Primary care physician referral practices regarding BRCA1/2 genetic counseling in a major health system.

PURPOSE: The United States Preventive Services Task Force recommends primary care physicians refer patients at high risk for BRCA1/2 mutations to genetic testing when appropriate. The objective of our study was to describe referrals for BRCA1/2 testing in a large integrated health system and to assess factors associated with referral. METHODS: This retrospective cohort study includes female patients between 18 and 50 years who had a primary care visit in the Cleveland Clinic Health System between 2010 and 2019. We used multivariable logistic regression to estimate differences in the odds of a woman being referred for BRCA1/2 testing by patient factors and referring physician specialty. We also assessed variation in referrals by physicians. RESULTS: Among 279,568 women, 5% were high risk. Of those, 22% were referred for testing. Black patients were significantly less likely to be referred than white patients (aOR 0.87; 95% CI 0.77, 0.98) and Jewish patients were more likely to be referred than non-Jewish patients (aOR 2.13; 95% CI 1.68, 2.70). Patients primarily managed by OB/GYN were significantly more likely to be referred than those cared for via Internal/Family Medicine (aOR 1.45; 95% CI 1.30, 1.61). Less than a quarter of primary care physicians ever referred a patient for testing. CONCLUSION: The majority of primary care patients at high risk for a BRCA1/2 mutation were not referred for testing, and over a decade, most physicians never referred a single patient. Internal/Family Medicine physicians, in particular, need support in identifying and referring women who could benefit from testing.

Vacuum impregnation of firming agents in red raspberries.

BACKGROUND: Red raspberries are a delicate and highly perishable fruit with a fragile pulp tissue. In this study we used vacuum impregnation (VI) methods to incorporate pectin and calcium chloride into whole red raspberries to improve their firmness. Specifically, we impregnated low methoxyl pectin (LMP) at 10 g of pectin kg-1 of solution and calcium chloride (CaCl2 ·2H2 O) at 30 g calcium kg-1 of pectin, and on the other side pectin methylesterase (PME) at 10 g of enzyme kg-1 of solution, and (CaCl2 ·2H2 O) at 10 g of calcium kg-1 of solution, into whole red raspberries. We tested three vacuum levels 33.9, 50.8, and 67.8 kPa, three vacuum impregnation times 2, 7, and 15 min, and two temperatures, 20 and 40 °C, during VI treatment. Maximum force (FM ) and gradient (GC3 ) were evaluated to assess raspberry firmness. RESULTS: A vacuum level of 50.8 kPa, processing time of 7 min, and a LMP and calcium infusion at 20 °C resulted in the firmest fruit compared to the other treatments. At these VI treatment conditions, FM and GC3 values of red raspberries obtained were 28 N, and 8.4 N mm-1 , respectively. CONCLUSION: The optimal VI conditions identified in this study can be used to improve firmness and structural integrity of red raspberries by infusion of LMP and calcium. Findings on vacuum-impregnated red raspberries may be used to develop dehydrofrozen berries for incorporation into bakery and dairy products. © 2018 Society of Chemical Industry.

Trout-skin gelatin-based edible films containing phenolic antioxidants: effect on physical properties and oxidative stability of cod-liver oil model food.

UNLABELLED: Trout-skin (Oncorhynchus mykiss) gelatin-based films containing antioxidants (epigallocatechin gallate (EGCG), 50 and 250 ppm w/w) and green tea powder (1% and 20% w/w of gelatin) were tested for tensile strength, elastic modulus, and elongation, and oxygen and water vapor transmission rates, in vitro antioxidant activity using the DPPH (2,2-diphenyl-1-picrylhydrazyl) assay and effect on stabilizing cod-liver oil held under mild thermal abuse conditions. Cod-liver oil overlaid with films was stored at 40 °C for 20 d and analyzed for peroxide value (PV) and thiobarbituric acid reactive substances (TBARS). Antioxidant activity was retained in films containing green tea powder, but was reduced (P < 0.05) in EGCG films (20 d, 23 °C). Water vapor transmission rate of the films incorporated with antioxidants did not change significantly (P > 0.05), but the oxygen transmission rate for films with 50 ppm EGCG and 20% green tea powder was significant (P < 0.05). Other physical properties varied with antioxidant incorporation. The TBARS and PV of control oil increased from 0.05 ± 0.01 to 4.71 ± 0.30 g MDA/kg oil and from 3.6 ± 0.2 to 178.3 ± 24.5 millieq peroxides/kg oil, respectively, after 20 d. For cod-liver oil covered with control or antioxidant-containing films, TBARS remained below 0.37 g MDA/kg oil and PV below 7 millieq peroxides/kg oil. Incorporation of antioxidants to the films did not reduce oil oxidation (P > 0.05) at the levels tested and this was confirmed by activation energy calculations. The rate of oil oxidation was more dependent upon the inherent oxygen barrier property of the films than the presence of antioxidants. PRACTICAL APPLICATION: This research has the potential to enhance the utilization of fish skins, a valuable food processing by-product, as edible films with natural antioxidants to extend the shelf life of foods. The film physical properties and barrier to oxygen and water are investigated.

Thermal degradation of anthocyanins from purple potato (cv. Purple Majesty) and impact on antioxidant capacity.

Degradation parameters of purified anthocyanins from purple-fleshed potato (cv. Purple Majesty) heated at high temperatures (100-150 °C) were determined. Purified anthocyanins, prepared by removing salts, sugars, and colorless nonanthocyanin phenolics from the crude extract, were monitored and quantified using HPLC and spectrophotometry for heat-induced degradation products. Separation of colorless phenolics from the anthocyanins was confirmed using HPLC at two wavelengths, 280 and 520 nm. The degradation kinetics of purified anthocyanins followed a first-order reaction with reaction rate constants (k values) of 0.0262-0.2855 min(-1), an activation energy of 72.89 kJ/mol, thermal death times (D values) of 8.06-8789 min, and a z value of 47.84 °C over the temperature range of 100-150 °C. The enthalpy and entropy of activation were 59.97 kJ/mol and -116.46 J/mol·K, respectively. The antioxidant capacity in the purified anthocyanins, measured by DPPH and ABTS assays, was increased after the thermal treatment, indicating antioxidant activities of degradation products in the samples.

Determination of quercetins in onion (Allium cepa) using infrared spectroscopy.

The rapid quantification of flavonoid compounds in onions by attenuated total reflectance (ATR) Fourier transform infrared (FT-IR) spectroscopy combined with multivariate analysis was evaluated as a possible alternative to high-performance liquid chromatography (HPLC) analysis. Quercetin content in onion varieties (yellow, red, and sweet) was quantified using ATR FT-IR (4000 to 400 cm⁻¹) spectroscopy and HPLC methods. Quercetin-3,4'-O-diglucoside (3,4'-Qdg) and quercetin-4'-O-glucoside (4'-Qmg) comprised >80% of the total flavonol content detected in the studied varieties. The quercetin compounds (3,4'-Qdg and 4'-Qmg) and total flavonol conjugates were quantified by HPLC, and results correlated closely with ATR-IR values (R > 0.95). Cross-validated (leave-one-out) partial least-squares regression (PLSR) models successfully predicted concentrations of these quercetins. The standard errors of cross-validation (SECV) of 3,4'-Qdg and 4'-Qmg, total quercetin, and total flavonol contents of onions were 20.43, 21.18, and 21.02 mg/kg fresh weight, respectively. In addition, supervised and unsupervised segregation analyses (principal component analysis, discriminant function analysis, and soft independent modeling of class analogue) were performed to classify onion varieties on the basis of unique infrared spectral features. There was a high degree of segregation (interclass distances > 3.0) for the different types of onion. This study indicated that the IR technique could predict 3,4'-Qdg, 4'-Qmg, total quercetin, and total flavonol contents and has advantages over the traditional HPLC method in providing a valid, efficient, and cost-effective method requiring less sample preparation for the quantification of quercetins in onion.

Determination of total phenolic content and antioxidant activity of garlic (Allium sativum) and elephant garlic (Allium ampeloprasum) by attenuated total reflectance-Fourier transformed infrared spectroscopy.

The total phenolic contents and antioxidant activities of garlics from California, Oregon, Washington, and New York were determined by Fourier transform infrared (FT-IR) spectroscopy (400-4000 cm(-1)). The total phenolic content was quantified [Folin-Ciocalteu assay (FC)] and three antioxidant activity assays, 2,2-diphenyl-picrylhydrazyl (DPPH) assay, Trolox equivalent antioxidant capacity (TEAC) assay, and ferric reducing antioxidant power (FRAP), were employed for reference measurements. Four independent partial least-squares regression (PLSR) models were constructed with spectra from 25 extracts and their corresponding FC, DPPH, TEAC, and FRAP with values for 20 additional extracts predicted (R > 0.95). The standard errors of calibration and standard error of cross-validation were <1.45 (TEAC), 0.36 (FRAP), and 0.33 µmol Trolox/g FW (DPPH) and 0.55 mg gallic acid/g FW (FC). Cluster and dendrogram analyses could segregate garlic grown at different locations. Hydroxyl and phenolic functional groups most closely correlated with garlic antioxidant activity.

Effect of extrusion on the antioxidant capacity and color attributes of expanded extrudates prepared from purple potato and yellow pea flour mixes.

Foods with antioxidant capacity provide protection against cardio-vascular, certain forms of cancers, and Alzheimer's diseases caused by oxidative damages and contribute health benefits. The effect of extrusion cooking on the antioxidant capacity and color attributes of extruded products prepared from 3 selected formulations of purple potato and yellow pea flours using a co-rotating twin screw extruder were studied. Expansion ratios of the extruded products varied from 3.93 to 4.75. The total antioxidant capacities (TAC) of the extruded products, using DPPH assay, were 3769 to 4116 µg trolox equivalent/g dry weight sample and not significantly different (P > 0.05) from their respective raw formulations. The total phenolic contents (TP) of the extruded products varied from 2088 to 3766 µg of gallic acid equivalent/g dry weight sample and retained 73% to 83% of the TP from the raw formulations after extrusion. The total anthocyanins contents (TA) in the extrudates were 0.116 to 0.228 mg of malvidin-3-glucosides/g dry weight sample. Compared with their raw formulations, significant losses (60% to 70%) of the TA in the extruded products occurred due to extrusion cooking. Browning indices and color attributes such as brightness, chroma, and hue angle agreed with degradation of anthocyanins in the extruded products. However, extrusion cooking retained antioxidant capacities of the raw formulations in the extruded products either in their natural forms or degraded products with radical scavenging activity. This study demonstrated the potential for the production of puffed extruded food products with the improved antioxidant content from colored potatoes and pulse formulations.

Effect of pectolytic enzyme preparations on the phenolic composition and antioxidant activity of asparagus juice.

Commercial pectolytic enzymes were investigated for their influence on phenolics and antioxidant activities of asparagus juice. The antioxidant activity of asparagus juice was analyzed according to 2,2'-diphenyl-l-picrylhydrazyl and 2,2'-azinobis(3-ethylbenzothiazoline-6-sulfonic acid) methods. The enzymes, with the exception of pectinase from Rhizopus sp., contained rutinase, which hydrolyzed rutin to quercetin. Asparagus juice treated with Viscozyme had the highest quercetin content without exhibiting a significant increase in the antioxidant activity. For a pectinase from Aspergillus niger, the antioxidant activity of asparagus juice was markedly reduced. Caution should be paid in the selection of pectolytic enzyme preparations for production of antioxidant activity-rich juice.