02 April 2019

Warren’s Notice Shutting Down

Sadly, it's time to end this blog. I won’t be adding any more posts, and the Warren's Notice website will be removed when the domain comes up for renewal. 

To save the posts, I've tweaked and transferred them to my long-standing blog website, Retired--Now What? (www.Retired--NowWhat.com). I may start blogging there again.

Thank you to all who have followed Warren’s Notice or occasionally stopped by.   -warren

29 March 2019

Fast-Food Changes

McDonald’s and Taco Bell (from
2012 blog post Fast-Food Photo Addendum).
Welcome to Warren’s Notice. Although I’ll down a veggie sub if we’re traveling and trying not to dally, my visits to fast-food restaurants are primarily for coffee and their restroom. That’s not to say that I wasn’t a huge fan of all manner of fast food at one time. Years ago, I caught the health bug. 

I never doubted that I made the right choice, and a recent study leads me to believe that I reformed none too soon. Researchers from Boston and Tufts universities profiled menu offerings of 10 of the most popular fast-food restaurants (based on sales) over 30 years, 1986 to 2016.

I won’t keep you in suspense. Yes, the restaurants have added some healthful items. Overall, however, their food was healthier 30 years ago.

Welcome to McDonald’s –
Typical fast-food meal.

(multiple websites)
Collecting Restaurant Data
The researchers assessed changes in entrees, sides and desserts offered by Arby’s, Burger King, Carl’s Jr., Dairy Queen, Hardee’s, Jack in the Box, KFC, Long John Silver’s, McDonald’s and Wendy’s.

Drawing upon The Fast Food Guide from 1986 and 1991 and online sources in 2016, they focused on the number of items, portion size, energy (calories), energy density, sodium and, though available for only 4 of the 10 restaurants, calcium and iron.

How the Menus Changed
Catering to or driving consumers’ tastes for the usual and the new, the restaurants increased the number of entrées, sides and desserts by 226% from 1986 to 2016.

Portion sizes of entrées and desserts, but not sides, increased. On average, entrées grew by 13 grams (0.46 ounces) each decade and desserts by 24 grams (0.85 ounces) each decade.

The energy of items in all three menu categories increased. As you might expect, desserts led the way, gaining on average 62 kilocalories each decade. (Don’t panic. Think about that as 62 not 62,000 calories. The “calorie” we usually refer to is, in fact, a “kilocalorie”; one kilocalorie is one Calorie--upper case C.)

The amount of sodium in all three menu categories also increased, with entrées growing the most, on average 4.6% of the daily value each decade.

Calcium increased in entrées and desserts, but not sides. On average, calcium in entrées rose by 1.2% of the daily value each decade and in desserts by 3.9% of the daily value each decade. While the change in calcium is certainly in the right direction, there are lower calorie, lower sodium sources that would be preferred.

And that also applies to iron, which increased only in desserts, on average, by 1.4% of the daily value each decade.

Wrap Up

The study provides insight into how changes in fast food may be contributing to the problem of obesity and related chronic conditions.

Consider first that, according to The Centers for Disease Control and Prevention’s National Center for Health Statistics, on any given day during 2013-2016, nearly 37% of adults, age 20 and older, consumed fast food. (The percentage declines with age, being highest in the 20 to 39 age group.)

Percentage of US adults aged 20 and over who consumed fast food on a given day, by gender and age, 2013–2016
 (from www.cdc.gov/nchs/products/databriefs/db322.htm).

Then recognize that, if what’s consumed is an entree and side, the average calorie intake approaches 40% of a 2,000-calorie a day diet. Would you like a sugary beverage with that? Add 5% to 10%. How about dessert?

Lastly, realize that, in 1960-1962, about 13% of U.S. adults ages 20 to 74 were obese. By 2003-2004, that grew to over 30% and by 2015-2016 to nearly 40%.

Percentage of US individuals who are overweight and obese by age, 1960-2004 (from www.cdc.gov/nchs/data/hus/hus07.pdf).

Fast food is part of the American diet, and it’s growing around the globe. The researchers posit that strategies are needed to help consumers reduce energy intake from fast-food restaurants. Short of spreading the health bug that I caught, what would you suggest?

Thanks for stopping by.


Study of changes in fast-food offerings in Jour. of the Academy of Nutrition and Dietetics: jandonline.org/article/S2212-2672(18)32383-9/fulltext
Articles on study on ScienceDaily and TIME websites:
Fast-food consumption in U.S., 2013-2016: www.cdc.gov/nchs/products/databriefs/db322.htm
Adult obesity facts: www.cdc.gov/obesity/data/adult.html

22 March 2019

Childbirth Complications

Childbirth delivery
Call the Midwife.

Welcome to Warren’s Notice. Maybe Vicki and I have watched too many episodes of Call the Midwife. Why else would I notice a study of birth delivery complications?

In any event, the study certainly raised a red flag, especially when I read that, every year, some 700 women in the U.S. die from preventable complications related to pregnancy and childbirth.

Welcome to the hospital’s
maternity department in the UK.

Identifying Delivery Risk Factors
Research collaborators affiliated with Colorado State University, Abt Associates, Inc. and the U.S. Department of Agriculture set out to identify hospital-based risk factors that might be modified to improve maternal health.

Limiting their analysis to Texas, the researchers examined the State Health Services’ records of over 2 million childbirths from 2005 through 2010.

They focused on physician-attended deliveries of single baby births following gestations longer than 20 weeks and normal labor onset. Of principal concern were labor or delivery complications, including third- or fourth-degree perineal laceration, ruptured uterus, unplanned hysterectomy, admission to intensive care unit and unplanned operating room procedure following delivery.

Among factors evaluated were timing and location. Specifically, did delivery complications vary by work shift (day vs. night), as hours pass within work shifts, and on weekends and holidays? Was there a difference between teaching and non-teaching hospitals? Did complications in teaching hospitals vary when new residents arrived, reducing physician experience and healthcare team coordination?

Labor and childbirth. (photo by New Health
Advisor from www.smartparenting.com.ph/)
Key Drivers of Delivery Risk
The analysis of hospital-based risk factors affecting birth delivery found:

The likelihood of experiencing a delivery complication was 21.3% higher during the night shift, and the odds of a delivery complication increased by 1.8% with every hour worked within a shift.

Weekend deliveries were 8.6% more likely to experience a complication than were weekday deliveries.

Births occurring on holidays were particularly susceptible to labor or delivery complications. Holiday births were 29.0% more likely to experience a complication.

Deliveries at teaching hospitals were 2.2 times more likely to experience a complication than were deliveries at non-teaching hospital.

The risk of a delivery complication at teaching hospitals increased by a factor of 1.3 when new residents joined the staff rotation. After a year of training and integration, there was no added risk.

Wrap Up
The researchers note that ineffective teamwork was implicated in an estimated 75% of preventable medical errors. One possible remedy they suggest is scheduling inexperienced physicians with more senior health professionals.

Clearly, every effort should be made to reduce risk associated with childbirth. Though my hospital expertise is only as a patient and my support to deliveries is limited to whispering in Vicki's right ear, it would seem the study has identified a number of areas that hospitals might target.

Thanks for stopping by.

Study of birth delivery complications in Risk Analysis journal: onlinelibrary.wiley.com/doi/abs/10.1111/risa.13273
Article on study on EurekAlert website: www.eurekalert.org/pub_releases/2019-02/sfra-srt022619.php

15 March 2019

Taxing Sugary Beverages

Take your pick,
water or soda.

(multiple websites)
Welcome to Warren’s Notice. Time’s up. I haven’t blogged about sugar-sweetened beverages in over four years.

Do you remember when then-New York City Mayor Bloomberg went after sugary beverages? His proposed law limiting the size of many sugar-sweetened drinks to 16 ounces never took effect and was eventually overturned.

Los Angeles County’s
poster of pouring soda
as sugar packets.

(multiple websites)
I blogged about that action and similar campaigns around the U.S. in Sugary Beverage Addendum. That was an addendum to the post Research Sponsor Bias, a review that found studies funded by beverage and sugar industries were five times more likely to conclude there was no link between sugar-sweetened beverages and weight gain than did studies with no industry affiliation.

Berkeley's Beverage Tax

I’m picking up the topic again because Berkeley, California, had overwhelming voter support to impose a one-cent per ounce tax on specified sugar-sweetened beverages, effective 1 January 2015.

Although the tax is levied on distributors, retailers pass through part of the tax to consumers. One survey found that shortly after the tax was imposed, 69% of the tax was added to the price of sodas and 47% of the tax was added to the price of other sweetened beverages.

Did the tax have any effect on consumption of sugar-sweetened beverages? That’s what a team of researchers from the University of California at Berkeley, Davis and San Francisco, as well as Stanford, set out to gauge three years after the tax was imposed.

Data Collection and Results
To measure response to the tax, the researchers collected annual beverage frequency questionnaires via street intercept surveys from 2014, before the tax was imposed, to 2017. They polled about 2,500 people each year in high foot-traffic intersections in demographically diverse neighborhoods across Berkeley and, for comparison, in Oakland and San Francisco.

They found that, in 2014, sugar-sweetened beverages were consumed 1.25 times/day in the Berkeley neighborhoods and 1.27 times/day in the comparison city neighborhoods.

Berkeley residents’ consumption dropped sharply in 2015, and by 2017, the residents reported drinking 52% fewer servings of sugar-sweetened beverages than they did in 2104. Water consumption increased 29%.

The changes in Berkeley residents’ consumption appear directly related to the tax as residents in the Oakland and San Francisco neighborhoods reported drinking about the same number of sugary beverages in 2017 as they did in 2014.

Change in beverage consumption in Berkeley and comparison cities 3 years after Berkeley taxed sugar-sweetened beverages (SSB) (from ajph.aphapublications.org/doi/10.2105/AJPH.2019.304971).
Wrap Up
Addressing study limitations, the researchers noted that their method of data collection--street intercept survey--does not provide a random sample of city residents and that other communities should be surveyed.

Nevertheless, the results strongly suggest that taxing sugar-sweetened beverages can be an effective approach to encourage healthier drinking habits.

That said, I (and I’m sure the researchers) would like to see longer term results. Will consumers continue drinking healthier beverages and will that change have an effect on obesity, diabetes, cardiovascular disease and tooth decay?

Oh, if you were wondering, most of Berkeley’s sugary beverage tax revenue supports nutrition education and gardening programs in schools and local organizations working to encourage healthier behaviors in the community.

Thanks for stopping by.

Study of Berkeley’s post-tax beverage consumption in American Jour. of Public Health: ajph.aphapublications.org/doi/10.2105/AJPH.2019.304971
Article on study on ScienceDaily website: www.sciencedaily.com/releases/2019/02/190221172056.htm
Related study on sugary beverage price hikes following tax in American Jour. of Public Health: ajph.aphapublications.org/doi/10.2105/AJPH.2015.302881

08 March 2019

The Restaurant Menu

Welcome to Warren’s Notice. Have you been to a restaurant lately, one where you sit and are given a menu? Did you pay any attention to the menu itself or just use it to select your dining fare?

Years ago, I recall my daughter, Rachel, designed the logo and menu for a casino. No doubt she and other graphic designers produce some phenomenal restaurant menus, but it turns out there’s been quite a bit of research on menus, for example, assessing typeface, weight, color and, of course, design.

Example of handwritten
typeface, "DJB This is Me"

(from darcybaldwin.com/).
This was all new to me until I came across a recent study by researchers from Ohio State and Pennsylvania State universities. They found handwritten typeface--printed typeface that appears to be written by humans--conveys a sense of human touch and love. (How could I not review that study?) Menus with handwritten typeface translated to good things, at least for “healthy” restaurants.

Testing the Menu Typeface
The researchers conducted two scenario-based survey experiments testing handwritten vs. machine-written typeface. One scenario was healthy vs. regular restaurants, the second was dining alone vs. dining with friends.

Healthy vs. Regular Restaurants
The researchers had 185 U.S. adults (average age 36, 54% male, 77% Caucasian, 63% had college degrees, 63% earned over $40K/year) read a menu while imagining themselves patronizing a fictitious restaurant.

Example of machine-
written typeface,
The participants were randomly assigned to one of four experimental conditions, reading either a handwritten typeface (“DJB This is Me”) or machine-written typeface (“Helvetica”) menu with identical content at either a healthy or regular restaurant.

The healthy restaurant was described for the participants as being health-conscious, committed to sustainability and having its entire menu based on locally grown, non-GMO, antibiotic-free ingredients. No such information was provided for the regular restaurant.

The participants were then asked to rate the menu (e.g., 1-dislike, 7-like; 1-unappealing, 7-appealing); food healthiness (e.g., 1-unhealthy, 7-healthy); the likelihood they would recommend the restaurant on social media (1-not at all, 7-very much); if the menu gave a sense of human contact, warmth and sensitivity (1-strongly disagree, 7-strongly agree); and if the dishes conveyed love, passion and warmheartedness (1-strongly disagree, 7-strongly agree). All experimental manipulations, such as scenario realism, were also rated and judged effective.

The tallies showed the handwritten typeface generated more favorable attitudes toward the menu, higher levels of perceived healthiness and higher levels of social media engagement than did the machine-written typeface, but only in the healthy restaurant condition. They were no differences in the regular restaurant condition.

Attitude toward different typeface menus of healthy vs. regular restaurant (from www.sciencedirect.com/science/article/abs/pii/S0148296319301122).

Dining Alone or With Friends
For the second experiment, the researchers had 191 U.S. adults (average age 37, 57% male, 74% Caucasian, 71% had college degrees, 69% earned over $40K/year) read a menu while imagining themselves patronizing a fictitious healthy restaurant.

The participants were randomly assigned to one of four experimental conditions, reading either a handwritten typeface menu or machine-written typeface menu while dining either alone or with friends.

As in the first experiment, the participants were asked to rate the menu, food healthiness and likelihood they would recommend the restaurant on social media. They were also checked on experimental manipulations of menu typeface and ease of processing and asked about the scenario realism.

The tallies replicated the findings of the first experiment for both dining alone and dining with friends. The handwritten typeface led to more favorable attitudes toward the menu.

Attitude toward different typeface menus of a healthy restaurant dining alone or with friends (from www.sciencedirect.com/science/article/abs/pii/S0148296319301122).

Wrap Up
The study findings suggest that adopting handwritten typeface for their menus could potentially be a simple and profitable marketing strategy for promoting healthy restaurants.

To explore this further the researchers recommend testing handwritten typeface with different sample populations in a field setting and collecting data on actual behavioral responses. That would include monitoring online review data for changes in social media engagement.

And that’s only one example of how important typeface can be. Thanks for stopping by.

Example of earlier study of menus in International Jour. of Hospitality Management: www.sciencedirect.com/science/article/pii/S0278431915001711

Menu typeface study in Jour. of Business Research: www.sciencedirect.com/science/article/abs/pii/S0148296319301122
Article on study on EurekAlert! website:

01 March 2019

Thermally Responsive Fabric

Never mind cotton. Forget wool. Skip those high-tech, wicking polyesters. Have I got a fabric for you. Well, I don’t, but researchers from the University of Maryland do.

Welcome to Warren’s Notice. I thought you’d be interested to learn about this new fabric, even if it’s not quite ready for market. In short, the fabric is thermally responsive. It automatically responds to the temperature and humidity of our skin to either release or trap heat.

I could stop there, but I’ll continue for those in disbelief or who just want to learn more. Since the fabric’s ability to regulate the heat exchange is tied to infrared radiation, I’ll start there.

Infrared Radiation and Our Bodies
In a blog post several years ago, I illustrated the use of thermal sensing in medical imaging (Thermal Body Mapping Addendum). 

Thermal images, where colors correspond to temperature differences, have been used to assess the effects of stress on hands of patients with different medical conditions or injuries (from iopscience.iop.org/0967-3334/33/3/R33/article).
As I wrote at the time, thermal imaging should at least be of value where dissipation of heat through the skin is diagnostic. Here’s what that was all about. 

Photographic cameras collect radiation that we see. Thermal sensors collect radiation in the infrared (IR) region, which is beyond the sensitivity of our eyes. IR radiation covers a broad spectrum of wavelengths. Thermal sensors normally collect IR radiation at longer wavelengths, where the level of radiation is related to the temperature of the object sensed. In general, the hotter the object, the more IR radiation it emits.

The principal way our bodies lose (emit) and gain (absorb) heat is through IR radiation, and our skin is a very efficient emitter and absorber of IR radiation. If we’re cold, we add clothes to reduce the transmission of IR radiation; if we’re warm, we remove clothes to promote the transmission of IR radiation. The newly developed fabric does both.

How the Fabric Works

For the new fabric, the researchers took fibers of two different synthetic components, one that absorbs water, the other that repels it. They coated the fibers with a thin layer of carbon nanotubes (lightweight, carbon-based, conductive metal).

Because the coated fibers both absorb and repel water, the fabric warps when exposed to humidity such as from a sweating body. That distortion opens pores in the fabric, allowing heat to escape.

Of greater consequence, the distortion brings the coated fibers closer together. That modifies the electromagnetic coupling between neighboring fibers, changing the way the fabric interacts with IR radiation. Depending on the tuning, the fabric will either allow IR radiation to pass or block it almost instantaneously. 

Thermally responsive fabric (photo by Faye Levine from today.umd.edu/articles/hot-and-cold-comfort-a77c4599-3bb4-4efd-83d2-79ac418ad018)
Wrap Up
The researchers report that the new fabric effectively modulated the IR radiation by over 35% as the relative humidity of the underlying skin changed.

They note that, while more work is required before we’ll see clothes of the new fabric, the materials are readily available. The carbon nanotube coating can be added easily during the dyeing process. And yes, the fabric can be knitted, dyed and washed like other sportswear fabrics. So, get ready.

Thanks for stopping by.

Study of new fabric in Science: science.sciencemag.org/content/363/6427/619
Example articles on study:
Example article on infrared radiation and our bodies: www.health.belgium.be/en/interaction-between-radiation-and-human-body

22 February 2019

Gun Violence and Mental Health

Welcome to Warren’s Notice. Given my earlier posts on gun violence (Gun Research, Gun Research Revisted), I suppose this post could be considered my annual call for research. Of the gun violence research I could have reviewed to illustrate the need, I chose the most recent study related to mental health, a common scapegoat.

I thought about adding “The Missing Link” to the blog post title. Despite evidence and earlier studies to the contrary, way too many people and politicians still think having a mental illness makes a person more likely to commit gun violence.

In 2016, John Oliver pointed out how foolish it is to blame gun violence on mental illness. (from www.pulseheadlines.com/mental-illness-violence-media-shows/34111/)
Texas Study
The limited research linking gun violence and mental health has usually rated mental illness among individuals arrested for violent crimes or focused on violence between individuals with severe mental illness. Researchers affiliated with the University of Texas Medical Branch at Galveston took a different approach.

They surveyed 663 young adults (average age 22 years; 62% female; self-identified as 34% Hispanic, 26% white, 27% Black, 13% other) in a long-term study about gun possession and use as well as mental health symptoms (anxiety, depression, stress, posttraumatic stress disorder, hostility, impulsivity, borderline personality disorder), mental health treatment and other demographic details.

Gun Violence Tied to Gun Access Not Mental Health
Their analysis found no link between the associations of gun violence and most mental health symptoms. Instead, access to guns stood out as the principal indicator of gun violence.

After controlling for a number of demographic factors and prior mental health treatment, individuals who had gun access were over 18 times more likely to have threatened someone with a gun than individuals with no gun access. Of mental health symptoms, high hostility individuals were about 3.5 times more likely to have threatened someone.

Wrap Up
The study sample was limited and relatively small for broad pronouncements; however, the findings were clear: There’s essentially no link between gun violence and the great majority of individuals exhibiting mental health symptoms.

Further, the finding that gun access is the key factor in gun violence is in line with other studies. That includes the 1993 study that found, rather than providing protection, keeping a gun in the home was strongly and independently associated with an increased risk of homicide. Virtually all of the risk involved homicide by a family member or intimate acquaintance.

That study, funded by the Centers for Disease Control and Prevention (CDC), precipitated the NRA-lobbied Congress to remove funding for gun violence research by the CDC, prohibit the CDC from spending funds “to advocate or promote gun control” and later apply the same funding constraint on the National Institutes of Health (see Gun Research).

The call for research on gun violence. (from Union of Concerned Scientists, blog.ucsusa.org/yogin-kothari/gun-violence-research-filibuster)

Two decades have passed and perhaps change is coming. In agency instructions attached to the recently approved government spending bill, the CDC is given the authority to conduct research on causes of gun violence. Although the measure did not address gun control or provide funding, the measure is a welcome step in the right direction. Maybe this will be my last call for gun research. Thanks for stopping by.

Texas study of gun violence and mental health in Preventive Medicine journal: www.sciencedirect.com/science/article/pii/S0091743519300143
Press release and example articles on study:
1993 study of guns in the home in New England Jour. of Medicine: www.nejm.org/doi/full/10.1056/NEJM199310073291506
Example articles on CDC gun research legislation: