Utilization of whole health services among veterans with spinal cord injuries and disorders (SCI/D): Early insights from the VA SCI/D system of care.

CONTEXT/OBJECTIVE: Our objective was to describe early participation in Whole Health programs across the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) System of Care. DESIGN: Retrospective analysis of VHA administrative data. SETTING: The VHA SCI/D System of Care. PARTICIPANTS: Veterans with SCI/D included in the FY2019 cumulative VHA SCI/D Registry cohort with living status during FY2017, FY2018, and FY2019. INTERVENTIONS: N/A. OUTCOME MEASURES: We assessed the number of encounters and unique Veterans with SCI/D, and the percent of Veterans with SCI/D, who utilized each Whole Health (WH) program available in VA. RESULTS: Utilization of WH Pathway and well-being Programs increased from 62 encounters to 1703 encounters between FY2017 and FY2019 (representing 0.09% to 3.13% of Veterans with SCI/D). Utilization of chiropractic care rose from 130 encounters to 418 encounters during the same time period. Similarly, utilization of complementary and integrative health programs increased from 886 encounters to 2655 encounters (representing 1.09% to 3.11% of Veterans; FY2017 to 2019). We also report utilization of specific WH programs. CONCLUSION: Participation in WH services has been increasing among Veterans with SCI/D who receive health care from the VHA SCI/D System of Care. However, utilization among Veterans with SCI/D remains low overall, and targeted efforts to increase WH program reach are needed. Additional information about the relative effectiveness of different strategies to support WH implementation is also needed, to ensure strategies likely to have the most impact are prioritized.

Co-Extraction Technique Improves Functional Capacity and Health-Related Benefits of Olive Oils: A Mini Review.

Olive oil, a fundamental component of the Mediterranean diet, is recognized as a functional food due to its health-promoting composition. The concentration of phenolic compounds in olive oil is influenced by various factors such as genetics, agro-climatic conditions, and technological processes. Therefore, to ensure an ideal intake of phenolics through the diet, it is recommended to produce functional enriched olive oil that contains a high concentration of bioactive compounds. The co-extraction technique is used to create innovative and differentiated products that promote the sensory and health-related composition of oils. To enrich olive oil, various natural sources of bioactive compounds can be used, including raw materials derived from the same olive tree such as olive leaves, as well as other compounds from plants and vegetables, such as herbs and spices (garlic, lemon, hot pepper, rosemary, thyme, and oregano). The development of functional enriched olive oils can contribute to the prevention of chronic diseases and improve consumers' quality of life. This mini-review compiles and discusses relevant scientific information related to the development of enriched olive oil using the co-extraction technique and its positive effects on the health-related composition of oils.

Overcoming Challenges in Pediatric Formulation with a Patient-Centric Design Approach: A Proof-of-Concept Study on the Design of an Oral Solution of a Bitter Drug.

Designing oral formulations for children is very challenging, especially considering their peculiarities and preferences. The choice of excipients, dosing volume and palatability are key issues of pediatric oral liquid medicines. The purpose of the present study is to develop an oral pediatric solution of a model bitter drug (ranitidine) following a patient centric design process which includes the definition of a target product profile (TPP). To conclude on the matching of the developed solution to TPP, its chemical and microbiological stability was analyzed over 30 days (stored at 4 °C and room temperature). Simulation of use was accomplished by removing a sample with a syringe every day. Taste masking was assessed by an electronic tongue. The developed formulation relied on a simple taste masking strategy consisting in a mixture of sweeteners (sodium saccharine and aspartame) and 0.1% sodium chloride, which allowed a higher bitterness masking effectiveness in comparison with simple syrup. The ranitidine solution was stable for 30 days stored at 4 °C. However, differences were noted between the stability protocols (unopened recipient and in-use stability) showing the contribution of the simulation of use to the formation of degradation products. Stock solution was subjected to acid and alkali hydrolysis, chemical oxidation, heat degradation and a photo degradation stability assessment. The developed pediatric solution matched the TPP in all dimensions, namely composition suitable for children, preparation and handling adapted to hospital pharmaceutical compounding and adequate stability and quality. According to the results, in-use stability protocols should be preferred in the stability evaluation of pediatric formulations.

Does water addition during the industrial milling phase affect the chemical-sensory quality of olive oils? The case of cv. Arbequina oils.

At olive oil industrial extraction, water addition is a practice overcoming the formation of thick pastes. The effect of water addition (0 to 6.2%, kgadded water/kgolives), during the industrial milling of cv. Arbequina olives, on the oils' chemical-sensory quality, was evaluated. Despite the extra virgin olive oil classification, compared with the water incorporation (1.2-6.2%), extraction without water addition resulted into oils that showed less primary oxidation (lower peroxide values and K232), greater total phenolic content (+12-22%) and higher oxidative stability (+22-31%). No water addition increased the oils secoiridoids content (+5-13%), mainly oleacein (+27-79%). Oils extracted without water addition had a more intense ripe fruity sensation (≥ +11%) but lower fruit intensities (at least -4%). Thus, the quality and stability of the cv. Arbequina oils can be favoured if extracted without adding water during the olives industrial milling.

Impact of fresh olive leaves addition during the extraction of Arbequina virgin olive oils on the phenolic and volatile profiles.

Leaves incorporation during the extraction of olive oils can enhance their chemical-sensory quality. Thus, leaves from cvs. Arbequina or Santulhana were added (1%, w/w) during the extraction of Arbequina oils using an Abencor system, being discussed the impacts on the phenolics and volatiles formation enzymatic pathways. Leaves addition contributed to a significant decrease (P-value < 0.05) of the contents of secoiridoids (-11%), C6-aldehydes (-16%), and ester compounds (-22%). This could be tentatively related to a reduction of the enzymatic activity of secoiridoids biosynthesis and lipoxygenase pathways, promoted by the leaves' addition. Moreover, in the presence of leaves, the oils' total contents of phenolics and volatiles were significantly reduced (-7 and -17%, respectively). Contrary, the incorporation of leaves significantly increased (P-value < 0.05) the contents of C6-alcohols (+37%) and the intensities of the green fruity (+25%) and apple (+30%) sensations.

Application of a lab-made electronic nose for extra virgin olive oils commercial classification according to the perceived fruitiness intensity.

An electronic nose, comprising nine metal oxide sensors, has been built aiming to classify olive oils according to the fruity intensity commercial grade (ripely fruity or light, medium and intense greenly fruity), following the European regulated complementary terminology. The lab-made sensor device was capable to differentiate standard aqueous solutions (acetic acid, cis-3-hexenyl, cis-3-hexen-1-ol, hexanal, 1-hexenol and nonanal) that mimicked positive sensations (e.g., fatty, floral, fruit, grass, green and green leaves attributes) and negative attributes (e.g., sour and vinegary defects), as well as to semi-quantitatively classify them according to the concentration ranges (0.05-2.25 mg/kg). For that, unsupervised (principal component analysis) and supervised (linear discriminant analysis: sensitivity of 92% for leave-one-out cross validation) classification multivariate models were established based on nine or six gas sensors, respectively. It was also showed that the built E-nose allowed differentiating/discriminating (sensitivity of 81% for leave-one-out cross validation) extra virgin olive oils according to the perceived intensity of fruitiness as ripely fruity, light, medium or intense greenly fruity. In conclusion, the gas sensor device could be used as a practical preliminary non-destructive tool for guaranteeing the correctness of olive oil fruitiness intensity labelling.

Characterization of Telehealth Use in Veterans With Spinal Cord Injuries and Disorders.

BACKGROUND: Individuals with spinal cord injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE: To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN: Cross-sectional, descriptive project. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION: Not applicable. OUTCOME MEASURES: Frequency and characteristics associated with VHA telehealth utilization. RESULTS: Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION: There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.

Impact of the malaxation temperature on the phenolic profile of cv. Cobrançosa olive oils and assessment of the related health claim.

Phenolic compounds contribute to the bioactive properties of olive oil. However, olive oils can only support a health claim concerning the protection against oxidative stress depending on the polyphenolic concentration, requiring effective measures during extraction to preserve/enhance their concentrations. The effect of the malaxation temperature (22, 28 and 34 °C) on the phenolic profile was studied for industrially extracted cv. Cobrançosa oils. Higher malaxation temperatures decreased the contents of the majority of the chromatographically detected compounds (P < 0.05, one-way ANOVA), enabling oils' differentiation. This decreasing trend was observed for hydroxytyrosol and tyrosol bound forms, determinant for the health claim, which were also negatively affected by temperature, despite revealing that all the industrially extracted oils tested supported the health claim. The observed constant free to bound forms ratio showed that the temperature range tested had a minor effect on bound-forms hydrolysis, being both free and bound forms equally affected by temperature.

An electronic tongue as a classifier tool for assessing perfume olfactory family and storage time-period.

The identification of more than three perfumes is difficult and no analytical tool can completely replace the human olfactory system for fragrance classification. Indeed, no analytical system can mimic the human fragrance perception, being the recognition of perfume aroma patterns by conventional or sensor-based analytical tools a challenging task. For the perfume sector, the possibility of applying fast, cost-effective and green analytical devices for perfume analysis would represent a huge economic revenue. Since the perfume aroma pattern will depend on the composition of the liquid phase and on the diffusion properties of their volatile components, this work aimed to apply a potentiometric electronic tongue, comprising non-specific cross-sensitive lipid polymeric membranes, combined with chemometric techniques, as a novel perfume classifier. The multisensors device allowed establishing perfumes' unique fingerprints, which were successfully used to discriminate men from women perfumes, to identify the perfume aroma family (Citric-Aromatic, Floral, Floral-Fruity, Floral-Oriental, Floral-Woody, Woody-Oriental and Woody-Spicy) and, assessing the perfume storage time-period (≤ 9 months; 9-24 months; and, ≥ 24 months). The established linear discriminant models were based on single-run potentiometric profiles gathered by sub-sets of sensors selected using the simulated annealing algorithm, which enabled achieving correct classification rates of 93-100% (for leave-one-out cross-validation procedure). The satisfactory performance of the electronic tongue demonstrates the versatility of the proposed approach as a practical perfume preliminary classifier sensor device, which industrial application may be foreseen in a near future, contributing to a green-sustained economic growth of the perfume industry.

Application of an electronic tongue as a single-run tool for olive oils' physicochemical and sensory simultaneous assessment.

Olive oil is highly appreciated due to its nutritional and organoleptic characteristics. However, a huge compositional variation is observed between olive oils, requiring the use of diverse analytical techniques for its classification including titration, spectrophotometry and chromatography, as well as sensory analysis. Chemical analysis is usually time-consuming, expensive and require skilled technicians, while the sensorial ones are dependent upon individual subjective evaluations, even if performed by trained panellists. This work evaluated and demonstrated the feasibility of using a potentiometric electronic tongue, comprising non-specific lipid polymeric and cross-sensitive sensor membranes, coupled with chemometric tools based on different sub-sets of sensors (from 11 to 14 sensors), to predict key quality parameters of olive oils based on single-run assays. The multivariate linear models established for 23 centenarian olive trees from different cultivars allowed predicting peroxide value, oxidative stability, total phenols and tocopherols contents, CIELAB scale parameters (L*, a* and b* values), as well as 11 gustatory-retronasal positive attributes (green, sweet, bitter, pungent, tomato and tomato leaves, apple, banana, cabbage, fresh herbs and dry fruits) with satisfactory accuracy (0.90 ±â€¯0.07 ≤ R2 ≤ 0.98 ±â€¯0.02 for the repeated K-fold-CV procedure, which ensured that 25% of the data was used for internal-validation purposes). The electronic tongue device had an accuracy statistically similar to that achieved with standard analytical techniques, pointing out the versatility of the device for the fast and simultaneous chemical and sensory analysis of olive oil.

Implementation and initial outcomes of a spinal cord injury home care program at a large veterans affairs medical center.

OBJECTIVES: Describe an interdisciplinary spinal cord injury home care program (SCIHCP), sample demographics for the veteran participants, and initial impact of SCIHCP on health care utilization and mortality. DESIGN: Retrospective review. SETTING: SCIHCP of the Spinal Cord Injury Center, VA North Texas Health Care System (VANTHCS). PARTICIPANTS: Patients with SCI/D enrolled in the SCIHCP during January 6, 2006 through January 9, 2012, whose injury occurred at least one year prior to enrollment(n = 125). MAIN OUTCOME MEASURES: VANTHCS hospital admissions, length of stay (LOS), and emergency department (ED) visits evaluated one year before and one year after SCIHCP enrollment; mortality evaluated one-year post-enrollment. RESULTS: There were no significant changes in number of ED visits, number of hospital admissions, or LOS over time. More home care visits and more mental health comorbidities predicted more hospital admissions. Older patients and those with more mental health comorbidities were more likely to experience increases in LOS. These prediction models were significant after adjusting for injury level, age, race, time since SCI, and number of medical comorbidities. More home care visits were associated with lower likelihood of mortality post-enrollment. CONCLUSIONS: Inpatient and ED utilization did not change one year after enrollment, but more SCIHCP visits predicted more hospital admissions and lower likelihood of mortality in the post-evaluation year. The support, education, and care continuity SCIHCP generates might be related to increased inpatient access and lower mortality rate. Veterans with increased mental health comorbidities used inpatient services more, and might need additional support.

Medical equipment classification: method and decision-making support based on paraconsistent annotated logic.

As technology evolves, the role of medical equipment in the healthcare system, as well as technology management, becomes more important. Although the existence of large databases containing management information is currently common, extracting useful information from them is still difficult. A useful tool for identification of frequently failing equipment, which increases maintenance cost and downtime, would be the classification according to the corrective maintenance data. Nevertheless, establishment of classes may create inconsistencies, since an item may be close to two classes by the same extent. Paraconsistent logic might help solve this problem, as it allows the existence of inconsistent (contradictory) information without trivialization. In this paper, a methodology for medical equipment classification based on the ABC analysis of corrective maintenance data is presented, and complemented with a paraconsistent annotated logic analysis, which may enable the decision maker to take into consideration alerts created by the identification of inconsistencies and indeterminacies in the classification.

Blood stem cell mobilization and collection in patients with chronic lymphocytic leukaemia: a nationwide analysis.

Some reports suggest that blood stem cell mobilization is difficult in a proportion of patients with CLL. We evaluated this issue in a large cohort of CLL patients. One hundred and twenty-eight patients with CLL underwent blood stem cell mobilization during 1995-2005 in Finland. Ninety-five percent of the patients had received fludarabine. The most common mobilization regimen was intermediate-dose CY plus G-CSF (90 patients, 70%). At least 2 x 10(6)/kg CD34+ cells were collected after the first mobilization attempt in 83 patients (65%), whereas 45 patients (35%) failed to reach this collection target. No differences were observed between these patient groups with regard to age, time from the diagnosis to mobilization, number of previous treatment lines, number of fludarabine courses, time from the last fludarabine-containing chemotherapy to mobilization, disease status or degree of marrow infiltration. Patients who failed collection had platelets <100 x 10(9)/l more commonly at the time of mobilization (30 vs 4%, P<0.001). A significant proportion of patients with CLL were difficult to mobilize. Adequate marrow function including platelet counts >100 x 10(9)/l seem to be important factors in terms of successful blood stem cell collection.

Killer-cell immunoglobulin-like receptor ligand compatibility in the outcome of Finnish unrelated donor hematopoietic stem cell transplantation.

Incompatibility in killer-cell immunoglobulin-like receptor (KIR) ligand between recipient and donor of hematopoietic stem cell transplantation has been reported to lead to natural killer (NK) cell activation. This activation may result in better transplantation outcome through reduced risk of graft-versus-host (GvH) disease, relapse and mortality. In the present study the effect of KIR ligand incompatibility was investigated retrospectively in 186 unrelated stem cell transplantations performed in Finland during years 1993-2004. No clear evidence for a better outcome in cases with KIR ligand incompatibility was obtained. Transplantation-related mortality was 64% in Kaplan-Meier analysis in the GvH direction KIR ligand-mismatched group and 33% in the KIR ligand-matched group. This difference was statistically non-significant. Consequently, no support could be obtained for a beneficial effect of KIR ligand incompatibility in the present set of unrelated donor transplantations.

Late non-relapse mortality among adult autologous stem cell transplant recipients: a nation-wide analysis of 1,482 patients transplanted in 1990-2003.

Data on the incidence and causes of late (>100 d) non-relapse mortality (NRM) in autologous stem cell transplant (ASCT) recipients is limited. We have analysed NRM in a cohort of 1,482 adult patients who received ASCT in 1990-2003 in six Finnish transplant centres. The most common diagnoses included non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (n = 132); Hodgkin's lymphoma (HL) (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). Until September 2005, 646 patients (44%) have died. Late NRM was observed in 68 patients (4.6% of ASCT recipients; 11% of all deaths). There were 38 males and 30 females with a median age of 58 yr (20-69) at the time of ASCT. The median time to NRM was 27 months from ASCT (3-112). The risk of NRM was highest in patients with CLL (9.5%) and those with HL (8.1%) followed by MM and NHL (4.9% and 4.8%, respectively). The risk of late NRM was comparable in patients who received total body irradiation (TBI) and those who received chemotherapy-only regimens (6.7% vs. 4.3%). Another malignancy was the most common cause of late NRM (24 patients, 35% of late NRM). Twelve patients (0.8% of ASCT recipients) have died due to secondary haematological malignancy. Altogether 22 patients (32% of late NRM) died from infectious causes. Malignancies and late infections are important causes of NRM after ASCT. These facts point out the importance of prolonged follow-up in ASCT recipients.

Autologous stem cell transplantation in patients with chronic lymphocytic leukaemia: the Finnish experience.

Although autologous stem cell transplantation (ASCT) has gained some popularity as a treatment option in patients with chronic lymphocytic leukaemia (CLL), limited multicentre data are available on the feasibility and efficacy of this approach. Between January 1995 and June 2005, 72 patients with CLL received ASCT in five Finnish centres. There were 45 men and 27 women with a median age of 57 years (38-69). The median time from diagnosis to ASCT was 32 months (6-181) and the median number of prior regimens 1 (1-4). All patients received blood stem cell grafts and CD34+ selection had been performed in 44 patients (61%). The most common high-dose regimen was a total body irradiation plus cyclophosphamide (38 patients, 53%). No early treatment-related deaths were observed. With a median follow-up of 28 months from ASCT, a relapse or progression has been observed in 27 patients (37%). The projected progression-free survival is 48 months (confidence interval (CI) 30-66). The projected median overall survival is 95 months (CI 74-101) from ASCT and is not influenced by graft selection or conditioning regimen used. Autologous stem cell transplantation is a feasible treatment option for CLL. Randomized trials against alternative treatments are needed to assess the impact of ASCT on the clinical course of CLL.

Early treatment-related mortality in adult autologous stem cell transplant recipients: a nation-wide survey of 1482 transplanted patients.

OBJECTIVES: To evaluate early (<100 d) treatment-related mortality (TRM) in autologous stem cell transplant (ASCT) recipients. PATIENTS: Altogether 1482 adult patients received ASCT in six Finnish centres 1990-2003. The most common diagnoses were non-Hodgkin's lymphoma (NHL) (n = 542), multiple myeloma (MM) (n = 528), breast cancer (BC) (n = 132), Hodgkin's lymphoma (n = 86) and chronic lymphocytic leukaemia (CLL) (n = 63). RESULTS: Forty-two patients (2.8%) died from treatment-related reasons <100 d from ASCT. The median time to death was 38 d from ASCT (0-99). The risk of TRM varied according to the diagnoses. The highest risk was observed in patients with AL amyloidosis (24%) followed by NHL (4.4%) and MM (1.9%). No early TRM was observed in patients transplanted for BC or CLL. Infections were the cause of death in 16 patients (fungal 7, bacterial 6, viral 3). Organ toxicity was responsible for early death in 26 patients (heart 9, lungs 7, other 10). CONCLUSIONS: This nation-wide survey indicated a low early TRM in ASCT recipients in general, but higher risks in patients with AL amyloidosis or NHL. In addition to patient selection, also optimization of transplant procedure may be needed in these patient groups to reduce early TRM.

Autologous stem cell transplantation in elderly (>60 years) patients with non-Hodgkin's lymphoma: a nation-wide analysis.

Limited experience is available on the feasibility and efficacy of autologous stem cell transplantation (ASCT) in elderly patients with non-Hodgkin's lymphoma (NHL). In 1994-2004 altogether 88 NHL patients > 60 years old received ASCT in six Finnish transplant centres. There were 57 male and 31 female patients with a median age of 63 years (range 60-70 years); 17 patients were>65 years. The histology included diffuse large B cell (n = 29), mantle cell (n = 27), follicular (n = 15), peripheral T cell (n = 12) and other (n = 5). Disease status at ASCT was I complete remission/partial remission (CR/PR) in 53 patients, II CR/PR in 30 patients and other in five patients. The conditioning regimens included BEAC (n = 49), BEAM (n = 34), TBI-CY (n = 4) and other (n = 1). Eighty-four patients received PB grafts. The medians to reach neutrophils > 0.5 and platelets > 20 were 10 and 14 days, respectively. The early treatment-related mortality (TRM) (<100 days) was 11%. With a median follow-up of 21 months for all patients, 45 patients (51%) are alive. A relapse or progression after ASCT has been observed in 32 patients (36%). ASCT is feasible in selected elderly patients with NHL, but the early TRM seems to be higher than in younger patients.