Studies on cold-smoked fish production and their relation to controlling spoilage and safety

Smoked fish products are currently part of the Portuguese diet, being accessible to a large group of people. They are presented on Portuguese commercial point of sale packed in a vacuum, in small sliced pieces or in the form of a fillet. Fishes such as salmon, salmon-trout and swordfish, with European provenance, are used as raw material for the cold smoking production. The shelf-life depends on the type of cold smoking applied, ranging from 2 to 6 weeks at refrigeration temperatures ≤5ºC. Microbiological and physicochemical characteristics have demonstrated the dominance of Lactic Acid Bacteria, Enterobacteriaceae, and vibrios, among others, with the possibility of other groups of microorganisms being present, such as the pathogen Listeria monocytogenes. Attemptsto create a quality index ofcold-smoked fish products havebeen the subject of several studies in order to establish a correlation between the useful shelf-life of the product and the physicochemical, sensorial and microbiological characteristics. The main objective of this research was to characterize the microbial ecology of vacuum packed cold-smoked fish available in a Portuguese commercial point of sale and at a pilot-scale production by the identification of determinant variables, which influence the microbiological and physicochemical quality of the cold smoked fish. The investigation was conducted to characterize commercial cold-smoked fish products available in the Portuguese market, mainly salmon (Salmo salar) and salmon trout (Oncorhynchus mykiss), considering microbiological and physicochemical studies. From microbiological characterization, the ability of different bacteria isolated from cold-smoked fish to produce biogenic amines was evaluated, using different descarboxylation agar growth medium. A pilot-scale cold smoking controlled experiments using salmon trout were conducted to study: a) the effect of the application of ozone as a disinfected agent on whole fresh fish and fillets on reduction of microorganisms, including L. innocua; b) the effect of a previous freezing step (-20°C) of individual samples of vacuum packed cold-smoked salmon trout before product commercialized at chilled storage on microbial ecology c) the effect of combined treatments of salting/drying/smoking (wet or dry salting, addition of sugar in the salting mixture and long and short smoking) on microbiological and physicochemical properties followed by the use of vacuum and modified atmospheres packaging chilled storage conditions at 5ºC. Results from samples obtained at the Portuguese point of saleevidenced differences on shelf-life products, as well as on microbiological numbers of the cold-smoked samples. Some of the cold-smoked samples would be at the limit of the allowed microbial load for RTE products, even before reaching shelf-life ́s limit. The results also suggested the decrease in coefficient of variation of samples for aerobic plate counts and for numbers of Enterobateriaceaein controlled time and temperature laboratory conditions. The results demonstrated the suitability of growth culture medium on selection of bacteria producing biogenic amines. Some bacterial strains belonging to the group of LAB and Enterobacteriaceaewere positive for tyramine production and less for histamine production. Complementary results obtained from HPLC determinations, showed higher concentration of tyramine production by Carnobacterium divergensand by Lactoccocus lactis lactis.From gaseous ozone treatments applied to whole and fresh fillets salmon trout, a decrease of less than 1Log10in L. innocua(as a surrogate for the pathogen L. monocytogenes) numbers occurred on ozone treated samples in all sampling occasions. Aerobic Plate Count was slightly lower on fresh fillets after treatment and during three weeks of storage. From ozone treatments applied to whole fresh fish, a reduction greater than 1 Log10/g of L. innocuaoccurred on smoked samples at the end of the storage period. These results were more pronounced when the slime present on the whole fish surface was removed. From a previous freezing step (-20ºC) the results showed an general effect on microbial load throughout storage of previously frozen samples at initial stage of chill storage (1stweek) for total aerobic plate count, LAB and H2S producing bacteria, as compared to non-frozen cold-smoked samples only chilled. Asignificant increase in numbers of H2S-producing bacteria was observed in previously frozen samples, independently of the type of salting applied. Enterobacteriaceaegroup wasless affected by the previously freezingstep. DSC thermograms showed changes in muscle structure after salting/cold-smoking process. The stability of myofibrillar proteins were affected by salting/smoking treatment and the additional freezing step can result in decrease in product quality. Results from combined treatments of salting/drying/smoking on production of cold-smoked salmon trout revealed that wet salting treatment (especially for shorter salting times) did not produce the same results on microbiological and physicochemical characteristics on the end product, compared with dry salting. Overall, dry salting is preferable to brining for reducing microbial growth in cold-smoked salmon trout stored in VP.Higher sugar content in the salting mixture (salt:sugar|3:1) induced an increase in microbiological numbers. The smoking process characterized by long drying and short smoking times (Group II –Dry 6h and Smoke 2h) encouraged a general increase in microbiological numbers of cold-smoked samples, with asignificant increase in LAB counts, but a negative effect on the samples regarding microbiological quality, with significant increase in Enterobacteriaceae and H2S-producing bacteria. After 3 week storage the average of samples presented levels of trimethylamine(TMA) (up to 30 mg in 100 g of fish). A positive effect of short dry and long smoke exposure on microbial ecology was observed (Group I –Dry 2h and Smoke 6h) in cold-smoked fish, dry salted and packaged either in VP or MAP. MAP represents an alternative of packaging to VP, reducing the microbiological activity of some spoilage bacteria.The present research highlights how essential is the improvement of careful control in three areas of work that compose the production of cold smoked fish: (1) the control of quality of the raw material; (2) the design of technological procedures applied during the curing/smoking preservation process and (3) type of packaging and chill storage conditions. Advances in the integrated production of cold smoked fish using the preservative combined effects as the 'hurdle concept' should be applied defining technical procedures to product stability and safety commercialization.Os produtos da pesca fumados fazem atualmente parte da alimentação dos portugueses, estando acessível a um grande grupo de pessoas. Apresentam-se nas superfícies comerciais portuguesas embaladas a vácuo, em peças pequenas laminados, e ou em forma de filete. Peixes como o salmão, a truta salmonada e o espadarte, com proveniência europeia, são utilizados como matéria-prima para a fumagem a frio do pescado. A vida de prateleira depende do tipo de fumagem a frio aplicado, variando entre 2 a 6 semanas, armazenado a temperaturas de refrigeração <5ºC. As características microbiológicas e físico-químicas têm demonstrado a dominância de Bactérias Ácido-Lácticas, Enterobacteriaceae, e vibrios, havendo a possibilidade de outros microrganismos estarem presentes como é o caso de Listeria monocytogenes, afetando a qualidade e a segurança destes produtos. Nos últimos anos, a tentativa de criar um índice de qualidade de peixe fumado a frio foi alvo de vários estudos, com o objetivo de estabelecer uma correlação entre a vida útil do produto e as características físico-químicas, sensoriais e microbiológicas. A presente investigaçãoteve como principal objetivoa caracterização da ecologia microbiana de peixe fumado a frio disponível no mercado português e à escala piloto, através da produção de peixe fumado a frio, identificando determinadas variáveis com influência na qualidade microbiológica e química destesprodutos. Numa primeira faseda investigação foi efetuada a caracterização microbiológicados produtos de pescado fumado a friodisponíveis no mercado português, essencialmente salmão (Salmo salar) e truta salmonada (Oncorhynchus mykiss). Relativamente à caracterização microbiológica, bactérias isoladas de salmão e truta salmonada foram testadas para a produção de aminas biogénicas, tiramina e de histamina, utilizando meios de cultura específicos de crescimento. Estudos à escala piloto sobre o processo de fumagem a frio de truta salmonada foram conduzidos, com objetivode estudar: a) o efeito da aplicação do ozono, enquanto agente desinfetante em filete e peixe inteiro de truta salmonada fresca na redução de microrganismos viáveis totais e L. innocua; b) a aplicação de um passo prévio de congelação (-20ºC) em amostras individuais de truta salmonada embalada a vácuo na ecologia microbiana do produto; c) o efeito de tratamentos combinados de salga/secagem/fumagem (salga seca e húmida, adição de açúcar na mistura da salga, duração curta e longa de fumagem) e embalamento a vácuo ou em atmosferas modificadas nas características físico-químicas e microbiológicas do produto final.Resultados sobre a classificação das amostras comerciais de peixe fumado a frio embalado a vácuo, demonstraram variabilidade das amostras, pelas diferenças nos períodos de vidas de prateleira e características microbiológicas. Algumas amostras apresentavam já estar muito próximo dos limites de rejeição estabelecidos para produtos prontos a comer, antes de terminar a vida de prateleira. Os resultados evidenciaram que em condições controladas de tempo e temperatura, houve uma diminuição do coeficiente de variação nas amostras, e para o número de microrganismos aeróbicos totais e grupo Enterobacteriaceae. Sobre o resultado da pesquisa de estirpes produtores de aminas biogénicas em condições específicas em meio de cultura, os resultados indicaram a habilidade de algumas bactérias LAB e Enterobacteriaceaeproduzirem tiramina e menos a histamina. Resultados complementares utilizando HPLC para a quantificação das aminas, mostraram níveis elevados de tiramina produzidos pelas bactérias Carnobacterium divergense Lactoccocus lactis lactis. Os resultados envolvendotratamento com ozono gasoso em filetes e em peixe inteiro fresco, mostrou um decréscimo inferior a 1Log10/g de L. innocuaem amostras tratadas com ozono em todas as experiências. Contagens totais de microrganismos viáveis foram baixas no peixe fresco e durante a armazenagem a frio ao final de três semanas. Uma redução superior a 1Log10/g de L. innocuafoi observada em peixe tratadono final do período da armazenagem. Quando retirado o slimeda superfície do peixe, o efeito de redução foi mais pronunciado. Relativamente ao tratamento prévio da congelação (-20ºC) aplicado em amostras individuais fumadas a frio de truta salmonada embalada a vácuo, os resultados evidenciaram um aumento da carga microbiana nas amostras previamente congeladas na primeira semana de armazenamento em refrigeração,essencialmente para as bactérias aeróbias totais, LAB e bactérias produtoras de H2S. Um aumento significativo para bactérias produtoras de H2S foi observado, independentemente do tipo de salga a que foram sujeitos. O processo prévio do passo da congelação pareceu ter menos efeito no grupo Enterobacteriaceae. Alterações na estrutura das proteínas musculares da truta-salmonada após o processo de salga/fumagem, foram evidenciadas nos termogramas obtidos por Differencial Scanning Calorimetry (DSC).A estabilidade das proteínas miofibrilares foram afetadas pelo processo da salga/fumagem e o processo adicional de congelação poderá afetara qualidade microbiológica da truta-salmonada fumada a frio.Os resultados obtidos sobre os tratamentos combinados da salga/secagem/fumagem revelaram que a salga húmida e salga seca apresentaram diferentes efeitos nas características físico-químicas e microbiológicas do produto final. Na generalidade, a salga seca apresentou efeito maior na perda de peso (menor rendimento do processo), e melhor desempenho na obtenção de teores de sal em fase aquosa, havendo efeito no controlo/redução do crescimento microbiano. A presença de maior teor de açúcarna mistura com sal (sal:açucar|3:1) induziu um incremento no crescimento microbiano nas amostras em geral, quando comparado com a mistura (sal:açucar|5:1).Relativamente ao efeito da fumagem, os resultados indicaram que a combinação 6h de secagem e 2h de fumagem (Grupo II) induziu um crescimento significativo de bactérias ácido lácticasno produto final, com efeitos similares em outros microrganismos, como o grupo Enterobacteriaceaee bactérias produtoras de H2S. Ao final de três semanas de armazenamento em refrigeração, foram registadas um aumento do teor médio de trimetilamina (TMA) (superior a 30 mg. em 100 g de peixe). Comparativamente, o tratamento combinado de 2h de secagem e 6h de fumagem (Grupo I) mostrou ser mais eficaz no controlo do crescimento microbiano, em amostras tratadas por salda seca (8h) e embaladas a vácuo ou em atmosferas modificadas.O embalamento em atmosferas modificadas representa uma alternativa reduzindo a actividade microbiana de alguns microorganismos degradativos.Genericamente o presente estudo evidencia a necessidade do controlo e implementação de procedimentos controlados no processo de produção de fumagem a frio de pescado, considerando (1) A qualidade microbiológica e química da matéria-prima; (2) A definição do processo tecnológico a aplicar (descrição, objetivose características produto final) e (3) Tipo de embalamento e controlo das condições de armazenagem. A criação de processos de fumagem a frio de peixe baseados em ‘'hurdle concept technology’ poderão através da sinergia dos agentes de preservação constituir uma solução à estabilidade e comercialização em segurança destes produtos

Nurses in the front line of the combat to Covid-19 in the hospital environment: related experience

Objective: to report nurses experiences at reference hospital in the care of patients diagnosed with COVID-19 in the state of Sergipe, Brazil. Method: descriptive study, of the experience report type, about nurses\u27 experience in assisting patients diagnosed with COVID-19 in the hospital environment. Results: The nurses\u27 experiences were structured into three categories: Structural and organizational changes in the hospital service; Nurse\u27s work routine on the front line in the respiratory area; Main difficulties for nurses in caring for patients in the respiratory area and experienced opportunities. The positive aspects identified were participation in training and support for newly hired professionals. Conclusion: the COVID-19 pandemic changed economic, political, social and health care behavior. In addition, changes in the hospital environment demanded a reorientation of workflows, impacting nurses\u27 mental health and suffering

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

Characterisation of microbial attack on archaeological bone

As part of an EU funded project to investigate the factors influencing bone preservation in the archaeological record, more than 250 bones from 41 archaeological sites in five countries spanning four climatic regions were studied for diagenetic alteration. Sites were selected to cover a range of environmental conditions and archaeological contexts. Microscopic and physical (mercury intrusion porosimetry) analyses of these bones revealed that the majority (68%) had suffered microbial attack. Furthermore, significant differences were found between animal and human bone in both the state of preservation and the type of microbial attack present. These differences in preservation might result from differences in early taphonomy of the bones. © 2003 Elsevier Science Ltd. All rights reserved

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)