methods: A cross-sectional, internet-based survey collected quantitative and qualitative data from learners April-June 2020. Descriptive statistics and univariate analyses were reported for quantitative data. Open-ended, qualitative responses were analyzed deductively using thematic analysis.

Results: Twenty percent of enrolled learners in that faculty of medicine (540/2741) participated including undergraduate [Bachelor's] students (25.7%), graduate [science] students (27.5%), undergraduate medical students (22.8%), and postgraduate resident physicians (23.5%). We found that learner wellness across all stages of training was negatively impacted and the ways in which learners were impacted varied as a result of their program's response to the COVID-19 pandemic.

Conclusions: Learners in health sciences and medical education report worsening well-being because of the programs and the systems in which they function with the added burden of the COVID-19 pandemic. Future interventions would benefit from a holistic framework of learner wellness while engaging in systems thinking to understand how individuals, programs and respective systems intersect. The importance of acknowledging equity, diversity and inclusion, fostering psychological safety and engaging learners as active participants in their journey during a pandemic and beyond are key elements in developing wellness interventions.
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http://dx.doi.org/10.36834/cmej.70995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263035PMC
June 2021

Exploring the global impact of the COVID-19 pandemic on medical education: an international cross-sectional study of medical learners.

Can Med Educ J 2021 Jun 30;12(3):28-43. Epub 2021 Jun 30.

Cumming School of Medicine, University of Calgary, Alberta, Canada.

Background: The evidence surrounding the impact of COVID-19 on medical learners remains anecdotal and highly speculative despite the anticipated impact and potential consequences of the current pandemic on medical training. The purpose of this study was to explore the extent that COVID-19 initially impacted medical learners around the world and examine global trends and patterns across geographic regions and levels of training.

Methods: A cross-sectional survey of medical learners was conducted between March 25-June 14, 2020, shortly after the World Health Organization declared COVID-19 a pandemic.

Results: 6492 learners completed the survey from 140 countries. Most medical schools removed learners from the clinical environment and adopted online learning, but students reported concerns about the quality of their learning, training progression, and milestone fulfillment. Residents reported they could be better utilized and expressed concerns about their career timeline. Trainees generally felt under-utilized and wanted to be engaged clinically in meaningful ways; however, some felt that contributing to healthcare during a pandemic was beyond the scope of a learner. Significant differences were detected between levels of training and geographic regions for satisfaction with organizational responses as well as the impact of COVID-19 learner wellness and state-trait anxiety.

Conclusions: The disruption to the status quo of medical education is perceived by learners across all levels and geographic regions to have negatively affected their training and well-being, particularly amongst postgraduate trainees. These results provide initial empirical insights into the areas that warrant future research as well as consideration for current and future policy planning.
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http://dx.doi.org/10.36834/cmej.71149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8263042PMC
June 2021

White Matter Abnormalities Associated With Prolonged Recovery in Adolescents Following Concussion.

Front Neurol 2021 24;12:681467. Epub 2021 Jun 24.

Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh, Pittsburgh, PA, United States.

Concussion symptoms in adolescents typically resolve within 4 weeks. However, 20 - 30% of adolescents experience a prolonged recovery. Abnormalities in tracts implicated in visuospatial attention and emotional regulation (i.e., inferior longitudinal fasciculus, ILF; inferior fronto-occipital fasciculus, IFOF; uncinate fasciculus; UF) have been consistently reported in concussion; yet, to date, there are no objective markers of prolonged recovery in adolescents. Here, we evaluated the utility of diffusion MRI in outcome prediction. Forty-two adolescents (12.1 - 17.9 years; female: 44.0%) underwent a diffusion Magnetic Resonance Imaging (dMRI) protocol within the first 10 days of concussion. Based on days of injury until medical clearance, adolescents were then categorized into SHORT (<28 days; = 21) or LONG (>28 days; = 21) recovery time. Fractional anisotropy (FA) in the ILF, IFOF, UF, and/or concussion symptoms were used as predictors of recovery time (SHORT, LONG). Forty-two age- and sex-matched healthy controls served as reference. Higher FA in the ILF (: adjusted odds ratio; AOR = 0.36, 95% CI = 0.15 - 0.91, = 0.030; : AOR = 0.28, 95% CI = 0.10 - 0.83, = 0.021), IFOF ( AOR = 0.21, 95% CI = 0.07 - 0.66, = 0.008; : AOR = 0.30, 95% CI = 0.11 - 0.83, = 0.020), and UF (: AOR = 0.26, 95% CI = 0.09 - 0.74, = 0.011; AOR = 0.28, 95% CI = 0.10 - 0.73, = 0.010) was associated with SHORT recovery. In additional analyses, while adolescents with SHORT recovery did not differ from HC, those with LONG recovery showed lower FA in the ILF and IFOF ( < 0.014). Notably, inclusion of dMRI findings increased the sensitivity and specificity (AUC = 0.93) of a prediction model including clinical variables only (AUC = 0.75). Our findings indicate that higher FA in long associative tracts (especially ILF) might inform a more objective and accurate prognosis for recovery time in adolescents following concussion.
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http://dx.doi.org/10.3389/fneur.2021.681467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264142PMC
June 2021

Relation between Isometric Neck Strength and White Matter Organization in Collegiate Athletes.

Neurotrauma Rep 2020 30;1(1):232-240. Epub 2020 Nov 30.

Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA.

Soccer athletes frequently experience repetitive head impacts (RHI) during games and practices, which may affect neural integrity over time and lead to altered brain structure. Neck strength is hypothesized to limit the transfer of force to the brain and decrease the effect of RHI on brain structure. The goal of our work was to examine whether greater neck strength is associated with more intact white matter organization (WMO) in collegiate athletes exposed to RHI. Collegiate soccer ( = 17) and limited/non-contact sport ( = 39) athletes were assessed prior to their athletic seasons. Participants completed neck strength assessments using handheld dynamometry in six test positions and diffusion tensor imaging. Fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD) were calculated for 20 white matter (WM) regions. A multi-variate approach was used to examine the relationship between neck strength and diffusion measures in soccer and limited/non-contact athletes. Neck strength was positively associated with FA and negatively associated with RD across several WM regions in soccer players only. Neck strength was not significantly associated with MD or AD in either group. Greater neck strength was related to more intact WMO in athletes with high exposure to RHI, particularly in regions prone to damage from brain trauma such as the basal ganglia, superior longitudinal fasciculus, and frontoparietal WM. Future studies should examine neck strength as a factor to moderate neural outcomes in athletes with exposure to RHI.
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http://dx.doi.org/10.1089/neur.2020.0025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240886PMC
November 2020

Structural Violence Education: A Critical Moment for Psychiatric Training.

Can J Psychiatry 2021 Jun 7:7067437211016243. Epub 2021 Jun 7.

Department of Medicine, 70401University of Calgary, Cumming School of Medicine, Alberta, Canada.

The mental health ramifications of structural violence are borne disproportionately by marginalized patient populations in North America, which includes Black, Indigenous, and 2SLGBTQIA+ communities and people who use drugs. Structural violence can comprise, for example, police or state violence, colonialism, and medical violence. We chronicle the history of psychiatric discourse around structural violence over the past 50 years and highlight the critical need for new formalized competencies to become incorporated into the training of medical students across Canada, specifically addressing the impacts of structural violence for the aforementioned populations. Finally, we offer a framework of learning objectives for designing educational sessions discussing structural violence and mental health for integration into pre-clerkship psychiatry curricula at medical schools across Canada.
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http://dx.doi.org/10.1177/07067437211016243DOI Listing
June 2021

The relation between neck strength and psychological distress: preliminary evidence from collegiate soccer athletes.

Concussion 2021 May 14;6(2):CNC91. Epub 2021 May 14.

Department of Rehabilitation & Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, USA.

Aim: To examine whether neck strength and symmetry are associated with psychological function in athletes with exposure to repetitive head impacts.

Methods: Collegiate soccer (n = 29) and limited/noncontact (n = 63) athletes without a history of concussion completed the Brief Symptom Inventory 18 and assessments of isometric neck strength. Neck strength symmetry was calculated as the difference in strength between opposing muscle groups.

Results: The results demonstrated that lower neck strength was associated with more symptoms of anxiety, whereas asymmetry in neck strength was associated with more symptoms of somatization and depression in soccer athletes only.

Conclusion: These preliminary results suggest that greater neck strength/symmetry is related to better psychological function in athletes who have higher exposure to repetitive head impacts.
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http://dx.doi.org/10.2217/cnc-2020-0023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162191PMC
May 2021

Aztreonam-Avibactam Susceptibility Testing Program for Metallo-Beta-Lactamase-Producing in the Antibiotic Resistance Laboratory Network, March 2019 to December 2020.

Antimicrob Agents Chemother 2021 07 16;65(8):e0048621. Epub 2021 Jul 16.

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Aztreonam-avibactam is a drug combination pending phase 3 clinical trials and is suggested for treatment of severe infections caused by metallo-beta-lactamase (MBL)-producing by combining ceftazidime-avibactam and aztreonam. Beginning in 2019, four Antibiotic Resistance Laboratory Network regional laboratories offered aztreonam-avibactam susceptibility testing by broth microdilution. For 64 clinical isolates tested, the MIC and MIC values of aztreonam-avibactam were 0.5/4 μg/ml and 8/4 μg/ml, respectively. Aztreonam-avibactam displayed potent activity against the MBL-producing tested.
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http://dx.doi.org/10.1128/AAC.00486-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8284474PMC
July 2021

Challenges to Navigating Pregnancy and Parenthood for Physician Parents: a Framework Analysis of Qualitative Data.

J Gen Intern Med 2021 May 6. Epub 2021 May 6.

Department of Medicine, University of Calgary, Calgary, Canada.

Background: Some gender-based disparities in medicine may relate to pregnancy and parenthood. An understanding of the challenges faced by pregnant physicians and physician parents is needed to design policies and interventions to reduce these disparities.

Objective: Our objective was to characterize work-related barriers related to pregnancy and parenthood described by physicians.

Design: We performed framework analysis of qualitative data collected through individual, semi-structured interviews between May and October 2018. Data related to pregnancy or parenthood were organized chronologically to understand barriers throughout the process of pregnancy, planning a parental leave, taking a parental leave, returning from parental leave, and parenting as a physician.

Participants: Physician faculty members of all genders, including parents and non-parents, from a single department at a large academic medical school in Canada were invited to participate in a department-wide study broadly exploring gender equity.

Approach: Thematic analysis guided by constructivism.

Key Results: Twenty-eight physicians were interviewed (7.2% of eligible physicians), including 22 women and 6 men, of which 18 were parents (15 mothers and 3 fathers). Common barriers included a lack of systems-level guidelines for pregnancy and parental leave, inconsistent workplace accommodations for pregnant physicians, a lack of guidance and support for planning parental leaves, and difficulties obtaining clinical coverage for parental leave. Without systems-level guidance, participants had to individually navigate challenges and resolve these difficulties, including negotiating with their leadership for benefits. This led to stress, wasted time and effort, and raised questions about fairness within the department.

Conclusions: Physician parents face unique challenges navigating institutional policies as well as planning and taking parental leave. Systems-level interventions such as policies for pregnancy, parental leave, and return to work are needed to address barriers experienced by physician parents.
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http://dx.doi.org/10.1007/s11606-021-06835-0DOI Listing
May 2021

A Comparison of Less Invasive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Diagnostic Specimens in Nursing Home Residents-Arkansas, June-August 2020.

Clin Infect Dis 2021 07;73(Suppl 1):S58-S64

COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing remains essential for early identification and clinical management of cases. We compared the diagnostic performance of 3 specimen types for characterizing SARS-CoV-2 in infected nursing home residents.

Methods: A convenience sample of 17 residents were enrolled within 15 days of first positive SARS-CoV-2 result by real-time reverse transcription polymerase chain reaction (RT-PCR) and prospectively followed for 42 days. Anterior nasal swabs (AN), oropharyngeal swabs (OP), and saliva specimens (SA) were collected on the day of enrollment, every 3 days for the first 21 days, and then weekly for 21 days. Specimens were tested for presence of SARS-CoV-2 RNA using RT-PCR and replication-competent virus by viral culture.

Results: Comparing the 3 specimen types collected from each participant at each time point, the concordance of paired RT-PCR results ranged from 80% to 88%. After the first positive result, SA and OP were RT-PCR-positive for ≤48 days; AN were RT-PCR-positive for ≤33 days. AN had the highest percentage of RT-PCR-positive results (21/26 [81%]) when collected ≤10 days of participants' first positive result. Eleven specimens were positive by viral culture: 9 AN collected ≤19 days following first positive result and 2 OP collected ≤5 days following first positive result.

Conclusions: AN, OP, and SA were effective methods for repeated testing in this population. More AN than OP were positive by viral culture. SA and OP remained RT-PCR-positive longer than AN, which could lead to unnecessary interventions if RT-PCR detection occurred after viral shedding has likely ceased.
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http://dx.doi.org/10.1093/cid/ciab310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135387PMC
July 2021

Making medical leadership more diverse.

BMJ 2021 04 26;373:n945. Epub 2021 Apr 26.

Division of General Internal Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.

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http://dx.doi.org/10.1136/bmj.n945DOI Listing
April 2021

Performance Evaluation of Serial SARS-CoV-2 Rapid Antigen Testing During a Nursing Home Outbreak.

Ann Intern Med 2021 07 27;174(7):945-951. Epub 2021 Apr 27.

Centers for Disease Control and Prevention, Atlanta, Georgia (S.L.M., F.A.T., E.D.M., K.M.H., A.B., S.P.L., D.A.J., J.B., D.C., B.F., S.E.G., J.M.F., M.M., P.L.S., B.B., K.W.R., R.A., M.D.B., S.C.R., J.A.J., A.C.B., L.C.M., P.K.K.).

Background: To address high COVID-19 burden in U.S. nursing homes, rapid SARS-CoV-2 antigen tests have been widely distributed in those facilities. However, performance data are lacking, especially in asymptomatic people.

Objective: To evaluate the performance of SARS-CoV-2 antigen testing when used for facility-wide testing during a nursing home outbreak.

Design: A prospective evaluation involving 3 facility-wide rounds of testing where paired respiratory specimens were collected to evaluate the performance of the BinaxNOW antigen test compared with virus culture and real-time reverse transcription polymerase chain reaction (RT-PCR). Early and late infection were defined using changes in RT-PCR cycle threshold values and prior test results.

Setting: A nursing home with an ongoing SARS-CoV-2 outbreak.

Participants: 532 paired specimens collected from 234 available residents and staff.

Measurements: Percentage of positive agreement (PPA) and percentage of negative agreement (PNA) for BinaxNOW compared with RT-PCR and virus culture.

Results: BinaxNOW PPA with virus culture, used for detection of replication-competent virus, was 95%. However, the overall PPA of antigen testing with RT-PCR was 69%, and PNA was 98%. When only the first positive test result was analyzed for each participant, PPA of antigen testing with RT-PCR was 82% among 45 symptomatic people and 52% among 343 asymptomatic people. Compared with RT-PCR and virus culture, the BinaxNOW test performed well in early infection (86% and 95%, respectively) and poorly in late infection (51% and no recovered virus, respectively).

Limitation: Accurate symptom ascertainment was challenging in nursing home residents; test performance may not be representative of testing done by nonlaboratory staff.

Conclusion: Despite lower positive agreement compared with RT-PCR, antigen test positivity had higher agreement with shedding of replication-competent virus. These results suggest that antigen testing could be a useful tool to rapidly identify contagious people at risk for transmitting SARS-CoV-2 during nascent outbreaks and help reduce COVID-19 burden in nursing homes.

Primary Funding Source: None.
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http://dx.doi.org/10.7326/M21-0422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8108910PMC
July 2021

Antimicrobial Susceptibility Profiles To Predict the Presence of Carbapenemase Genes among Carbapenem-Resistant Pseudomonas aeruginosa Isolates.

J Clin Microbiol 2021 05 19;59(6). Epub 2021 May 19.

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Detection of carbapenem-resistant (CRPA) with carbapenemase-producing (CP) genes is critical for preventing transmission. Our objective was to assess whether certain antimicrobial susceptibility testing (AST) profiles can efficiently identify CP-CRPA. We defined CRPA as with imipenem or meropenem MICs of ≥8 μg/ml; CP-CRPA was CRPA with CP genes ( / / / / ). We assessed the sensitivity and specificity of AST profiles to detect CP-CRPA among CRPA isolates collected by CDC's Antibiotic Resistance Laboratory Network (AR Lab Network) and the Emerging Infections Program (EIP) during 2017 to 2019. Three percent (195/6,192) of AR Lab Network CRPA isolates were CP-CRPA. Among CRPA isolates, adding not susceptible (NS) to cefepime or ceftazidime to the definition had 91% sensitivity and 50% specificity for identifying CP-CRPA; adding NS to ceftolozane-tazobactam had 100% sensitivity and 86% specificity. Of 965 EIP CRPA isolates evaluated for CP genes, 7 were identified as CP-CRPA; 6 of the 7 were NS to cefepime and ceftazidime, and all 7 were NS to ceftolozane-tazobactam. Among 4,182 EIP isolates, clinical laboratory AST results were available for 96% of them for cefepime, 80% for ceftazidime, and 4% for ceftolozane-tazobactam. The number of CRPA isolates needed to test (NNT) to identify one CP-CRPA isolate decreased from 138 to 64 if the definition of NS to cefepime or ceftazidime was used and to 7 with NS to ceftolozane-tazobactam. Adding not susceptible to cefepime or ceftazidime to CRPA carbapenemase testing criteria would reduce the NNT by half and can be implemented in most clinical laboratories; adding not susceptible to ceftolozane-tazobactam could be even more predictive once AST for this drug is more widely available.
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http://dx.doi.org/10.1128/JCM.02874-20DOI Listing
May 2021

Infectious Period of Severe Acute Respiratory Syndrome Coronavirus 2 in 17 Nursing Home Residents-Arkansas, June-August 2020.

Open Forum Infect Dis 2021 Mar 30;8(3):ofab048. Epub 2021 Jan 30.

COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Background: To estimate the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in older adults with underlying conditions, we assessed duration of coronavirus disease 2019 (COVID-19) symptoms, reverse-transcription polymerase chain reaction (RT-PCR) positivity, and culture positivity among nursing home residents.

Methods: We enrolled residents within 15 days of their first positive SARS-CoV-2 test (diagnosis) at an Arkansas facility from July 7 to 15, 2020 and instead them for 42 days. Every 3 days for 21 days and then weekly, we assessed COVID-19 symptoms, collected specimens (oropharyngeal, anterior nares, and saliva), and reviewed medical charts. Blood for serology was collected on days 0, 6, 12, 21, and 42. Infectivity was defined by positive culture. Duration of culture positivity was compared with duration of COVID-19 symptoms and RT-PCR positivity. Data were summarized using measures of central tendency, frequencies, and proportions.

Results: We enrolled 17 of 39 (44%) eligible residents. Median participant age was 82 years (range, 58-97 years). All had ≥3 underlying conditions. Median duration of RT-PCR positivity was 22 days (interquartile range [IQR], 8-31 days) from diagnosis; median duration of symptoms was 42 days (IQR, 28-49 days). Of 9 (53%) participants with any culture-positive specimens, 1 (11%) severely immunocompromised participant remained culture-positive 19 days from diagnosis; 8 of 9 (89%) were culture-positive ≤8 days from diagnosis. Seroconversion occurred in 12 of 12 (100%) surviving participants with ≥1 blood specimen; all participants were culture-negative before seroconversion.

Conclusions: Duration of infectivity was considerably shorter than duration of symptoms and RT-PCR positivity. Severe immunocompromise may prolong SARS-CoV-2 infectivity. Seroconversion indicated noninfectivity in this cohort.
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http://dx.doi.org/10.1093/ofid/ofab048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7928697PMC
March 2021

Teaching mindfulness-based stress management techniques to medical learners through simulation.

Can Med Educ J 2021 Feb 26;12(1):e95-e97. Epub 2021 Feb 26.

Cumming School of Medicine, University of Calgary, Alberta, Canada.

Acutely traumatic clinical events can exacerbate stress and burnout amongst healthcare providers. The Simulated Training for Resilience in Various Environments (STRIVE) course may provide a useful framework for medical educators to teach stress management skills to promote resilience amongst physician trainees. The course introduces the Big Four+ techniques (goal setting, visualization, self-talk, progressive muscular relaxation, attention control and tactical breathing) created by the Canadian Armed Forces using clinical scenarios. This framework can be easily adapted across other training contexts to equip future clinicians with a foundational skill set to optimize their response and recovery following critically stressful incidents.
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http://dx.doi.org/10.36834/cmej.69821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7931486PMC
February 2021

Comparing Entrustment and Competence: An Exploratory Look at Performance-Relevant Information in the Final Year of a Veterinary Program.

J Vet Med Educ 2021 Mar 4:e20190128. Epub 2021 Mar 4.

Workplace-based assessments and entrustment scales have two primary goals: providing formative information to assist students with future learning; and, determining if and when learners are ready for safe, independent practice. To date, there has not been an evaluation of the relationship between these performance-relevant information pieces in veterinary medicine. This study collected quantitative and qualitative data from a single cohort of final-year students (n = 27) across in-training evaluation reports (ITERs) and entrustment scales in a distributed veterinary hospital environment. Here we compare progression in scoring and performance within and across student, within and across method of assessment, over time. Narrative comments were quantified using the Completed Clinical Evaluation Report Rating (CCERR) instrument to assess quality of written comments. Preliminary evidence suggests that we may be capturing different aspects of performance using these two different methods. Specifically, entrustment scale scores significantly increased over time, while ITER scores did not. Typically, comments on entrustment scale scores were more learner specific, longer, and used more of a coaching voice. Longitudinal evaluation of learner performance is important for learning and demonstration of competence; however, the method of data collection could influence how feedback is structured and how performance is ultimately judged.
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http://dx.doi.org/10.3138/jvme-2019-0128DOI Listing
March 2021

Individual Baseline Balance Assessments in a Large Sample of Incoming NCAA Division I Athletes Using a Force Plate System.

Int J Sports Phys Ther 2021 Feb 1;16(1):126-133. Epub 2021 Feb 1.

Rutgers University - New Brunswick.

Background: Individualized baseline testing is resource and time intensive. The use of normative data to approximate changes after a suspected concussion is thus an appealing alternative. Yet, few peer-reviewed, large-sample studies are available from which to develop accurate normative averages of balance using force-plate technology.

Purpose: This study sought to validate a normative dataset from the force-plate manufacturer and examine the magnitude and nature of sample variability.

Study Design: Cross-sectional.

Methods: Baseline balance and self-reported sex, sport, and concussion history were assessed in 533 prospective collegiate athletes (45% female) during pre-participation physical examinations. Balance was measured using four stances from the modified Clinical Test of Sensory Interaction and Balance and quantified as Sway Index Scores with the Biodex Biosway Portable Balance System. Group averages are contrasted to data from the force-plate manufacturer. Individual variability around these averages was visualized and analyzed by sex and sport.

Results: Male student athletes showed significantly more sway in the eyes open, soft stance condition than female athletes. These differences were maintained when concussion history was included as a covariate. Athletes, particularly male athletes, in the high versus low contact sport group showed significantly more sway in the eyes open, soft surface and the eyes closed, hard and soft surface stances.

Conclusion: There was substantial individual variability that was partially explained by sex differences and sport differences. The development of normative averages for sway may benefit from consideration of sex and sport. Further studies should characterize other factors that influence baseline balance in collegiate athletes.

Level Of Evidence: 2b.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7872460PMC
February 2021

Assessing the in vitro impact of ceftazidime on aztreonam/avibactam susceptibility testing for highly resistant MBL-producing Enterobacterales.

J Antimicrob Chemother 2021 03;76(4):979-983

Division of Healthcare Quality Promotion, CDC, Atlanta, GA, USA.

Background: Aztreonam/avibactam is a combination agent that shows promise in treating infections caused by highly antibiotic-resistant MBL-producing Enterobacterales. This combination can be achieved by combining two FDA-approved drugs: ceftazidime/avibactam and aztreonam. It is unknown whether ceftazidime in the combination ceftazidime/aztreonam/avibactam has a synergistic or antagonistic effect on the in vitro activity of aztreonam/avibactam by significantly increasing or decreasing the MIC.

Objectives: To determine whether increasing ceftazidime concentrations affect the MICs of aztreonam/avibactam alone.

Methods: A custom 8 × 8 chequerboard broth microdilution (BMD) panel was made using a digital dispenser (Hewlett-Packard, Corvallis, OR, USA). The panel included orthogonal 2-fold dilution series of aztreonam and ceftazidime ranging from 0.5 to 64 mg/L. Avibactam concentration was kept constant at 4 mg/L throughout the chequerboard. Thirty-seven Enterobacterales isolates from the CDC & FDA Antibiotic Resistance Isolate Bank or CDC's internal collection with intermediate or resistant interpretations to aztreonam and ceftazidime/avibactam were included for testing. All isolates harboured at least one of the following MBL genes: blaIMP, blaNDM or blaVIM.

Results: Regardless of the concentration of ceftazidime, aztreonam/avibactam with ceftazidime MICs for all 37 isolates were within one 2-fold doubling dilution of the aztreonam/avibactam MIC.

Conclusions: Ceftazidime, in the combination ceftazidime/avibactam/aztreonam, did not affect the in vitro activity of aztreonam/avibactam in this sample of isolates. These findings can help assure clinical and public health laboratories that testing of aztreonam/avibactam by BMD can act as a reliable surrogate test when the combination of ceftazidime/avibactam and aztreonam is being considered for treatment of highly antibiotic-resistant MBL-producing Enterobacterales.
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http://dx.doi.org/10.1093/jac/dkaa531DOI Listing
March 2021

The new normal: Medical education during and beyond the COVID-19 pandemic.

Can Med Educ J 2020 Dec 7;11(6):e167-e169. Epub 2020 Dec 7.

Cumming School of Medicine, University of Calgary, Alberta, Canada.

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http://dx.doi.org/10.36834/cmej.70317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749678PMC
December 2020

Say something nice: A meta-analytic review of peer reporting interventions.

J Sch Psychol 2020 12 12;83:89-103. Epub 2020 Nov 12.

University of Cincinnati, USA.

Peer reporting interventions (i.e., Positive Peer Reporting and tootling) are commonly used peer-mediated interventions in schools. These interventions involve training students to make reports about peers' prosocial behaviors, whether in oral or written form. Although peer reporting interventions have been included in meta-analyses of group contingencies, this study is the first meta-analytic review of single-case research focusing exclusively on peer reporting interventions. The literature search and application of inclusion criteria yielded 21 studies examining the impact of a peer reporting intervention on student behavior compared to baseline conditions. All studies used single-case experimental designs including at least three demonstrations of an effect and at least three data points per phase. Several aspects of studies, participants, and interventions were coded. Log response ratios and Tau were calculated as effect size estimates. Effect size estimates were synthesized in a multi-level meta-analysis with random effects for (a) studies and (b) cases within studies. Overall results indicated peer reporting interventions had a non-zero and positive impact on student outcomes. This was also true when data were subset by outcome (i.e., disruptive behavior, academically engaged behavior, and social behavior). Results were suggestive of more between- than within-study variability. Moderator analyses were conducted to identify aspects of studies, participants, or peer reporting interventions associated with differential effectiveness. Moderator analyses suggested published studies were associated with higher effect sizes than unpublished studies (i.e., theses/dissertations). This meta-analysis suggests peer reporting interventions are effective in improving student behavior compared to baseline conditions. Implications and directions for future investigation are discussed.
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http://dx.doi.org/10.1016/j.jsp.2020.10.002DOI Listing
December 2020

A Tale of Four Programs: How Residents Learn About Quality Improvement during Postgraduate Medical Education at the University of Calgary.

Teach Learn Med 2021 Aug-Sep;33(4):390-406. Epub 2020 Nov 19.

Department of Community Health Sciences, University of Calgary , Calgary , Canada.

Quality Improvement (QI) has become increasingly incorporated into competency frameworks for physician learners over the past two decades. As contemporary medical education adapts competency-based models of training, learners will be required to demonstrate competency in QI. There is a need to explore how various residency programs are currently teaching QI, including how residents might participate in experiential QI activities, and the various outcomes of these strategies. A collective case study examined how residents in four postgraduate programs at a single academic institution have learned about QI since the formal integration of QI as a cross-cutting competency. Data from surveys, interviews, observations, and archival records were collected in order to develop a comprehensive understanding of each case in its real-life context and explore current and historical trends and patterns within and across the four programs. Teaching and resident involvement in QI projects increased across all four programs since its formal integration into the national physician competency framework. Two programs had a longitudinal, hybrid QI curriculum involving didactic and experiential components. Two programs had didactic-alone QI curricula, with minimal resident engagement in applied QI activities. Between-program differences were quantified with regards to learning climate, safety climate, QI knowledge, skills, and attitudes, attitudes toward research during residency, and quality of mentorship for scholarly activities. Residents in programs with experiential learning reported higher knowledge, skills, and attitudes toward QI were motivated to lead improvement efforts in their future practice. Residents in programs with didactic-only QI teaching perceived that the historical operationalization of the scholarly project as research was a barrier to their involvement in QI, as it was not valued or legitimized in their academic and clinical contexts. Common barriers and facilitators to engagement with QI across all programs included time, mentorship, motivation, and competing demands such as feeling pressure to conduct research in order to obtain competitive fellowship positions or employment. Common across all programs was the perception of the residency scholarly project requirement as a "checkbox." Associations were quantified between the constructs of learning climate with safety culture, and safety culture with QI knowledge, skills, and attitudes. While hybrid QI curricula with experiential learning remains an effective curriculum strategy, tensions between research and QI may be a critical barrier to learner engagement in experiential activities. In addition to providing learners with support, time, mentorship, and explicitly communicating the value QI by the program, the local safety culture may impact QI learning beyond the core curriculum. Reconceptualization of the scholarly project requirements to normalize QI activities and recognizing the potential influence of the local organizational culture on QI learning and how trainees can positively or negatively shape these cultures warrants consideration.
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http://dx.doi.org/10.1080/10401334.2020.1847652DOI Listing
November 2020

Understanding American premium chocolate consumer perception of craft chocolate and desirable product attributes using focus groups and projective mapping.

PLoS One 2020 4;15(11):e0240177. Epub 2020 Nov 4.

Department of Food Science, The Pennsylvania State University, University Park, Pennsylvania, United States of America.

Craft chocolate is a relatively new and fast-growing segment of the American chocolate market. To understand American premium chocolate consumer perception of craft chocolate and desirable chocolate product attributes, we conducted a mixed-methods study using focus groups and projective mapping. Projective mapping revealed that participants segmented products in terms of quality based upon usage occasion rather than cost or other factors. We found that American premium chocolate consumers use search attributes such as segmentation, price, availability, and packaging as quality determinants. Additionally, they desire credence attributes that convey trust through, for example, the presence or absence of sustainability certifications, or a semblance of meaning. Premium chocolate consumers seek out experience attributes such as utility and/or joy, which are achieved by purchasing a chocolate product as a gift, for its nostalgic purposes, or for desired post-ingestive effects. We propose a Desirable Chocolate Attribute Concept Map to explain our findings.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0240177PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641343PMC
December 2020
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