Development and quality evaluation of polyphenols enriched black carrot (Daucus carota L.) powder incorporated bread.

Black carrot is a prominent source of polyphenols and the cheapest source of anthocyanins in India. In this study, an attempt has been made to examine the feasibility of black carrot powder as an ingredient in bread. Black carrot bread was prepared by incorporating different concentrations of black carrot powder (BCP) at 2.5, 5.0, 7.5 and 10 %. The developed bread samples were analyzed for physical and textural quality, proximate composition, bioactive compounds, antioxidant properties, sensory characteristics, mineral content and storage quality. The results revealed that loaf volume and specific volume decreased (1995-1254 mL, 5.25-3.28 mL/g) with the incorporation of BCP into bread. Textural analysis revealed that the addition of BCP led to increased hardness in the bread (0.110-12 0.151 N), whereas the resilience (43.64-35.10 %), cohesion and springiness (89.930-13 82.146 %) decreased significantly. The content of bioactive compounds such as total phenols, anthocyanins (29.63-112.68 mg/100 g) and flavonoids increased to exceptionally high levels in BCP-incorporated bread and showed high antioxidant activity. Incorporation of BCP up to 7.5 % showed the most acceptable sensory analysis score (7.85) with a significant increase in dietary fiber (40 %) and total mineral content (50 %), which revealed that black carrot powder could be used up to 7.5 % as an ingredient into bread with high acceptability. The present study revealed significant enhancement in bioactive compounds and mineral content of bread after the incorporation of black carrot powder, which supports its immense potential in preventing hunger and oxidative stress-induced disorders in developing countries.

Patient preferences for the treatment of chronic cough: a discrete choice experiment.

BACKGROUND: Chronic cough is common, negatively affects quality of life and has limited treatment options. Inhibition of purinergic signalling is a promising therapeutic approach but is associated with taste-related adverse effects. Little is known about treatment preferences from the perspective of patients with chronic cough, such as trade-offs between efficacy and side effect. METHODS: Patients with chronic cough completed an online discrete choice experiment survey in which they answered a series of questions requiring a choice between two constructed treatment options characterised by varying attribute levels. Selection of cough and taste-related attributes was informed by qualitative interviews and clinical trial data. Logit-based models were used to analyse resulting choice data. RESULTS: The discrete choice experiment survey was completed by 472 participants with chronic cough. Among study attributes, frequency of intense cough attacks was the most important to participants, followed by taste change, frequency of night-time coughing and frequency of daytime coughing. To accept the least preferred taste disturbance of a bitter, metallic, chalky or oily taste change, participants required either: (1) elimination of night-time cough along with a slight reduction in daytime cough; (2) elimination of daytime cough along with a pronounced reduction in night-time or (3) reduction in intense cough attacks from 7 to 2 times per week. Two distinct preference patterns were identified, each placing different importance on efficacy versus side effect trade-offs. CONCLUSIONS: Participants with chronic cough were willing to accept some taste disturbances in exchange for improved efficacy of chronic cough treatments. Knowledge of patient preferences can facilitate shared decision-making.

Did a bot eat your homework? An assessment of the potential impact of bad actors in online administration of preference surveys.

BACKGROUND: Online administration of surveys has a number of advantages but can also lead to increased exposure to bad actors (human and non-human bots) who can try to influence the study results or to benefit financially from the survey. We analyze data collected through an online discrete-choice experiment (DCE) survey to evaluate the likelihood that bad actors can affect the quality of the data collected. METHODS: We developed and fielded a survey instrument that included two sets of DCE questions asking respondents to select their preferred treatments for multiple myeloma therapies. The survey also included questions to assess respondents' attention while completing the survey and their understanding of the DCE questions. We used a latent-class model to identify a class associated with perverse preferences or high model variance, and the degree to which the quality checks included in the survey were correlated with class membership. Class-membership probabilities for the problematic class were used as weights in a random-parameters logit to recover population-level estimates that minimizes exposure to potential bad actors. RESULTS: Results show a significant proportion of respondents provided answers with a high degree of variability consistent with responses from bad actors. We also found that a wide-ranging selection of conditions in the survey screener is more consistent with choice patterns expected from bad actors looking to qualify for the study. The relationship between the number of incorrect answers to comprehension questions and problematic choice patterns peaked around 5 out of 10 questions. CONCLUSIONS: Our results highlight the need for a robust discussion around the appropriate way to handle bad actors in online preference surveys. While exclusion of survey respondents must be avoided under most circumstances, the impact of "bots" on preference estimates can be significant.

"Let's Use This Mess to Our Advantage": Calls to Action to Optimize School Nutrition Program beyond the Pandemic.

School nutrition programs mitigate food insecurity and promote healthy eating by offering consistent, nutritious meals to school-aged children in communities across the United States; however, stringent policy guidelines and contextual challenges often limit participation. During COVID-19 school closures, most school nutrition programs remained operational, adapting quickly and innovating to maximize reach. This study describes semi-structured interviews with 23 nutrition directors in North Carolina, which aimed to identify multi-level contextual factors that influenced implementation, as well as ways in which the innovations during COVID-19 could translate to permanent policy and practice change and improve program reach. Interviews were conducted during initial school closures (May-August 2020) and were deductively analyzed using the Social Ecological Model (SEM) and Consolidated Framework for Implementation Research (CFIR). Analysis elicited multiple relevant contextual factors: director characteristics (motivation, leadership style, experience), key implementation stakeholders (internal staff and external partners), inner setting (implementation climate, local leadership engagement, available resources, structural characteristics), and outer setting (state leadership engagement, external policies and incentives). Findings confirm the strength and resilience of program directors and staff, the importance of developing strategies to strengthen external partnerships and emergency preparedness, and strong support from directors for policies offering free meals to all children.

Patients' Experiences With Staphylococcus aureus and Gram-Negative Bacterial Bloodstream Infections: Results From Cognitive Interviews to Inform Assessment of Health-Related Quality of Life.

BACKGROUND: We previously conducted a concept elicitation study on the impact of Staphylococcus aureus and gram-negative bacterial bloodstream infections (SAB/GNB) on health-related quality of life (HRQoL) from the patient's perspective and found significant impacts on HRQoL, particularly in the physical and functional domains. Using this information and following guidance on the development of patient-reported outcome (PRO) measures, we determined which combination of measures and items (ie, specific questions) would be most appropriate in a survey assessing HRQoL in bloodstream infections. METHODS: We selected a variety of measures/items from the Patient-Reported Outcomes Measurement Information System (PROMIS) representing different domains. We purposefully sampled patients ~6-12 weeks post-SAB/GNB and conducted 2 rounds of cognitive interviews to refine the survey by exploring patients' understanding of items and answer selection as well as relevance for capturing HRQoL. RESULTS: We interviewed 17 SAB/GNB patients. Based on the first round of cognitive interviews (n = 10), we revised the survey. After round 2 of cognitive interviewing (n = 7), we finalized the survey to include 10 different PROMIS short forms/measures of the most salient HRQoL domains and 2 adapted questions (41 items total) that were found to adequately capture HRQoL. CONCLUSIONS: We developed a survey from well-established PRO measures that captures what matters most to SAB/GNB patients as they recover. This survey, uniquely tailored to bloodstream infections, can be used to assess these meaningful, important HRQoL outcomes in clinical trials and in patient care. Engaging patients is crucial to developing treatments for bloodstream infections.

Patient preferences pertaining to treatment options for drug-resistant focal epilepsy.

OBJECTIVE: To determine patient acceptability of benefit-risk trade-offs in selecting treatment options for drug-resistant mesial temporal lobe epilepsy, including open brain surgery, laser ablation (laser interstitial thermal therapy [LITT]), and continued medications. METHODS: A discrete-choice experiment survey was developed, consisting of 20 versions that were randomly assigned to respondents. Each version had 8 sets of constructed treatment alternatives, representing open brain surgery, LITT, or continued medical management. For each set, respondents indicated the treatment alternative they would choose first. Treatment alternatives were characterized by varying levels of chance of seizure freedom for at least 2 years (20-70%), risk of 30-day mortality (0-10%), and risk of neurological deficits (0-40%). Respondents' choices were analyzed using random-parameters logit models to quantify acceptable benefit-risk trade-offs. Preference heterogeneity was evaluated using latent-class analysis. RESULTS: The survey was administered to 2 cohorts of adult patients with drug-resistant epilepsy: a Duke cohort identified using diagnostic codes (n = 106) and a web-recruited panel with a self-reported physician diagnosis of drug-resistant epilepsy (n = 300). Based on mean preference weights, respondents who indicated a willingness to consider surgical intervention would accept a reduction in chance of seizure freedom from 70% to a minimum-acceptable benefit (MAB) of 23% if they could undergo LITT rather than open brain surgery. For a reduction in 30-day mortality from 1% to 0%, MAB was 52%. For a reduction in risk of long-term deficits from 10% to 0%, MAB was 39%. Latent-class analysis revealed additional choice patterns identifying respondent groups that more strongly favored continuing medications or undergoing surgery. CONCLUSION: Patients who are receptive to surgery would accept significantly lower treatment effectiveness to undergo a minimally invasive procedure relative to open brain surgery. They also were willing to accept lower treatment benefit to reduce risks of mortality or neurological deficits.

Evaluation of polyphenols enriched dairy products developed by incorporating black carrot (Daucus carota L.) concentrate.

BACKGROUND: Dairy products like ice cream, yogurt and buttermilk are consumed widely due to their rich taste but these products lack anthocyanins, which are polyphenol and exhibit great antioxidant activity in both in vivo and in vitro studies. Therefore, adding a natural source of these antioxidants to the commonly consumed dairy product will be beneficial to the masses. Among all the sources, black carrots are the extraordinary and cheapest source of anthocyanins, which are commonly consumed as a natural fermented drink. In this study, an attempt has been made to examine the feasibility of black carrot concentrate as an ingredient into dairy products. METHODOLOGY: Ice cream, yogurt and buttermilk were prepared by incorporating black carrot concentrate at 2.5, 5.0, 7.5 and 10% level and were subjected to sensory analysis. The most acceptable products with 7.5% black carrot concentrate were analyzed for minerals, polyphenols and antioxidant activity. Effects of storage on physicochemical, microbial and sensory attributes of black carrot concentrate incorporated dairy products were further analyzed. RESULTS: Sensory analysis revealed that black carrot concentrate could be used up to 7.5% as an ingredient into dairy product with high acceptability. Significant improvement in mineral content (Mg and Fe), polyphenols and antioxidant activity were reported in black carrot concentrate added dairy products. Developed dairy products exhibited an excellent amount of 24.52-113.27 mg/100g anthocyanins. Flavonoids increased by 14.52-34.62 times and Folin-Ciocalteu reducing capacity increased by 26.39-35.87 times in experimental dairy products. The storage study revealed that ice cream could be stored for more than 60 days, yogurt up to 5 days and buttermilk up to 10 days with excellent stability attributes. CONCLUSION: Incorporation of black carrot concentrate at the level of 7.5% resulted in high acceptability and exceptional nutraceutical property of dairy products. Incorporation of black carrot concentrate into dairy products would enhance the nutraceutical properties and mineral content of food, which could be highly significant in preventing hidden hunger and oxidative stress-induced disorders in developing countries.

Patients' Experiences With Staphylococcus aureus and Gram-negative Bacterial Bloodstream Infections: A Qualitative Descriptive Study and Concept Elicitation Phase To Inform Measurement of Patient-reported Quality of Life.

BACKGROUND: Although Staphylococcus aureus and gram-negative bacterial bloodstream infections (SAB/GNB) cause substantial morbidity, little is known regarding patient perceptions' of their impact on quality of life (QOL). Guidance for assessing QOL and disease-specific measures are lacking. We conducted a descriptive qualitative study to gain an in-depth understanding of patients' experiences with SAB/GNB and concept elicitation phase to inform a patient-reported QOL outcome measure. METHODS: We conducted prospective one-time, in-depth, semi-structured, individual, qualitative telephone interviews 6- 8 weeks following bloodstream infection with either SAB or GNB. Patients were enrolled in an institutional registry (tertiary academic medical center) for SAB or GNB. Interviews were audio-recorded, transcribed, and coded. Directed content analysis identified a priori and emergent themes. Theme matrix techniques were used to facilitate analysis and presentation. RESULTS: Interviews were completed with 30 patients with SAB and 31 patients with GNB. Most patients were at or near the end of intravenous antibiotic treatment when interviewed. We identified 3 primary high-level concepts: impact on QOL domains, time as a critical index, and sources of variability across patients. Across both types of bloodstream infection, the QOL domains most impacted were physical and functional, which was particularly evident among patients with SAB. CONCLUSIONS: SAB/GNB impact QOL among survivors. In particular, SAB had major impacts on multiple QOL domains. A combination of existing, generic measures that are purposefully selected and disease-specific items, if necessary, could best capture these impacts. Engaging patients as stakeholders and obtaining their feedback is crucial to conducting patient-centered clinical trials and providing patient-centered care.

Study on Breakfast Consumption Pattern and Its Outcomes in Relation to Hematological and Body Composition Indices among Adolescent Girls.

Breakfast consumption is of utmost importance for adolescents to attain nutritional adequacy. The association of breakfast skipping with overall nutritional status has been supported with little causal evidences. Therefore, the present investigation was undertaken to examine this conjecture. A total of 500 adolescent girls from rural and urban government schools of Ludhiana District in the Punjab State of India in the age group of 16-18 years were randomly interviewed to assess their breakfast consumption pattern. Based on their breakfast consumption pattern, 90 subjects out of 500 interviewed girls were selected and categorized in three groups of regular, occasional, and never breakfast consumers. They were further assessed for body composition and hematological profile including hemoglobin level, red blood cell count, packed cell volume to evaluate the association with breakfast consumption. Consequently, a higher percentage of regular breakfast (83%) consumers were found in the normal category of BMI as compared to occasional (30%) and never (27%) consumers. There was a significant (p ≤ 0.05) association of body mass index and muscle mass with breakfast consumption. Similarly, a higher percentage of regular breakfast consumers (60%) were found non-anemic in comparison to occasional (13%) and never (3%) and showed a significant association with breakfast consumption.

Use of a human-centered design approach to adapt a nurse-led cardiovascular disease prevention intervention in HIV clinics.

Stakeholder-informed strategies addressing cardiovascular disease (CVD) burden among people living with HIV (PWH) are needed within healthcare settings. This study provides an assessment of how human-centered design (HCD) guided the adaptation of a nurse-led intervention to reduce CVD risk among PWH. Using a HCD approach, research staff guided two multidisciplinary "design teams" in Ohio and North Carolina, with each having five HCD meetings. We conducted acceptability and feasibility testing. Six core recommendations were produced by two design teams of key stakeholders and further developed after the acceptability and feasibility testing to produce a final list of 14 actionable areas of adaptation. Acceptability and feasibility testing revealed areas for adaptation, e.g. patient preferences for communication and the benefit of additional staff to support patient follow-up. In conclusion, along with acceptability and feasibility testing, HCD led to the production of 14 key recommendations to enhance the effectiveness and scalability of an integrated HIV/CVD intervention.

E-Cigarette Use Among Adult Primary Care Patients: Results from a Multisite Study.

BACKGROUND: Primary care settings provide opportunities to identify electronic-cigarette (e-cigarette) use and to implement strategies for changing tobacco use behavior. However, a better understanding of the extent and associated characteristics of e-cigarette use among primary care patients are needed to inform such efforts. OBJECTIVE: To describe patient demographic and substance use characteristics by e-cigarette use status among a large sample of primary care patients. To examine the prevalence and correlates of e-cigarette use among tobacco users in the sample. DESIGN: Cross-sectional analysis from a multisite validation study of a substance use screening instrument. PARTICIPANTS: Adult primary care patients aged 18 and older (n = 2000) recruited across 5 primary care clinics in the Eastern USA from 2014 to 2015. MAIN MEASURES: Patients reported past 3-month e-cigarette use, sociodemographics, tobacco use, and other substance use. Current nicotine dependence and DSM-5 criteria for past-year substance use disorders were also assessed. KEY RESULTS: Among the total sample, 7.7% (n = 154) adults reported past 3-month e-cigarette use. Adults who reported e-cigarette use (vs. no use) were more likely to be younger, white, or have frequent tobacco use, nicotine dependence, or past-year illicit drug use/disorders. Among past 3-month tobacco users, 16.3% reported e-cigarette use. Adjusted logistic regression indicated that odds of e-cigarette use were greater among tobacco users who had some college education or more (vs. < high school) or were daily/almost daily tobacco users (vs. not); odds were lower among Blacks/African-Americans (vs. whites). E-cigarette use among tobacco users was associated with increased odds of current nicotine dependence or tobacco use disorder as well as more severe dependence/disorder. CONCLUSIONS: Enhanced surveillance of e-cigarette use among adult tobacco users in primary care, particularly among those who use tobacco frequently, may have implications for helping patients with tobacco cessation using established approaches including behavioral support, pharmacotherapy, or referral to specialized care.

Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses: A Systematic Review.

Background: Prescription drug monitoring programs (PDMPs) are a key component of the president's Prescription Drug Abuse Prevention Plan to prevent opioid overdoses in the United States. Purpose: To examine whether PDMP implementation is associated with changes in nonfatal and fatal overdoses; identify features of programs differentially associated with those outcomes; and investigate any potential unintended consequences of the programs. Data Sources: Eligible publications from MEDLINE, Current Contents Connect (Clarivate Analytics), Science Citation Index (Clarivate Analytics), Social Sciences Citation Index (Clarivate Analytics), and ProQuest Dissertations indexed through 27 December 2017 and additional studies from reference lists. Study Selection: Observational studies (published in English) from U.S. states that examined an association between PDMP implementation and nonfatal or fatal overdoses. Data Extraction: 2 investigators independently extracted data from and rated the risk of bias (ROB) of studies by using established criteria. Consensus determinations involving all investigators were used to grade strength of evidence for each intervention. Data Synthesis: Of 2661 records, 17 articles met the inclusion criteria. These articles examined PDMP implementation only (n = 8), program features only (n = 2), PDMP implementation and program features (n = 5), PDMP implementation with mandated provider review combined with pain clinic laws (n = 1), and PDMP robustness (n = 1). Evidence from 3 studies was insufficient to draw conclusions regarding an association between PDMP implementation and nonfatal overdoses. Low-strength evidence from 10 studies suggested a reduction in fatal overdoses with PDMP implementation. Program features associated with a decrease in overdose deaths included mandatory provider review, provider authorization to access PDMP data, frequency of reports, and monitoring of nonscheduled drugs. Three of 6 studies found an increase in heroin overdoses after PDMP implementation. Limitation: Few studies, high ROB, and heterogeneous analytic methods and outcome measurement. Conclusion: Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of "best practices" and complementary initiatives to address these consequences. Primary Funding Source: National Institute on Drug Abuse and Bureau of Justice Assistance.

Effect of processing on nutrients and fatty acid composition of garden cress (Lepidium sativum) seeds.

Garden cress seeds were undergone for different processing methods and analyzed for its nutritional composition. Effect of processing on nutrient retention was evaluated to attain the best processed form of seeds with maximum amount of nutrients. Soaking improved protein and ash by 2.10 and 2.48 percent respectively. Boiling improved fat and fibre by 1.66 and 8.32 percent respectively. Maximum retention of iron and zinc was found with roasting. It also improved calcium by 3.18 percent. Percent ionizable iron and bioavailability was found maximum with boiling (13.59 and 6.88% respectively). In vitro starch and protein digestibility were found maximum on boiling (57.98 and 32.39% respectively) with a decrease of 9.65 and 14.13 percent in phytin phosphorus and oxalate respectively. Amino acids and fatty acids were decreased with heat treatment and maximum retention was found with soaking. Overall improvement in nutrient composition and maximum nutrient retention was found with boiling method.

Development of rice bran oil blends for quality improvement.

Six rice bran oil (RBO) blends were prepared in two ratios i.e., 80:20 and 70:30 and analysed for physicochemical properties, and antioxidants and fatty acid composition. Among all the RBO blends, rice bran oil+groundnut oil (70:30) had the highest smoke point (204 °C) and rice bran oil+olive oil (70:30) was the most stable blend in terms of chemical parameters. The highest value of total antioxidants was observed in rice bran oil+sunflower oil (70:30) (2568.7 mg/kg). Fatty acid composition (SFA:MUFA:PUFA) (1:1.5:2) of rice bran oil+palm oil (80:20), and products prepared using this RBO blend, were close to the recommended intake. Boiling with sautéing was a better cooking method in terms of maintaining fatty acid ratios.

Nutritional profiles of urban and rural men of Punjab with regard to dietary fat intake.

This study was undertaken to determine the quantity and type of fat consumed by urban and rural men in relation to BMI. Researchers surveyed 200 Punjabi men from rural and urban areas of Ludhiana District; total fat intake (74 g/day) by urban men was significantly more than that of men in rural areas. The energy percentage from total fat was positively and significantly (p ≤ .05) associated with BMI, accounting for 3.1%, 4.2%, and 2.9% of variation in the rural, urban, and total sample, respectively. Fatty-acid ratios were closer to recommendations for urban men than for men from rural areas.