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Summary: Background: While many patients seem to recover from SARS-CoV-2 infections, many patients report experiencing SARS-CoV-2 symptoms for weeks or months after their acute COVID-19 ends, even developing new symptoms weeks after infection. These long-term effects are called post-acute sequelae of SARS-CoV-2 (PASC) or, more commonly, Long COVID. The overall prevalence of Long COVID is currently unknown, and tools are needed to help identify patients at risk for developing long COVID. Methods: A working group of the Rapid Acceleration of Diagnostics-radical (RADx-rad) program, comprised of individuals from various NIH institutes and centers, in collaboration with REsearching COVID to Enhance Recovery (RECOVER) developed and organized the Long COVID Computational Challenge (L3C), a community challenge aimed at incentivizing the broader scientific community to develop interpretable and accurate methods for identifying patients at risk of developing Long COVID. From August 2022 to December 2022, participants developed Long COVID risk prediction algorithms using the National COVID Cohort Collaborative (N3C) data enclave, a harmonized data repository from over 75 healthcare institutions from across the United States (U.S.). Findings: Over the course of the challenge, 74 teams designed and built 35 Long COVID prediction models using the N3C data enclave. The top 10 teams all scored above a 0.80 Area Under the Receiver Operator Curve (AUROC) with the highest scoring model achieving a mean AUROC of 0.895. Included in the top submission was a visualization dashboard that built timelines for each patient, updating the risk of a patient developing Long COVID in response to clinical events. Interpretation: As a result of L3C, federal reviewers identified multiple machine learning models that can be used to identify patients at risk for developing Long COVID. Many of the teams used approaches in their submissions which can be applied to future clinical prediction questions. Funding: Research reported in this RADx® Rad publication was supported by the National Institutes of Health. Timothy Bergquist, Johanna Loomba, and Emily Pfaff were supported by Axle Subcontract: NCATS-STSS-P00438.

Abstract Background Family physicians (FPs) fill an essential role in public health emergencies yet have frequently been neglected in pandemic response plans. This exclusion harms FPs in their clinical roles and has unintended consequences in the management of concurrent personal responsibilities, many of which were amplified by the pandemic. The objective of our study was to explore the experiences of FPs during the first year of the COVID-19 pandemic to better understand how they managed their competing professional and personal priorities. Methods We conducted semi-structured interviews with FPs from four Canadian regions between October 2020 and June 2021. Employing a maximum variation sampling approach, we recruited participants until we achieved saturation. Interviews explored FPs’ personal and professional roles and responsibilities during the pandemic, the facilitators and barriers that they encountered, and any gender-related experiences. Transcribed interviews were thematically analysed. Results We interviewed 68 FPs during the pandemic and identified four overarching themes in participants’ discussion of their personal experiences: personal caregiving responsibilities, COVID-19 risk navigation to protect family members, personal health concerns, and available and desired personal supports for FPs to manage their competing responsibilities. While FPs expressed a variety of ways in which their personal experiences made their professional responsibilities more complicated, rarely did that affect the extent to which they participated in the pandemic response. Conclusions For FPs to contribute fully to a pandemic response, they must be factored into pandemic plans. Failure to appreciate their unique role and circumstances often leaves FPs feeling unsupported in both their professional and personal lives. Comprehensive planning in anticipation of future pandemics must consider FPs’ varied responsibilities, health concerns, and necessary precautions. Having adequate personal and practice supports in place will facilitate the essential role of FPs in responding to a pandemic crisis while continuing to support their patients’ primary care needs.

Introducción: La pitahaya es un fruto con gran potencial para el desarrollo de productos alimenticios funcionales e innovadores. Uno de los principales retos es producir una pulpa estable y con una viscosidad que facilite su manejo durante el procesamiento. Objetivo: Evaluar condiciones de maceración enzimática que permitan mejorar las propiedades reológicas de la pulpa de pitahaya al reducir su viscosidad, con la menor afectación posible de las betacianinas y el color. Metodología: Evaluamos las condiciones del tratamiento enzimático midiendo el cambio de la viscosidad de la pulpa de pitahaya, la concentración de betacianinas y el color instrumental mediante un diseño central compuesto rotable, considerando dos factores: concentración de enzima (Rapidase fiber de DSM) y tiempo de maceración. Para los puntos de diseño, la concentración de enzima estuvo entre 109,8 g/ton y 640,2g/ton y el tiempo entre 1,0h y 3,5h; para los puntos axiales, el nivel mínimo de concentración de la enzima fue de 0g/ton y el máximo de 750g/ton y con respecto al tiempo, el mínimo fue de 0,5h y el máximo de 4,0h, siendo el punto central de 375g/ton de enzima y 2,3h de maceración. Resultados: El tratamiento enzimático evaluado permitió una reducción significativa de la viscosidad de la pulpa con una baja afectación sobre las betacianinas (92% de retención promedio), mientras que los cambios en los parámetros de color instrumental que no se consideran negativos. Conclusión: El tratamiento enzimático permite la reducción de viscosidad de la pulpa de pitahaya con poca afectación en compuestos y características de importancia en este producto. Esto tiene potencial aplicación industrial para el manejo y estabilización de una pulpa, que puede utilizarse en la elaboración de diversos productos alimenticios, permitiendo la valorización y aprovechamiento de la fruta.

Introduction: Throughout the COVID-19 pandemic, primary care nurses were often redeployed to areas outside of primary care to mitigate staffing shortages. Despite this, there is a scarcity of literature describing their perceptions of and experiences with redeployment during the pandemic. Objectives: This paper aims to: 1) describe the perspectives of primary care nurses with respect to redeployment, 2) discuss the opportunities/challenges associated with redeployment of primary care nurses, and 3) examine the nature (e.g., settings, activities) of redeployment by primary care nurses during the COVID-19 pandemic. Methods: In this qualitative study, semi-structured interviews were conducted with primary care nurses (i.e., Nurse Practitioners, Registered Nurses, and Licensed/Registered Practical Nurses), from four regions in Canada. These include the Interior, Island, and Vancouver Coastal Health regions in British Columbia; Ontario Health West region in Ontario; the province of Nova Scotia; and the province of Newfoundland and Labrador. Data related to redeployment were analyzed thematically. Results: Three overarching themes related to redeployment during the COVID-19 pandemic were identified: (1) Call to redeployment, (2) Redeployment as an opportunity/challenge, and (3) Scope of practice during redeployment. Primary care nurses across all regulatory designations reported variation in the process of redeployment within their jurisdiction (e.g., communication, policies/legislation), different opportunities and challenges that resulted from redeployment (e.g., scheduling flexibility, workload implications), and scope of practice implications (e.g., perceived threat to nursing license). The majority of nurses discussed experiences with redeployment being voluntary in nature, rather than mandated. Conclusions: Redeployment is a useful workforce strategy during public health emergencies; however, it requires a structured process and a decision-making approach that explicitly involves healthcare providers affected by redeployment. Primary care nurses ought only to be redeployed after other options are considered and arrangements made for the care of patients in their original practice area.

IntroductionEarly in the COVID-19 pandemic, Canadian primary care practices rapidly adapted to provide care virtually. Most family physicians lacked prior training or expertise with virtual care. In the absence of formal guidance, they made individual decisions about in-person versus remote care based on clinical judgement, their longitudinal relationships with patients, and personal risk assessments. Our objective was to explore Canadian family physicians' perspectives on the strengths and limitations of virtual care implementation for their patient populations during the COVID-19 pandemic and implications for the integration of virtual care into broader primary care practice.MethodsWe conducted semi-structured qualitative interviews with family physicians working in four Canadian jurisdictions (Vancouver Coastal health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region, Newfoundland and Labrador). We analyzed interview data using a structured applied thematic approach.ResultsWe interviewed 68 family physicians and identified four distinct themes during our analysis related to experiences with and perspectives on virtual care: (1) changes in access to primary care; (2) quality and efficacy of care provided virtually; (3) patient and provider comfort with virtual modalities; and (4) necessary supports for virtual care moving forward.ConclusionsThe move to virtual care enhanced access to care for select patients and was helpful for family physicians to better manage their panels. However, virtual care also created access challenges for some patients (e.g., people who are underhoused or living in areas without good phone or internet access) and for some types of care (e.g., care that required access to medical devices). Family physicians are optimistic about the ongoing integration of virtual care into broader primary care delivery, but guidance, regulations, and infrastructure investments are needed to ensure equitable access and to maximize quality of care.

Background: Prior to the COVID-19 pandemic, Canada had longer wait-times for specialist appointments compared to other Commonwealth countries. During the pandemic, many specialist services were postponed or suspended, impacting access. The purpose of this study was to explore family physicians’ perspectives on specialist care availability during the pandemic and implications for family physician workload and patient management. These experiences can inform future pandemic plans. Methods: Using semi-structured interviews, we explored family physicians’ experiences during COVID-19 across regions within four Canadian provinces (British Columbia, Ontario, Nova Scotia, Newfoundland and Labrador). Thematic and framework analyses were used to identify themes from the interviews. Results: We interviewed 68 family physicians between October 2020 and June 2021. Of these 68 participants, 27 discussed their interactions with specialists during the pandemic. We identified themes around access to, and collaboration with, specialists. At times, specialists were less available for patient care and family physician consultations, and communications were uncoordinated across the system. Family physicians took on additional work to address the lack of access and identified pandemic planning challenges. Participants offered recommendations for improving collaboration and access post-pandemic. Interpretation: The COVID-19 pandemic exacerbated existing challenges in the Canadian healthcare system pertaining to specialist access. Pandemic plans should reflect the importance of specialist consultations. Decision-makers should consider innovations to facilitate collaboration between family physicians and specialists.

Abstract Background Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians’ perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. Methods We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. Results We identified three prominent themes throughout participants’ reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. Conclusion Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.

Introduction Individuals with asthma breathe at higher operating lung volumes during exercise compared with healthy individuals, which contributes to increased exertional dyspnoea. In health, females are more likely to develop exertional dyspnoea than males at a given workload or ventilation, and therefore, it is possible that females with asthma may develop disproportional dyspnoea on exertion. The purpose of this study was to compare operating lung volume and dyspnoea responses during exercise in females with and without asthma.Methods Sixteen female controls and 16 females with asthma were recruited for the study along with 16 male controls and 16 males with asthma as a comparison group. Asthma was confirmed using American Thoracic Society criteria. Participants completed a cycle ergometry cardiopulmonary exercise test to volitional exhaustion. Inspiratory capacity manoeuvres were performed to estimate inspiratory reserve volume (IRV) and dyspnoea was evaluated using the Modified Borg Scale.Results Females with asthma exhibited elevated dyspnoea during submaximal exercise compared with female controls (p

Introducción: El consumo de tomate fresco ha ido en aumento a través de los años y los sistemas de cultivo (convencional o hidropónico), las prácticas de cosecha y poscosecha, el agua de riego y los contenedores pueden incidir sobre su calidad microbiológica. Objetivo: Comparar la calidad microbiológica de la fruta cultivada o cosechada, del agua de riego y de los contenedores de cosecha en dos fincas de producción de tomate (convencional e hidropónica). Métodos: Realizamos tres muestreos a cada finca (repeticiones), tomando, en cada repetición, 3 tomates de cada tipo que conformaron una muestra compuesta, 50 ml de agua de riego e hisopando 50cm2 de la superficie de tres contenedores de cosecha (muestra compuesta). Determinamos los indicadores microbiológicos de recuento total aerobio mesófilo, recuento de hongos filamentosos y levaduras, coliformes totales, coliformes termotolerantes y E. coli. Además, analizamos la presencia de Listeria monocytogenes en los frutos. Aplicamos pruebas de t-student a un nivel de significancia del 5%. Resultados: Los recuentos total aerobio mesófilo y hongos filamentosos y levaduras del tomate hidropónico fueron significativamente menores que en el tomate convencional, mientras que no hubo diferencia en los recuentos de coliformes totales y E. coli, además L. monocytogenes estuvo ausente en todas las muestras. El recuento total aerobio mesófilo fue mayor en los contenedores de cosecha de la finca convencional. En ambas fincas el agua de riego no se consideró fuente de contaminación pues tuvo niveles muy bajos de coliformes totales, coliformes termotolerantes y E. coli. Finalmente, se presume un control adecuado en las fincas durante la cosecha, al no haber encontrado diferencia en los indicadores microbiológicos entre el tomate cultivado y el cosechado. Conclusión: Los tomates hidropónicos presentan mayor probabilidad de tener un mejor perfil microbiológico y mayor vida útil en comparación con los tomates cultivados de forma convencional, evidenciando la importancia del control ambiental y la limpieza y desinfección de todos los insumos utilizados en los procesos de cultivo, cosecha y poscosecha.

IntroductionProviding family physicians (FPs) with the information they need is crucial for their participation in a coordinated pandemic or health emergency response, and to allow them to effectively run their practices. Most pandemic planning documents do not address communication plans specific to FPs. This study describes FPs' experiences and challenges with information management during the COVID-19 pandemic in Canada.MethodsWe conducted semi-structured qualitative interviews with FPs across four Canadian regions and asked about their roles during different pandemic stages, as well as facilitators and barriers they experienced in performing these roles. We transcribed the interviews, used a thematic analysis approach to develop a unified coding template across the four regions, and identified recurring themes.ResultsWe interviewed 68 FPs and identified two key themes specifically related to communication. The first is FPs' experiences obtaining and managing information during the COVID-19 pandemic. FPs were overwhelmed by the volume of information and had difficulty applying the information to their practices. The second is the specific attributes FPs need from the information sent to them. Participants wanted summarized and consistent information from credible sources that are relevant to primary care.DiscussionProviding clear, collated, and relevant information to FPs is essential during pandemics and other health emergencies. Future pandemic plans should integrate strategies to deliver information to FPs that is tailored to primary care. Findings highlight the need for a coordinated communication strategy to effectively inform FPs in health emergencies.

Context: The COVID-19 pandemic disproportionally affected long-term care (LTC) homes and other community-based congregate residential care settings. Although family physicians (FPs) play important roles in the care of residents in LTC homes, provincial pandemic plans make few references to their specific roles in LTC. Objective: To examine the experiences of FPs providing care in LTC homes and other congregate care settings in Canada during the first year of the COVID-19 pandemic (2020–2021). Methods: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four Canadian regions. Interviews were transcribed, and a thematic analysis approach was employed. Findings: Twenty-one of the 68 FPs interviewed discussed providing care in congregate residential settings, including LTC. We identified three major themes: 1) the roles of FPs in community-based congregate residential care settings during a pandemic, 2) modification of the delivery of routine care, and 3) special workforce considerations in pandemic response for community-based congregate residential care settings. Limitations: We interviewed FPs in four Canadian jurisdictions between October 2020 and June 2021; findings may not be generalisable to later pandemic stages or to other provinces. Our recruitment strategy did not specifically target FPs who worked in different types of congregate residential care facilities; further research is needed to examine these settings in greater depth. Implications: FPs have a unique understanding of the populations they serve and are well suited to plan and implement community-adaptive procedures. Future pandemic plans should implement LTC-related FP roles during the pre-pandemic stage of a pandemic response.

Abstract Background Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians’ (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. Methods As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. Results A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. Conclusions During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic.

Introducción: El huevo, uno de los principales alimentos que aporta nutrientes a la población mundial, pierde su calidad de forma acelerada en estado fresco. Para la industria del huevo sería beneficioso contar con alternativas tecnológicas que permitan aumentar su vida útil, como la utilización de recubrimientos para prevenir su deterioro. Objetivo: Evaluar el efecto de la aplicación de recubrimientos de aceite sobre la calidad fisicoquímica, microbiológica y sensorial de huevos de gallina en almacenamiento. Métodos: Por inmersión, aplicamos recubrimientos de aceite mineral grado medicinal desodorizado o de oleína de palma y soya con TBHQ 0,02% a huevos de gallina Isa Brown categoría A de un productor local, sin previa limpieza, lavado o desinfección. Luego de dejar escurrir por 6 horas los almacenamos en una cámara a 21°C y 43% HR. Medimos los parámetros de calidad seleccionados cada 7 días por un total de 42 días y comparamos estadísticamente las tendencias en el tiempo para los huevos recubiertos y sin recubrimiento. También realizamos un análisis sensorial mediante comparaciones pareadas para huevo fresco y huevo recubierto almacenado por determinado tiempo y una medición de aceptación general por medio de una escala hedónica a los 35 días de almacenamiento. Resultados: Los recubrimientos evaluados no afectaron el comportamiento normal del color y pH de la yema, las unidades Haugh, la resistencia a la ruptura y los recuentos total aerobio y de mohos y levaduras durante el almacenamiento, al tiempo que retardaron el deterioro relacionado con el índice de yema, el pH de la clara y la pérdida de masa. Además, la aplicación de dichos recubrimientos permite mantener la percepción del sabor del huevo almacenado al compararlo con huevo fresco; provee huevos con el mismo olor y adhesividad que el huevo sin recubrimiento; otorga brillo y no influyen negativamente en su aceptación sensorial externa. Conclusión: La vida útil del huevo durante su almacenamiento puede alargarse con la aplicación de recubrimientos de aceite mineral o de palma.

Introducción. El interés de la población por el consumo de productos frescos como las hortalizas ha ido en aumento a través de los años. Existen diferentes métodos de cultivo para producir hortalizas como zanahoria, tomate y repollo. Los sistemas de cultivo convencional y orgánico son los más comunes. Objetivo. Comparar la microbiología de zanahoria, tomate y repollo, provenientes de fincas con sistemas productivos de agricultura orgánica o convencional en Costa Rica. Materiales y métodos. El trabajo se realizó en Cartago, Heredia y Alajuela, Costa Rica, de setiembre 2020 a noviembre 2021, durante la época lluviosa en todos los casos. Se muestrearon hortalizas de fincas modelo de producción de zanahoria, tomate y repollo, una de producción orgánica y tres de producción convencional. Se determinaron recuentos totales de aerobios mesófilos, coliformes totales, Escherichia coli, mohos y levaduras, y la ausencia/presencia de Listeria monocytogenes. Resultados. Los recuentos totales aerobios, de mohos y levaduras y de coliformes totales de la zanahoria, el repollo y el tomate de cultivo convencional y orgánico no difirieron entre sí. En las hortalizas estudiadas los recuentos de E. coli fueron de

Analyzing the worst-case performance of deep neural networks against input perturbations amounts to solving a large-scale non-convex optimization problem, for which several past works have proposed convex relaxations as a promising alternative. However, even for reasonably-sized neural networks, these relaxations are not tractable, and so must be replaced by even weaker relaxations in practice. In this work, we propose a novel operator splitting method that can directly solve a convex relaxation of the problem to high accuracy, by splitting it into smaller sub-problems that often have analytical solutions. The method is modular, scales to very large problem instances, and compromises of operations that are amenable to fast parallelization with GPU acceleration. We demonstrate our method in bounding the worst-case performance of large convolutional networks in image classification and reinforcement learning settings, and in reachability analysis of neural network dynamical systems.

Premature termination codons can cause early translation termination and lead to disease. Here the authors perform a screen to identify compounds with readthrough activity and show that these reduce eRF1 levels to suppress premature termination associated with cystic fibrosis.

BackgroundChemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited.ObjectivesTo (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use.DesignRetrospective cohort study with a time series analysis.ParticipantsAcute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020.Main measuresWe used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR).Key resultsWe included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (pConclusionsThe COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.

Introducción. El huevo de gallina (Gallus gallus domesticus) es un alimento nutritivo de la dieta de millones de personas. Su producción mundial se obtiene con el empleo de jaulas convencionales, aunque existen sistemas alternativos como el pastoreo. Objetivo. Comparar la calidad microbiológica, fisicoquímica y el sabor de huevos provenientes de granjas con sistemas productivos convencionales o de pastoreo en Costa Rica. Materiales y métodos. El trabajo se realizó en Alajuela, Costa Rica de octubre del 2016 a mayo del 2017. Se muestrearon superficies y huevos de gallinas Isa Brown en granjas con sistemas productivos convencionales o de pastoreo y se determinó el recuento de coliformes totales, Escherichia coli, mohos y levaduras y ausencia/presencia de Salmonella sp. Además, se analizaron parámetros fisicoquímicos (unidades Haugh, índice de yema, pH, color de yema y dureza de cáscara) y se realizó una prueba sensorial de discriminación con consumidores. Resultados. Los sistemas de producción de pastoreo tienen superficies en contacto con los huevos con recuentos de coliformes totales y E. coli significativamente mayores que las superficies del sistema convencional. Los huevos de pastoreo presentaron recuentos de coliformes totales (3,2 log10 UFC huevo-1) significativamente mayores que los huevos convencionales (2,3 log10 UFC huevo-1). Salmonella sp. estuvo presente en 8 % de las muestras de pastoreo (incidencia no diferente de 0) y ausente en las convencionales. Se encontró diferencia en el color de la yema (más oscura en los huevos convencionales). Además, hubo diferencia significativa en el sabor de ambos tipos de huevo. Conclusión. En general, existió diferencia en la calidad microbiológica, fisicoquímica y el sabor de huevos producidos en granja de tipo convencional o pastoreo.

Allogeneic stem cell transplantation (alloSCT) is utilised to cure haematological malignancies through a combination of conditioning regimen intensity and immunological disease control via the graft versus tumour (GVT) effect. Currently, conventional myeloablative chemotherapeutic or chemoradiation conditioning regimens are associated with significant side effects including graft versus host disease (GVHD), infection, and organ toxicity. Conversely, more tolerable reduced intensity conditioning (RIC) regimens are associated with unacceptably higher rates of disease relapse, partly through an excess incidence of mixed chimerism. Improvement in post-alloSCT outcomes therefore depends on promotion of the GVT effect whilst simultaneously reducing conditioning-related toxicity. We have previously shown that this could be achieved through BCL-2 inhibition, and in this study, we explored the modulation of JAK1/2 as a strategy to lower the barrier to donor engraftment in the setting of RIC. We investigated the impact of short-term treatment of BCL2 (venetoclax) or JAK1/2 (ruxolitinib) inhibition on recipient natural killer and T cell immunity and the subsequent effect on donor engraftment. We identified striking differences in mechanism of action of these two drugs on immune cell subsets in the bone marrow of recipients, and in the regulation of MHC class-II and interferon-inducible gene expression, leading to different rates of GVHD. This study demonstrates that the repurposed use of ruxolitinib or venetoclax can be utilised as pre-transplant immune-modulators to promote the efficacy of alloSCT, whilst reducing its toxicity.

Introduction Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians’ roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario.Methods and analysis We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians’ proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses.Ethics and dissemination Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care.

Liver transplant programs in Canada require a period of 6 months of abstinence from alcohol before considering a patient with liver disease secondary to alcohol for transplantation. Although some studies have demonstrated good outcomes following a transplant in carefully selected patients before the 6‐month abstinence period has been met, there have been arguments against this, including the claim that the public has a general negative perception of those with alcohol dependence. We performed a multicenter cross‐sectional survey to determine the perception of people in British Columbia, Canada, toward liver transplantation in patients with liver disease due to alcohol who have not demonstrated the capacity to remain abstinent from alcohol for 6 months. A total of 304 patient questionnaires were completed, and 83.1% agreed with a period of abstinence of 6 months. In those patients who were unlikely to survive 6 months without a transplant, 34.1% of respondents agreed with, 44.1% did not agree with, and 21.4% were neutral about, early transplantation; 42.8% would have less trust in the process of transplantation if a period of abstinence was not maintained, but relaxing the requirement for an abstinence period would not have an impact on the majority's decision to donate organs. Only 30.5% would support abandoning the abstinence criteria. Conclusion: Among patients followed at general gastroenterology, medicine, or transplant clinics, there is a willingness to relax the criteria in selected patients unlikely to survive without a transplant, although a general consensus remains in support of the existing 6‐month alcohol abstinence rule. A larger scale survey of all provinces in Canada would be required to assess support for such a change in policy.

Type I interferons (IFN-I) are antiviral cytokines that signal through the ubiquitous IFN-I receptor (IFNAR). Following footpad infection with ectromelia virus (ECTV), a mouse-specific pathogen, C57BL/6 (B6) mice survive without disease, while B6 mice broadly deficient in IFNAR succumb rapidly. We now show that for survival to ECTV, only hematopoietic cells require IFNAR expression. Survival to ECTV specifically requires IFNAR in both natural killer (NK) cells and monocytes. However, intrinsic IFNAR signaling is not essential for adaptive immune cell responses or to directly protect non-hematopoietic cells such as hepatocytes, which are principal ECTV targets. Mechanistically, IFNAR-deficient NK cells have reduced cytolytic function, while lack of IFNAR in monocytes dampens IFN-I production and hastens virus dissemination. Thus, during a pathogenic viral infection, IFN-I coordinates innate immunity by stimulating monocytes in a positive feedback loop and by inducing NK cell cytolytic function.

Mutations in the CBL gene were first identified in adults with various myeloid malignancies. Some patients with juvenile myelomonocytic leukemia (JMML) were also noted to harbor mutations in CBL, but were found to have generally less aggressive disease courses compared to patients with other forms of Ras pathway-mutant JMML. Importantly, and in contrast to most reports in adults, the majority of CBL mutations in JMML patients are germline with acquired uniparental disomy occurring in affected marrow cells. Here, we systematically studied a large cohort of 33 JMML patients with CBL mutations and found that this disease is highly diverse in presentation and overall outcome. Moreover, we discovered somatically acquired CBL mutations in 15% of pediatric patients who presented with more aggressive disease. Neither clinical features nor methylation profiling were able to distinguish patients with somatic CBL mutations from those with germline CBL mutations, highlighting the need for germline testing. Overall, we demonstrate that disease courses are quite heterogeneous even among patients with germline CBL mutations. Prospective clinical trials are warranted to find ideal treatment strategies for this diverse cohort of patients.

PurposeChronic heart failure (CHF) is characterized by heightened sympathetic nervous activity, carotid chemoreceptor (CC) sensitivity, marked exercise intolerance and an exaggerated ventilatory response to exercise. The purpose of this study was to determine the effect of CC inhibition on exercise cardiovascular and ventilatory function, and exercise tolerance in health and CHF.MethodsTwelve clinically stable, optimally treated patients with CHF (mean ejection fraction: 43 ± 2.5%) and 12 age- and sex-matched healthy controls were recruited. Participants completed two time-to-symptom-limitation (TLIM) constant load cycling exercise tests at 75% peak power output with either intravenous saline or low-dose dopamine (2 μg⋅kg–1⋅min–1; order randomized). Ventilation was measured using expired gas data and operating lung volume data were determined during exercise by inspiratory capacity maneuvers. Cardiac output was estimated using impedance cardiography, and vascular conductance was calculated as cardiac output/mean arterial pressure.ResultsThere was no change in TLIM in either group with dopamine (CHF: saline 13.1 ± 2.4 vs. dopamine 13.5 ± 1.6 min, p = 0.78; Control: saline 10.3 ± 1.2 vs. dopamine 11.5 ± 1.3 min, p = 0.16). In CHF patients, dopamine increased cardiac output (p = 0.03), vascular conductance (p = 0.01) and oxygen delivery (p = 0.04) at TLIM, while ventilatory parameters were unaffected (p = 0.76). In controls, dopamine improved vascular conductance at TLIM (p = 0.03), but no other effects were observed.ConclusionOur findings suggest that the CC contributes to cardiovascular regulation during full-body exercise in patients with CHF, however, CC inhibition does not improve exercise tolerance.

Summary: During disseminating viral infections, a swift innate immune response (IIR) in the draining lymph node (dLN) that restricts systemic viral spread is critical for optimal resistance to disease. However, it is unclear how this IIR is orchestrated. We show that after footpad infection of mice with ectromelia virus, dendritic cells (DCs) highly expressing major histocompatibility complex class II (MHC class IIhi DCs), including CD207+ epidermal Langerhans cells (LCs), CD103+CD207+ double-positive dermal DCs (DP-DCs), and CD103−CD207− double-negative dermal DCs (DN-DCs) migrate to the dLN from the skin carrying virus. MHC class IIhi DCs, predominantly LCs and DP-DCs, are the first cells upregulating IIR cytokines in the dLN. Preventing MHC class IIhi DC migration or depletion of LCs, but not DP-DC deficiency, suppresses the IIR in the dLN and results in high viral lethality. Therefore, LCs are the architects of an early IIR in the dLN that is critical for optimal resistance to a disseminating viral infection. : Wong et al. show that by producing chemokines that recruit monocytes and by upregulating NKG2D ligands that activate ILCs, Langerhans cells are responsible for the innate immune cascade in the lymph node that is critical for survival of infection with a disseminating virus. Keywords: virus infection, ectromelia virus, dendritic cells, skin, Langerhans cells, lymph node, inflammatory monocytes, natural killer cells

Summary: Circulating natural killer (NK) cells help protect the host from lympho-hematogenous acute viral diseases by rapidly entering draining lymph nodes (dLNs) to curb virus dissemination. Here, we identify a highly choreographed mechanism underlying this process. Using footpad infection with ectromelia virus, a pathogenic DNA virus of mice, we show that TLR9/MyD88 sensing induces NKG2D ligands in virus-infected, skin-derived migratory dendritic cells (mDCs) to induce production of IFN-γ by classical NK cells and other types of group 1 innate lymphoid cells (ILCs) already in dLNs, via NKG2D. Uninfected inflammatory monocytes, also recruited to dLNs by mDCs in a TLR9/MyD88-dependent manner, respond to IFN-γ by secreting CXCL9 for optimal CXCR3-dependent recruitment of circulating NK cells. This work unveils a TLR9/MyD88-dependent mechanism whereby in dLNs, three cell types—mDCs, group 1 ILCs (mostly NK cells), and inflammatory monocytes—coordinate the recruitment of protective circulating NK cells to dLNs. : Wong et al. show that infected migratory dendritic cells (mDCs) in draining lymph nodes (dLNs) upregulate NKG2D ligands through TLR9/MyD88. This results in NKG2D-dependent IFN-γ production by group 1 innate lymphoid cells, mostly NK cells. IFN-γ induces CXCL9 in uninfected inflammatory monocytes, leading to the recruitment of protective NK cells to dLNs. Keywords: viral infection, mouse, poxvirus, ectromelia virus, NK cells, dendritic cells, monocytes, dendritic cells, innate lymphoid cells, interferon

Abstract Background To explore the determinants of job satisfaction and work-life balance satisfaction of family physicians in Canada. Methods This is a secondary analysis of the Canadian 2013 National Physician’s Survey using descriptive statistics and binomial logistic regression. An estimated 34,753 family physicians practicing in Canada at the time of survey administration in 2013 were eligible for the survey. The main outcome measures were respondent satisfaction with professional life and satisfaction with work-life balance. Results The survey had a response rate of 17%. Seventy-two percent of respondents were satisfied with their professional lives, and 49% were satisfied with their work-life balance. Male family physicians had lower odds of satisfaction with their work-life balance than their female counterparts (OR = 0.86, 95% CI 0.82–0.92). Family physicians using an electronic medical record had higher odds of dissatisfaction with their professional lives (OR = 1.13, 95% CI 1.05–1.22) and work-life balance (OR = 1.22, 95% CI 1.15–1.30) than those not using an EMR. Family physicians not in a focused practice had greater odds of dissatisfaction (OR = 1.61, 95% CI 1.50–1.72) with both their professional lives and work-life balance (OR = 1.29, 95% CI 1.22–1.37) compared to their colleagues who have one or more areas of clinical focus. Conclusions Canadian family physicians are more satisfied with their professional lives than with their work-life balance. Novel findings that family physicians with one or more clinical areas of focus are more satisfied with their work and work-life balance satisfaction, and that family physicians using electronic health records are less satisfied with their work and their work-life balance merit further inquiry.

Abstract: Natural killer (NKs) cells provide rapid responses to viral-infected and malignant cells, including acute myeloid leukemia (AML) blasts. The balance among inhibitory and activating signals, delivered by multiple interactions between ligands on target cells and NK receptors, determines the posture of the NK cell response to either one of target cell elimination or tolerance. The aim of this work was to study the influence of the differential expression of activating and inhibitory NK receptor ligands (NKRLs) by leukemic blasts on clinical outcome in newly diagnosed AML patients. Leukemic cells and clinical data from 66 patients undergoing induction chemotherapy were obtained from the Australasian Leukemia Lymphoma Group tissue bank. Expression of 6 activating (MICA, MICAB, CD155, CD112, ULBP1, and ULBP2/5/6) and 3 inhibitory (HLA class I, PD-L1, and PD-L2) NKRLs was analyzed by flow cytometry. AML blasts displayed heterogeneous expression of NKRLs. MICA, CD112, and ULBP1 were most frequently expressed. ULBP1 expression was significantly associated with improved 2-year overall survival (51.4% vs 11.4%), relapse-free survival (42.5% vs 10.0%), and reduced relapse (44.1% vs 78.6%). We calculated a net score of activating minus inhibitory ligands and demonstrated that the expression of an overall activating NK ligand phenotype was associated with superior 2-year overall survival (59.6% vs 24.4%) and reduced relapse (31.5% vs 68.2%). Our study provides clinical evidence for the role of NK cell–mediated immunoediting against AML, mediated by the expression of NKRLs on blasts, and supports investigation into strategies to enhance NK cell function to improve outcomes in patients with AML.

The development of both a T- and B-cell lymphoproliferative disorder in one patient is an unlikely coincidence due to the low prevalence of each malignancy. We report a 65-year-old man with a previously documented history of B hairy cell leukemia, who presented with a new-onset acneiform eruption of his scalp, face, trunk, back, and extremities. Routine pathology of the skin lesions with immunohistochemical stains and molecular studies were consistent with a folliculotropic mycosis fungoides. B hairy cell leukemia and mycosis fungoides occurring in the same patient seems to be a rare phenomenon with only 5 cases reported in the literature.

Background: Current theory in medical education emphasizes engaging learners as educators while tailoring teaching to their learning needs. However, little is known about learners’ perceptions of their proposed roles as teachers and educators. Methods: Canadian medical students were invited to complete an English language online questionnaire structured to include: teaching experience, participation and/or awareness of teacher development at their school and awareness and/or interest in further training in medical education. The survey was developed by the Canadian Association for Medical Education (CAME) Membership Subcommittee, and distributed via the Canadian Federation of Medical Students (CFMS) email list and the CAME twitter account in March 2014. Results: Of the 169 undergraduate medical student respondents, 36% (n=61) reported a lack of prior teaching experience and 45% (n=73) were unsure if their school provided teaching instruction. Overall, 91% (n=150) indicated that they planned to incorporate teaching or medical education into their future careers. Conclusion: While the majority of medical student respondents are expecting or planning to teach, most report not having access to adequate training through medical school. Further effort is necessary to support medical students as teachers to prepare them for increased teaching responsibilities as residents and to expose them to potential careers in medical education.

When dosed appropriately on carefully chosen patients, methadone can be a very safe and effective choice in managing chronic pain. Many authors have discussed important issues surrounding patient selection, drug interactions, screening for QTc prolongation and monitoring. This article will focus on the dosing dilemma that exists after the patient is deemed an appropriate candidate for methadone and a conversion is necessary from another opioid. Despite many publications dedicated to addressing this challenging topic, there is no consensus on the most appropriate method for converting an opioid regimen to methadone. Given the lack of concrete guidance, clinicians in a community setting are likely to be faced with an increased challenge if there are no available pain specialists to provide clinical support. Common methods for converting morphine to methadone will be reviewed and two clinical patient scenarios used to illustrate the outcomes of applying the methods.

BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent disorder that is associated with significant patient morbidity and societal burden. In general, wait times for health care in Ontario are believed to be lengthy; however, many diseases lack specific corroborative wait time data.

BACKGROUND: It is postulated that children with asthma who receive an interactive, comprehensive education program would improve their quality of life, asthma management and asthma control compared with children receiving usual care.

StarD4 protein is a member of the StarD4 subfamily of steroidogenic acute regulatory-related lipid transfer (START) domain proteins that includes StarD5 and StarD6, proteins whose functions remain poorly defined. The objective of this study was to isolate and characterize StarD4's sterol binding and to determine in a hepatocyte culture model its sterol transport capabilities. Utilizing purified full-length StarD4, in vitro binding assays demonstrated a concentration-dependent binding of [14C]cholesterol by StarD4 similar to that of the cholesterol binding START domain proteins StarD1 and StarD5. Other tested sterols showed no detectable binding to StarD4, except for 7α-hydroxycholesterol, for which StarD4 demonstrated weak binding on lipid protein overlay assays. Subsequently, an isolated mouse hepatocyte model was used to study the ability of StarD4 to bind/mobilize/distribute cellular cholesterol. Increased expression of StarD4 in primary mouse hepatocytes led to a marked increase in the intracellular cholesteryl ester concentration and in the rates of bile acid synthesis. The ability and specificity of StarD4 to bind cholesterol and, as a function of its level of expression, to direct endogenous cellular cholesterol suggest that StarD4 plays an important role as a directional cholesterol transporter in the maintenance of cellular cholesterol homeostasis.

To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.

Although severe acute respiratory syndrome (SARS) is highly infectious in clinical settings, SARS has not been well examined in household settings. The household and household member attack rates were calculated for 1,214 SARS case-patients and their household members, stratified by two phases of the epidemic. A case-control analysis identified risk factors for secondary infection. Secondary infection occurred in 14.9% (22.1% versus 11% in earlier and later phases) of all households and 8% (11.7% versus 5.9% in the earlier and later phases) of all household members. Healthcare workers’ households were less likely to be affected. Risk factors from the multivariate analysis included at-home duration before hospitalization, hospital visitation to the SARS patient (and mask use during the visit), and frequency of close contact. SARS transmission at the household level was not negligible in Hong Kong. Transmission rates may be greatly reduced with precautionary measures taken by household members of SARS patients.

Despite infection control measures, breakthrough transmission of severe acute respiratory syndrome (SARS) occurred for many hospital workers in Hong Kong. We conducted a case-control study of 72 hospital workers with SARS and 144 matched controls. Inconsistent use of goggles, gowns, gloves, and caps was associated with a higher risk for SARS infection (unadjusted odds ratio 2.42 to 20.54, p < 0.05). The likelihood of SARS infection was strongly associated with the amount of personal protection equipment perceived to be inadequate, having

Para evaluar el efecto de cultivos probióticos sobre Listeria monocytogenes durante la producción y almacenamiento de yogur se preparó una mezcla para yogur (10.6% de sólidos líquidos no grasos (SLNG), 3% de grasa y 0.3% de gelatina); la cual se homogeneizó y pasteurizó. El yogur se inoculó con cantidades de 0, 10², 10(4) y 10(6) UFC/ml de L. monocytogenes y con 0.02% de cultivo láctico tradicional YC 180 (Streptococcus thermophilus y Lactobacillus bulgaricus) y de cultivo probiótico ABY-1(Bifidobacterium longum, B. bifidum, B, infantis, Lactobacillus acidophilus, Streptococcus thermophilus y Lactobacillus delbrueckii subsp. Bulgaricus). La mezcla de yogur se incubó a 43°C por 3 horas, hasta un pH de 4.8 aproximadamente, seguido por refrigeración a 5°C durante 21 días. Durante la fermentación se tomaron muestras cada hora y durante el almacenamiento cada 3 días, determinándose, para cada tiempo, pH, conteo de bacterias lácticas, bifidobacterias y del patógeno. Se demostró que no hubo un efecto simple significativo para el tipo de cultivo (ABY-1 y YC180) (p=0.684) sobre la cantidad de L. monocytogenes presente en el yogur durante el periodo de fermentación y su almacenamiento, por lo que se puede decir que la presencia de bifidobacterias en el cultivo ABY-1 no presentó un efecto significativo sobre L. monocytogenes. Por su parte, el efecto de la variable tiempo sobre la Listeria monocytogenes no resultó ser significativo (p= 0.448). Se puede afirmar que para este caso en particular, los cultivos ABY-1 y YC 180 mostraron un efecto bacteriostático sobre el desarrollo del patógeno. Esto no tiene ninguna relación con el efecto protector que estos cultivos tienen a nivel intestinal ya que las condiciones in vivo favorecen la producción de antimicrobianos como ciertas bacteriocinas que actúan sobre los patógenos.Evaluation of the effect of probiotic cultures over Listeria monocytogenes during the production and storage of yogurt. The effect of probiotic cultures over Listeria monocytogenes during the production and storage of yogurt was evaluated. A yogurt mixture (10,6% non-fat solid liquids, 3% fat and 0,3% gelatin) was prepared, homogenized and pasteurized. Yogurt was inoculated with 0, 10², 10(4) and 10(6) CFU/mL of L. monocytogenes and 0,02% of traditional lactic culture YC 180 (Streptococcus thermophilus and Lactobacillus bulgaricus) and probiotic culture ABY-1 (Bifidobacterium longum, B. bifidum, B, infantis, Lactobacillus acidophilus, Streptococcus thermophilus y Lactobacillus delbrueckii subsp. bulgaricus). It was incubated for 3h at 43ºC until pH reached an approximate value of 4,8, followed by refrigeration at 5ºC for 21 days. During fermentation, samples were taken every hour, and during storage every 3 days, analyzing pH and lactic, bifidobacteria and pathogen count for each time. It was demonstrated that there was no significant simple effect for the type of culture used (ABY-1 and YC 180) (p=0,684) over the amount of L. monocytogenes present in yogurt during the fermentation and storage periods. The presence of bifidobacteria in the ABY-1 culture did not present a significant effect over L. monocytogenes. Neither the effect of time presented a significant effect over L. monocytogenes (p=0,448). In this case, the ABY-1 and YC 180 cultures present a bacteriostatic effect over the pathogen. The probiotic cultures had a bacteriostatic but not bactericidal effect over L. monocytogenes. This is not related to the protective effect of these cultures in bowel, since in-vivo conditions favor the production of antimicrobial substances, such as bacteriocins that act over pathogens.

BACKGROUND: Assessment of health-related quality of life (HRQL) of patients with chronic lung disease has become an important aspect of many clinical investigations. The authors examined the measurement properties of a disease-specific HRQL questionnaire, the Chronic Respiratory Questionnaire (CRQ), when used by independent investigators in clinical trials and observational studies.

Chronic obstructive pulmonary disease (COPD) is associated with primary respiratory impairment, disability and handicap, as well as with secondary impairments not necessarily confined to the respiratory system. Because the primary goals of managing patients with COPD include relief of dyspnea and the improvement of health-related quality of life (HRQL), a direct measurement of HRQL is important. Fourteen disease-specific and nine generic questionnaires (four health profiles and five utility measures) most commonly used to measure health status in patients with COPD were reviewed. The measures were classified according to their domain of interest, and their measurement properties - specifications, validity, reliability, responsiveness and interpretability - were described. This review suggests several findings. Currently used health status instruments usually refer to the patients’ perception of performance in three major domains of HRQL - somatic sensation, physical and occupational function, and psychological state. The choice of a questionnaire must be related to its purpose, with a clear distinction being made between its evaluative and discriminative function. In their evaluative function, only a few instruments fulfilled the criteria of responsiveness, and the interpretability of most questionnaires is limited. Generic questionnaires should not be used alone in clinical trials as evaluative instruments because of their inability to detect change over time. Further validation and improved interpretability of existing instruments would be of greater benefit to clinicians and scientists than the development of new questionnaires.

Background: The medical literature suggests that patients and physicians are deficient in their ability to use a self-injectable epinephrine device (EpiPen®) for management of anaphylaxis. This study aims to determine whether a computer module is an effective tool for the instruction of a technical skill to medical trainees. Methods: We conducted a two group comparison study of 35 Post-Graduate Year 1 and 2 Family Medicine residents. Participants were instructed on use of the EpiPen® using either a written module or a computer module. Participants were evaluated on use of the EpiPen® using standardized objective outcome measures by a blinded assessor. Assessments took place prior to and following instruction, using the assigned learning modality. Results: There were 34 participants who completed the study. Both groups demonstrated significant improvement in demonstrating use of the EpiPen® following training (p

Es común encontrar publicaciones científicas en las que el análisis de variancia (ANDEVA) se utiliza incorrectamente y además, en las que los análisis posteriores tras encontrar significancia en el ANDEVA también son incorrectos. En este trabajo se describe el fundamento teórico del ANDEVA y de las pruebas que pueden aplicarse posteriormente, y se presentan ejemplos prácticos de la ciencia de los alimentos que tienen el objetivo de mostrar al lector la escogencia y aplicación apropiadas de estas pruebas.

Este estudio se realizó en el Ce ntro Na cional de Cie ncia y Tecnología de Alimentos en el año 2000, con el fin de determinar la reducción de Vibrio mimicus en huevo de tortuga lora utilizando calor o ácido acético. Para ellos se determinó el tiempo de coagulación a diferentes temperaturas o niveles de pH con el fin de seleccionar los que podían utilizarse para la reducción del patógeno sin afectar las cualidades sensoriales del huevo crudo. Los huevos inoculados con Vibrio mimicus con cargas superiores a 6,0 log10UFC/g, fueron tratados con las diferentes alternativas de inmersión en agua caliente o soluciones de ácido acético por un tiempo determinado. Los tratamientos con calor (45, 55 ó 65°C por 20 minutos) lograron reducciones entre 1,4 y > 6,0 log10UFC/g, mientras que la inmersión en ácido acético (pH 3,0; 3,5; 4,0 ó 4;5 por una hora) sólo logró reducciones entre 0,2 y 1,5 log10UFC/g causadas probablemente por la neutralización observada del pH en el tiempo.

En el año 2000, en el Centro Nacional de Ciencia y Tecnología de Alimentos de la Universidad de Costa Rica, se estudió la sobrevivencia de Vibrio mimicus en la clara y yema del huevo de tortuga lora. Se inocularon muestras de clara o yema con el vibrio (aproximadamente 2,5 x 104 UFC/g) y se determinó la carga inicial y final al cabo de 18 horas de incubación a 25°C. De forma análoga se trabajó una muestra control en agua peptonada alcalina(APA) como medio óptimimo de crecimiento para el vibrio y una muestra control de clara o yema sin inocular. Con los recuentos obtenidos se calcularon los incrementos promedio (log10 UFC/g). En la clara los resultados mostraron incrementos similares para la muestra sin inocular, muestra inoculada y control en APA (4,67, 5,24 y 5,49 respectivamente). El crecimiento, en la muestra de clara sin inocular, se atribuyó a contaminación proveniente de la cáscara al abrir el huevo. En el caso de la yema, al comparar los incrementos observados para la muestra inoculada (4,42) y el control en APA (5,21), no se encontraron diferencias significativas, sin embargo, al comparar estos dos valores contra el de la muestra sin inocular (0,00), la diferencia fue evidente. En este caso se consideró que es menos probable que la contaminación de la cáscara llegue a la yema al abrir el huevo. Los resultados de esta investigación muestran que la clara y la yema de huevo de tortuga lora constituyen medios de cultivo adecuados para la reproducción de V. mimicus.