Comparison of Interstitial Lung Disease Between Antineutrophil Cytoplasmic Antibodies Positive and Negative Patients: A Retrospective Cohort Study.

OBJECTIVE: Positive antineutrophil cytoplasmic antibodies (ANCAs) may occur in the setting of interstitial lung disease (ILD), with or without ANCA-associated vasculitis (AAV). We aim to compare the characteristics and clinical course of patients with ILD and positive ANCA (ANCA-ILD) to those with negative ANCA. METHODS: We performed a single-center retrospective cohort study from 2018 to 2021. All patients with ILD and ANCA testing were included. Patient characteristics (symptoms, dyspnea scale, and systemic AAV), test results (pulmonary high-resolution computed tomography and pulmonary function tests), and adverse events were collected from electronic medical records. Descriptive statistics and the Fisher exact test were used to compare the outcomes of patients with ANCA-ILD to those with ILD and negative ANCA. RESULTS: A total of 265 patients with ILD were included. The mean follow-up duration was 69.3 months, 26 patients (9.8%) were ANCA positive, and 69.2% of those with ANCA-ILD had another autoantibody. AAV occurred in 17 patients (65.4%) with ANCA-ILD. In 29.4% of patients, AAV developed following ILD diagnosis. Usual interstitial pneumonia was the most common radiologic pattern in patients with ANCA-ILD. There was no association between ANCA status and the evolution of dyspnea, diffusing capacity of the lungs for carbon monoxide, and lung imaging. Forced vital capacity improved over time in 42% of patients with ANCA-ILD and in 17% of patients with negative ANCA (P = 0.006). Hospitalization occurred in 46.2% of patients with ANCA-ILD and in 21.8% of patients with negative ANCA (P = 0.006). Both groups had similar mortality rates. CONCLUSION: Routine ANCA testing should be considered in patients with ILD. Patients with ANCA-ILD are at risk for AAV. More research is required to better understand and manage patients with ANCA-ILD.

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.

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.

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.

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.

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.

The interaction between wheat and pea protein influences the final chemical and sensory characteristics of extruded high moisture meat analogs.

Plant-based meat analog products, including those produced by extrusion processing, have become increasingly popular. Complete comprehension of the texturization mechanism and the formation of fibrousness would help improve existing products and extend the variety of plant sources used. Therefore, this study aimed to provide improved insight into the mechanism of texturization during the processing of high-moisture meat analog (HMMA) products. Blends with different wheat and pea protein ratios (100:0, 80:20, 60:40, 40:60, 20:80, and 0:100 wheat:pea) were extruded at a screw speed of 400 rpm, two different moisture contents (50% and 55%), and a feed rate of 90 g/min using a co-rotating twin-screw extruder. Extrudates were analyzed for their texture, free sulfhydryl groups, disulfide bonds, and solubility in different extractants relative to the raw ingredient blends. In addition, a sensory analysis was conducted using the rapid and cost-effective "rate-all-that-apply" (RATA) methodology. The interplay between the two protein types had synergistic effects on the system parameters torque, pressure, and specific mechanical energy, as well as on some textural and sensory parameters. Molecular analyses were not influenced by the interplay between wheat and pea protein as the molecular analyses followed linear trends with the pea inclusion level. Analysis of protein solubility suggests that the texturization mechanism differs slightly depending on the protein type. It is suggested that the texturization of wheat protein depends highly on disulfide bonds, whereas the texturization of pea protein relies on the combination of disulfide bonds and non-covalent interactions. Additionally, RATA was found to be a valuable tool for HMMA products.

Assessment and comparison of probability scores to predict giant cell arteritis.

INTRODUCTION/OBJECTIVES: To assess and compare the performance of the giant cell arteritis probability score (GCAPS), Ing score, Bhavsar-Khalidi score (BK score), color Doppler ultrasound (CDUS) halo count, and halo score, to predict a final diagnosis of giant cell arteritis (GCA). METHOD: A prospective cohort study was conducted from April to December 2021. Patients with suspected new-onset GCA referred to our quaternary CDUS clinic were included. Data required to calculate each clinical and CDUS probability score was systematically collected at the initial visit. Final diagnosis of GCA was confirmed clinically 6 months after the initial visit, by two blinded vasculitis specialists. Diagnostic accuracy and receiver operator characteristic (ROC) curves for each clinical and CDUS prediction scores were assessed. RESULTS: Two hundred patients with suspected new-onset GCA were included: 58 with confirmed GCA and 142 without GCA. All patients with GCA satisfied the 2022 ACR/EULAR classification criteria. A total of 5/15 patients with GCA had a positive temporal artery biopsy. For clinical probability scores, the GCAPS showed the best sensitivity (Se, 0.983), whereas the BK score showed the best specificity (Sp, 0.711). As for CDUS, a halo count of 1 or more was found to have a Se of 0.966 and a Sp of 0.979. Combining concordant results of clinical and CDUS prediction scores showed excellent performance in predicting a final diagnosis of GCA. CONCLUSION: Using a combination of clinical score and CDUS halo count provided an accurate GCA prediction method which should be used in the setting of GCA Fast-Track clinics. Key Points • In this prospective cohort of participants with suspected GCA, 3 clinical prediction tools and 2 ultrasound scores were compared head-to-head to predict a final diagnosis of GCA. • For clinical prediction tools, the giant cell arteritis probability score (GCAPS) had the highest sensitivity, whereas the Bhavsar-Khalidi score (BK score) had the highest specificity. • Ultrasound halo count was both sensitive and specific in predicting GCA. • Combination of a clinical prediction tool such as the GCAPS, with ultrasound halo count, provides an accurate method to predict GCA.

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.

The influence of food sensory properties on eating behaviours in children with Down syndrome.

Developing new food products for children is challenging, particularly in vulnerable groups including children with Down syndrome (DS). Focusing on children with DS, the aim of this study was to study the influence of parent liking on acceptance of food products by children with DS and demonstrate the influence of food sensory properties on indicators of food acceptance, food rejection, and challenging eating behaviours. Children (ages 1158 months) with DS (n = 111) participated in a home use test evaluating snack products with varying sensory properties as profiled by a trained sensory panel. Parents recorded their children's reactions to each food product; trained coders coded videos for eating behaviours. To understand the influence of each sensory modality on eating behaviour, ordered probit regression models were run. Results found a significant correlation between the parent liking and overall child disposition to the food (p < 0.05). From the regression analysis, the inclusion of all food sensory properties, including texture, flavour, taste, product shape and size, improved the percentage of variance explained in child mealtime behaviours and overall disposition over the base model (containing no sensory modalities), with texture having the largest influence. Overstuffing the mouth, a challenging eating behaviour, was most influenced by product texture (children ≥ 30 months), and product texture and size (children < 30 months). In both age groups, coughing/choking/gagging was most influenced by food texture and was associated with a product that was grainy and angular (sharp corners). In both age groups, product acceptance was associated with a product that was dissolvable, crispy, and savoury while rejection was associated with a dense, gummy and fruity product. These results suggest that a dissolvable, crispy texture, with a cheesy or buttery flavour are the sensory properties important in a desirable flavoured commercial snack product for children with DS; however, overall disposition must be balanced against mouth overstuffing.

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.

Older adults' acceptance of ready-to-eat meals in relation to food choice and sensory ability.

With the growing population of older adults, a deeper understanding of their food choice and acceptance is vital to improving older adult dietary intake. The objectives of this study were to: (1) determine acceptance of three ready-to-eat (RTE) meals developed for older adults (age = 60+); (2) characterize the oral health status and food choices of these older adults and relate these data to meal acceptance. Participants (n = 52; average age = 71.7) completed an initial session that evaluated oral health and sensory perception followed by a home-use test of three RTE meals developed from a previous conjoint analysis study: teriyaki chicken with rice, marinated tofu and carrots, and vegetable ratatouille. Sensory evaluation measured liking of various meal components. Participant food choices were evaluated with the Food Choice Questionnaire (FCQ). Few participants suffered from reduced sensory ability; all had good quality oral health. Sensory evaluations revealed that the marinated tofu meal was liked significantly less than the other two meals (p < 0.0001). FCQ results clustered participants into two clusters; the responses of Cluster 1 were significantly higher for 29 of the 36 items (p < 0.05). The factors of greatest average importance were sensory appeal (4.6), health (4.3), and price (3.9) in Cluster 1 (n = 30) and sensory appeal (3.8), health (3.6), and weight control (3.2) in Cluster 2 (n = 20). Sensory appeal and health were significantly more important (p < 0.0001) to Cluster 1. Results of this study suggest that sensory appeal and health greatly contribute to food choice which was reflected in the sensory acceptance of the RTE meals. PRACTICAL APPLICATION: Older adults may suffer from sensory loss, but sensory appeal of food is still greatly important to them. Healthy and nutritious food is also important to older adult food choice. Food products developed for older adults should be formulated to provide both nutrition and a pleasant sensory experience, while also keeping price and convenience in mind.

Preserving Ready-to-Eat Meals Using Microwave Technologies for Future Space Programs.

The crewed suborbital and space flights launched by private companies over the past three years have rejuvenated public interest in space travel, including space tourism. Ready-to-eat meals (MREs) are the main source of nutrients and energy for space travelers. It is critical that those meals are free of bacterial and viral pathogens and have adequate shelf life. The participation of private companies in space programs will create new opportunities and demand for high-quality and microbiologically safe MREs for future space travels. In this article, we provide a brief review of nutrition and energy requirements for human activities in space. We discuss the general thermal processing requirements for control of bacterial and viral pathogens in MREs and introduce advanced thermal preservation technologies based on microwaves for production of MREs with different shelf-lives under various storage conditions. We also present the latest advancements in the development of polymer packaging materials for quality preservation of thermally stabilized MREs over extended storage. Finally, we recommend future research on issues related to the sensory quality of specially formulated MREs, microbial safety of dried foods that complement high moisture MREs, and food package waste management in future space missions.

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.

Influences of modified fiber inclusion with varying particle size on corn starch-based extrudate expansion.

The inclusion of cellulose nanocrystals (CNC) and microcrystalline cellulose (MCC) during extrusion processing of corn starch (CS) is presented in this study. Blends were prepared by incorporating CNC and MCC at different concentrations, 1%, 3%, 5%, and 10% w/w in CS. The crystallinity index (CrI) of CNC and MCC was determined using X-ray diffraction, and the chemical functionality of CNC, MCC, and CS was studied using Fourier transform infrared spectroscopy. The pasting properties of the blends were studied using Micro Visco-Amylo-Graph before extrusion. The blends were preconditioned to 18 ± 0.5% (w.b.) moisture and extruded using a twin-screw extruder at 200 and 250 rpm at 140°C. CS-CNC's expansion ratio (ER) values were 2.95 to 3.35 and 2.72 to 3.22 for MCC. CNC's CrI and particle size were significantly lower than MCC, allowing CNC-based extrudates to have ER values similar to the control even at high CNC concentration (≤10% w/w). This study demonstrated that fiber with particle size <100 µm can be added in direct-expanded product formulations at high concentrations without negatively influencing the extrudate texture while offering increased nutritional value. PRACTICAL APPLICATION: This study gives insight into the potential application of cellulose nanocrystals and microcrystalline cellulose in manufacturing direct-expanded extruded products, providing high fiber content without compromising the product quality. This knowledge could also be translated into manufacturing other food products such as breakfast cereals, pasta, and bread.

Sensory properties of 6- and 18-month-stored wines made with pectinase-producing non-Saccharomyces yeasts.

Recently, the use and commercial availability of non-Saccharomyces yeasts (NSY) in winemaking to reduce alcohol content have increased. However, research exploring the influence on sensory quality of the wine, particularly during storage, is limited. Therefore, the objective of this study was to characterize the sensory profiles of Merlot and Chardonnay wines made with pectinase-producing NSY, with added substrate, that is, pectin. Apple pectin (0 or 0.5 g/L) was added to Merlot and Chardonnay grape musts after inoculation with (a) only Saccharomyces cerevisiae or (b) a three species mixture of NSY; after 3 days, S. cerevisiae was added. Addition of NSY with added pectin resulted in higher concentrations of d-galacturonic acid and glycerol concentration in the wines after 6 months of aging. However, mouthfeel (viscosity or weight) of wines with or without added pectin as determined by a sensory evaluation panel was not altered by the presence of these yeasts. Significant interactions among the yeast utilized, pectin addition, and 6-month aging affected some flavors (solvent) of Merlot, while addition of NSY increased other attributes (cherry) during aging. No sensory differences were perceived among Chardonnay samples due to NSY; however, aging from 6 to 18 months increased the intensity of 40 sensory attributes. Though mouthfeel was not specifically affected, the utilization of NSY may be a useful tool to alter wine quality in Merlot by increasing specific aromas during storage. PRACTICAL APPLICATION: We found that must fermented with pectinase-producing non-Saccharomyces yeasts (NSY) modified the chemical composition of the final young wine. After one additional year of aging, an increase in cherry flavor was observed in Merlot wines made with NSY, which may increase perceived quality. Thus, the use of these pectinase-producing NSY may be a useful tool for winemakers.

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..

Improving the chemical and sensory characteristics of red and white wines with pectinase-producing non-Saccharomyces yeasts.

This study examined the influence of pectinase-producing non-Saccharomyces yeasts on the chemical and sensory attributes of red and white wines with added pectin. Merlot and Chardonnay wines were produced with or without a mixture of pectinase-producing non-Saccharomyces yeasts (Cryptococcus adeliensis, Issatchenkia orientalis, and Pichia kluyveri) added to the must prior to alcoholic fermentation conducted by a commercial strain of Saccharomyces cerevisiae. To ensure sufficient substrate was present, varying concentrations of apple pectin (up to 1.25 g/L for red wines and 1.00 g/L for white wine) were added at the start of fermentation. After bottling, trained panelists (n = 10) analyzed these wines for aroma, flavor, taste, and mouthfeel attributes. For both wines, significant interactions were noted between the presence of non-Saccharomyces yeasts and pectin addition which affected pH, titratable acidity, and concentrations of D-galacturonic acid. While no significant sensory differences were observed among the red wines, limited changes were noted for white wines. However, a strong positive correlation was found between the D-galacturonic acid and buttery aroma for Chardonnay and with flavor for Merlot. Increasing D-galacturonic acid concentrations, through utilization of non-Saccharomyces yeasts, may improve the wine quality as a buttery aroma is often associated with high-quality Chardonnay. For both red and white wines, the utilization of these particular non-Saccharomyces yeasts significantly influenced chemical properties but yielded minor sensory changes without any faults. PRACTICAL APPLICATION: With the recent trend to reduce alcohol content in commercial wines, the interest in non-Saccharomyces yeasts has grown. This study showed that the addition of non-Saccharomyces yeasts, perhaps due to their pectinase activity, influenced the chemical characteristics of red and white wines with limited sensory differences, making these yeasts a useful tool for winemakers to modify wine properties.

Rare Ischemic Complications of Giant Cell Arteritis: Case Series and Literature Review.

BACKGROUND Some ischemic complications due to giant cell arteritis (GCA) are rare and underdiagnosed. We describe the clinical features and outcomes of patients with GCA presenting with rare ischemic complications. CASE REPORT Our single-center retrospective database of patients with GCA was reviewed from 1994 to 2020. We describe 3 cases of rare ischemic complications secondary to GCA. We review the literature regarding ischemic complications due to GCA and their outcomes. All 3 cases met the American College of Rheumatology criteria for GCA. All patients experienced rare ischemic complications due to GCA. In case 1, the patient presented with a sixth cranial nerve palsy. In case 2, the patient presented with tongue and scalp necrosis, and with permanent visual loss due to anterior ischemic optic neuropathy. In case 3, the patient presented with scalp necrosis. In all 3 cases, the patients received glucocorticoids either intravenously and/or orally, which led to improvement. They all improved within the course of their followup visits. A literature review was performed to identify similar cases and outcomes. CONCLUSIONS Ischemic complications due to GCA can be part of the initial presentation of the vasculitis, making confirmation of the diagnosis more difficult. Physicians should be aware of these rare complications since rapid diagnosis and initiation of glucocorticoids may alter the course of the disease.