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BACKGROUND: Many treatments for acute migraine exist. Chlorpromazine is effective but has serious side effects. Ketorolac has only rare side effects. OBJECTIVE: To compare intramuscular ketorolac troinethamine with intravenous chlorpromazine hydrochloride in treating acute migraine. METHODS: We performed a prospective, randomized, double-blind trial comparing the clinical effectiveness of 60 mg of intramuscular ketorolac tromethamine with 25 mg of intravenous chlorpromazine hydrochloride in patients with acute migraine headache seen in the emergency department. Pain intensity, quantitated using the Wong-Baker Faces Rating Scale, was measured every 30 minutes for 2 hours in the emergency department. Patients returned pain scores at 6, 12, 24, and 48 hours by mail. RESULTS: Fifteen patients were entered into each treatment arm. No differences were seen between the mean pain scores or the mean change in pain scores. The ketorolac group mean (+/- SEM) pain score decreased from 4.07 +/- 0.18 to 0.73 +/- 0.3 in 2 hours. The chlorpromazine group pain score decreased from 4.47 +/- 0.17 to 0.87 +/- 0.4. Two of the 3 nonresponders responded to the alternate group's treatment. No side effects were seen. CONCLUSIONS: Using 60 mg of intramuscular ketorolac tromethamine is as effective as 25 mg of intravenous chlorpromazine hydrochloride in the treatment of acute migraine headache. Patients who do not respond to one of these medications may respond to the other. [ABSTRACT FROM AUTHOR]

Our interviews of inpatient clinicians (physicians, physician assistants) modeled after the Capability, Opportunity, and Motivation Model of Behavior model revealed opportunity and motivation as important drivers for overdiagnosis and overprescribing for asymptomatic bacteriuria in older adults. Understanding these barriers is an important step toward implementing age-friendly stewardship interventions., Competing Interests: Dr Advani reports support from National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grant no. K12DK100024), the Centers for Disease Control and Prevention (grant nos. 5U54CK000616-02 and SHEPheRD 75D30121D12733-D5-E003), the Society for Healthcare Epidemiology of America, and the Duke Claude D. Pepper Older Americans Independence Center (National Institute on Aging grant no. P30AG028716), as well as consulting fees from Locus Biosciences (ended), Sysmex America (ended), GlaxoSmithKline, bioMérieux, and the Infectious Diseases Society of America. Dr. Advani became an employee of GSK/ViiV Healthcare after submission and acceptance of this manuscript., (© The Author(s) 2024.)

Synthetic turf has been a mainstay of field sports and local communities for decades, and in that time, has faced both community and government pressure to ensure its safety and fitness for purpose. Considerable research and regulations have been applied to synthetic turf with regards to its safety, construction, potential toxicity, sports impact, as well as environmental considerations. However, very little attention has been paid to reports of odorous impacts from synthetic turf fields. This is problematic as odours are both a source of most complaints by communities towards other industries, as well as the fact that synthetic turf has a unique placement within communities themselves. It is wholly possible that the concerns surrounding synthetic turf are being modulated by the odours that the fields themselves produce through previously identified psychological mechanisms. As a result, ensuring good standards for synthetic turf with regards to odorous emissions should be benchmarked for community acceptability. This review investigates prior research into synthetic turf with regards to identified volatile organic compounds emitted, as well as proposing the means by which community stakeholders engage with synthetic turf, as well as how they should be consulted. From here, this review provides trajectories for future research within this space, and how regulatory bodies should address potential issues. This research space is currently in its infancy and therefore information relating to synthetic turf odour factors must be carefully considered., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Richard Stuetz reports financial support was provided by Office of the NSW Chief Scientist and Engineer, NSW Government. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Understanding phenology, its genetics and agronomic consequences, is critical for crop adaptation. Here we aim to (i) characterize lentil response to photoperiod with a focus on five loci: the lentil ELF3 orthologue Sn, two loci linked to clusters of lentil FT orthologues, and two loci without candidates in chromosomes 2 and 5 (Experiment 1: 36 lines, short and long days in a phytotron), and (ii) establish the phenology-yield relationship (Experiment 2: 25 lines, 11 field environments). A vintage perspective, where we quantify time trends in phenotype over three decades of breeding, links both experiments. Yield increased linearly from older to newer varieties at 29 kg ha-1 year-1 or 1.5% year-1, correlated negatively with flowering time in both winter- and summer-rainfall regimes, and decoupled from biomass in favourable environments. Time to flowering shortened from older to newer varieties at -0.56% year-1 in the field, and -0.42% year-1 (short days) and -0.99% year-1 (long days) in the phytotron. Early-flowering lines of diverse origin carried multiple early alleles for the five loci, indicating that at least some of these loci affect phenology additively. Current germplasm primarily features the early-flowering haplotype for an FTb cluster region, hence the potential to increase phenological diversity with yield implications., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Experimental Biology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

It is widely accepted that milk provides the greatest relief from capsaicin burn, an effect typically attributed to its fat content and temperature. Previously, Lawless et al. reported partitioning lipophilic capsaicin in fat reduces burn, whereas Green showed lower temperature reduces burn. Recent research shows that dairy and nondairy proteins also reduce capsaicin burn, suggesting that multiple factors reduce oral burn from chilies. Here, we investigated the effectiveness of palate cleansers with varied viscosities, temperatures, and sugar, fat, and protein content. Specifically, we tested ice cream, Italian ice, yogurt, lassi, cold water (4°C), and warm water (37°C). Participants rinsed with a 5 ppm capsaicin solution, followed by a palate cleanser, before rating burn intensity continuously for 2 min on a general Labeled Magnitude Scale. Inspection of the time-intensity (TI) curves revealed all palate cleansers performed better than warm water. Italian ice performed on par with cold water, which did better than yogurt. Pairwise comparisons showed that ice cream and lassi had significantly lower burn ratings at some time points relative to warm or cold water. We extracted scaffolding parameters for each TI curve, finding that ice cream and lassi had the lowest areas-under-the-curve and the greatest percent decrease from their maxima, with ice cream performing slightly better in both parameters. These data support the view that it is not just one characteristic of a product, but rather a combination of product factors that reduce oral burn, including fat content, protein content, and temperature. More research is required to determine the relative weight of these factors in combination, given the multiple mechanisms underlying burn reduction., (© 2024 The Author(s). Journal of Food Science published by Wiley Periodicals LLC on behalf of Institute of Food Technologists.)

Over the last half-century, variable responses to sweetness have repeatedly been shown to fall into a small number of hedonic responses, implying that looking only at group means may can obfuscate meaningfully different response patterns. Comparative data for sourness is quite sparse, especially in adults. While increased liking with higher acid concentration has been reported for some children, in adults, sourness is classically assumed to be aversive, with a monotonic drop in liking with increasing sourness. Here, we test this assumption using a simple model system or experimental beverage in convenience samples of adults from the United States (increasing citric acid in water) and Italy (increasing citric acid in pear juice). Participants rated intensity and liking of sampled stimuli. For both cohorts, we find clear evidence of three distinct patterns of responses: a strong negative group where liking dropped with increased sourness, an intermediate group who showed a more muted drop in liking with more sourness, and a strong positive group where liking increased with more sourness. Strikingly, both cohorts showed similar proportions of response patterns, with ~63-70% in the strong negative group, and 11-12% in the strong positive group, suggesting these proportions may be stable across cultures. Notably, the three groups did not differ by age or gender. These data support the existence of different hedonic response profiles to sour stimuli in adults, once again highlighting the importance of looking at individual differences and potential consumer segments, rather than merely averaging hedonic responses across all individuals within a group., Competing Interests: 9. Conflict of Interest The authors declare no conflict of interest. Several of the authors have received consulting or speaking fees from various industrial clients in the food industry, but these organizations have no involvement with the work described here and they were not involved in study conception, design or interpretation, or the decision to publish these data.

Phytophthora root rot (PRR), caused by Phytophthora medicaginis, is a major soil-borne disease of chickpea in Australia. Breeding for PRR resistance is an effective approach to avoid significant yield loss. Genetic resistance has been identified in cultivated chickpea (Cicer arietinum) and in the wild relative C. echinospermum, with previous studies identifying independent genetic loci associated with each of these sources. However, the molecular mechanisms associated with PRR resistance are not known. RNA sequencing analysis employed in this study identified changes in gene expression in roots of three chickpea genotypes grown hydroponically, early post-infection with P. medicaginis zoospores. Analyses of differentially expressed genes (DEG) identified the activation of a higher number of non-specific R-genes in a PRR-susceptible variety than in the resistant genotypes, suggesting a whole plant resistance response occurring in chickpea against the pathogen. Contrasting molecular changes in signaling profiles, proteolysis and transcription factor pathways were observed in the cultivated and wild Cicer-derived resistant genotypes. DEG patterns supported a hypothesis that increased root elongation and reduced adventitious root formation limit the pathogen entry points in the genotype containing the wild Cicer source of PRR resistance. Candidate resistance genes, including an aquaporin and a maltose transporter in the wild Cicer source and GDSL esterases/lipases in the cultivated source of resistance, were oppositely regulated. Increased knowledge of these genes and pathways will improve our understanding of molecular mechanisms controlling PRR resistance in chickpea, and support the development of elite chickpea varieties through molecular breeding approaches., (© 2024 The Author(s). Physiologia Plantarum published by John Wiley & Sons Ltd on behalf of Scandinavian Plant Physiology Society.)

Despite its importance as an undesirable food texture, the phenomenon of chalkiness remains understudied. Chalky sensations presumably arise from fine particulates found in foods, but semantic overlap with other common descriptors of small particles, like gritty or sandy, is unclear. Here, we compare the usage of Chalky with related descriptors, and determine the effect of particle size, concentration, and xanthan content on Chalky ratings in a model beverage. A 2 3 factorial design with starch particle size (D 90 = 33.8 and 64.6 µm), starch concentrations (10 and 20% w / v ), and xanthan content (0.075 and 0.15% w / v ) was used. Participants' salivary flow rate was also assessed. A multi-sip taste test was performed where naïve consumers (n = 82; 39% men, 60% women; age range = 18-79 years) rated the intensity of Chalky , Powdery , Gritty , Sandy , Mouthdrying , and Residual mouthcoating at 0, 30, and 60 s after each of three consecutive sips. All attribute ratings were highly correlated, with Chalky , Powdery , and Residual Mouthcoating being more closely correlated with each other than Gritty or Sandy . Although Chalky was still reported 60 s after consumption, no evidence of build-up was found with repeated sips. A larger size and higher concentration increased Chalky ratings, with the low-salivary-flow group reporting greater ratings for Chalky relative to the high-flow group. Our results suggest consumer percepts of small particles are overlapping but not entirely redundant. This suggests researchers and product developers should carefully distinguish between these descriptors when trying to understand consumer perception of food products containing fine particles.

Geometric and textural properties of food, like unit size, have previously been shown to influence energy intake. While mechanism(s) driving this effect are unclear, unit size may relate to intake by affecting eating microstructure (e.g., eating rate, bite size). In a randomized crossover study, we investigated relationships between unit size, eating microstructure, and intake. Adults (n = 75, 75% women) consumed an ad libitum snack three times in our laboratory. This snack was a 70-g portion (∼2.5 servings) of one of three sizes of pretzel (small, medium, large). Intake was measured in grams by difference in weight before and after the snack. Each session was video recorded to measure eating microstructure; snack duration (min) and number of bites were annotated and used to calculate mean eating rate (g/min) and mean bite size (g/bite). Results revealed unit size influenced intake (grams and kcal; both p's ≤ 0.001), such that participants consumed 31% and 22% more of the large pretzels (16.9 ± 2.3 g) compared to the small (12.9 ± 2.3 g) and medium sizes (13.8 ± 2.3 g), respectively. Unit size also influenced eating rate and bite size (both p's < 0.001); the largest pretzel size yielded the fastest eating rate and largest mean bite size. Further analysis revealed that after accounting for eating microstructure, the effects of unit size on intake were no longer significant, suggesting eating microstructure was driving these effects. Together, these findings indicate that unit size influences intake by affecting eating microstructure and that food properties like unit size can be leveraged to moderate snack intake., Competing Interests: Declaration of competing interest Dr. Hayes has received speaker honoraria, consulting fees, and/or travel expenses from numerous organizations, including federal agencies, universities, nonprofit organizations, trade groups, and for-profit corporations, to present data on taste biology, flavor perception and consumer behavior. Dr. Hayes holds equity in Redolynt LLC, which he co-founded in 2021. The Penn State Sensory Evaluation Center routinely conducts product tests for industrial clients to facilitate experiential learning for undergraduate and graduate students. Dr. Hayes is the Director of this facility. None of these entities have had any role in the work presented here, including study design or interpretation, or the decision to publish these data. The remaining authors have indicated they have no financial relationships or other potential conflicts of interest to disclose. All findings and conclusions in this publication belong solely to the authors and should not be construed to represent any official U.S. Government determination, position, or policy., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Bitterness from phenylthiocarbamide and 6-n-propylthiouracil (PROP) varies with polymorphisms in the TAS2R38 gene. Three SNPs form two common (AVI, PAV) and four rare haplotypes (AAI, AAV, PVI, and PAI). AVI homozygotes exhibit higher detection thresholds and lower suprathreshold bitterness for PROP compared to PAV homozygotes and heterozygotes, and these differences may influence alcohol and vegetable intake. Within a diplotype, substantial variation in suprathreshold bitterness persists, and some AVI homozygotes report moderate bitterness at high concentrations. A second receptor encoded by a gene containing a functional polymorphism may explain this. Early work has suggested that PROP might activate TAS2R4 in vitro, but later work did not replicate this. Here, we identify three TAS2R4 SNPs that result in three diplotypes-SLN/SLN, FVS/SLN, and FVS/FVS-which make up 25.1%, 44.9%, and 23.9% of our sample. These TAS2R4 haplotypes show minimal linkage disequilibrium with TAS2R38, so we examined the suprathreshold bitterness as a function of both. The participants ( n = 243) rated five PROP concentrations in duplicate, interleaved with other stimuli. As expected, the TAS2R38 haplotypes explained ~29% ( p < 0.0001) of the variation in the bitterness ratings, with substantial variation within the haplotypes (AVI/AVI, PAV/AVI, and PAV/PAV). Notably, the TAS2R4 diplotypes (independent of the TAS2R38 haplotypes) explained ~7-8% of the variation in the bitterness ratings ( p = 0.0001). Given this, we revisited if PROP could activate heterologously expressed TAS2R4 in HEK293T cells, and calcium imaging indicated 3 mM PROP is a weak TAS2R4 agonist. In sum, our data are consistent with the second receptor hypothesis and may explain the recovery of the PROP tasting phenotype in some AVI homozygotes; further, this finding may potentially help explain the conflicting results on the TAS2R38 diplotype and food intake.

We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge and practice as well as opportunities to improve communication with nursing colleagues., Competing Interests: All other authors report no financial conflicts related to this work., (© The Author(s) 2024.)

The Teruel Orthorexia Scale (TOS) defines two related but distinct constructs: Orthorexia Nervosa (OrNe), a pathological fixation on a healthy diet, and Healthy Orthorexia (HeOr), an interest in a healthy diet independent of psychopathology. Here, we (a) assessed both types of Orthorexia in a large North American sample using the TOS and (b) explored if engaging in regular physical activity was associated with a greater risk of Orthorexia. A cohort of physically active adults ( n = 927; 41% men) completed the TOS, as well as the Rapid Assessment of Physical Activity (RAPA), to broadly assess aerobic physical activity level and participation in strength and/or flexibility training. As expected, scores for HeOr and OrNe differed between participants, with lower scores for Orthorexia Nervosa in our physically active non-clinical sample. Higher HeOr scores were associated with lower BMI, and this was true for both men and women. We also found that measures of Orthorexia were associated with self-reported physical activity: active adults reporting more aerobic physical activity had higher HeOr scores, with the most active men having the highest scores. Notably, adults who reported regular strength training had higher scores for both HeOr and OrNe, with men who strength trained showing higher OrNe scores than women. Here, those who participate in regular strength training are more likely to exhibit orthorexic behaviors, and this effect was more pronounced for men than women. Prior work has validated the TOS in young, primarily female samples of non-English speakers outside the United States: present data from an age-diverse, physically active, gender balanced sample support the use of TOS for measurement of Orthorexia Nervosa and Healthy Orthorexia in English speakers and suggest that more work is needed to assess potential gender differences in these constructs.

Consumer concern about intake of added sugars has increased commercial demand for sugar-reduced chocolates. However, substitution with high-potency sweeteners is not possible as sugar serves as an important bulking agent. Here, we investigated replacement of sucrose in chocolate compound with oat or rice flours, with starch granules smaller than 10 µm, focusing on texture, sweetness, and acceptability. In Study 1, six chocolates were made: a control with 54% sucrose, four sucrose-reduced versions (reductions of 25% or 50%, using either oat or sweet rice flour), and one 54% sucrose chocolate with reduced refining time. These chocolates were compared in a Difference from Control (DFC) test in a within-subject design, with and without nose clips. Particle size distribution, yield stress, and plastic viscosity were measured. Chocolates with 25% sucrose reduction by either sweet rice or oat flour (or reduced refining time) were not significantly different from the blind control (p > 0.05), regardless of nose clip use. In open-ended comments, participants reported differences in rice-flour-containing chocolates were due to a chalkier texture, while oat-flour-containing chocolates were described as smoother, softer, and creamier. DFC scores from the chocolates were positively correlated with plastic viscosity and negatively correlated with yield stress. In Study 2, 25% reduced sugar chocolates made with rice flour were liked significantly less than control, but the oat flour sample did not differ from control. Collectively, these results suggest up to 25% of sucrose in chocolate can be replaced with oat flour without negatively affecting texture or consumer acceptance., (© 2024 The Authors. Journal of Food Science published by Wiley Periodicals LLC on behalf of Institute of Food Technologists.)

Responses to capsaicin are reduced following repeated exposure, a phenomenon known as capsaicin desensitization. Heavy consumers of chilies consistently report reduced oral burn relative to infrequent consumers, presumably due to chronic desensitization. However, the mechanism(s) underlying capsaicin desensitization remain poorly understood. We hypothesized that reduced response to capsaicin due to repeated oral exposure may result from a change in the expression of the capsaicin receptor (TRPV1) gene. To test this, we conducted two longitudinal desensitization studies in healthy human volunteers. In Study 1, 51 adults completed a 17-day capsaicin desensitization protocol. The study consisted of three in-person visits where they were asked to sample stimuli, including 3, 6, and 9 ppm capsaicin, and rate intensity on a general labeled magnitude scale (gLMS). Between days 3 & 17, participants rinsed at home with 6 ppm capsaicin (n = 31) or a control (n = 20) solution (20 uM sucrose octaccetate; SOA) twice a day. Before and after the oral exposure protocol, a clinician collected fungiform papillae. Participants randomized to the capsaicin rinse showed a statistically significant reduction in oral burn ratings that was not observed in controls, indicating repeated low-dose exposure can systematically induce desensitization. TRPV1 expression was not associated with reported capsaicin burn, and there was no evidence of a decrease in TRPV1 expression following capsaicin exposure. In Study 2, participants (n = 45) rinsed with 6 ppm capsaicin in a similar protocol, rating capsaicin, vanillyl butyl ether (VBE), cinnamaldehyde, ethanol, menthol, and sucrose on days 1, 3, & 17. Burn from capsaicin, VBE, cinnamaldehyde, and ethanol all showed a statistically significant change - capsaicin, VBE and cinnamaldehyde burn all dropped ∼20 %, and a larger reduction was seen for ethanol - while menthol cooling and sucrose sweetness did not change. Collectively, this suggests reductions in oral burn following chronic capsaicin exposure generalizes to other stimuli (i.e., cross desensitization) and this cannot be explained by a change in TRPV1 mRNA expression. More work is needed to elucidate the underlying mechanism for capsaicin desensitization in the oral cavity., Competing Interests: Declaration of Competing Interest A.A.N., A.I.S., and G.L. have no conflicts to declare. J.E.H. has received speaking or consulting fees from corporate clients in the food industry. Additionally, the Sensory Evaluation Center at Penn State routinely conducts taste tests for industrial clients to facilitate experiential learning for undergraduate and graduate students. None of these organizations have had any role in study conception, design or interpretation, or the decision to publish these data., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Oat (Avena sativa L.) is an important cereal grain with a unique nutritional profile including a high proportion of lipids. Understanding lipid composition and distribution in oats is valuable for plant, food and nutritional research, and can be achieved using MALDI mass spectrometry imaging (MALDI-MSI). However, this approach presents several challenges for sample preparation (hardness of grains) and analysis (isobaric and isomeric properties of lipids). Here, oat sections were successfully mounted onto gelatin-coated indium tin oxide slides with minimal tearing. Poor detection of triacylglycerols was resolved by applying sodium chloride during mounting, increasing signal intensity. In combination with trapped ion mobility spectrometry (TIMS), lipid identification significantly improved, and we report the separation of several isobaric and isomeric lipids with visualisation of their "true" spatial distributions. This study describes a novel MALDI-TIMS-MSI analytical technique for oat lipids, which may be used to improve the discovery of biomarkers for grain quality., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Foods lower in saturated fat, sodium, and added sugars (ie, overconsumed dietary components) must have an acceptable flavor profile to promote intake., Objective: The aim of this research was to model the influence of using herbs/spices as flavor-enhancers when reducing overconsumed dietary components in commonly consumed foods and evaluate acceptance of these flavor-enhanced reformulations., Design: Ten leading sources of overconsumed dietary components were identified using the National Health and Nutrition Examination Survey 2015-2018 dietary data. These foods were reformulated to reduce overconsumed dietary components and herbs/spices were used to preserve acceptability. The influence of consumer adoption of the reformulated foods on intake of overconsumed dietary components was modeled using National Health and Nutrition Examination Survey data. Consumer acceptability of the reformulated recipes was assessed with blind taste testing., Participants/setting: Dietary data from adults aged 19 years and older (n = 9,812) included in the National Health and Nutrition Examination Survey 2015-2018 were used to identify foods for reformulation and model the potential influence of reformulation. The blind taste testing included 85 to 107 consumers per panel., Main Outcome Measures: Estimated daily change in total intake of saturated fat, sodium, added sugars, and energy with intake of the reformulated foods instead of the original foods. Consumer ratings of overall liking of the reformulated recipes vs the original recipes were assessed using standard 9-point hedonic scales., Statistical Analyses Performed: Descriptive statistics with use of survey procedures were used to model the influence of reformulated food adoption. Mixed effect models were used for analysis of the blind tasting data., Results: With intake of the reformulated foods, instead of the original versions, by 25% to 100% of current consumers, estimates suggest lowering of saturated fat (25% consumer adoption to 100% consumer adoption -2.9% to -11.4%, respectively), sodium (-3.2 to -11.5%, respectively), and added sugars (-0.5 to -2.7%, respectively) intake. The overall liking ratings for seven of the 10 reformulated foods were superior or at parity with the original foods., Conclusions: This proof-of-concept research suggests that using herbs/spices to create flavor-enhanced recipes lower in overconsumed dietary components has the potential to reduce intake and is acceptable to consumers., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Overeating associated with neurogenic obesity after spinal cord injury (SCI) may be related to how persons with SCI experience satiation (processes leading to meal termination), their eating frequency, and the context in which they eat their meals. In an online, cross-sectional study, adults with (n = 688) and without (Controls; n = 420) SCI completed the Reasons Individuals Stop Eating Questionnaire-15 (RISE-Q-15), which measures individual differences in the experience of factors contributing to meal termination on five scales: Physical Satisfaction, Planned Amount, Decreased Food Appeal, Self-Consciousness, and Decreased Priority of Eating. Participants also reported weekly meal and snack frequency and who prepares, serves, and eats dinner with them at a typical dinner meal. Analysis revealed that while Physical Satisfaction, Planned Amount, and Decreased Food Appeal were reported as the most frequent drivers of meal termination in both groups, scores for the RISE-Q-15 scales differed across the groups. Compared to Controls, persons with SCI reported Physical Satisfaction and Planned Amount as drivers of meal termination less frequently, and Decreased Food Appeal and Decreased Priority of Eating more frequently (all p < 0.001). This suggests that persons with SCI rely less on physiological satiation cues for meal termination than Controls and instead rely more on hedonic cues. Compared to Controls, persons with SCI less frequently reported preparing and serving dinner meals and less frequently reported eating alone (all p < 0.001), indicating differences in meal contexts between groups. Individuals with SCI reported consuming fewer meals than Controls but reported a higher overall eating frequency due to increased snacking (p ≤ 0.015). A decrease in the experience of physical fullness, along with a dependence on a communal meal context and frequent snacking, likely contribute to overeating associated with neurogenic obesity after SCI., Competing Interests: Declaration of competing interest JEH has received speaker honoraria, consulting fees, and/or travel expenses from federal agencies, universities, nonprofit organizations, trade groups, and for-profit corporations to present data on consumer behavior, taste biology, and flavor perception. The Sensory Evaluation Center at The Pennsylvania State University routinely conducts product tests for industrial clients to facilitate experiential learning for undergraduate and graduate students; JEH is the Director of this facility. JEH co-founded and holds equity in Redolynt LLC; this financial interest has been reviewed by and is under active management by the Penn State Conflict of Interest Committee. None of these entities have had any role or interest in the work presented here, including study design or interpretation or the decision to publish these data. The remaining authors have indicated they have no financial relationships or other potential conflicts of interest to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study explores the use of food texture terms by adults in the northeastern United States. The purpose of the study was to compare the effect of food texture on food liking and texture term usage among age groups via two complementary online surveys that differed in the specific task given to participants. Survey 1 gathered common food items associated with 25 texture terms using open-ended questions from 345 participants (45% men, 55% women; age range = 20-79 years); it also collected liking scores for foods with these textures. Next, a new group of participants (n = 349, 46% men, 54% women; age range = 20-79 years) completed Survey 2, which asked them to match up to three texture terms to 32 different foods drawn from Survey 1, using a provided list of 35 texture terms. "Tough," "Chalky," and "Rubbery" had a negative impact on food liking scores while "Tender," "Juicy," and "Crispy" were associated with higher mean food liking scores. "Soft," "Crunchy," "Crispy," "Juicy," and "Greasy" were commonly used texture terms regardless of age. Within those aged 50-79 years, "Smooth," "Tender," "Crunchy," "Soft," "Moist," "Crispy," and "Creamy" were used more often while "Chalky," "Rough," "Mealy," "Foamy/Airy," "Gritty" were used less often. Our results identified commonly used texture terms and revealed differential usage in older and younger adults. These data deepen our understanding of the texture of foods in the modern food environment, highlighting how texture perception may vary with age., (© 2023 The Authors. Journal of Texture Studies published by Wiley Periodicals LLC.)

Transient loss of smell is a common symptom of influenza and other upper respiratory infections. Loss of taste is possible but rare with these illnesses, and patient reports of 'taste loss' typically arise from a taste / flavor confusion. Thus, initial reports from COVID-19 patients of loss of taste and chemesthesis (i.e., chemical somatosensation like warming or cooling) were met with skepticism until multiple studies confirmed SARS-CoV-2 infections could disrupt these senses. Many studies have been based on self-report or on single time point assessments after acute illness was ended. Here, we describe intensive longitudinal data over 28 days from adults aged 18-45 years recruited in early 2021 (i.e., prior to the Delta and Omicron SARS-CoV-2 waves). These individuals were either COVID-19 positive or close contacts (per U.S. CDC criteria at the time of the study) in the first half of 2021. Upon enrollment, all participants were given nose clips, blinded samples of commercial jellybeans (Sour Cherry and Cinnamon), and scratch-n-sniff odor identification test cards (ScentCheckPro), which they used for daily assessments. In COVID-19 cases who enrolled on or before Day 10 of infection, Gaussian Process Regression showed two distinct measures of function - odor identification and odor intensity - declined relative to controls (exposed individuals who never developed COVID-19). Because enrollment began upon exposure, some participants became ill only after enrollment, which allowed us to capture baseline ratings, onset of loss, and recovery. Data from these four cases and four age- and sex- matched controls were plotted over 28 days to create panel plots. Variables included mean orthonasal intensity of four odors (ScentCheckPro), perceived nasal blockage, oral burn (Cinnamon jellybeans), and sourness and sweetness (Sour Cherry jellybeans). Controls exhibited stable ratings over time. By contrast, COVID-19 cases showed sharp deviations over time. Changes in odor intensity or odor identification were not explained by nasal blockage. No single pattern of taste loss or recovery was apparent, implying different taste qualities might recover at different rates. Oral burn was transiently reduced for some before recovering quickly, suggesting acute loss may be missed in datasets collected only after illness ends. Collectively, intensive daily testing shows orthonasal smell, oral chemesthesis and taste were each altered by acute SARS-CoV-2 infection. This disruption was dyssynchronous for different modalities, with variable loss and recovery rates across both modalities and individuals., Competing Interests: Declaration of Competing Interest SDM, JEH, and RCG each hold equity in Redolynt, LLC, which they co-founded in 2021. This financial interest has been reviewed by the Individual Conflict of Interest Committee at each of their respective universities and is being actively managed by each university. None of the other authors have any conflicts to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Varieties of gas chromatography (GC) combined with chemical detection (CD) and sensory analysis at the odour detection port (ODP) for the evaluation of environmental odorants has steadily increased in application and sophistication; this has given rise to a plethora of techniques that cater to specific tasks. With this diversity of approaches in mind, there is a need to assess the critical points at which these approaches differ, as well as likely risks and factors that may affect them. These critical points explained within this review include sample preparation, GC separation techniques (with associated co-elution risks), how the elute is separated between CD and sensory analysis, the type of CD, the type of sensory analysis (with particular attention paid to its factors and guidelines), integrative data techniques, as well as how that data may be used. Additionally, this review provides commentary on the current state of the research space and makes recommendations based on how these analyses should be reported, the standardisation of nomenclature, as well as the impediments to the future goals of this research area. By careful consideration of the critical points of varying analytical processes and how best to communicate these findings, the quality of output within this area will improve. This review provides a benchmark for how GC-CD/sensory analysis should be undertaken and reported., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Food texture properties and consumer characteristics influence oral processing behaviors. Little is known about oral processing behavior of pungent spicy foods. In two experiments, we investigated how adding ground dried chilies to tomato soup or beef patties and curried rice altered oral processing behaviors. In Experiment One, tomato soups differing in concentration of added ground dried chilies (0.01, 0.03, 0.20 or 0.40% w/w) were consumed (n = 23). In Experiment Two, lunch meals that differed in added ground dried chilies consisting of beef patties (0.0, 0.6 or 1.2% w/w) and curried rice (0.0, 0.4 or 1.0% w/w) were consumed (n = 49). Sip/bite sizes were determined using hidden balances. Oral processing behavior was quantified using video recordings followed by post hoc annotations of specific behaviors. When eating tomato soup, increasing oral burn was associated with increasing number of water sips, water intake and total time between sips. For the solid meals (beef patties and curried rice), increasing oral burn was associated with increased time between bites and total sips of water; conversely, total oral exposure time, total number of chews and number of chews per bite all decreased with greater burn. Saliva content and rate of saliva incorporation into the solid food bolus increased with added ground dried chilies while oral exposure time decreased. We conclude consumers adapt their oral processing behaviors to oral burn of solid foods by reducing oro-sensory exposure time, chewing bites less, increasing time between bites, and consuming more water, potentially to mitigate the discomfort associated with the burn imparted by ground dried chilies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier B.V.)

Background: There is a prevailing view that humans' capacity to use language to characterize sensations like odors or tastes is poor, providing an unreliable source of information., Methods: Here, we developed a machine learning method based on Natural Language Processing (NLP) using Large Language Models (LLM) to predict COVID-19 diagnosis solely based on text descriptions of acute changes in chemosensation, i.e., smell, taste and chemesthesis, caused by the disease. The dataset of more than 1500 subjects was obtained from survey responses early in the COVID-19 pandemic, in Spring 2020., Results: When predicting COVID-19 diagnosis, our NLP model performs comparably (AUC ROC ~ 0.65) to models based on self-reported changes in function collected via quantitative rating scales. Further, our NLP model could attribute importance of words when performing the prediction; sentiment and descriptive words such as "smell", "taste", "sense", had strong contributions to the predictions. In addition, adjectives describing specific tastes or smells such as "salty", "sweet", "spicy", and "sour" also contributed considerably to predictions., Conclusions: Our results show that the description of perceptual symptoms caused by a viral infection can be used to fine-tune an LLM model to correctly predict and interpret the diagnostic status of a subject. In the future, similar models may have utility for patient verbatims from online health portals or electronic health records., (© 2023. The Author(s).)

The bulk vegetable oil-water partition coefficient of caffeine and quinine was determined by a shake-flask method as log K ow  = -1.32 and 2.97. These values were consistent with the effect of oil concentration on the distribution of the bitterants in an oil-in-water emulsion (0-2 and 0-20 wt% oil stabilized with 0.125 and 1 wt% whey protein isolate, respectively). For example, in a 20% o/w emulsion, approximately 90% of the total caffeine remained in the aqueous phase, whereas in a 2% o/w emulsion, only ∼20% of the quinine remained in the aqueous phase. The intensity of the bitter taste of caffeine and quinine in emulsions was assessed by a large cohort (n = 100) of untrained participants. An increase in fat in the emulsions (from 0.5 wt% to 2 wt% oil emulsions stabilized with 0.125 wt% whey protein isolate) caused a significant decrease in perceived bitterness that was accompanied by a decrease in the aqueous concentration of the hydrophobic bitterant quinine Specifically, the bitterness of quinine was reduced ∼13% in the o/w emulsion with more fat, and this drop paralleled a drop in the aqueous concentration and was generally consistent with aqueous dose-response functions published elsewhere. For the hydrophilic bitterant caffeine, there was no significant change in the perceived bitterness or aqueous concentration with changing oil concentration. We conclude that the perceived bitterness of a hydrophobic bitterant like quinine in an emulsion depends on the aqueous concentration rather than the overall concentration., (© 2022 Institute of Food Technologists.)

This study focused on the effect of binding of capsaicin by milk proteins on oral burn. The concentration of free, unbound capsaicin in 5 ppm capsaicin solution containing 0-5% (w/w) micellar casein or whey protein isolate was measured by extraction into hexadecane. The concentration of free capsaicin decreased linearly with protein concentration and the decrease was greater for casein than for whey protein. The intensity of the capsaicin burn in similar solutions was assessed by a large cohort (n = 89) of untrained participants in a time-intensity study. The maximum burn intensity decreased with protein concentration and was lower for samples containing casein than for samples containing whey protein isolate. The maximum burn was linearly related to the free, unbound capsaicin concentration. When protein solutions (1-5% w/w) were used as rinses following exposure to a 5 ppm aqueous capsaicin solution, only the 5% (w/w) micellar casein solution was significantly more effective than the water rinse in reducing oral burn., (© 2022 Institute of Food Technologists.)

People often confuse smell loss with taste loss, so it is unclear how much gustatory function is reduced in patients self-reporting taste loss. Our pre-registered cross-sectional study design included an online survey in 12 languages with instructions for self-administering chemosensory tests with 10 household items. Between June 2020 and March 2021, 10,953 individuals participated. Of these, 5,225 self-reported a respiratory illness and were grouped based on their reported COVID test results: COVID-positive (COVID+, N = 3,356), COVID-negative (COVID-, N = 602), and COVID unknown for those waiting for a test result (COVID?, N = 1,267). The participants who reported no respiratory illness were grouped by symptoms: sudden smell/taste changes (STC, N = 4,445), other symptoms excluding smell or taste changes (OthS, N = 832), and no symptoms (NoS, N = 416). Taste, smell, and oral irritation intensities and self-assessed abilities were rated on visual analog scales. Compared to the NoS group, COVID+ was associated with a 21% reduction in taste (95% confidence interval (CI): 15-28%), 47% in smell (95% CI: 37-56%), and 17% in oral irritation (95% CI: 10-25%) intensity. There were medium to strong correlations between perceived intensities and self-reported abilities (r = 0.84 for smell, r = 0.68 for taste, and r = 0.37 for oral irritation). Our study demonstrates that COVID-19-positive individuals report taste dysfunction when self-tested with stimuli that have little to none olfactory components. Assessing the smell and taste intensity of household items is a promising, cost-effective screening tool that complements self-reports and may help to disentangle taste loss from smell loss. However, it does not replace standardized validated psychophysical tests., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The scope of antimicrobial stewardship programs has expanded beyond the acute hospital setting. The need to optimize antimicrobial use in emergency departments, urgent, primary, and specialty care clinics, nursing homes, and long-term care facilities prompted the development of core elements of stewardship programs in these settings. Identifying the most innovative and well-designed stewardship literature in these novel stewardship areas can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network evaluated antimicrobial stewardship-related, peer-reviewed literature published in 2021 that detailed actionable interventions specific to the nonhospital setting. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for expansion of antimicrobial stewardship programs beyond the acute hospital setting., Competing Interests: Potential conflicts of interest. All authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Menthol upregulates nicotinic acetylcholine receptors and is associated with tobacco dependence. The effects of menthol when smoking cigarettes with varying low nicotine content up to 98 % (e.g., non-addicting) less than commercial cigarettes is not well understood. The U.S. Food and Drug Administration is considering two tobacco product standards in cigarettes including banning menthol and reducing nicotine content. These new standards have the potential to significantly reduce smoking initiation and maintenance by limiting the mechanistic effects of nicotine and menthol on the brain., Methods: We conducted two parallel randomized clinical trials of gradually reduced nicotine in cigarettes from 11.6 mg down to 0.2 mg nicotine/cigarette (very low nicotine content; VLNC) vs. usual nicotine content (11.6 mg; UNC) over an 18-week period in people who smoke cigarettes with low socioeconomic status (SES) and mental health conditions., Results: Compared to UNC, VLNC was associated with significant reductions in cotinine, cigarettes per day, expired carbon monoxide levels, nicotine dependence and symptomology. These associations did not differ between menthol and non-menthol cigarettes, except people who smoke menthol cigarettes had less of a cotinine reduction in the SES trial. The pooled odds ratio of being adherent with using only VLNC study cigarettes in the gradual nicotine reduction arm for people who smoke non-menthol vs. menthol cigarettes was 2.6 (95 % CI:1.0, 6.4; p-value: 0.04)., Conclusions: When nicotine is lowered to non-addicting levels, the results indicate an independent effect of menthol on the need to sustain nicotine intake in addicted people who smoke cigarettes., Competing Interests: Conflicts of interest Jonathan Foulds has completed paid consulting for pharmaceutical companies involved in producing smoking cessation medications, including GSK, Pfizer, Novartis, J&J, and Cypress Bioscience, and received a research grant from Pfizer (not related to reduced nicotine cigarettes). The other authors declare that they have no conflict of interest. Dr. Hayes has received speaking and/or consulting fees from nonprofit organizations, corporate entities in the food and beverage industries, and federal agencies, including the US Food and Drug Administration Center for Tobacco Products. The FDA CTP was not involved in this project and the views shown here belong solely to the authors., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The US FDA announced its commitment to prohibiting menthol as a characterizing flavor in tobacco. The relationship between cigarette menthol and exposure to toxic substances in mainstream tobacco smoke is not well characterized., Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2015 to 2016 special sample were used to study markers of 26 harmful and potentially harmful constituents (HPHC) in tobacco smoke. These include urine metabolites of polycyclic aromatic hydrocarbons (PAH), volatile organic compounds (VOC), and heavy metals in exclusive menthol (n = 162) and nonmenthol (n = 189) cigarette smokers. Urine metabolites of 7 PAHs, 15 VOCs, and 4 heavy metal biomarkers were compared by menthol status. Multivariable analyses were conducted on creatinine-adjusted concentrations., Results: There were no significant differences in cotinine levels or in 22 of 26 HPHCs. Among the urine metabolites of PAHs, the levels of 1-hydroxyphenanthrene were about 16% lower in menthol smokers. Among the urine metabolites of VOCs, menthol cigarette smokers presented significantly lower concentrations of acrylamide, N,N-dimethylformamide, and acrylonitrile. Menthol and nonmenthol smokers presented similar levels of heavy metals. Menthol did not affect the levels of cotinine and the nicotine metabolite ratio in urine., Conclusions: Menthol and nonmenthol cigarettes deliver similar levels of most HPHCs., Impact: Findings on toxicity are similar for menthol and nonmenthol cigarettes., (©2022 American Association for Cancer Research.)

Starch-guest inclusion complexes (ICs) are a novel, clean-label flavor encapsulation system with the potential to improve stability of aroma volatiles. While amylase has been shown to modulate guest release in vitro, release by sensory perception has not been evaluated. Here, Temporal Check-All-That-Apply (TCATA) and CATA were used to compare flavor perception of starch-limonene ICs to uncomplexed limonene, and the differences in perception were explored as a function of participant salivary α-amylase activity (sAA) and salivary flow rate (sFR). High sFR levels decreased limonene perception while high sAA increased limonene perception, highlighting the potential influence of these physiological factors on flavor perception of foods. Temporal flavor perception of a chewing gum containing starch-limonene ICs and a second chewing gum containing uncomplexed limonene and corn starch (CTL) was evaluated by 99 untrained consumers who assessed taste, texture, and aroma attributes over 17 min by TCATA and CATA. In addition, participants were segmented into three clusters based on their sAA and sFR, and cluster TCATA curves for each sample and attribute were statistically compared. Overall, participants rated Citrus, Sour and Bitter (p < 0.05) significantly higher for the IC sample and rated Sweet higher for the CTL. For Citrus, Sour, and Bitter, significant differences were observed between the three clusters for the IC chewing gum, while the CTL gum showed no significant differences for these three attributes. We demonstrate that flavor perception of starch-guest ICs varies with participants' salivary α-amylase activity and flow rate. Additionally, TCATA and CATA were found to be well suited to characterize flavor release systems over a long period of time as multiple flavor percepts can be simultaneously tracked., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The cone-rod homeobox (CRX) protein is a critical K50 homeodomain transcription factor responsible for the differentiation and maintenance of photoreceptor neurons in the vertebrate retina. Mutant alleles in the human gene encoding CRX result in a variety of distinct blinding retinopathies, including retinitis pigmentosa, cone-rod dystrophy, and Leber congenital amaurosis. Despite the success of using in vitro biochemistry, animal models, and genomics approaches to study this clinically relevant transcription factor over the past 25 years since its initial characterization, there are no high-resolution structures in the published literature for the CRX protein. In this study, we use bioinformatic approaches and small-angle X-ray scattering (SAXS) structural analysis to further understand the biochemical complexity of the human CRX homeodomain (CRX-HD). We find that the CRX-HD is a compact, globular monomer in solution that can specifically bind functional cis-regulatory elements encoded upstream of retina-specific genes. This study presents the first structural analysis of CRX, paving the way for a new approach to studying the biochemistry of this protein and its disease-causing mutant protein variants., (© 2022 The Authors. Proteins: Structure, Function, and Bioinformatics published by Wiley Periodicals LLC.)

For pharmaceuticals to deliver their full benefits with maximum efficacy, patients need to follow recommended dosing schedules, in terms of amount and frequency. Unfortunately, the aversive taste of many drugs, especially bitterness, can reduce patient compliance in oral liquid formulations. Given common genetic differences in bitter taste receptor genes ( TAS2Rs ), some individuals may be at increased risk for poor compliance due to heightened bitterness that becomes a barrier to proper use. Here we report on the sensory profile of two antibiotics, chloramphenicol and ofloxacin, investigating whether bitterness intensity associates with nominally functional TAS2R variants. Participants ( n = 143) rated suprathreshold intensity on a general Labeled Magnitude Scale (gLMS) for chloramphenicol and ofloxacin; propylthiouracil (PROP) was included as a control, given robust prior associations with TAS2R38 variants. The dominant sensation from chloramphenicol and ofloxacin was bitterness, falling just below "moderate" on a gLMS. TAS2R38 diplotype associated with variable bitterness of chloramphenicol and PROP, but not ofloxacin. The bitterness of ofloxacin associated with a TAS2R9 SNP (V187A). This pilot study provides novel evidence on differences in the bitterness from two antibiotics, which are associated with TAS2R variants. Improved understanding of individualized barriers to patient compliance, especially for oral formulations, can guide future efforts to optimize delivery systems for improved compliance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Nolden, Hayes and Feeney.)

Thousands start smoking or vaping daily, despite long-standing efforts by public health authorities to curb initiation and use of nicotine containing products. Over the last 15 years, use of electronic nicotine delivery systems has increased dramatically, with a diverse range of products on the market, including pod-based, disposable, and refillable electronic cigarettes (eCigs). Originally intended for harm reduction and smoking cessation, eCigs may encourage nicotine use among never smokers, given the vast range of appealing flavors that are available. To better understand abuse liability and to facilitate appropriate regulations, it is crucial to understand the science of flavor, and flavor perception within the context of eCig use. Here, we (a) provide a brief primer on chemosensory perception and flavor science for addiction and nicotine researchers, and (b) highlight existing some literature regarding flavor and nicotine use, with specific attention given to individual differences in perception, and interaction between different sensory modalities that contribute to flavor. Dramatic increases in use of eCigs highlights the importance of flavor science in contemporary addiction research, both with regards to public health and regulatory efforts. Other recent work summarizes findings on flavored e-liquids and eCig use, but none have focused explicitly on chemosensory processes or flavor perception as they relate to appeal and use of such products. We argue flavor science needs to be considered as perceptual and behavioral phenomena, and not merely from analytical, toxicological and pharmacological perspectives; we help address this gap here., Competing Interests: AB is employed by Curion, a research service provider to the Food, Beverage, and FMGC industries, where she manages taste tests on chocolate and confectionary products; Curion has no other interest or involvement in this work. JH has received speaking and/or consulting fees from non-profit organizations, corporate clients in the food and beverage industries, and federal agencies, including the United States Food and Drug Administration Center for Tobacco Products. The FDA CTP was not involved in this project and the views shown here belong solely to the authors. JH also serves as Director of the Penn State Sensory Evaluation Center, which conducts routine taste tests for food industry clients to facilitate experiential learning for undergraduate and graduate students. JH holds equity in Redolynt LLC, which he cofounded in 2021; Redolynt has no involvement in the work described here. None of the organizations listed above have had any role in the conception, drafting or decision to publish this work., (Copyright © 2022 Hayes and Baker.)

Background: Sudden smell loss is a specific early symptom of COVID-19, which, prior to the emergence of Omicron, had estimated prevalence of ~40% to 75%. Chemosensory impairments affect physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. The aim of this cohort study was to characterize smell function and recovery up to 11 months post COVID-19 infection., Methods: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial survey (S1) about respiratory symptoms, chemosensory function and COVID-19 diagnosis between April and September 2020, were invited to complete a follow-up survey (S2). Between September 2020 and February 2021, 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness., Results: At follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID illness. The ability to smell during COVID-19 was rated slightly lower by those who did not eventually recover their pre-illness ability to smell at S2., Conclusions: While smell ability improves for many individuals who lost it during acute COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is associated with broader persistent symptoms of COVID-19, and may last for many months following acute COVID-19. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that even conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.