Photoacoustic Processing of Decellularized Extracellular Matrix for Biofabricating Living Constructs.

The diverse biomolecular landscape of tissue-specific decellularized extracellular matrix (dECM) biomaterials provides a multiplicity of bioinstructive cues to target cells, rendering them highly valuable for various biomedical applications. However, the isolation of dECM biomaterials entails cumbersome xenogeneic enzymatic digestions and also additional inactivation procedures. Such, increases processing time, increments costs and introduces residues of non-naturally present proteins in dECM formulations that remain present even after inactivation. To overcome these limitations, herein we report an innovative conjugation of light and ultrasound-mediated dECM biomaterial processing for fabricating dECM biomaterials. Such approach gathers on ultrasound waves to facilitate dECM-in-liquid processing and visible light photocrosslinking of tyrosine residues naturally present in dECM biomaterials. This dual step methodology unlocked the in-air production of cell laden dECM hydrogels or programmable dECM hydrogel spherical-like beads by using superhydrophobic surfaces. These in-air produced units do not require any additional solvents and successfully supported both fibroblasts and breast cancer cells viability upon encapsulation or surface seeding. In addition, the optimized photoacoustic methodology also enabled a rapid formulation of dECM biomaterial inks with suitable features for biofabricating volumetrically defined living constructs through embedded 3D bioprinting. The biofabricated SdECM hydrogel constructs supported cell adhesion, spreading and viability for 7 days. Overall, the implemented photoacoustic processing methodology of dECM biomaterials offers a rapid and universal strategy for upgrading the processing of dECM biomaterials from virtually any tissue. STATEMENT OF SIGNIFICANCE: Leveraging decellularized matrix biomaterials as cell instructive has potential to open new avenues for tissue engineering and in vitro disease modelling. The processing of dECM remains however, lengthy, costly and introduces non-naturally present proteins in the final biomaterials formulations. In this regard, here we report an innovative light and ultrasound mediated dECM hydrogel crosslinking methodology that enables rapid dECM-in-liquid processing and downstream photocrosslinking of hydrogel beads and 3D bioprinted constructs. Such acoustic-light based processing constitutes a universally applicable method for processing any type of tissue-derived dECM biomaterials.

Ultrasound-Assisted Nanoemulsion Loaded with Optimized Antibacterial Essential Oil Blend: A New Approach against Escherichia coli, Staphylococcus aureus, and Salmonella Enteritidis in Trout (Oncorhynchus mykiss) Fillets.

This study aimed to obtain and characterize an oil-in-water nanoemulsion (NE) loaded with an in vitro optimized bactericidal essential oil blend of 50% oregano, 40% thyme, and 10% lemongrass and to evaluate its potential at three different concentrations (0.5%, 1%, and 2%) in the inactivation of Escherichia coli, Staphylococcus aureus, and Salmonella enterica serotype Enteritidis inoculated in rainbow trout fillets stored at 4 °C for 9 days. Regarding the NE, the nanometric size (<100 nm) with low polydispersion (0.17 ± 0.02) was successfully obtained through ultrasound at 2.09 W/cm2. Considering the three concentrations used, S. Enteritidis was the most susceptible. On the other hand, comparing the concentrations used, the NE at 2% showed better activity, reducing S. Enteritidis, E. coli, and S. aureus by 0.33, 0.20, and 0.73 log CFU/g, respectively, in the trout fillets. Thus, this data indicates that this is a promising eco-friendly alternative to produce safe fish for consumption and reduce public health risks.

Platelet phosphatidylserine exposure and microparticle production as health bioindicators in marine mammals.

In human medicine, various pathologies, including decompression sickness, thrombocytopenia, and rheumatoid arthritis, have been linked to changes in cellular microparticles (MP) formation, particularly platelet microparticles (PMP). Similar disorders in marine mammals might be attributed to anthropogenic threats or illnesses, potentially impacting blood PMP levels. Thus, detecting platelet phosphatidylserine (PS) exposure and PMP formation could serve as a crucial diagnostic and monitoring approach for these conditions in marine mammals. Our group has developed a methodology to assess real-time PS exposure and PMP formation specifically tailored for marine mammals. This method, pioneered in species such as bottlenose dolphins, beluga whales, walruses, and California sea lions, represents a novel approach with significant implications for both clinical assessment and further research into platelet function in these animals. The adapted methodology for evaluating PS exposure and PMP formation in marine mammals has yielded promising results. By applying this approach, we have observed significant correlations between alterations in PMP levels and specific pathologies or environmental factors. These findings underscore the potential of platelet function assessment as a diagnostic and monitoring tool in marine mammal health. The successful adaptation and application of this methodology in marine mammals highlight its utility for understanding and managing health concerns in these animals.

Humoral Immune Response to SARS-CoV-2 Spike Protein Receptor-Binding Motif Linear Epitopes.

The worldwide spread of SARS-CoV-2 has led to a significant economic and social burden on a global scale. Even though the pandemic has concluded, apprehension remains regarding the emergence of highly transmissible variants capable of evading immunity induced by either vaccination or prior infection. The success of viral penetration is due to the specific amino acid residues of the receptor-binding motif (RBM) involved in viral attachment. This region interacts with the cellular receptor ACE2, triggering a neutralizing antibody (nAb) response. In this study, we evaluated serum immunogenicity from individuals who received either a single dose or a combination of different vaccines against the original SARS-CoV-2 strain and a mutated linear RBM. Despite a modest antibody response to wild-type SARS-CoV-2 RBM, the Omicron variants exhibit four mutations in the RBM (S477N, T478K, E484A, and F486V) that result in even lower antibody titers. The primary immune responses observed were directed toward IgA and IgG. While nAbs typically target the RBD, our investigation has unveiled reduced seroreactivity within the RBD's crucial subregion, the RBM. This deficiency may have implications for the generation of protective nAbs. An evaluation of S1WT and S2WT RBM peptides binding to nAbs using microscale thermophoresis revealed a higher affinity (35 nM) for the S2WT sequence (GSTPCNGVEGFNCYF), which includes the FNCY patch. Our findings suggest that the linear RBM of SARS-CoV-2 is not an immunodominant region in vaccinated individuals. Comprehending the intricate dynamics of the humoral response, its interplay with viral evolution, and host genetics is crucial for formulating effective vaccination strategies, targeting not only SARS-CoV-2 but also anticipating potential future coronaviruses.

Factors associated with mortality of elderly people due to COVID-19: Protocol for systematic review and meta-analysis.

INTRODUCTION: The COVID-19 pandemic has become a significant health crisis, marked by high mortality rates on a global scale, with mortality from the disease being notably concentrated among the elderly due to various factors. OBJECTIVE: This study aims to investigate the biological and non-biological factors associated with COVID-19 mortality rates among the elderly worldwide. METHODS: The following databases will be consulted: PubMed, Scopus, EMBASE, Web of Science and ScienceDirect. Longitudinal observational studies (cohort and case-control-risk factors) will be included. The risk of bias, defined as low, moderate, high, will be assessed using the National Heart, Lung and Blood Institute (NHLBI) Quality Assessment Tool for observational cohort and cross-sectional studies. Two independent authors will conduct the searches, and any possible disagreements will be resolved by a third author. Heterogeneity between study results will be assessed using a standard X2 test with a significance level of 0.05, and an I2 value will be calculated to further assess heterogeneity. The random effects model for meta-analyses will be adopted to distribute the weight between the studies and standardize their contributions. The meta-analyses will be conducted using RevMan software. DISCUSSION: Despite the numerous publications on COVID-19 mortality among the elderly, there is still a gap in knowledge, as there is no systematic review and meta-analysis that summarizes the main biological and non-biological associated factors globally. CONCLUSION: The results of this study will consolidate the latest evidence and address gaps in the overall understanding of biological or non-biological associated factors. This knowledge will facilitate the development of appropriate health strategies for this demographic group and pave the way for further research. TRIAL REGISTRATION: PROSPERO (CRD42023400873).

Embedded 3D Bioprinting for Engineering Miniaturized In Vitro Tumor Models.

Embedded extrusion 3D bioprinting is a rapidly emerging additive manufacturing methodology that provides a precise spatial deposition of synthetic or natural-origin low-viscosity bioinks during the extrusion printing process. Such a strategy has to date unlocked the freeform extrusion biofabrication of complex micro-to-macro-scale living architectures for numerous applications, including tissue engineering and in vitro disease modeling. In this chapter, we describe a suspension bioprinting methodology leveraging a continuous viscoelastic biopolymer supporting bath functionalized with divalent calcium cations to enable a rapid processing of user-defined bioinks toward architecturally complex 3D in vitro tumor models. This highly simple and cost-effective viscoelastic supporting bath enables a full freeform biofabrication of cell-laden 3D tumor-mimetic architectures that exhibit structural stability in culture post-printing. The cytocompatibility of the supporting bath, its ease of removal from biofabricated living constructs, and its adaptability for processing different ECM-mimetic bioinks open avenues for multi-scale fabrication of numerous types of physiomimetic 3D tumor models for preclinical screening of candidate therapeutics.

Oil-in-water emulsion loaded with optimized antioxidant blend improved the shelf-life of trout (Oncorhynchus mykiss) fillets: a study with simplex-centroid design.

This study aimed to obtain optimized mixture with three essential oils (EOs) for maximum antioxidant activity through the augmented simplex-centroid mixture design and evaluate the effect of this optimized blend on total aerobic psychrotrophic count (TAPC), lipid and protein oxidation, instrumental color parameters and texture profile in rainbow trout fillets at refrigerated storage for nine days. Considering the DPPH and FRAP assays, the ideal EO blend was 66% lemongrass and 34% oregano. During refrigerated storage, this blend at 2000 ppm was equally effective as BHT (100 ppm) (p > 0.05), mitigating the discoloration (a* and b*), lipid, and protein oxidation in 38.83%, 12.95%, 76.13%, and 35.13%, respectively, besides shows greater effectiveness for preserving texture changes (p < 0.05) and extending the shelf life in 13 h. The lemongrass + oregano EO blend reveals a promising natural alternative to enhance the quality of rainbow trout fillets under refrigerated storage. Furthermore, the multiresponse optimization showed to be a strong ally in enabling the use of these EOs by food industries.

Advances in screening hyperthermic nanomedicines in 3D tumor models.

Hyperthermic nanomedicines are particularly relevant for tackling human cancer, providing a valuable alternative to conventional therapeutics. The early-stage preclinical performance evaluation of such anti-cancer treatments is conventionally performed in flat 2D cell cultures that do not mimic the volumetric heat transfer occurring in human tumors. Recently, improvements in bioengineered 3D in vitro models have unlocked the opportunity to recapitulate major tumor microenvironment hallmarks and generate highly informative readouts that can contribute to accelerating the discovery and validation of efficient hyperthermic treatments. Leveraging on this, herein we aim to showcase the potential of engineered physiomimetic 3D tumor models for evaluating the preclinical efficacy of hyperthermic nanomedicines, featuring the main advantages and design considerations under diverse testing scenarios. The most recent applications of 3D tumor models for screening photo- and/or magnetic nanomedicines will be discussed, either as standalone systems or in combinatorial approaches with other anti-cancer therapeutics. We envision that breakthroughs toward developing multi-functional 3D platforms for hyperthermia onset and follow-up will contribute to a more expedited discovery of top-performing hyperthermic therapies in a preclinical setting before their in vivo screening.

Optimizing UVC-LED application to improve the shelf life of vacuum-packed refrigerated stored Nile tilapia (Oreochromis niloticus) fillets.

Although ultraviolet-C light-emitting diode (UVC-LED) has proven antimicrobial effectiveness doses needed to reach it cause adverse effects on the physicochemical quality of fish, and thus, optimization studies are crucial to boost its industrial application. This study aimed to identify optimal UVC-LED conditions for maximum shelf life extension with the least possible quality changes of refrigerated stored tilapia fillets from a central composite rotatable design (CCRD). UVC-LED powers (1, 1.38, and 1.58 mW/cm2 ) and times (500, 1800, and 2700 s) were set on the CCRD, which generated 11 treatments, including three replicate experiments. Treatments were analyzed for total aerobic psychrotrophic count, lipid oxidation, instrumental color, and texture parameters on days 0, 2, 4, 7, 11, and 14. The UVC-LED affected shelf life and physicochemical parameters in a nonlinear fashion. UVC-LED-treated fish had increased shelf life by 2.80-4.76 days and increase or decrease in lipid oxidation (0.025-0.276 mg of malondialdehyde [MDA]/kg), total color change (∆E = 3.47-9.06), and hardness (1.31-8.51 N) over the refrigerated storage depending on specific UVC-LED conditions applied. The optimal UVC-LED condition was 0.97 mW/cm2 with 2503.6 s (2428.50 mJ/cm2 ), which increased the fillet's shelf life by 2.5-fold (2 days) while maintaining quality closer to the original throughout refrigerated storage, resulting in ∆E < 5, an increase of only 0.05 mg of MDA/kg, and preservation of the decrease in hardness by 3.38 N compared to its control counterparts. Therefore, it represents an eco-friendly technology that can easily scaled industrially to enhance the sustainable fish production chain. PRACTICAL APPLICATION: The high fish perishability is a global concern due to food safety risks and waste generation impacting the environment adversely, especially nowadays, where fish production and consumption have increased, and there are more evident efforts to sustainable production. UVC-LED is an eco-friendly technology with proven antimicrobial effectiveness but doses needed to reach this effect enhance oxidative degradation. Despite that, optimization studies concerning the maximum shelf life extension while retaining the physicochemical quality of refrigerated stored fish are a gap in the literature and a barrier to its industrial application. Our findings are helpful in sustainably enhancing the fish production chain.

Can Extraintestinal Pathogenic Escherichia coli with Heat Resistance Profile Overcome Nonthermal Technologies?

Ultraviolet-C light-emitting diode (UVC-LED) and ultrasound (US) are two nonthermal technologies with the potential to destroy pathogens. However, little is known about their effectiveness in strains with a history of heat resistance. Thus, this study aimed to evaluate the phenotype and genotype of heat-resistant extraintestinal pathogenic Escherichia coli (ExPEC) with heat resistance genes after the application of US, UVC-LED, and UVC-LED+US. For this, two central composite rotatable designs were used to optimize the UVC-LED and US conditions in four ExPEC isolated from beef. From the genome of these isolates obtained in a previous study, possible genes for UVC resistance were analyzed. Results showed that US was ineffective in reducing >0.30 log colony-forming unit/mL, and that when used after UVC-LED, it showed a nonsynergic or antagonistic effect. Also, UVC-LED had the greatest effect at the maximum dose (4950 mJ/cm2 from 1.65 mW/cm2 for 50 min). However, the strains showed some recovery after that, which could be implicated in the expression of genes included in SOS system genes, some others present in the transmissible Locus of Stress Tolerance (trxBC and degP), and others (terC). Thus, ExPEC can overcome the conditions used in this study for US, UVC-LED, and UVC-LED+US, probably due to the history of resistance to other cellular damage. The result of this study will contribute to future studies that aim to find better treatment conditions for each food product.

Lifelong learning entre profissionais de enfermagem: Desafios contemporâneos / Lifelong learning in nursing: Modern challenges / Lifelong learning entre los profesionales de enfermería: Retos contemporáneos

Resumo Enquadramento: A construção do processo educativo deve ocorrer de forma ininterrupta na trajetória de vida profissional. Objetivo: Refletir sobre os desafios da aprendizagem ao longo da vida (lifelong learning) de profissionais de enfermagem no mundo contemporâneo. Principais tópicos em análise: avanços na prática de enfermagem depende da incorporação de conhecimentos, envolvendo aspetos profissionais, pessoais, culturais e socioeconómicos. Importantes mudanças no saber teórico e prático, exigem maior complexidade nas ações e serviços assistenciais, exigindo dos enfermeiros, aprendizagem para o ajustamento contínuo às novas tecnologias. O processo educativo e a aprendizagem perpassam diferentes gerações, com características e interesses diversos. Enfermeiros precisam de gerir de forma ativa os seus próprios conhecimentos, habilidades e atitudes, compatibilizando exigências e desafios profissionais com qualidade de vida. Conclusão: O profissional inovador reúne habilidades técnicas e comportamentais.O principal desafio é a articulação entre ambiente de trabalho, contexto social e estratégias educacionais, potencializando o sucesso na aprendizagem, resultando em práticas seguras prestadas aos pacientes e à coletividade, colaborando para o alcance da saúde universal.

Abstract Background: Education is a process that must be continuously developed throughout professional life. Objective: To reflect on the challenges of lifelong learning in modern nursing. Main topics under analysis: The advancement of nursing practice depends on integrating professional, personal, cultural, and socioeconomic knowledge. The fundamental changes occurring in theoretical and practical knowledge require more complex care actions and services, which demand that nurses learn to adapt continuously to new technologies. Different generations with distinctive characteristics and interests undergo the learning and educational process. Nurses must actively manage their knowledge, skills, and attitudes and harmonize professional demands and challenges with quality of life. Conclusion: The innovative nursing professional combines technical and behavioral skills. The main challenge is the combination of work environment, social context, and educational strategies, which should stimulate learning success, allow safe care delivery to patients and communities, and contribute to universal health.

Resumen Marco contextual: La construcción del proceso educativo debe producirse de forma ininterrumpida en la trayectoria de la vida profesional. Objetivo: Reflexionar sobre los retos del aprendizaje a lo largo de la vida (lifelong learning) para los profesionales de enfermería en el mundo contemporáneo. Principales temas en análisis: Los avances en la práctica enfermera dependen de la incorporación de conocimientos, que implican aspectos profesionales, personales, culturales y socioeconómicos. Los importantes cambios en los conocimientos teóricos y prácticos exigen una mayor complejidad en las acciones y los servicios asistenciales, lo que requiere que los enfermeros tengan que aprender a adaptarse continuamente a las nuevas tecnologías. El proceso educativo y el aprendizaje atraviesan distintas generaciones, con características e intereses diferentes. Los enfermeros necesitan gestionar activamente sus propios conocimientos, habilidades y actitudes, y compatibilizar las exigencias y los retos profesionales con la calidad de vida. Conclusión: El profesional innovador reúne competencias técnicas y comportamentales. El principal desafío es la articulación entre ambiente de trabajo, contexto social y estrategias educativas, lo que potencia el éxito en el aprendizaje, resulta en prácticas seguras proporcionadas a los pacientes y a la colectividad, y contribuye a alcanzar la universalización de la salud.

Mapping IgA Epitope and Cross-Reactivity between Severe Acute Respiratory Syndrome-Associated Coronavirus 2 and DENV.

BACKGROUND: The newly introduced COVID-19 vaccines have reduced disease severity and hospitalizations. However, they do not significantly prevent infection or transmission. In the same context, measuring IgM and IgG antibody levels is important, but it does not provide information about the status of the mucosal immune response. This article describes a comprehensive mapping of IgA epitopes of the S protein, its cross-reactivity, and the development of an ELISA-peptide assay. METHODS: IgA epitope mapping was conducted using SPOT synthesis and sera from RT-qPCR COVID-19-positive patients. Specific and cross-reacting epitopes were identified, and an evolutionary analysis from the early Wuhan strain to the Omicron variant was performed using bioinformatics tools and a microarray of peptides. The selected epitopes were chemically synthesized and evaluated using ELISA-IgA. RESULTS: A total of 40 IgA epitopes were identified with 23 in S1 and 17 in the S2 subunit. Among these, at least 23 epitopes showed cross-reactivity with DENV and other organisms and 24 showed cross-reactivity with other associated coronaviruses. Three MAP4 polypeptides were validated by ELISA, demonstrating a sensitivity of 90-99.96% and a specificity of 100%. Among the six IgA-RBD epitopes, only the SC/18 epitope of the Omicron variants (BA.2 and BA.2.12.1) presented a single IgA epitope. CONCLUSIONS: This research unveiled the IgA epitome of the S protein and identified many epitopes that exhibit cross-reactivity with DENV and other coronaviruses. The S protein of variants from Wuhan to Omicron retains many conserved IgA epitopes except for one epitope (#SCov/18). The cross-reactivity with DENV suggests limitations in using the whole S protein or the S1/S2/RBD segment for IgA serological diagnostic tests for COVID-19. The expression of these identified specific epitopes as diagnostic biomarkers could facilitate monitoring mucosal immunity to COVID-19, potentially leading to more accurate diagnoses and alternative mucosal vaccines.

Interdisciplinary health consultations for older people in Portugal: primary care and hospitals.

OBJECTIVE: To analyze the perspective of doctors, nurses, and social workers about practices for older people health in primary care and in hospitals; to create guidelines for the practice of interdisciplinary consultations. METHOD: Cross-sectional study involving 291 professionals from public institutions in the northern region of Portugal. Data were collected between May/2018 and March/2019, using a questionnaire which was then subjected to descriptive and analytical statistical analysis. RESULTS: The usefulness of scales for elderly people showed no differences between hospital and primary care. Hospital professionals collected the following data: eyesight/hearing; medication; direct contact or contact by writing between professionals; daily team meetings; need to share information among colleagues. Primary care professionals, in turn, valued: weight/height, swallowing; the need for home visits; direct contact or via e-mail between professionals; weekly team meetings. CONCLUSION: The practices of the professionals suggested an intervention model with common aspects in both groups, but with specificities for both primary and hospital care.

Evaluation of remote teaching in master programs in the Oral Pathology and Oral Medicine during the COVID-19 pandemic. Brazilian multicentric study

Background: With the COVID-19 pandemic, there was a need to adopt online teaching methods in a generalized and sudden way, a situation that led to unprecedented changes in the routine of post-graduate students and research development. This study aimed to analyze the evaluation of remote teaching by graduates of master's degrees and advisors in master's programs in the Oral Pathology and Oral Medicine who needed to adapt to a remote teaching methodology in the pandemic. Material and Methods: This quantitative study evaluated the remote teaching in the perception of master's graduates and advisors from postgraduate programs in Oral Pathology and Oral Medicine. Data were collected through an online Google forms® questionnaire. Results: Participated in the study 14 master graduates and 14 master's advisors. Master graduates evaluated that the professors had a good performance (p=0.001), that the duration of the classes was adequate (p=0.015), that the interaction with professors was satisfactory (p=0.007), that they had good interaction with the advisor (p=0.001), that they were satisfied with the remote guidance process (p=0.038) and that face-to-face practical activities were missed (p=0.002). Master's advisors reported satisfaction with remote teaching, good adaptation (p=0.018) and motivation for remote teaching (p=0.016), they evaluated that students were cooperative in activities (p=0.019) and that face-to-face practical activities were missed (p=0.002). Conclusions: Despite the difficulties, remote teaching proved to be an effective alternative to face-to-face teaching. (AU)

Doulas da morte: uma revisão de escopo / Death doulas: a scoping review

Introdução. O profissional doula da morte é considerado um colaborador solidário, cujo objetivo é melhorar a qualidade de morte no processo de terminalidade de pacientes, de forma a proporcionar uma 'boa morte'. Objetivo. O objetivo do estudo é mapear as evidências científicas sobre os papéis das doulas da morte na terminalidade da vida. Materiais e Métodos. Trata-se de uma revisão de escopo realizada nas bases de dados CINHAL, EMBASE, WOS, PUBMED e LILACS usando descritores de saúde conectados pelos operados booleanos AND e OR no espaço temporal entre 2000 e 2021. Resultados: Dos 467 artigos encontrados, somente 11 fizeram parte da amostra final. Dentre a diversidade e flexibilidade de papéis, os profissionais doulas realizam tarefas, serviços e prestam cuidados práticos e não clínicos durante todo o processo de morrer, morte, pós-morte e luto de pacientes e seus familiares, bem como promovem educação para a morte, levando em consideração as dimensões biopsicossocial e espiritual do cuidado humano. Possíveis barreiras no movimento de doulas da morte incluem a inconsistência nos programas de treinamento existentes e a ausência de um órgão regulamentador para a supervisão da prática e a padronização de honorários. Discussão. O trabalho das doulas da morte concentra-se na presença e atenção plenas, escuta sensível, compassiva e centrada na pessoa em processo de terminalidade, respeitando os seus desejos e horando sua biografia. Conclusão. As doulas de morte podem aumentar os serviços de cuidados de fim de vida existentes, fornecendo serviços de cuidados holísticos e personalizados em todos os cenários da rede de atenção à saúde, contudo, há necessidade de estudos mais rigorosos para explorar a percepção dos profissionais de saúde sobre esse papel e investigar resultados clínicos entre pessoas que estão morrendo e suas famílias.

Introduction: The professional death doula is considered a supportive collaborator, whose goal is to improve the quality of death in the process of terminality of patients, to provide a 'good death'. Objective: The objective of the study is to map the scientific evidence on the roles of death doulas in the terminality of life. Materials and Methods: This is a scoping review conducted in the databases CINHAL, EMBASE, WOS, PUBMED and LILACS using health descriptors connected by the Boolean operands AND and OR in the time frame between 2000 and 2021. Results: Of the 467 articles found, only 11 were part of the final sample. Among the diversity and flexibility of roles, professional doulas perform tasks, services and provide practical and non-clinical care throughout the dying, death, postmortem and bereavement process of patients and their families, as well as promote death education, considering the biopsychosocial and spiritual dimensions of human care. Possible barriers in the death doula movement include the inconsistency in existing training programs and the absence of a regulatory body for the supervision of practice and the standardization of fees. Discussion: The work of death doulas focuses on full presence and attention, sensitive, compassionate listening, and centering on the person in the process of terminality, respecting their wishes and honoring their biography. Conclusion: Death doulas can augment existing end-of-life care services by providing holistic and personalized care services across health care settings, however, there is a need for more rigorous studies to explore health professionals' perceptions of this role and investigate clinical outcomes among dying people and their families.

Introducción: La doula de la muerte profesional se considera un colaborador de apoyo, cuyo objetivo es mejorar la calidad de la muerte en el proceso de terminalidad de los pacientes, con el fin de proporcionar una "buena muerte". Objetivo: El objetivo del estudio es mapear la evidencia científica sobre las funciones de las doulas de muerte en la terminalidad de la vida. Materiales y Métodos: Se trata de una revisión exploratoria realizada en las bases de datos CINHAL, EMBASE, WOS, PUBMED y LILACS utilizando descriptores de salud conectados por los operandos booleanos AND y OR en el marco temporal comprendido entre 2000 y 2021. Resultados: De los 467 artículos encontrados, sólo 11 formaron parte de la muestra final. Entre la diversidad y flexibilidad de roles, las doulas profesionales realizan tareas, servicios y proporcionan cuidados prácticos y no clínicos a lo largo del proceso de morir, muerte, postmortem y duelo de los pacientes y sus familias, así como promueven la educación sobre la muerte, teniendo en cuenta las dimensiones biopsicosociales y espirituales del cuidado humano. Entre los posibles obstáculos al movimiento de las doulas de la muerte se encuentran la incoherencia de los programas de formación existentes y la ausencia de un organismo regulador para la supervisión de la práctica y la normalización de los honorarios. Discusión: El trabajo de las doulas de la muerte se centra en la presencia y atención plena, la escucha sensible, compasiva y centrada en la persona en proceso de terminalidad, respetando sus deseos y honrando su biografía. Conclusión: Las doulas moribundas pueden aumentar los servicios existentes de atención al final de la vida proporcionando servicios de atención holísticos y personalizados en todos los entornos de atención sanitaria; sin embargo, se necesitan estudios más rigurosos para explorar las percepciones de los profesionales sanitarios sobre esta función e investigar los resultados clínicos entre los moribundos y sus familias.

Yield and Technological Quality of Pirarucu Trimming Surimi According to the Number of Washing Cycles, Rice Flour Content, and Cooking Temperature.

This research aimed to optimize surimi production with innovative raw materials called pirarucu trimmings and broken rice grains, which are by-products from food industries. The effects of three independent variables (number of washing cycles, content, and cooking temperature of rice flour-RF) on surimi's physical, chemical, and technological qualities were investigated through a Box-Behnken design. The number of washing cycles affected yield (77-93%), moisture (55-67%), lipids (18-35%), protein (7.15-11.88%), whiteness (46.73-64.45), chroma (8.86-13.18), hue angle (80.79-93.12°), cohesiveness (0.40-0.61), springiness (0.51-0.99), and freeze stability after 4 weeks (85.16-96.53%). RF concentration affected moisture, lipids, cohesiveness, springiness, and freeze-thaw stability after 4 weeks. RF cooking temperature affected moisture, chroma, cohesiveness, and springiness. The optimal conditions for surimi production with high yield and overall quality were three washing cycles, 6% of RF, and RF cooking temperature at 85 °C. It reveals the promising potential of both by-products to be used as an ingredient in restructured products and contribute to improving agri-industry sustainability.

The elusive Luminal B breast cancer and the mysterious chemokines.

PURPOSE: Invasive ductal breast cancer (IDC) is heterogeneous. Staging and immunohistochemistry (IH) allow for effective therapy but are not yet ideal. Women with Luminal B tumors show an erratic response to treatment. This prospective study with 81 women with breast cancer aims to improve the prognostic stratification of Luminal B patients. METHODS: This is a prospective translational study with 81 women with infiltrating ductal carcinoma, grouped by TNM staging and immunohistochemistry, for survival analysis, and their correlations with the chemokines. Serum measurements of 13 chemokines were performed, including 7 CC chemokines [CCL2(MCP1), CCL3(MIP1α), CCL4(MIP1ß), CCL5(Rantes), CCL11(Eotaxin), CCL17(TARC), CCL20(MIP3α)], 6 CXC chemokines [CXCL1(GroAlpha), CXCL5(ENA78), CCXCL8(IL-8), CXCL9(MIG), CXCL10(IP10), CXCL11(ITAC)]. RESULTS: Overall survival was significantly dependent on tumor staging and subtypes by immunohistochemistry, with a median follow-up time the 32.87 months (3.67-65.63 months). There were age correlations with IP10/CXCL10 chemokines (r = 0.4360; p = 0.0079) and TARC/CCL17 (Spearman + 0.2648; p = 0.0360). An inverse correlation was found between body weight and the chemokines Rantes/CCL5 (r = - 0.3098; p = 0.0169) and Eotaxin/CCL11 (r = - 0.2575; p = 0.0470). Smokers had a higher concentration of MIP3α/CCL20 (Spearman + 0.3344; p = 0.0267). Luminal B subtype patients who expressed lower concentrations of ENA78/CXCL5 (≤ 254.83 pg/ml) (Log-Rank p = 0.016) and higher expression of MIP1ß/CCL4 (> 34.84 pg/ml) (Log-Rank p = 0.014) had a higher risk of metastases. CONCLUSION: Patients with Luminal B breast tumors can be better stratified by serum chemokine expression, suggesting that prognosis is dependent on biomarkers other than TNM and IH.

Effectiveness of crisis resolution and home treatment teams in mental health crisis: a systematic review protocol / A efetividade das equipas de hospitalização domiciliária psiquiátrica: um protocolo de revisão sistemática / La efectividad de los equipos de hospitalización domiciliaria de atención psiquiátrica: un protocolo de revisión sistemática

Abstract Background: People with mental health crises may need intensive care support that, in many countries, implies a psychiatric hospitalization that may negatively affect the individual. Furthermore, it involves the individuals' removal from their daily spaces, which implies an adaptive effort when returning to the community. In order to reduce the treatment's impact of a mental health crisis, Crisis Resolution or Home Treatment (CRHT) Teams have been providing an alternative to inpatient treatment. Aim: To analyze and highlight CRHT teams' effectiveness in reducing days of treatment, relapse, and rehospitalization of adults (18-65 years) compared to treatment as usual defined as inpatient treatment. Methods: We will develop a systematic review of the current literature by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Two authors will independently conduct study inclusion, data extraction, quality, and bias risk assessments. We will include experimental study designs like randomized clinical trials, non-randomized, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case-control studies involving working-age adults (18-65 years) irrespective of culture, ethnicity, or mental health diagnosis. Results: We will include primary outcomes like days of treatment, relapse (as defined by each study), and rehospitalization. Secondary outcomes will be service user satisfaction, dropout rate, and the proportion of patients with adverse events (suicide, self-harm, or aggression/violence). Conclusions: This study will allow evidence to determine the need to create and encourage the implementation of CRHT teams to provide an effective alternative response to psychiatric hospitalization.

Resumo Contexto: A pessoa em crise de saúde mental pode precisar de tratamento intensivo que, em muitos países, implica um internamento psiquiátrico que pode afetar negativamente o indivíduo. Além disso, envolve o seu afastamento dos espaços quotidianos, o que implica um esforço adaptativo ao retornar à comunidade. A fim de reduzir o impacto do tratamento de uma crise de saúde mental, as Equipes de Hospitalização Domiciliária Psiquiátrica (EHDP) constituem-se como alternativa ao internamento hospitalar. Objetivo: Analisar e evidenciar a eficácia das EHDP na redução de dias de tratamento, recaídas e reinternamento de adultos (18-65 anos) em comparação com o tratamento usual definido como internamento hospitalar. Métodos: Desenvolveremos uma revisão sistemática da literatura de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2019 Statement. Dois autores conduzirão independentemente a inclusão de estudos, a extração de dados, a avaliação da qualidade e do risco de viés. Incluiremos estudos experimentais como ensaios clínicos randomizados, não randomizados, quase-experimentais, estudos pré e pós-teste, estudos de coorte prospetivos e retrospetivos e estudos de caso-controle envolvendo adultos em idade ativa (18-65 anos), independentemente da cultura, etnia ou diagnóstico de saúde mental. Resultados: Incluiremos outcomes primários como dias de tratamento, recaída (conforme definido por cada estudo) e reinternamento. Os outcomes secundários incluem a satisfação do cliente com o serviço, taxa de abandono e proporção de pacientes com eventos adversos (suicídio, automutilação ou agressão/violência). Conclusões: Este estudo trará evidências para determinar a necessidade de criar e incentivar a implementação de EHDP como uma resposta alternativa eficaz ao internamento psiquiátrico.

Resumen Contexto: Las personas con crisis de salud mental pueden necesitar apoyo en cuidados intensivos que, en muchos países, implica una hospitalización psiquiátrica que puede afectar negativamente al individuo. Además, implica la salida de los individuos de sus espacios cotidianos, lo que implica un esfuerzo adaptativo al regresar a la comunidad. Para reducir el impacto del tratamiento de una crisis de salud mental, los equipos de resolución de crisis o de tratamiento en el hogar (ERCTH) han estado brindando una alternativa al tratamiento hospitalario. Objetivo: Analizar y destacar la efectividad de los ERCTH en la reducción de días de tratamiento, recaída y rehospitalización de adultos (18-65 años) en comparación con el tratamiento habitual definido como tratamiento hospitalario. Metodología: Desarrollaremos una revisión sistemática de la literatura actual mediante la Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Dos autores realizarán de forma independiente la inclusión de los estudios, la extracción de datos, las evaluaciones de la calidad y riesgo de sesgo. Incluiremos diseños de estudios experimentales como ensayos clínicos aleatorizados, no aleatorizados, cuasiexperimentales, estudios de antes y después, estudios de cohortes prospectivos y retrospectivos, y estudios de casos y controles con adultos en edad laboral (18-65 años) independientemente de la cultura, origen étnico o diagnóstico de salud mental. Resultados: Incluiremos resultados primarios como días de tratamiento, recaída (según la definición de cada estudio) y rehospitalización. Los resultados secundarios será la satisfacción del cliente del servicio, la tasa de abandono y la proporción de pacientes con eventos adversos (suicidio, autolesiones o agresión/violencia). Conclusiones: Este estudio aportará evidencias para determinar la necesidad de crear y fomentar la implementación de ERCTH para ofrecer una respuesta alternativa efectiva a la hospitalización psiquiátrica.

Comparing Different Packaging Conditions on Quality Stability of High-Pressure Treated Serra da Estrela Cheeses during Cold Storage.

Serra da Estrela cheese with a Protected Designation of Origin (PDO) is a traditional cheese that is wrapped in paper without vacuum. High-pressure processing (HPP), which requires vacuum packaging of the cheese, has been used for its cold pasteurization to overcome safety issues. In this study, two packaging systems were studied: non-vacuum greaseproof paper wrapping package and vacuum packaging in plastic film. Lactococci, lactobacilli, enterococci, and total mesophiles reached ca. 8 log cfu g-1 and 4-6 log cfu g-1 in control (unpasteurized) and HPP-treated cheeses, respectively, with no significant differences between packaging systems. Spoilage microorganisms' viable cell numbers were reduced to <3 log cfu g-1 (quantification limit) in HPP-treated cheeses, independently of the packaging system. Yeasts and molds reached >5 log cfu g-1 in non-vacuum paper-wrapped cheeses. A vacuum-packaging system enabled better control of cheese proteolysis, which was revealed to be closer to that of the original control cheese values at the end of the 10-month storage period. In addition, cheese stored under vacuum film packaging became harder than non-vacuum paper-wrapped cheeses at each time point. Overall, conventional non-vacuum paper wrapping is adequate for short storage periods (<3 months), but for long periods vacuum packaging in plastic film is preferable.

Combined UV-C Technologies to Improve Safety and Quality of Fish and Meat Products: A Systematic Review.

This study aimed to identify the best UV-C combined treatments for ensuring the safety and quality of fish and meat products. A total of 4592 articles were screened in the relevant databases, and 16 were eligible studies. For fish, the most effective treatments to reduce Gram-negative and Gram-positive bacteria were UV-C at 0.5 J/cm2 + non-thermal atmospheric plasma (NTAP) for 8 min (33.83%) and 1% Verdad N6 + 0.05 J/cm2 + vacuum packaging (25.81%), respectively. An oxygen absorber with 0.102 J/cm2 was the best combined treatment, reducing lipid oxidation (65.59%), protein oxidation (48.95), color (ΔE = 4.51), and hardness changes (18.61%), in addition to a shelf-life extension of at least 2 days. For meat products, Gram-negative bacteria were more reduced by nir-infrared heating (NIR-H; 200.36 µW/cm2/nm) combined with 0.13 J/cm2 (70.82%) and 0.11 J/cm2 (52.09%). While Gram-positive bacteria by 0.13 J/cm2 with NIR-H (200.36 µW/cm2/nm), 1, 2, or 4 J/cm2 with flash pasteurization (FP) during 1.5 or 3 s, and 2 J/cm2 with FP for 0.75 s (58.89-67.77%). LAE (5%) + 0.5 J/cm2 was promising for maintaining color and texture. UV-C combined technologies seem to be a cost-effective alternative to ensure safety with little to no quality changes in fish and meat products.