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Orange Syllabub with Crunchy Orange Sprinkle

Ingredients

2/3 cup southern French Muscat or other strong sweet white wine
1 tablespoon Cointreau or other orange liqueur
finely grated zest of 2 unwaxed oranges
2 tablespoons freshly squeezed orange juice
2 tablespoons freshly squeezed lemon juice
4 tablespoons sugar
1-3/4 cup heavy cream, chilled

Method

  1. Pour the wine into a bowl, add the Cointreau or orange liqueur, half the grated orange zest, the orange and lemon juice, and 2 tablespoons sugar. Stir, cover, and chill in the refrigerator for several hours or overnight.
  2. Mix the remaining orange zest and sugar in a bowl. Spread it over a plate and leave for a couple of hours to crisp up. Store it in an airtight container until ready to serve.
  3. Strain the wine mixture through a fine, non-metallic sieve. Pour the cream into the large chilled bowl and beat with a hand-held electric mixer until it starts to thicken. Gradually add the orange-flavored wine, beating well after each addition, until the cream thickens again—you want a thick pouring consistency. When the final addition of wine has been incorporated the mixture should hold a trail when you lift out the beaters, but it shouldn’t be stiff. (Don’t overbear it, or it will separate.)
  4. Ladle the mixture into 6 individual glass dishes and chill them in the refrigerator for at least 1 hour before serving.
  5. Just before serving, sprinkle the orange sugar over the top of each syllabub.

Makes 6 servings.

Source: Cooking with Wine

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Online Triage Tool May Help Patients Decide if They Need Immediate Care

Linda Carroll wrote . . . . . . . . .

An online tool that analyzes symptoms may help people decide whether to seek immediate care in the emergency room or to adopt a wait-and-see strategy, a new study suggests.

After analyzing data from more than 150,000 encounters between patients and the Buoy Health triage tool, researchers found that nearly a third of users concluded after using the tool that their situation was less dire and their need for care less urgent than originally assumed. In 4% of cases, patients decided their situation was more serious than they initially thought, according to the results published in JAMA Network Open.

The researchers also found a reduction in the proportion of patients who were uncertain about the seriousness of their health problem, from 34% before using the tool to 21% afterward.

The new findings show the “chatbot can impact the care patients intend to receive,” said the study’s lead author, Aaron Winn, from the school of pharmacy at the Medical College of Wisconsin, in Milwaukee.

Patients interested in learning more about their symptoms are led through a series of questions by a chatbot that is designed to home-in on possible causes. Along with the symptom questions, users are asked to provide only their age and gender.

The developers were cognizant of the dangers of having the chatbot dispense medical advice, which is why certain safeguards were programmed in, said coauthor Dr. Bradley Crotty, also from Medical College of Wisconsin. Crotty has served as an advisor to Buoy Health.

“For 75-plus conditions that are too dangerous for a person to be chatting with a computer for, Buoy automatically routes them to the ER,” Crotty said in an email. “For example, for someone coming in with crushing chest pain, Buoy immediately suggests the ER as opposed to asking more questions. These conditions are consistently being monitored by Buoy’s internal clinical team.”

Currently a version of the chatbot is sold to health insurers and self-insured employees, Crotty said. “Investors include Optum, Cigna, Humana and F-Prime,” he added.

To get a quick look at how the chatbot might be impacting people’s care-seeking intentions, the researchers combed through 158,083 encounters between the program and patients. The average patient age was 40, and 78% were women.

The most common organ system with queries from patients was the reproductive system. That was followed by general symptoms and gastrointestinal issues, the researchers found.

The most common symptom types were pain, abnormal functioning and discharge. Most patients, 47%, using the chatbot initially thought they should see a primary care physician, while 34% said they were uncertain, 9% thought they should be seeking urgent care and another 9% thought they should be heading to the emergency room.

The researchers couldn’t determine what the patients did after getting an analysis of their symptoms. “That would be something for a follow-up study,” Winn said.

Dr. Gabe Kelen was both “excited” and “concerned,” about the new tool.

“I wonder, what is the business model for the company,” said Kelen, a professor and chair of the department of emergency medicine at Johns Hopkins Medicine in Baltimore, Maryland. “Are they selling this data to somebody? I wonder if patients are unwittingly putting their health status out there on the internet.”

On the other hand, “the exciting part is this technology probably not only can’t be stopped but also if properly developed and used could be a disrupter in healthcare delivery,” said Kelen, who wasn’t involved in the study. “I really like that and think it is the future. In our department we have developed an electronic triage tool. We looked at hundreds of thousands of cases and tested it in a number of settings.”

The idea behind the Hopkins tool is to ferret out the patients with the most urgent needs for care, Kelen said.

Source: Reuters

Sleep Disturbances May Trigger Migraine

Sleep disturbances appear to be a trigger for migraine headaches, according to a new study.

“We found that low sleep efficiency, which is the amount of time you’re awake in bed when you’re trying to sleep, was associated with migraines not on the day immediately following, but on the day after that,” said study co-author Dr. Suzanne Bertisch, a sleep specialist at Brigham and Women’s Hospital in Boston.

The finding supports claims by nearly half of people with the debilitating headaches.

The study included 98 adults who had at least two migraines, but fewer than 15, each month. They recorded details about their sleep, migraines and health habits for six weeks. During that time, they also wore a device on their wrist that recorded their sleep patterns.

The participants had a total of 870 migraines during the six weeks.

After adjusting for other migraine triggers such as caffeine, alcohol, physical activity and stress, the researchers found that getting 6.5 hours or less of sleep a night and poor sleep quality were not associated with migraines the day immediately after (day 0) or the day after that (day 1).

However, sleep disturbances were associated with a higher risk of a migraine on day 1, according to the study.

“When it comes to sleep and migraines, there’s a lot that we don’t know. I became interested in this topic because migraine patients are frequently referred to me in the sleep clinic for help with treating their insomnia,” Bertisch said in a hospital news release.

“Anyone treating these patients wants to be able to counsel them on what to do to decrease their risk of a migraine, but the literature is unclear on what kind of sleep interventions may be helpful,” she added.

Additional research is needed to learn more about the link between sleep fragmentation and migraine risk before it may be possible to develop preventive measures, the study authors said.

The findings were published in the journal Neurology.

Source: HealthDay


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