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ABSTRACT Over two subsequent seasons, emission of volatile compounds, consumer acceptability and quality parameters were analyzed in 'Fuji' apples. In both seasons, apples were harvested at the same maturity stage and stored for 19 or 30 weeks at 1C and 92% relative humidity under an ultralow oxygen (ULO) atmosphere (1% O2 + 1% CO2) or under an ULO atmosphere followed by different periods (2 or 4 weeks) in cold air. The results revealed, for both seasons, that 4 weeks of cold air storage after ULO storage helped to increase the emission of some volatile compounds for both storage period, including characteristic volatile compounds for the variety, and did not have a negative effect on quality parameters. Additionally, the consumer acceptability was superior for those fruits. PRACTICAL APPLICATIONS It is well known for various apple varieties that long-term storage under ULO conditions reduces volatile production resulting in poor flavor and aroma compared with fruits stored in air. Consequently, there is often dissatisfaction among consumers with the flavor of fruits which have been subjected to cold storage. The strategy that is proposed in the present work could be recommended to enhance the aromatic quality of fruit provided by the apple industry and, in consequence, increase its acceptability by consumers. [ABSTRACT FROM AUTHOR]

The production of aroma volatile compounds and standard quality attributes, in addition to lipoxygenase (LOX), hydroperoxide lyase (HPL), pyruvate decarboxylase (PDC), alcohol dehydrogenase (ADH) and alcohol o-acyltransferase (AAT) activities, were assessed during maturation of ‘Pink Lady®’ apples. Low production of aroma volatiles was observed in early harvested fruit, which gradually increased as ripeness approached. Hexyl acetate, hexyl 2-methylbutanoate, hexyl hexanoate, hexyl butanoate, 2-methylbutyl acetate and butyl acetate were prominent within the blend of volatiles produced by fruit throughout maturation. Multivariate analysis showed these compounds had the highest influence on differentiation of maturity stages, indicating that aroma volatile emission is an important factor for definition of fruit ripeness, which suggests production of these esters might be useful as an index of maturity. No large variations in AAT activity were found throughout the experimental period despite increasing ester emission, suggesting the enhancement of ester production by ‘Pink Lady®’ apples at ripening arises mainly from greater availability of substrates. Increased LOX activity was observed at later stages of fruit development, and the possible role of this enzyme activity on enhanced capacity for aroma volatile biosynthesis in more mature fruit is discussed. [Copyright &y& Elsevier]

Objective: The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption.Methods: A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii).Results: There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level.Conclusions: Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain. [ABSTRACT FROM AUTHOR]

The Spanish Euthanasia Law introduces a new right that is added to the portfolio of services provided by the Spanish health system and whose application is guaranteed within a period of 40 days. From the perspective of clinical experience, it is argued that without the effective right to quality palliative care and given the current shortcomings in dependant care, this law may send a threatening message to particularly fragile and dependant individuals that will lead to them feeling like a burden to their families and society. It is reasoned that basing the right to die on the dignity of the individual may have unexpected social repercussions. The text of the law presents the flaws of having been written hastily and without the support of advisory entities. There are issues that require clarification with regard to the application of euthanasia within the context of general practice. The conclusion is that this new law will pose more problems of the type it aims to resolve., (Copyright © 2021. Publicado por Elsevier España, S.L.U.)

Background and Purpose: Professional commitment is frequently used as a humanistic care indicator. Thus, it is important to design and validate a tool which is able to measure professional commitment of nurses in Spain. In this study we aimed to analyze the psychometric properties of the Nijmegen Professionalism Scale for Spanish (NPS-S) nursing in order to verify its validity and reliability., Methods: We undertook the pilot testing and psychometric validation of the NPS-S. A total sample of 249 nursing professionals from a variety of areas of expertise took part in this study. The STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Statement was used for reporting this research., Results: The NPS-S achieved a high degree of content validity, construct validity, internal consistency, temporal stability, and usability; this version is, thus, equivalent to the Nijmegen Professionalis Scale in its original version., Implications for Practice: Based on the results obtained from the validation of this tool, it is possible to affirm that the NPS-S is an effective instrument for measuring professional commitment in this population. The NPS-S will evaluate and thus contribute to the promotion of professional commitment in Spanish nursing. Additionally, it will serve to establish correlations between professional commitment and other variables including quality of care and patient satisfaction. Future studies should analyze the evaluation capacity of this tool., (© Copyright 2021 Springer Publishing Company, LLC.)

In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession., (Copyright © 2019. Publicado por Elsevier España, S.L.U.)

Objective: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations., Method: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories., Results: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation., Conclusions: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The concept of professional commitment is being widely studied at present. However, although it is considered an indicator for the most human part of nursing care, there is no clear definition for it, and different descriptors are being used indiscriminately to reference it., Objective: The aim of this study is to clarify the concept of professional commitment in nursing through the Rodgers' evolutionary concept analysis process., Design: Systematic search using English and Spanish descriptors and concept analysis. Studies published between 2009 and June 2015, front-to-back analysis of the Nursing Ethics journal and manual check of articles cited in studies related to the Nijmegen Professionalism Scale., Research Design: The procedure of concept analysis developed by Rodgers was used., Ethical Considerations: Although the topic was not labeled as sensitive and subject to ethical approval, its realization was approved by the Ethical Committee of Clinical Research of Aragon (CEICA) approved the study on 18 March 2015 and also careful procedures have been followed according to ethics expressed in the Declaration of Helsinki., Findings and Discussion: A total of 17 published studies. A clear definition of the concept was made, and surrogate terms, concept dimension, differential factors related to the concept, sociocultural variations and consequences for nursing practice were identified., Conclusion: There is a need for continuous advancement in the development of the concept, specific actions to encourage this and the improvement of evaluation methods for its study.

Objective: This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately., Methods: A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training., Results: There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects., Conclusion: There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.

Background and Purpose: The aim of this investigation was to perform the cross-cultural and linguistic translation and adaptation of the Nijmegen Professionalism Scale for Spanish nursing. Originally designed by Tromp et al. (2010) for its use by general practitioners, the new Spanish version of this tool assesses professional commitment, allowing for the comparison, prevention, association, and longitudinal monitoring of commitment among nursing professionals., Methods: The linguistic translation from English to Spanish was performed using the translation-back-translation method; the process of cross-cultural adaptation to the Spanish nursing context was carried out following the recommendations given by a panel of experts comprised of 24 practicing nurses with different professional backgrounds. The data for the feasibility study were collected between December 2015 and January 2016., Results: The original English version of the instrument contains 106 items and was originally developed for assessing professional behavior of general practitioner trainees; the new version, with a significant reduction in the initial number of items, comprises 49 items and is now ready for pilot testing and validation in our context., Implications for Practice: The Nijmegen Professionalism Scale in its Spanish version will act not only as a tool for measuring professional commitment among Spanish nurses but also as a motivational resource and means for reflection which will, in turn, increase the quality of the care provided by these professionals., (© Copyright 2019 Springer Publishing Company, LLC.)

[This corrects the article DOI: 10.1371/journal.pone.0146184.].

At the University of Zaragoza in Spain we developed an innovative way to teach the concept of confidentiality to medical students, which we tested by comparing the use of customized comics with more traditional methods. We proved that using comics is more attractive to students than lectures and class discussions, that it increases class participation and students' self-awareness of learning, and that it maintains the same academic results. We share our experience visually in a two-page comic., (© 2018 American Medical Association. All Rights Reserved.)

Aim: To reflect on the definition of compassion and analyse the concepts encompassed by the term., Background: A large number of authors have defined compassion, with certain nuances that differ from case to case. This raises the need for specificity in the definition of the term., Data Sources: First, a systematic search was conducted of scientific databases. Second, a selection of experts were consulted and a request made to them for specific articles. Third, the snowball method was used., Design: The keywords used in the literature search were 'compassion' and 'empathy', a MeSH term given for compassion. There are terms, such as self-compassion, compassion meditation, compassion fatigue and mindfulness, which, owing to their specific nature, were not included, because this study deals with the general aspects of compassion., Results: The systematic search found 104 articles, of which 6 articles were selected after applying the inclusion and exclusion criteria. The eight experts provided a total of 14 references, of which seven articles met the inclusion criteria. Finally, 15 references were identified with the snowball method (n=28)., Conclusions: Compassion originates as an empathic response to suffering, as a rational process which pursues patients' wellbeing, through specific, ethical actions directed at finding a solution to their suffering. We therefore define the term compassion to mean the sensitivity shown in order to understand another person's suffering, combined with a willingness to help and to promote the wellbeing of that person, in order to find a solution to their situation. This should be a duty in healthcare professionals' daily work.

Background: The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD., Methods: Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy., Findings: All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD., Conclusions: This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

The effects of various pulsed electric field (PEF) parameters on the extraction of polyacetylenes from carrot slices were investigated. Optimised conditions with regard to electric field strength (1-4 kV/cm), number of pulses (100-1500), pulse frequency (10-200 Hz) and pulse width (10-30 μs) were identified using response surface methodology (RSM) to maximise the extraction of falcarinol (FaOH), falcarindiol (FaDOH) and falcarindiol-3-acetate (FaDOAc) from carrot slices. Data obtained from RSM and experiments fitted significantly (p < 0.0001) the proposed second-order response functions with high regression coefficients (R2) ranging from 0.82 to 0.75. Maximal FaOH (188%), FaDOH (164.9%) and FaDOAc (166.8%) levels relative to untreated samples were obtained from carrot slices after applying PEF treatments at 4 kV/cm with 100 number of pulses of 10 μs at 10 Hz. The predicted values from the developed quadratic polynomial equation were in close agreement with the actual experimental values with low average mean deviations (E%) ranging from 0.68% to 3.58%.

Recently, we reported that the application of the strain CPA-7 of Pseudomonas graminis, previously isolated from apple, could reduce the population of foodborne pathogens on minimally processed (MP) apples and peaches under laboratory conditions. Therefore, the objective of the present work was to find an antioxidant treatment and a packaging atmosphere condition to improve CPA-7 efficacy in reducing a cocktail of four Salmonella and five Listeria monocytogenes strains on MP apples under simulated commercial processing. The effect of CPA-7 application on apple quality and its survival to simulated gastric stress were also evaluated. Ascorbic acid (2%, w/v) and N-acetyl-l-cysteine (1%, w/v) as antioxidant treatments reduced Salmonella, L. monocytogenes and CPA-7 recovery, meanwhile no reduction was observed with NatureSeal(®) AS1 (NS, 6%, w/v). The antagonistic strain was effective on NS-treated apple wedges stored at 10 °C with or without modified atmosphere packaging (MAP). Then, in a semi-commercial assay, efficacy of CPA-7 inoculated at 10(5) and 10(7) cfu mL(-1) against Salmonella and L. monocytogenes strains on MP apples with NS and MAP and stored at 5 and 10 °C was evaluated. Although high CPA-7 concentrations/populations avoided Salmonella growth at 10 °C and lowered L. monocytogenes population increases were observed at both temperatures, the effect was not instantaneous. No effect on apple quality was detected and CPA-7 did not survived to simulated gastric stress throughout storage. Therefore, CPA-7 could avoid pathogens growth on MP apples during storage when use as part of a hurdle technology in combination with disinfection techniques, low storage temperature and MAP., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

All efforts to improve fruit quality are rewarded when consumers are satisfied after tasting the fruit. Apples are often stored under controlled atmosphere conditions to preserve them over time, but this frequently results in a loss of flavor. The aim of this work, which was based on two seasons, was to evaluate the influence of a period of short-term air storage (periods of 2 and 4 weeks) after removal from ultralow oxygen (ULO) storage (1 kPa of O(2)/1 kPa of CO(2)) with respect to increases in volatile compound emissions and the effect on standard and sensory quality in 'Golden Reinders' apples. The results showed that emissions of 26 volatile compounds increased as a result of ULO + 2 weeks or ULO + 4 weeks of storage. However, the results of tastings involving a panel of consumers and trained experts revealed that this increase was not matched by corresponding increases in either the degree of consumer preference or flavor attributes.

An extra period under cold air after ultra-low oxygen storage has been shown to increase the concentration of some volatile compounds emitted by stored 'Fuji' apples. The purpose of this work was to assess the role, if any, of lipoxygenase and hydroperoxide lyase activities in the regeneration of fruit capacity for volatile production after ultra-low oxygen storage. Fruits were stored at 1 °C and 92% relative humidity under ultra-low oxygen (1 kPa of O2/1 kPa of CO2); one lot was kept under hypoxia for 19 or 30 weeks, a second lot was maintained for 17 or 28 weeks under these conditions and then stored for 2 weeks in cold air, and a third lot remained for either 15 or 26 weeks under ultra-low oxygen followed by 4 weeks under cold air. Samples were placed subsequently at 20 °C, and analyses of volatile emission and enzyme activities were undertaken 1 and 7 days thereafter. Fruit stored during 4 weeks in cold air after ultra-low oxygen storage showed the highest capacity for volatile regeneration. Higher emission of volatiles by these samples was concomitant with higher levels of lipoxygenase activity. Results suggest that lipoxygenase activity, particularly in the flesh tissue, was strongly related to the regeneration of the emission of volatile compounds allowed by the extra period in cold air after ultra-low oxygen storage and, thus, appears to be a key control point for successful recovery of fruit ability for volatile compound production.

The aim of this work was to assess whether extra time spent under AIR conditions after storage in an ultra low oxygen (ULO) atmosphere could allow the regeneration of volatile compound emission without negatively affecting quality parameters and the consumer acceptability of Fuji apples. Fruits were stored for 19 and 30 weeks at 1 degrees C and 92% RH under ULO atmosphere conditions (1 kPa O 2:1 kPa CO 2) or under ULO conditions followed by different periods (2 and 4 weeks) in cold AIR atmosphere (ULO + 2w or ULO + 4w, respectively). Standard quality and emission of volatile compounds were analyzed after storage plus 1 and 7 days at 20 degrees C. Sensory attributes and acceptability were also determined after 7 days at 20 degrees C. The extra period of 30 weeks in an AIR atmosphere after ULO storage resulted in an increase in the concentration of the compounds that most contribute to the flavor of Fuji apples. These fruits were relatively well accepted by consumers despite a slight decline in firmness and acidity.