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Introduction: Guidelines recommend individualized breast cancer screening and prevention interventions for women in their 40s. Yet, few primary care clinicians assess breast cancer risk.Study Design: Pretest-Posttest trial.Setting/participants: Women aged 40-49 years were recruited from one large Boston-based academic primary care practice between July 2017 and April 2019.Intervention: Participants completed a pretest, received a personalized breast cancer risk report, saw their primary care clinician, and completed a posttest.Main Outcome Measures: Using mixed effects models, changes in screening intentions (0-100 scale [0=will not screen to 100=will screen]), mammography knowledge, decisional conflict, and receipt of screening were examined. Analyses were conducted from June 2019 to February 2020.Results: Patient (n=337) mean age was 44.1 (SD=2.9) years, 61.4% were non-Hispanic white, and 76.6% were college graduates; 306 (90.5%) completed follow-up (203 with 5-year breast cancer risk <1.1%). Screening intentions declined from pre- to post-visit (79.3 to 68.0, p<0.0001), especially for women with 5-year risk <1.1% (77.2 to 63.3, p<0.0001), but still favored screening. In the 2 years prior, 37.6% had screening mammography compared with 41.8% over a mean 16 months follow-up (p=0.17). Mammography knowledge increased and decisional conflict declined. Eleven (3.3%) women met criteria for breast cancer prevention medications (ten discussed medications with their clinicians), 22 (6.5%) for MRI (19 discussed MRI with their clinician), and 67 (19.8%) for genetic counseling (47 discussed with the clinician).Conclusions: Receipt of a personalized breast cancer report was associated with women in their 40s making more-informed and less-conflicted mammography screening decisions and with high-risk women discussing breast cancer prevention interventions with clinicians.Trial Registration: This study is registered at www.clinicaltrials.govNCT03180086. [ABSTRACT FROM AUTHOR]

The article provides information on training medical students on electronic patient communication, which provides a novel educational opportunity to develop important written communication and patient care skills. Topics discussed include how the training was conducted, lessons learned from the program, and the importance of further development of training programs designed to meet the needs of telemedicine.

Cell metabolism is an important platform for sustainable biofuel, chemical and pharmaceutical production but its complexity presents a major challenge for scientists and engineers. Although in silico strains have been designed in the past with predicted performances near the theoretical maximum, real-world performance is often sub-optimal. Here, we simulate how strain performance is impacted when subjected to many randomly varying perturbations, including discrepancies between gene expression and in vivo flux, osmotic stress, and substrate uptake perturbations due to concentration gradients in bioreactors. This computational study asks whether robust performance can be achieved by adopting robustness-enhancing mechanisms from naturally evolved organisms–in particular, redundancy. Our study shows that redundancy, typically perceived as a ubiquitous robustness-enhancing strategy in nature, can either improve or undermine robustness depending on the magnitude of the perturbations. We also show that the optimal number of redundant pathways used can be predicted for a given perturbation size. [ABSTRACT FROM AUTHOR]

Arctic precipitation is predicted to increase in the coming century, due to a combination of enhanced northward atmospheric moisture transport and local surface evaporation from ice-free seas. However, large model uncertainties, limited long-term observations, and high spatiotemporal variability limit our understanding of these mechanisms, emphasizing the need for paleoclimate records of precipitation changes. Here we use lipid biomarkers in lake sediments to reconstruct precipitation seasonality in northern Spitsbergen, Svalbard. We measured the hydrogen isotopic ratios (δ2H) of n -alkanoic acids (C 20 –C 30) from sedimentary leaf waxes in lake Austre Nevlingen, Spitsbergen. We interpret δ2H values of mid-chain (C 22) and long-chain (C 28) n -alkanoic acids to represent δ2H of lake and soil water, respectively. Austre Nevlingen lake water δ2H reflects amount-weighted mean annual precipitation δ2H. In contrast, soil water is mostly recharged by summer rainfall, and therefore reflects δ2H values of summer precipitation. Austre Nevlingen leaf wax δ2H values are 2H-depleted in the Early Holocene, suggesting high winter precipitation amounts. This coincides with high summer insolation, strong Atlantic water advection and reduced spring sea-ice cover in surrounding waters. Winter precipitation continued to dominate until c. 6 cal. kyr BP. After 6 cal. kyr BP, the trend in the biomarker record is not as clear. This could be related to colder conditions causing longer duration of seasonal lake-ice cover, thereby influencing the precipitation seasonality registered by the lake water. The Austre Nevlingen record suggests a close relationship between precipitation seasonality and regional ocean surface conditions, consistent with simulations suggesting that Arctic winter sea-ice loss will lead to increased local evaporation. • Terrestrial and aquatic δ2H at this site reflect different precipitation seasonality. • Reconstructions suggest most prominent Holocene precipitation changes occurred in winter. • Early Holocene warming reduced sea ice, enhanced evaporation and increased winter precipitation. • Supports models suggesting sea-ice loss causes increased Arctic winter precipitation. [ABSTRACT FROM AUTHOR]