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Introduction and Objectives: La Clínica Latina is a free clinic that strives to meet the healthcare needs of the Spanish-speaking population of Franklin County, Ohio, including metropolitan Columbus. As a student-run free clinic, care is provided each week by volunteer medical students and resident physicians under the administrative leadership of the medical student board and clinical supervision of licensed physicians. Patients served by the clinic have a multitude of chronic health conditions, which are managed by clinic volunteers through the delivery of over 1500 appointments per year. In order to better serve the rapidly growing patient population, this study describes the delivery and results of an assessment aimed at understanding the needs that are being met sufficiently at the clinic and what pitfalls still exist in the clinic’s provision of care. Methods: By delivering a survey inquiring about the experiences of patients at La Clínica Latina, clinic workflow can be optimized for the provision of patient-centered care. Results: Insights collected from a convenience sample of 30 patients demonstrate mobile phone use as the primary mode of communication with clinic volunteers, previously under-appreciated musculoskeletal health concerns, longer than desired wait times after check-in, and variable experiences of health literacy by patient gender. Conclusion: By addressing each of these insights in updates to clinic workflow, La Clínica Latina may prove to become an even more useful resource to the region’s growing Hispanic population.

Food is a must for all life to survive. Global food production has increased owing to population augmentation, increasing the generation of food and agricultural residues. Agro-wastes are important sources of natural compounds such as biopolymers that can be used to develop value-added products contributing to replacing synthetic compounds. Biopolymers like pectin, starch, and chitin, have multiple functional properties, useful to improve the sensorial properties of foods, and provide a sustainable alternative to conventional materials in food processing and packaging. Researchers and the industrial sector have successfully converted agricultural residues into valuable edible biopolymers with prebiotic potential, antioxidant, and antimicrobial properties by using emerging technologies such as ultrasound, microwave-assisted extraction, enzymatic hydrolysis, fermentation, and/or bioconversion. The variation of the extraction conditions using emerging technologies allows the modification of the structural properties of the polymer giving a wide range for their application in the food sector. Besides, the incorporation of Industry 4.0 in these processes allows the optimization, automatization, and obtention of high yields of polymers of improved quality. This review highlights the potential of emerging technologies to convert agricultural waste into valuable biopolymers to promote a greener and more innovative food sector. Graphical Abstract

(1) Background: Jackfruit leaves (Artocarpus heterophyllus Lam.) are rich in proteins but are under-utilized in the food industry due to their poor sensory properties and low solubility. High-intensity ultrasound (HIU) can enhance protein solubility by disrupting internal interactions and altering protein structures, making them more suitable for industrial applications. (2) Methods: This study aimed to modify the structure of jackfruit leaf proteins using HIU at different powers (600, 840, and 1080 W) and treatment times (10, 15, and 20 min). This research also characterized the amino acid composition and the techno-functional and antioxidant properties of the modified proteins. (3) Results: The HIU treatments significantly improved the foaming capacity and enhanced the emulsion stability within the proteins treated at 1080 W for 15 min, which showed a monomodal size distribution profile. Additionally, the modified proteins exhibited a higher antioxidant capacity compared to the native protein. (4) Conclusions: These findings suggest that structurally modified proteins from jackfruit leaves could be directly utilized in the formulation of emulsions or as foam stabilizers, offering added benefits to consumers due to their significant antioxidant properties.

Background Self‐care and patient engagement are important elements of heart failure (HF) care, endorsed in the guidelines. Digital health tools may improve quality of life (QOL) in HF patients by promoting care, knowledge, and engagement. This manuscript describes the rationale and challenges of the design and implementation of a pragmatic randomized controlled trial to evaluate the efficacy of three digital health technologies in improving QOL for patients with HF. Hypothesis We hypothesize that digital health interventions will improve QOL of HF patients through the early detection of warning signs of disease exacerbation, the opportunity of self‐tracking symptoms, and the education provided, which enhances patient empowerment. Methods Using a fully electronic enrollment and consent platform, the trial will randomize 200 patients across HF clinics in the Yale New Haven Health system to receive either usual care or one of three digital technologies designed to promote self‐management and provide critical data to clinicians. The primary outcome is the change in QOL as assessed by the Kansas City Cardiomyopathy Questionnaire at 3 months. Results First enrollment occurred in September 2021. Recruitment was anticipated to last 6–8 months and participants were followed for 6 months after randomization. Our recruitment efforts have highlighted the large digital divide in our population of interest. Conclusion Assessing clinical outcomes, patient usability, and ease of clinical integration of digital technologies will be beneficial in determining the feasibility of the integration of such technologies into the healthcare system.

Background: Fontan circulation maintains an elevated venous pressure; this promotes venous and lymphatic congestion and may lead to late circuit failure. Our objective was to determine the association between thoracic lymphatic perfusion patterns assessed by magnetic resonance imaging and late Fontan failure. Methodology: A retrospective study was performed. We included patients who underwent the Fontan procedure between January 2005 and December 2019 and who were evaluated with lymphatic mapping using magnetic resonance imaging. Lymphatic abnormalities were classified into four types. The prevalence of late failure was determined, and logistic regression analysis was performed to establish the association between the variables of interest and the outcome. Results: Fifty-four patients were included with a mean age at surgery of 8.8 years ± 3.5 years; 42.6% (n = 23) were men. The most frequent diagnosis was tricuspid atresia (50%, n = 27), and the Fontan procedures were mainly performed using an extracardiac conduit (96.3%, n = 52). The prevalence of late Fontan failure was 35.2%. The lymphatic perfusion patterns observed were Type 1 in 25.9% (n = 14), Type 2 in 46.3% (n = 25), Type 3 in 25.9% (n = 14), and Type 4 in 1.8% (n = 1), with no differences in relation to late failure. (p = 0.42). The age at surgery was found to be a factor associated with the late Fontan failure (OR: 1.23; 95% CI: 1.02–1.48; p = 0.02). Conclusions: One-third of patients with Fontan circulation may experience late failure, not significantly associated with lymphatic changes, but when the total cavopulmonary connection is completed at an older age.

Right atrial isomerism (RAI) is a complex entity with varying diagnostic and treatment outcomes due to its rarity. Treatment options range from palliative to corrective surgeries, resulting in heterogeneous outcomes. The aim of this study was to analyze the results obtained after cardiac surgery in patients with RAI. A retrospective study was conducted, including patients diagnosed with RAI who underwent cardiac surgery. Their follow-up was from 1 January 2010 to 31 March 2020. Demographic characteristics and perioperative conditions were described. Thirty-eight patients were included, the median age was 4 years (IQR 2–9.2) and 57.9% were men. The main diagnoses were atrioventricular canal (63.2%) and pulmonary stenosis (55.3%). The most common surgical procedures were modified Blalock–Taussig shunt (65.8%) and total cavopulmonary connection with an extracardiac conduit fenestrated without cardiopulmonary bypass (15.9%). We did not find any factors associated with negative outcomes in these patients. The overall survival was 86.8%, with a better outcome in those who did not require reintubation (log rank, p < 0.01). The survival of RAI was similar to other centers. Individuals with RAI should be evaluated rigorously to determine an adequate repair strategy, considering high morbidity and mortality.

Abstract Introduction: In patients with chronic kidney disease stages 4 and 5 (CKD stages 4–5) without dialysis and arterial hypertension, it is unknown if the values of systolic blood pressure (SBP) considered in control (<120 mm Hg) are associated with kidney replacement therapy (KRT) and mortality. Methods: In this retrospective cohort study, hypertensive CKD stages 4–5 patients attending the Renal Health Clinic at the Hospital Civil de Guadalajara were enrolled. We divided them into those that achieved SBP <120 mm Hg (controlled group) and those who did not (>120 mm Hg), the uncontrolled group. Our primary objective was to analyze the association between the controlled group and KRT; the secondary objective was the mortality risk and if there were subgroups of patients that achieved more benefit. Data were analyzed using Stata software, version 15.1. Results: During 2017–2022, a total of 275 hypertensive CKD stages 4–5 patients met the inclusion criteria for the analysis: 62 in the controlled group and 213 in the uncontrolled group; mean age 61 years; 49.82% were male; SBP was significantly lower in the controlled group (111 mm Hg) compared to the uncontrolled group (140 mm Hg); eGFR was similar between groups (20.41 mL/min/1.73 m2). There was a tendency to increase the mortality risk in the uncontrolled group (HR 6.47 [0.78–53.27]; p = 0.082) and an association by the Kaplan-Meir analysis (Log-rank p = 0.043). The subgroup analysis for risk of KRT in the controlled group revealed that patients ≥61 years had a lower risk of KRT (HR 0.87 [95% CI, 0–76-0.99]; p = 0.03, p of interaction = 0.005), but no differences were found in the subgroup analysis for mortality. In a follow-up of 1.34 years, no association was found in the risk of KRT according to the controlled or uncontrolled groups in a multivariate Cox analysis. Conclusion: In a retrospective cohort of patients with CKD stages 4–5 and hypertension, SBP >120 mm Hg was not associated with risk of KRT but could be associated with the risk of death. Clinical trials are required in this group of patients to demonstrate the impact of reaching the SBP goals recommended by the KDIGO guidelines.