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Bio‐inspired soft robots provide a promising solution for robots working in human‐centered scenarios and interacting with unstructured environments. However, the functional versatility and multimodal sensing of soft robots still need improvements. On one hand, the configuration of a soft robot is predefined during manufacturing; on the other hand, the multimodal perception of the deformable soft actuator is challenging. In this work, a reconfigurable and proprioceptive soft origami module is presented, where two kinds of basic actuation modes (i.e., extension and bending) are realized, and multimodal perception is enabled using a novel foldable self‐inductance sensor. As a result, the origami module can be reconfigured to assemble multifunctional robots that can measure interaction force, body configuration, and other environmental information. Dedicated experiments are performed to validate the performance of the proposed origami module. An intelligent gripper assembled using three origami modules is designed with the capabilities of grasping mode adjustment, grasping force measurement, and the grasping target's size measurement. An intelligent jellyfish is assembled using five origami modules, and equipped with buoyancy adjustment and underwater grasping capabilities. The proposed proprioceptive modular soft origami provides an effective solution for versatile and intelligent soft robot design.

Background: Bluetongue virus serotype 3 (BTV-3) was detected for the first time in cattle and sheep in southern England in 2023, the first UK BTV incursion for more than 15 years. Clinical signs were not observed, yet severe clinical disease and mortality were reported during recent BTV-3 outbreaks in northern Europe., Methods: To investigate the clinical disease and infection kinetics associated with this UK BTV-3 strain, five British sheep were infected with a UK BTV-3 isolate using Culicoides biting midges. Clinical signs, pathology, infection dynamics, immune responses and Culicoides infection rates were assessed., Results: All sheep were infected with BTV-3 and developed mild to moderate clinical bluetongue disease, characterised by fever, haemorrhagic diarrhoea, lameness, depression and widespread petechial haemorrhage. Three sheep reached clinical humane endpoints and were euthanased. Clinical signs/severity, infection kinetics and immune responses were highly variable. Infectious BTV-3 was isolated from sheep blood up to 28 days postinfection., Limitations: The impact of BTV-3 infection on British cattle and infection rate in UK Culicoides require investigation to fully determine the risk of this strain to UK livestock., Conclusions: This study confirms the potential impact of a BTV-3 incursion/outbreak on the UK sheep population, highlighting the need for an effective vaccine., (© 2024 The Author(s). Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

Scientists are often inspired by nature, where naturally occurring morphologies, such as those that resemble animals and plants, can be created in the lab. In this review, we have provided an overview on complex superstructures of animals, plants and some similar shapes from the natural world. We begin this review with a discussion about the formation of various animal-like shapes from small organic molecules and polymers, and then move onto plants and other selected shapes. Literature surveys reveal that most of the polymers studied tend to form micellar structures, with some exceptions. Nevertheless, small organic molecules tend to form not only micellar structures but also other animal shapes such as worms and caterpillars. These superstructures tend to have high surface areas and variable surface morphology, making them very useful material for applications in various field such as catalysis, solar cells, and biomedicine, amongst others., (© 2022 The Chemical Society of Japan & Wiley-VCH GmbH.)

Mimicking natural objects such as flowers, is an objective of scientists not only because of their attractive appearance, but also to understand the natural phenomena that underpin real world applications such as drug delivery, enzymatic reactions, electronics, and catalysis, to name few. This article reviews the types, preparation methods, and structural features of flower-like structures along with their key applications in various fields. We discuss the various types of flower-like structures composed of inorganic, organic-inorganic hybrid, inorganic-protein, inorganic-enzyme and organic compositions. We also discuss recent development in flower-like structures prepared by self-assembly approaches. Finally, we conclude our review with the future prospects of flower-like micro-structures in key fields, being biomedicine, sensing and catalysis., (© 2020 The Chemical Society of Japan & Wiley-VCH GmbH.)

Purpose: The rationale for choosing a final group-based trajectory modeling (GBTM) specification and evaluations of patient adherence patterns within groups are often omitted in the GBTM medication adherence literature. We aimed to (1) reveal the complexity of GBTM and (2) assess model discrimination of patient medication adherence patterns., Methods: Medicare administrative claims were used to measure statin medication adherence as a continuous value in the 6 months before an acute myocardial infarction (AMI) hospitalization. Different GBTM specifications beyond default settings were constructed and compared with the Bayesian information criterion. Spaghetti plots were used to compare individual adherence patterns with group averages., Results: Overall, 113,296 prevalent statin users met eligibility criteria. Four adherence groups were identified: persistently adherent, moderately adherent, progressively nonadherent, and persistently nonadherent. Spaghetti plots showed the persistently adherent and persistently nonadherent groups had relatively homogeneous adherence patterns that matched predicted trajectories well. Spaghetti plots also showed that, while adherence patterns in the progressively nonadherent group were not as homogeneous, most patients in this group appeared to be discontinuing statin therapy pre-AMI., Conclusions: Subjective decisions are necessary to identify a final trajectory model. Greater transparency and disclosure of these decisions in the medication adherence literature are needed. Individual patient adherence patterns from spaghetti plots provided additional diagnostic information about trajectory models beyond standard model-fit assessments to determine if group-average adherence estimates represent homogeneous patterns of medication adherence., (© 2019 John Wiley & Sons, Ltd.)

Background: Patient navigation programs are emerging that aim to address disparities in clinical trial participation among medically underserved populations, including racial/ethnic minorities. However, there is a lack of consensus on the role of patient navigators within the clinical trial process as well as outcome measures to evaluate program effectiveness., Methods: A review of the literature was conducted of PubMed, Medline, CINHAL, and other sources to identify qualitative and quantitative studies on patient navigation in clinical trials. The search yielded 212 studies, of which only 12 were eligible for this review., Results: The eligible studies reported on the development of programs for patient navigation in cancer clinical trials, including training and implementation among African Americans, American Indians, and Native Hawaiians. A low rate of clinical trial refusal (range, 4%-6%) was reported among patients enrolled in patient navigation programs. However, few studies reported on the efficacy of patient navigation in increasing clinical treatment trial enrollment., Conclusions: Outcome measures are proposed to assist in developing and evaluating the efficacy and/or effectiveness of patient navigation programs that aim to increase participation in cancer clinical trials. Future research is needed to evaluate the efficacy of patient navigators in addressing barriers to clinical trial participation and increasing enrollment among medically underserved cancer patients., (© 2014 American Cancer Society.)

Background: To ensure that National Institutes of Health-funded research is relevant to the population's needs, specific emphasis on proportional representation of minority/sex groups into National Cancer Institute (NCI) cancer centers' clinical research programs is reported to the NCI., Methods: EMPaCT investigators at 5 regionally diverse comprehensive cancer centers compared data reported to the NCI for their most recent Cancer Center Support Grant competitive renewal to assess and compare the centers' catchment area designations, data definitions, data elements, collection processes, reporting, and performance regarding proportional representation of race/ethnicity and sex subsets., Results: Cancer centers' catchment area definitions differed widely in terms of their cancer patient versus general population specificity, levels of specificity, and geographic coverage. Racial/ethnic categories were similar, yet were defined differently, across institutions. Patients' socioeconomic status and insurance status were inconsistently captured across the 5 centers., Conclusions: Catchment area definitions and the collection of patient-level demographic factors varied widely across the 5 comprehensive cancer centers. This challenged the assessment of success by cancer centers in accruing representative populations into the cancer research enterprise. Accrual of minorities was less than desired for at least 1 racial/ethnic subcategory at 4 of the 5 centers. Institutions should clearly and consistently declare their primary catchment area and the rationale and should report how race/ethnicity and sex are defined, determined, collected, and reported. More standardized, frequent, consistent collection, reporting, and review of these data are recommended, as is a commitment to collecting socioeconomic data, given that socioeconomic status is a primary driver of cancer disparities in the United States., (© 2014 American Cancer Society.)

Background: The impact of race and ethnicity on the biologic features and outcome variables of women who are diagnosed with preinvasive breast cancer-ductal carcinoma in situ (DCIS)-has not been addressed widely in the published literature., Methods: Patient demographic, clinical, and pathologic features and outcome variables were analyzed with respect to the patient's initial self-reported race/ethnicity among women who received treatment for a diagnosis of pure DCIS from 1996 to 2009., Results: Of 1902 patients, 1411 were white (74.2%), 214 were African American (11.3%), 175 were Hispanic (9.1%), and 102 were Asian/Pacific Islander (5.4%). The majority of patients were between ages 41 and 70 years (83%). Patients of Hispanic and Asian/Pacific Islander descent were significantly younger than white and African American patients (P < .001). DCIS size and grade, the presence of necrosis, and the frequency of breast-conserving surgery did not differ significantly between groups. African American patients aged >70 years and Hispanic patients aged <50 years were significantly more likely to have estrogen receptor-positive DCIS than patients of other races in the same age categories (P < .001). Adjuvant radiotherapy and tamoxifen were received significantly less often by white women (P < .001). At a median follow-up of 4.8 years (range, 1-14 years), recurrence rates and the development of contralateral breast cancer did not differ significantly among racial/ethnic groups when stratified by treatments received., Conclusions: There was variation in age at presentation, biologic features, and treatment of DCIS among the different ethnic groups. Additional studies with larger numbers of ethnic minority patients are needed to confirm whether the consistent application of evidence-based treatment practices presents an opportunity for reducing disparities in patients with DCIS., (Copyright © 2012 American Cancer Society.)

Background: Health-related quality of life (HRQOL), body mass index (BMI), and physical activity (PA) levels have all been associated with prognosis following breast cancer and may explain partially the higher mortality for breast cancer in certain racial/ethnic subgroups. In this study, associations between PA, BMI, and HRQOL by race were examined in a sample of breast cancer survivors., Methods: Measures of PA, BMI, and HRQOL as well as demographic and medical characteristics of women (N = 3013, 13% nonwhite) who participated in the Women's Healthy Eating and Living Study were assessed at baseline. Analysis of covariance was used to examine the relationship between PA and obesity with HRQOL outcomes. Statistical tests were 2-sided., Results: African American women were less likely to meet guidelines for PA and more likely to be obese than women from other ethnic groups (P < .05). In adjusted models, women who met guidelines for PA reported significantly higher physical health composite (point differences ranged from 10.5 to 21.2 points, all P < .05) and vitality (point differences ranged from 9.9 to 16.5 points, all P < .05) scores than those who did not, regardless of race/ethnicity. Associations between obesity and HRQOL were mixed with fewer associations for Asian American and African American women and stronger associations for whites., Conclusions: Breast cancer survivors from racially and ethnically diverse populations have lower levels of PA and higher rates of obesity that are generally associated with poorer HRQOL. Culturally sensitive PA and weight loss interventions may improve these lifestyle characteristics and result in improved HRQOL., (Copyright © 2012 American Cancer Society.)

Background: The objective of this study was to determine whether women who were participating in the Women's Healthy Eating and Living (WHEL) Study exhibited similar dietary changes, second breast cancer events, and overall survival regardless of race/ethnicity., Methods: For this secondary analysis, the authors used data from 3013 women who were self-identified as Asian American, African American, Hispanic, or white and who were assigned randomly to a dietary intervention or a comparison group. Changes in dietary intake over time by race/ethnicity and intervention status were examined using linear mixed-effects models. Cox proportional hazards models were used to examine the effects of the intervention on the occurrence of second breast cancer events and overall survival. Statistical tests were 2-sided., Results: African Americans and Hispanics consumed significantly more calories from fat (+3.2%) and less fruit (-0.7 servings daily) than Asians and whites at baseline (all P < .01). Overall, intervention participants significantly improved their dietary pattern from baseline to the end of Year 1, reducing calories from fat by 4.9% and increasing intake of fiber (+6.6 grams daily), fruit (+1.1 servings daily), and vegetables (+1.6 servings daily; all P < .05). Despite improvements in the overall dietary pattern of these survivors, the intervention did not significantly influence second breast cancer events or overall survival., Conclusions: Overall, all racial groups significantly improved their dietary pattern over time, but the maintenance of these behaviors were lower among African-American women. More research and larger minority samples are needed to determine the specific factors that improve breast cancer-specific outcomes in diverse populations of survivors., (Copyright © 2011 American Cancer Society.)

Despite many important efforts to increase equity in the US health care system, not all Americans have equal access to health care-or similar health outcomes. With the goal of lowering costs and increasing accessibility to health care, the nation's new health care reform legislation includes certain provisions that expand health insurance coverage to uninsured and underinsured populations, promote medical homes, and support coordination of care. These provisions may help narrow existing health care disparities. Many of the most vulnerable patients, however, may continue to have difficulty accessing and navigating the complex US health care delivery system. This article explores the unique role that patient navigation can play in improving health outcomes for racial and ethnic minorities, as well as other underserved populations, in the context of a changing healthcare environment. Patient navigators can not only facilitate improved health care access and quality for underserved populations through advocacy and care coordination, but they can also address deep-rooted issues related to distrust in providers and the health system that often lead to avoidance of health problems and non-compliance with treatment recommendations. By addressing many of the disparities associated with language and cultural differences and barriers, patient navigators can foster trust and empowerment within the communities they serve. Specific patient navigator activities are discussed, and metrics to evaluate program efforts are presented., (Copyright © 2011 American Cancer Society.)

Background: Health-related quality of life has been hypothesized to predict time to additional breast cancer events and all-cause mortality in breast cancer survivors., Methods: Women with early-stage breast cancer (n=2967) completed the SF-36 (mental and physical health-related quality of life) and standardized psychosocial questionnaires to assess social support, optimism, hostility, and depression prior to randomization into a dietary trial. Cox regression was performed to assess whether these measures of quality of life and psychosocial functioning predicted time to additional breast cancer events and all-cause mortality; hazard ratios were the measure of association., Results: There were 492 additional breast cancer events and 301 deaths occurred over a median 7.3 years (range: 0.01-10.8 years) of follow-up. In multivariate models, poorer physical health was associated with both decreased time to additional breast cancer events and all-cause mortality (p trend=0.005 and 0.004, respectively), while greater hostility predicted additional breast cancer events only (p trend=0.03). None of the other psychosocial variables predicted either outcome. The hazard ratios comparing persons with poor (bottom two quintiles) to better (top three quintiles) physical health were 1.42 (95% CI: 1.16, 1.75) for decreased time to additional breast cancer events and 1.37 (95% CI: 1.08, 1.74) for all-cause mortality. Potentially modifiable factors associated with poor physical health included higher body mass index, lower physical activity, lower alcohol consumption, and more insomnia (p<0.05 for all)., Conclusion: Interventions to improve physical health should be tested as a means to increase time to additional breast cancer events and mortality among breast cancer survivors., (Copyright © 2010 John Wiley & Sons, Ltd.)

Background: Overall, Latinas are more likely to be diagnosed with a more advanced stage of breast cancer and are 20% more likely to die of breast cancer than non-Hispanic white women. It is estimated that from 2003 to 2006, $82.0 billion in direct medical care expenditures, in addition to 100,000 lives annually, could be saved by eliminating health disparities experienced by Latinos and increasing the use of up to 5 preventive services in the United States. An additional 3700 lives could be saved if 90% of women aged ≥40 years were recently screened for breast cancer., Methods: The authors examined the risk for breast cancer in a case-control, population-based sample of Mexican-origin women in Harris County, Texas (n=714), where the rates of breast cancer mortality for Latina women have doubled since 1990., Results: Half of breast cancer cases (n=119) were diagnosed in women aged <50 years. In a multivariate model, women who had a family history of breast cancer (odds ratio [OR], 4.3), who were born in Mexico and had high levels of language acculturation (OR, 2.5), and who did not have health insurance (OR, 1.6) had the highest risk for breast cancer., Conclusions: Because the current results indicated that Mexican-origin women are at high-risk for early onset, premenopausal breast cancer, the authors recommended policies that target screening, education, and treatment to prevent increased disparities in mortality. The authors concluded that the inclusion of community members and policymakers as partners in these endeavors would further safeguard against an increase in cancer health disparities and aid in formulating a policy agenda congruent with scientifically based, community-driven policy efforts that address breast cancer screening, education, and treatment in this vulnerable population., (Copyright © 2010 American Cancer Society.)

Periparturient relaxation of immunity (PPRI) to secondary infection with nematodes is believed to have a nutritional basis due to differential partitioning of scarce nutrient resources, particularly protein, to reproductive rather than immune functions. At times of protein scarcity, an increase in protein supply has been reported to assuage this phenomenon. The Nippostrongylus brasiliensis reinfected lactating rat model is now being utilized to investigate the immune reactions underlying the modifying role of dietary protein on PPRI. Herein, we demonstrate that lactating rats reinfected with N. brasiliensis under high protein (HP) dietary conditions exhibit decreased worm burdens and reduced colon egg counts compared to their low protein (LP) counterparts. These reductions correlated with increased mastocytosis and greater goblet cell hyperplasia. Additionally, the local antibody profile revealed that HP reinfected lactating rats developed a stronger antigen specific IgG2b response earlier in infection in comparison with their LP counterparts. Our study provides evidence that increased dietary protein content reduces the PPRI to N. brasiliensis re-infection in the lactating rat through improved mucosal immune responses.

Aims: Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician., Methods: We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit. Providers and patients were blinded to the study hypothesis. Immediately after the clinical encounter, patients completed a survey including questions on trust (range 0 to total trust = 100), knowledge, and decisional conflict. Researchers reviewed videotaped encounters and assessed patient participation (using the OPTION scale) and visit length., Results: Overall mean trust score was 91 (median 97.2, IQR 86, 100). After adjustment for patient characteristics, results suggested greater total trust (trust = 100) with the decision aid [odds ratio (OR) 1.77, 95% CI 0.94, 3.35]. Total trust was associated with knowledge (for each additional knowledge point, OR 1.3, 95% CI 1.1, 1.6), patient participation (for each additional point in the OPTION scale, OR 1.1, 95% CI 1.1, 1.2), and decisional conflict (for every 5-point decrease in conflict, OR 1.5, 95% CI 1.2, 1.9). Total trust was not associated with visit length, which the decision aid did not significantly affect. There was no significant effect interaction across the trial factors., Conclusions: Preliminary evidence suggests that decision aids do not have a large negative impact on trust in the physician and may increase trust through improvements in the decision-making process.

Issue Addressed: To evaluate the effectiveness of a brief intervention using a pedometer and step-recording diary on promoting physical activity in people with type 2 diabetes or impaired glucose tolerance (IGT)., Methods: People with type 2 diabetes or IGT who attended the Illawarra Diabetes Service were invited to participate. Participants in the intervention group received a pedometer and a diary to record their daily steps for a two-week period. Both the intervention and comparison group received advice on physical activity. Physical activity levels were measured using the Active Australia Survey at baseline, and at two and 20 weeks., Results: A total of 226 participants were recruited. At two-week follow-up the mean self-reported minutes of walking was significantly higher in the intervention group than the comparison group (223 minutes versus 164 minutes; p=0.01), as was the percentage of intervention participants achieving recommended levels of moderate-intensity physical activity (63.5% versus 41.8%, p=0.02) and the percentage of intervention participants achieving adequate levels of total physical activity (68.9% versus 48.0%, p=0.04). There were no differences between study groups for any physical activity measure at 20-week follow-up., Conclusions: A pedometer and a step-recording diary were useful tools to promote short-term increase in physical activity in people diagnosed with type 2 diabetes or IGT. Future studies need to examine whether a longer intervention, individualised physical activity counselling and support for achieving step goals could result in increasing physical activity over the long term.

The objectives of this study were to examine sex differences in depressive symptom patterns in 475 sib pairs with well-defined recurrent major depression and to test the hypotheses that (a) symptom patterns show higher intraclass correlations within same sex sib pairs versus mixed sex sib pairs; and (b) symptoms more associated with women, e.g. atypical depressive and anxiety symptoms, account for differences between male and female siblings within the same family. A total of 878 individuals, with a past history of at least two depressive episodes, were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry interview and diagnosed according to DSM-IV using a computerized scoring program (CATEGO5). Intraclass correlations were compared between mixed and same sex sibs, and a conditional regression analysis in mixed sex sib pairs was performed to test whether specific symptoms account for differences between male and female siblings within the same family. Women showed a significantly earlier onset of depression compared with men (23.0 years, SD=10.6 versus 25.5, SD=12.5 years, P=0.0004), and a significantly greater frequency of several aspects of depressed mood was found in women compared with men, including atypical depressive features of fatiguability, appetite gain, weight gain and hypersomnia. Discordant sib-pair data analyses revealed five symptoms that accounted for the sex differences between siblings (P=.000035): phobia (exp(B)=2.04, P=0.017), hypersomnia (exp(B)=1.37, P=0.055), appetite loss (exp(B)=1.38, P=0.004) and appetite gain (exp(B)=2.19, P<0.001). Sex significantly modifies clinical features of depression and an earlier onset of depression and atypical depressive symptoms occur more frequently in women.

Ocular toxoplasmosis (OT) can occur in the children of mothers infected with Toxoplasma gondii during pregnancy. It is not limited to the congenitally infected, but can also occur following adult-acquired infection or as a result of disease reactivation in immune-compromised and pregnant individuals. Many aspects of immune privilege in the eye, including constitutive TGF-beta expression and reduced MHC class 1 expression, would appear at first to favour parasite survival. Conversely, many of the mechanisms that control parasite multiplication in other anatomical sites, such as nitric oxide expression, IFN-gamma and TNF-alpha, are known to disrupt immune privilege and are associated with ocular damage. Taking into account the opposing needs of limiting parasite multiplication and minimizing tissue destruction we review the pathogenesis of OT in the murine model.

The theme for the 2004 AANCART Academy, "Community Partnerships for Cancer Control: From Vision to Synergy to Reality", characterizes Best Practices for the Houston AANCART site. Researchers and community members share a common vision for addressing the cancer and health disparities that exist in our Asian community. They banded together synergistically to bring to reality the programs and projects that are enabling more Asian Americans to understand their risks for cancer, receive screening and education, and access treatment and survivorship support. Along the way, Houston AANCART was also able to conduct meaningful and relevant community-based participatory research and to train young Asian and other investigators in how to reach out to this community in a culturally sensitive and appropriate manner., (Cancer 2005. (c) 2005 American Cancer Society.)

Background: Prenatal exposure to the synthetic estrogen diethylstilbestrol (DES) is associated with the subsequent development of clear cell adenocarcinoma of the lower reproductive tract in young women, and data concerning the molecular genetic alterations involved in the etiology of this tumor type have not previously been reported. Such knowledge would be of potential value by providing insight into the molecular mechanisms of hormonal carcinogenesis in general, as well as by suggesting molecular markers for risk assessment in the estrogen-exposed population., Methods: A total of 24 samples of clear cell adenocarcinoma of the vagina or cervix, 16 associated with exposure in utero to DES and 8 with no history of DES exposure, were obtained as archival fixed and embedded tissue specimens. DNA was purified from these tissues and used to examine a number of biologically plausible molecular genetic endpoints for tumor specific alterations., Results: No evidence was found for mutations in the K-ras or H-ras protooncogenes, the Wilms' tumor (WT1) tumor suppressor gene, or the estrogen receptor gene. Sporadic overexpression of the p53 tumor suppressor gene was detected in some tumor cell nuclei by immunohistochemistry, but in the absence of detectable p53 gene mutation. Genetic instability as manifested by somatic mutation of microsatellite repeats was widespread in these tumors, with evidence of microsatellite instability in all DES-associated tumors examined, and in 50% of those tumors not associated with DES exposure., Conclusions: These data are consistent with the hypothesis that the induction of genomic instability may be an important mechanism of DES-induced carcinogenesis.

An assay for cytoplasmic progesterone receptor is described in which receptor is bound to hydroxylapatite and is washed before saturation analysis. Using 3H-progesterone as ligand, the assay yields lower, more reproducible nonspecific binding than is obtained with dextran-coated charcoal techniques and may provide a clinically useful method of measuring progesterone receptor in breast carcinoma. Nuclear progesterone receptors can also be determined by the same technique.

This study attempted to determine the relationship of nutritional status, menopausal status, presence of breast cancer, stage of disease, and tumor estrogen receptor levels to percent non-protein-bound estradiol (%NPBE) and percent distribution of estradiol on sex hormone-binding globulin (SHBG) and albumin in breast cancer patients and control patients. Normal-weight controls had significantly lower %NPBE compared with overweight controls and normal-weight and overweight breast cancer patients. There was a significant shift in the percent distribution of estradiol from SHBG to albumin in breast cancer patients, independent of body weight. Elevated %NPBE and abnormal percent estradiol distribution on albumin persisted after mastectomy and were unrelated to menopausal status, presence and stage of disease, and tumor estrogen receptor levels. These results show that breast cancer patients have increased exposure to unbound circulating estradiol and an increased percentage of estradiol bound to albumin, which may influence the availability of estradiol, considering its low binding affinity to albumin. Because these abnormalities persist after mastectomy, the current results may be important in developing dietary intervention protocols that correct %NPBE and abnormal estradiol distribution on binding proteins.