Quality of minimally processed table cassava cultivated in southeastern Pará, brazilian Amazonian / Qualidade da mandioca de mesa minimamente processada cultivada no sudeste do Pará, Amazônia brasileira

This paper aimed to assess the quality of the cassava roots of the variety Cacau minimally processed. Physical characterization of 100 root samples was carried out by measuring the weight of roots, weight of roots without bark, weight of bark, root yield, length and diameter. The following treatments were performed: T1: roots was washed in running water; T2: sanitized roots (150 mg. L-1); T3: sanitized roots (150 mg. L-1) and acidified roots (1% citric acid) and T4: sanitized roots (150 mg. L-1) and bleached (55ºC/10 min). The physicochemical characterization of leaves, stems and roots were performed through the analysis of pH, total titratable acidity (TTA), moisture, ashes, protein content, lipids, carbohydrates and total energy value (TEV). For the variables of plant growth, the number of roots (9.10 units) and dry matter of the roots (1312.15 g), in addition the yield of the unshelled root (80.95 kg or 61.80 %) was close to the values reported in the literature. As for the physicochemical parameters of minimally processed cassava roots, they were in accordance with those established by the Brazilian Table Food Composition. These parameters are considered the most important for the industry, so they explain the reasons for the agroindustrial potential this feedstoock. 

Desenvolvimento e caracterização de farinha de tapioca obtida a partir de féculas de mandiocas cultivadas no Nordeste do Pará / Development and characterization of tapioca flour obtained from cassava starches cultivated in the Northeast of Pará

A farinha de tapioca é um alimento produzido artesanalmente a partir da fécula de mandioca (Manihot esculenta Crantz). O objetivo deste trabalho foi realizar a caracterização físico-química e morfológica, e a avaliação microbiológica e sensorial das farinhas de tapioca obtidas com as féculas de três variedades de mandioca produzidas no estado do Pará (Pai Ambrósio, Pocu e Paulo Velho), através de dois processos térmicos (com e sem escaldamento) utilizados pelos produtores paraenses. Na formulação das farinhas foram utilizados grânulos de fécula, com 40% de umidade inicial e tamanho médio inferior a 3,0 mm. Todas as farinhas de tapioca obtidas atenderam os padrões de identidade físico-químicos e de qualidade microbiológica, estabelecidos pela Legislação Brasileira. A microscopia eletrônica de varredura indicou que a etapa de escaldamento provoca um maior dano nos grânulos da farinha de tapioca. A farinha de tapioca obtida com a fécula da variedade de mandioca Paulo Velho e não submetida ao processo de escaldamento foi a que obteve a maior aceitação dos provadores, porém todas as farinhas obtiveram boa aceitação

Desenvolvimento e caracterização de doces de leite bubalino pastosos saborizados com doces de bacuri e Cupuaçu / Development and characterization of dulce de leche from buffalo milk flavored with bacuri and Cupuaçu

O objetivo desta pesquisa foi desenvolver novos produtos de doce de leite a partir do leite de búfala e realizar a caracterização dos produtos formulados e das matérias prima empregadas. Foram elaborados três produtos: doce de leite bubalino tradicional (DLBUF), doce de leite bubalino com doce de bacuri (DBUFB), e doce de leite bubalino com doce de cupuaçu (DBUFC). Foram realizadas as análises de pH, acidez total titulável (ATT), sólidos solúveis totais (SST), umidade, cinzas, lipídios, proteínas,cálculo do valor de carboidratos e estimado o valor energético total (VET). Realizou-se a análise de variância (ANOVA) juntamente com o teste de tukey a 5% de probabilidade. Os resultados para os doces de leite elaborados variaram de: 5,75 a 7,45 para o pH; ATT de 0,59 a 1,01 % ácido lático; SST de 57,0 a 60,0 ºBrix; umidade de 30,08 a 34,77%; cinzas de 0,97 a 1,37%; lipídios de 13,13 a 14,59%; proteína de 11,17 a 15,34%; carboidratos de 34,54 a 44,49%; VET de 325,34 a 345,39 Kcal/100g. Parâmetros importantes como o teor de proteína foram superiores em relação ao de outras espécies, assim como maior rendimento final, sendo esses resultados importantes para a bubalinocultura leiteira e a indústria de produtos lácteos, além de apresentar vantagens para o mercado consumidor.O objetivo desta pesquisa foi desenvolver novos produtos de doce de leite a partir do leite de búfala e realizar a caracterização dos produtos formulados e das matérias prima empregadas. Foram elaborados três produtos: doce de leite bubalino tradicional (DLBUF), doce de leite bubalino com doce de bacuri (DBUFB), e doce de leite bubalino com doce de cupuaçu (DBUFC). Foram realizadas as análises de pH, acidez total titulável (ATT), sólidos solúveis totais (SST), umidade, cinzas, lipídios, proteínas, cálculo do valor de carboidratos e estimado o valor energético total (VET). Realizou-se a análise de variância (ANOVA) juntamente com o teste de tukey a 5% de probabilidade. Os resultados para os doces de leite elaborados variaram de: 5,75 a 7,45 para o pH; ATT de 0,59 a 1,01 % ácido lático; SST de 57,0 a 60,0 ºBrix; umidade de 30,08 a 34,77%; cinzas de 0,97 a 1,37%; lipídios de 13,13 a 14,59%; proteína de 11,17 a 15,34%; carboidratos de 34,54 a 44,49%; VET de 325,34 a 345,39 Kcal/100g. Parâmetros importantes como o teor de proteína foram superiores em relação ao de outras espécies, assim como maior rendimento final, sendo esses resultados importantes para a bubalinocultura leiteira e a indústria de produtos lácteos, além de apresentar vantagens para o mercado consumidor

Processamento e caracterização de doces de leite saborizados obtidos de vacas oriundas do Sudeste do Estado do Pará / Processing and characterization of flavored milk candy obtained of the cows from the Southeast of Pará State

O objetivo deste estudo foi produzir novos produtos de doce de leite e avaliar as características físico-químicas dos doces e das matérias primas produzidas no Sudeste do Estado do Pará. Foram desenvolvidas três formulações: doce de leite bovino tradicional (DLB), doce de leite bovino com doce de bacuri (DLBB), doce de leite bovino com doce de cupuaçu (DLBC). Para a caracterização físico-química dos doces de leite formulados foram realizadas as análises de pH, acidez total titulável, sólidos solúveis totais, umidade, cinzas, lipídios, proteínas, foi calculado o valor de carboidratos e estimado o valor energético total (VET). O método estatístico utilizado foi o teste de análise de variância, seguido do teste de tukey a 5% de probabilidade. As matérias primas utilizadas no processamento atendem os parâmetros físico-químicos segundo a legislação, assim como os doces de leite formulados. Portanto, os doces de leite tradicional e doces de leite saborizados com doce em massa de bacuri e cupuaçu apresentam grande potencial nutricional, além de valorizar as matérias primas regionais do Sudeste do Estado do Pará

Estudo sensorial de produtos artasanais de maracujá doce cultivado no centro tecnológico de agricultura familiar de Parauapebas-Pa / Sensory study of artisinal sweet passion frruit products grown in the family farming technology center of Parauapeba-Pa

No presente estudo objetivou-se elaborar produtos artesanais (néctar, geléia e doce em massa) e avaliar as características sensoriais dos produtos saborizados com flor de camomila, produzidos a partir dos frutos de maracujá BRS Rubi do Cerrado. Para obtenção dos seguintes produtos: néctar, geleia e doce em massa foram elaboradas duas formulações de polpas diluídas em água (F1: 25% de polpa de fruta e 75% de água; F2: 50% de polpa de fruta e 50% de água). As análises microbiológicas realizadas na polpa de maracujá e nos produtos elaborados foram fungos filamentosos e leveduras, Salmonella spp., Coliformes a 35 °C e a 45 °C e Staphylococcus coagulase positiva. Para a avaliação sensorial foram realizados os testes de aceitabilidade para os seguintes parâmetros: aparência, aroma, textura, sabor e impressão global; assim como o índice de aceitação e a intenção de compra dos produtos. Os resultados das análises sensoriais dos produtos artesanais foram submetidos à análise de variância através do teste de Tukey a 5% de probabilidade. Os resultados verificados na polpa de maracujá e nos produtos elaborados, indicaram ausência de microrganismos para 25 g de amostra. Todos os parâmetros avaliados no teste de aceitação sensorial obtiveram notas médias entre 6 (gostei ligeiramente) e 7 (gostei moderadamente), indicando aceitação e intenção de compra dos produtos por parte dos provadores. De acordo com os resultados obtidos, os produtos podem se tornar uma opção de aproveitamento integral dos frutos de maracujá pelo Centro Tecnológico de Agricultura Familiar, além de uma fonte alternativa de geração de renda aos agricultores familiares do município de Parauapebas-PA.

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt