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The prognosis of patients with node-negative T1b tumors according to human epidermal growth factor receptor 2 (HER2) status is not known. This group of patients has not been studied in the available randomized trials. The objective of this study was to evaluate the survival of patients in a monoethnic group diagnosed with T1b lymph node-negative breast cancer depending on HER2 status. We analyzed 3110 patients with T1bN0M0 breast cancer whose data were deposited into the Korean Breast Cancer Society Registry database between 2000 and 2009. Overall survival (OS) and breast cancer-specific survival (BCSS) were compared according to HER2 status. Among all patients, 494 (15.9%) had HER2-positive breast cancer. At a mean follow-up of 93 months, 108 deaths and 86 breast cancer-specific deaths were noted among all patients. There was no significant difference in OS between the HER2-negative and HER2-positive groups (p = 0.103). The same result was observed for BCSS. However, in the subgroup of estrogen receptor (ER)-positive women, HER2-negative patients had a better BCSS prognosis than HER2-positive patients (p = 0.025). Multivariate analysis also indicated a significant difference in BCSS in the ER-positive subgroup (HR 2.60; 95% CI 1.15–5.87; p = 0.021). This study analyzed a large nationwide and monoethnic cohort and found a significant difference only in BCSS in the ER-positive subgroup according to HER2 status. Anti-HER2 therapy may be considered in HER2-positive and ER-positive patients with small, node-negative breast cancer.

This study has been designed to investigate the determinants of competitiveness in the logistics industry. In particular, we focus on the expansion of transportation as a central theme. Size and economy of scale are important issues in many industries. Previous studies have typically highlighted the positive aspects of large scale in terms of competitiveness. However, this study acknowledges that the large scale of transportation means, such as container ships and cargo planes, may not necessarily be positive for the competitiveness of the logistics industry. We believe that expansion is a double-edged sword. Economy of scale can have negative aspects associated with it. This study analyzes how transportation size affects competitiveness in the logistics industry. Additionally, we discuss other determinants of logistics performance such as ICT capability and green transportation. According to empirical findings, we could not identify a specific relationship between the large scale of marine transportation and logistics performance. Moreover, a negative influence behind the increase in air transportation is discussed. Additionally, this study attempts to establish theoretical foundations for logistics performance. This study has been designed to investigate the impact of transportation expansion on logistics performance based on the RBV, transaction cost analysis (TCA), and institutional theory.

Electrically conductive materials can stimulate stem cells through electric shock and thereby contribute to the regulation of cell proliferation and differentiation. Recently, polymer-metal complexes composed of polyaniline and gold nanoparticles have emerged as novel candidates for use in regenerative medicine. By mixing two different materials, such composites maximize the benefits while alleviating the disadvantages of using either material alone. Based on their excellent conductivity, these complexes can be applied to nerve regeneration using stem cells. In this study, we investigated a method for producing hybrid nanocomposites by complexing gold nanoparticles to polyaniline and tested the resultant composites in a model of nerve regeneration. We manipulated the shape, size, and electrical conductivity of the hybrid composites by compounding the component materials at various ratios. The most efficient nanocomposite was named conductive reinforced nanocomposites (CRNc's). When the CRNc was delivered directly to cells, no cytotoxicity was observed. After the intracellular delivery of the CRNc, the stem cells were electrically stimulated using an electroporator. As a result of performing mRNA-sequencing (Seq) analysis after electrical stimulation (ES) of the CRNc-internalized cells, it was confirmed that the CRNc-internalized cells have a pattern similar to that of the positive group-induced neuron cells. In particular, microtubule-associated protein 2 is more than twice that of the control group (negative control), and the nerve fiber protein is strongly expressed as in the positive control group. In addition, we verified that neural differentiation progressed by monitoring the growth of neurites from stem cells. Together, these findings show that the CRNc can be used to induce the formation of neuron-like cells by applying ES to stem cells.

Background: Because articular chondrocyte-based autologous chondrocyte implantations (ACIs) have restrictively restored articular cartilage defects, alternative cell sources as a new therapeutic option for cartilage repair have been introduced. Purpose: To assess whether implantation of a costal chondrocyte–derived pellet-type (CCP) ACI allows safe, functional, and structural restoration of full-thickness cartilage defects in the knee. Study Design: Case series; Level of evidence, 4. Methods: In this first-in-human study, 7 patients with symptomatic, full-thickness cartilage lesions were enrolled. The chondrocytes isolated from the patients’ costal cartilage were expanded, followed by 3-dimensional pellet culture to prepare the CCP-ACI. Implantation of the pellets was performed via minimal arthrotomy and secured with a fibrin sealant. Clinical scores, including the International Knee Documentation Committee (IKDC) subjective, Lysholm, and Tegner activity scores, were estimated preoperatively and at 1, 2, and 5 years postoperatively. High-resolution magnetic resonance imaging was also performed to evaluate cartilage repair as well as to calculate the MOCART (magnetic resonance observation of cartilage repair tissue) score. Results: The costal chondrocytes of all patients formed homogeneous-sized pellets, which showed the characteristics of the hyaline cartilaginous tissue with lacunae-occupied chondrocytes surrounded by glycosaminoglycan and type II collagen-rich extracellular matrix. There were no treatment-related serious adverse events during the 5-year follow-up period. Significant improvements were seen in all clinical scores from preoperative baseline to the 5-year follow-up (IKDC subjective score, 34.67 to 75.86; Lysholm score, 34.00 to 85.33; Tegner activity score, 1.17 to 4.67; and MOCART score, 28.33 to 83.33). Two patients had complete defect filling on magnetic resonance imaging evaluation at 1 year. Moreover, at 5 years postoperatively, complete defect filling was observed in 4 patients, and hypertrophy or incomplete defect filling (50%-100%) was observed in 2 patients. Conclusion: The overall results of this clinical study suggest that CCP-ACI can emerge as a promising therapeutic option for articular cartilage repair with good clinical outcomes and structural regeneration and with stable results at midterm follow-up. Registration: NCT03517046 ( ClinicalTrials.gov identifier)

Background Federal nutrition education programs such as the Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) utilize a peer educator model to teach low-income Americans about healthy eating behaviors. Recipe demonstrations are an important part of such programs and may influence participants’ eating and food preparation behaviors at home. Little is known about how peer educators perceive program recipes and related participants’ recipe acceptability and preparation behaviors. Objective To examine peer educators’ acceptability of recipes through evaluation of sensory attributes (appearance, flavor, texture, and saltiness or sweetness), preparation behaviors, and participants’ perceived behaviors. Study Design, Setting, Participants Eight online surveys were conducted with peer educators (100% female, 47% African American, 14-28 responses per recipe) in the University of Georgia EFNEP and SNAP-Ed programs. Educators completed the surveys independently in a location of their choice. Survey links were sent to educators in a single document, and weekly reminders paced them to complete 2 surveys per week. Measurable Outcome/Analysis Sensory acceptability of 16 recipes was evaluated on a 9-point hedonic scale (0=Dislike Extremely; 5=Neither Like nor Dislike; 9=Like Extremely). Preparation intent and behaviors of educators and participants were evaluated on a similar scale. Standard range of acceptability is ≥7. Results Thirteen recipes received acceptable ratings on most sensory attributes and preparation questions. Three recipes (Curly Noodles Supreme, Easy Cheesy Broccoli Soup, and Ranch Sauce) received unacceptable ratings. Across all recipes, recipe acceptability, preparation intent, and program participant perception were not significantly different by educators’ program, length of employment, and quadrant district in Georgia. Conclusion The findings suggest that peer educators for the nutrition education of low-income Georgians reported overall acceptable sensory attributes and preparation behaviors related to the program recipes and indicate areas for improvement in select recipes. Sensory evaluation methodology could be used to improve nutrition education recipes for higher acceptability and healthier recipe preparation behaviors in low-income participants.

Background FVRx programs combining produce prescription and nutrition education have the potential to improve multiple diet-related behaviors of low-income adults. In 2018, the Athens FVRx program expanded nutrition education from 1 SNAP-Ed program (2017) to 2 SNAP-Ed programs and 1 financial literacy program. Objective To examine the effects of an FVRx program with expanded nutrition education and financial literacy education on nutrition and clinical outcomes in low-income adults. Study Design, Settings, Participants A 6-month non-randomized, parallel, controlled trial with 1 intervention (FVRx [n = 31]) and 2 comparison groups (Ad-hoc Nutrition Education (n = 10), and control [n = 16]). The final analytic sample (n = 36) included food insecure adults with a diet-related condition (mean age 53.8 ± 12.2 years (P Measurable Outcome/Analysis Pre- and post-intervention, 3 separate self-administered surveys assessed dietary intake, food security, food purchasing practices, and financial and food resource management. Clinical biomarkers (blood lipids, HbA1c) and biometrics (blood pressure, BMI) were measured. Descriptive analysis and one-way ANOVA were conducted. Results Post-intervention, FVRx participants significantly increased the frequency of consuming vegetables (once a day-once a week) by 22.2%, and knowledge, purchase, and preference of seasonally and locally available produce by (44.4%, 72.2%, and 16.7% respectively) compared to the comparison groups (P Conclusion Combining expanded nutrition and financial literacy education with produce prescription improves low-income adults’ financial and food resources, knowledge, purchase, preference, and consumption of locally grown vegetables.

The prognostic role of primary tumor surgery in women with metastatic breast cancer at diagnosis is contentious. A subset of patients who will benefit from aggressive local treatment is needed to be identified. Using a nationwide database, we developed and validated a predictive model to identify long-term survivors among patients who had undergone primary tumor surgery. A total of 150,043 patients were enrolled in the Korean Breast Cancer Registry between January 1990 and December 2014. Of these, 2332 (1.6%) presented with distant metastasis at diagnosis. Using Cox proportional hazards regression, we developed and validated a model that predicts survival in patients who undergo primary tumor surgery, based on the clinicopathological features of the primary tumor. A total of 2232 metastatic breast cancer patients were reviewed. Of these, 1541 (69.0%) patients had undergone primary tumor surgery. The 3-year survival rate was 62.6% in this subgroup. Among these patients, advanced T-stage, high-grade tumor, lymphovascular invasion, negative estrogen receptor status, high Ki-67 expression, and abnormal CA 15-3 and alkaline phosphatase levels were associated with poor survival. A prediction model was developed based on these factors, which successfully identified patients with remarkable survival (score 0–3, 3-year survival rate 87.3%). The clinical significance of the model was also validated with an independent dataset. We have developed a predictive model to identify long-term survivors among women who undergo primary tumor surgery. This model will provide guidance to patients and physicians when considering surgery as a treatment modality for metastatic breast cancer.

Cross-border e-commerce has been very successful in the last decade. Merchants and consumers have been encouraged to participate in e-commerce, including B2C or B2B. B2C is not limited to a domestic market anymore. Consumers across countries are interested in overseas direct purchases. They are willing to purchase products from major online shopping sites such as Amazon and eBay. We aim at gaining a better understanding of overseas direct purchases. Determinants of overseas direct purchases based on cross-national data are identified. Accordingly, we investigate logistics and regulatory determinants. Furthermore, external environments such as regulatory institutions and globalization are discussed in terms of overseas direct purchases. This study incorporates theoretical foundations into empirical findings. Specifically, the institutional theory and the resource-based view are applied to explain the internal and external determinants to increase overseas direct purchases. We conduct an empirical test using panel data for each country to identify the various determinants associated with overseas direct purchases.

Objective To conduct an exploratory formative evaluation of a culturally adapted nutrition education program for SNAP-eligible Hispanic/Latino adult Georgians Use of Theory or Research Nutrition education programs for low-income Hispanics/Latinos must be culturally tailored to be effective. Target Audience Spanish-speaking SNAP-eligible adult Georgians Program Description “Hablemos de Comida: Comida: “Por SU Salud!” (HCPSS) is a cultural adaptation of “Food Talk: Better U,” an evidence-based program focusing on healthy weight management by University of Georgia SNAP-Ed. A comprehensive needs assessment informed systematic translation and cultural tailoring. The program consists of four 90-minute didactic lessons taught by bilingual paraprofessionals focusing on portion control, limiting added sugar, and making small healthy changes. The program content is interactive and features physical activity using culturally appropriate music and 6 Hispanic/Latino-inspired, low sodium recipes. Evaluation Methods A mixed-method formative evaluation was conducted using self-administered participant surveys (n = 15), program administrative data, key informant interviews with program developers and providers (n = 6), program participant focus groups (n = 3), and in-class observations (n = 10) in 1 pilot county in 2019. Results Focus group and key informant interview findings suggested acceptability and cultural appropriateness of HCPSS. Major themes from development and implementation phases emphasized the importance of attending to diversity and cultural appropriateness for target audiences and language, translation, and other interpersonal facilitator skills such as cultural competence and humility. A team-based approach was recommended to address cultural diversity, recruitment barriers, ongoing staff training needs, and other population-specific barriers regarding language, literacy, and mistrust. Administrative data and class observation data suggested high fidelity but the importance of fully bilingual paraprofessionals and additional training for physical activity. Conclusion and Implications This study found that the culturally adapted nutrition education and obesity prevention programming targeted to low-income Hispanics/Latinos and strategies to strengthen ongoing development and implementation efforts was feasible.

Background Mobile text messaging intervention is a promising method for improving health promotion and behavior change. Little is known about feasibility and strategies for text messaging interventions targeted to low-income adults. Objective The objective of this study was to explore opinions about feasibility, tone, and content for the development of a texting campaign for Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible adults to encourage drinking more water and drinking less sugar-sweetened beverages (SSBs). Study Design, Setting, Participants A qualitative research design was used to elicit the opinions of SNAP-Ed eligible individuals living in the state of Georgia. Using a convenience sample, 13 former SNAP-Ed direct education participants (84.6% female, 69.2% African American) were recruited by text message and email and participated in 4 focus groups and 1 in-depth interview through Zoom. Interviews focused on participants’ texting behavior, current beverage consumption, and proposed content of text messages. Measurable Outcome/ Analysis Focus group interviews were digitally recorded, transcribed verbatim, and coded to establish emergent themes using constant comparative method and Atlas.ti. Results Participants indicated text messaging would be an affordable, desirable, and comfortable way to receive information about nutrition and health. Participants expressed a desire to increase water consumption for themselves due to existing health concerns and wanted to reduce the number of SSBs they drank per day, despite currently drinking SSBs daily. The price and taste of water and unsweetened beverages were reported as the most common barriers to making healthier drink choices. Participants preferred content relevant to their lives (including health issues and abilities), and desired opportunities to build upon their previous knowledge with action-oriented, interactive, and engaging text messages. Conclusion Text messaging is a feasible method to provide nutrition education to SNAP-Ed eligible adults. The findings from this study will inform and guide a new University of Georgia SNAP-Ed text messaging intervention

Background Community and clinic-based health care organizations play a vital role in administering nutrition education to low-income populations facing various financial and geographical barriers. Technology-based, online programs are accessible, flexible, and low-cost options to provide this audience with reliable nutrition education. Objective This study examined the current status of nutrition education and needs for online nutrition education resources among low-income Georgians from community and clinic-based health care providers' perspectives. Study Design, Setting, Participants A statewide online survey was conducted in a sample of 163 community key informants (86.8% female, 18.3% African American) serving a SNAP-eligible population. Purposive and convenience sampling methods were used to recruit 113 respondents from University of Georgia Cooperative Extension (UGA CE) and 50 community and clinic-based health care providers (HCPs), respectively. The survey included questions assessing nutrition education programs, partnerships, and eLearning experience and interest. Measurable Outcome/Analysis Descriptive analyses were conducted to summarize sample characteristics and responses to the online survey's key domains. Results Existing nutrition education programs were more prevalent in UGA CE settings (87.5%) than HCP settings (56.3%). Overall, experience in providing online programs was low among UGA CE and HCP respondents (18.8% and 28.3%, respectively). Participants from both groups expressed interest in offering online nutrition education programs to their clients (75.6% for UGA CE and 84.8% for HCPs), especially those from rurally based organizations. The most preferred format of online nutrition education programs was interactive scenario/game-based learning. Perceived challenges to offering online programs included client interest and motivation, access to technical assistance, and funding. Conclusion Organizations serving low-income Georgian populations are interested in offering online nutrition education programs to expand their current services and better reach their clientele. The findings of this study will inform the implementation and dissemination strategies for evidence-based online nutrition education programming for low-income Georgians.

In this study, we developed the disc-type bio-cartilage reconstruction strategies for transplantable hyaline cartilage for reconstructive surgery using 3D-cell sheet culture of human bone marrow stromal cells and human costal chondrocytes. We compared chondrogenesis efficiency between different chondrogenic-induction methods such as micromass culture, pellet culture, and 3D-cell sheet culture. Among them, the 3D-cell sheet culture resulted in the best chondrogenesis with the disc-type bio-cartilage (>12 mm diameter in size) in vitro, but sometimes spontaneous curling and contraction of 3D-cell sheet culture resulted in the formation of bead-type cartilage, which was prevented by type I collagen coating or by culturing on amniotic membrane. Previously, it was reported that tissue-engineered cartilage reconstructed in vitro does not maintain its cartilage phenotype after transplantation but tends to transform to other tissue type such as bone or connective tissue. However, the disc-type bio-cartilage of 3D-cell sheet culture maintained its hyaline cartilage phenotype even after exposure to the osteogenic-induction condition in vitro for 3 weeks or after the transplantation for 4 weeks in mouse subcutaneous. Collectively, the disc-type bio-cartilage with 12 mm diameter can be reproducibly reconstructed by the 3D-cell sheet culture, whose hyaline cartilage phenotype and shape can be maintained under the osteogenic-induction condition as well as after the transplantation. This disc-type bio-cartilage can be proposed for the application to reconstructive surgery and repair of disc-type cartilage such as mandibular cartilage and digits.

This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services.

Background Social marketing (SM) has the potential to deliver nutrition education messages targeted to low-income individuals, but limited evidence is available on its feasibility in SNAP-Ed programs. Objective To examine the process and impact of the Partnership for a Healthier America's FNV campaign to promote fruit and vegetable consumption in SNAP-Ed eligible adults in Georgia during the 3 consecutive summers in 2017-2019. Study Design, Setting, Participants Process evaluation was conducted throughout the campaign using commercial administrative data reporting tools. After each year's FNV campaign, outcome and impact evaluation implemented the same self-administered post-intervention survey using 3 modalities (ie, online, intercept, and direct mail surveys) while employing a non-randomized control study design (2017-2018) or one-group posttest-only design (2019). During the 3-year campaign, 1,904 Georgians (mean age 49.3 ± 16.6, 77.9% female, 62.6% minority, 82.6% from intervention counties) from 7 intervention and 3 control counties participated in the survey. Intervention Each year's FNV campaign used a mix of billboards, radio ads, newspaper ads, food retail ads, and Facebook available in the selected SNAP-Ed eligible zip code areas to saturate FNV messages while partnering with local stakeholders including County Extension Agents. Outcome Measures/Analysis Process evaluation estimated program reach, impressions, dosage, and engagement. Outcome and impact evaluation assessed participants’ awareness and intention to change due to campaign exposure. Results Over the 3 summers, the FNV campaign reached over 2 million people and generated 10.3 million impressions with 154,403 engagements and provided critical process evaluation data on the successes and challenges of the programmatic and evaluation strategies tested. Those exposed to the FNV campaign were more likely to report willingness and actual behaviors of eating of >1 fruits and vegetables/day than those not exposed. Conclusions and Implications The findings of the 3-year FNV campaign suggest the feasibility and impact of SM for low-income audiences and will inform a new statewide SNAP-Ed SM intervention development in Georgia.

We analyzed the clinicopathologic characteristics and prognosis of pregnancy-associated breast cancer (PABC) according to clinical subtypes to better understand the characteristics of PABC. A total of 83,792 female patients between the ages of 20 and 49 were enrolled in the Korean Breast Cancer Society Registry database from January 1, 1996 to December 31, 2015. ‘PABC’ is defined as breast cancer diagnosed during pregnancy or within 1 year after delivery. Other patients were defined as ‘non-PABC’ patients. In non-PABC patients, luminal A subtype was the most common (50.2%). In PABC patients, TNBC was the most common (40.4%) subtype, while luminal A comprised 21.2% and HER2 subtype comprised 17.3%. There was a significant difference in overall survival (OS). In non-PABC patients, TNBC had the highest HR (HR 2.3, 95% CI 2.1–2.6). In PABC patients, the luminal B subtype (HR+ HER2-high Ki67) had the highest HR at 7.0 (95% CI 1.7–29.1). In multivariate analysis of OS by subtypes, PABC patients had significantly higher HR than non-PABC patients in the HER2 subtype (HR 2.0, 95% CI 1.1–3.7) and luminal B subtype (HR+ HER2-high Ki67) (HR 4.4, 95% CI 1.6–12.3). PABC showed different biologic features than non-PABC. PABC had a particularly poor prognosis in the luminal B (HR+ HER2-highKi67) and HER2 subtypes. To improve the prognosis of PABC, treatment should be considered according to subtype. Development of drugs that can be used during pregnancy is needed.

Objective To examine the impact of Food Talk: Better U (FTBU), the University of Georgia SNAP-Ed's new healthy weight management program on healthy eating, food resource management, and physical activity behaviors in a sample of low-income Georgians. Use of Theory or Research Social cognitive theory and expanded health belief model. Target Audience SNAP-Ed eligible Georgian adults with children Program Description FTBU was developed based on a comprehensive formative evaluation. FTBU is a series of four 90-minute lessons taught by paraprofessionals focusing on portion control, goal setting, limiting added sugar, small healthy shifts, and problem-solving strategies. Each lesson includes a sharing session, didactic lesson, physical activity (PA), cooking demonstration and tasting, and goal setting. Evaluation Methods Outcome evaluation of the program used pre- and post-self-administered questionnaire, 24-hour dietary recalls, and self-reported and measured weight. Outcome measures included Medium Term behavior change indicators (MT1, 2, and 3) from the SNAP-Ed Evaluation Framework and other validated measures. McNemar tests were used to examine changes in reported healthy behaviors between pre- and post-test. Results A total of 454 low-income Georgians participated in FTBU in FY 2018 (mean age 52.6 ± 17.1 years, 74.4% females, 47.6% Black, 68.3% overweight/obese). Overall, participants reported engaging in more healthy behaviors after the intervention. The percent of participants who reported eating more than one fruit (MT1c) and vegetable (MT1d) per day significantly increased after the intervention. Most food resource management indicators (MT2a, b) showed a significant increase between pre- and post-test. The percent meeting guidelines for engaging in moderate-vigorous PA (MT3b) and PA to make muscles stronger (MT3c) also increased significantly post-intervention. Conclusions The findings suggest FTBU has potential to improve healthy behaviors aimed at healthy weight management practices among SNAP-Ed eligible adults with a high burden of obesity. Further evaluations are needed using a rigorous research design with control groups. Funding SNAP-Ed.

Background Federal nutrition education programs for low-income Americans, such as SNAP-Ed, often include recipes to facilitate healthy eating behaviors; however, little is known about acceptance and sensory evaluation of such recipes among target audiences. Objective To examine the feasibility of using sensory evaluation methodology to assess acceptability including overall liking (OL) and five specific sensory attributes (appearance, flavor, texture, saltiness, and sweetness) of the seven newly developed culturally-tailored recipes for low-income adult Georgians. Study Design, Settings, Participants Sensory evaluation was conducted to assess acceptability of the new recipes in 566 participants (83% ≥ 60 years old; 83% female; 74% African American) in the University of Georgia SNAP-Ed Food Talk Farmers Market program during summer, 2018. Recipes were prepared following standardized instructions for preparation and portion size. Participants were asked to rate for acceptability. Measurable Outcome/Analysis Sensory evaluation ballots used traditional nine-point hedonic scale to evaluate OL and five sensory attributes of the recipes (1=dislike extremely, 5=neither like nor dislike, and 9=like extremely). Standard range of acceptability for a recipe is ≥ 7.0. Descriptive statistics of the scales and their relationship with reported intention to healthy behavior changes were analyzed. Results Overall, the new recipes received favorable acceptability with the highest ratings for recipes containing meat or meat alternatives (eg, Chicken Chili with White Beans, mean OL = 7.34, flavor = 7.11, texture = 7.31) and the lowest ratings for recipes with a fruit (Banana Pudding Overnight Oats, mean OL = 5.18, flavor = 4.92, texture = 6.18). Those with standard acceptability ratings (≥ 7) also reported high intention to follow healthy behaviors. Conclusion The findings suggest the feasibility and utility of sensory evaluation methodology in the development of recipes that are more effective and responsive to the sensory preferences of low-income adults for nutrition education programs. Funding SNAP-Ed.

OBJECTIVE Currently single-incision laparoscopic appendectomy (SIL-A) has become an option for treating appendicitis. The aim of this study was to evaluate the safety and feasibility of SIL-A compared with conventional laparoscopic appendectomy (CL-A) on a large experimental cohort. BACKGROUND Several studies had reported the safety and technical feasibility of SIL-A, albeit with a limited number of study subjects. METHODS A total of 2587 patients (1208 SIL-A and 1379 CL-A) who underwent laparoscopic appendectomy from May 2008 to April 2013 were studied retrospectively. The clinical characteristics and short-term operative outcomes of these patients were reviewed and analyzed. RESULTS There were more simple type appendicitis in the SIL-A group and more complicated type appendicitis in CL-A group (81.0% vs 74.7% and 19% vs 25.3%, P

An effective and standardized method for applying a tilt table as a supplementary treatment in the early rehabilitation of stroke patients is still missing. The aim of this study was to determine the influence of progressive task-oriented training on the tilt table on the improvement in lower extremity (LE) muscle activation and clinical function in subjects with hemiplegia due to stroke. Thirty-nine subjects with acute stroke were randomly allocated to three groups; control group, tilt table group, and task-oriented training group on the tilt table, with 13 patients, respectively. All of the subjects received the routine therapy for half an hour, and subjects in the experimental groups additionally received training on two different tilt table applications for 20min a day, five times a week for three weeks. The effect of tilt table applications was assessed using the surface electromyography (EMG) analysis during stepping-like movements on the tilt table for LE muscle activation and clinical scores for function. Our results showed that there was a significantly greater increase in the EMG patterns of the extensors and flexors of the affected leg muscles during flexion and extension movements of both legs and clinical scores in patients undergoing the progressive task-oriented training on the tilt table compared to the other groups. These findings suggest that progressive task-oriented training on the tilt table can improve LE muscle activation and clinical scores of functional performance for early rehabilitation of subjects with acute stroke.

Little is known about pathways underlying inpatient hospital (re)admissions in older adults unable to meet basic needs. This study examined the factors associated with (re)admissions in a sample of low-income older Medicare beneficiaries in need of food assistance in Georgia in 2008 (N = 892, mean age 75.4 ± 8.8 years, 30.3% Black, 68.5% female). About 35.3% of the sample experienced 1 + hospital (re)admissions. (Re)admissions were significantly more likely in individuals who requested Older Americans Act Nutrition Program Home Delivered Meals services (OR 2.3; 95% CI 1.4, 3.8), had more outpatient emergency room visits (1 visit: OR 2.1; 95% CI 1.4, 3.1; 2+ visits: OR 3.6; 95% CI 2.4, 5.4), and experienced greater multimorbidity (OR 1.6; 95% CI 1.4, 3.1). Support for home and community-based services may be critical in reducing potentially avoidable inpatient hospital (re)admissions.

This descriptive study examined characteristics of older Georgians receiving Older Americans Act Nutrition Program Services and other home- and community-based services (HCBS) using state aging administrative data (N = 31,341, mean age: 76.6 ± 9.2 y, 71.2% female, 52.3% White). Home-delivered meals (HDM) was used most frequently. The characteristics of older Georgian HCBS participants varied by the type and number of HCBS received. Those receiving HDM and other in-home and caregiving services were more likely to show poorer sociodemographic, economic, and functional characteristics, and food insecurity. Those receiving multiple HCBS were most vulnerable, but showed lower level of food insecurity than those receiving single HCBS, suggesting potential combined benefits of receiving multiple programs. This study underscores the importance of documenting dynamic needs for HCBS, especially HDM, among vulnerable older adults as part of standard administrative process to identify those at high risk of institutionalization, optimize HCBS delivery and coordination, and maximize HCBS benefits.

Purpose: No study has examined the effects of the combination of respiratory muscle training (RMT) and abdominal drawing-in maneuver (ADIM) on respiratory muscle activity and function in stroke patients during early pulmonary rehabilitation. The purpose of this study was to investigate the effects of RMT combined with ADIM on decreased respiratory muscle activity and function in patients with post-stroke hemiplegia. Methods: Thirty-seven subjects with post-stroke hemiplegia were randomly allocated to three groups; integrated training group (ITG), respiratory muscle training group (RMTG), and control group (CG). All of the subjects received routine therapy for stroke rehabilitation for 1 hour, five times a week for 6 weeks. Especially, the ITG received RMT using an incentive respiratory spirometer and ADIM using a Stabilizer, and the RMTG only received RMT using incentive respiratory spirometer for 15 minutes a day, five times a week for 6 weeks. Pulmonary function was evaluated using spirometry for measuring the forced vital capacity (FVC) and force expiratory volume in 1 second (FEV1). Additional surface electromyography (sEMG) analysis was included by measuring the respiratory muscle activity. Results: Our results showed that changes between the pre- and post-test values of FVC (F512?50, P50?02) and FEV1 (F512?81, P50?01) (Pv0?05) in the ITG were significantly (Pv0?05) greater. Changes in EMG activation of the diaphragm (F513?75, P50?003) and external intercostal (F514?33, P50?002) (Pv0?01) muscles of patients in the ITG during maximal static inspiratory efforts were significantly (Pv0?05) greater than those in patients of the RMTG and the CG at post-test. Conclusions: Our findings suggested that RMT combined with ADIM could improve pulmonary function in patients with post-stroke hemiplegia.

Mortalin/mtHsp70 is a member of Hsp70 family of proteins. Enriched in a large variety of cancers, it has been shown to contribute to the process of carcinogenesis by multiple ways including inactivation of tumor suppressor p53 protein, deregulation of apoptosis and activation of EMT signaling. In this study, we report that upregulation of mortalin contributes to cancer cell stemness. Several cancer cell stemness markers, such as ABCG2, OCT-4, CD133, ALDH1, CD9, MRP1 and connexin were upregulated in mortalin-overexpressing cells that showed higher ability to form spheroids. These cells also showed higher migration, and were less responsive to a variety of cancer chemotherapeutic drugs. Of note, knockdown of mortalin by specific shRNA sensitized these cells to all the drugs used in this study. We report that low doses of anti-mortalin molecules, MKT-077 and CAPE, also caused similar sensitization of cancer cells to chemotherapeutic drugs and hence are potential candidates for effective cancer chemotherapy.

The relationship between reproductive breast risk factors and breast cancer survival in patients with different breast cancer subtypes is not well known.We examined a large-sized, retrospective study of 23,882 subjects from the Korean Breast Cancer Registry. The breast cancer subtype was determined by immunohistochemical staining for estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2). Information regarding reproductive factors, including breastfeeding, age at first birth (AFB), and parity, was gathered. Multivariate Cox regression analysis was used to estimate the association among breast cancer subtypes, such as luminal A, luminal B, Her-2/neu overexpressing, and triple negative breast cancer (TNBC), and breast cancer survival as dependent variables and adjusting for age and stage.High parity (≥ 5) increased the recurrence risk of luminal A and B breast cancer (hazard ratio [HR], 1.95; 95% confidence interval [CI], 0.96-3.97; P = .0055 and HR, 1.12; 95% CI, 0.42-3.02, respectively; P = .0073) in breast cancer-specific survival (BCSS), but 1 to 3 child births decreased the recurrence risk of luminal A breast cancer (HR, 0.56; 95% CI, 0.34-0.91; P = .0055) and luminal B breast cancer (HR, 0.32; 95% CI, 0.17-0.61; P = .0073) in BCSS. Early AFB (20 years) increased the recurrence risk of luminal A breast cancers (HR, 1.61; 95% CI, 0.62-4.26; P = .039) in BCSS and of TNBC (HR, 1.31; 95% CI, 0.78-2.21; P = .0006) in overall survival. Her-2/neu overexpressing breast cancer had no correlation with parity and AFB in breast cancer survival.High parity (≥ 5) and early AFB (20 years) were correlated with worse clinical outcomes in patients with luminal breast cancer, but not with other subtyped breast cancers.