High Acceptance Research Articles

Young, deprived women are more at risk of testing positive for Chlamydia Trachomatis: results from a cross-sectional multicentre study in French Health Examination Centres.

ObjectivesChlamydia Trachomatis (CT) is the most sexually transmitted infection in France. This study aimed to assess the feasibility of systematic screening for CT among people attending a preventive health examination in Health Examination Centres (HECs) and to compare positive CT cases according to deprivation. DesignA cross-sectional multicentre study in thirteen HECs in France in January 2018. MethodsSelf-sampling CT screening was proposed among 18-25 years women and 18-30 years men, who were sexually active and without recent CT treatment. Related data and referred specimens were collected among attendees for the study, including deprivation and health status. CT positivity was estimated by genders. We explored association between CT infection and deprivation by univariate and multivariate modelling. ResultsThe CT screening was proposed to 1701 eligible young people. 90.1% [88.6-91.5] accepted and participated with 43.6% being women, 54.3% being deprived people. 75.4% [72.1-78.6] screened women performed self-taken vaginal swabs and others took urinary tests. Screening was conducted in 1486 people. Overall prevalence of CT infection was 4.7% [3.7%-5.9%], significantly higher for women than men (6.4% vs 3.4%, p=0.009). Among women, being deprived increased the likelihood of CT positivity (aOR 4.95; 95% CI 2.02 to 12.00) more than it did for men. ConclusionsIndividual deprivation was significantly associated with having a CT infection among women. The feasibility of CT screening in HECs was demonstrated, with a high acceptance, and led to the implementation of CT screening in all HECs. Promoting access to CT screening to deprived population might contribute to reduce social inequalities in health.

Advanced technology in fruit preservation: Effects of nanoscale charged water particles on storage quality and reactive oxygen species in blueberries

During the postharvest period, blueberries with a short shelf life due to microbial activity and an overload of reactive oxygen species (ROS) were still a major unresolved problem. In this study, the effect of nanoscale charged water particles (NCWP) treatment on the postharvest characteristics and ROS metabolism in blueberries (Vaccinium ashei Reade) were investigated. The results showed that NCWP treatment significantly inhibited microbial growth, maintained high firmness and commercial acceptability, and extended the storage period of blueberries. The nutrient of blueberries was retained and elevated after NCWP treatment, especially in the 6 d of NCWP-9 h treatment, the total phenol and anthocyanin content reached the peak at 565.1 mg/L and 5.26 mg/g, which contribute to the total antioxidant capacity of blueberries increased. SEM showed that NCWP-9 h treatment maintained the integrity of the cuticular wax of the blueberry peel, which indirectly decelerated the decline of blueberry firmness. The NCWP treatment significantly enhanced the antioxidant enzyme system of blueberry peel. On days 2, 4 and 6 after NCWP-9 h treatment, the CAT, SOD and APX activities were significantly different from the control group (P < 0. 05), with 585.09 ΔA/min/g, 79.34 U/g and 3.32 umol/min/g, respectively, which effectively scavenged the oxidative stress markers (H2O2, O2−) accumulated in the blueberry peels, and slowed down the aging and deteriorated of the blueberry process. This finding demonstrates that NCWP is an effective postharvest preservation method for blueberries and provides a viable strategy for quality maintenance in the postharvest fruit and vegetable sector.

Recent Advances in Orally Disintegrating Tablet: Properties, Formulation and Production

: Healthcare practitioners, patients, and consumers widely recognize the convenience as-sociated with administering oral tablets. The emergence of orally disintegrating tablets (ODTs) represents a significant advancement in solid dosage forms, facilitating more convenient oral de-livery while maintaining medication safety, effectiveness, and quality. The ODTs market is ex-pected to experience continuous growth in the coming years despite the internal challenges faced by commercial manufacturers. This paper initiates a comprehensive discussion of the properties of ODTs, including palatability and taste, drug content, disintegration, mechanical strength, mois-ture content, safety, and efficacy. The formulation factors that affect each of these qualities are also discussed. Additionally, this review delves into the processes of the production of ODTs, en-compassing the approaches and technologies from the mixing of active ingredients and recipients to the formation and packaging of ODTs. This review provides valuable insights into the ad-vancement in ODTs technology, aiming to equip researchers with the knowledge necessary to improve quality and optimize efficiency, ultimately receiving high acceptance from patients or consumers.

The Sleep Course: An inclusive trial examining the feasibility, acceptability, and preliminary efficacy of a digital sleep intervention for adults with self-reported sleep difficulties

Cognitive Behavioural Therapy for Insomnia (CBTi) is a well-established first-line treatment for insomnia and sleep difficulties, yet numerous barriers hinder its widespread adoption. One potential criticism of the existing evidence base for CBTi is that many trials exclude participants that would commonly be seen in in primary care, such as those aged over 65, with comorbid health conditions, or prescribed sleep medication. The current pilot study therefore aimed to assess the acceptability and efficacy of a brief, digitally delivered sleep intervention, the Sleep Course using a broad range of participants. Participants (n = 74) completed the 6-week, 4-lesson intervention alongside measures of sleep disturbance, sleep-related impairment, depression, anxiety and sleep-wake patterns (via sleep diary). Generalized estimating equations analysis modelled change in participants' outcomes from pre- to post-treatment and 3-month follow-up, and subgroup analyses explored the role of possible moderators (e.g., age over 65, co-morbidities, and concurrent prescription medication use). The intervention was associated with good rates of satisfaction (79 %) and lesson completion (70 %). Results showed significant and large reductions in insomnia, sleep disturbance and associated symptoms (e.g., d = 1.06–1.37 change in insomnia symptoms). Evidence of high acceptability and clinical improvement was found irrespective of age, physical comorbidity, and sleep medication use. However, there was evidence of less improvement among those taking medications or having tried psychological treatment in the past. These results provide strong preliminary evidence for the intervention as an acceptable, efficacious and scalable treatment for a broad range of participants with sleep difficulties. Larger randomised controlled trials are needed.

Digital Transformation in Family Businesses: An Analysis of Drivers with fsQCA

The digital transformation (DT) encompasses profound technological changes. Businesses face the challenge of adapting their activities to the pace of new technologies to increase the efficiency of business processes, improve the customer experience, and create innovative value propositions while recognizing the importance of sustainability. This research focuses on how family businesses, which are a relevant part of global economic activity and job creation, address the challenges associated with the DT. Based on the case of the automotive retail sector in a small European country characterized by the high acceptance of technologies, we use fuzzy-set qualitative comparative analysis (fsQCA) to understand how critical success factors (causal conditions) combine towards adopting technologies representing different perspectives of the DT. The results confirm the existence of multiple configurations based on the importance of organizational culture, change management, knowledge, human capital, IT systems, and DT strategy towards the adoption of customer relationship management, digital marketing, and social networks technologies, thus helping family businesses to understand the adoption of these technologies leading to organizational success in the context of the DT.

Acceptability of Forensic Sexual Assault Telehealth Consultation.

Introduction: Telehealth shows promise in increasing access to specialty care for individuals who experience sexual assault. Methods: This study analyzed 466 cases from rural and urban hospitals between September 2018 and March 2024, examining telehealth acceptability rates and reasons for declination. Of 362 eligible cases, 89.5% accepted telehealth consultation. Among those who declined, 65.8% were not given the opportunity to interact with a telehealth sexual assault nurse examiner(teleSANE) during decision-making. Results: These findings indicate high acceptability of forensic sexual assault telehealth and suggest that providing patients the opportunity to interact with teleSANEs before deciding may further increase acceptance. Conclusion: The study contributes to understanding telehealth's viability for sexual assault care across diverse settings and demographics, supporting the potential of teleSANE programs to enhance equitable access to specialty care, particularly in underserved areas. This research addresses gaps in existing literature by exploring acceptability in a wide range of settings, demographics, and circumstances.

Successful Implementation of Nirsevimab and Factors Influencing Uptake in Neonatal Care.

Objective: To describe the implementation of nirsevimab for the prevention of respiratory syncytial virus (RSV)-associated lower respiratory tract disease in a pediatric hospital, focusing on strategies to ensure equitable access and address logistical challenges. Additionally, we aimed to identify predictors of nirsevimab deferral among eligible infants. Patients and Methods: Our hospital implemented a universal immunization campaign to all eligible infants, including those discharged from the newborn nursery, intermediate care nursery (ICN), and neonatal intensive care unit (NICU). We identified key drivers and barriers, formed a multidisciplinary team, and applied a systematic approach for integration of nirsevimab orders into existing workflows. We developed and disseminated educational resources for staff and caregivers. After the implementation, we conducted univariate and multivariate analyses to identify predictors of nirsevimab deferral to evaluate implementation success and possible gaps. Results: Despite challenges, we offered nirsevimab to 99% of eligible infants prior to discharge from the newborn nursery, ICN, and NICU with 71% receiving the immunization. On multivariate analysis, independent predictors of nirsevimab deferral included preferred language of English, deferral of hepatitis B vaccine, discharge from the newborn nursery, and public insurance. Conclusions: Our implementation strategy ensured equitable access to nirsevimab for newborns, with both our high uptake and acceptance rate underscoring the effectiveness of our approach. Key strategies for success included early stakeholder engagement, multidisciplinary collaboration, and proactive logistical planning. Our approach serves as a model for other institutions to offer nirsevimab prior to hospital discharge and highlights the importance of addressing both clinical and socioeconomic barriers.

Effect of lotus (Nelumbo Nucifera, G.) rhizome powder as a fat replacer on the quality attributes of muffins

Lotus (Nelumbo nucifera, G.) is a perennial aquatic plant, which is utilized for a variety of therapeutic and food applications. Muffins are a kind of baking product that is typically consumed for breakfast or as a snack. Currently, many baked goods in the market use fat replacers to lower the overall fat content, while conserving consumer approval. The study's objectives were to produce low-fat muffins and to characterize the types of quality changes that occurred in the muffins. Lotus rhizome was sliced, dried and converted into powder, which used as fat substitute in muffins, at 0, 5, 10, 15 and 20% replacement levels, with names as M0, M1, M2, M3 and M4, respectively. Composite flours having these proportions of lotus Rhizome Powder (LRP) were analyzed for proximate and rheological parameters. Increasing levels of LRP caused increased water absorption and dough development time of the composite flours. Proximate analyses of muffins showed highest value of moisture (25.05%), ash (2.43%), fiber (0.99%), protein (11.89%) and NFE (58.45%) in M4. Whereas, fat content and energy value were significantly reduced in M4, as highest fat was found to be in M0 (36.65%) and highest calories in M0 (576.5 kcal), which were significantly reduced to 26.24% and 514.5 kcal, respectively in M4. High yeast and mold count was of M0 at first day as 98 CFU/g, which was increased to 129 CFU/g at day 7, whereas M4 presented this count to be 44 CFU/g at day one, which was increased to 70.33 CFU/g at day 7. Texture analysis showed softest texture of M4 as firmness value was 1887 g, which was significantly high in M0 as 2285 g. The research revealed that M3 best performed out of all treatments as 15% replacement of fat with LRP significantly improved the rheological properties of the flour, ash and fiber content were high, whereas fat contents were significantly low in these muffins. Textural and sensory analysis also supported the M3 due to softer texture and significantly high color, appearance, flavor, and overall acceptability scores. From the results of this study, it could be concluded that a 15% replacement of shortenings with LRP could be considered as optimum for developing good quality baked muffins.Graphical

A first look at diversity gaps in psychotherapy research publications and representation

Objective There is a pervasive underrepresentation of researchers and clinicians from diverse backgrounds in psychology. This is the first study to focus on diversity gaps in Psychotherapy Research. We examine a gap in the representation of research from low-income countries and summarize barriers and solutions to increase diversity in the field. Method We examined trends in submission, acceptance, and rejection rates of all submissions (n = 7183) from 75 countries, representing eight geographical regions to Psychotherapy Research, between 28 April 2005 and 22 June 2023. Results Most submissions were from Europe and North America, with the fewest from Africa and Asia/Northeast Asia. High-income countries had significantly more submissions than low-income countries, with gaps increasing over time. North America and Europe had the highest acceptance rates and Africa and Asia/Southeast Asia had the lowest rates. Conclusion Psychotherapy Research is one of the most internationally representative journals in the field. Yet, we found underrepresentation of non-western countries. There is a need to increase the representation of research participants and researchers from non-western countries through direct initiatives and investments in research and researchers from underrepresented backgrounds.

Nutrients Composition of Acha Base Complementary Food Supplemented with Soybean and Sweet Potato Flour

Poor complementary food and feeding had been shown to increase the morbidity and mortality among under-five children in developing countries in which Nigeria is not exempted. This study aimed at evaluating the Nutrients Composition of Acha -Based complementary food supplemented with soybean and sweet potato flour. Raw materials used for the formulated of the complementary were purchased from Erekesan market in Akure Local Government Area of Ondo State. Five (5) samples were formulated in different ratios of Acha (100:70:60:50:40), Soyabean (20:25:30:35) and Orange flesh sweet potato (10:15:20:25). Samples were subjected to chemical and instrumental analysis in line with standard method. The data obtained were statistically analyzed using ANOVA to test for the significant difference among means (P&lt;0.05) using Statistical Package for Social Science (SPSS version 22). Finding shows that Moisture, crude fibre, and carbohydrate was significantly (p&lt;0.05) higher in sample Awhile, Sample E was significantly (p&lt;0.05) higher protein (18.42%) and fat (12.40%) compared to other formulated samples. The Moisture, crude fibre, and CHO was significantly (p&lt;0.05) decreases with decreased in the quantity of Acha use in the formulation of the CFs while crude fat, Ash and protein increases with increase in the quantity of soybean incorporated in the formulations. Sample E is significantly (P&lt;0.05) higher in vitamin B1, B3 and B9 compared with sample A. vitamin B1, B3 and B9 increases with increase in the quantity of soybean and OFSP. All the samples have appreciable amount of sodium, calcium, phosphorus, magnesium and potassium but, zinc and iron was low in the entire sample. Sample E was exceptional in all the minerals but significantly (p&lt;0.05) lower in Zinc and iron. The mean sensory scores revealed that sample C was different in after taste, flavour, mouth feel, colour and overall acceptability. The mean scores increase with increase in the proportion of soybean and potato in the formulated complementary food samples in terms of all the sensory attributes tested. The scores showed that sample C had the highest acceptability by the panelists. The complementary foods had improved nutrients that can support optimal nutrition of undernourished children and other older people.

Acceptance Towards COVID-19 Vaccination in Breast Cancer Patients: An Analytical Cross-Sectional Study in A Tertiary Care Hospital of Rawalpindi, Pakistan

Objective: To determine the level of COVID-19 vaccine acceptance among patients diagnosed with breast cancer. Study Design: Analytical cross-sectional. Place and Duration of Study: The study was conducted in Breast Cancer Outpatient Department located in a tertiary care hospital in Rawalpindi, Pakistan from Nov 2021 to Jul 2022. Methodology: Validated questionnaire was used to collect data from patients diagnosed with breast cancer. Sample size of n=134 was attained using non-probability consecutive sampling. Data was analyzed using SPSS version 22. A p-value of &lt;0.05 was taken as significant. Outcome assessed was whether breast cancer patient’s personal level of knowledge, mindset, motivation, and concerns towards getting about COVID-19 vaccination helped or hindered their acceptance of COVID-19 vaccination. Results: COVID-19 vaccine acceptance was found among 124(92.5%) breast cancer patients. Social media and means of mass communication such as television were significant sources of information for COVID-19 related vaccine information (p&lt;0.05). A strong positive correlation was found between Total Vaccine Acceptance Score with domains of Knowledge (r=0.353, p&lt;0.000), Mindset (r=0.662, p&lt; 0.000), Motivation (r=0.780, p&lt; 0.000) and Concerns (r=0.800, p&lt; 0.000). Higher awareness with positive motivators and mindset of participants lead to greater acceptance of COVID-19 vaccines despite breast cancer diagnosis. Conclusion: High vaccine acceptance was found among breast cancer patients. High scores of COVID-19 disease knowledge, positive mindset and high motivation towards COVID-19 vaccines leading to a higher overall vaccine acceptance.

How to improve sustainability of nutrient dense diets for children and adolescents: an exemplary assessment in Germany

BackgroundThe global climate crisis requires a paradigm shift in dietary concepts, respecting the needs of children. A global reference diet has been suggested by the EAT-Lancet Commission. On this basis, the detailed “Planetary Health Diet Index” (PHDI) has been proposed. The objective of this assessment is (1) to apply the PHDI to the Food-Based Dietary Guidelines, the so-called Optimized Mixed Diet (OMD) for children and adolescents in Germany in its original composition and (2) to check how the planetary value of the OMD could be improved by modifying food selection within meals while keeping the high nutrient densities of the guideline diet.MethodsThe PHDI specifies 16 food groups and their proportion of total daily energy intake. The PHDI of the original OMD was calculated by assigning the foods of the 7-day menu to the PHDI food groups in order to score them. In this way, it became apparent which food groups had the potential to improve the sustainability. The diet was then updated by either reducing or increasing individual foods from these food groups in the meals and deriving the resulting PHDI. The nutrient densities of the original and updated daily OMD were calculated.ResultsThe original diet obtained a PHDI score of 68.24 points, representing 45.5% of the theoretical maximum of 150 points. The following food groups achieved 9.9 to 10 out of 10 points: fruits, total vegetables, fish & seafood, vegetable oils, chicken (and substitutes). Conversely, food groups receiving a zero score included tubers & potatoes, dairy, red meat, animal fat, and added sugars. The updated diet resulted in increased consumption of ‘nuts & peanuts’, ‘legumes’, ‘green vegetables’, ‘whole grains’, and decreased consumption of ‘tubers & potatoes’ and ‘red meat’. Overall, the PHDI increased from 68.24 to 81.51 points with the updated OMD, reflecting a 13.27% increase compared to the original diet. The nutrient densities were not significantly affected, but even slightly increased for most nutrients.ConclusionsThe PHDI was applied to demonstrate how the sustainability of the guideline diet for children and adolescents in Germany could be improved through changes in individual food groups that can be easily implemented in practice while maintaining high nutrient densities and acceptability for children.Trial registrationNA.

Factors influencing demand and acceptance of hospice care among Chinese older adults: A meta-analysis

ABSTRACT This study aimed to systematically integrate existing research findings on relevant factors influencing Chinese older adults to choose hospice care, thus providing targeted theoretical support and a basis for the promotion of hospice care services in China. The literature on factors affecting the older adults’ choice of hospice care services were retrieved from nine databases, including PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Wanfang Data, VIP, CBM, and SinoMed. The data were extracted and analyzed using Revman5.3 and Stata17.0. A total of 11 articles are incorporated, and 13 related factors are extracted. The meta-analysis results show that the demand and acceptance of hospice care services in the older adults are related to age (RR = 1.39, 95% CI (1.17,1.65), p = 0.0002), education level (RR = 1.94, 95% CI (1.42,2.63), p < 0.001), marital status (RR = 1.21, 95% CI (1.05,1.40), P = 0.007), death attitude (RR = 1.21, 95% CI (1.53,9.45), p = 0.004), having experienced or witnessed emergency treatment (RR = 2.07, 95% CI (1.51,2.85), p < 0.001), and living condition (RR = 1.32, 95% CI (1.00,1.73), P = 0.05). The elders who are at an advanced age, well educated, unmarried in solitude, and have experienced or witnessed emergency treatment have a high demand and acceptance of hospice care services

Meeting the Relational and Developmental Needs of Young Children Exposed to Potentially Traumatic Events Through Trauma-Informed Care

ABSTRACT This study examined the acceptability, feasibility, satisfaction, and preliminary effectiveness of the Ready to Learn Through Relationships (RLR) Program, a culturally-attuned and developmentally appropriate program designed to facilitate universal integration of trauma-informed care (TIC) in early childhood education (ECE) settings. Pre- and post-intervention surveys were administered to assess ECE professionals’ TIC knowledge, beliefs, and practices. Low-intensity (Lo-RLR) and high-intensity (Hi-RLR) versions were implemented to assess the level of support needed to impact educators. Research Findings: Participants reported high program acceptability, feasibility, and satisfaction. Hi-RLR participants reported greater program adoption and a desire for more coaching and consultation. Teachers in both conditions reported greater TIC practice-use. Hi-RLR teachers reported greater improvements in some cases. From pre- to post-intervention, Hi-RLR teachers reported more favorable attitudes toward TIC; Hi-RLR and Lo-RLR teachers reported greater use of self-care practices; coaches reported greater preparedness to support children exposed to trauma; and the magnitude of change in self-reported knowledge was greater for Hi-RLR than Lo-RLR teachers. Additionally, Hi-RLR teachers had more TIC-favorable attitudes than Lo-RLR teachers at post-intervention. Practice or Policy: Findings have implications for enhancing the RLR Program and informing the development of similar programs to support educators’ integration of TIC in ECE settings.

First report of Colletotrichum nymphaeae causing anthracnose on Hass avocados in Brazil.

The Hass cultivar is one of the most cultivated and distributed avocado varieties throughout the world, having high productivity, nutritional quality, market acceptance and adaptation to different climatic zones (Dreher and Davenport 2013). Anthracnose affects avocado production in tropical and subtropical regions, causing economic losses, especially post-harvest (Fuentes-Aragón et al. 2020). Correct identification of Colletotrichum species causing anthracnose is essential, as different species vary in important phenotypes such as virulence and sensitivity to fungicides (Chen et al. 2016). Twelve samples from batches of avocados with anthracnose were collected in Minas Gerais State, Brazil, in September 2023. The observed symptoms were brown to black depressed circular spots, ranging from a few millimeters to 3 cm in diameter on the epicarp of the fruits, covered in center by mucilaginous layers of pathogen sporulation. Isolation was performed directly from the spore masses and monoconidial isolates were cultured in PDA at 25°C for 7 days for morphological characterization and preserved in sterile water at 4°C. One of the morphotypes commonly recovered from lesions, represented by isolate UCBV 362 (Culture Collection COAD 3843), formed fast-growing colonies having white aerial mycelium and intense salmon-colored sporulation. The cylindrical conidia were 13 to 17.5 μm long and 4.5 to 7 μm wide (average 14.5 x 5.7 μm, N=100), produced on conidiophores dispersed in the aerial mycelium or aggregated on melanized conidiomata formed on the agar. The partial sequence of the second largest subunit of the RNA polymerase II gene (RPB2) from isolate UCBV 362 (GenBank: PQ034617, 1116 nt) showed 99% of coverage and 99.37% of nucleotide identity with the RPB2 sequence of the ex-epitype strain of Colletotrichum nymphaeae ICMP 17918 (=CBS 515.78) (GenBank: JN985506). In a Maximum Likelihood phylogenetic tree composed with RBP2 sequences from reference strains of the Colletotrichum acutatum species complex, the isolate UCBV 362 formed a highly supported clade with the ex-epitype and other reference strains of Colletotrichum nymphaeae, occupying the Clade 2 of the species complex together with C. scovillae and C. simmondsii (Damm et al. 2012). This result shows the reliability of RPB2 for phylogeny and species delimitation within Colletotrichum. To confirm pathogenicity, 10-mm discs from a 7-day-old colony were inoculated at 3 different points on healthy-looking avocado fruits and incubated at 28°C. Uninoculated fruits served as controls. The first symptoms appeared 5 days after inoculation and were similar to those observed in the original samples, while the fruits in the control group remained asymptomatic. The pathogen was reisolated from the lesions and identified morphologically, fulfilling Koch's postulates. Colletotrichum nymphaeae has been associated with avocado anthracnose in Mexico (Fuentes-Aragón et al. 2020). In Brazil, a study based on molecular phylogeny identified Colletotrichum siamense and C. karsti as etiological agents of this disease (Soares et al. 2021). This report expands the range of species that cause avocado anthracnose in Brazil and provides etiological information for the implementation and monitoring of control methods, especially chemical control.

Development of a Novel Gluten-Free Cookie Premix Enriched with Natural Flours Using an Extreme Vertices Design: Physical, Sensory, Rheological, and Antioxidant Characteristics

This work aimed to develop novel alternative gluten-free premixes for use in the production of cookies by optimizing the formulation of three different starches (corn, potato, and tapioca starch) in a rice/corn formula and then enriching the optimized formula with various natural flours (acorn, soy, chestnut, chickpea, millet, and quinoa). An extreme vertices mixture design was used to optimize the mixing sub-part consisting of 30% (w/w) of starches. The enriched gluten-free cookies were characterized by physical, rheological, antioxidant, color, and sensory properties. An optimum was obtained by mixing 18.5084 g of corn starch, 6 g of potato starch, and 5.4916 g of tapioca starch. The enrichment results indicated that soy-enriched gluten-free cookies have a high specific volume (2.428 cm3/g) with the highest spread ratio (12.25) compared to other cookies. The rheological properties of enriched gluten-free doughs indicated a higher value of the consistency coefficient (K) of soy-enriched gluten-free cookies. The antioxidant characteristics were enhanced by replacing corn with several types of flours, with higher TPC for acorn (2.83 mg GAE/g dw) and soy-enriched cookies (2.49 mg GAE/g dw) with better antioxidant activities (DPPH, ABTS, and RED). The tasters gave all the cookies favorable ratings for overall acceptability. With an average rating of 7.09, cookies enhanced with chickpea flour have a high acceptability compared to the other cookies. Considering all the tested parameters, PCA analysis clustered millet, corn, quinoa, and chestnut gluten-free enriched cookies into the same group. However, acorn and soy cookies were placed in a separate group, and chickpea-enriched cookies were classified separately.

Utilization of Fish Skin Gelatin for Nutritional Value Enhancement of Avocado‐Based Low‐Fat Ice Cream

ABSTRACTGelatin is one of the most widely used food ingredients, with wide applications in the food industry as stabilizing, gelling, and foaming agents. Fish skin is the basic source of gelatin, which contains a high amount of protein. The results show that the proximate compositions (protein, fat, ash, moisture, fiber, carbohydrate, and total energy) of the optimized ice cream product with ingredient compositions of (30% milk, 40% avocado pulp, 10% sugar, 15% gelatin, and 5% cream) show values of 3.26 ± 0.35, 9.32 ± 0.22, 2.79 ± 0.02, 57.83 ± 0.14, 3.46 ± 0.24, 23.26 ± 0.71, and 190.54 ± 0.02, respectively. Also, the microbe load in the optimized ice cream product was not detected up to 1 week, while total plate count and Staphylococcus aureus bacteria were starting to grow up after a week, and the results of panelists from sensory values indicate high acceptability of products with the aim of assessing the influence of fish skin gelatin on the nutritional values of avocado‐based low‐fat ice cream. Considering the results, gelatin has a significant effect on the nutritional and rheological properties of ice cream, specifically striking visibility on protein composition.

A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals

BackgroundDespite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS).MethodsA stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level.ResultsCompared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38–6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53–63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as ‘good’ or ‘very good.’ No unintended harms were reported.ConclusionsThe VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists.Ethics numberGWHREC 2019/ETH13355.Trial registrationANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities.

Optical Diagnosis in the Era or Artificial Intelligence.

The development of new image enhancement modalities and improved endoscopic imaging quality have not led to increased adoption of resect-and-discard in routine practice. Studies have shown that endoscopists have the capacity to achieve quality thresholds to perform optical diagnosis, however, this has not led to acceptance of optical diagnosis as a replacement for pathology for diminutive (1-5mm) polyps. In recent years, Artificial Intelligence (AI)-based Computer Assisted Characterisation (CADx) of diminutive polyps has recently emerged as a strategy that could potentially represent a breakthrough technology to enable widespread adoption of resect-and-discard. Recent evidence suggests that pathology-based diagnosis is suboptimal, as polyp non-retrieval, fragmentation, sectioning errors, incorrect diagnosis as 'normal mucosa', and inter-pathologist variability limit the efficacy of pathology for the diagnosis of 1-5mm polyps. New paradigms in performing polyp diagnosis with or without AI have emerged to compete with pathology in terms of efficacy. Strategies, such as Autonomous AI, AI-assisted human diagnosis, AI-unassisted human diagnosis, and combined strategies have been proposed as potential paradigms for resect-and-discard, although further research is still required to determine the optimal strategy. Implementation studies with high patient acceptance, where polyps are truly being discarded without histologic diagnosis are paving the way towards normalizing resect-and-discard in routine clinical practice. Ultimately the largest challenges for CADx remain liability perceptions from endoscopists. The potential benefits of AI-based resect-and-discard are many, with very little potential harm. Real world implementation studies are therefore required to pave the way for the acceptability of such strategies in routine practice.

High acceptability of point-of-care HIV testing at the colposcopy outpatient clinic in hospitals in the Netherlands.

Cervical cancer and its precursor are labeled as HIV indicator conditions, justifying the recommendation of HIV testing for all patients. This study aimed to assess the acceptance and patients' and gynecologists' perceptions on HIV testing in patients with cervical dysplasia at the colposcopy outpatient clinic in hospitals in the Netherlands. A cross-sectional study was conducted between May 2021 and February 2023 to implement point-of-care HIV testing in five hospitals in the Rotterdam region, the Netherlands. We included patients aged 18 years and older, without documented HIV, presenting with cervical dysplasia. The primary outcome was the HIV test acceptance rate. Secondary outcomes were the HIV positivity rate and the association between dysplasia severity and test acceptance. We also assessed patients' and gynecologists' perspectives on this testing strategy with a questionnaire. Of 563 patients, 523 accepted HIV testing, resulting in a test acceptance rate of 92.9% (95% confidence interval, 90.45%-94.88%). Testing rates were consistent among participating hospitals (91.6%-100.0%) None of the patients tested positive for HIV. Severity of dysplasia was not associated with test acceptance (P = 0.768). Most patients (n = 500, 96.0%) reported good or higher experience with this testing strategy. The main barriers for gynecologists to offer HIV testing were lack of time (n = 22, 33.9%) and fear to offend a patient (n = 7, 12.5%). Less than half (n = 19, 39.3%) of gynecologists believed an HIV test should be offered to all patients with cervical dysplasia. Point-of-care HIV testing at colposcopy outpatient clinics was well accepted by patients. The data indicate that the primary barrier lies with the physicians to offer such testing.