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Approximately 90% of African American patients with newly diagnosed breast cancer have multimorbidity – with obesity as one of the most common conditions. Obesity is related to negative impacts across all aspects of cancer care as well as more adverse side effects of cancer treatment. African American breast cancer survivors (BCS) show higher incidences of chronic conditions, like obesity, with barriers to body wellness. Lifestyle interventions can improve survivorship outcomes, but most have not been adapted to African American BCS needs. The purpose of this research is to explore and honor the lived experiences of breast cancer survivorship among African American women with obesity to better understand their experiences and perceptions of how their cancer journey intersects with other health behaviors and to identify barriers to health behaviors. A co-design approach with five participants was used to understand specific barriers to a healthy weight and lifestyle as well as potential solutions that would benefit African American or Black BCS entering an evidence-based lifestyle intervention that targeted weight and body wellness. Participants completed one co-design session for problem identification. This initial session identified the participants' most impactful cancer- and non-cancer-related barriers to building health behaviors. Cancer- and non-cancer-related carriers to a healthy lifestyle were identified from artifact creation and affinity diagramming for intensity and frequency. Top cancer-related barriers were pain and fatigue related to cancer treatment and its side effects. Non-cancer related barriers included time and responsibilities, nutrition, exercise, and the definition of health used by medical professionals. Both cancer-related and non-cancer related barriers were identified in contributing to difficulty in maintaining health behaviors. Further research should examine how these barriers can be addressed in lifestyle interventions targeted to African American BCS.

Endogenous Cushing’s syndrome (CS) is a rare disease characterized by prolonged glucocorticoid excess. Timely diagnosis is critical to allow prompt treatment and limit long-term disease morbidity and risk for mortality. Traditional biochemical diagnostic modalities each have limitations and sensitivities and specificities that vary significantly with diagnostic cutoff values. Biochemical evaluation is particularly complex in patients whose hypercortisolemia fluctuates daily, often requiring repetition of tests to confirm or exclude disease, and when delineating CS from physiologic, nonneoplastic states of hypercortisolism. Lastly, traditional pituitary MRI may be negative in up to 60% of patients with adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas (termed “Cushing’s disease” [CD]) whereas false positive pituitary MRI findings may exist in patients with ectopic ACTH secretion. Thus, differentiating CD from ectopic ACTH secretion may necessitate dynamic testing or even invasive procedures such as bilateral inferior petrosal sinus sampling. Newer methods may relieve some of the diagnostic uncertainty in CS, providing a more definitive diagnosis prior to subjecting patients to additional imaging or invasive procedures. For example, a novel method of cortisol measurement in patients with CS is scalp hair analysis, a non-invasive method yielding cortisol and cortisone values representing long-term glucocorticoid exposure of the past months. Hair cortisol and cortisone have both shown to differentiate between CS patients and controls with a high sensitivity and specificity. Moreover, advances in imaging techniques may enhance detection of ACTH-secreting pituitary adenomas. While conventional pituitary MRI may fail to identify microadenomas in patients with CD, high-resolution 3T-MRI with 3D-spoiled gradient-echo sequence has thinner sections and superior soft-tissue contrast that can detect adenomas as small as 2 mm. Similarly, functional imaging may improve the identification of ACTH-secreting adenomas noninvasively; Gallium-68-tagged corticotropin-releasing hormone (CRH) combined with PET-CT can be used to detect CRH receptors, which are upregulated on corticotroph adenomas. This technique can delineate functionality of adenomas in patients with CD from patients with ectopic ACTH secretion and false positive pituitary lesions on MRI. Here, we review emerging methods and imaging modalities for the diagnosis of CS, discussing their diagnostic accuracy, strengths and limitations, and applicability to clinical practice.

BackgroundResearch and policy demonstrate the value of and need for systematically identifying and preparing care partners for their caregiving responsibilities while their family member or friend living with dementia is hospitalized. The Care Partner Hospital Assessment Tool (CHAT) has undergone content and face validation and has been endorsed as appropriate by clinicians to facilitate the timely identification and preparation of care partners of older adult patients during their hospitalization. However, the CHAT has not yet been adapted or prospectively evaluated for use with care partners of hospitalized people living with dementia. Adapting and testing the CHAT via a pilot study will provide the necessary evidence to optimize feasibility and enable future efficacy trials. ObjectiveThe purpose of this paper is to describe the study protocol for the adaptation and testing of the CHAT for use among care partners of hospitalized people living with dementia to better prepare them for their caregiving responsibilities after hospital discharge. MethodsOur protocol is based on the National Institutes of Health Stage Model and consists of 2 sequential phases, including formative research and the main trial. In phase 1, we will use a participatory human-centered design process that incorporates people living with dementia and their care partners, health care administrators, and clinicians to adapt the CHAT for dementia care (ie, the Dementia CHAT [D-CHAT]; stage IA). In phase 2, we will partner with a large academic medical system to complete a pilot randomized controlled trial to examine the feasibility and estimate the size of the effect of the D-CHAT on care partners’ preparedness for caregiving (stage IB). We anticipate this study to take approximately 60 months to complete, from study start-up procedures to dissemination. The 2 phases will take place between December 1, 2022, and November 30, 2027. ResultsThe study protocol will yield (1) a converged-upon, ready-for-feasibility testing D-CHAT; (2) descriptive and feasibility characteristics of delivering the D-CHAT; and (3) effect size estimates of the D-CHAT on care partner preparedness. We anticipate that the resultant D-CHAT will provide clinicians with guidance on how to identify and better prepare care partners for hospitalized people living with dementia. In turn, care partners will feel equipped to fulfill caregiving roles for their family members or friends living with dementia. ConclusionsThe expected results of this study are to favorably impact hospital-based care processes and outcomes for people living with dementia and their care partners and to elucidate the essential caregiving role that so many care partners of people living with dementia assume. Trial RegistrationClinicalTrials.gov NCT05592366; https://clinicaltrials.gov/ct2/show/NCT05592366 International Registered Report Identifier (IRRID)PRR1-10.2196/46808

BackgroundResearch and policy demonstrate the value and need for the systematic inclusion of care partners in hospital care delivery of people living with Alzheimer disease and related dementias (ADRD). Support provided to care partners through information and training regarding caregiving responsibilities is important to facilitating their active inclusion and ultimately improving hospital outcomes of people living with ADRD. To promote care partners’ active inclusion, a toolkit that guides health systems in the identification, assessment, and training of care partners is needed. User-centered approaches can address this gap in practice by creating toolkits that are practical and responsive to the needs of care partners and their hospitalized family members and friends living with ADRD. ObjectiveThis paper describes the study protocol for the development and refinement of the ADRD Systematic Hospital Inclusion Family Toolkit (A-SHIFT). A-SHIFT will provide health care systems with guidance on how to effectively identify, assess, and train care partners of hospitalized persons living with ADRD. MethodsThe A-SHIFT study protocol will use a 3-aimed, convergent mixed method approach to iteratively develop and refine the toolkit. In Aim 1, we will use a systems-engineering approach to characterize patterns of care partner inclusion in hospital care for people living with ADRD. In Aim 2, we will partner with stakeholders to identify and prioritize health care system facilitators and barriers to the inclusion for care partners of hospitalized people living with ADRD. In Aim 3, we will work with stakeholders to co-design an adaptable toolkit to be used by health systems to facilitate the identification, assessment, and training of care partners of hospitalized people living with ADRD. Our convergent mixed method approach will facilitate triangulation across all 3 aims to increase the credibility and transferability of results. We anticipate this study to take 24 months between September 1, 2022, and August 31, 2024. ResultsThe A-SHIFT study protocol will yield (1) optimal points in the hospital workflow for care partner inclusion, (2) a prioritized list of potentially modifiable barriers and facilitators to including care partners in the hospitalization of people living with ADRD, and (3) a converged-upon, ready for feasibility testing of the toolkit to guide the inclusion of care partners of people living with ADRD in hospital care. ConclusionsWe anticipate that the resultant A-SHIFT will provide health systems with a readiness checklist, implementation plan, and resources for identifying, assessing, and training care partners on how to fulfill their caregiving roles for people living with ADRD after hospital discharge. A-SHIFT has the potential to not only improve care partner preparedness but also help reduce health and service use outcomes for people living with ADRD after hospital discharge. International Registered Report Identifier (IRRID)DERR1-10.2196/45274

Abstract The aim of our study was to investigate the association of hepatic steatosis derived from quantitative ultrasound and magnetic resonance imaging (MRI) with prediabetes in a large population-based study conducted in Northeast Germany. Hepatic steatosis was assessed through transabdominal ultrasound and quantitative MRI. For analysis we included 1622 subjects with MRI who participated in an oral glucose tolerance test and reported no known type 2 diabetes mellitus (T2DM). We classified participants as proposed by the American Diabetes Association: isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), combined IFG and IGT (IFG + IGT), and undiagnosed T2DM. Regression models were adjusted for age, sex body mass index and alcohol consumption. We observed positive associations of hepatic steatosis with glycated hemoglobin, fasting glucose and insulin, 2-h glucose and insulin, as well as homeostasis model assessment-insulin resistance index. Similarly, individuals having hepatic steatosis as defined by MRI had a higher relative risk ratio (RR) to be in the prediabetes groups i-IFG (RR = 1.6; 95% confidence interval (CI) 1.2; 2.2), i-IGT (RR = 3.3, 95% CI 2.0; 5.6) and IFG + IGT (RR = 2.5, 95% CI 1.6; 3.9) or to have undiagnosed T2DM (RR = 4.8, 95% CI 2.6; 9.0). All associations were attenuated when defining hepatic steatosis by ultrasound. Hepatic steatosis is associated with prediabetes and undiagnosed T2DM in the general population. Quantitative liver MRI revealed stronger associations with prediabetes and undiagnosed T2DM compared to ultrasound, which indicates the higher sensitivity and specificity of MRI to determine hepatic steatosis.

Cellobiose lipids (CL) are extracellular glycolipids that are produced by many microorganisms from the family Ustilaginaceae. The sugarcane smut fungus Sporisorium scitamineum has been long known as a producer of the glycolipids mannosylerythritol lipids (MEL) and was recently described to additionally secrete CL as a byproduct. In fact, we identified 11 homologous genes in S. scitamineum by in silico analysis sharing a high similarity to the CL biosynthesis gene cluster of Ustilago maydis. We here report the first systematic cultivation of S. scitamineum targeting the synthesis of CL with high product titers and its transfer to the bioreactor. In an initial screening we examined different fermentation media compositions, consisting of a mineral salts solution with vitamins and/or trace elements, three carbon sources (glucose, fructose, sucrose), three pH values (2.5, 4.0, 6.7) and three levels of C/N values (42.2, 83.8, 167.2 molC⋅molN–1) with urea as nitrogen source. A pH of 2.5 proved to result in the highest product titers. An increase of urea concentration from 0.6 to 1.2 g⋅L–1 had a positive effect on biomass formation, however the glycolipid formation was favored at a C/N ratio of 83.8 molC⋅molN–1, using 0.6 g⋅L–1 urea. Amongst the examined carbon sources, sucrose resulted in an increase in the secretion of cellobiose lipids, compared to glucose. Comparing different media compositions, vitamins were identified as not necessary for CL synthesis. We obtained a concentration of cellobiose lipids of 8.3 ± 1.0 g⋅L–1 in shaking flasks. This increased to 17.6 g⋅L–1 in the 1 L bioreactor with additional feeding of carbon source, with a final purity of 85–93%. As a side product, erythritol and mannosylerythritol lipids (MEL) were also synthesized. Via HPTLC coupled MALDI-TOF MS we were able to analyze the secreted CL structures. S. scitamineum produces a mixture of acylated low molecular weight D-glucolipids, linked to a 2,15,16-trihydroxy-hexadecanoic acid via their ω-hydroxyl group (CL-B). The produced cellobiose lipids precipitate as needle like crystals at an acidic pH value of 2.5.

We used a sociotechnical systems approach—which conceptualizes a system of interacting people, technologies, and tasks, to identify individual differences in personal health information management (PHIM) that can inform the design of patient-friendly environments, tools, and technologies. We conducted a secondary thematic analysis of data collected as part of a parent project, vizHOME. The goal of vizHOME was to improve health and health outcomes through identifying key features in the environment that will inform the design of consumer health information technology HIT. We analyzed interview data collected from 20 individuals with diabetes. We found seven dimensions of PHIM: (1) level of privacy preferred for PHIM; (2) amount of engagement in PHIM; (3) extent of guidance preferred for PHIM; (4) level of documentation preferred for PHIM; (5) degree of physical distribution of PHIM; (6) amount of flexibility in PHIM routine; and (7) use of external cues to manage PHIM. Our results suggest that each dimension exists as a continuum, which are anchored from low to high. Exploring the interaction between PHIM and the sociotechnical system in which PHIM is performed revealed key dimensions of PHIM as well as individual differences in those PHIM dimensions. Identification of individual differences in PHIM can support the creation of human-centered design considerations for tailored environments, products, processes, and technologies that support PHIM. Future research will seek to validate PHIM dimensions in a larger population and develop a PHIM-typing measure to identify PHIM types toward tailoring processes, products, and to individual needs in context. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this lens

The usage of antimicrobial drugs (AMs) leads to an increase in antimicrobial resistance (AMR). Although different antimicrobial usage (AMU) monitoring programs exist for livestock animals in Germany, there is no such system for horses. However, with the increasing usage of electronic practice management software (EPMS), it is possible to analyze electronic field data generated for routine purposes. The aim of this study was to generate AMU data for German horses with data from the Clinic for Horses (CfH), University of Veterinary Medicine Hannover (TiHo), and in addition to show that different processes of data curation are necessary to provide results, especially considering quantitative indices. In this investigation, the number of antimicrobial doses used and the amount and percentage of active ingredients applied were calculated. Data contained all drugs administered between the 1st of January and the 31st of December 2017. A total of 2,168 horses were presented for veterinary care to the CfH and 34,432 drug applications were documented for 1,773 horses. Of these, 6,489 (18.85%) AM applications were documented for 837 (47.21%) horses. In 2017, 162.33 kg of active ingredients were documented. The most commonly used antibiotic classes were sulfonamides (84.32 kg; 51.95 %), penicillins (30.11 kg; 18.55%) and nitroimidazoles (24.84 kg; 15.30%). In 2017, the proportion of Critically Important Antibiotics (CIA)—Highest Priority used was 0.15% (0.24 kg) and the proportion of CIA—High Priority used was 20.85% (33.85 kg). Of the total 9,402 entries of antimicrobial active ingredients, the three with the largest number used were sulfonamides [n = 2,798 (29.76%)], trimethoprim [n = 2,757 (29.76%)] and aminoglycosides [n = 1,381 (14.69%)]. Comparison between Administered Daily Dose (ADA) and Recommended Daily Dose of CfH (RDDCfH), showed that 3.26% of ADA were below RDDCfH, 3.18% exceeded RDDCfH and 93.55% were within the range around RDDCfH. This study shows that data generated by an EPMS can be evaluated once the method is set up and validated. The method can be transferred to evaluate data from the EPMS of other clinics or animal species, but the transferability depends on the quality of AMU documentation and close cooperation with respective veterinarians is essential.

It is well-established that antimicrobial use is a major factor for the development of antimicrobial resistance. To analyze the associations between antimicrobial resistance and usage of antimicrobial agents, data from monitoring and surveillance systems are crucial. Within the project VetCAb (Veterinary Consumption of Antibiotics), antibiotic usage data in German livestock is regularly collected and evaluated. Based on a cross-sectional study in 2011, the project was continued as the longitudinal study VetCAb-Sentinel with ongoing participant recruitment and data collection from 2013. The data collection is based on official German application and delivery forms (ADF), voluntarily provided by veterinarians and farmers. In this study the results of antibiotic usage data of dairy cows, dairy calves and beef cattle were described, using a semi-annual treatment frequency, and 95,944 ADF issued between 2011 and 2015 were analyzed. Results show that the median of the treatment frequency in dairy calf and beef cattle holdings slightly decreased from 0.4 to 0.3 and from 0.2 to 0 days, respectively, whereas the median in dairy cow holdings ranged between 1.9 and 2.3 during the observed period. Temporal changes and the effect of the factors “farm size” and “region” on the treatment frequency were investigated, using multiple linear mixed and logistic regression models. Generally, the factor “time” has a statistically significant impact on the treatment frequency in all production types. In addition, a temporal trend test over the first six half-years shows that an increasing linear trend can be stated in dairy cows and dairy calves (p = 0.017; p = 0.004, respectively). If the time-period is extended to all eight half-years under study, this turns into a quadratic effect (dairy cows: p = 0.006; dairy calves: p < 0.001). In dairy calves and beef cattle the factor “farm size” also has a statistically significant impact. The factor “region,” in contrast, shows no statistically significant impact at all. Compared to other livestock populations in Germany, the use of antimicrobials in dairy cows, dairy calves, and beef cattle appears to be low, but varies across several associated factors. Considering these effects, it is recommended that the size of dairy calf and beef cattle holdings is regularly considered in the evaluation of antimicrobial usage data over time.

Tackling the problem of rising antibiotic resistance requires valid and comparable data on the use of antimicrobial drugs in livestock. To date, no harmonized monitoring of antimicrobial usage in animals is available, and there is no system to assess usage data throughout Europe, thus hampering a direct comparison between different European countries. Most of the currently applied monitoring systems are based on sales data. Placement of sales data in relation to the population at risk requires overall assumptions about the weights of the animals treated and the doses applied. Only a few monitoring systems collect data in which the number of treated animals is reported exactly and does not need to be estimated. To evaluate the influence of different calculation methods on the standardizing procedure of antibiotic usage and benchmarking of farms, the treatment frequency for several farms (broiler, suckling piglets, and fattening pigs) was calculated in the following two different ways: first, based on the Used Daily Dose (TFUDD), and second, based on the Defined Daily Dose (TFDDD). To support this evaluation, consumption data from the Veterinary Consumption of Antibiotics Sentinel (VetCAb-S) project in Germany were used as example data. The results show discrepancies between both outcomes depending on the calculation method applied. In broiler holdings, the median values of TFDDD were 20.89% lower than the median values of TFUDD. In suckling piglets and fattening pig holdings, the median values of TFDDD were increased 77.14% and 16.33%, respectively, which may have serious implications for the benchmarking of farms. Furthermore, this finding reflects that the calculation procedure also has an impact on the comparison between populations. Therefore, UDD-based calculations should be preferred to run monitoring systems with a benchmark mission. If, in contrast, the DDD approach is chosen to compare antimicrobial usage between populations, additional considerations should be made to adjust for the addressed discrepancies.

Abstract When bacteria are cultured in medium with multiple carbon substrates, they frequently consume these substrates simultaneously. Building on recent advances in the understanding of metabolic coordination exhibited by Escherichia coli cells through cAMP‐Crp signaling, we show that this signaling system responds to the total carbon‐uptake flux when substrates are co‐utilized and derive a mathematical formula that accurately predicts the resulting growth rate, based only on the growth rates on individual substrates.

To study antibiotic use in livestock in a temporal context with the development of antimicrobial resistance, long-term changes in antibiotic use must be mapped and their possible causes must be explored. Therefore, the present work assesses the changes in antibiotic use over time in German livestock husbandry. In addition, factors associated with antibiotic use were analyzed to identify possible strategies for further reducing antimicrobial usage. For 2011, 2013 and 2014, antibiotic usage data were collected and examined within the VetCAb project. Three hundred participating pig holdings provided information on their antibiotic use based on obligatory application and delivery forms (ADFs) filled in by their veterinarian as well as information on their current stabling capacities for each production type held. Data on sow, piglet, weaner and fattening pig holdings were described separately, using the semi-annual treatment frequency (TF) to measure antibiotic consumption. Multiple linear mixed models were used to investigate the effects of time, farm size, region and farm management category on the treatment frequency. The study yielded significant time changes with p-values below 0.001 in antibiotic administration with a decreasing median TF in piglets from 3.8 in the first half of 2011 (IQR = 1.1-10.6) to 1.7 in the second half of 2014 (IQR = 0.2-4.5) and in fattening pigs from 5.1 in the first half of 2011 (IQR = 0.2-15.4) to 0.7 in the second half of 2014 (IQR = 0.1-6.7). Meanwhile the TF fluctuated between 8.2 and 12.2 in weaners during the observational period (IQRs between zero (lower quartile) and 37.9 (upper quartile)). Piglet, weaner and fattening pig holdings belonging to the upper third of the holdings in size used significantly more antibiotics than the other holdings investigated. Particularly for weaner and fattening pig holdings, a higher TF was noted for farms without breeding units. The region was only a significant factor in weaners. In conclusion, for 2011, 2013 and 2014, the present study shows a clear reduction in antibiotic treatment frequency in German pig holdings. In addition, the association with various factors such as herd size and farm organization on the antibiotic usage frequency is indisputable. Therefore, these factors should be included in monitoring systems and considered when evaluating intervention measures.

Hydrophilic oxybathophenanthroline dendrons (generation 1–3) have been synthesized by treatment of 4,7-bis(4′-hydroxyphenyl)-1,10-phenanthroline with the corresponding bromo-functionalized etheraryl branching units containing triethylene glycol monomethyl end groups. Radiotracer experiments using 64Cu prove the rapid formation of stable copper(ii) complexes in aqueous solution. These 64Cu complexes remain unchanged even upon addition of a high excess of glutathione as competing ligand, thus demonstrating the high stability of the formed copper(ii) complexes. Electronic and EPR spectroscopy indicate the formation of [Cu(L)2(OH2)2]2+(L= ligand) complexes in aqueous solution, confirmed by time-resolved laser fluorescence spectroscopy and supported by molecular mechanics modeling. [ABSTRACT FROM AUTHOR]

The REstarting Safe Education and Testing program for children with medical complexity was implemented in May 2021 at the University of Wisconsin to evaluate the feasibility of in-home rapid antigen COVID-19 testing among neurocognitively affected children. Parents or guardians administered BinaxNOW rapid antigen self-tests twice weekly for three months and changed to symptom and exposure testing or continued surveillance. In-home testing was feasible: nearly all (92.5%) expected tests were conducted. Symptomatic testing identified seven of nine COVID-19 cases. School safety perceptions were higher among those opting for symptom testing. Clinical Trials.gov identifier: NCT04895085. ( Am J Public Health . 2022;112(S9):S878-S882. https://doi.org/10.2105/AJPH.2022.306971).