Developing policies and actions in response to missed nursing care: A consensus process.

AIM: To support the development of appropriate policies and actions in the field of missed nursing care (MNC). BACKGROUND: There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. METHOD: A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. RESULTS: A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. CONCLUSIONS: We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. IMPLICATIONS FOR NURSING MANAGEMENT: The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

Effect of the use of anti-hail nets on codling moth (Cydia pomonella) and organoleptic quality of apple (cv. Braeburn) grown in Alto Adige Region (northern Italy).

BACKGROUND: The anti-hail nets are widely used to protect apple fruit against hailstorms and hail damage. They can have also beneficial effects against pests in apple orchards, in particular codling moth (Cydia pomonella). However, covering the trees with anti-hail nets can modify the orchard microclimate and reduce the interception of light, thus potentially causing negative consequences on the organoleptic quality of apple fruits. RESULTS: A consistent reduction of the percentage of apple fruits infested by codling moth was registered as a result of the use of anti-hail nets during two consecutive harvest years. Their use did not affect fruit maturity, but reduced the skin colour, sugar content, pulp total phenol content, volatile compound composition and sensory characteristics. However, the results were inconsistent over the two years apart for total phenols, formation of two volatile compounds (butyl and hexenyl acetate, the first being one of the main odorants in most apple cultivars), sensory attributes of 'flavour of lemon' and 'juiciness'. For these parameters, the fruits from plots where the trees were not covered showed higher values than those from plots where anti-hail nets were used. CONCLUSIONS: The use of anti-hail nets was effective in preventing the attack of codling moth to apple fruits, suggesting their use in organic management where conventional insecticides are prohibited. Under the conditions tested, anti-hail nets showed a negative effect on some of the quality characteristics measured on apple fruits, which could influence consumer acceptability.

Quality assessment of baby food made of different pre-processed organic raw materials under industrial processing conditions.

The market for processed food is rapidly growing. The industry needs methods for "processing with care" leading to high quality products in order to meet consumers' expectations. Processing influences the quality of the finished product through various factors. In carrot baby food, these are the raw material, the pre-processing and storage treatments as well as the processing conditions. In this study, a quality assessment was performed on baby food made from different pre-processed raw materials. The experiments were carried out under industrial conditions using fresh, frozen and stored organic carrots as raw material. Statistically significant differences were found for sensory attributes among the three autoclaved puree samples (e.g. overall odour F = 90.72, p < 0.001). Samples processed from frozen carrots show increased moisture content and decrease of several chemical constituents. Biocrystallization identified changes between replications of the cooking. Pre-treatment of raw material has a significant influence on the final quality of the baby food.

The influence of organic production on food quality - research findings, gaps and future challenges.

Although several meta-analysis studies have been published comparing the quality of food derived from organic and non-organic origin, it is still not clear if food from organic production per se can guarantee product-related added value to consumers. This paper aims to summarize the status quo in order to identify research gaps and suggest future research challenges. Organic food is described according to a quality model already published. The influence of organic production on food quality is structured in primary production and processing. Furthermore, organic food authentication is discussed. Organic food seems to contain fewer pesticide residues and statistically more selected health-related compounds such as polyphenols in plant products and polyunsaturated fatty acids in milk and meat products, but the health relevance for consumers is not clear yet. Comparing food from organic origin with so called 'conventional' food seems not to be appropriate, because 'conventional' is not defined. In organic food quality research a system approach is needed from which systemic markers can be selected. Research on the impact of processing technologies on the quality according to organic principles seems of high relevance, since most of the food is processed.

Organic food processing: a framework for concept, starting definitions and evaluation.

In 2007 EU Regulation (EC) 834/2007 introduced principles and criteria for organic food processing. These regulations have been analysed and discussed in several scientific publications and research project reports. Recently, organic food quality was described by principles, aspects and criteria. These principles from organic agriculture were verified and adapted for organic food processing. Different levels for evaluation were suggested. In another document, underlying paradigms and consumer perception of organic food were reviewed against functional food, resulting in identifying integral product identity as the underlying paradigm and a holistic quality view connected to naturalness as consumers' perception of organic food quality. In a European study, the quality concept was applied to the organic food chain, resulting in a problem, namely that clear principles and related criteria were missing to evaluate processing methods. Therefore the goal of this paper is to describe and discuss the topic of organic food processing to make it operational. A conceptual background for organic food processing is given by verifying the underlying paradigms and principles of organic farming and organic food as well as on organic processing. The proposed definition connects organic processing to related systems such as minimal, sustainable and careful, gentle processing, and describes clear principles and related criteria. Based on food examples, such as milk with different heat treatments, the concept and definitions were verified. Organic processing can be defined by clear paradigms and principles and evaluated according criteria from a multidimensional approach. Further work has to be done on developing indicators and parameters for assessment of organic food quality.

Multi-method comparison of carrot quality from a conventional and three organic cropping systems with increasing levels of nutrient recycling.

BACKGROUND: There is a need to advance the study of the effects of organic and conventional systems on product quality. In particular, little is known about the importance of different farming practices concerning nutrient cycling and the use of external inputs within organic farming for the quality characteristics of the products. In this study the quality characteristics of carrot grown under different farming practices (conventional and three organic cropping systems) over a two-year period were analysed with the aim of discriminating between organic and conventional and investigating the effect of different organic farming practices concerning nutrient recycling and use of external nutrient input. RESULTS: All quality characteristics measured did not give a clear differentiation between the carrots from the different growing systems, even when multivariate statistical evaluation (principal component analysis) was applied, because of the significance of the differences between the field replicates within each management system and of the seasonality. Only some tendencies were emphasised over the two years that could be related to the fertilisation practices and the external inputs used. CONCLUSION: The results indicated that it was not possible to discriminate over the years between carrots from conventional and different organic cropping systems even though controlled conditions and a multi-method approach of analysis were adopted.

Measuring the impact of a social programme on healthcare: a 10-year retrospective cohort study in Trieste, Italy.

OBJECTIVES: Poor social conditions are strong determinants of poor health but positive health and healthcare changes caused by social interventions are difficult to demonstrate. In 2006, in Trieste (Italy), a social intervention known as 'Habitat Microaree' (HM) project was implemented in eight deprived neighbourhoods. In 2016, an observational study was launched to assess the impact of the HM project on healthcare. DESIGN: Retrospective cohort study. SETTING: The eight geographically defined neighbourhoods of Trieste involved in the 2006 HM project, accounting for a total of 11 380 residents. PARTICIPANTS: Participants were all residents in the intervention areas. By means of a propensity score based on deprivation index, age, sex, Charlson index and drug utilisation, a non-participating, comparison group was defined. INTERVENTION: The community-based intervention consisted of facilitating access to social services and outpatient healthcare facilities, coordinating intersectoral public services and specifically planning hospital discharge. These services were not provided in other areas of the city. OUTCOME MEASURES: Hospital admissions and emergency department access. RESULTS: We followed 16 256 subjects between 2008 and 2015. Living in microareas was associated with an HR for first hospital admission, for all causes, of 0.95 (95% CI 0.91 to 0.99); while the HR for urgent admissions in females was 0.92 (95% CI 0.85 to 1.00). The HR for psychiatric disorders, in females, was 0.39 (95%CI 0.18 to 0.82); in particular, the HR for psychosis was 0.15 (95% CI 0.05 to 0.51). The HR for acute respiratory diseases in females was 0.44 (95% CI 0.21 to 0.95). In males, the HR for genitourinary diseases and heart diseases were 0.65 (95% CI 0.42 to 1.01) and 0.72 (95% CI 0.54 to 0.97), respectively. Concerning urgent multiple admissions, the OR for fractures in females was 0.75 (95% CI 0.58 to 0.97). CONCLUSION: In the study period, the effects on healthcare appear evident, especially in females.

Reprint of "Capturing consumer perception of vegetable freshness in a simulated real-life taste situation".

Consumer testing in re-created purchase or consumption contexts may produce results with a higher external validity than laboratory testing and be a valid alternative to consumer testing in real-life contexts. Hence, the present study evaluates the utility of a novel immersive approach in sensory consumer testing. An immersive multisensory room was designed to reproduce consumption conditions close to real life, with large wall screen projections, audio and olfactory stimuli and furniture consistent with the video scenario. Overall liking and perceived freshness of two vegetable products (salad tomato and wild rocket) at different storage time were evaluated by a group of volunteers, regular consumers of the products. Evaluations were performed both in a immersive environment setting - the scenario was the dining room of a holiday farm overlooking a patio and the countryside - and in a traditional sensory lab setting, as a control. The magnitude of liking was higher when evaluations were performed in the immersive environment setting than in the traditional lab setting. However, the discrimination efficacy for freshness and liking of stored and un-stored vegetables was reduced in the immersive environment with respect to the control lab. Additional research, aimed at exploring other products and other consumption or purchase immersive scenarios, will further clarify whether these findings are product-dependent or determined by the contingent immersive situation.

Capturing consumer perception of vegetable freshness in a simulated real-life taste situation.

Consumer testing in re-created purchase or consumption contexts may produce results with a higher external validity than laboratory testing and be a valid alternative to consumer testing in real-life contexts. Hence, the present study evaluates the utility of a novel immersive approach in sensory consumer testing. An immersive multisensory room was designed to reproduce consumption conditions close to real life, with large wall screen projections, audio and olfactory stimuli and furniture consistent with the video scenario. Overall liking and perceived freshness of two vegetable products (salad tomato and wild rocket) at different storage time were evaluated by a group of volunteers, regular consumers of the products. Evaluations were performed both in a immersive environment setting - the scenario was the dining room of a holiday farm overlooking a patio and the countryside - and in a traditional sensory lab setting, as a control. The magnitude of liking was higher when evaluations were performed in the immersive environment setting than in the traditional lab setting. However, the discrimination efficacy for freshness and liking of stored and un-stored vegetables was reduced in the immersive environment with respect to the control lab. Additional research, aimed at exploring other products and other consumption or purchase immersive scenarios, will further clarify whether these findings are product-dependent or determined by the contingent immersive situation.

Characterization of volatiles and identification of odor-active compounds of rocket leaves.

The volatile profile of crushed rocket leaves (Eruca sativa and Diplotaxis tenuifolia) was investigated by applying Headspace Solid-Phase MicroExtraction (HS-SPME), combined with GC-MS, to an aqueous extract obtained by homogenization of rocket leaves, and stabilized by addition of CaCl2. A detailed picture of volatile products of the lipoxygenase pathway (mainly C6-aldehydes) and of glucosinolate hydrolysis (mainly isothiocyanates), and their dynamics of formation after tissue disruption was given. Odor-active compounds of leaves were characterized by GC-Olfactometry (GC-O) and Aroma Extract Dilution Analysis (AEDA): volatile isolates obtained by HS-SPME from an aqueous extract and by Stir-Bar Sorptive Extraction (SBSE) from an ethanolic extract were analyzed. The most potent odor-active compounds fully or tentatively identified were (Z)- and (E)-3-hexenal, (Z)-1,5-octadien-3-one, responsible for green olfactory notes, along with 4-mercaptobutyl and 4-(methylthio)butyl isothiocyanate, associated with typical rocket and radish aroma. Relatively high odor potency was observed for 1-octen-3-one, (E)-2-octenal and 1-penten-3-one.

[Missed nursing care and italian nursing practice: preliminary finding of a consensus conference]. / Missed nursing care e pratica infermieristica italiana:risultati preliminari di una consensus conference.

. Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

How the Organic Food System Supports Sustainable Diets and Translates These into Practice.

Organic production and consumption provide a delineated food system that can be explored for its potential contribution to sustainable diets. While organic agriculture improves the sustainability performance on the production side, critical reflections are made on how organic consumption patterns, understood as the practice of people consuming significant amounts of organic produce, may also be taken as an example for sustainable food consumption. The consumption patterns of regular organic consumers seem to be close to the sustainable diet concept of FAO. Certain organic-related measures might therefore be useful in the sustainability assessment of diets, e.g., organic production and organic consumption. Since diets play a central role in shaping food systems and food systems shape diets, the role of organic consumption emerges as an essential topic to be addressed. This role may be based on four important organic achievements: organic agriculture and food production has a definition, well-established principles, public standards, and useful metrics. By 2015, data for organic production and consumption are recorded annually from more than 160 countries, and regulations are in force in more than 80 countries or regions. The organic food system puts the land (agri-cultura) back into the diet; it is the land from which the diet in toto is shaped. Therefore, the organic food system provides essential components of a sustainable diet.

Impact of different distribution scenarios and recommended storage conditions on flavor related quality attributes in ripening fresh tomatoes.

Tomato (Solanum lycopersicum) fruits of three cultivars picked at different ripening stages were subjected to conditions in the laboratory simulating both short and long distribution chains as occurring in commercial practice and to recommended storage conditions. At the end of the postharvest experiments, a flavor quality profile of fruits was obtained by chemical determination of volatile compounds, sugars, and organic acids, and physical measurement of texture properties. In two of the three cultivars, the overall profile and many of the individual quality attributes was significantly affected by the distribution chain conditions, the effect being more pronounced in tomatoes marketed at full ripeness than in those marketed at an intermediate ripening stage. In these cultivars, tomatoes harvested at the Breaker stage, subjected to long chain conditions and then allowed to achieve full ripeness at room temperature, did not develop the same overall profile observed on fruits fully ripened on the vine and exposed to a simulated short chain. Fruits subjected to recommended commercial storage conditions, cold stored above the chilling range (10 or 13 °C) and at high relative humidity (95%), developed a different profile when compared to fruit exposed to the simulated long distribution chain (6 °C and 55-80% RH), suggesting that these changes in temperature and relative humidity may remarkably affect flavor formation in tomato fruits. Major drivers of profile differentiation between tomatoes subjected to different postharvest scenarios were the levels of some aroma compounds derived from aminoacids (1-nitro-2-phenylethane, 2-isobutylthiazole, phenylacetaldehyde, 2-phenylethanol, and 2- and 3-methylbutanal) and lipids ((E,E)- and (E,Z)-2,4-decadienal), and, among nonvolatile flavor compounds, of organic acids (citric and malic).

Impact of innovative controlled atmosphere storage technologies and postharvest treatments on volatile compound production in cv. Pinova apples.

Organically grown apples cv. Pinova harvested at two different dates were stored at 1.3 degrees C for up to 4 months in air, up to 7 months in ULO (1.5 kPa of O(2) and 1.3 kPa of CO(2)) and in dynamic controlled atmosphere (DCA) conditions (0.4-0.6 kPa of O(2) and 0.6-0.8 kPa of CO(2)); the DCA storage method involved the use of a chlorophyll fluorescence monitoring system in order to detect low-O(2) stress in apples and to allow for the dynamic adaptation of storage atmosphere to O(2) levels that were lower than in ULO but still tolerated by fruits. A postharvest 1-MCP treatment (for 24 h at 1.3 degrees C) and a hot water treatment (for 180 s at 50 degrees C) were also tested on apples stored afterward in ULO and air, respectively. Volatile compounds isolated from the pulp of fruits were measured after 4 and 7 months, just upon removal from storage and after 11 days at 22 degrees C. Total amount of aroma compounds detected in apples stored in DCA was markedly higher (from 2- to 4-fold) than in fruits exposed to 1-MCP + ULO but, at most sampling times, significantly lower than in ULO fruits. Moderate differences in storage atmosphere composition between ULO and DCA significantly affected both total amount and profile of volatile esters. Analogous effects were observed on the alcohol precursors of the main esters. Exposure to 1-MCP inhibited biosynthesis of straight-chain esters more than that of branched-chain esters. The hot water treatment did not seem to produce marked changes in volatile composition after four months of air storage, except for a sharp accumulation of aldehydes during the shelf-life time. DCA storage technology, besides avoiding any chemical treatment, can preserve apple aroma compounds better than 1-MCP + ULO during long-term storage.