Fruit and vegetable mixtures for health-promoting colored extruded snacks

Diet-related non-communicable diseases have an impact on sustainable development and have greatly influenced mortality worldwide, even nowadays, where they regained a greater relevance with COVID-19 pandemic emergence. Food habits and immunity have been closely related, and technological adaptions to produce healthier snacks are now on the global agenda of the food industry. As naturally functional raw materials, fruit and vegetables (F&V) effectively meet the high nutritional value and sensory appeal necessary to snacks design. This work aimed to harness the potential of such resources, including both native and introduced F&V species that confer visually attractive color to cold processed extrudates. The performance of different F&V processing methods was tested, for final blending with hydrocolloids resulting in sugarless confectionery-like extruded snacks. Liquid and dry milling of F&V yielded colorful pigment-rich ingredients, whose physical characteristics differed in terms of extraction efficiency, water activity, and moisture, with associated technological process advantages or handicaps. Formulas with different hydrocolloids were tested, and the one with the highest sensory acceptability was reported. © 2023 International Society for Horticultural Science. All rights reserved.

Technological performance of cucumber and squash as an opportunity for post-COVID-19 economic recovery

Cucumber (Cucumis sativus) and zucchini (Cucurbita pepo) are produced on small farms in the Andean tropics. Previously, the only identified use was for salads but, in the last five years, diverse applications have developed. Smoothies, juice and other combined beverages based on cucumber are new products in the food industry. Likewise, dehydrated cucumber and zucchini slices could be a new snack. In particular, transformed vegetables that have healthy kinds of bioactive and phytoterapeutic components could be used in small, local, commercial markets post-COVID-19. Fresh vegetables are not easily marketable, especially with post-COVID-19 limitations in affected latitudes, but dehydrated cucumber and zucchini offer simple processing lines in the farmer-producer-transformer-consumer chain. “Junk food” sees high consumption by children and young people, resulting in poor nutrition and predisposition for obesity and other non-communicable illnesses in future adults. Healthy snacks are required for a radical change in food habits. Fresh cucumber and zucchini slices were dehydrated with two methods: direct convection and irradiance, providing crisp slices. Osmotic dehydration was applied with NaCl2 solutions, from 1 to 3%. Natural flavors, pepper and paprika and sea salt spices, were included in the osmotic solutions to make the flavor of the slices more attractive for consumers. The slice thickness varied from 0.3 to 0.5 cm, providing the most desirable product. The slices flavored with paprika or pepper were accepted by the panel without differences for the zucchini slices, while, for the cucumber slices flavored with sea salt spices, thin slices were preferred because of the texture. According to the results, cucumber and zucchini possess technological aptitude for producing crisp slices with good organoleptic characteristics. Simple technological processing lines should be implemented in medium and small sized food companies, thereby contributing to economic recovery under post-COVID-19 vulnerable commercial production conditions in the tropics. © 2022 International Society for Horticultural Science. All rights reserved.

Patient and caregiver satisfaction with novel en masse oral food challenge performance

Background: Oral food challenge (OFC) is the gold standard for the diagnosis of food allergy. OFC are traditionally performed in hospital, as a day ward procedure, with a high medical caregiver to patient ratio. This is likely to enhance communication and patient satisfaction. Despite the high incidence of adverse reactions, families generally report a positive experience . In Sep-Oct 2020 a novel, high throughput, OFC initiative was carried out by a cross-hospital, multidisciplinary Irish paediatric allergy team. Up to 25 OFCs were performed each day at an offsite, COVID-19 stepdown facility. The unique model was designed in response to the impact of the pandemic, on provision of ambulatory allergy services. It was essential to evaluate the patient experience of this unique, alternative OFC model, compounded by COVID related distancing. Method: An anonymised survey was conducted of randomised cross-section of patients attending. The survey was completed by the primary caregiver of the child attending for the OFC. 178 survey responses were collected from a total of 474 families and included for analysis. The survey was designed to assess patient satisfaction across a number of parameters. Results: 81% of respondents were highly satisfied with ease of use of a non-hospital facility. 81% reported that the site was “child friendly”. Patient experience was scored as “excellent” 82.9% of the time with a further 12.35% reporting it as above average. Communication was effective with 89% of carers reporting good understanding of the results of the OFC. 94.7% stated that their questions were answered by the Allergy Team present. Conclusion: Our results are remarkable for enhanced patient satisfaction despite a reduced medical caregiver to patient ratio. The patient's overall satisfaction was rated overwhelmingly as “excellent” despite almost 30% of patients experiencing allergic reactions. The pandemic has forced health services to seek new ways of doing things. This data reassures, that OFC models can be changed without sacrificing patient experience.

Mass food challenges in a vacant COVID-19 stepdown facility: The children's health Ireland food challenge initiative 2020

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short term (6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland (HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Method: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusion: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in -even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID- 19 era.

Early palliative supportive care within the lung cancer committee (LCC): Descriptive study of the patient's characteristics after one year experience in a tertiary hospital

Background: Many studies have shown benefits of early Palliative Care(PC)in advanced lung cancer patients. There's increasing evidence about better symptom control and survival. A PC physician joined the multidisciplinary LCC last year. Despite the SARS-CoV2 pandemic,472 cases were presented to the LCC in 2020. 470 cases were presented in 2018, so his activity remains stable. Aims: To describe clinical profile of the patients presented to the LCC and early referred to PC. To compare patient's survival when referred from ambulatory setting or when they are admitted in hospital. Methods: Descriptive study.DATA:Age, Gender, Comorbilities, Cancer Histology Tobacco exposure, TNM, Oncology Therapy, Survival time, Barthel, Charlson, Time to first PC consultation. ANALYSIS:T test to compare means of continuous variables and Chi-squared to compare proportions of categorical variables. Kaplan-Meier curve for survival analysis. Results: 41patients of 472(9%) were referred to PC. Males(75%),Median Age 72,87 years old(DS 11,95) no age differences by gender. Current Smokers 25%,Former smokers 65%.Hypertension 70%,Diabetes 45%,Dyslipemia 60%,Heart Failure45%, Renal impairment 35%. Barthel:mean 63,6(DS:22,7) Charlson:mean 6,5(DS2,35) Cancer Histology: Squamous55%, Adenocarcinome35%, Small Cell 7,5%,Other Neuroendocrine2,5%, Disease Stage: StageIV 65%, StageIII 55%, Cancer therapy: Chemotherapy 44%,Radiotherapy 56%, Immunotherapy 30%.PC exclusive follow-up:24,4%, PC and shared follow-up:75,6%. Setting: Refered to Ambulatory PC: 44%, Refered to PC when admitted in an hospital ward: 56%. Time from LCC to PC visit: Ambulatory setting: mean 27,7 days, median 14. Admitted hospital ward: mean 63,14 days(p=0,036), Survival: Ambulatory: mean 142,12 days (DS 90,9), Admitted Hospital ward 59,68 days (DS 59,1)p=0,002. Conclusion: Patients referred from LCC to Ambulatory PC showed an early intervention and better survival profile. Collaboration between LCC and the PC team can improve the early PC support.

Pedagogical Strategies Used by English Teacher Educators to Overcome the Challenges Posed by Emergency Remote Teaching During the covid-19 Pandemic

The crisis in the education system generated by the appearance of covid-19 revealed the multiple gaps that exist due to the diversity of contexts to which students and teachers belong. This article reports on a case study which explored the challenges English teacher educators (tes) at a public university in Neiva, Colombia faced during the pandemic due to the imposition of emergency remote teaching (ert), the pedagogical strategies they used to respond to these challenges, and the ones that remain. To do this, data were collected from a questionnaire and a focus group with tes and pre-service teachers (psts) from the language teacher education program. The main findings show that the transition from classroom teaching to ert brought some challenges for tes and their trainees related to the social realities existing in the context of the latter. To respond to these challenges, tes had to adjust their teaching strategies and learn to use some technologies such as videoconferencing software and educational apps. Still some challenges remain for the future, such as enhancing pst's motivation, autonomy and classroom interaction. The study suggests the need to continue training language tes on the use of ert technologies and to find more and better ways to promote autonomous learning processes to adapt teaching practices to current times. © 2021 Universidad de Antioquia. All Rights Reserved.

COVIDOSE: Low-dose tocilizumab inthe treatment of COVID-19 pneumonitis

Background: Morbidity and mortality due to coronavirus disease 2019 (COVID-19) may in part be due tointerleukin-6 (IL-6)-mediated hyperinflammation. The IL-6 receptor-targeted monoclonal antibody tocilizumab (TCZ)has been repurposed to treat COVID-19-related hyperinflammation, but prospective data are lacking. Given TCZ'srisks of secondary infection and potential blunting of the adaptive immune response and its finite supply, study of theefficacy, safety, and dose response of TCZ for the treatment of COVID-19-related hyperinflammation is needed. Methods: We conducted an adaptive phase 2 study of low-dose (LD) TCZ in hospitalized, non-mechanicallyventilated adult patients with COVID-19 pneumonitis and evidence of hyperinflammatory syndrome, with C-reactiveprotein (CRP) ≥ 40 micrograms per milliliter. Dose cohorts were determined by a trial Operations Committee, withthe initial doses of 80 or 200 milligrams, depending on the magnitude of CRP elevation and epidemiologic riskfactors. Doses were decreased to 40 mg and 120 mg after interim assessment. The primary objective was to assessthe relationship of dose to clinical improvement in temperature and oxygen requirement and biochemical responseby CRP. Results: 32 patients received LD TCZ. 25 of 32 (78%) patients receiving LD TCZ at any dose achieved feverresolution. In terms of dose-response, fever resolution in 24 hours was observed in 6 of 8 (75%) who received 200milligrams, 3 of 4 (75%) who received 120 milligrams, 11 of 15 (73%) who received 80 milligrams, and 5 of 5 (100%)who received 40 milligrams (p = 0.80 for response rate difference). Biochemical response consistent withinterleukin-6 pathway inhibition, corresponding to a ≥ 25% CRP decline, after a single dose of LD TCZ wasobserved in 5 of 8 (63%) who received 200 milligrams, 4 of 4 (100%) who received 120 milligrams, 10 of 15 (67%)who received 80 milligrams, and 5 of 5 (100%) who received 40 milligrams (p = 0.34 for response rate difference).100% of patients achieved CRP response within two doses of LD TCZ. Within the 28-day follow-up period, 5 (16%)patients died. For patients who recovered, median time to clinical recovery was 4 days (interquartile range, 2-5).Clinically presumed and/or cultured bacterial superinfections were reported in 4 (12.5%) patients. Correlativebiologic studies examining anti-SARS-CoV-2 antibody production across a range of TCZ doses are presentedseparately (abstract A-22514927). Conclusions: LD TCZ, in addition to standard of care, was associated with improvement of clinicalhyperinflammation parameters in hospitalized adult patients with COVID-19 pneumonitis. No relationship betweenTCZ dose and clinical or biochemical response relationship was identified. Results of the COVIDOSE trial provide arationale for a randomized, controlled trial of LD TCZ versus standard of care in those patients with COVID-19pneumonitis who have evidence of hyperinflammation. (COVIDOSE, ClinicalTrials.gov number, NCT04331795 .).

Treatment with tocilizumab does notinhibit induction of anti-COVID-19 antibodies in patients with severe SARS-CoV-2 infection

Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor-blocking monoclonal antibody, is used to treat variousrheumatologic conditions and cytokine release syndrome in CAR-T cell therapy and has been repurposed to treatCOVID-19-related hyperinflammation. There are limited data available reporting how TCZ affects the immuneresponse in the context of COVID-19. To investigate this question, we recruited patients treated with TCZ as part ofa COVID-19 biobanking protocol (A-28063295) to study immune parameters that might be affected. We enrolled 19patients who were treated with a range of 40-200mg TCZ as part of a low-dose TCZ trial (COVIDOSE, reportedseparately as abstract A-94803796), and 11 patients who received 400mg TCZ on a standard-of-care expanded-access basis. As IL-6 acts as a stimulant of B-cell proliferation, plasma cell maturation, and antibody responses, weevaluated whether blocking the IL-6 receptor with TCZ therapy impairs antibody generation to SARS-CoV-2. Toevaluate antibody levels in these patients, we performed ELISAs against the SARS-CoV-2 spike glycoprotein and itsreceptor-binding domain (RBD). The spike glycoprotein, a structural protein of SARS-CoV-2, is a crucial componentin the recognition, attachment, and entry of the virus into host cells. Specifically, the RBD is responsible for bindingthe ACE2 receptor on human cells, and likely serves as a major target for neutralizing antibodies. To establish if theformation and persistence of antibodies was affected by TCZ treatment, we analyzed serum and plasma sampleslongitudinally from 29 patients treated with TCZ and 26 control patients. To account for potential variability betweenplates, the measured optical density (OD) values were normalized to the OD for COVID-19-negative control serumat 1:50 dilution, and the same negative control was tested on each plate. Titers were calculated as the linearinterpolation of the inverse dilution at which the normalized OD value crossed a threshold of 1, representing themaximum OD measured for the negative control. Anti-spike and anti-RBD antibodies increased significantly overtime in both TCZ-treated patients and controls (p < 0.005 for both). Increasing antibody titers throughout the diseasecourse followed a similar trajectory in TCZ-treated patients compared to control patients, suggesting that TCZtreatment does not impede the generation of antibodies to SARS-CoV-2. Additionally, TCZ-treated patients achievedcomparable maximal observed antibody titers to control patients (average maximal log10 (titer) of 5.42 and 4.96 forspike and of 4.39 and 4.44 for RBD, respectively). These data suggest that TCZ does not impair the induction ofanti-SARS-CoV-2 antibodies.

Tissue banking from patients withSARS-CoV-2 (COVID-19) infection

The clinical spectrum of SARS-CoV-2 (COVID-19) infection ranges from asymptomatic infection to fatal pneumonia, but the determinants of outcome are not well understood. To characterize the immune response to COVID-19, weestablished a protocol to collect biologic specimens from patients with confirmed or suspected COVID-19. BetweenApril 9th and June 8th, 2020, we enrolled 146 inpatients and 169 outpatients at the University of Chicago. Wehypothesized that the complex interplay of viral, environmental, and host genetic factors may influence diseaseseverity in patients with COVID-19. To probe for genetic predispositions that may influence outcomes, we collectedgermline DNA from 140 patients spanning the breadth of clinical severity, which will be sequenced for SNPs ingenes previously implicated in immune responsiveness and ARDS. To determine whether a pattern of commensalbacteria correlates with disease severity, we will analyze the composition of airway microbiota from 226nasopharyngeal swabs, using viral quantification and 16S sequencing. Longitudinal serum samples from 156patients were obtained to probe for the presence of antibodies using an ELISA against the spike protein of SARS-CoV-2. In tandem, 36-color flow cytometry on PBMCs, from the same patients, will characterize immune cellphenotypes influenced by infection. We also hypothesized that by characterizing mechanisms of immune-hyperresponsiveness, we may elucidate key biologic pathways that inform the development of novel therapeutics.To determine if severity of disease and response to therapy correlates with soluble factors, we are performing 44-plex cytokine Luminex assays on serum samples. We will probe the adaptive immune response using an ELISAagainst the SARS-CoV-2 RBD domain, and by performing IFN-g ELISPOT analysis against peptide pools fromSARS-CoV-2 proteins. We developed a bioinformatic pipeline to integrate clinical data with the results from thediverse data types and will adopt a machine learning approach to identify parameters contributing to diseaseseverity, response to therapies, and outcomes. In establishing this protocol, there were significant biosafetyconsiderations. To limit potential exposure and virus transmission, research coordinators contacted inpatients byphone for an informed consent discussion, and patients completed the consent form electronically using REDCap(n=61). Inpatients who were unable to navigate the electronic consent were visited with a paper consent (n= 85).Samples were processed in a BSL2 laboratory with enhanced biosafety precautions. Where feasible, samples werecollected into reagents such as Zymo DNA/RNA shield to immediately inactivate the virus. Other safety measuresincluded heat inactivation of some samples and use of a laminar flow washer to minimize aerosolization duringFACS staining. In summary, we have established a biorepository of specimens from patients with COVID-19, including a subset with active cancer or a history of the disease (n=22).