Search

Plants frequently incorporate the monosaccharide l-fucose (Fuc; 6-deoxy-l-galactose) into glycans and glycopolymers located in diverse cellular locations. The incorporation of Fuc onto these varied glycans is carried out by fucosyltransferases (FUTs), that make up a protein superfamily with equally varied and diverse functions. The structures wherein Fuc is found have numerous proposed and validated functions, ranging from plant growth and development, cell expansion, adhesion, and signaling, to energy metabolism, among others. FUTs from several different plant species have been identified and described; however, very few of them have been extensively characterized biochemically and biologically. In this review, we summarize plant FUTs that have been biochemically characterized and biologically investigated for associated phenotypes, offering greater insight and understanding into the physiological importance of Fuc in plants and in plant cell wall structures, glycans, and proteins.

Objective: Prior research has shown that there are more supermarket displays of sugar-sweetened beverages (SSB) during times when Supplemental Nutrition Assistance Program (SNAP) benefits are distributed ('issuance periods'). This may contribute to inequitable purchasing and consumption. This study examines whether SSB marketing in weekly supermarket circulars, which retailers use to advertise products, is more prevalent during issuance periods compared to non-issuance periods., Design: We conducted longitudinal, difference-in-differences analyses of data extracted from weekly supermarket circulars of randomly selected SNAP-authorised retailers in six states. Analyses tested whether SSB advertisements ('ads') were more prevalent during SNAP issuance periods compared to non-issuance periods within states with distinct issuance periods (3, 5, 10 or 15 d), compared to one state with continuous benefit issuance (28 d; the 'control' state)., Setting: Weekly online supermarket circulars collected from August to September 2019 were analysed in 2021., Participants: The study sample included 5152 circulars from 563 SNAP-authorised retailers in the states California, Connecticut, Nebraska, New Jersey and Texas (distinct issuance period states) as well as Florida ('control' state)., Results: The estimated mean percentage of beverage ads classified as SSB ads during issuance days was 51·5 % compared to 48·4 % during non-issuance days ( P < 0·001). In difference-in-differences analyses comparing to the 'control' state with continuous issuance, SSB ad counts were 2·9 % higher (95 % CI 1·9 %, 3·9 %) during SNAP issuance relative to non-issuance., Conclusions: SSB ads are slightly more prevalent in weekly supermarket circulars during SNAP issuance periods. Future research should explore the linkages between circular ads and SSB purchasing and consumption.

Objective: To understand variation in enrollment in tiered network health plans (TNPs) and the local provider market characteristics associated with TNP penetration., Data Sources and Study Setting: We used 2013-2017 Massachusetts three-digit ZIP code level employer-sponsored health insurance enrollment data, data on physician horizontal and vertical affiliations from the Massachusetts Provider Database, state hospital reports in 2013, 2015, and 2017, and the 2013-2017 Massachusetts All-Payer Claims database., Study Design: Linear regressions were used to estimate associations between TNP and local provider market characteristics., Data Extraction: We constructed measures of TNP penetration and local provider market characteristics and linked these data using three-digit ZIP code., Principal Findings: TNP penetration was at least 10% in all employer market sectors and highest among jumbo sized employers. All state employee health plan enrollees were in a tiered network health plan. Among enrollees not in the state employee health plan, TNP penetration varied from 6.0% to 19.6% across three-digit ZIP codes in Massachusetts. TNP penetration was higher in areas with less horizontal and vertical physician market concentration., Conclusions: Market competition, rather than the absolute quantity of physicians in an area, is associated with TNP penetration., (© 2023 Health Research and Educational Trust.)

The Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) causes reproductive failure and respiratory symptoms, leading to huge economic losses for the pig farming industry. Although several vaccines against PRRSV are available in the market; they show an overall low efficacy, and several countries have the need for vaccines covering the local, circulating variants. This project aims at developing a new chimeric antigen targeting specific epitopes from PRRSV and evaluating two test adjuvants to formulate a vaccine candidate. The test antigen was called LTB-PRRSV, which was produced recombinantly in Escherichia coli and consisted of the heat labile enterotoxin B subunit from E. coli (LTB) and four epitopes from PRRSV. LTB-PRRSV was rescued as inclusion bodies and methods for its solubilization, IMAC-based purification, and refolding were standardized, leading to mean yields of 18 mg of pure protein per liter culture. Layered double hydroxides (LDH) have been used as vaccine adjuvants given their biocompatibility, low cost, and positive surface charge that allows an efficient adsorption of negatively charged biomolecules. Therefore, LDH were selected as delivery vehicles of LTB-PRRSV. Pure LTB-PRRSV was adsorbed onto LDH by incubation at different LDH:LTB-PRRSV mass ratios (1:0.25, 1:0.5, 1:1, and 1:2) and at pH 9.5. The best adsorption occurred with a 1:2 mass ratio, and in a sucrose-tween solution. The conjugates obtained had a polydispersity index of 0.26, a hydrodynamic diameter of 192 nm, and a final antigen concentration of 64.2 μg/mL. An immunogenicity assessment was performed by injecting mice with LDH:LTB-PRRSV, Alum/LTB-PRRSV, or LTB-PRRSV in a scheme comprising three immunizations at two-week intervals and two dose levels (1 and 5 μg). LTB-PRRSV was capable of inducing strong humoral responses, which lasted for a longer period when LDH was used as the delivery vehicle/adjuvant. The potential of LDH to serve as an attractive carrier for veterinary vaccines is discussed.

Currently, there is limited data available comparing Primary Mediastinal Large B-cell Lymphoma (PMBL) and mediastinal Hodgkin disease, nodular sclerosis type (HDNS). This is a retrospective cohort study that compares the clinical features, histology through immunohistochemistry (IHC) and treatment outcomes of 19 cases of PMBL and 39 cases of HDNS diagnosed over 13 years at a single institution in San Juan, PR. Superior Vena Cava syndrome (SVCS) and elevated Lactate Dehydrogenase (LDH) levels were more frequently seen in the PMBL cohort. At the median follow-up visit, of 74 months, no significant difference was seen in overall survival or progression free survival between PMBL and HDNS. Almost all of the relapses in the PMBL group occurred within 12 months of diagnosis. Our data suggests that PMBL and HDNS differ in their clinical presentation and have a favorable prognosis.

Background: Chagas disease (CD) is transmitted by vectors but can also be transmitted orally through contaminated food, drinks, or meat. The One Health perspective aims to understand the complex interaction between human, animal, and environmental health in controlling disease. This study analyzed risk factors and drew lessons from past outbreaks of orally transmitted CD to develop effective preventive strategies., Methods: A simultaneous mixed methods study was conducted. The study consisted of two phases: an ecological epidemiological analysis at the municipal level using secondary data spanning from 1992 to 2023, and semistructured interviews with health providers and policymakers at the national level in Colombia. The results from both phases were triangulated to gain a comprehensive understanding of the topic., Results: A total of 64 outbreaks, infecting 302 individuals, were reported. Most of these outbreaks (89.2%) were classified as family-related, and they occurred most frequently during the months of April to June (46.6%). It is worth noting that a significant number of these outbreaks took place in municipalities that lacked vector control plans. Risk factors for oral transmission included the location of food preparation, poor housing quality, food preparation water source, the presence of vectors/marsupials, forest type, and climatic variables. Interviews conducted emphasized the importance of implementing outbreak plans and providing staff training to effectively address the issue., Conclusion: A One Health approach strengthening prevention, surveillance, case management and cross-sectoral collaboration is needed to control outbreaks and reduce transmission in Colombia. Preparedness plans and education of health professionals are also important. This study identified modifiable risk factors to guide public health interventions., Competing Interests: The authors declare no known competing financial interests or personal relationships that could have influenced the work reported in this paper., (© 2024 The Authors.)

Type IVc Pili (T4cP), also known as Tad or Flp pili, are long thin microbial filaments that are made up of small-sized pilins. These appendages serve different functions in bacteria, including attachment, biofilm formation, surface sensing, motility, and host colonization. Despite their relevant role in diverse microbial lifestyles, knowledge about T4cP in bacteria that establish symbiosis with legumes, collectively referred to as rhizobia, is still limited. Sinorhizobium meliloti contains two clusters of T4cP-related genes: flp-1 and flp-2 , which are located on the chromosome and the pSymA megaplasmid, respectively. Bundle-forming pili associated with flp-1 are involved in the competitive nodulation of alfalfa plants, but the role of flp-2 remains elusive. In this work, we have performed a comprehensive bioinformatic analysis of T4cP genes in the highly competitive S. meliloti GR4 strain and investigated the role of its flp clusters in pilus biogenesis, motility, and in the interaction with alfalfa. Single and double flp -cluster mutants were constructed on the wild-type genetic background as well as in a flagellaless derivative strain. Our data demonstrate that both chromosomal and pSymA flp clusters are functional in pili biogenesis and contribute to surface translocation and nodule formation efficiency in GR4. In this strain, the presence of flp-1 in the absence of flp-2 reduces the competitiveness for nodule occupation.

Bacterial predators are decisive organisms that shape microbial ecosystems. In this study, we investigated the role of iron and siderophores during the predatory interaction between two rhizosphere bacteria: Myxococcus xanthus, an epibiotic predator, and Sinorhizobium meliloti, a bacterium that establishes nitrogen-fixing symbiosis with legumes. The results show that iron enhances the motility of the predator and facilitates its predatory capability, and that intoxication by iron is not used by the predator to prey, although oxidative stress increases in both bacteria during predation. However, competition for iron plays an important role in the outcome of predatory interactions. Using combinations of predator and prey mutants (nonproducers and overproducers of siderophores), we have investigated the importance of competition for iron in predation. The results demonstrate that the competitor that, via the production of siderophores, obtains sufficient iron for growth and depletes metal availability for the opponent will prevail in the interaction. Consequently, iron fluctuations in soils may modify the composition of microbial communities by altering the activity of myxobacterial predators. In addition, siderophore overproduction during predation can alter soil properties, affecting the productivity and sustainability of agricultural operations., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Society for Microbial Ecology.)

Rhizobia are soil proteobacteria able to establish a nitrogen-fixing interaction with legumes. In this interaction, rhizobia must colonize legume roots, infect them, and become hosted inside new organs formed by the plants and called nodules. Rhizobial motility, not being essential for symbiosis, might affect the degree of success of the interaction with legumes. Because of this, the study of rhizobial motility (either swimming or surface motility) might be of interest for research teams working on rhizobial symbiotic performance. In this chapter, we describe the protocols we use in our laboratories for studying the different types of motilities exhibited by Sinorhizobium fredii and Sinorhizobium meliloti, as well as for analyzing the presence of flagella in these bacteria. All these protocols might be used (or adapted) for studying bacterial motility in rhizobia., (© 2024. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: This paper identifies opportunities and challenges for leishmaniasis control and elimination in Colombia, emphasizing the role of pooled procurement of essential medicines and supplies. Colombia is among the countries most affected by leishmaniasis globally, and also faces the dual challenge of procuring critically needed medicines in the context of limited national resources. It recently renewed its commitment to the control and elimination of leishmaniasis under its 2022-2031 Public Health Plan (PDSP) through a comprehensive public health approach., Methodology/principal Findings: The methodology comprises a comprehensive literature review and key informant interviews with leishmaniasis experts from the Colombian national control program and PAHO/WHO, focusing on cutaneous, mucocutaneous, and visceral leishmaniasis. Leishmaniasis is endemic throughout Colombia, with over 11 million people at risk, many of whom live in poverty-stricken, remote and isolated rural areas with limited access to health services. Leishmaniasis care, including medicines, is provided free of charge, but many barriers were nonetheless identified at environmental, population, and health system levels, including the supply of quality-assured medicines. Opportunities to alleviate these barriers were identified, including the support of the PAHO Strategic Fund. Within the context of the sustainable development goals and international leishmaniasis control and elimination targets, Colombian officials have established their own priorities, the highest of which is the reduction of deaths from visceral leishmaniasis., Conclusions/significance: The elimination of leishmaniasis as a public health problem presents significant challenges, given its biological complexity and diversity, physical and clinical manifestations, social and economic impacts, frequently burdensome treatment regimens, and insufficient supply of necessary medicines. However, rigorous prevention and control efforts through strong political commitment and a highly motivated workforce can dramatically reduce its burden. Colombia's new PDSP, which highlights leishmaniasis control, is an opportunity for a revitalized health system response through committed leadership, intersectoral actions, and partnerships with international organizations that share a common vision., Competing Interests: The authors declare no competing interest, (Copyright: © 2023 Vlassoff et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: To determine the diagnostic contribution of the absolute quantification of the myocardial deposit of 99m Tc-DPD in patients with cardiac amyloidosis due to transthyretin deposits (ATTR)., Materials and Methods: SPECT/CT was performed in 41 patients with positive scintigraphic results for ATTR cardiac amyloidosis. The patients were divided into two groups (Perugini grades 2 and 3) and the SUVmax at the level of the bone and both ventricles and the percentage of dose calculated in these areas were calculated. The Student's t-test was used to compare results and the area under the curve (AUC) was calculated to assess differential efficacy and establish discriminatory cut-off points between both groups of patients., Results: Statistically significant differences were observed in all the study variables, with the exception of bone SUV max . The differences with the greatest statistical power were observed in the variables SUV maxRV and the percentage of dose in both ventricles (p < 0.001). The cut-off point obtained for the variable SUVm axLV was 8.620 (sensitivity 87.9% and specificity 100%; AUC 0.966), while that of the variable SUV maxRV was 6.195 (sensitivity 81.8% and specificity 100%; AUC 0.955)., Conclusions: The absolute quantification of myocardial uptake of 99m Tc-DPD in the SPECT/CT images of patients with suspected cardiac amyloidosis due to transthyretin deposits represents a new diagnostic tool that allows adequate classification of patients according to the Perugini visual grading scale., (Copyright © 2023 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

The discovery and validation of new adjuvants are critical areas for vaccinology. Mineral materials (e.g., alum microparticles) have been used for a long time as adjuvants in human vaccine formulations. Nonetheless, the use of nanosized materials is a promising approach to diversify the properties of adjuvants. Nanoclays are potential adjuvants proposed by some research groups. However, their adjuvant mechanisms and safety have not been fully elucidated. Herein, we aimed at expanding the knowledge on the potential adjuvanticity of layered double hydroxide (LDH) nanoparticles by reporting a detailed method for the synthesis and characterization of LDHs and the adsorption of a model antigen (bovine serum albumin, BSA). LDHs varying in diameter (from 56 to 88 nm) were obtained, and an in vitro evaluation revealed that the LDHs are not inherently toxic. BSA was passively adsorbed onto the LDHs, and the immunogenicity in mice of the conjugates obtained was compared to that of free BSA and BSA co-administered with alum (Alum-BSA). The LDH-BSA conjugates induced a higher humoral response that lasted for a longer period compared with that of free BSA and Alum-BSA, confirming that LDH exerts adjuvant effects. The 56 nm LDH particles were deemed as the more efficient carrier since they induced a higher and more balanced Th1/Th2 response than the 88 nm particles. This study is a contribution toward expanding the characterization and use of nanoclays in vaccinology and justifies further studies with pathogen-specific antigens.

Background: Oral cancer is the 11th most common type of cancer in the world, with established major risk factors as tobacco and alcohol, and recently included high-risk human papillomavirus types 16 and 18. HPV types 16 and 18 are the etiologic agents of cervical cancers and a proportion of oropharyngeal cancers. However, the picture of HPV and the clinical implications of oral cancers are not clear with most reports combining oral cancer data with head and neck cancers. It has been confirmed as a favorable prognostic factor in oropharyngeal cancer. However, the prognostic value of HPV in oral squamous cell carcinoma is still unclear., Material and Methods: The main objective of this article is to present the evidence encountered following a bibliographical review of recent publications specifically related to oral cancer and its differences from oropharyngeal cancer. The secondary goals are to present the findings of a five-year retrospective observational study of the prevalence of HPV infection in oral cancer patients treated by the Oral and Maxillofacial Surgery Department at La Paz University Hospital (Madrid, Spain), and finally, we to evaluate and compare our country's HPV prevention program in comparison to other European countries., Results: According to the review of the literature, HPV positive oral squamous cell carcinoma is associated with significantly decreased overall survival and distant control. Bibliographic review suggest HPV infection can be used as a negative prognostic factor in oral squamous cell carcinoma., Conclusions: As regards diagnostic testing for HPV, it should be extended to as many cases of oral cavity squamous cell carcinoma as possible, especially in those with risk factors. The current vaccination program in Spain does not have adequate coverage and is significantly under the level of other European Union countries; it should be expanded and catch-up strategies should be included. Key words: HPV, OSSC, Papillomavirus, oral carcinoma, prevention., Competing Interests: Conflicts of interest The authors have no conflicts of interest to declare., (Copyright: © 2023 Medicina Oral S.L.)

TRIMER, Transcription Regulation Integrated with MEtabolic Regulation, is a genome-scale modeling pipeline targeting at metabolic engineering applications. Using TRIMER, regulated metabolic reactions can be effectively predicted by integrative modeling of metabolic reactions with a transcription factor-gene regulatory network (TRN), which is modeled through a Bayesian network (BN). In this article, we focus on sensitivity analysis of metabolic flux prediction for uncertainty quantification of BN structures for TRN modeling in TRIMER. We propose a computational strategy to construct the uncertainty class of TRN models based on the inferred regulatory order uncertainty given transcriptomic expression data. With that, we analyze the prediction sensitivity of the TRIMER pipeline for the metabolite yields of interest. The obtained sensitivity analyses can guide optimal experimental design (OED) to help acquire new data that can enhance TRN modeling and achieve specific metabolic engineering objectives, including metabolite yield alterations. We have performed small- and large-scale simulated experiments, demonstrating the effectiveness of our developed sensitivity analysis strategy for BN structure learning to quantify the edge importance in terms of metabolic flux prediction uncertainty reduction and its potential to effectively guide OED.

Bacterial predation impacts microbial community structures, which can have both positive and negative effects on plant and animal health and on environmental sustainability. Myxococcus xanthus is an epibiotic soil predator with a broad range of prey, including Sinorhizobium meliloti , which establishes nitrogen-fixing symbiosis with legumes. During the M. xanthus - S. meliloti interaction, the predator must adapt its transcriptome to kill and lyse the target (predatosome), and the prey must orchestrate a transcriptional response (defensome) to protect itself against the biotic stress caused by the predatory attack. Here, we describe the transcriptional changes taking place in S. meliloti in response to myxobacterial predation. The results indicate that the predator induces massive changes in the prey transcriptome with up-regulation of protein synthesis and secretion, energy generation, and fatty acid (FA) synthesis, while down-regulating genes required for FA degradation and carbohydrate transport and metabolism. The reconstruction of up-regulated pathways suggests that S. meliloti modifies the cell envelop by increasing the production of different surface polysaccharides (SPSs) and membrane lipids. Besides the barrier role of SPSs, additional mechanisms involving the activity of efflux pumps and the peptide uptake transporter BacA, together with the production of H 2 O 2 and formaldehyde have been unveiled. Also, the induction of the iron-uptake machinery in both predator and prey reflects a strong competition for this metal. With this research we complete the characterization of the complex transcriptional changes that occur during the M. xanthus - S. meliloti interaction, which can impact the establishment of beneficial symbiosis with legumes., Competing Interests: JP was one of the topic editors for the research topic this manuscript is submitted to: “Mechanisms of Prokaryotic Predation, Volume II.” The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Soto, Pérez, Muñoz-Dorado, Contreras-Moreno and Moraleda-Muñoz.)

Bacterial surface motility is a complex microbial trait that contributes to host colonization. However, the knowledge about regulatory mechanisms that control surface translocation in rhizobia and their role in the establishment of symbiosis with legumes is still limited. Recently, 2-tridecanone (2-TDC) was identified as an infochemical in bacteria that hampers microbial colonization of plants. In the alfalfa symbiont Sinorhizobium meliloti , 2-TDC promotes a mode of surface motility that is mostly independent of flagella. To understand the mechanism of action of 2-TDC in S. meliloti and unveil genes putatively involved in plant colonization, Tn 5 transposants derived from a flagellaless strain that were impaired in 2-TDC-induced surface spreading were isolated and genetically characterized. In one of the mutants, the gene coding for the chaperone DnaJ was inactivated. Characterization of this transposant and newly obtained flagella-minus and flagella-plus dnaJ deletion mutants revealed that DnaJ is essential for surface translocation, while it plays a minor role in swimming motility. DnaJ loss-of-function reduces salt and oxidative stress tolerance in S. meliloti and hinders the establishment of efficient symbiosis by affecting nodule formation efficiency, cellular infection, and nitrogen fixation. Intriguingly, the lack of DnaJ causes more severe defects in a flagellaless background. This work highlights the role of DnaJ in the free-living and symbiotic lifestyles of S. meliloti .

Clay materials and nanoclays have gained recent popularity in the vaccinology field, with biocompatibility, simple functionalization, low toxicity, and low-cost as their main attributes. As elements of nanovaccines, halloysite nanotubes (natural), layered double hydroxides and hectorite (synthetic) are the nanoclays that have advanced into the vaccinology field. Until now, only physisorption has been used to modify the surface of nanoclays with antigens, adjuvants, and/or ligands to create nanovaccines. Protocols to covalently attach these molecules have not been developed with nanoclays, only procedures to develop adsorbents based on nanoclays that could be extended to develop nanovaccine conjugates. In this review, we describe the approaches evaluated on different nanovaccine candidates reported in articles, the immunological results obtained with them and the most advanced approaches in the preclinical field, while describing the nanomaterial itself. In addition, complex systems that use nanoclays were included and described. The safety of nanoclays as carriers is an important key fact to determine their true potential as nanovaccine candidates in humans. Here, we present the evaluations reported in this field. Finally, we point out the perspectives in the development of vaccine prototypes using nanoclays as antigen carriers.

Importance: In the Supplemental Nutrition Assistance Program (SNAP), families may temporarily lose benefits for which they are still eligible because of administrative issues. This lapse in benefits, referred to as churning, increases the risk of food insecurity for families, which is linked with poorer health., Objectives: To examine the rate of churning among SNAP participants with young children and evaluate the association of administrative policy changes with churning risk., Design, Setting, and Participants: A cross-sectional study of recertifications among 9735 SNAP-participating households with at least 1 child younger than 6 years from May to November 2019 tested whether there were sociodemographic differences in churning risk. An interrupted time series analysis of recertifications among 70 799 households from January 1, 2014, to December 31, 2019, tested whether state-level administrative policy changes were associated with churning risk. Data were analyzed between February and November 2021., Exposures: Three Massachusetts SNAP administrative policy changes., Main Outcomes and Measures: Churn episodes, defined as losing SNAP benefits after a deadline for eligibility recertification followed by receiving benefits again within 30 days, measured using state SNAP administrative data., Results: In 2019, a total of 9752 recertification events occurred among 9735 households (3841 [39.4%] Hispanic, 2138 [21.9%] non-Hispanic Black, and 3533 [36.2%] White) with at least 1 child younger than 6 years participating in SNAP. Of these households, 3984 (40.9%) experienced SNAP churning for a period of 1 to 30 days because of missed recertification forms in any given month. Churning was more common among Hispanic households (by 3.9 percentage points; 95% CI, 1.2-6.6 percentage points) than non-Hispanic White households and more common among households with more than 1 child younger than 6 years (by 5.6 percentage points; 95% CI, 3.0-8.1 percentage points) compared with smaller households. Among households that churned, non-Hispanic White households lost a mean of $10.51 (95% CI, $10.16-$10.86) in benefits per household member, and non-Hispanic Black households lost an additional $1.10 (95% CI, $0.47-$1.74) per household member. On implementation of a task-based, first-available-caseworker model, mean churn episode length was significantly shorter immediately on introduction of the model (-0.30 days per each month after the policy change; 95% CI, -0.52 to -0.07 days) and over time (-0.23 days per each month after the policy change; 95% CI, -0.26 to -0.20 days). At the addition of a second policy change to expand participants' access to simplified reporting requirements, a decrease was seen in the trend in the probability of a churn episode by -0.74 percentage points per month (95% CI, -0.87 to -0.62 percentage points). A third policy to expand online services for submitting recertification paperwork was not associated with a change in churn risk over time., Conclusions and Relevance: Churning in SNAP is common among households with young children and is disproportionately experienced by Black and Hispanic households and lower-income households. Administrative changes to simplify caseworkers' workloads and streamline eligibility reporting for participants may reduce churn.

Bacteria can spread on surfaces to colonize new environments and access more resources. Rhizobia, a group of α- and β- Proteobacteria , establish nitrogen-fixing symbioses with legumes that rely on a complex signal interchange between the partners. Flavonoids exuded by plant roots and the bacterial transcriptional activator NodD control the transcription of different rhizobial genes (the so-called nod regulon) and, together with additional bacterial regulatory proteins (such as TtsI, MucR or NolR), influence the production of different rhizobial molecular signals. In Sinorhizobium fredii HH103, flavonoids and NodD have a negative effect on exopolysaccharide production and biofilm production. Since biofilm formation and motility are often inversely regulated, we have analysed whether flavonoids may influence the translocation of S. fredii HH103 on surfaces. We show that the presence of nod gene-inducing flavonoids does not affect swimming but promotes a mode of surface translocation, which involves both flagella-dependent and -independent mechanisms. This surface motility is regulated in a flavonoid-NodD1-TtsI-dependent manner, relies on the assembly of the symbiotic type 3 secretion system (T3SS), and involves the participation of additional modulators of the nod regulon (NolR and MucR1). To our knowledge, this is the first evidence indicating the participation of T3SS in surface motility in a plant-interacting bacterium. Interestingly, flavonoids acting as nod -gene inducers also participate in the inverse regulation of surface motility and biofilm formation, which could contribute to a more efficient plant colonisation.

Introduction: This study aimed to quantify the prevalence of advertisements for ultraprocessed foods and beverages in U.S. supermarket circulars, which are digital and print marketing materials with weekly sales promotions., Methods: Food and beverage advertisements on the first page of 4,181 weekly circulars from 453 stores across 6 states were analyzed from August 2019 to September 2019. Products were classified into 1 of 4 mutually exclusive categories on the basis of the extent and purposes of their industrial processing using a variant of the NOVA classification system adapted for the U.S. food supply: unprocessed and minimally processed, basic processed, moderately processed, and highly processed., Results: A total of 86,099 food and beverage advertisements were classified. Highly processed foods accounted for 45.7% of advertisements, followed by unprocessed/minimally processed foods at 41.2%, moderately processed foods at 8.0%, and basic processed foods at 5.1%., Conclusions: U.S. supermarket circulars advertise a high proportion of processed and highly processed foods and beverages., (© 2022 The Authors.)

Objectives: We explore physical activity in early farming societies of Central Chile during the Early Ceramic and Late Intermediate Periods (200-1450 CE), a time of technological changes and intensification of food production. The existence of differences in entheseal changes (EC) between females and males is evaluated in two periods with different subsistence strategies., Material and Methods: EC were recorded with method in the upper and lower limbs of 56 male and female adult individuals from the Early Ceramic Period (ECP) and Late Intermediate Period (LIP). Hierarchical multiple factor analysis and hierarchical clustering on principal components were performed using an exploratory approach., Results: In all the analyzed limbs, the EC scores are higher in males than females, which may be explained by sexual dimorphism. A constant overlap in the variability of the EC among males and females is observed. However, the EC scores show a different pattern of variability when comparing ECP females with LIP females. The results show that the scores increase in the latter. In contrast, when comparing ECP males with LIP males scores decrease in the later period., Discussion: Physical activity in the societies of Central Chile with incipient agriculture did not vary by sex or during the timeframe studied. Nevertheless, the interaction between sex-period and the variability pattern of the EC from one period to another suggests different ways of doing similar physical activities or different emphases for similar biomechanical actions., (© 2021 Wiley Periodicals LLC.)

This protocol explains the pipeline for condition-dependent metabolite yield prediction using Transcription Regulation Integrated with MEtabolic Regulation (TRIMER). TRIMER targets metabolic engineering applications via a hybrid model integrating transcription factor (TF)-gene regulatory network (TRN) with a Bayesian network (BN) inferred from transcriptomic expression data to effectively regulate metabolic reactions. For E. coli and yeast, TRIMER achieves reliable knockout phenotype and flux predictions from the deletion of one or more TFs at the genome scale. For complete details on the use and execution of this protocol, please refer to Niu et al. (2021)., Competing Interests: The authors declare no competing interests., (© 2022 The Author(s).)

Importance: Calorie labeling on menus is required in US chain food establishments with 20 or more locations. This policy may encourage retailers to offer lower-calorie items, which could lead to a public health benefit by reducing customers' calorie intake from prepared foods. However, potential reformulation of restaurant menu items has not been examined since nationwide enforcement of this policy in 2018., Objective: To examine the calorie content of menu items at large chain restaurants before and after implementation of federally mandated menu calorie labels., Design, Setting, and Participants: This pre-post cohort study used restaurant menu data from MenuStat, a database of nutrition information for menu items offered in the largest chain restaurants in the US, collected annually from 2012 to 2019. The study comprised 35 354 menu items sold at 59 large chain restaurants in the US. Statistical analysis was conducted from February 4 to October 8, 2021., Intervention: Nationwide implementation of menu calorie labeling., Main Outcomes and Measures: Changes in menu items' calorie content after restaurant chains implemented calorie labels were estimated, adjusting for prelabeling trends. All menu items, continuously available items, items newly introduced to menus, and items removed from menus were examined separately., Results: Among the 59 restaurant chains included in the study, after labeling, there were no changes in mean calorie content for all menu items (change = -2.0 calories; 95% CI, -8.5 to 4.4 calories) or continuously available items (change = -2.3 calories; 95% CI, -11.5 to 6.3 calories). Items that were newly introduced after labeling, however, had a lower mean calorie content than items introduced before labeling (change = -112.9 calories; 95% CI, -208.6 to -25.2 calories), although there was heterogeneity by restaurant type. Items removed from menus after labeling had similar calorie content as items removed before labeling (change = 0.5 calories; 95% CI, -79.4 to 84.0 calories)., Conclusions and Relevance: In this cohort study of large chain restaurants, implementing calorie labels on menus was associated with the introduction of lower-calorie items but no changes in continuously available or removed items.

There has been extensive research in predictive modeling of genome-scale metabolic reaction networks. Living systems involve complex stochastic processes arising from interactions among different biomolecules. For more accurate and robust prediction of target metabolic behavior under different conditions, not only metabolic reactions but also the genetic regulatory relationships involving transcription factors (TFs) affecting these metabolic reactions should be modeled. We have developed a modeling and simulation pipeline enabling the analysis of Transcription Regulation Integrated with Metabolic Regulation: TRIMER. TRIMER utilizes a Bayesian network (BN) inferred from transcriptomes to model the transcription factor regulatory network. TRIMER then infers the probabilities of the gene states relevant to the metabolism of interest, and predicts the metabolic fluxes and their changes that result from the deletion of one or more transcription factors at the genome scale. We demonstrate TRIMER's applicability to both simulated and experimental data and provide performance comparison with other existing approaches., Competing Interests: The authors declare no competing interests., (© 2021 The Authors.)

Introduction: This study provides the most recent estimates for fast-food consumption in the U.S., overall and by race/ethnicity and age., Methods: Data from adults (aged ≥20 years, N=3,560) in the National Health and Nutrition Examination Survey, 2017-2018, were used to identify the (1) percentage of adults consuming fast food, (2) estimated mean percentage of calories consumed from fast food, and (3) estimated mean total calories consumed from fast food on a typical day. Intake was measured by in-person, 24-hour dietary recall. Analysis was conducted in 2020., Results: During 2017-2018, fast food was consumed by 36.5% of adults on a typical day, accounting for 13.8% of daily calories, an average of 309 kcal/day. More non-Hispanic Black adults consumed fast food (42.6%), consumed the largest percentage of daily calories from fast food (17.4%), and consumed the greatest number of daily calories from fast food (381 kcal/day) than adults of other racial/ethnic groups. Young non-Hispanic Black adults had the highest level of fast-food consumption, and this was significantly higher than that among Mexican Americans: percentage consuming fast food (53.5% vs 42.5%, p=0.02) and percentage of calories from fast food (24.1% vs 16.8%, p=0.03). Young non-Hispanic Black adults consumed the highest total fast-food calories, which were significantly higher than that among non-Hispanic Asian young adults (526 kcal vs 371 kcal, p=0.04). No significant differences in the study outcomes were observed by race/ethnicity and age compared with non-Hispanic White adults of the same group., Conclusions: Fast-food consumption among adults in the U.S. is high, particularly among young non-Hispanic Black adults., (Copyright © 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Cervicocranial arterial dissection (CIAD) is an important cause of stroke., Aim: To describe the clinical and imaging characteristics of patients with CIAD., Material and Methods: An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively)., Results: Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD., Conclusions: Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Background: Consumer demand for vegetarian options is growing. Fast-food restaurants have responded by adding high-profile vegetarian offerings, but little is known about the overall availability or nutrient profile of vegetarian options at these establishments, or how these items compare with nonvegetarian items., Objective: The purpose of this study was to quantify trends in the availability and nutrient profile of vegetarian items in US fast-food restaurants from 2012 to 2018., Design: This study was a longitudinal analysis of secondary data. We used nutrient data from the MenuStat database for menu offerings at 36 large US fast-food chain restaurants (2012 to 2018). Vegetarian items were identified through automated key word searches and item description hand-coding., Outcome Measures: Annual counts and proportions of vegetarian and nonvegetarian items by category, and annual trends and differences in predicted mean calories; saturated, unsaturated, and trans fats; sugar; nonsugar carbohydrates; protein; sodium between and within vegetarian and nonvegetarian items., Statistical Analysis Performed: We report counts and proportions of vegetarian items by menu category, then use Tobit regression models to examine annual trends and differences in predicted mean nutrients between and within vegetarian and nonvegetarian items. Sensitivity analyses were calorie-adjusted., Results: The annual proportion of vegetarian items remained consistent (approximately 20%), and counts increased (2012, n = 601; 2018, n = 713). Vegetarian items had significantly fewer calories (2018: -95 kcal) and, even after adjustment for calories, lower saturated fat (-1.6 g), unsaturated fat (-1.8 g), protein (-3.8 g), and sodium (-62 mg) annually (P < .05) compared with nonvegetarian items. Vegetarian items were significantly higher in sugar (2018: +2.0 g; P < .01) and nonsugar carbohydrates (2018: +9.7 g; P < .01), after calorie adjustment, compared with nonvegetarian items., Conclusions: Vegetarian items were generally lower in several overconsumed nutrients of public health concern (eg, sodium and saturated fat) than nonvegetarian items, but nutrient changes suggest surveillance remains important as vegetarian options increase in popularity., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Bacteria release a wide range of volatile compounds that play important roles in intermicrobial and interkingdom communication. Volatile metabolites emitted by rhizobacteria can promote plant growth and increase plant resistance to both biotic and abiotic stresses. Rhizobia establish beneficial nitrogen-fixing symbiosis with legume plants in a process starting with a chemical dialog in the rhizosphere involving various diffusible compounds. Despite being one of the most studied plant-interacting microorganisms, very little is known about volatile compounds produced by rhizobia and their biological/ecological role. Evidence indicates that plants can perceive and respond to volatiles emitted by rhizobia. In this perspective, we present recent data that open the possibility that rhizobial volatile compounds have a role in symbiotic interactions with legumes and discuss future directions that could shed light onto this area of investigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Soto, López-Lara, Geiger, Romero-Puertas and van Dillewijn.)

The development of vaccines is a crucial response against the COVID-19 pandemic and innovative nanovaccines could increase the potential to address this remarkable challenge. In the present study a B cell epitope (S 461-493 ) from the spike protein of SARS-CoV-2 was selected and its immunogenicity validated in sheep. This synthetic peptide was coupled to gold nanoparticles (AuNP) functionalized with SH-PEG-NH 2 via glutaraldehyde-mediated coupling to obtain the AuNP-S 461-493 candidate, which showed in s.c.-immunized mice a superior immunogenicity (IgG responses) when compared to soluble S 461-493 ; and led to increased expression of relevant cytokines in splenocyte cultures. Interestingly, the response triggered by AuNP-S 461-493 was similar in magnitude to that induced using a conventional strong adjuvant (Freund's adjuvant). This study provides a platform for the development of AuNP-based nanovaccines targeting specific SARS-CoV-2 epitopes., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Sugar-sweetened beverage (SSB) consumption has declined steadily. This study uses the latest national data to examine trends in SSB consumption among children and adults by race and/or ethnicity and to document whether long-standing disparities in intake remain., Design: Trend analyses of demographic and dietary data measured by 24-h dietary recall from the National Health and Nutrition Examination Survey (NHANES)., Setting: Data from the 2003-2004 through 2017-2018 NHANES survey cycles were analysed in 2020., Participants: The study sample included 21 156 children aged 2-19 years and 32 631 adults aged 20+ years., Results: From 2003-2004 to 2017-2018, the prevalence of drinking any amount of SSB on a given day declined significantly among all race and/or ethnicity groups for children (non-Hispanic (NH) White: 81·6 % to 72·7 %; NH Black: 83·2 % to 74·8 %, Hispanic: 86·9 % to 77·2 %) and most race and/or ethnicity groups for adults (NH White: 72·3 % to 65·3 %; Hispanic: 84·6 % to 77·8 %). Consumption declined at a higher rate among NH Black and Hispanic children aged 12-19 years compared with their NH White peers; among NH Black children aged 6-11 years, the rate of decline was lower. Despite significant declines in per capita SSB energy consumption from soda and fruit drinks, consumption of sweetened coffee/tea beverages increased among older children and nearly all adults and consumption of sweetened milk beverages increased among NH White and Hispanic children., Conclusions: SSB consumption has declined steadily for children and adults of all race and/or ethnicity groups, but disparities persist, and overall intake remains high.

Importance: The relationship between a sweetened beverage tax and changes in the prices and purchases of beverages and high-sugar food is understudied in the long term and in small independent food retail stores where sugar-sweetened beverages are among the most commonly purchased items., Objective: To examine whether a 1.5 cent-per-fluid-ounce excise tax on sugar- and artificially sweetened beverages Philadelphia, Pennsylvania, was associated with sustained changes in beverage prices and purchases, as well as calories purchased from beverages and high-sugar foods, over 2 years at small independent stores., Design, Setting, and Participants: This cross-sectional study used a difference-in-differences approach to compare changes in beverage prices and purchases of beverages and high-sugar foods (candy, sweet snacks) at independent stores in Philadelphia and Baltimore, Maryland (a nontaxed control) before and 2 years after tax implementation, which occurred on January 1, 2017. Price comparisons were also made to independent stores in Philadelphia's neighboring counties., Main Outcomes and Measures: Changes in mean price (measured in cents per fluid ounce) of taxed and nontaxed beverages, mean fluid ounces purchased of taxed and nontaxed beverages, and mean total calories purchased from beverages and high-sugar foods., Results: Compared with Baltimore independent stores, taxed beverage prices in Philadelphia increased 2.06 cents per fluid ounce (95% CI, 1.75 to 2.38 cents per fluid ounce; P < .001), with 137% of the tax passed through to prices 2 years after tax implementation, while nontaxed beverage prices had no statistically significant change. A total of 116 independent stores and 4738 customer purchases (1950 [41.2%] women; 4351 [91.8%] age 18 years or older; 1006 [21.2%] White customers, 3185 [67.2%] Black customers) at independent stores were assessed for price and purchase comparisons. Purchases of taxed beverages declined by 6.1 fl oz (95% CI, -9.9 to -2.4 fl oz; P < .001), corresponding to a 42% decline in Philadelphia compared with Baltimore; there were no significant changes in purchases of nontaxed beverages. Although there was no significant moderation by neighborhood income or customer education level, exploratory stratified analyses revealed that declines in taxed beverage purchases were larger among customers shopping in low-income neighborhoods (-7.1 fl oz; 95% CI, -13.0 to -1.1 fl oz; P = .001) and individuals with lower education levels (-6.9 fl oz; 95% CI, -12.5 to -1.3 fl oz; P = .001)., Conclusions and Relevance: This cross-sectional study found that a tax on sweetened beverages was associated with increases in price and decreases in purchasing. Beverage excise taxes may be an effective policy to sustainably decrease purchases of sweetened drinks and calories from sugar in independent stores, with large reductions in lower-income areas and among customers with lower levels of education.

Objectives: The diagnostic validity of salivary gland scintigraphy in Sjögren's syndrome (SS) has not been conclusively defined. Whether a quantitative (excretion fraction) interpretation of scintigraphy is superior to a qualitative one (visual analysis) remains a matter of debate. We sought to determine whether the diagnostic discrimination of excretion fraction is higher compared to that obtained by visual analysis., Methods: Diagnostic test validity study that encompassed 137 suspected SS subjects who underwent scintigraphy for diagnostic purposes. Patients were diagnosed as SS and non-SS according to the rheumatologist's clinical judgment, and by using the American-European Consensus Group (AECG) and American College of Rheumatology (ACR) classification criteria. Visual analysis (normal vs. abnormal and Schall's classification grade) and excretion fraction scores were calculated. The diagnostic discrimination of these methods was compared through the area under the curve (AUC) analysis. Scintigraphy associations with SS clinical and laboratory features were assessed through multivariable regression analysis., Results: Schall's classification AUC reached statistical significance in its diagnostic discrimination for SS clinical judgment (0.704 [95%CI 0.597-0.811]) and AECG criteria (0.764 [95%CI 0.641-0.886]). Similarly, submandibular excretion fraction was associated with SS diagnosis based on ACR (0.737 [95%CI 0.546-0.931]) and AECG criteria (0.715 [95%CI 0.597-0.833]). However, AUC comparisons between qualitative and quantitative methods did not yield statistically significant values. Both interpretation modalities were associated with SS serological features. Moreover, excretion fraction was also associated with salivary gland biopsy., Conclusions: SS diagnostic discrimination of excretion fraction is not superior to that obtained by qualitative visual analysis. Both qualitative and quantitative scintigraphy methods are associated with SS clinical and laboratory characteristics.

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved., (Copyright © 2020 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To examine the prevalence and nutrient composition of menu offerings targeted to customers with dietary restrictions at US fast casual and full-service chain restaurants., Design: We used 2018 data from MenuStat, a database of nutrient information for menu items at large US chain restaurants. Five alternative diets were examined: gluten-free, low-calorie, low-carbohydrate, low-fat and vegetarian. Diet offerings were identified by searching MenuStat item descriptions and reviewing online menus. For each diet, we reported counts and proportions. We used bootstrapped multilevel models to examine differences in predicted mean kilojoules, saturated fat, Na and sugars between diet and non-diet menu items., Setting: Forty-five US fast casual and full-service chain restaurants in 2018 (including 6419 items in initial analytic sample across small plates, salads and main dishes)., Participants: None., Results: The most prevalent diets were gluten-free (n 631, 9·8 % of menu items), low-calorie (n 306, 4·8 %) and vegetarian (n 230, 3·6 %). Compared with non-diet counterparts, low-calorie main dishes had significantly lower levels of all nutrients examined and vegetarian main dishes had significantly lower levels of all nutrients except saturated fat. Gluten-free small plates had significantly fewer kilojoules, grams of saturated fat and milligrams of Na compared with non-diet small plates., Conclusions: A small proportion of fast casual and full-service restaurant menus are targeted towards customers with dietary restrictions. Compared with non-diet items, those classified as gluten-free, low-calorie or vegetarian generally have healthier nutrient profiles, but overall nutrient values are still too high for most menu items, regardless of dietary label.

The bulk of plant biomass is comprised of plant cell walls, which are complex polymeric networks, composed of diverse polysaccharides, proteins, polyphenolics, and hydroxyproline-rich glycoproteins (HRGPs). Glycosyltransferases (GTs) work together to synthesize the saccharide components of the plant cell wall. The Arabidopsis thaliana fucosyltransferases (FUTs), At FUT4, and At FUT6, are members of the plant-specific GT family 37 (GT37). At FUT4 and At FUT6 transfer fucose (Fuc) onto arabinose (Ara) residues of arabinogalactan (AG) proteins (AGPs) and have been postulated to be non-redundant AGP-specific FUTs. At FUT4 and At FUT6 were recombinantly expressed in mammalian HEK293 cells and purified for biochemical analysis. We report an updated understanding on the specificities of At FUT4 and At FUT6 that are involved in the synthesis of wall localized AGPs. Our findings suggest that they are selective enzymes that can utilize various arabinogalactan (AG)-like and non-AG-like oligosaccharide acceptors, and only require a free, terminal arabinofuranose. We also report with GUS promoter-reporter gene studies that AtFUT4 and AtFUT6 gene expression is sub-localized in different parts of developing A. thaliana roots., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Soto, Prabhakar, Wang, Backe, Chapla, Bartetzko, Black, Azadi, Peña, Pfrengle, Moremen, Urbanowicz and Hahn.)

In the Rhizobium-legume symbiosis, strigolactones (SLs) promote root nodule formation; however, the exact mechanism underlying this positive effect remains unknown. The recent finding that an SL receptor legume mutant shows a wild-type nodulation phenotype suggests that SLs influence the symbiosis by acting on the bacterial partner. In agreement with this, the application of the synthetic SL analog GR24 on the alfalfa symbiont Sinorhizobium (Ensifer) meliloti has been shown to stimulate swarming, a specialized bacterial surface motility, which could influence infection of legumes by Rhizobia. Surface motility assays for many bacteria, and particularly for Rhizobia, are challenging. The establishment of protocols to study bacterial surface motility is key to decipher the role of SLs as rhizosphere cues for rhizobacteria. In this chapter, we describe a set of protocols implemented to study the different types of motility exhibited by S. meliloti.

Background: Although previous studies have documented declines in intake from sugar-sweetened beverages (SSB) in the United States, it is important to examine whether heavy SSB intake (≥500 kcal/day) is decreasing in parallel. Examining the intake patterns of heavy SSB consumers is imperative because these individuals face the greatest health risks and thus may benefit the most from targeted policy and programmatic efforts to reduce intake., Objective: To provide the most recent national estimates for trends in heavy SSB intake among children and adults in the United States between 2003-2004 and 2015-2016, to examine whether these trends differ by sociodemographic characteristics, and to describe where SSB are acquired and consumed by the heaviest SSB consumers., Design: Trend analyses of demographic and 24-hour dietary recall data in the 2003-2004 to 2015-2016 National Health and Nutrition Examination Survey., Participants/setting: Participants were 21,783 children (aged 2 to 19 years) and 32,355 adults (aged ≥20 years)., Main Outcome Measures: Heavy SSB intake (≥500 kcal/day)., Statistical Analysis: Survey-weighted logistic regression was used to estimate the proportion of heavy SSB consumers, overall and by age group, race/ethnicity, sex, and income status (lower income = <130% Federal Poverty Level). Proportions were used to summarize where SSB are most often acquired and consumed., Results: Between 2003-2004 and 2015-2016, the prevalence of heavy SSB intake declined significantly among children (10.9% to 3.3%) and adults (12.7% to 9.1%). For children, these declines were observed across age group, sex, family income status, and most races/ethnicities. For adults, these significant declines were observed among 20- to 39-year olds, most races/ethnicities, and higher-income adults. However, there was a significant increase in heavy SSB intake among adults aged ≥60 years and no significant change among 40- to 59-year olds and non-Mexican Hispanic adults. The majority of energy intake from SSB consumed by heavy SSB drinkers was from products acquired from stores and was consumed at home., Conclusions: Heavy SSB intake is declining, but attention must be paid to certain subgroups with high intake for whom trends are not decreasing, particularly 40- to 59-year olds and non-Mexican Hispanic adults., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Importance: Restaurants spend billions of dollars on marketing. However, little is known about the association between restaurant marketing and obesity risk in adults., Objective: To examine associations between changes in per capita county-level restaurant advertising spending over time and changes in objectively measured body mass index (BMI) for adult patients., Design, Setting, and Participants: This cohort study used regression models with county fixed effects to examine associations between changes in per capita county-level (370 counties across 44 states) restaurant advertising spending over time with changes in objectively measured body mass index (BMI) for US adult patients from 2013 to 2016. Different media types and restaurant types were analyzed together and separately. The cohort was derived from deidentified patient data obtained from athenahealth. The final analytic sample included 5 987 213 patients, and the analysis was conducted from March 2018 to November 2019., Exposure: Per capita county-level chain restaurant advertising spending., Main Outcomes and Measures: Individual-level mean BMI during the quarter., Results: The included individuals were generally older (37.1% older than 60 years), female (56.8%), and commercially insured (53.5%). For the full population of 29 285 920 person-quarters, there was no association between changes in all restaurant advertising per capita (all media types, all restaurants) and changes in BMI. However, restaurant advertising spending was positively associated with weight gain for patients in low-income counties but not in high-income counties. A $1 increase in quarterly advertising per capita across all media and restaurant types was associated with a 0.053-unit increase in BMI (95% CI, 0.001-0.102) for patients in low-income counties, corresponding to a 0.12% decrease in BMI at the 10th percentile of changes in county advertising spending vs a 0.12% increase in BMI at the 90th percentile., Conclusions and Relevance: The results of this study suggest that restaurant advertising is associated with modest weight gain among adult patients in low-income counties. To date, there has been no public policy action or private sector action to limit adult exposure to unhealthy restaurant advertising. Efforts to decrease restaurant advertising in low-income communities should be intensified and rigorously evaluated to understand their potential for increasing health equity.

On September 20 of 2017, Hurricane Maria made landfall in Puerto Rico as a strong category 4 hurricane with destructive winds and flooding. Everyone suffered in the aftermath of the hurricane due to overwhelming destruction and lack of available resources. For medical students, these conditions were intensified due to their duty as first responders, academic responsibilities from medical school, personal losses, and financial difficulties. Despite the hardships, these students learned lessons and found solutions to overcome their challenges. The objective of this article is to portray the situations that medical students confronted and offer suggestions on how medical students and academic institutions can prepare for future natural disasters., (Copyright ©2020, Yale Journal of Biology and Medicine.)