High-value Health Research Articles

Using calcined oyster shell powder as a natural preservative for extending the quality of black king fish (Rachycentron canadum) fillets

AbstractAquacultural foods represent a valuable source of nutrition with high nutritional value and numerous health benefits. They are widely consumed as a palatable and easily digestible source of protein. However, they are highly susceptible to spoilage after harvesting and subsequent processing and storage. Natural and green biological methods for inhibiting or reducing the growth of microorganisms and controlling the quality of products during storage are of particular commercial importance. In this study, black king fish (BKF) fillets treated with calcined oyster shell powder (COSP) exhibited the dual benefits of extended shelf life and natural safety and nontoxicity. In particular, COSP inhibited acid‐producing microorganisms and aerobic bacteria by regulating pH throughout the refrigerated storage of BFK fillets. TVB‐N levels in BFK fillets were maintained below 20 mg/100 g, while peroxide values (PV), thiobarbituric acid reactive substances (TBARS), and trimethylamine (TMA) levels were all within acceptable ranges, all of which were significantly different (p < 0.05) compared to the control group. In addition, the hardness and overall acceptability performance showed significantly favorable results compared to the control group. The results of this study may be widely applicable to aquatic food products. Minimizing postharvest and financial losses in large‐scale aquatic products production by extending shelf life will provide additional economic benefits.Novelty impact statement COSP treatment can inhibit the growth of microorganisms. COSP treatment can control the quality of products during frozen storage. Fish fillets treated with COSP exhibited the benefits extended shelf life and natural safety and nontoxicity.

Value in maternal care: Using the Learning Health System to facilitate action.

There is an increasing need to deliver high-value health care. Here, we discuss how value should be measured and implemented in maternity care through a Learning Health System. High-value maternity care will produce the highest level of benefit for women at a given cost. As pregnancy is not an illness state, and there is no cure or remission to be achieved, we believe that patient-reported outcomes should be an integral component of benefit quantification when measuring value. Furthermore, as care impacts more than just health outcomes-particularly in maternity care-there is also a need to consider patient-reported experiences as a part of defining the level of benefit. However, to move beyond traditional narrow and passive measurement of value, we need to partner with stakeholders to identify priorities for change, identify evidence for how to achieve this change, integrate measurement activities, and promote effective implementation, in a continuous, learning cycle-a Learning Health System. A robust Framework for implementing a Learning Health System has been developed, which could be applied in maternity care.

Machine Learning Models for Predicting Postoperative Outcomes following Skull Base Meningioma Surgery.

Objective While predictive analytic techniques have been used to analyze meningioma postoperative outcomes, to our knowledge, there have been no studies that have investigated the utility of machine learning (ML) models in prognosticating outcomes among skull base meningioma patients. The present study aimed to develop models for predicting postoperative outcomes among skull base meningioma patients, specifically prolonged hospital length of stay (LOS), nonroutine discharge disposition, and high hospital charges. We also validated the predictive performance of our models on out-of-sample testing data. Methods Patients who underwent skull base meningioma surgery between 2016 and 2019 at an academic institution were included in our study. Prolonged hospital LOS and high hospital charges were defined as >4 days and >$47,887, respectively. Elastic net logistic regression algorithms were trained to predict postoperative outcomes using 70% of available data, and their predictive performance was evaluated on the remaining 30%. Results A total of 265 patients were included in our final analysis. Our cohort was majority female (77.7%) and Caucasian (63.4%). Elastic net logistic regression algorithms predicting prolonged LOS, nonroutine discharge, and high hospital charges achieved areas under the receiver operating characteristic curve of 0.798, 0.752, and 0.592, respectively. Further, all models were adequately calibrated as determined by the Spiegelhalter Z -test ( p >0.05). Conclusion Our study developed models predicting prolonged hospital LOS, nonroutine discharge disposition, and high hospital charges among skull base meningioma patients. Our models highlight the utility of ML as a tool to aid skull base surgeons in providing high-value health care and optimizing clinical workflows.

Nutrient Constituents, Bioactive Phytochemicals, and Antioxidant Properties of Service Tree (Sorbus domestica L.) Fruits.

The current study aimed to determine the major and minor nutritional constituents of Sorbus domestica L. fruits. It was revealed that palmitic acid was the most commonly occurring saturated fatty acid, while linoleic acid represented the major polyunsaturated fatty acid. The sterol fraction consisted mainly of β-sitosterol. Small amounts of lipophilic pigments were quantified. Potassium, iron, and boron were the most abundant macro-, micro-, and ultra-trace elements. The amino acid composition analysis suggested that the non-essential amino acids predominated over the essential ones. Soluble sugars (fructose and glucose) represented a large part of the total carbohydrate content, but pectin formed the major part of polysaccharides. Malic acid was the most abundant organic acid whereas quercetin-3-β-glucoside, neochlorogenic, and 3,4-dihydroxybenzoic acids were the major phenolic constituents. Fruits exhibited free-radical scavenging and protecting ability against peroxyl and hydroxyl radicals. Service tree fruits provided valuable bioactive constituents having a high nutritional value and potential health benefits.

An overview and update on the chemical composition and potential health benefits of Opuntia ficus-indica (L.) Miller.

Opuntia ficus-indica (OFI), widely recognized as prickly pear, is native to Mexico and it is distributed in many areas of the world because of its socioeconomic, agronomic, and ecological benefits, besides its large amounts of functional, nutraceutical, and biological activities. Various parts of this plant including the fruit pulp and peel, cladode, and seeds are scientifically proven to have therapeutic potentials and are safe for human use. The contents of phytochemical compounds in each part of the OFI are different. Each pharmacological activity depends on the phytochemical compounds, the components used, and the extraction type. In this review, we summarize the active constituents from different parts of OFI and their pharmacological effects including the antioxidant, wound healing, skin protective, hepatoprotective, anticancer, antidiabetic, antihypercholesterolemic, and anti-obesity activities. Besides its effects on the bone health, cardiovascular system, kidneys, and gastrointestinal tract, its gastroprotective, anti-ulcer, anti-inflammatory, antiviral, neuroprotective, sedative, analgesic, anxiolytic and antimicrobial effects and effects on cognitive and memory function are also mentioned. PRACTICAL APPLICATIONS: Over the past few decades, the health benefits of Opuntia ficus-indica (OFI) have received much attention. All parts of the plant, including the fruit pulp and peel, cladode, and seeds have found use in the treatment of many diseases. The chemical composition of OFI provides both a high nutritional value and various health benefits. Therefore, the aim of this review is to present the up-to-date research carried out on OFI phytochemicals, showing the most important biological activities reported.

Measuring and driving hospitalist value: Expanding beyond wRVUs.

Measuring and driving hospitalist value: Expanding beyond wRVUs.

Bacterially Converted Oat Active Ingredients Enhances Antioxidative and Anti-UVB Photoaging Activities.

Oat (Avena sativa L.) is one of the most widely consumed cereal grains worldwide and is considered as an important cereal crop with high nutritional value and potential health benefits. With different bacterial strains, fermented oat extracts were examined for the antioxidant and antiaging effects on the skin after optimization of extraction conditions. Fermented oats contained high avenanthramides, and its function was investigated on matrix metalloproteinase-1 and collagen expression with human dermal fibroblast cells. After fractionation, butanol layers showed the highest avenanthramides contents. Therefore, the microbial fermentation of oats enhances the quality and content of functional ingredients of oats, which provide natural dietary supplements, antioxidants, and antiaging agents.

Developing and validating high-value patient digital follow-up services: a pilot study in cardiac surgery

BackgroundThe existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients’ follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges.MethodsThe study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients.ResultsPatients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service’s evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues.ConclusionsWe propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

Associations Between Physician Continuous Professional Development and Referral Patterns: A Systematic Review and Meta-Analysis.

Both overuse and underuse of clinician referrals can compromise high-value health care. The authors sought to systematically identify and synthesize published research examining associations between physician continuous professional development (CPD) and referral patterns. The authors searched MEDLINE, Embase, PsycInfo, and the Cochrane Database on April 23, 2020, for comparative studies evaluating CPD for practicing physicians and reporting physician referral outcomes. Two reviewers, working independently, screened all articles for inclusion. Two reviewers reviewed all included articles to extract information, including data on participants, educational interventions, study design, and outcomes (referral rate, intended direction of change, appropriateness of referral). Quantitative results were pooled using meta-analysis. Of 3,338 articles screened, 31 were included. These studies enrolled at least 14,458 physicians and reported 381,165 referral events. Among studies comparing CPD with no intervention, 17 studies with intent to increase referrals had a pooled risk ratio of 1.91 (95% confidence interval: 1.50, 2.44; P < .001), and 7 studies with intent to decrease referrals had a pooled risk ratio of 0.68 (95% confidence interval: 0.55, 0.83; P < .001). Five studies did not indicate the intended direction of change. Subgroup analyses revealed similarly favorable effects for specific instructional approaches (including lectures, small groups, Internet-based instruction, and audit/feedback) and for activities of varying duration. Four studies reported head-to-head comparisons of alternate CPD approaches, revealing no clear superiority for any approach. Seven studies adjudicated the appropriateness of referral, and 9 studies counted referrals that were actually completed (versus merely requested). Although between-study differences are large, CPD is associated with statistically significant changes in patient referral rates in the intended direction of impact. There are few head-to-head comparisons of alternate CPD interventions using referrals as outcomes.

Economic Evaluation of the Merit-Based Incentive Payment System for Ophthalmologists

The Merit-Based Incentive Payment System (MIPS) is intended to promote high-value health care through quality-related Medicare payment adjustments. To assess the economic evaluation of MIPS scoring and reporting on ophthalmologists. In this retrospective, cross-sectional, multicenter economic evaluation conducted from October 10 to November 30, 2021, MIPS performance and related payment adjustments were evaluated using the US Centers for Medicare & Medicaid Service (CMS) public data files for ophthalmologists. Participants were stratified by reporting affiliation. Analysis of variance and summary statistics were used to characterize and compare total and subcategory MIPS scores and adjustments received by participants. Reported CMS methodology and performance year (PY) 2019 payment percentages were used to estimate payment adjustments for the following categories: positive MIPS adjustment plus potential additional adjustment for exceptional performance, positive MIPS adjustment, neutral payment adjustment, negative MIPS payment adjustment, and maximum negative MIPS payment adjustment. Study participants included ophthalmologists registered for Medicare Part B with participation in the Quality Payment Program (QPP) in PY 2019. Proportion of ophthalmologists qualifying for payment adjustments and payment adjustments. For PY 2019, 76.5% of ophthalmologists (13 621) who registered for Medicare participated in the MIPS pathway of the QPP. Ophthalmologists practiced in a predominantly large metropolitan area (12 302; 90.3%). Roughly 99% of participants (11 182) received nonnegative reimbursement adjustments, and 92.6% (10 367) received positive adjustments. Ophthalmologists filing as individuals were less likely to achieve exceptional performance scores compared with those who had a filing category of advanced alternative payment model (APM; odds ratio [OR], 0.0003; 95% CI, 0.00002-0.00481) or group (OR, 0.21013; 95% CI, 0.19020-0.23215). When analyzing participating ophthalmologists with available Medicare payment data (11 193), a total of 8777 (78.4%) achieved exceptional MIPS scores corresponding to mean (SD) adjustments per physician of $244.60 ($217.36) to $4864.78 ($4323.08), or 0.07% ($2 146 835.21 of $3 212 011 252.88) to 1.33% ($42 698 166.89 of $3 212 011 252.88), of the total nondrug Medicare payment. Results of this economic evaluation showed that although 78.4% of ophthalmologists received exceptional positive payment adjustments, roughly 84% (798916 of 954615) of all health care professionals nationally achieved this benchmark. Exceptional MIPS was associated with filing as group or APM, resulting in, on average, a relatively small additional payment per participant; this suggests that ophthalmologists who file as individuals should consider an alternative filing approach. Changes in MIPS methodology may disproportionately affect certain ophthalmologists, which warrants further study.

Formation of carboxylated and decarboxylated betalains in ripening grains of Chenopodium quinoa by a dual dioxygenase.

Chenopodium quinoa (quinoa) is a pseudo-cereal that forms part of the cultural heritage of Andean countries, and its grains have high nutritional value and potential health benefits. Betalains are nitrogenous water-soluble pigments and bioactive molecules that contribute to these health-promoting properties. Betalains are restricted to plants of the order Caryophyllales, to which quinoa belongs. A new family of betalains has been discovered in the form of unconventional decarboxylated pigments. Here, we show that these pigments accumulate in ripening quinoa grains of fluorescent nature, and are putatively based on a dopamine-cleaving activity. This study describes for the first time the purification and molecular and functional characterization of a 4,5-dopamine extradiol dioxygenase enzyme from plants. It is a monomeric protein with a molecular mass of 34.5 kDa characterized by chromatography, electrophoresis, and time-of-flight mass spectrometry. We demonstrate that this key enzyme has a dual function in a square-shaped biosynthetic pathway towards the formation of both carboxylated and decarboxylated pigments. Enzyme kinetic properties are characterized for the production of 6-decarboxy-betalamic acid and 3,4-dihydroxy-l-phenylalanine-derived betalamic acid, the two structural units of plant pigment in nature. The profile of multiple betalains present in quinoa grains has been reproduced in one-pot bioreactors containing the novel enzyme and two competing substrates.

Metabolomics of Rice Bran Differentially Impacted by Fermentation With Six Probiotics Demonstrates Key Nutrient Changes for Enhancing Gut Health.

The consumption of rice bran has been shown to have a positive effect on nutritional status and prevention of chronic diseases related to hundreds of metabolites with bioactivity. Consumption after fermentation can lead to specific beneficial effects, yet is lacking complete characterization when fermented with diverse strains. The objective of this study was to examine the effect of fermentation on the rice bran metabolite profile. Bacterial probiotics (Bifidobacterium longum, Limosilactobacillus fermentum, Lacticaseibacillus paracasei, Lacticaseibacillus rhamnosus and, Escherichia coli) were used to ferment rice bran alone or after incubation with yeast probiotic Saccharomyces boulardii. Fermented rice bran was methanol extracted and analyzed by UPLC-MS/MS. The metabolome of the two fermentation types was deeply modified when compared with non-fermented rice bran. The two-step fermentation provided alternative substrate to the bacteria in a few cases. Key metabolites of high nutritional value (essential amino acids, vitamins) and gut health (arabinose, maltotriose) were identified.

Physiological maturity and wound-based orchard practices influence the antioxidant content and metabolic activity of two species of açai fruit at harvest and during storage

Pre-harvest treatments like wound-based orchard management practices and early harvest were applied to açai plants (Euterpe oleracea Mart., Euterpe precatoria Mart.) to yield higher levels of antioxidants. Orchard practices like 50% shoot suppression and 50% cluster thinning when applied 87 d before harvest (187 days DAA) were similar to control fruits at harvest and during storage (20 °C). However, lesions in the stipe applied 187 DAA altered the acid, carbohydrate, phenolic content and the ethylene biosynthesis compared to control fruits, showing enhanced fruit antioxidant activity. Early harvest of fruit including 120 and 150 DAA, showed higher acid, lower sugars, higher phenolic content and higher ethylene biosynthesis and respiration rate compared to control fruits, showing the highest levels of fruit antioxidant activity. The selected strategies studied may achieve higher yields of phenolic antioxdants from açai fruit and target high value health markets including functional foods and dietary supplements.

High value health care is low carbon health care.

We are in a health emergency precipitated by climate change.1 As well as physical health threats, climate change and its effects are adversely affecting Australians' mental health,2 and worsening the health inequities suffered by vulnerable populations. In response, the Australian health care community must both adapt to increased demand and to deteriorating environmental conditions, and mitigate the carbon footprint of health care, currently 7% of our national carbon emissions.3 Using economic data from 360 sectors, Malik and colleagues3 estimated carbon emissions by Australian Institute of Health and Welfare categories of health care expenditure, finding that the hospital and pharmaceutical sectors had the largest footprints, together accounting for 63% of health care emissions.

The low cost high value Health care from the value chain to the dynamic capabilities

Low cost high value companies have shifted their view of the individual sector business to the value system in which all stakeholders, internal and external, should work to create share value. Business to low-cost high-value health care are the first mover and have started their business in a new field. In the paper this field is explored, with the aim of reinventing the value for new activities or to reinvent the value chain for the existing activities. Business strategies must be adapted to the ability to catch the opportunities presented by the external environment. The needs of the population in quality health sector have increased, and it’s necessary to ensure an appropriate response to the needs with the highest productivity in terms of overall service rendered. The health services must adapt to changing needs in order to develop, manage, measure and control the flow of knowledge and intangible. Businesses low cost high value health care have the ability to sense the needs (ex-ante) and the satisfaction (ex-post). The economic and monetary sacrifice is opposed to the benefits derived from the service received and the satisfaction of the proposed requirements. The final objective of the study is to analyze the different strategic choices from the value chain to the dynamic capabilities developed by two companies that have adopted low-cost high-value: the Centro Medico Santagostino and OdontoSalute allocated in northern Italy. By comparing the two case works we will highlight their business model.

Impact of Cost Information on Parental Decision Making: A Randomized Clinical Trial Evaluating Cast Versus Splint Selection for Pediatric Distal Radius Buckle Fractures.

Price transparency purports to help patients make high-value health care decisions, however, there is little data to support this. The pediatric distal radius buckle fracture (DRBF) has 2 equally efficacious but not equally priced treatment options (cast and splint), serving as an excellent potential model for studying price transparency. This study uses the DRBF model to assess the impact of up-front cost information on a family's treatment decisions when presented with clinically equivalent treatment options for a low-risk injury. Participants age 4 to 14 presenting with an acute DRBF to a hospital-based pediatric orthopaedic clinic were recruited for this randomized controlled trial. Participants were randomized into cost-informed or cost-blind cohorts. All families received standardized information about the injury and treatment options. Cost-informed families received additional cost information. Both groups were allowed to freely choose a treatment. Families were surveyed regarding their decision factors. Cost-blinded families were subsequently presented with the cost information and could change their decision. Independent samples t tests and χ2 tests were utilized to evaluate differences. A total of 127 patients were enrolled (53% cost-informed, 47% cost-blind). The 2 groups did not significantly differ in demographics. Immobilization selection did not differ between groups, with 48% of the cost-informed families selecting the more expensive option (casting), compared with 47% of the cost-blind families. Cost was the least influential factor in the decision-making process according to participant survey, influencing only 9% of families. Only one family changed their decision after receiving cost information, from a splint to a cast. Families appear to be cost-insensitive when making medical treatment decisions for low-risk injuries for their child. Price transparency alone may not help families arrive at a decision to pursue high-value treatment in low-risk orthopaedic injuries. Level I.

A Catalog of Natural Products Occurring in Watermelon-Citrullus lanatus.

Sweet dessert watermelon (Citrullus lanatus) is one of the most important vegetable crops consumed throughout the world. The chemical composition of watermelon provides both high nutritional value and various health benefits. The present manuscript introduces a catalog of 1,679 small molecules occurring in the watermelon and their cheminformatics analysis for diverse features. In this catalog, the phytochemicals are associated with the literature describing their presence in the watermelon plant, and when possible, concentration values in various plant parts (flesh, seeds, leaves, roots, rind). Also cataloged are the chemical classes, molecular weight and formula, chemical structure, and certain physical and chemical properties for each phytochemical. In our view, knowing precisely what is in what we eat, as this catalog does for watermelon, supports both the rationale for certain controlled feeding studies in the field of precision nutrition, and plant breeding efforts for the development of new varieties with enhanced concentrations of specific phytochemicals. Additionally, improved and comprehensive collections of natural products accessible to the public will be especially useful to researchers in nutrition, cheminformatics, bioinformatics, and drug development, among other disciplines.

Analysis of lipidomics profile of Carya cathayensis nuts and lipid dynamic changes during embryonic development

Hickory (Carya cathayensis) nuts contain higher amount of lipids, and possess high nutritional value and substantial health benefits. However, their lipid composition and dynamic changes during embryogenesis have not been thoroughly investigated. Therefore, lipidomics profile and lipid dynamic changes during embryonic development were analyzed using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Totally, 544 kinds of lipids were identified in mature hickory nuts with higher proportions of glycerolipids (59.94%) and glycerophospholipids (38.66%). Notably, diacylglycerols showed gradual uptrends, which corresponded with total glycerolipid and glycerophospholipid at middle and late stage of embryogenesis, suggesting the pivotal role of diacylglycerols in the accumulation of glycerolipids and glycerophospholipids. Moreover, triacylglycerols, diacylglycerols, phosphatidylethanolamines and phosphatidylcholines had high relative content with abundance of unsaturated fatty acids, specifically oleic acid, linoleic acid and linolenic acid, localized mainly at sn-2 lipid position. Together, our study provides innovative perspectives for studying the nutritional benefits of hickory nut lipids.

Pulse-based snacks as functional foods: Processing challenges and biological potential.

Despite their high nutritional value and potential health benefits, pulse intake has not increased in the last three decades. Several strategies have been implemented to increase pulse consumption, such as their incorporation in bakery products, breakfast cereals, and snacks. The inclusion of pulses in these products could be an alternative to satisfy the consumers' demand for healthy foods. However, pulse-based snacks face important challenges, including reducing antinutritional factors, achieving consumer acceptance, and consolidating the pulse-based snacks as functional foods. This review summarizes and discusses methods for producing snacks where cereals or tubers were replaced with at least 50% pulses. Also, it briefly assesses their effect on nutritional composition, antinutritional factors, sensory acceptance, and different health benefits evaluations. Extruded snacks exhibited high protein and dietary fiber and low fat content, contrary to the high fat content of deep fat-fried snacks. Meanwhile, baked snacks presented moderate concentrations of protein, dietary fiber, and lipids. Pulses must be pretreated using process combinations such as soaking, dehulling, cooking, fermentation, germination, and extrusion to reduce the antinutritional factors. Pulse-based snacks show good sensory acceptance. However, sensory evaluation should be more rigorous using additional untrained judges. Several studies have evaluated the health benefits of pulse-based snacks. More research is needed to validate scientifically the health benefits associated with their consumption. Pulse-based snacks could be an alternative to improve the nutritional composition of commercially available snacks. The use of pulses as ingredients of healthier snacks represents an important alternative for the food industry due to their low cost, sensory characteristics, high nutritional profile, and environmental benefits.

Out-of-pocket costs for preventive care persist almost a decade after the Affordable Care Act

Higher cost-sharing reduces the amount of high-value health care that patients use, such as preventive care. Despite a sharp reduction in out-of-pocket (OOP) costs for preventive care after the implementation of the Affordable Care Act (ACA), patients often still get unexpected bills after receiving preventive services. We examined out-of-pocket costs for preventive care in 2018, almost ten years after the implementation of the ACA. We quantify the excess cost burden on a national scale using a partial identification approach and explore how this burden varies geographically and across preventive services. We found that in addition to premium costs meant to cover preventive care, Americans with employer-sponsored insurance were still charged between $75 million and $219 million in total for services that ought to be free to them ($0.50 to $1.40 per ESI-covered individual and $0.75 to $2.17 per ESI-covered individual using preventive care). However, some enrollees still faced OOP costs for eligible preventive services ranging into the hundreds of dollars. OOP costs are most likely to be incurred for women's services (e.g., contraception) and basic screenings (e.g., diabetes and cholesterol screenings), and by patients in the South or in rural areas.