The entwined circles of quality improvement & advocacy.

Health policy and quality improvement initiatives exist symbiotically. Quality projects can be spurred by policy decisions, such as the creation of financial incentives for high-value care. Then, advocacy can streamline high-value care, offering opportunities for quality improvement scholars to create projects consistent with evidenced-based care. Thirdly, as pediatrics and neonatology reconcile with value-based payment structures, successful quality initiatives may serve as demonstration projects, illustrating to policy-makers how best to allocate and incentivize resources that optimize newborn health. And finally, quality improvement (QI) can provide an essential link between broad reaching advocacy principles and boots-on-the-ground local or regional efforts to implement good ideas in ways that work practically in particular environments. In this paper, we provide examples of how national legislation elevated the importance of QI, by penalizing hospitals for low quality care. Using Medicaid coverage of pasteurized human donor milk as an example, we discuss how advocacy improved cost-effectiveness of treatments used as tools for quality projects related to reduction of necrotizing enterocolitis and improved growth. We discuss how the future of QI work will assist in informing the agenda as neonatology transitions to value-based care. Finally, we consider how important local and regional QI work is in bringing good ideas to the bedside and the community.

Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments.

AIMS: Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. METHODS AND RESULTS: We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. CONCLUSIONS: The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption.

Quantitative microbiological risk assessment for the occurrence of listeriosis in Brazil due to the consumption of milk processed by pasteurization or thermosonication.

This study aimed to estimate the risk of listeriosis from the consumption of pasteurized milk in Brazil, comparing conventional treatment with the technology of thermosonication. The Quantitative Microbiological Risk Assessment (QMRA) model was developed, covering the entire milk production chain, from milking to the moment of consumption. In general, higher risks were observed in association with higher initial concentrations of the pathogen and the vulnerable population. The highest risk predicted (3.67 × 10-5) was related to the scenario considering the initial concentration range of L. monocytogenes between 4 and 6 log CFU/mL, with conventional treatment and considering the vulnerable population, resulting in one case of listeriosis every 27,248 servings. When considering thermosonication treatment, lower risks have been predicted. The scenario analysis indicated that the steps related to storage conditions in retail and at the consumer's home (post-processing steps) are the most influential in the associated risk, in all scenarios. The predictive parameters of inactivation related to the applied treatment also have a considerable influence on the risk. The results point to the influence of the stages of the dairy production chain and the thermosonication treatment applied in the food safety of milk, subsidizing information for industrial application and for regulatory agencies.

Assessment of biofilm, enzyme production and antibiotic susceptibility of bacteria from milk pre- and post-pasteurization pipelines in Algeria.

Bacterial biofilm is a major concern of dairy industry due to its association with milk contamination and its derived products. Algerian pasteurized milk shelf-life does not exceed one day, which may reflect the high level of contamination of this product and presence of extracellular enzymes such as lipases and proteases. This work aimed to investigate the microbial biodiversity in milk-processing surfaces of a dairy plant in Algeria. Therefore, stainless steel cylinders were placed in piping system of the dairy system before and after pasteurization of the milk, being removed after 7 days, for biofilm maturation and microorganism isolation and identification by mass spectrometry. Fifty-nine Gram-positive isolates were identified, namely Bacillus altitudinis, Bacillus cereus, Bacillus pumilus, Bacillus subtilis, Bacillus weithenstephanensis, Enterococcus casseliflavus, Enterococcus faecium, and Staphylococcus epidermidis. In addition, twenty-four Gram-negative isolates were identified, namely Acinetobacter schindleri Enterobacter cloacae, Enterobacter xiangfangensis, Leclercia adecarboxylata, and Raoultella ornithinolytica. Bacterial isolates showed ability for production of extracellular enzymes, being 49 % capable of both proteolytic and lipolytic activities. Milk isolates were tested for the ability to form biofilms on stainless steel. The cell numbers recovered on plate count agar plates from stainless steel biofilms ranged from 3.52 to 6.92 log10 CFU/cm2, being the maximum number detected for Enterococcus casseliflavus. Bacterial isolates showed intermediate and/or resistant profiles to multiple antibiotics. Resistance to amoxicillin, cefoxitin and/or erythromycin was commonly found among the bacterial isolates.

Expanding Medicaid Payment for Pasteurized Donor Human Milk in High-Risk Neonates.

Pasteurized donor human milk (PDHM) is associated with a reduced incidence of necrotizing enterocolitis in very low birth weight (VLBW) infants. Absence of Medicaid and private insurance payment for PDHM use in neonatal intensive care units contributes to disparities based on state of birth and socioeconomic level. Before 2017, 5 states had policies for PDHM coverage, incorporating less than 30% of VLBW infants born nationally. In this case study, we outline the partnership of local American Academy of Pediatrics (AAP) chapters with the national AAP Section on Neonatal-Perinatal Medicine to create a PDHM Advocacy Toolkit to facilitate Medicaid PDHM coverage. Over 5 years, neonatologist-led advocacy, incentivized via AAP funds, contributed to 5 additional states providing Medicaid payment for PDHM, resulting in over 55% of VLBW infants born nationally in states with funded coverage. Partnerships with state AAP chapters, pilot grant funding with deliverables, emphasis on advocacy coaching, and modification of the generalized toolkit to suit local needs were essential in engineering Medicaid PDHM payment. Together these actions provide a template for other pediatric subspecialists to help advance niche-focused advocacy issues at the state level.

Comparative analyses of holder pasteurization vs. HTST pasteurization for donor milk: a cost-minimization study applicable to human milk banks.

BACKGROUND: High-temperature short-time (HTST) pasteurization (72-75 °C, 15 s) is an alternative treatment to traditional Holder pasteurization (HoP) (62ºC, 30 min) for donor milk. HTST pasteurization guarantees the milk's microbiological safety and retains more of its biologically and nutritionally active compounds, but the cost of implementing this technology for a human milk bank is unknown. METHODS: A cost-minimization study was carried out on the facilities of a regional human milk bank in a public hospital. Total production costs (fixed plus variables) were quantified using HTST pasteurization and HoP in three hypothetical scenarios: (1) costs of the first 10 L of pasteurized milk in a newly opened milk bank; (2) costs of the first 10 L of pasteurized milk in an active milk bank; and (3) costs using the maximum production capacity of both technologies in the first two years of operation. The following costs were analyzed: health care professionals, equipment and software, external services, and consumables. RESULTS: In scenario 1, the total production costs were € 228,097.00 for the HTST method versus € 154,064.00 for the HoP method. In scenario 2, these costs were similar (€ 6,594.00 for HTST pasteurization versus € 5,912.00 for HoP). The cost of healthcare professionals was reduced by more than half when pasteurization was carried out by the HTST method versus the Holder method (€ 84.00 and € 191.00, respectively). In scenario 3, the unit cost of milk pasteurized by the HTST method decreased from the first to the second year by 43.5%, while for the HoP method, it decreased by 30%. CONCLUSIONS: HTST pasteurization requires a high initial investment in equipment; however, it provides a significant minimization of production costs in the long term, pasteurizes large quantities of donor milk per working day and achieves a more efficient management of the time of the health care professionals in charge of the bank's operation compared to HoP.

Evaluación del valor de acidez Dornic de la leche humana según el tiempo de conservación en freezer y el lugar de extracción / Assessment of Dornic acidity in breast milk based on storage time in the freezer and place of expression

Introducción. El grado de acidez Dornic (AD), medida indirecta del grado de contaminación de la leche humana cruda (LHC), proporciona información sobre la calidad de esta. Recién extraída, el valor oscila entre 1,0° y 4,0° (óptimo). Descalifica el consumo si es >8,0 °D. Se evaluó la correlación de la AD de la LHC de donantes internas (DI) y externas (DE) según el tiempo de conservación hasta la pasteurización, y se determinó la prevalencia de AD ≤4 ºD. Población y método. Estudio retrospectivo analítico. Resultados. Sobre 13 203 muestras, la AD a partir del día 14 de conservación fue menor en las donantes internas, de 2,92; (IC95% 2,69-3,15) versus 4,01 (IC95%: 3,94-4,08); p <0,001] con mayor proporción de AD ≤4 ºD (88 % en DI versus 76 % en DE); OR: 2,30 (IC95%: 1,25-4,24); p = 0,003. Coeficiente de correlación para las DI: R 2 :0; p = 1). Conclusión. La AD a partir del día 14 fue menor en DI, presentando mayor prevalencia de AD ≤ 4ºD. No existió correlación entre el tiempo de conservación y la AD en las DI.

Introduction. The degree of Dornic acidity (DA) is an indirect measure of milk contamination and quality. In freshly expressed milk, DA ranges between 1.0 and 4.0 (optimal). If DA is > 8.0 °D, it should be discarded. The correlation between DA in raw breast milk from internal donors (ID) and external donors (ED) based on storage time until pasteurization was assessed. Population and method. Retrospective, analytical study. Results. In 13 203 samples, DA was lower in IDs as of 14 days of storage: 2.92 (95% CI: 2.69­3.15) versus 4.01 (95% CI: 3.94­4.08), with a higher proportion of DA ≤ 4 °D (88% in IDs versus 76% in EDs); odds ratio: 2.30 (95% CI: 1.25­4.24). Conclusion. DA as of 14 days of storage was lower in IDs, with a higher prevalence of DA ≤ 4 °D. No correlation was observed between storage time and DA in ID samples.

Low-cost, on-farm intervention to reduce spores in bulk tank raw milk benefits producers, processors, and consumers.

Bacterial spores, which are found in raw milk, can survive harsh processing conditions encountered in dairy manufacturing, including pasteurization and drying. Low-spore raw milk is desirable for dairy industry stakeholders, especially those who want to extend the shelf life of their product, expand their distribution channels, or reduce product spoilage. A recent previous study showed that an on-farm intervention that included washing towels with chlorine bleach and drying them completely, as well as training milking parlor employees to focus on teat end cleaning, significantly reduced spore levels in bulk tank raw milk. As a follow up to that previous study, here we calculate the costs associated with that previously described intervention as ranging from $9.49 to $13.35 per cow per year, depending on farm size. A Monte Carlo model was used to predict the shelf life of high temperature, short time fluid milk processed from raw milk before and after this low-cost intervention was applied, based on experimental data collected in a previous study. The model predicted that 18.24% of half-gallon containers of fluid milk processed from raw milk receiving no spore intervention would exceed the pasteurized milk ordinance limit of 20,000 cfu/mL by 17 d after pasteurization, while only 16.99% of containers processed from raw milk receiving the spore intervention would reach this level 17 d after pasteurization (a reduction of 1.25 percentage points and a 6.85% reduction). Finally, a survey of consumer milk use was conducted to determine how many consumers regularly consume fluid milk near or past the date printed on the package (i.e., code date), which revealed that over 50% of fluid milk consumers surveyed continue to consume fluid milk after this date, indicating that a considerable proportion of consumers are exposed to fluid milk that is likely to have high levels spore-forming bacterial growth and possibly associated quality defects (e.g., flavor or odor defects). This further highlights the importance of reducing spore levels in raw milk to extend pasteurized fluid milk shelf life and thereby reducing the risk of adverse consumer experiences. Processors who are interested in extending fluid milk shelf life by controlling the levels of spores in the raw milk supply should consider incentivizing low-spore raw milk through premium payments to producers.

Assessment of Dornic acidity in breast milk based on storage time in the freezer and place of expression. / Evaluación del valor de acidez Dornic de la leche humana según el tiempo de conservación en freezer y el lugar de extracción.

Introduction. The degree of Dornic acidity (DA) is an indirect measure of milk contamination and quality. In freshly expressed milk, DA ranges between 1.0 and 4.0 (optimal). If DA is > 8.0 °D, it should be discarded. The correlation between DA in raw breast milk from internal donors (ID) and external donors (ED) based on storage time until pasteurization was assessed. Population and method. Retrospective, analytical study. Results. In 13 203 samples, DA was lower in IDs as of 14 days of storage: 2.92 (95% CI: 2.69-3.15) versus 4.01 (95% CI: 3.94-4.08), with a higher proportion of DA ≤ 4 °D (88% in IDs versus 76% in EDs); odds ratio: 2.30 (95% CI: 1.25-4.24). Conclusion. DA as of 14 days of storage was lower in IDs, with a higher prevalence of DA ≤ 4 °D. No correlation was observed between storage time and DA in ID samples.

Introducción. El grado de acidez Dornic (AD), medida indirecta del grado de contaminación de la leche humana cruda (LHC), proporciona información sobre la calidad de esta. Recién extraída, el valor oscila entre 1,0° y 4,0° (óptimo). Descalifica el consumo si es >8,0 °D. Se evaluó la correlación de la AD de la LHC de donantes internas (DI) y externas (DE) según el tiempo de conservación hasta la pasteurización, y se determinó la prevalencia de AD ≤4 ºD. Población y método. Estudio retrospectivo analítico. Resultados. Sobre 13 203 muestras, la AD a partir del día 14 de conservación fue menor en las donantes internas, de 2,92; (IC95% 2,69-3,15) versus 4,01 (IC95%: 3,94-4,08); p <0,001] con mayor proporción de AD ≤4 ºD (88 % en DI versus 76 % en DE); OR: 2,30 (IC95%: 1,25-4,24); p = 0,003. Coeficiente de correlación para las DI: R 2:0; p = 1). Conclusión. La AD a partir del día 14 fue menor en DI, presentando mayor prevalencia de AD ≤ 4ºD. No existió correlación entre el tiempo de conservación y la AD en las DI.

Monte Carlo simulation model predicts bactofugation can extend shelf-life of pasteurized fluid milk, even when raw milk with low spore counts is used as the incoming ingredient.

Bacterial spores from raw milk that survive the pasteurization process are responsible for half of all the spoilage of fluid milk. Bactofugation has received more attention as a nonthermal method that can reduce the presence of bacterial spores in milk and with it the spoilage of fluid milk. The objective of this work was to determine the effectiveness of bactofugation in removing spores from raw milk and estimate the effect the spore removal could have on shelf-life of fluid milk. The study was conducted in a commercial fluid milk processing facility where warm spore removal was performed using one-phase bactofuge followed by warm cream separation and high temperature, short time pasteurization. Samples from different stages of fluid milk processing with and without the use of bactofuge were tested for total plate count, mesophilic spore count, psychrotolerant spore count (PSC), and somatic cell count. Results were evaluated to determine the count reductions during different stages of fluid milk processing and compare counts in fluid milk processed with and without bactofugation. Bactofugation on average reduced the total plate count by 1.81 ± 0.72 log cfu/mL, mesophilic spore count by 1.08 ± 0.71 log cfu/mL, PSC by 0.86 ± 0.59 log cfu/mL, and somatic cell count by 135,881 ± 43,942 cells/mL. Psychrotolerant spore count in final pasteurized skim milk processed with and without bactofugation was used to predict the shelf-life of the pasteurized skim milk using the Monte Carlo simulation model. Although PSC in the initial raw milk was already low (-0.63 ± 0.47 log cfu/mL), the predicted values from the simulation model showed that bactofugation would extend the shelf-life of pasteurized skim milk by approximately 2 d. The results of this study will directly help fluid milk processors evaluate the benefits of using bactofugation as an intervention in their plants, and also demonstrate the benefits of using mathematical modeling in decision making.

The processing factors of canning and pasteurization for the most frequently occurring fungicides and insecticides in apples and their application into dietary risk assessment.

The challenge of the present comprehensive work was to study, from apple orchards to consumer's plate, the influence of high- and low-temperature thermal treatments on the most frequently occurring fungicides (boscalid, captan, pyraclostrobin) and insecticides (acetamiprid, methoxyfenozide) in apples and processing factor (PF) application for more realistic dietary risk assessment in the new EFSA methodology. Dry pasteurization and canning combined with previous preliminary treatment gave PFs = 0.25-1.8 of the five active substances. Acute exposure (expressed as %ARfD) in the raw commodity was demonstrated to be 168.1% for acetamiprid in the worst case (input - highest residue) and 307.9% for boscalid in the most critical case (input - MRL), and after re-calculation for PF, decreased to 139.5% for acetamiprid in canned product and 203.2% for boscalid in pasteurized apples. These novel data may be helpful in estimating new threshold residue levels significant in food safety especially intended for children.

Development of a Monte Carlo simulation model to predict pasteurized fluid milk spoilage due to post-pasteurization contamination with gram-negative bacteria.

Psychrotolerant gram-negative bacteria introduced as post-pasteurization contamination (PPC) are a major cause of spoilage and reduced shelf life of high-temperature, short-time pasteurized fluid milk. To provide improved tools to (1) predict pasteurized fluid milk shelf life as influenced by PPC and (2) assess the effectiveness of different potential interventions that could reduce spoilage due to PPC, we developed a Monte Carlo simulation model that predicts fluid milk spoilage due to psychrotolerant gram-negative bacteria introduced as PPC. As a first step, 17 gram-negative bacterial isolates frequently associated with fluid milk spoilage were selected and used to generate growth data in skim milk broth at 6°C. The resulting growth parameters, frequency of isolation for the 17 different isolates, and initial concentration of bacteria in milk with PPC, were used to develop a Monte Carlo model to predict bacterial number at different days of shelf life based on storage temperature of milk. This model was then validated with data from d 7 and 10 of shelf life, collected from commercial operations. The validated model predicted that the parameters (1) maximum growth rate and (2) storage temperature had the greatest influence on the percentage of containers exceeding 20,000 cfu/mL standard plate count on d 7 and 10 (i.e., spoiling due to PPC), which indicates that accurate data on maximum growth rate and storage temperature are important for accurate predictions. In addition to allowing for prediction of fluid milk shelf life, the model allows for simulation of "what-if" scenarios, which allowed us to predict the effectiveness of different interventions to reduce overall fluid milk spoilage due to PPC through a set of proof-of-concept scenario (e.g., frequency of PPC in containers reduced from 100% to 10%; limiting distribution temperature to a maximum of 6°C). Combined with other models, such as previous models on fluid milk spoilage due to psychrotolerant spore-forming bacteria, the data and tools developed here will allow for rational, digitally enabled, fluid milk shelf life prediction and quality enhancement.

The battle over milk: consumption, public health and the industrialization of the milk supply in São Paulo, 1911-1945. / La lucha por la leche: consumo, salud pública y la industrialización del abasto de leche líquida en São Paulo, 1911-1945.

In 1911, the city of São Paulo decided to modernize its milk supply system by opening up the import market for industrially pasteurized milk. But the industrial product was widely rejected, creating even more demand for raw milk produced in small barns under potentially unsafe conditions. This study examines how public authorities handled the double challenge of both minimizing the health risks of raw milk and helping to improve the industrial product, over the course of three decades. The article ends with an analysis of the effects of mandatory pasteurization, introduced in 1939, which equated to a ban on the sale of raw milk in the city of São Paulo.

En 1911, la ciudad de São Paulo decidió modernizar su sistema de abastecimiento de leche mediante la apertura del mercado para la importación de leche industrialmente pasteurizada. Pero el producto industrial provocó un amplio rechazo que hizo crecer todavía más la demanda por la leche cruda, producida en pequeños establos bajo condiciones precarias. Este estudio examina, a través de tres décadas, cómo las autoridades públicas afrontaban el doble reto de, a la vez, minimizar los riesgos sanitarios de la leche cruda e impulsar el mejoramiento del producto industrial. El trabajo cierra con un análisis de los efectos de la pasteurización obligatoria, introducida en 1939, que equivalía a la prohibición de la venta de leche cruda en el municipio.

Study on bisphenol F, a bisphenol A analogue, at a dairy company: Health hazard and risk assessment.

The occurrence of analogues of bisphenol A (BPA), including bisphenol F(BPF) in milk is still not well known. BPF may enter the milk chain at the farm and during milk processing at the dairy company. This study identified the main BPF contamination pathways using a monitoring model based on the identification of the hazard at three stages along the dairy chain: raw milk from the storage tank, pasteurized milk from the storage tank, and cardboard packaged milk. Quantitative analysis was performed by high-performance liquid chromatography with fluorometric detection (HPLC/FD) system. BPF was detected in all analysed stages (from

Review: High temperature short time treatment of cell culture media and feed solutions to mitigate adventitious viral contamination in the biopharmaceutical industry.

Events of viral contaminations occurring during the production of biopharmaceuticals have been publicly reported by the biopharmaceutical industry. Upstream raw materials were often identified as the potential source of contamination. Viral contamination risk can be mitigated by inactivating or eliminating potential viruses of cell culture media and feed solutions. Different methods can be used alone or in combination on raw materials, cell culture media, or feed solutions such as viral inactivation technologies consisting mainly of high temperature short time, ultraviolet irradiation, and gamma radiation technologies or such as viral removal technology for instance nanofiltration. The aim of this review is to present the principle, the advantages, and the challenges of high temperature short time (HTST) technology. Here, we reviewed effectiveness of HTST treatment and its impact on media (filterability of media, degradation of components), on process performance (cell growth, cell metabolism, productivity), and product quality based on knowledge shared in the literature.

Donor Human Milk for Preterm Infants: A Cost-Consequence Analysis of Alternative Preservation Methods.

OBJECTIVES: To perform cost-consequence and cost-effectiveness analyses of 2 methods of donor human milk (DHM) preservation-Holder pasteurization (HoP) and high-pressure processing (HPP)-in human milk banks in Poland. METHODS: We used the results of the LACTOTECHnology as an answer to special nutritional requirements of preterm infants (LACTOTECH) preclinical study on the impact of different preservation methods on the content of bioactive milk components. The cost analysis was performed from the hospital perspective. To estimate the Diagnosis-Related Group (DRG) tariff for enteral feeding with DHM preserved by HPP, the pricing process used by the Polish health technology assessment agency (Agencja Oceny Technologii Medycznych i Taryfikacji) was followed. One-way deterministic and probabilistic sensitivity analyses on costs and human milk component parameters were undertaken. RESULTS: HPP maintains an average of 55% more potentially beneficial DHM components than HoP, but is more expensive (€35 750 vs €5066). The DRG tariff relating to milk from human milk banks preserved by the HPP method should be about €54 (130%) higher than with HoP. The cost-effectiveness ratio ranged from €0.84 to €10.27 per 1% gain in the active compound content in a daily portion of DHM. Sensitivity analysis showed that the cost of an HPP device had the most significant impact on pascalization expenses. CONCLUSIONS: HPP is a potentially more beneficial method of DHM preservation than HoP, but it is also about 7 times more expensive. Because of high pascalization costs, the cost-effectiveness analysis based on clinically significant endpoints will play an important role in decision making regarding the implementation of HPP into clinical practice of human milk banking.

Quantitative microbial spoilage risk assessment (QMSRA) of pasteurized strawberry purees by Aspergillus fischeri (teleomorph Neosartorya fischeri).

Aspergillus fischeri ascospores are known as potential spoilage microorganisms of pasteurized fruit products due to their high incidence in fruits, the ability to survive pasteurization and to grow in acidic conditions. This study aimed to develop a quantitative microbial spoilage risk assessment (QMSRA) model approach to estimate the spoilage risk of packaged strawberry purees due to A. fischeri under various scenarios regarding product formulation, processing and storage conditions. The development of the risk assessment comprised three steps: (1) initial contamination level of raw material by ascospores (N0), (2) inactivation of ascospores during thermal processing (Np) and (3) determination of the number of ascospores which are able to survive thermal processing and develop visible mycelia (D = 2 mm) during storage (Nf). Data of visible growth (tv, days) comprised distributions previously obtained as function of water activity (aw) (0.860-0.985), oxygen (0-21%), temperature (8-30 °C) and pasteurization (95-105 °C/15 s). The simulations were performed in triplicate with 100,000 iterations using the software R. The outcome "spoilage risk" was defined as the probability of having at least one ascospore (Nf) capable of forming visible colonies in 100 g-pack strawberry puree within the typical use-by dates. Overall, high probabilities of spoilage were estimated for purees pasteurized at milder treatments at 85 °C/15-60 s (67%) and 90 °C/15-60 s (≥40%) stored at ambient temperature (22 °C). The spoilage risk was only effectively reduced (0.02%) by increasing pasteurization conditions to 95 °C for at least 45 s. Moreover, the microbial stability of such purees, i.e., spoilage risk <0.001% (=less than 1 spoilage pack out of 105 produced units) was predicted to occur for purees treated at 100 °C/15 s or stored at chilled conditions (≤8 °C) or at strict anaerobic conditions or produced as concentrates (aw ≤ 0.860). Based on the outcomes obtained, a set of specifications for Heat-Resistant Moulds (HRMs) in raw material and pasteurized purees aimed to be used as an ingredient was suggested. Furthermore, the results can be used to support risk management decisions in identifying and quantifying the impact of possible interventions during formulation, processing and storage conditions of fruit purees to effectively reduce this risk.

Mix-and-read method for assessment of milk pasteurization using a smartphone or a common digital camera.

Alkaline phosphatase (ALP) is the most widely used marker of the adequacy of milk pasteurization since it is inactivated at temperatures slightly higher than those required for elimination of pathogens. The cutoff level is 350 mU/L. The approved colorimetric, fluorometric, and chemiluminometric methods require specialized readers with photomultipliers as detectors, and the samples are usually analyzed one-by-one. We developed a low-cost mix-and-read method that exploited a smartphone or a common digital camera as detectors for the chemiluminometric determination of ALP in milk. As samples, we used pasteurized cow and sheep milk spiked with ALP, as well as mixtures of pasteurized and raw (non-pasteurized) milk. Chemiluminescence images acquired by the smartphone or the digital camera were analyzed by the ImageJ software. The limits of detection (LODs), for images captured by the smartphone, were 4.4 mU/L and 11.1 mU/L for cow milk and sheep milk, respectively, while with the digital camera, the respective LODs were 6.2 mU/L and 6.7 mU/L, respectively. The coefficients of variation (CVs) at the cutoff level of 350 mU/L were 8% and 8.5% for the cow and sheep milk, respectively. For images by the digital camera, the CVs were 5.8% and 5% for cow and sheep milk, respectively. The performance of the method is similar to methods that use a microtiter plate and a luminometer for chemiluminescence measurements. Sample pretreatment is not necessary. The microtiter well format combined with detection by a smartphone enables the analysis of multiple samples simultaneously. It is anticipated that the method will prove useful for the rapid assessment of milk pasteurization efficiency in dairy industries, especially in remote areas where expensive instruments are not available. Graphical abstract.

Impact assessment of different electric fields on the quality parameters of blueberry flavored dairy desserts processed by Ohmic Heating.

The effect of ohmic heating (OH) (1.82, 3.64, 5.45, 7.30, 9.1 V cm-1, 90 °C/3 min) and conventional pasteurization in the parameters of quality of dairy desserts with blueberry flavor was investigated. Processes performances (heating rate, thermal load and energy consumption), physicochemical characteristics (fatty acids profile, volatile compounds, rheological assay and color parameters) and bioactive compounds (total phenolics, anthocyanins, antioxidant activity, inhibition of α-glycosidase, α-amylase, and angiotensin-converting enzymes) were evaluated. OH technology proportionated decreased heat generation, energy consumption and heat rate compared to conventional process. OH-treated dairy desserts subjected to higher electric field strength greater inhibition of α-glucosidase and ACE enzymes, without difference in fatty acid profile; however negative effects were observed in color parameters, volatiles profiling and rheological behavior. Overall, the results suggest the influence of ohmic heating on blueberry dairy processing is multidimensional, being the conditions of operation should be carefully chosen to keep the functional and structural aspects of the product.