Aneurysmal Disease in Patients With Takayasu Arteritis.

OBJECTIVE: Takayasu arteritis (TA) leads to stenotic disease. Aneurysmal lesions are rarer. This study assessed the main characteristics of aneurysmal disease in a Canadian cohort of patients with TA. METHODS: This monocentric retrospective study included patients with TA followed at the Mount Sinai Hospital Vasculitis Clinic in Toronto. Diagnosis of TA was based on clinical findings and/or satisfied the 1990 American College of Rheumatology classification criteria. RESULTS: Seventy-four patients were included. At any time, aneurysmal disease was found in 23 (31%) patients. Median disease duration was 9.0 (IQR 7.0-19.0) years. Prior hypertension (P = 0.02), fever (P = 0.04), and seizure disorders (P = 0.03) were more common. Limb claudication was less frequent (P = 0.01). Persistent and/or new aneurysms were demonstrated in 22/23 patients at follow-up. Thoracic aorta aneurysm (13/22) was most common, followed by abdominal aorta (8/22), subclavian (7/22), and carotid (6/22) artery disease. Aortic valve regurgitation was more frequent (9/23 vs 3/48; P = 0.001). Twenty-one patients had been treated with glucocorticoids (median 6.1 years [IQR 3.7-8.1]). Methotrexate, azathioprine, and leflunomide were repeatedly used. Infliximab (7/23) was used more often (P = 0.04), whereas tocilizumab was received by only 4 patients with aneurysmal disease (P = 0.01). Patients with aneurysms suffered more frequent relapses (2.0 [IQR 0.0-4.0] vs 1.0 [IQR 0.0-2.0], P = 0.04). CONCLUSION: Aneurysmal disease was found in a significant proportion of patients with TA. Given that aneurysms may carry a risk of rupture, and are associated with a higher rate of relapse, this finding should be reported systematically in TA studies.

CanVasc consensus recommendations for the use of avacopan in antineutrophil cytoplasm antibody-associated vasculitis: 2022 addendum.

OBJECTIVE: In 2020, the Canadian Vasculitis Research Network (CanVasc) published their updated recommendations for the management of ANCA-associated vasculitides (AAV). The current addendum provides further recommendations regarding the use of avacopan in AAV based on a review of newly available evidence. METHODS: An updated systematic literature review on avacopan (formerly, CCX168) using Medline, Embase, and the Cochrane Library was performed for publications up to September 2022. New recommendations were developed and categorized according to the EULAR grading levels, as done for previous CanVasc recommendations. A modified Delphi procedure and videoconferences were used to reach ≥80% consensus on the inclusion, wording and grading of each recommendation. RESULTS: Three new recommendations were developed. They focus on avacopan therapy indication and duration, as well as timely glucocorticoid tapering. CONCLUSION: These 2022 addended recommendations provide rheumatologists, nephrologists and other specialists caring for patients with AAV with guidance for the use of avacopan, based on current evidence and consensus from Canadian experts.

Listeria monocytogenes cross-contamination during apple waxing and subsequent survival under different storage conditions.

This study evaluated Listeria monocytogenes cross-contamination between inoculated fruits, waxing brush, and uninoculated fruits during apple wax coating and investigated the fate of L. monocytogenes on wax-coated apples introduced via different wax coating schemes. There were 1.8-1.9 log10 CFU/apple reductions of L. monocytogenes on PrimaFresh 360, PrimaFresh 606, or Shield-Brite AP-450 coated apples introduced before wax coating after 6 weeks of ambient storage (22 °C and ambient relative humidity). L. monocytogenes showed a similar trend (P > 0.05) on waxed apples under cold storage (1 °C and ∼ 90% relative humidity); there were 1.8-2.0 log10 CFU/apple reductions of L. monocytogenes during the 12 weeks of cold storage regardless of wax coating type. For cross-contamination study, a waxing brush was used to wax one inoculated apple (6.2 log10 CFU/apple); then, this brush was used to wax five uninoculated apples in a sequence. There were 3.7, 3.5, 3.3, 2.9, and 2.7 log10 CFU/apple and 3.6 log10 CFU/brush of L. monocytogenes transferred from the inoculated apple to uninoculated apple 1 to apple 5, and the waxing brush, respectively. The die-off rate of L. monocytogenes on wax-coated apples contaminated during wax coating was not significantly different from that contaminated on apples before wax coating, and 1.8-1.9 log10 CFU/apple reductions were observed during the 12 weeks of cold storage. The application of wax coatings, regardless of wax coating type, did not impact the survival of endogenous yeasts and molds on apples during ambient or cold storage. L. monocytogenes transferred onto waxing brushes during wax coating remained relatively stable during the 2-week ambient holding. Fungicide application during wax coating reduced (P < 0.05) yeast and mold counts but had a minor impact (P > 0.05) on the survival of L. monocytogenes on apples after 12 weeks of cold storage. Collectively, this study indicated that a high cross-contamination risk of L. monocytogenes during apple waxing, and L. monocytogenes on wax-coated apples introduced via different scenarios is stable during subsequent cold storage, highlighting the need for potential intervention strategies to control L. monocytogenes on wax-coated apples.

The Association between Immediate Postpartum Depot Medroxyprogesterone Acetate Use and Postpartum Depressive Symptoms.

OBJECTIVE: While postpartum depot medroxyprogesterone acetate (DMPA) is a highly effective form of contraception, some data suggest an association with depressive symptoms. Our objective was to evaluate the relationship between receipt of DMPA in the immediate postpartum period and postpartum depressive symptoms. STUDY DESIGN: This retrospective cohort study included all women who received prenatal and postpartum care at academic obstetric clinics affiliated with a tertiary care institution between January 1, 2008 and December 31, 2014. All women were counseled on contraception prior to hospital discharge. DMPA was available in the hospital pharmacy, and its utilization was documented in the electronic health record. The Patient Health Questionnaire 9 (PHQ-9) was used to screen for postpartum depression for all women at all postpartum visits. A score of 10 or greater was categorized as positive. Bivariable and multivariable analyses were used to identify the association between immediate postpartum DMPA use and a positive postpartum depression screen. RESULTS: Of the 5,073 women who met inclusion criteria, 410 (8.1%) received DMPA prior to hospital discharge. Compared with women who did not receive DMPA, women who received DMPA prior to hospital discharge were younger, more likely to identify as Black race or Latinx ethnicity, and more likely to be publicly insured. Clinical characteristics also differed. Women who received DMPA were more likely to be obese and to have experienced prenatal depressive symptoms, been diagnosed with a hypertensive disorder of pregnancy, delivered preterm, and delivered vaginally. Receipt of immediate postpartum DMPA was not associated with having a positive screen for postpartum depression in bivariable (5.4 vs. 6.0%, p = 0.29) or multivariable (adjusted odds ratio 0.94, confidence interval 0.53-1.68) analyses. CONCLUSION: Receipt of postpartum DMPA is not associated with a positive postpartum PHQ-9 screen. Concerns about precipitating postpartum depression should not preclude the utilization of DMPA as a contraceptive agent. KEY POINTS: · Contraception is an important issue for obstetricians to address with postpartum patients.. · Concerns have been raised over the relationship between DMPA and depression.. · Our study shows that DMPA is not associated with a positive postpartum depression screen..

Observations of feeding practices of US parents of young children with Down syndrome.

Parental behaviours influence food acceptance in young children, but few studies have measured these behaviours using observational methods, especially among children with Down syndrome (CWDS). The overall goal of this study was to understand parent feeding practices used during snack time with young CWDS (N = 111, aged 11-58 months). A coding scheme was developed to focus on feeding practices used by parents of CWDS from a structured home-use test involving tasting variously textured snack products. Behavioural coding was used to categorise parental feeding practices and quantify their frequencies (N = 212 video feeding sessions). A feeding prompt was coded as successful if the child ate the target food product or completed the prompt within 20 s of the prompt being given without a refusal behaviour. CWDS more frequently consumed the test foods and completed tasks in response to Autonomy-Supportive Prompts to Eat (49.3%), than to Coercive-Controlling Prompts to Eat (24.2%). By exploring the parent-CWDS relationship during feeding, we can identify potentially desirable parent practices to encourage successful feeding for CWDS. Future research should build upon the knowledge gained from this study to confirm longitudinal associations of parent practices with child behaviours during feeding.

The Association between Positive Antenatal Depression Screening and Breastfeeding Initiation and Continuation.

OBJECTIVE: This study was aimed to determine the association between antenatal depression and breastfeeding initiation and continuation at 6 weeks postpartum. STUDY DESIGN: This retrospective cohort study included all live-born deliveries after 24weeks' gestation at a single tertiary care institution between 2009 and 2014 with a documented antenatal depression screen using the Patient Health Questionnaire-9 (PHQ-9). During the study period, it was recommended that routine screening occur during both the first and third trimesters. A positive screen was defined as a PHQ-9 score ≥ 10. Breastfeeding initiation and continuation until 6 weeks' postpartum were compared between women with and without a positive screen using bivariable analyses. Stepwise backward elimination regressions were used to identify whether a positive screen was independently associated with breastfeeding rates after controlling for confounders. RESULTS: Among the 2,871 women meeting inclusion criteria, 302 (10.5%) were screened positive for antenatal depression. After adjusting for confounders, there were no differences in breastfeeding initiation (adjusted odds ratio [aOR] = 0.78, 95% confidence interval [CI]: 0.52-1.16), but women with a positive antenatal depression screen were significantly less likely to continue breastfeeding at 6 weeks' postpartum (aOR= 0.67, 95% CI: 0.48-0.96). CONCLUSION: A positive antenatal depression, screened in the first or third trimester, is a significant risk factor for early breastfeeding cessation.

A prospective pilot study to assess the impact of the etonogestrel implant on postpartum depression.

OBJECTIVES: To assess the feasibility of comparing the rates of positive depression screens at 6 weeks and 3 months postpartum in women using immediate postpartum etonogestrel implant (ENG-implant) and women using non-hormonal contraception or sterilisation. METHODS: This was a pilot prospective cohort study performed to test the design adequacy of comparing the rates of positive postpartum PHQ-9 screens (≥10) in women using immediate postpartum ENG-implant and women using non-hormonal contraception or sterilisation. Participants were recruited during the third trimester of pregnancy or during delivery hospitalisation. They self-allocated to one of the two comparison groups. PHQ-9 surveys were administered during the third trimester of pregnancy, immediately postpartum, and at 6 weeks and 3 months postpartum. RESULTS: Between June 2017 and March 2018, 91 patients were recruited. Of these patients, 11 were excluded and the remaining 80 were split evenly into each cohort. The women in the ENG-implant group were younger, less educated, and more often publicly insured. The percentage of participants with positive PHQ-9 screens were: 3% during the postpartum hospitalisation, 6.2% at 6 weeks postpartum, and 10.2% at 3 months postpartum. PHQ-9 scores were similar between groups at both postpartum time points. CONCLUSION: The rates of positive PHQ-9 screens at 6 weeks postpartum were similar between groups. These preliminary data suggest that immediate postpartum placement of the ENG-implant does not negatively impact the risk for a positive depression screen. Larger-scale, adequately powered studies are warranted to further investigate this finding.

Pregnancy Outcomes in Systemic Vasculitides.

PURPOSE OF REVIEW: In recent years, improvements in the recognition of primary vasculitides and increased treatment options have led to greater survival rates and a better quality of life for patients. Therefore, pregnancy in women with vasculitis has become a more frequent consideration or event. Literature on pregnancy outcomes in this population has grown and allowed us, in this article, to review the effects of pregnancy on disease activity, as well as maternal and fetal outcomes for each type of vasculitides. RECENT FINDINGS: Successful pregnancies in patients with vasculitides are possible, especially when conception is planned, and the disease is in remission. The risk of vasculitis flare is highly dependent on the type of vasculitis, but overall limited. The most frequent complication associated with large-vessel vasculitis (mainly Takayasu arteritis) is hypertension and preeclampsia. Preterm deliveries and intrauterine growth restriction occur more frequently with small- and medium-vessel vasculitis. Pregnancies in patients with vasculitis should be considered high risk and followed by a multidisciplinary team with expertise in the field. Flares should be managed as in the non-pregnant population, while avoiding medications with unknown safety in pregnancy or known teratogens. Although commonly prescribed for the prevention of preeclampsia, there is limited evidence supporting the use of low-dose aspirin for pregnant women with vasculitis. Prospective registries or studies are needed, to better assess the value of aspirin, the place and long-term impact of new biologics and, to identify predictors of pregnancy outcomes other than disease status at conception.

Preference for and sensitivity to flavanol mean degree of polymerization in model wines is correlated with body composition.

Bitterness and astringency (dryness) are characteristic sensory attributes of flavanol-rich foods. The degree of polymerization (DP) of flavanols influences their bitter and astringent sensations. Smaller DP compounds can enter the papillae on the tongue, eliciting a bitter response. Larger DP compounds are sterically inhibited from entering papillae and instead interact with oral proteins, cause precipitation, and elicit astringent sensations. Previous research has indicated that bitterness preference is related to health status, density of fungiform papillae on the tongue, and sensitivity to bitter compounds such as 6-n-propyl-thiouracil (PROP). The purpose of this study was to examine trends in liking, bitterness intensity, and astringency intensity of wine-like products with flavanols of different DP using a consumer sensory panel. Participants (n = 102) were segmented by phenotypes: body fat percentage (BF%), body mass index (BMI), PROP sensitivity, and stated bitter food preference. Differences in wine liking, perceived bitterness intensity, and astringency intensity were observed between three model wine samples of varying flavanol mean degrees of polymerization (mDP, i.e. the average size (polymer length) of flavanol compounds in a mixture). Specifically, with increased mDP, overall liking and bitterness liking decreased, with concurrent increased perception of bitterness and astringency intensity. Greater differences between phenotypes were observed when participants were segmented by BF% and BMI classification, than when segmented by PROP sensitivity classification. Reduced ability to detect differences in bitterness and astringency were noted in participants of higher weight status. Overall, these data suggest that weight status in adults is a greater predictor of liking of flavanol-rich foods than bitterness sensitivity (as determined by PROP classification), and that reduced perception of bitterness and astringency associated with weight gain may impact selection and preference for these foods.

Multivariable Analysis of the Association between Antenatal Depressive Symptomatology and Postpartum Visit Attendance.

OBJECTIVE: We sought to evaluate whether antenatal depression was associated with postpartum visit nonattendance. STUDY DESIGN: This retrospective cohort study included women who received prenatal care at the academic outpatient offices of a single tertiary care center between March 1, 2009, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariate and multivariable analyses. RESULTS: Of the 2,870 women who met the inclusion criteria, 566 (19.7%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial/ethnic minority, publicly insured, or multiparous; they were more likely to have a higher body mass index, as well as a vaginal delivery. Compared with those without antenatal depressive symptomatology, women with antenatal depressive symptomatology were significantly less likely to attend their postpartum visit (18.6 vs. 29.2%, p < 0.001). This association persisted even after controlling for potential confounders (adjusted odds ratio: 0.69, 95% confidence interval: 0.48-0.99). CONCLUSION: Antenatal depressive symptomatology is significantly associated with nonattendance at the postpartum visit.

Discriminating aging and protein-to-fat ratio in Cheddar cheese using sensory analysis and a potentiometric electronic tongue.

The objectives of this study were to evaluate the flavor and taste attributes of full-fat Cheddar cheeses with different protein-to-fat ratios (PFR) over aging time using a descriptive sensory analysis panel and a consumer panel, and to correlate these attributes with instrumental parameters obtained by the potentiometric electronic tongue. Three Cheddar cheese formulations (PFR of 0.74, 0.85, and 1.01) were produced in triplicate and composition was verified. Cheese was aged at 7.2°C and evaluated at 2, 5, 8, 10, 11, and 12 mo by a trained panel (n = 10) for 8 flavor and 5 taste attributes and using an electronic tongue for 7 nonvolatile taste attributes. Cheese aged for 12 mo was also evaluated by a consumer sensory panel for liking and intensity attributes. Principal component analysis was performed to discriminate cheese based on aging time and PFR, whereas correlation between sensory and instrumental attributes was assessed using partial least squares regression. Descriptive sensory analysis of flavor and taste attributes differentiated Cheddar cheeses over aging time, but not among PFR formulations. The electronic tongue distinguished changes among cheese samples due to PFR formulation and aging time. The electronic tongue proved successful in characterizing the nonvolatile flavor components in Cheddar cheese and correlated with taste perceptions measured by descriptive sensory analysis. Consumer evaluations showed distinctive attribute profiles for the 3 PFR Cheddar cheese formulations. Overall, higher fat content was associated with increased flavor intensities in Cheddar cheese and drove consumer acceptability and purchase intent ratings. The electronic tongue detected smaller changes in tastes (bitter, metallic, salty, sour, spicy, sweet, and umami) of the 3 PFR formulations over time when compared with the trained panelists, who detected no differences, suggesting that the electronic tongue may be more sensitive to tastants than humans and may have the capability for early detection or identification of problems in a batch of cheese during aging. Results suggest taste quality of cheese may be monitored using the electronic tongue with greater sensitivity than a trained panel, and may be more objective, rapid, and cost effective than human panelists.

Student Preparation for Nursing Leadership: Lessons from an Undergraduate Programs Review.

Facilitating student achievement of nationally recognized entry-level-competencies in nursing leadership is a critical step in building capacity to promote patient safety, quality of care, and healthy work environments. Data for this substudy were drawn from a larger multi-phased, multi-method, cross-sectional, descriptive study conducted to inform comprehensive undergraduate curricular revision. The research question for this substudy was: what are the perceptions about undergraduate program preparation for nursing leadership? Frequencies and percentages summarized relevant quantitative data from the surveys and deductive content analysis was used to further explore the category of leadership which emerged from content analysis of qualitative data in the larger study. Key findings illustrate need for additional attention to learning experiences in conflict management, delegation and supervision of clinical teams, and advocacy. Greater collaboration between educational and clinical agencies is needed to find mutually beneficial strategies to support nursing leadership development for nursing students and new graduates.

Development of a Rapidly Dissolvable Oral Pediatric Formulation for Mefloquine Using Liposomes.

Mefloquine (Mef), a poorly soluble and highly bitter drug, has been used for malaria prophylaxis and treatment. The dosage form for Mef is mostly available as adult tablets, and thus children under the age of 5 suffer from poor medication adherence. We have developed a stable, rapidly dissolvable, and palatable pediatric formulation for Mef using liposomes composed of 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC) and cholesterol with a mean diameter of ∼110 nm. Mef was actively loaded into the liposomes via an ammonium sulfate gradient using the solvent-assisted loading technology (SALT) developed in our lab. Complete loading of Mef inside the liposomal core was achieved at a high drug-to-lipid ratio (D/L) of 0.1-0.2 (w/w), and the final drug content in the formulation was ∼8 mg/mL, well above the solubility of Mef (<0.6 mg/mL in simulated fluids). The strong bitterness of Mef was masked by the liposomal encapsulation as measured by an electronic tongue. Incubating the Mef-liposomes (Mef-Lipo) in the simulated gastric fluid (pH 1.2) and the simulated intestinal fluid containing 3 mM sodium taurocholate (pH 6.8) induced changes in liposome size and the polydispersity, resulting in drug release (∼40% in 2 h). However, no drug release from the Mef-Lipo was measured in the bile salt-free intestinal fluid or simulated saliva (0% in 3 h). These data suggest that drug release from the Mef-Lipo was mediated by a low pH and the presence of a surfactant. Pancreatic lipase did not degrade DSPC in the Mef-Lipo after 8 h of incubation nor induce Mef release from the liposomes, indicating that lipid digestion played a minor role for drug release from the Mef-Lipo. In order to improve long-term room temperature storage, the Mef-Lipo was lyophilized to obtain a solid formulation, which was completely dissolvable in water in 10 s and displayed similar in vitro profiles of release as the liquid form. The lyophilized Mef-Lipo was stable at room temperature for >3 months. In mice, orally delivered liquid and lyophilized Mef-Lipo displayed comparable absorption with bioavailability (BA) of 81-86%, while the absorption of the standard Mef suspension was significantly lower with BA of 70% and 20% decreased maximal plasma concentration and area under the curve. Our data suggest that the Mef-Lipo was a stable, palatable, and bioavailable formulation that might be suitable for pediatric use.

Regulatory focus and food choice motives. Prevention orientation associated with mood, convenience, and familiarity.

The authors tested the robustness of the Food Choice Questionnaire (FCQ) with a U.S. sample and examined the relationship between individual differences in regulatory focus and everyday food choice motives. Although a popular measure in cross-culture research, the FCQ has seen limited use with U.S. samples, and its psychometric properties have not been tested in this population. American participants (n = 408) completed the Regulatory Focus Questionnaire and a measure of food choice motives. The data did not support the nine-factor FCQ structure. An ad hoc revised measure of food choice motives showed complete measurement invariance (loadings, intercepts, and residuals) across regulatory focus. Regarding everyday food choices, participants with a prevention focus placed greater importance on mood, convenience, and familiarity than participants with a promotion focus. There were no significant differences regarding the importance of health, environmental protection, impression management, natural content, price, and sensory appeal. Several food choice motives were positively correlated. Compared with the promotion-focused participants, the prevention-focused participants more strongly associated the importance of sensory appeal with the importance of natural content and the importance of price.

Sensory Perception and Food-Evoked Emotions of Older Adults Assessing Microwave-Processed Meals with Different Salt Concentrations.

This study employed a home-use test to explore the sensory perception and evoked emotions of older adults in the assessment of chicken pasta meals with different salt concentrations. Ready-to-eat (RTE) meals with three salt levels (100%, 75%, and 50%) and two treatments-with and without added herbs-were tested. Multiple sensory attributes and overall meal liking were evaluated by participants (n = 54; 60-86 years of age) with hedonic and just-about-right scores. Twenty-five food-evoked emotions were also tested. Sensory results suggested a 50% salt reduction is possible with minimal impact on the overall liking, while a 25% salt reduction did not affect the saltiness and flavor liking of the meals. Herb addition positively impacted the aroma, flavor, and spiciness liking of the meals. The emotions that differed (p < 0.05) among meals were active, aggressive, bored, calm, happy, and wild, with the meals with herbs added eliciting more positive emotions. A questionnaire elicited information about participants' interest in healthy eating, food technology neophobia, and picky behaviors to determine the influence of these factors on participants' salt consumption habits. Sensory acceptance data combined with questionnaires explored what influenced this group of older adults in their acceptance of and interest in RTE meals.

Identifying desirable attributes in dairy-rich breakfast and desserts for older adults.

In the next decade, the US anticipates a rapid increase in the older adult population, who also face an increased risk for disease. To reduce this risk, research should explore increasing intake of nutrient-dense foods and prepared meals that include dairy foods and utilize novel food processing that better retain nutrients. This study identified attributes that older adults (age = 65+) desire in dairy-rich ready-to-eat breakfasts and desserts, two meals important in healthy aging. Two online choice-based conjoint analysis surveys were fielded (one for breakfast and one for dessert) to determine desirable attributes amongst respondents (breakfast n = 211; dessert n = 300). Breakfast concepts included protein source, primary ingredient, type of dairy, and health claim. Dessert concepts included primary flavor, primary sweetener, type of inclusion, and health claim. Breakfast results revealed the desirable attributes included "no meat" (utility value [UV] = 0.138), "eggs" (UV = 0.384), "cheese" (UV = 0.034), and "good source of fiber" (UV = 0.163). Two consumer clusters were identified with cluster 1 (n = 151) desiring "red meat" as the protein source and cluster 2 (n = 60) preferring "no meat." The majority of respondents (86%) indicated a willingness to consume foods processed with a novel technique. For the dessert meals, desirable attributes were "chocolate flavor" (UV = 0.638), "sugar" (UV = 0.859), "fruit inclusions" (UV = 0.522), and "heart-healthy" (UV = 0.453). Dessert consumer cluster 1 (n = 145) desired chocolate desserts sweetened with sugar, whereas cluster 2 (n = 155) desired vanilla desserts sweetened with honey. Participants who preferred oral manipulation of food via "smooshing" expressed a higher liking for desserts with no inclusions. These results provide insight for future product development for older adults involving dairy products or novel processing techniques. PRACTICAL APPLICATIONS: This study shows that both sensory attributes and health claims are important considerations when developing ready to eat meals for older adults. For breakfast, providing a vegetarian option is important while for desserts, both chocolate and vanilla remain popular options.

Sensory profiling of pears from the Pacific Northwest: Consumers' perspective and descriptive analysis.

This study used data from consumer testing, descriptive analysis (DA), and preference mapping to determine the sensory characteristics of pear cultivars from two harvest seasons in the Pacific Northwest (PNW). A trained sensory panel (n = 10) used generic DA to evaluate multiple sensory modalities of 22 pear cultivars. Six pears from summer and six from winter season were evaluated by consumers (n = 219) to assess their liking of different attributes. Results of the DA showed the trained panel significantly discriminated the summer and winter pears on most of the sensory modalities. To identify the attributes driving consumer acceptability, external preference mapping was applied. Attributes such as pear aroma, pear flavor, sweet, sour, and juicy were the most contributory attributes to the liking of the summer pears. Conversely, fermented aroma, stemmy-woody aroma, fermented flavor, stemmy-woody flavor, and grainy-gritty attributes were associated with a reduction in consumer liking. Summer cultivars, "Bartlett," coded pear 573, and "Seckel" had the broadest preference, satisfying 60% to 80% of the consumers. Seventy-five percent of the consumers identified winter cultivars "Comice" and "Paragon" as the most appealing. Overall, cluster analysis showed that different pears appeal to different types of consumers; however, summer cultivars like "Bartlett" and "Seckel" and winter cultivars like "Comice" and "Paragon" would appeal to the greatest number of consumers in the PNW market. PRACTICAL APPLICATION: Sensory attributes like pear flavor, sweet, and juicy, were important drivers of liking for pear consumers in the Pacific Northwest. These results should prove useful to pear growers and marketers to increase pear consumption in the United States.

Development of a Midwifery Student Peer Debriefing Tool: An interpretive descriptive study.

BACKGROUND: Psychosocial traumatisation associated with giving birth, can occur in those present with the woman giving birth, a phenomenon known as vicarious trauma. It has been identified that there are currently no interventions available for midwifery students who have experienced vicarious trauma following difficult birth experiences. OBJECTIVE: To explore whether the counselling intervention developed by Gamble et al. (2005), can be adapted for midwifery students to be appropriately and feasibly used as a counselling intervention with peers who have experienced midwifery practice-related vicarious trauma. DESIGN: Interpretive descriptive methodology. SETTING: This study was set at two Australian universities from which pre-registration midwifery courses are delivered. PARTICIPANTS: The work of reviewing the original tool and adapting it for use by and with midwifery students associated with this project was conducted by a key stakeholder group of seven representative midwifery students and five midwifery academics. METHODS: Ethics were approved. Data were collected via one face to face and two online conversations using the Microsoft Teams™ platform. Reflexive Thematic analysis were applied to revise the tool following each round of data collection and to finalise the adaptation of the intervention for its new intended purpose. RESULTS: The Midwifery Student Peer Debriefing Tool is presented as a six-step intervention that guides the midwifery student through a process of debriefing with their peer. The feasibility of the tool resulted in an overarching theme labelled "I want this to mean something" and captures the therapeutic power of peer debriefing toward a meaningful outcome that fostered growth, and a deeper understanding of the profession. CONCLUSION: Vicarious trauma is widely recognised as a core reason for midwives and midwifery students leaving the workforce. The peer debriefing tool helps midwifery students move through the process of recovering from adversity but also fostered learnings about midwifery practice and the profession.

Comparative assessment of Riesling wine fault development by the electronic tongue and a sensory panel.

Wine faults threaten brand recognition and consumer brand loyalty. The objective of this study was to compare the acuteness of e-tongue and human sensory evaluation of wine fault development in Riesling wine over 42 days of storage. Riesling wines uninoculated (control) or inoculated with 104 CFU/mL cultures of Wickerhamomyces anomalus, Acetobacter aceti, Lactobacillus brevis, or Pediococcus parvulus were assessed every 7 days with the e-tongue and a rate-all-that-apply (RATA) sensory panel. After 7 days of storage, the e-tongue detected differences in all four wine spoilage microorganism treatments, compared to control wine, with discrimination indices over 86%. The RATA sensory panel detected significant differences beginning on day 35 of storage, 28 days after the e-tongue detected differences. This study showed that the e-tongue was more sensitive than the human panel as a detection tool, without sensory fatigue. PRACTICAL APPLICATION: This research is useful for winemakers seeking additional instrumental methods in the early detection of wine faults. Given the results of this study, the e-tongue can be a useful tool for detecting early chemical changes in white wines that have undergone microbial spoilage, providing winemakers with time to mitigate faults before they surpass sensory thresholds.

Influence of saliva on the sensory properties of US commercial smoke affected wines: Preliminary findings.

Previous research has suggested that the impact of smoke affected wines require human evaluation due to in-mouth changes in perception, perhaps associated with saliva. Smoke affected wines (n = 36) from three major wine growing regions in the US were sourced from commercial wineries. A subset of these wines (n = 7) were evaluated by a consumer panel (n = 57) and electronic tongue (e-tongue) to determine the influence of saliva in the sensory profile. Consumers assessed the wines for aroma and other sensory attributes, before and after individual saliva addition. Pooled saliva from consumers was used to treat all wines obtained (n = 36) and then analyzed using the e-tongue. Results showed that saliva did not significantly alter the overall aroma, other than fruity or woody aroma liking by consumers (p > .05). However, the presence of saliva significantly lowered overall liking in both red and white wines that were affected by smoke (p ≤ .05). Consumers rated the subset of smoke affected wines below the "might purchase" category, indicating these wines were not considered acceptable by consumers. When individual pairs of smoke affected wines (before and after saliva additions) were assessed using the e-tongue, the device was able to differentiate the pairs, validating potential usefulness to discern wine changes, though the discrimination indices were moderate to low (68.8% to 11.9%). Based on these data, in human ratings of the aroma and appearance of smoked affected wines, saliva decreased overall liking, and this was somewhat distinguishable by e-tongue analysis.