Educational video while "waiting-to-be-seen" in a cardiology outpatient clinic promotes opt-in self-consent for biobanking of remnant clinical biospecimens: A randomized-controlled trial.

Objectives: Consenting donors for remnant clinical biospecimen donation is critical for scaling research biorepositories. Opt-in, low-cost, self-consenting for donations that solely relied on clinical staff and printed materials was recently shown to yield ∼30% consent rate. We hypothesized that adding an educational video to this process would improve consent rates. Methods: Randomized patients (by clinic day) in a Cardiology clinic received either printed materials (control) or the same materials plus an educational video on donations (intervention) while waiting to be seen. Engaged patients were surveyed at the clinic checkout for an "opt-in" or "opt-out" response. The decision was documented digitally in the electronic medical record. The primary outcome of this study was the consent rate. Results: Thirty-five clinic days were randomized to intervention (18) or control (17). Three hundred and fifty-five patients were engaged, 217 in the intervention and 158 in the control. No significant demographic differences were noted between treatment groups. Following an intention-to-treat analysis, the rate of opt-in for remnant biospecimen donation was 53% for the intervention and 41% for the control group (p-value = 0.03). This represents a 62% increase in the odds of consenting (OR = 1.62, 95% CI = 1.05-2.5). Conclusion: This is the first randomized trial showing that an educational video is superior to printed materials alone when patients are self-consenting for remnant biospecimen donation. This result adds to the evidence that efficient and effective consenting processes can be integrated into clinical workflows to advance universal consenting in medical research.

Nutritional and Technological Properties of Albino Peach Palm (Bactris gasipaes) from the Amazon: Influence of Cooking and Drying.

This study aimed to subject the albino peach palm to cooking and drying processes and characterize the raw pulp (RP), cooked pulp (CP), raw pulp flour (RPF), and cooked pulp flour (CPF). The product's chemical composition, bioactive compounds, and physicochemical, color, thermal, morphological, and functional-technological properties were evaluated. The proximate composition showed that carbohydrates were the main constituents of all the products (69.59-72.08 g/100 g). The cooking process decreased the lipids (10.21 to 8.63 g/100 g), dietary fiber (13.64 to 12.81 g/100 g), and total sugar content (59.18 to 49.10 g/100 g) of the CP. The colorimetric parameters indicated a significant browning of the CP and CPF, which can be attributed to the Maillard reaction and lipid oxidation. After cooking, the total phenolic compound and ascorbic acid content decreased in the pulp. The RPF and CPF displayed different thermogravimetric behaviors. The spectral patterns in the infrared region showed the characteristic bands of organic compounds that are present in the structure of starches. The scanning electron microscopy showed amyloplast and fiber bundles with starches in the RP and gelatinized starch granules in the CP and CPF. The RPF presented small and heterogeneous starch granules with isolated amyloplast. The RPF and CPF showed different granulometric patterns and technological indices. The results suggest that the pulp and flour from the pulp of albino peach palms can be exploited by the food, pharmaceutical, and biotechnological industries.

An Analytical Model for the Aggregate Throughput of IEEE 802.11ah Networks under the Restricted Access Window Mechanism.

The IEEE 802.11ah is an amendment to the IEEE 802.11 standard to support the growth of the Internet of Things (IoT). One of its main novelties is the restricted access window (RAW), which is a channel access feature designed to reduce channel contention by dividing stations into RAW groups. Each RAW group is further divided into RAW slots, and stations only attempt channel access during the RAW slot they were assigned to. In this paper, we propose a discrete-time Markov chain model to evaluate the average aggregate throughput of IEEE 802.11ah networks using the RAW mechanism under saturated traffic and ideal channel conditions. The proposed analytical model describes the behavior of an active station within its assigned RAW slot. A key aspect of the model is the consideration of the event of RAW slot time completion during a station's backoff operation. We study the average aggregate network throughput for various numbers of RAW slots and stations in the network. The numerical results derived from our analytical model are compared to computer simulations based on an IEEE 802.11ah model developed for the ns-3 simulator by other researchers, and its performance is also compared to two other analytical models proposed in the literature. The presented results indicate that the proposed analytical model reaches the closest agreement with independently-derived computer simulations.

Spirituality in Serious Illness and Health.

Importance: Despite growing evidence, the role of spirituality in serious illness and health has not been systematically assessed. Objective: To review evidence concerning spirituality in serious illness and health and to identify implications for patient care and health outcomes. Evidence Review: Searches of PubMed, PsycINFO, and Web of Science identified articles with evidence addressing spirituality in serious illness or health, published January 2000 to April 2022. Independent reviewers screened, summarized, and graded articles that met eligibility criteria. Eligible serious illness studies included 100 or more participants; were prospective cohort studies, cross-sectional descriptive studies, meta-analyses, or randomized clinical trials; and included validated spirituality measures. Eligible health outcome studies prospectively examined associations with spirituality as cohort studies, case-control studies, or meta-analyses with samples of at least 1000 or were randomized trials with samples of at least 100 and used validated spirituality measures. Applying Cochrane criteria, studies were graded as having low, moderate, serious, or critical risk of bias, and studies with serious and critical risk of bias were excluded. Multidisciplinary Delphi panels consisting of clinicians, public health personnel, researchers, health systems leaders, and medical ethicists qualitatively synthesized and assessed the evidence and offered implications for health care. Evidence-synthesis statements and implications were derived from panelists' qualitative input; panelists rated the former on a 9-point scale (from "inconclusive" to "strongest evidence") and ranked the latter by order of priority. Findings: Of 8946 articles identified, 371 articles met inclusion criteria for serious illness; of these, 76.9% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for serious illness: (1) incorporate spiritual care into care for patients with serious illness; (2) incorporate spiritual care education into training of interdisciplinary teams caring for persons with serious illness; and (3) include specialty practitioners of spiritual care in care of patients with serious illness. Of 6485 health outcomes articles, 215 met inclusion criteria; of these, 66.0% had low to moderate risk of bias. The Delphi panel review yielded 8 evidence statements supported by evidence categorized as strong and proposed 3 top-ranked implications of this evidence for health outcomes: (1) incorporate patient-centered and evidence-based approaches regarding associations of spiritual community with improved patient and population health outcomes; (2) increase awareness among health professionals of evidence for protective health associations of spiritual community; and (3) recognize spirituality as a social factor associated with health in research, community assessments, and program implementation. Conclusions and Relevance: This systematic review, analysis, and process, based on highest-quality evidence available and expert consensus, provided suggested implications for addressing spirituality in serious illness and health outcomes as part of person-centered, value-sensitive care.

Nutraceutical potential of Amazonian oilseeds in modulating the immune system against COVID-19 - A narrative review.

Since the outbreak of COVID-19 disease, medical and scientific communities are facing a challenge to contain its spread, develop effective treatments, and reduce its sequelae. Together with the therapeutical treatments, the use of dietary bioactive compounds represents a promising and cost-effective strategy to modulate immunological responses. Amazonian oilseeds are great sources of bioactive compounds, thus representing not only a dietary source of nutrients but also of substances with great interest for human health. This narrative review compiled the available evidence regarding the biochemical properties of some Amazonian oilseeds, especially Brazil nut, Açaí berry, Bacaba, Peach palm, Sapucaya and Tucuma fruits, on human health and its immune system. These effects were discussed from an etiological and pathophysiological perspective, emphasizing their potential role as a co-adjuvant strategy against COVID-19. Besides this, the cost associated with these strategies hinders their applicability in many nations, especially low-income countries and communities living in social insecurity.

Low-level laser therapy attenuates lung inflammation and airway remodeling in a murine model of idiopathic pulmonary fibrosis: Relevance to cytokines secretion from lung structural cells.

Idiopathic pulmonary fibrosis (IPF) is a progressive and chronic inflammatory disease with a poor prognosis and very few available treatment options. Low-level laser therapy (LLLT) has been gaining prominence as a new and effective anti-inflammatory and immunomodulatory agent. Can lung inflammation and the airway remodeling be regulated by LLLT in an experimental model of IPF in C57Bl/6 mice? The present study investigated if laser attenuates cellular migration to the lungs, the airway remodeling as well as pro-fibrotic cytokines secretion from type II pneumocytes and fibroblasts. Mice were irradiated (780 nm and 30 mW) and then euthanized fifteen days after bleomycin-induced lung fibrosis. Lung inflammation and airway remodeling were evaluated through leukocyte counting in bronchoalveolar lavage fluid (BALF) and analysis of collagen in lung, respectively. Inflammatory cells in blood were also measured. For in vitro assays, bleomycin-activated fibroblasts and type II pneumocytes were irradiated with laser. The pro- and anti-inflammatory cytokines level in BALF as well as cells supernatant were measured by ELISA, and the TGFß in lung was evaluated by flow cytometry. Lung histology was used to analyze collagen fibers around the airways. LLLT reduced both migration of inflammatory cells and deposition of collagen fibers in the lungs. In addition, LLLT downregulated pro-inflammatory cytokines and upregulated the IL-10 secretion from fibroblasts and pneumocytes. Laser therapy greatly reduced total lung TGFß. Systemically, LLLT also reduced the inflammatory cells counted in blood. There is no statistical difference in inflammatory parameters studied between mice of the basal group and the laser-treated mice. Data obtained indicate that laser effectively attenuates the lung inflammation, and the airway remodeling in experimental pulmonary fibrosis is driven to restore the balance between the pro- and anti-inflammatory cytokines in lung and inhibit the pro-fibrotic cytokines secretion from fibroblasts.

Modeling Clinical Processes to Consent Research Donors of Remnant Biospecimens in an Outpatient Cardiology Clinic.

Introduction: Informed consent for research biospecimen donations is traditionally obtained through a face-to-face interaction with research staff and by signing an Institutional Review Board (IRB)-approved printed form. Electronic signatures (eSign) are routinely used in the electronic medical record (EMR) for the consenting of clinical services after patients review printed documentation. Our goal was to develop an electronic self-consenting workflow that mimicked clinical services. Specifically, we tested a research consent process for the biobanking of remnant clinical samples that relies solely on clinical resources in a busy outpatient practice. Materials and Methods: The Biorepositories Core Resource (BCR) unit initiated a new enterprise-wide biobanking infrastructure for consenting patients, termed Biospecimen Use for Research-Related Investigations and Translational Objectives (BURRITO). BURRITO is modeled after an established clinical process called Terms and Conditions of Service (TACOS). The TACOS requires patients to annually review printed documentation and self-consent electronically for clinical services. BURRITO also requires patients to review printed documentation and self-consent with eSign to opt-in for remnant biospecimen banking, but patients must complete this process only once. We captured eSign for consents directly into the EMR without research staff. Results: Patients reviewed the IRB-approved documents and self-consented during their cardiology clinic visit. At checkout, their participation preferences were electronically documented by clinic staff. During a 6-month period, 123 patients agreed to donate. After a review of process, a second 3-month period identified 202 patients agreeing to donate. BURRITO did not require face-to-face interactions with research staff, used a "no-paper" eSign for consent, and created discrete fields in the clinical EMR of the patient's preference. Conclusions: BURRITO electronically documents informed consent using an EMR functionality and the least amount of clinical and research resources. Our results show promise for developing institutionally adopted processes, which could leverage existing clinical workflows for universal research consenting and scalability.

Chromatographic profile and bioactive compounds found in the composition of pupunha oil (Bactris gasipaes Kunth): implications for human health / Perfil cromatográfico e compostos bioativos presentes na composição do óleo de pupunha (Bactris gasipaes Kunth): implicações para a saúde humana

ABSTRACT Objective The presence of dietary bioactive compounds in the human diet becomes a major factor in combating the etiology of different pathologies. Thus, the aim of this investigation was to evaluate the fatty acids profile, cardiovascular functionality indices, bioactive compounds and spectroscopic pattern of peach palm oil (pupunha oil) and their impact on human health. Methods The oil was obtained by soxhlet extraction; the oil yield and qualities were determined according to the standards of the Association of Official Analytical Chemists. For the fatty acids profile, the practical recommendations of the American Oil Chemists' Society and of the International Organization for Standardization were followed. Total carotenoids and polyphenols were determined by spectrophotometry; the composition of the chemical groups was determined by infrared spectroscopy. The anti-atherogenic, antithrombogenic and hypocholesterolemic indices were obtained using mathematical models. Results The results showed good quality oil based on acid and peroxyde indices (2.45±0.33mg KOH g-1 and 5.47±1.05mEq kg-1). The main fruit bioactive compound was β-carotene (832.4±0.64µg/100g). The chromatographic profile showed a high saturated fatty acid content (53.74%); unsaturated (46.25%); fats were monounsaturated (39.66%) and polyunsaturated (6.59%). The antiatherogenic, antithrombogenic and hypocholesterolemic indices were, on average, 1.10, 2.04 and 0.84, respectively. The spectroscopic profile exhibited bands with variation from 2918.8cm-1 to 714cm-1. Conclusion The results indicate that the consumption of isolated lipid content of the pupunha palm oil provides health protection with emphasis on the prevention of cardiovascular diseases.

RESUMO Objetivo A presença de fontes alimentares ricas em compostos bioativos na dieta humana torna-se fator preponderante no combate à etiologia de diversas patologias. Assim, o objetivo desta pesquisa foi avaliar o perfil de ácidos graxos, índices de funcionalidade cardiovasculares, compostos bioativos e padrão espectroscópico do óleo da pupunha vermelha e suas implicações para a saúde humana. Métodos O óleo foi obtido por extração via soxhlet; seu rendimento e qualidade foram determinados segundo as normas da Association of Official Analytical Chemists. Para o perfil de ácidos graxos, seguiram-se as recomendações práticas da American Oil Chemists' Society e da International Organization for Standardization. Os carotenoides e polifenóis totais foram estipulados por espectrofotometria; a constituição de grupos químicos, por espectroscopia de infravermelho. Os índices antiaterogênico, antitrombogênico e hipocolesterolêmico foram obtidos por modelos matemáticos. Resultados Os resultados evidenciaram um óleo com boa qualidade, com base nos índices de acidez e peróxido (2,45±0,33mg KOH g-1 e 5,47±1,05mEq kg-1). O principal composto bioativo desse fruto foi o β-caroteno (832,4±0,64µg/100g). O perfil cromatográfico revelou um elevado teor de ácidos graxos saturados (53,74%); os insaturados (46,25%) se mostraram distribuídos em monoinsaturados (39,66%) e poli-insaturados (6,59%). Os índices de antiaterogênico, antitrombogênico e hipocolesterolêmico foram, em média, respectivamente 1,10; 2,04 e 0,84. O perfil espectroscópico apresentou destaques com variação de 2918,8cm-1 a 714cm-1. Conclusão Os resultados indicam que o consumo do conteúdo lipídico isolado da pupunha atua na proteção da saúde, em especial para a prevenção de agravos cardiovasculares.

New Insight into the Dissolution of Epoxy Resin-based Sealers.

INTRODUCTION: The purpose of this study was to evaluate the use of solvents that are not traditionally used in dentistry for the dissolution of an epoxy resin-based sealer and the effect of ultrasonic agitation (UA). METHODS: The dissolution of the AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) and the effect of UA in various solvents (eucalyptol, xylene, chloroform, EndoSolv R [Septodont, Cedex, France], EndoSolv E [Septodont], methyl ethyl ketone [MEK], and ethyl acetate) were quantified. The dissolving capacity was assessed by weight loss, Vicker microhardness, scanning electron microscopy (SEM), and X-ray diffraction (XRD). The results were compared with factorial analysis of variance using IBM SPSS Statistics 23.0 software (IBM, Armonk, NY), considering a 0.05 significance level. A preliminary ex vivo study was performed in extracted teeth, with MEK activated by UA as the final irrigation after mechanical removal of the filling material. SEM was used for assessing the cleanliness of the root canal walls. RESULTS: The new solvent proposals, ethyl acetate and MEK, exhibited high dissolution ability, almost reaching chloroform. UA increased dissolution. Vicker values corroborated the dissolution assays. SEM and XRD revealed that solvents affected mainly the organic component of the sealer. Ex vivo results confirmed the immersion model findings. CONCLUSIONS: MEK and ethyl acetate proved to be excellent alternatives to chloroform or xylene solvents. MEK presented a high sealer dissolving ability in a short period, especially with UA, without the potential hazards of chloroform, suggesting it is a good approach to AH Plus sealer's dissolution empowered by UA. These results should encourage further studies in order to confirm their clinical relevance.

Assessing Researcher Needs for a Virtual Biobank.

INTRODUCTION: Biosamples and associated clinical data accelerate translational and clinical research discoveries. A lack of high quality biosamples both stalls projects and limits research advances. In this study, we targeted a wide audience of University of California (UC) biobanking stakeholders who were either involved with the collection or the utilization of biosamples to assess the scope of their biobanking activities and their interest in virtual biobanking or cooperating in the formation of the UC-wide biorepository. MATERIALS AND METHODS: Each institutional review board from the five UC medical campuses' provided a dataset of potential researchers involved with biobanking. Once identified, a brief six item web-based questionnaire was administered electronically to these researchers. RESULTS: Most survey participants (80%) responded "yes" (n = 348) that they were actively collecting biosamples for research, and 68% of participants indicated they would either definitely (30%, n = 131) or maybe (38%, n = 166) request biosample materials now or within the next year. An equal proportion of participants responded yes (42% or n = 184) and maybe (42% or n = 182) when asked if they would voluntarily contribute specimens to a UC-wide virtual biobank. DISCUSSION: The results presented above show high levels of support among UC biobanking stakeholders for both requesting material from and contributing material to a UC-wide virtual biobank. In addition, a considerable number of individual researchers on our five UC medical campuses are conducting biospecimen research (i.e., well over n = 435 respondents).

Comprehensive native glycan profiling with isomer separation and quantitation for the discovery of cancer biomarkers.

Glycosylation is highly sensitive to the biochemical environment and has been implicated in many diseases including cancer. Glycan compositional profiling of human serum with mass spectrometry has already identified potential biomarkers for several types of cancer and diseases; however, composition alone does not fully describe glycan stereo- and regioisomeric diversity. The vast structural heterogeneity of glycans presents a formidable analytical challenge. We have developed a method to identify and quantify isomeric native glycans using nanoflow liquid chromatography (nano-LC)/mass spectrometry. A microfluidic chip packed with graphitized carbon was used to chromatographically separate the glycans. To determine the utility of this method for structure-specific biomarker discovery, we analyzed serum samples from two groups of prostate cancer patients with different prognoses. More than 300 N-glycan species (including isomeric structures) were identified, corresponding to over 100 N-glycan compositions. Statistical tests established significant differences in glycan abundances between patient groups. This method provides comprehensive, selective, and quantitative glycan profiling.

Effects of a high dose, aglycone-rich soy extract on prostate-specific antigen and serum isoflavone concentrations in men with localized prostate cancer.

The efficacy and safety of consuming high-dose isoflavone supplements for prostate cancer is not clear. A double-blind, placebo controlled, randomized trial was conducted in 53 men with prostate cancer enrolled in an active surveillance program. The treatment group consumed a supplement containing 450 mg genistein, 300 mg daidzein, and other isoflavones daily for 6 mo. Prostate-specific antigen (PSA) was measured in both groups at baseline, 3 mo, and 6 mo, and serum concentrations of genistein, daidzein, and equol were assessed at baseline and 6 mo in the treatment group. Following the completion of the 6-mo double-blind study, men were enrolled in a 6-mo open label trial with the same isoflavone-rich supplement, and PSA was measured at 3 and 6 mo. PSA concentrations did not change in either group after 6 mo or after 12 mo when the open-label study was included. The 6 mo serum concentrations of genistein and daidzein (39.85 and 45.59 µmol/l, respectively) were significantly greater than baseline values and substantially higher than levels previously reported in other studies. Equol levels did not change. Although high amounts of aglycone isoflavones may result in significantly elevated serum concentrations of genistein and daidzein, these dietary supplements alone did not lower PSA levels in men with low-volume prostate cancer.

Effects of a genistein-rich extract on PSA levels in men with a history of prostate cancer.

OBJECTIVES: To determine whether supplemental amounts of soy isoflavone (genistein-rich extract) would lower prostate-specific antigen (PSA) levels more than 50% in patients with prostate cancer (CaP). METHODS: A total of 62 men (mean age 73.6 years, range 61.4 to 89.3) with histologically proven CaP who had two consecutive elevated PSA readings were accrued during a 13-month period. An open-label pilot study was conducted for 6 months in which the patients took capsules containing the genistein-rich extract three times daily by mouth. The subjects were in one of five groups: after radical retropubic prostatectomy (n = 9), after radiotherapy (n = 17), after both radical retropubic prostatectomy and radiotherapy (n = 6), off-cycle during hormonal therapy (intermittent hormones; n = 14), or active surveillance (n = 16). The primary endpoint for the trial was a 50% reduction in the PSA level at 6 months compared with before treatment. RESULTS: Of the 62 men enrolled, 52 were available for evaluation at 6 months. Three patients discontinued because of adverse events (diarrhea) and seven because of personal choice. One of 52 patients had a more than 50% reduction in the PSA level (1.9% response, 95% confidence interval 0.1% to 10.3%). An additional 7 patients had PSA reductions that were less than 50%. All 8 patients with lower PSA levels at 6 months were in the active surveillance (watchful waiting) treatment subgroup. Repeated measure regression models allowing for correlation between initial levels and change also indicated a decline in PSA in this group compared with other groups: 0 of 52 had a complete response, 9 (17%) had a partial response, 8 (15%) had stable disease, and 35 (67%) had disease progression. In the 9 patients with a partial response, 6 had pathologic findings that were moderately differentiated, 2 had well-differentiated findings, and 1 had poorly differentiated findings. Therefore, the response in this group of patients did not appear to be driven by the Gleason score. The total testosterone level was lowered in one of the patients responding, but it was higher in five others. CONCLUSIONS: A genistein-rich extract as the sole treatment for CaP did not reduce PSA levels by 50% or more in 51 of 52 subjects. Thus, it does not appear to be an effective treatment for CaP when given alone. However, 8 of 13 evaluated patients in the active surveillance group had either no rise or a decline in PSA levels of less than 50%. More study is warranted for those choosing active surveillance.

Effects of a mushroom mycelium extract on the treatment of prostate cancer.

OBJECTIVES: To determine whether supplemental amounts of a polysaccharide/oligosaccharide complex obtained from a shiitake mushroom extract (SME) would lower the prostate-specific antigen (PSA) level in patients with prostate cancer. METHODS: A total of 62 men (mean age 73.2 years, range 53.6 to 85.5) with histologically proven prostate cancer who had two consecutive elevated PSA readings were accrued to the study during a 3-month period. This was an open-label study in which the patients received oral administration of capsules containing SME given three times daily for 6 months. The endpoint for the trial was the lowering of the PSA levels. RESULTS: Of the 62 men enrolled in the study, 61 were assessable. At 4 months, 1 patient withdrew because of unrelated surgery and 7 withdrew because of disease progression; none had responded with a decrease of greater than 50% in the PSA level. By 6 months, a total of 23 patients had progression and none had responded. Thirty-eight patients had stable PSA levels after 6 months. Although not the primary endpoint of the study, in other studies these patients could have been included as responders. When the patients' rates of PSA rise before study entry were analyzed, 4 (7%) had stabilized disease while taking SME. Thus, the final results for our study patients were 0 with a complete response, 0 with a partial response, 4 (7%) with stable disease, and 23 of 61 with progression while taking SME. CONCLUSIONS: SME alone is ineffective in the treatment of clinical prostate cancer.