High-value Health Research Articles

Social Determinants of Health and Insurance Claim Denials for Preventive Care.

The Patient Protection and Affordable Care Act (ACA) eliminated out-of-pocket cost-sharing for recommended preventive care for most privately insured patients. However, patients seeking preventive care continue to face cost-sharing and administrative hurdles, including claim denials, which may exacerbate inequitable access to care. To determine whether patient demographics and social determinants of health are associated with denials of insurance claims for preventive care. This cohort study of patients insured through their employers or the ACA Marketplaces used claims and remittance data from Symphony Health Solutions' Integrated DataVerse from 2017 to 2020; analysis was completed from January to July 2024. Seeking preventive care. The primary outcome was the frequency of insurer denials for preventive services across 5 categories: specific benefit denials, billing errors, coverage lapses, inadequate coverage, and other. Subgroup analysis was performed across patient household income, education, and race and ethnicity. Secondary outcomes included charges for denied claims, approximating patients' remaining financial responsibility for care. A total of 1 535 181 patients received 4 218 512 preventive services in 2 507 943 unique visits (mean [SD] age at visits, 54.02 [13.19] years; 1 804 637 visits for female patients [71.96%]); 585 299 patients (23.30%) had an annual household income $100 000 or higher, and 824 540 patients had some college education (32.88%). A total of 20 658 individuals (0.82%) were Asian, 139 950 (5.58%) were Hispanic, 219 646 (8.76%) were non-Hispanic Black, 1 372 223 (54.72%) were non-Hispanic White, and 25 412 (1.0%1) were other races and ethnicities not included in the other 4 groups. Of preventive claims, 1.34% (95% CI, 1.32%-1.36%) were denied, consisting mainly of specific benefit denials (0.67%; 95% CI, 0.66%-0.68%) and billing errors (0.51%; 95% CI, 0.50%-0.52%). The lowest-income patients had 43.0% higher odds of experiencing a denial than the highest-income patients (odds ratio, 1.43; 95% CI, 1.37-1.50; P < .001). The least educated enrollees had a denial rate of 1.79% (95% CI, 1.76%-1.82%) compared with 1.14% (95% CI, 1.12%-1.16%) for enrollees with college degrees. Denial rates for Asian (2.72%; 95% CI, 2.55%-2.90%), Hispanic (2.44%; 95% CI, 2.38%-2.50%), and non-Hispanic Black (2.04%; 95% CI, 1.99%-2.08%) patients were significantly higher than those for non-Hispanic White patients (1.13%; 95% CI, 1.12%-1.15%). In this cohort study of 1 535 181 patients seeking preventive care, denials of insurance claims for preventive care were disproportionately more common among at-risk patient populations. This administrative burden potentially perpetuates inequitable access to high-value health care.

Hydroxycinnamate decarboxylase in Metschnikowia pulcherrima promotes the formation of vinylphenolic pyranoanthocyanins to enhance the color stability of blueberry wine

Blueberry wine is popular among consumers due to its high nutritional value, appealing color, and potential health benefits. However, the instability of its color during the brewing process poses challenges for storage and the overall growth of the blueberry wine industry. This study found that vinylphenolic pyranoanthocyanins in blueberry wine provide a more stable color than their anthocyanin precursors. The presence of yeast with hydroxycinnamic acid decarboxylase (HCDC) enhances the formation of vinylphenolic pyranoanthocyanins. Metschnikowia pulcherrima Y4, isolated from decayed blueberry peels, promotes the production of six specific vinylphenolic pyranoanthocyanins in blueberry wine: malvidin-4-vinylcatechol, delphinidin-3-arabinoside-4-vinylcatechol, cyanidin-3-galactoside/glucoside (C3G)-4-vinylcatechol, cyanidin-3-O-arabinoside-4-vinylcatechol, malvidin-3-O-glucoside/galactoside-4-vinylcatechol, and C3G-4-vinylphenol. Blueberry wine fermented solely with M. pulcherrima Y4 exhibits a 25% increase in light stability under direct outdoor light conditions and a 19% increase in temperature stability at 60 °C compared to Saccharomyces cerevisiae K1. Furthermore, the use of M. pulcherrima Y4 in fermenting blueberry wine significantly decreases the time required to form vinylphenolic pyranoanthocyanins to eight days. Hence, M. pulcherrima Y4 is highly effective in accelerating the synthesis of these compounds, providing a valuable approach for improving the stability and color of blueberry wine.

Exploring the Health Benefits of Boletus aereus Polysaccharides: Extraction, Structural Characterization, and Antiproliferative Properties against Non-Hodgkin's Lymphomas (NHLs).

Boletus aereus Fr. ex Bull. stands out as a delectable edible mushroom with high nutritional and medicinal values, featuring polysaccharides as its primary nutrient composition. In our continuous exploration of its beneficial substances, a novel polysaccharide (BAPN-1) with a molecular weight of 2279 kDa was prepared. It was identified as a glucan with a backbone composed of the residues →4)-α-Glcp-(1→ and →4,6)-α-Glcp-(1→ connected in a proportion of 5:1 and a β-Glcp-(1→ side residue attached at C6 of the →4,6)-α-Glcp-(1→ residue. Biologically, BAPN-1 exhibited broad-spectrum antiproliferative activities against various NHL cells, including HuT-78, OCI-LY1, OCI-LY18, Jurkat, RL, and Karpas-299, with IC50 values of 0.73, 1.21, 3.18, 1.52, 3.34, and 4.25 mg/mL, respectively. Additionally, BAPN-1 significantly induced cell cycle arrest in the G2/M phase and caused apoptosis of NHL cells. Mechanistically, bulk RNA sequencing and Western blot analysis revealed that BAPN-1 could upregulate cyclin B1 and enhance cleaved caspase-9 expression through the inhibition of FGFR3 and RAF-MEK-ERK signaling pathways. This work supports the improved utilization of B. aereus in high-value health products.

Utilization of low- and high-value health care by individuals with and without cognitive impairment.

Cognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia. Retrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018). We examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition. Receipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P = .047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P = .029], statins [32-percentage-point reduction; P = .045], and antiresorptive therapy [61-percentage-point reduction; P = .019]). LV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.

Excessive Preoperative Testing in Otolaryngology: A Retrospective Comparison of Primary Care and Perioperative Providers.

To assess the association between provider type (primary care provider [PCP] or perioperative provider) and excessive preoperative testing. Cross-sectional study. Academic medical center. Electronic medical records of adult patients who obtained an outpatient preoperative assessment and underwent surgery in the Department of Otolaryngology-Head and Neck Surgery during the first 2 weeks of January 2019 (n = 94) were reviewed. Patients receiving preoperative tests beyond those recommended by the guidelines were deemed to have had excessive testing. Descriptive statistics were used to characterize the study population. Simple and multivariate logistic regression were used to analyze the association between the outcome and the predictor variables. Overall, 44.7% of preoperative evaluations had excessive testing. Patients who had their preoperative evaluation performed by a perioperative provider had 89% lower odds of having excessive preoperative testing compared to those evaluated by a PCP (odds ratio = 0.11, 95% confidence interval: [0.03, 0.37], P < .001). Female sex, younger age, and higher risk of major adverse cardiac events were associated with greater odds of excessive testing. Excessive preoperative testing is more commonly performed by PCPs compared to perioperative providers. These results give preliminary evidence in support of a potential shift in the clinical responsibility of preoperative evaluation from PCPs to perioperative providers in order to reduce excessive testing and promote high-value health care. The next steps include validating these findings, identifying reasons for differential guideline concordance, and intervening accordingly.

Unlocking the potential of olive residues for functional purposes: update on human intervention trials with health and cosmetic products.

Olive mill waste (OMW) is a promising source of valuable compounds such as polyphenols, terpenes, sterols, and other bioactive compounds, which are of interest to the pharmaceuticals and cosmeceutical industries. This review examines the potential of OMW extracts for health and beauty applications based on evidence reports from human clinical trials. The results achieved to date indicate health-enhancing properties, but little is known about the underlying mechanisms of action, dose-response relationships, and long-term impacts. Therefore, while olive by-products, extracted using eco-friendly methods, present opportunities for the development of high-value health and cosmetic products, further studies are necessary to determine the full range of their effects and establish specific therapeutic strategies. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Area-Level Socioeconomic Disadvantage and Health Care Spending

Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models. To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost. A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023. This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending. The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.

Effects of Traditional and Novel Cooking Processes on the Nutritional and Bioactive Profile of Brassica oleracea (Kale)

The present study investigates the impact of traditional and novel cooking techniques on the nutritional and bioactive profile of Brassica oleracea, commonly known as kale. As a member of the Brassica family, kale is well known for its high nutritional value and possible health benefits. However, it is crucial to remember that the cooking techniques can significantly impact the nutritional profile of kale. Various cooking methods were applied to kale samples through controlled experiments. Traditional techniques like boiling and steaming were compared with innovative approaches such as microwave cooking and vacuum cooking. Soluble solids, which include sugars and other compounds, were used as indicators of nutritional change. Additionally, the levels of vital bioactive components, such as vitamins, antioxidants, and phytochemicals, were analyzed to assess the overall impact of cooking methods. Preliminary findings suggest that the choice of cooking method plays a pivotal role in determining the extent of nutritional and bioactive alterations in kale. Traditional methods, such as boiling, exhibited substantial losses of soluble solids and certain heat-sensitive nutrients. In contrast, novel methods like vacuum cooking displayed better preservation of soluble solids and bioactive compounds. The study sheds light on the complex relationship between cooking techniques and the nutritional integrity of kale. By exploring various methods, this review paper contributes to understanding how culinary practices can be optimized to enhance the retention of vital nutrients and beneficial bioactive components in kale. These findings hold practical implications for individuals seeking to maximize the health benefits of kale consumption while enjoying its culinary versatility.

Origin tracing and adulteration identification of bird's nest by high- and low-field NMR combined with pattern recognition

Edible bird’s nest (EBN) is a high-value health food with various nutrients and bioactive components. With increasing demand for EBN, they are often adulterated with cheaper ingredients or falsely labeled by the origin information, thus harming consumer interests. In this study, high- and low-field nuclear magnetic resonance (HF/LF-NMR) technology combined with multivariate statistical analysis was used to identify the geographical marker of EBN from different origins and authenticate the adulterated EBN with various adulterants at different adulteration rates. Authentic EBN samples from Malaysia were used to simulate adulteration using gelatin (GL), agar (AG) and starch (ST) at 10 %, 20 %, 40 %, 60 %, 80 %, and 100 % w/w, respectively. The results showed significant differences in composition among EBN from different origins, with isocaproate and citric acid serving as geographical markers for Malaysia and Vietnam, respectively. Leucine, glutamic acid, and N-acetylglycoprotein serving as geographical markers for Indonesia. In addition, PLS model further verified the accuracy of origin identification of EBN. The LF-NMR results of adulteration EBN showed a linear correlation between the transverse relaxation (T2, S2) and the adulterated ratio. The OPLS-DA based on T2 spectra could accurately identify authentic EBN from adulterated with GL, AG and ST at 40 %, 20 %, and 20 %, respectively. Fisher discrimination model was able to differentiate at 20 %, 20 %, and 40 %, respectively. These results show that the 1H NMR combined with multivariate statistical analysis method could be a potential tool for the detection of origin and adulteration of EBN.

Toward Higher-Value Health Care: A Multifaceted Approach

Summary This issue of NEJM Catalyst Innovations in Care Delivery includes articles, case studies, and research reports on organizing care delivery around conditions and accompanying insights on value-based care, primary care redesign, multidimensional approaches to measuring health care quality, improving treatment of heart failure, striving for zero harm, and home-based care.

Bioactive potential of ripened white cheeses manufactured in different geographical regions of Turkey.

This study investigated the potential bioactive properties of white cheeses produced in different regions of Turkey, including their potential antioxidant, antihypertensive, antidiabetic, antimicrobial, and anticancer activities. The cheese samples were analyzed both before and after in vitro digestion. The study found that all cheese samples exhibited significant angiotensin-converting enzyme inhibition activity both before (45.5%-70.1% for 0.03gcheese/mL) and after in vitro digestion (25.5%-63.5% for 0.0167g cheese/mL), whereas α-amylase inhibition activity was present in all samples (in the range of 5.1%-50.0% for 3.0×10-5 gcheese/mL) but disappeared after digestion, and α-glucosidase inhibition activity was only detected after in vitro digestion (from 20.5% to 60.4% for 5.6×10-5 gcheese/mL), indicating potential antidiabetic properties. However, antimicrobial and anticancer activities were not observed in any of the samples. The results also suggest that the bioactivity potential of white cheese may vary depending on the region of production, as cheeses from the Marmara region exhibited high α-glucosidase inhibition activity after digestion. In conclusion, while white cheese is a valuable addition to the diet due to its high nutritional value and potential health benefits. This study revealed the bioactive potential of ripened white cheese and in vivo investigations of the cheese components would better show their possible benefits. PRACTICAL APPLICATION: Although the bioactivity potentials varied among the ripened white cheese samples produced in different regions of Turkey, a consistent trend was observed in terms of their presence or absence. Our research revealed that all ripened cheese samples demonstrated significant potential antioxidant and antihypertensive activities, as well as potential antidiabetic properties. Moreover, it can be interpreted that ripened white cheese has the potential to reduce the digestion of carbohydrates when consumed with carbohydrate-rich foods. Although the present results provide limited practical findings directly applicable to the industry, if the data and information obtained from this study are further explored and further studies delving into specific mechanisms of bioactive components could emerge.

Massachusetts' innovative policy approach to expanding contraceptive options in primary care.

As health systems pivot toward value-based care and as the reversal of Roe vs Wade has significantly decreased access to abortion care in the United States, contraception is increasingly recognized as a high-value health service. However, the United States has a long and troubling history of using contraceptive policies and practices, including forced sterilization, to limit the reproductive rights of people of color and individuals with disabilities. We hope to highlight an innovative program developed by Massachusetts' Medicaid program, which seeks to expand access to long-acting reversible contraception (LARC) within primary care clinics in a way that promotes both value and reproductive justice. This program provides financial incentives for clinics that serve patients with Medicaid to offer LARC to all patients within the primary care space. Unlike LARC programs that exclusively target patients with Medicaid insurance and provide incentivizes based on number of LARC insertions, this policy has the potential to "lift all boats" and expand access to LARC for all patients regardless of payer. Careful evaluation of this program will be necessary to ensure that the intended outcomes-to increase access to LARC, promote reproductive justice, and deliver value to the health system-are achieved.

Data-Driven Leadership: Clinical Registries Drive Higher Value Health Care.

Population Health ManagementAhead of Print Data-Driven Leadership: Clinical Registries Drive Higher Value Health CareMatthew L. Moorman, Andrew M. Loudon, and Peter J. PronovostMatthew L. MoormanAddress correspondence to: Matthew L. Moorman, MD, MBA, FACS, FAWM, FCCM, Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Suite 6200, Cleveland, OH 44106, USA E-mail Address: matthew.moorman@UHHospitals.orgDepartment of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Search for more papers by this author, Andrew M. LoudonDepartment of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Search for more papers by this author, and Peter J. Pronovosthttps://orcid.org/0000-0002-9740-3775Departments of Surgery and Anesthesia, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.Department of Anesthesia, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.Search for more papers by this authorPublished Online:21 Jun 2023https://doi.org/10.1089/pop.2023.0066AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Matthew L. Moorman, Andrew M. Loudon, and Peter J. Pronovost.Data-Driven Leadership: Clinical Registries Drive Higher Value Health Care.Population Health Management.ahead of printhttp://doi.org/10.1089/pop.2023.0066Online Ahead of Print:June 21, 2023PDF download

Paradigm Shifts in Alloplastic Breast Reconstruction: A Nationwide Analysis of Direct-to-Implant Trends.

Direct-to-implant breast reconstruction is an attractive choice for appropriately selected patients, as a single-stage procedure can enhance global metrics of care. In an era of high-value health care, therefore, it is important to investigate use of such procedures. This study investigated direct-to-implant trends over the past decade on a nationwide basis. This was a retrospective investigation of direct-to-implant reconstruction between 2010 and 2018 in the United States, using the National Inpatient Sample database. All study analyses were undertaken using Stata version 15.0. The weighted sample included 287,093 women who underwent implant-based reconstruction between 2010 and 2018, of whom 43,064 (15%) underwent direct-to-implant reconstruction. Across the study period, the proportion of direct-to-implant procedures increased significantly ( P = 0.03), relative to staged and delayed implant-based procedures. Although direct-to-implant patients were younger and more likely to be White and privately insured, the proportion of non-White, publicly insured patients undergoing direct-to-implant reconstruction increased significantly by 2018 ( P < 0.05). Furthermore, direct-to-implant use among Medicaid patients was 2.2 times the rate in Medicaid expansion states compared with nonexpansion states. Direct-to-implant patients had significantly higher All Patient Refined Diagnosis Related Group risk scores in 2018 than in 2010 ( P = 0.02), indicating expanding clinical indications for this procedure. Direct-to-implant reconstruction had significantly lower inpatient charges than staged procedures ( P = 0.03), when considering expander placement and expander-to-implant exchange. Overall, use of direct-to-implant breast reconstruction has significantly increased over the past decade, facilitated by expanding clinical indications and improved insurance coverage. However, certain disparities continue to exist. Further work should investigate drivers of disparities to allow continued expansion of direct-to-implant reconstruction as clinically appropriate. Therapeutic, III.

Differentiation of the Organoleptic Volatile Organic Compound Profile of Three Edible Seaweeds.

The inclusion of seaweeds in daily-consumption food is a worthy-of-attention challenge due to their high nutritional value and potential health benefits. In this way, their composition, organoleptic profile, and toxicity must be assessed. This work focuses on studying the volatile organic compounds (VOCs) emitted by three edible seaweeds, Grateloupia turuturu, Codium tomentosum, and Bifurcaria bifurcata, with the aim of deepening the knowledge regarding their organoleptic profiles. Nine samples of each seaweed were prepared in glass vials, and the emitted headspace was analyzed, for the first time, with a gas chromatography-ion mobility spectrometry device, a highly sensitive technology. By statistically processing the collected data through PCA, it was possible to accurately differentiate the characteristic patterns of the three seaweeds with a total explained variance of 98%. If the data were pre-processed through PLS Regression, the total explained variance increased to 99.36%. The identification of 13 VOCs was accomplished through a developed database of compounds. These outstanding values in addition to the identification of the main emissions of VOCs and the utilization of a never-before-used technology prove the capacity of GC-IMS to differentiate edible seaweeds based solely on their volatile emissions, increase the knowledge regarding their organoleptic profiles, and provide an important step forward in the inclusion of these highly nutritional ingredients in the human diet.

An integrated untargeted metabolomic approach reveals the quality characteristics of black soybeans from different geographical origins in China

Black soybeans are extensively planted and consumed in China due to their high nutritional value and numerous health benefits. However, very few is known about the characteristic metabolites of black soybeans from different geographical origins in China. In the present study, 31 black soybean samples were collected from 11 main producing provinces in China. A combined metabolomics approach using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) and gas chromatography coupled to an Orbitrap mass analyzer (GC-orbitrap-MS) was performed for the first time to comprehensively investigate the metabolite variability among the black soybeans from different geographical origins. A total of 48 differential non-volatile metabolites and 14 differential volatile metabolites were identified based on orthogonal partial least squares discriminant analysis (OPLS-DA) coupled with analysis of variance (ANOVA). Higher procyanidin B1, procyanidin B2, epicatechin, malonylated isoflavones, and β-pinene were observed in Gansu black soybeans. Guangxi black soybeans had higher amounts of linoleic acid and its oxidation products of hexanal and pentane. The black soybeans from Xinjiang and Yunnan were found to have higher delphinidin-derived anthocyanins, gamma-glutamyl peptides, and aromatic hydrocarbons. The characteristic metabolites of black soybeans from other geographical origins were also clarified. This study indicated that the integrated untargeted metabolomic approach can be a powerful tool to provide knowledge for developing specialty black soybeans.

Implementation of inclisiran in United Kingdom primary care for patients with atherosclerotic cardiovascular disease or its-risk equivalents: rationale and design of Victorion-spirit, a pragmatic phase IIIb, randomised controlled study

Background: Translational gaps exist in implementing health innovations rapidly in clinical practice. Pragmatic effectiveness and implementation studies, therefore, play a pivotal role in understanding how high-value health innovations could be deployed and delivered in healthcare systems to reduce barriers to adoption and provide more rapid patient benefit. Victorion-spirit is an ongoing pragmatic, 9-month, phase IIIb, open-label, multicentre, randomised controlled study evaluating the implementation, patient experience, and delivery of the subcutaneous lipid-lowering therapy, inclisiran sodium 300 mg, in participants with elevated low-density lipoprotein cholesterol (LDL-C) who are on established lipid-lowering medication, or have been recommended lipid-lowering therapy, but are unable to tolerate treatment. Methods: Victorion-spirit utilises a type 1 hybrid effectiveness-implementation design, where the primary objective is to demonstrate superiority of inclisiran with or without (±) behavioural support versus standard of care (SOC; e.g., statin and/or other lipid-lowering therapies) + behavioural support in terms of percentage reduction in LDL-C from baseline to Day 270 in a primary care setting. Secondary objectives will evaluate implementation of inclisiran ± behavioural support versus SOC + behavioural support through assessment of patient satisfaction and patient activation/empowerment after treatment at Day 90; adherence to cardiovascular disease self-management; and serious adverse event profile. Additionally, a process evaluation ascertaining the views of patients, providers and national health service (NHS) commissioners will explore barriers and enablers to integrating inclisiran within primary care. Conclusions: The results of Victorion-spirit have potential to change our approach to lipid management and inform further implementation efforts in healthcare systems, such as the NHS. Trial registration: ClinicalTrials.gov NCT04087400.

Development and Characterization of Cultured Buttermilk Fortified with Spirulina plantensis and Its Physico-Chemical and Functional Characteristics

In recent years, there has been an unprecedented increase in the demand for fermented dairy products due to medical recommendations and lifestyle preferences. Cultured buttermilk, as an ancient fermented dairy beverage, is an appropriate product choice in this context. This study presents a novel cultured buttermilk formulated by fortification with high protein microalgae Spirulina platensis, thus making it valuable and attractive because of its antioxidant properties. The fermentation process, nutraceutical properties, and sensory characteristics of developed cultured buttermilk with various concentrations of Spirulina (0.25, 0.5, and 1%) were compared with the control sample (0% Spirulina buttermilk). Different concentrations of Spirulina in buttermilk result in a significant increase in chlorophyll and carotenoid content, boosting its antioxidant properties. The study also evaluated the prebiotic properties of Spirulina, thus, demonstrating its ability to promote a healthy digestive system. It was found that the addition of 0.25% Spirulina was able to ferment the product more quickly and retained the sensory acceptability of the finished product. The protein content, free radical scavenging activity, chlorophyll, carotenoid, and total phenolic content of 0.25% Spirulina-fortified buttermilk was 1.83%, 48.19%, 30.9 mg/g, 8.24 mg/g, and 4.21 mg/g GAE, respectively. Based on the results obtained, it was concluded that cultured buttermilk with a high nutritional value and functional health benefits can be developed by fortification with 0.25% Spirulina as a natural ingredient.

The chemodiversity of polar lipidomes of microalgae from different taxa

Polar lipids from microalgae are attracting an increasing interest due to their structural diversity, high value, and beneficial health effects. However, the relationship between lipid composition and biological diversity, as well as the potential applications of high-value microalgae lipids need to be further explored. In this study, we characterized and compared the polar lipidome of a taxonomically diverse set of 7 species of microalgae belonging to the phyla Chlorophyta (Chlorella vulgaris, Scnedesmus obliquus, Tetraselmis chuii, Chlorococcum amblystomatis), Ochrophya (Nannochloropsis oceanica, Phaeodactylum tricornutum) and Cyanobacteria (Spirulina sp.), using high-resolution LC-MS analysis, to assess the chemotaxonomic specificity of polar lipids. 498 different species of polar lipids have been identified, including 109 common to all microalgae. Each microalga had a species-specific polar lipid signature, with the majority differing by >20 % of the others, allowing for possible distinction at lower taxonomic levels. Phospholipids and betaine lipids were the lipid species that contributed the most to discrimination between species of microalgae. The specificity of the lipidome of microalgae favours the use of selected microalgae as bio-factories of specific lipids with high added value with a multitude of biological, sustainable, and ecological applications.

AGA Institute Quality Indicator Development and Uses

The Affordable Care Act, which was signed into law in 2010, established several national priorities for health care delivery, including reinforcing the importance of high-value health care. Cost and quality are fundamental functions of value. Although costs may be clearly definable, quality can be more elusive to calculate and measure. The use of structured quality measures, which are standardized tools to quantify health care processes and outcomes, can reduce variability in quality reporting. One prominent example of a gastroenterology-focused quality measure is the adenoma detection rate, which reflects the percentage of average-risk screening colonoscopies in which at least 1 adenoma is detected. Like adenoma detection rate, all quality measures require discrete specifications for calculating a numerator and denominator to allow widespread standardization and reliable measurement across practices. Ultimately, this reproducibility permits the establishment of benchmark targets, which in turn allow insights into variable measure adherence and opportunity to develop and implement improvement.