Identification of aroma-active compounds in Cheddar cheese imparted by wood smoke.

Cheddar cheese is the most popular cheese in the United States, and the demand for specialty categories of cheese, such as smoked cheese, are rising. The objective of this study was to characterize the flavor differences among Cheddar cheeses smoked with hickory, cherry, or apple woods, and to identify important aroma-active compounds contributing to these differences. First, the aroma-active compound profiles of hickory, cherry, and apple wood smokes were analyzed by solid-phase microextraction (SPME) gas chromatography-olfactometry (GCO) and gas chromatography-mass spectrometry (GC-MS). Subsequently, commercial Cheddar cheeses smoked with hickory, cherry, or apple woods, as well as an unsmoked control, were evaluated by a trained sensory panel and by SPME GCO and GC-MS to identify aroma-active compounds. Selected compounds were quantified with external standard curves. Seventy-eight aroma-active compounds were identified in wood smokes. Compounds included phenolics, carbonyls, and furans. The trained panel identified distinct sensory attributes and intensities among the 3 cheeses exposed to different wood smokes (P < 0.05). Hickory smoked cheeses had the highest intensities of flavors associated with characteristic "smokiness" including smoke aroma, overall smoke flavor intensity, and meaty, smoky flavor. Cherry wood smoked cheeses were distinguished by the presence of a fruity flavor. Apple wood smoked cheeses were characterized by the presence of a waxy, green flavor. Ninety-nine aroma-active compounds were identified in smoked cheeses. Phenol, guaiacol, 4-methylguaiacol, and syringol were identified as the most important compounds contributing to characteristic "smokiness." Benzyl alcohol contributed to the fruity flavor in cherry wood smoked cheeses, and 2-methyl-2-butenal and 2-ethylfuran were responsible for the waxy, green flavor identified in apple wood smoked cheeses. These smoke flavor compounds, in addition to diacetyl and acetoin, were deemed important to the flavor of cheeses in this study. Results from this study identified volatile aroma-active compounds contributing to differences in sensory perception among Cheddar cheeses smoked with different wood sources.

Consumer perception of smoked Cheddar cheese.

Consumer perception of smoked cheese was evaluated through focus groups, surveys, and central location testing. Three focus groups (n = 29) were conducted with consumers of smoked cheese. Subsequently, 2 online surveys were conducted. The purpose of the first survey (n = 1,195) was to understand types of smoked cheeses consumed and if consumers associated specific wood smokes with smoked cheese. Next, an adaptive choice-based conjoint (n = 367) was designed to evaluate consumer perception of different attributes of smoked cheese. Maximum difference scaling and familiarity questions were also included in the adaptive choice-based conjoint survey. Following the surveys, a central location test (n = 135) was conducted with cheeses smoked with 3 different woods at a low and high intensity (6 cheeses total). Hierarchical Bayesian estimation, 1-way ANOVA, agglomerative hierarchical clustering, and 2-way ANOVA (smoke type × intensity level) were used to interpret the collected data. Results from the focus groups indicated that smoked cheese was perceived as an artisan, high-end product and that appearance and price were strong purchase factors. In general, consumers were not aware of how smoked flavor was imparted to cheese, but when informed of the processes, they preferred cold-smoked cheese to the addition of liquid smoke flavor. Results from both surveys confirmed focus group observations. Consumers perceived flavor differences among different wood smokes and smoked products. Method of smoking, smoke intensity, type of wood, and type of cheese were the most important attributes for purchase of smoked cheese. When tasting, consumers differentiated smoke aroma and flavor among cheeses and preferred cherry wood smoked cheeses over apple wood or hickory smoked cheeses. Understanding consumer perceptions of smoked cheese will give insight into the desired experience that consumers expect when purchasing smoked cheese.

Quality of care for obstetric emergencies in 4 general hospitals in Egypt: an observational study of delays in receiving care and blood bank services.

A lack of available blood contributes to 16% of all maternal deaths in Egypt. This study aimed to assess the quality of care for obstetric emergencies in 4 general hospitals in Egypt over a 6-month period with the focus on delays in receiving care and blood bank services. Observations were made of the processes and delays in the clinical setting, from the start of each patient's complaint until discharge, and the receipt and filling of orders for blood at the blood bank. Patients failed to recognize danger signs. Lack of transportation, incorrect choice of provider or facility and unclear referral systems added further delays. Delays occurred in hospital admission, assessment of patients, initiation of resuscitation, initiation of medical or surgical interventions, ordering blood, J receipt of blood and administration of blood to patients. The blood ordering procedures were substandard. Lack of blood availability had multidisciplinary causes.

Quality of care for obstetric emergencies in 4 general hospitals in Egypt: an observational study of delays in receiving care and blood bank services

A lack of available blood contributes to 16% of all maternal deaths in Egypt. This study aimed to assess the quality of care for obstetric emergencies in 4 general hospitals in Egypt over a 6-month period with the focus on delays in receiving care and blood bank services. Observations were made of the processes and delays in the clinical setting, from the start of each patient's complaint until discharge, and the receipt and filling of orders for blood at the blood bank. Patients failed to recognize danger signs. Lack of transportation, incorrect choice of provider or facility and unclear referral systems added further delays. Delays occurred in hospital admission, assessment of patients, initiation of resuscitation, initiation of medical or surgical interventions, ordering blood, receipt of blood and administration of blood to patients. The blood ordering procedures were substandard. Lack of blood availability had multidisciplinary causes

Impact of clean delivery kit use on clean delivery practices in Beni Suef Governorate, Egypt.

OBJECTIVE: A major factor contributing to neonatal and maternal infections is unhygienic delivery practices. This study explores the impact of clean delivery kit (CDK) use on clean delivery practices during home and facility deliveries. DESIGN: Kits were distributed from primary care facilities and mothers and birth attendants received training on kit importance and use. The study was designed as a cross-sectional cohort study. Raedat (community health workers) visited 349 women during the postpartum period to administer a structured questionnaire. SETTING: The study was conducted from mid-March through mid-July 2001 in two rural areas of Ihnasia district in Beni Suef Governorate (Upper Egypt). RESULT: In bivariate analysis, CDK users in the home were more likely to report that the birth attendant had clean hands (P<0.001), washed/wiped the mother's perineum (P<0.001), used a sterile cord tie (P=0.001), applied antiseptic to the cord after cutting (P<0.001), and used a sterile cord cover (P<0.001) as compared with non-CDK users. CDK users at the facility were more likely to report that the birth attendant washed/wiped the mothers perineum (P=0.049) and used a sterile cord cover (P=0.030) as compared with non-CDK users. CONCLUSION: In settings in which unhygienic practices during home as well as facility deliveries are prevalent, use of inexpensive CDKs can promote clean delivery practices.

Use of the non-pneumatic anti-shock garment (NASG) to reduce blood loss and time to recovery from shock for women with obstetric haemorrhage in Egypt.

Obstetric haemorrhage is one of the leading causes of maternal mortality. In many low-resource settings, delays in transport to referral facilities and in obtaining lifesaving treatment, contribute to maternal deaths. The non-pneumatic anti-shock garment (NASG) is a low-technology pressure device that decreases blood loss, restores vital signs, and has the potential to improve adverse outcomes by helping women survive delays in receiving adequate emergency obstetric care. With brief training, even individuals without medical backgrounds can apply this first-aid device. In this secondary analysis of hospital data from a pre-post intervention study in Egypt (N=364 women with obstetric haemorrhage and shock), 158 received standard care, while 206 received standard care plus the NASG. The NASG significantly reduced blood loss, time to recovery from shock, and, for those with postpartum haemorrhage due to uterine atony who received oxytocin, the NASG had a significant effect on blood loss independent of oxytocin. These results indicate that the NASG may be a valuable innovation for reducing maternal mortality in low-resource settings. Testing at community and household levels will be necessary in order to determine whether the NASG can help women survive the longest delays.

Diarrhoea and mortality in Menoufia, Egypt.

From 1982 the Ministry of Health of Egypt implemented the National Control of Diarrhoeal Diseases Project (NCDDP) which attempted to improve case management of childhood diarrhoea by making oral rehydration salts (ORS) widely available and used, to improve feeding patterns during diarrhoea, and other measures. National data indicate a high level of success in achieving the targets. However, impact evaluation is hampered by weak national baseline information available prior to NCDDP on case management of diarrhoea and causes of infant and childhood mortality. A study in Menoufia Governorate in 1979-80 obtained such information. Consequently, in 1988 the area was revisited to examine subsequent changes. Findings showed marked improvement in case management of diarrhoea and rapid mortality decline, with diarrhoeal mortality apparently declining somewhat faster than mortality from other causes.

PIP: The Ministry of Health (MOH) of Egypt has done much for more than a decade to control diarrheal disease (CDD). Oral rehydration salts (ORS) have been distributed since 1978, and the National Control of Diarrheal Diseases Project (NCDDP) was launched in 1982. Full CDD measures in place since 1984 have expanded the use of ORS to treat diarrhea, and have resulted in lower levels of infant and child mortality across the country. Impact evaluation is, however, hampered by weak national baseline data. At the national level, information on the cause of death in the vital register is not considered reliable. Second, there is little data on the case management of diarrhea before the initiation of the NCDDP. These issues were addressed in some sample villages in Dakahlia Governorate, where increases in knowledge and the use of ORS between 1980 and 1986 were associated with a decrease in diarrheal mortality. A potentially comparable situation existed in Menoufia Governorate, where the effect of a program of home distribution of ORS on mortality was evaluated in 12 villages in 1979-80. This paper reports findings from a return visit to the villages in 1988 to compare the current treatment of diarrheal diseases and mortality patterns against conditions at baseline. The authors report marked improvement in the case management of diarrhea and rapid mortality decline, with diarrheal mortality apparently declining somewhat faster than mortality from other causes.