Recovery and concentration of phenolic compounds in blood orange juice by membrane operations

Cross-flow ultrafiltration (UF) and osmotic distillation (OD) were implemented on laboratory scale to obtain formulations of interest for food and/or pharmaceutical industry starting from the blood orange juice produced in the Calabria region. The freshly squeezed juice, after a depectinization step, was submitted to an UF process in order to recover natural antioxidants, such as hydroxycinnamic acids, hydroxybenzoic acids, flavanones, flavan-3-ols, and anthocyanins. The UF permeate, with an initial total soluble solids (TSS) content of 10.5°Brix, was concentrated by OD up to a final concentration of 61.4°Brix. The performance of both processes was analyzed in terms of productivity (permeate fluxes in UF and evaporation fluxes in OD) and quality of clarified and concentrated samples through the identification and quantization of phenolic compounds. The UF membrane showed a rejection towards the identified phenolic compounds in the range 0.4–6.9% and a little decrease of the TAA (8.2%) was observed in the UF permeate in comparison with the fresh juice. Phenolic compounds were also well preserved in the retentate of the OD process as demonstrated by the constant value of the ratio between the concentration of phenolic compounds in the OD retentate and the concentration of these compounds in the UF permeate stream (in the range 5.54–6.39)

Communication Strategies to Improve Antibiotic Prescribing in Pediatric Urgent Care Centers

OBJECTIVE: Urgent care (UC) clinicians frequently prescribe inappropriate antibiotics for upper respiratory illnesses. In a national survey, pediatric UC clinicians reported family expectations as a primary driver for prescribing inappropriate antibiotics. Communication strategies effectively reduce unnecessary antibiotics while increasing family satisfaction. We aimed to reduce inappropriate prescribing practices in otitis media with effusion (OME), acute otitis media (AOM), and pharyngitis in pediatric UC clinics by a relative 20% within 6 months using evidence-based communication strategies. METHODS: We recruited participants via e-mails, newsletters, and Webinars from pediatric and UC national societies. We defined antibiotic-prescribing appropriateness based on consensus guidelines. Family advisors and UC pediatricians developed script templates based on an evidence-based strategy. Participants submitted data electronically. We reported data using line graphs and shared deidentified data during monthly Webinars. We used χ2 tests to evaluate change in appropriateness at the beginning and end of the study period. RESULTS: The 104 participants from 14 institutions submitted 1183 encounters for analysis in the intervention cycles. Using a strict definition of inappropriateness, overall inappropriate antibiotic prescriptions for all diagnoses trended downward from 26.4% to 16.6% (P = 0.13). Inappropriate prescriptions trended upward in OME from 30.8% to 46.7% (P = 0.34) with clinicians\u27 increased use of watch and wait for this diagnosis. Inappropriate prescribing for AOM and pharyngitis improved from 38.6% to 26.5% (P = 0.03) and 14.5% to 8.8% (P = 0.44), respectively. CONCLUSIONS: Using templates to standardize communication with caregivers, a national collaborative decreased inappropriate antibiotic prescriptions for AOM and had downward trend in inappropriate antibiotic prescriptions for pharyngitis. Clinicians increased the inappropriate use of watch and wait antibiotics for OME. Future studies should evaluate barriers to the appropriate use of delayed antibiotic prescriptions

A Multisite Collaborative to Decrease Inappropriate Antibiotics in Urgent Care Centers

BACKGROUND: Urgent care (UC; a convenient site to receive care for ambulatory-sensitive) centers conditions; however, UC clinicians showed the highest rate of inappropriate antibiotic prescriptions among outpatient settings according to national billing data. Antibiotic prescribing practices in pediatric-specific UC centers were not known but assumed to require improvement. The aim of this multisite quality improvement project was to reduce inappropriate antibiotic prescribing practices for 3 target diagnoses in pediatric UC centers by a relative 20% by December 1, 2019. METHODS: The Society of Pediatric Urgent Care invited pediatric UC clinicians to participate in a multisite quality improvement study from June 2019 to December 2019. The diagnoses included acute otitis media (AOM), otitis media with effusion, and pharyngitis. Algorithms based on published guidelines were used to identify inappropriate antibiotic prescriptions according to indication, agent, and duration. Sites completed multiple intervention cycles from a menu of publicly available antibiotic stewardship materials. Participants submitted data electronically. The outcome measure was the percentage of inappropriate antibiotic prescriptions for the target diagnoses. Process measures were use of delayed antibiotics for AOM and inappropriate testing in pharyngitis. RESULTS: From 20 UC centers, 157 providers submitted data from 3833 encounters during the intervention cycles. Overall inappropriate antibiotic prescription rates decreased by a relative 53.9%. Inappropriate antibiotic prescribing decreased from 57.0% to 36.6% for AOM, 54.6% to 48.4% for otitis media with effusion, and 66.9% to 11.7% for pharyngitis. CONCLUSIONS: Participating pediatric UC providers decreased inappropriate antibiotic prescriptions from 60.3% to 27.8% using publicly available interventions