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Hearing loss is an important global public health issue which can be alleviated through treatment with hearing aids. However, most people who would benefit from hearing aids do not receive them, in part due to challenges in accessing hearing aids and related services, which are most salient in low- and middle-income countries (LMIC) and other resource-limited settings. Innovative approaches for hearing aid service delivery can overcome many of the challenges related to access, including that of limited human resources trained to provide ear and hearing care. The purpose of this systematic scoping review is to synthesize evidence on service delivery approaches for hearing aid provision in LMIC and resource-limited settings. We searched 3 databases (PubMed, Scopus, Ovid MEDLINE) for peer-reviewed articles from 2000 to 2022 that focused on service delivery approaches related to hearing aids in LMIC or resource-limited settings. Fifteen peer-reviewed articles were included, which described hospital-based (3 studies), large-scale donation program (1 studies), community-based (7 studies), and remote (telehealth; 4 studies) service delivery approaches. Key findings are that hearing aid services can be successfully delivered in hospital- and community-based settings, and remotely, and that both qualified hearing care providers and trained non-specialists can provide quality hearing aid services. Service delivery approaches focused on community-based and remote care, and task sharing among qualified hearing care providers and trained non-specialists can likely improve access to hearing aids worldwide, thereby reducing the burden of untreated hearing loss.

Recurrent urogenital infections such as bacterial vaginosis, vulvovaginal candidiasis, and urinary tract infections have a high prevalence and pronounced psychosocial impact. However, no review has compared the psychosocial impacts across infection types. This narrative review discusses the impact of common recurrent urogenital infections on psychosocial aspects, including quality of life, stress, mental health, sexual health, work productivity, race and ethnicity, and satisfaction of medical care. Validated questionnaires show that women with recurrent vulvovaginal candidiasis and urinary tract infections have decreased scores on all aspects of quality of life. Those with recurrent vulvovaginal candidiasis and urinary tract infections show lower mental health scores compared to the general population, with increased risk of anxiety and depression. Recurrent urogenital infections affect sexual relationships and intimacy, including avoidance due to symptoms or as a method of prevention. Recurrent infections also increase medical cost and negatively affect work productivity, leading to a combined estimated cost of over US$13 billion per year. There are clear effects of racial inequality involving minority populations that affect diagnosis, treatment, prevalence, and reporting of recurrent urogenital infections. Satisfactory medical treatment improves quality of life and mental health in those suffering from these conditions. Research evaluating psychosocial aspects of recurrent urogenital infections is variable and is not comparable across vulvovaginal conditions. Even so, psychosocial factors are important in understanding contribution and consequence of urogenital infections. Education, awareness, normalization, community support, and access to care can help to alleviate the negative implications of recurrent urogenital infections.

Background: Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose: Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children. Methods: Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons. Results: Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education. Conclusion: Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.

Abstract Golden-Syrian hamsters have been used as an animal model to assess diet-induced atherosclerosis since the early 1980s. Advantages appeared to include a low rate of endogenous cholesterol synthesis, receptor-mediated uptake of LDL cholesterol, cholesteryl ester transfer protein activity, hepatic apoB-100 and intestinal apoB-48 secretion, and uptake of the majority of LDL cholesterol via the LDL receptor pathway. Early work suggested hamsters fed high cholesterol and saturated fat diets responded similarly to humans in terms of lipoprotein metabolism and aortic lesion morphology. Recent work has not consistently replicated these findings. Reviewed was the literature related to controlled hamster feeding studies that assessed the effect of strain, background diet (non-purified, semi-purified) and dietary perturbation (cholesterol and/or fat) on plasma lipoprotein profiles and atherosclerotic lesion formation. F1B hamsters fed a non-purified cholesterol/fat-supplemented diet had more atherogenic lipoprotein profiles (nHDL-C > HDL-C) than other hamster strains or hamsters fed cholesterol/fat-supplemented semi-purified diets. However, fat type; saturated (SFA), monounsaturated or n-6 polyunsaturated (PUFA) had less of an effect on plasma lipoprotein concentrations. Cholesterol- and fish oil-supplemented semi-purified diets yielded highly variable results when compared to SFA or n-6 PUFA, which were antithetical to responses observed in humans. Dietary cholesterol and fat resulted in inconsistent effects on aortic lipid accumulation. No hamster strain was reported to consistently develop lesions regardless of background diet, dietary cholesterol or dietary fat type amount. In conclusion, at this time the Golden-Syrian hamster does not appear to be a useful model to determine the mechanism(s) of diet-induced development of atherosclerotic lesions.

Kumar and colleagues report cryo-EM structures of Arabidopsis O-fucosyltransferase SPINDLY in its apo and GDP-fucose bound states, revealing distinct active-site features enabling GDP-fucose recognition and surprisingly dynamic conformations that regulate its enzymatic activity.

This study seeks to expand the conceptualization of campus safety incorporating both physical and psychological dimensions and drawing attention to the experiences of Black college students. Using the 2019 ACHA-NCHA biannual assessment, this study examined campus safety experiences of Black/African American in comparison to White undergraduate students (N = 27,820) and how these relate to psychological distress and suicide attempts. Results demonstrate that Black students felt significantly less safe and reported experiencing physical assault and sexual penetration without consent (rape) compared to White students. Significantly more Black students reported feeling angry, hopeless, and attempted suicide. Moderation analyses showed ways in which being stalked and verbally threatened strengthened the relationship between feelings of safety and psychological distress. Implications for university policies and initiatives are discussed.

Media campaigns can reduce or promote the consumption of sugar-sweetened beverages (SSBs). Brief, US-based English-language online messages were gathered from searchable media platforms, a process that yielded 112 anti-SSB videos and 29 pro-SSB commercials. Using a combination of inductive and deductive methods, a content analysis of those messages was conducted to identify their properties. They were coded for the direction (pro vs. anti), target of the advocacy (e.g., consumption vs. policy), actor demographics (gender, age, and ethnicity), persuasive theme (e.g., excessive sugar, nurturing), and message sensation value. Anti-SSB appeals primarily targeted individual-level consumption behavior. They utilized six persuasive themes and often included more than one theme in a single message. Pro-SSB messages used feel-good themes and utilized only one theme per message. The proportions of adults, adolescents, and children differed by the direction of the advocacy. Black, Hispanic, and Asian actors were under-represented in the anti-SSB sample relative to Whites. Pro-SSB appeals were slightly higher than anti-SSB appeals in message sensation value (p = 0.09). The findings illuminate the message features that characterize the universe of brief anti-SSB appeals available online, highlight messaging disparities, and reveal the absence of certain common, effective persuasive themes.

Professionalized nursing and anarchism could not be more at odds. And yet, if nursing wishes to have a future in the precarious times in which we live and die, the discipline must take on the lessons that anarchism has on offer. Part love note to a problematic profession we love and hate, part fever dream of what could be, we set out to think about what nursing and care might look like after it all falls down, because it is all falling down. Drawing on alternate histories, alternate visions of nursing history, we imagine what nursing values would look like, embracing anarchist principles. We consider examples of community survival, mutual aid, and militant joy as strategies to achieve what nursing could be if nurses put an end to their cop shit, shrugging off their shroud of white cisheteropatriarchal femininity that manifests as professionalism and civility. We conclude with a call to action and a plan for skill-building because this can all be different.

ABSTRACT The bacterial cell envelope is a key subcellular compartment with important roles in antibiotic resistance, nutrient acquisition, and cell morphology. We seek to gain a better understanding of proteins that contribute to the function of the cell envelope in Alphaproteobacteria. Using Rhodobacter sphaeroides, we show that a previously uncharacterized protein, RSP_1200, is an outer membrane (OM) lipoprotein that non-covalently binds peptidoglycan (PG). Using a fluorescently tagged version of this protein, we find that RSP_1200 undergoes a dynamic repositioning during the cell cycle and is enriched at the septum during cell division. We show that the position of RSP_1200 mirrors the location of FtsZ rings, leading us to propose that RSP_1200 is a newly identified component of the R. sphaeroides’ divisome. Additional support for this hypothesis includes the co-precipitation of RSP_1200 with FtsZ, the Pal protein, and several predicted PG L,D-transpeptidases. We also find that a ∆RSP_1200 mutation leads to defects in cell division, sensitivity to PG-active antibiotics, and results in the formation of OM protrusions at the septum during cell division. Based on these results, we propose to name RSP_1200 DalA (for division-associated lipoprotein A) and postulate that DalA serves as a scaffold to position or modulate the activity of PG transpeptidases that are needed to form envelope invaginations during cell division. We find that DalA homologs are present in members of the Rhodobacterales order within Alphaproteobacteria. Therefore, we propose that further analysis of this and related proteins will increase our understanding of the macromolecular machinery and proteins that participate in cell division in Gram-negative bacteria. IMPORTANCE Multi-protein complexes of the bacterial cell envelope orchestrate key processes like growth, division, biofilm formation, antimicrobial resistance, and production of valuable compounds. The subunits of these protein complexes are well studied in some bacteria, and differences in their composition and function are linked to variations in cell envelope composition, shape, and proliferation. However, some envelope protein complex subunits have no known homologs across the bacterial phylogeny. We find that Rhodobacter sphaeroides RSP_1200 is a newly identified lipoprotein (DalA) and that loss of this protein causes defects in cell division and changes the sensitivity to compounds, affecting cell envelope synthesis and function. We find that DalA forms a complex with proteins needed for cell division, binds the cell envelope polymer peptidoglycan, and colocalizes with enzymes involved in the assembly of this macromolecule. The analysis of DalA provides new information on the cell division machinery in this and possibly other Alphaproteobacteria.

Little is known about the role of epithelial membrane protein-2 (EMP2) in breast cancer development or progression. In this study, we tested the hypothesis that EMP2 may regulate the formation or self-renewal of breast cancer stem cells (BCSC) in the tumor microenvironment. In silico analysis of gene expression data demonstrated a correlation of EMP2 expression with known metastasis-related genes and markers of cancer stem cells (CSC) including aldehyde dehydrogenase (ALDH). In breast cancer cell lines, EMP2 overexpression increased and EMP2 knockdown decreased the proportion of stem-like cells as assessed by the expression of the CSC markers CD44+/CD24-, ALDH activity, or by tumor sphere formation. In vivo, upregulation of EMP2 promoted tumor growth, whereas knockdown reduced the ALDHhigh CSC population as well as retarded tumor growth. Mechanistically, EMP2 functionally regulated the response to hypoxia through the upregulation of HIF-1α, a transcription factor previously shown to regulate the self-renewal of ALDHhigh CSCs. Furthermore, in syngeneic mouse models and primary human tumor xenografts, mAbs directed against EMP2 effectively targeted CSCs, reducing the ALDH+ population and blocking their tumor-initiating capacity when implanted into secondary untreated mice. Collectively, our results show that EMP2 increases the proportion of tumor-initiating cells, providing a rationale for the continued development of EMP2-targeting agents.

Background: The ideal extracorporeal membrane oxygenation (ECMO) modality choice (venoarterial [VA] versus venovenous [VV]) for a primary respiratory reason is complex and multifactorial. There is an increasing need to identify the ideal (VV vs. VA) support modality in this population. The objective of this study was to compare survival outcomes of subjects with respiratory failure who could have received VV or VA ECMO. Subjects and Methods: Children ≤20 kg requiring ECMO for respiratory indications from January 2015 to December 2019 were identified retrospectively from the Extracorporeal Life Support Organization registry. To identify a cohort eligible for VV, we excluded subjects receiving cardiac support therapies and included only those receiving mechanical ventilation with a positive end expiratory pressure ≥10 or high frequency oscillatory ventilation or had a PaO2/FiO2 ratio ≤200 or an oxygenation index ≥16. Subjects were grouped by initial cannulation strategy. Statistical approach utilized doubly robust propensity weighted logistic regression and primary outcome was survival to hospital discharge. Results: Of 1686 VV candidates, 871 underwent VV and 815 VA ECMO for a respiratory indication. VV ECMO was associated with higher survival (odds ratio: 1.57; confidence interval: 1.22–2.03, P < 0.001). Conclusions: VV ECMO selection for subjects with respiratory failure was associated with lower mortality in small pediatric and neonatal patients.

Abstract Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. A clear gap in our existing CD diagnostics and current disease management approaches is the lack of highly specific biomarkers that can be used to streamline or personalize disease management. Comprehensive profiling of metabolites holds promise; however, these high-dimensional profiles need to be reduced to have relevance in the context of CD. Machine learning approaches are optimally suited to bridge this gap in knowledge by contextualizing the metabolic alterations in CD using genome-scale metabolic network reconstructions. Our work presents a framework for studying altered metabolic reactions between patients with CD and controls using publicly available transcriptomic data and existing gene-driven metabolic network reconstructions. Additionally, we apply the same methods to patient-derived ileal enteroids to explore the utility of using this experimental in vitro platform for studying CD. Furthermore, we have piloted an untargeted metabolomics approach as a proof-of-concept validation strategy in human ileal mucosal tissue. These findings suggest that in silico metabolic modeling can potentially identify pathways of clinical relevance in CD, paving the way for the future discovery of novel diagnostic biomarkers and therapeutic targets.

Background: The purpose of this study is to determine whether underserved middle-aged and older African Americans are receiving a colorectal cancer (CRC) screening test (sigmoidoscopy or colonoscopy) and if recommended by their provider. Additionally, we examined correlates of both provider recommendation and uptake of CRC screening. Methods: Seven hundred forty African American individuals, aged 55 and older, participated in this local community cross-sectional survey. We used a multivariate technique of logistic regression. Results: One out of three participants reported that they never received a sigmoidoscopy or colonoscopy for CRC screening. More than 31% indicted that their providers never suggested CRC testing. However, participants who indicated that their providers recommended sigmoidoscopy/colonoscopy were almost 49 times (odds ratio [OR]: 48.9, 95% confidence interval [CI]: 29.5–81.2) more likely to obtain it compared to their counterparts who were not advised to have these procedures. Our data suggest that African American men were significantly less likely than women to receive recommendations from their providers (OR: 0.70, 95% CI: 0.50-0.91). Furthermore, controlling for other variables, the following factors: 1) living arrangement (OR: 1.44, 95% CI: 1.02–2.04), 2) health maintenance organization (HMO) membership (OR: 1.84, 95% CI: 1.28–2.67), 3) number of providers (OR: 1.15, 95% CI: 1.01–1.32), 4) satisfaction with access to and quality of care (OR: 1.24, 95% CI: 1.03–1.51), 5) depressive symptoms (OR: 0.92, 95% CI: 0.86–0.98), and 6) gastrointestinal conditions (OR: 1.73, 95% CI: 1.16–2.58) were associated with obtaining a sigmoidoscopy or colonoscopy test. Conclusion: Our findings suggest that the absence of a provider recommendation is the primary barrier preventing underserved older African Americans from obtaining CRC screening. In addition, our data revealed significant association between obtaining CRC screening and some of the predisposing characteristics of participants, satisfaction with access to and quality of care, and physical and mental health. These findings are consistent with this notion that disparities in health care for African Americans can be traced back to four primary factors: patients, healthcare providers, the healthcare system, and society as a whole, and emphasize the need for establishing theory-driven, culturally-sensitive, and cost-effective CRC screening interventions that recognize and address the constraints to cancer screening experienced by this segment of population.

I am so very sorry to note the untimely death of our Contributing Editor, Casey Clabough. I first met Casey when I heard him read a scholarly paper at the [...]

Purpose: The aim of this study was to determine the long-term associations of musical training with speech perception in adverse conditions and cognition in a longitudinal cohort study of middle-age to older adults. Method: This study is based on Epidemiology of Hearing Loss Study participants. We asked participants at baseline (1993-1995) about their musical training. Speech perception (word recognition in competing message; Northwestern University Auditory Test Number 6), cognitive function (cognitive test battery), and impairment (self-report or surrogate report of Alzheimer's disease or dementia, and/or a Mini-Mental State Examination score [less than or equal to] 24) were assessed up to 5 times over the 20-year follow-up. We included 2,938 Epidemiology of Hearing Loss Study participants who had musical training data and at least one follow-up of speech perception and/or cognitive assessment. We used linear mixed-effects models to determine associations between musicianship and decline in speech perception and cognitive function over time and Cox regression models to evaluate associations of musical training with 20-year cumulative incidence of speech perception and cognitive impairment. Models were adjusted for age, sex, and occupation and repeated with additional adjustment for health-related confounders and education. Results: Musicians showed less speech perception decline over time with stronger effects in women (0.16% difference, 95% confidence interval [CI] [0.05, 0.26]). Among men, musicians had, on average, better speech perception than nonmusicians (3.41% difference, 95% CI [0.62, 6.20]) and were less likely to develop a cognitive impairment than nonmusicians (hazard ratio = 0.58, 95% CI [0.37, 0.91]). Conclusions: Musicians showed an advantage in speech perception abilities and cognition later in life and less decline over time with different magnitudes of effect sizes in men and women. Associations remained with further adjustment, indicating that some degree of the advantage of musical training is independent of socioeconomic or health differences. If confirmed, these findings could have implications for developing speech perception intervention and prevention strategies.