Probiotic edible films as a new strategy for developing functional bakery products: The case of pan bread.

In the present paper, a novel approach for the development of probiotic baked cereal products is presented. Probiotic pan bread constructed by the application of film forming solutions based either on individual hydrogels e.g. 1% w/w sodium alginate (ALG) or binary blends of 0.5% w/w sodium alginate and 2% whey protein concentrate (ALG/WPC) containing Lactobacillus rhamnosus GG, followed by an air drying step at 60 °C for 10 min or 180 °C for min were produced. No visual differences between the bread crust surface of control and probiotic bread were observed. Microstructural analysis of bread crust revealed the formation of thicker films in the case of ALG/WPC. The presence of WPC improved significantly the viability of L. rhamnosus GG throughout air drying and room temperature storage. During storage there was a significant reduction in L. rhamnosus GG viability during the first 24 h, viable count losses were low during the subsequent 2-3 days of storage and growth was observed upon the last days of storage (day 4-7). The use of film forming solutions based exclusive on sodium alginate improved the viability of L. rhamnosus GG under simulated gastro-intestinal conditions, and there was no impact of the bread crust matrix on inactivation rates. The presence of the probiotic edible films did not modify cause major shifts in the mechanistic pathway of bread staling - as shown by physicochemical, thermal, texture and headspace analysis. Based on our calculations, an individual 30-40 g bread slice can deliver approx. 7.57-8.98 and 6.55-6.91 log cfu/portion before and after in-vitro digestion, meeting the WHO recommended required viable cell counts for probiotic bacteria to be delivered to the human host.

Predicting fluid responsiveness in children: a systematic review.

BACKGROUND: Administration of fluid to improve cardiac output is the mainstay of hemodynamic resuscitation. Not all patients respond to fluid therapy, and excessive fluid administration is harmful. Predicting fluid responsiveness can be challenging, particularly in children. Numerous hemodynamic variables have been proposed as predictors of fluid responsiveness. Dynamic variables based on the heart-lung interaction appear to be excellent predictors of fluid responsiveness in adults, but there is no consensus on their usefulness in children. METHODS: We systematically reviewed the current evidence for predictors of fluid responsiveness in children. A systematic search was performed using PubMed (1947-2013) and EMBASE (1974-2013). Search terms included fluid, volume, response, respond, challenge, bolus, load, predict, and guide. Results were limited to studies involving pediatric subjects (infant, child, and adolescent). Extraction of data was performed independently by 2 authors using predefined data fields, including study quality indicators. Any variable with an area under the receiver operating characteristic curve that was significantly above 0.5 was considered predictive. RESULTS: Twelve studies involving 501 fluid boluses in 438 pediatric patients (age range 1 day to 17.8 years) were included. Twenty-four variables were investigated. The only variable shown in multiple studies to be predictive was respiratory variation in aortic blood flow peak velocity (5 studies). Stroke volume index, stroke distance variation, and change in cardiac index (and stroke volume) induced by passive leg raising were found to be predictive in single studies only. Static variables based on heart rate, systolic arterial blood pressure, preload (central venous pressure, pulmonary artery occlusion pressure), thermodilution (global end diastolic volume index), ultrasound dilution (active circulation volume, central blood volume, total end diastolic volume, total ejection fraction), echocardiography (left ventricular end diastolic area), and Doppler (stroke volume index, corrected flow time) did not predict fluid responsiveness in children. Dynamic variables based on arterial blood pressure (systolic pressure variation, pulse pressure variation and stroke volume variation, difference between maximal or minimal systolic arterial blood pressure and systolic pressure at end-expiratory pause) and plethysmography (pulse oximeter plethysmograph amplitude variation) were also not predictive. There were contradicting results for plethymograph variation index and inferior vena cava diameter variation. CONCLUSIONS: Respiratory variation in aortic blood flow peak velocity was the only variable shown to predict fluid responsiveness in children. Static variables did not predict fluid responsiveness in children, which was consistent with evidence in adults. Dynamic variables based on arterial blood pressure did not predict fluid responsiveness in children, but the evidence for dynamic variables based on plethysmography was inconclusive.

Enterocyte-specific epidermal growth factor prevents barrier dysfunction and improves mortality in murine peritonitis.

Systemic administration of epidermal growth factor (EGF) decreases mortality in a murine model of septic peritonitis. Although EGF can have direct healing effects on the intestinal mucosa, it is unknown whether the benefits of systemic EGF in peritonitis are mediated through the intestine. Here, we demonstrate that enterocyte-specific overexpression of EGF is sufficient to prevent intestinal barrier dysfunction and improve survival in peritonitis. Transgenic FVB/N mice that overexpress EGF exclusively in enterocytes (IFABP-EGF) and wild-type (WT) mice were subjected to either sham laparotomy or cecal ligation and puncture (CLP). Intestinal permeability, expression of the tight junction proteins claudins-1, -2, -3, -4, -5, -7, and -8, occludin, and zonula occludens-1; villus length; intestinal epithelial proliferation; and epithelial apoptosis were evaluated. A separate cohort of mice was followed for survival. Peritonitis induced a threefold increase in intestinal permeability in WT mice. This was associated with increased claudin-2 expression and a change in subcellular localization. Permeability decreased to basal levels in IFABP-EGF septic mice, and claudin-2 expression and localization were similar to those of sham animals. Claudin-4 expression was decreased following CLP but was not different between WT septic mice and IFABP-EGF septic mice. Peritonitis-induced decreases in villus length and proliferation and increases in apoptosis seen in WT septic mice did not occur in IFABP-EGF septic mice. IFABP-EGF mice had improved 7-day mortality compared with WT septic mice (6% vs. 64%). Since enterocyte-specific overexpression of EGF is sufficient to prevent peritonitis-induced intestinal barrier dysfunction and confers a survival advantage, the protective effects of systemic EGF in septic peritonitis appear to be mediated in an intestine-specific fashion.

Development and validation of an APCI-MS/GC-MS approach for the classification and prediction of Cheddar cheese maturity.

Headspace techniques have been extensively employed in food analysis to measure volatile compounds, which play a central role in the perceived quality of food. In this study atmospheric pressure chemical ionisation-mass spectrometry (APCI-MS), coupled with gas chromatography-mass spectrometry (GC-MS), was used to investigate the complex mix of volatile compounds present in Cheddar cheeses of different maturity, processing and recipes to enable characterisation of the cheeses based on their ripening stages. Partial least squares-linear discriminant analysis (PLS-DA) provided a 70% success rate in correct prediction of the age of the cheeses based on their key headspace volatile profiles. In addition to predicting maturity, the analytical results coupled with chemometrics offered a rapid and detailed profiling of the volatile component of Cheddar cheeses, which could offer a new tool for quality assessment and accelerate product development.

The Performance of a Mobile Phone Respiratory Rate Counter Compared to the WHO ARI Timer.

OBJECTIVE: To compare the accuracy and efficiency of the respiratory rate (RR) RRate mobile application to the WHO ARI Timer. METHODS: Volunteers used both devices to measure RR from reference videos of infants and children. Measurements were compared using correlation, Bland-Altman analysis, error metrics and time taken. RESULTS: Measurements with either device were highly correlated to the reference (r = 0.991 and r = 0.982), and to each other (r = 0.973). RRate had a larger bias than the ARI Timer (0.6 vs. 0.04 br/min), but tighter limits of agreement (-4.5 to 3.3 br/min vs. -5.5 to 5.5 br/min). RRate was more accurate than the ARI Timer (percentage error 10.6% vs. 14.8%, root mean square error 2.1 vs. 2.8 br/min and normalized root mean square error 5.6% vs. 7.5%). RRate measurements were 52.7 seconds (95% CI 50.4 s to 54.9 s) faster. CONCLUSION: During video observations, RRate measured RR quicker with a similar accuracy compared to the ARI Timer.

A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda.

BACKGROUND: Children discharged from hospitals in developing countries are at high risk of morbidity and mortality. However, few data describe these outcomes among children seen and discharged from rural outpatient centers. OBJECTIVE: The objective of this exploratory study was to identify predictors of immediate and follow-up morbidity and mortality among children visiting a rural health center in Uganda. METHODS: Subjects 0-12 years of age seeking care with a caregiver were consecutively enrolled from a single rural health center in Southwestern Uganda. Baseline variables were collected by research nurses and outcomes of referral, admission or death were recorded (immediate events). Death, hospital admission and health seeking occurring during the 30 days following the clinic visit were also determined (follow-up events). Univariate logistic regression was performed to identify baseline variables associated with immediate outcome and follow-up outcomes. RESULTS: Over the four-month recruitment period 717 subjects were enrolled. There were 85 (11.9%) immediate events (10.1% were admitted, 2.2% were referred, none died). Forty-seven (7.8%) events occurred within 30 days after the visit (7.3% sought care from a health provider, 1.5% were admitted and 0.5% died). Variables associated with immediate events included living more than 30 minutes from the health center, age older than 5 years, having received an antimalarial prior to the visit, having seen a community health worker prior to the visit, elevated respiratory rate or temperature, and depressed weight-for-age z score or decreased oxygen saturation. These variables were not associated with follow-up events. CONCLUSIONS: Sick-child visits at a rural health center in South Western Uganda were associated with rates of mortality and subsequent admission of less than 2% in the period following the sick child visits. Other types of health seeking behavior occurred in approximately 7% of subjects during this same period. Several variables were associated with immediate events but there were no reliable predictors of follow-up events, possibly due to low statistical power.

Healthcare Engineering Defined: A White Paper.

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

Atmospheric pressure chemical ionisation mass spectrometry analysis linked with chemometrics for food classification - a case study: geographical provenance and cultivar classification of monovarietal clarified apple juices.

In the present work, we have evaluated for first time the feasibility of APCI-MS volatile compound fingerprinting in conjunction with chemometrics (PLS-DA) as a new strategy for rapid and non-destructive food classification. For this purpose 202 clarified monovarietal juices extracted from apples differing in their botanical and geographical origin were used for evaluation of the performance of APCI-MS as a classification tool. For an independent test set PLS-DA analyses of pre-treated spectral data gave 100% and 94.2% correct classification rate for the classification by cultivar and geographical origin, respectively. Moreover, PLS-DA analysis of APCI-MS in conjunction with GC-MS data revealed that masses within the spectral ACPI-MS data set were related with parent ions or fragments of alkyesters, carbonyl compounds (hexanal, trans-2-hexenal) and alcohols (1-hexanol, 1-butanol, cis-3-hexenol) and had significant discriminating power both in terms of cultivar and geographical origin.

Improving the accuracy and efficiency of respiratory rate measurements in children using mobile devices.

The recommended method for measuring respiratory rate (RR) is counting breaths for 60 s using a timer. This method is not efficient in a busy clinical setting. There is an urgent need for a robust, low-cost method that can help front-line health care workers to measure RR quickly and accurately. Our aim was to develop a more efficient RR assessment method. RR was estimated by measuring the median time interval between breaths obtained from tapping on the touch screen of a mobile device. The estimation was continuously validated by measuring consistency (% deviation from the median) of each interval. Data from 30 subjects estimating RR from 10 standard videos with a mobile phone application were collected. A sensitivity analysis and an optimization experiment were performed to verify that a RR could be obtained in less than 60 s; that the accuracy improves when more taps are included into the calculation; and that accuracy improves when inconsistent taps are excluded. The sensitivity analysis showed that excluding inconsistent tapping and increasing the number of tap intervals improved the RR estimation. Efficiency (time to complete measurement) was significantly improved compared to traditional methods that require counting for 60 s. There was a trade-off between accuracy and efficiency. The most balanced optimization result provided a mean efficiency of 9.9 s and a normalized root mean square error of 5.6%, corresponding to 2.2 breaths/min at a respiratory rate of 40 breaths/min. The obtained 6-fold increase in mean efficiency combined with a clinically acceptable error makes this approach a viable solution for further clinical testing. The sensitivity analysis illustrating the trade-off between accuracy and efficiency will be a useful tool to define a target product profile for any novel RR estimation device.

Pediatric surgical camps as one model of global surgical partnership: a way forward.

BACKGROUND/PURPOSE: A uniquely Ugandan method of holding surgical "camps" has been one means to deal with the volume of patients needing surgery and provides opportunities for global partnership. METHODS: We describe an evolved partnership between pediatric surgeons in Uganda and Canada wherein Pediatric Surgical Camps were organized by the Ugandans with team participation from Canadians. The camp goals were to provide pediatric surgical and anesthetic service and education and to foster collaboration as a way forward to assist Ugandan health delivery. RESULTS: Three camps were held in Uganda in 2008, 2011, and 2013. A total of 677 children were served through a range of operations from hernia repair to more complex surgery. The educational mandate was achieved through the involvement of 10 Canadian trainees, 20 Ugandan trainees in surgery and anesthesia, and numerous medical students. Formal educational sessions were held. The collaborative mandate was manifest in relationship building, an understanding of Ugandan health care, research projects completed, agreement on future camps, and a proposal for a Canadian-Ugandan pediatric surgery teaching alliance. CONCLUSION: Pediatric Surgical Camps founded on global partnerships with goals of service, education, and collaboration can be one way forward to improve pediatric surgery access and expertise globally.

Ultra-low-cost clinical pulse oximetry.

An ultra-low-cost pulse oximeter is presented that interfaces a conventional clinical finger sensor with a mobile phone through the headset jack audio interface. All signal processing is performed using the audio subsystem of the phone. In a preliminary volunteer study in a hypoxia chamber, we compared the oxygen saturation obtained with the audio pulse oximeter against a commercially available (and FDA approved) reference pulse oximeter (Nonin Xpod). Good agreement was found between the outputs of the two devices.