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This qualitative study aims to understand how community garden (CG) participants experience the effects of participation on fruit and vegetable (FV) consumption and health behaviors. Semi-structured interviews and focus groups were conducted with a total of 61 CG managers and participants in the fall of 2017, in CGs located in rural low-wealth communities. Five themes were identified: Community gardens influence FV access and consumption, nutritional and agricultural knowledge improve through CG participation, CGs may serve as a kickstart to other improvements to health and wellbeing, CGs have positive impacts on participants’ mental health, and successful gardens contribute to community cohesion.

OBJECTIVES This study is aimed to evaluate the management of acute kidney injury (AKI) in our inner city, American hospital. We intended to ascertain whether or not there is prompt recognition of AKI in cirrhosis according to International Club of Ascites and acute kidney injury network criteria as well how effective we are at distinguishing among different causes of AKI. We aimed to calculated the mortality of hepatorenal syndrome (HRS) in our hospital, and to evaluate the adequacy of the established treatment of AKI at each stage of its algorithm. PATIENTS AND METHODS ICD diagnostic codes were used to identify patients with liver cirrhosis and acute renal failure. A total of 725 patients met the search criteria. We excluded the patients without clinical or imaging evidence of ascites, heart failure, on hemodialysis, baseline creatinine more than 1.5 mg/dl and patients who died within 48 h of developing acute renal failure. 291 patients met the inclusion criteria. All statistical analyses were performed using SPSS version 23.0 software with a two-sided significance level set at P value less than 0.05. RESULTS Mean age was 55.7 ± 0.61 and baseline serum creatinine was 0.94 ± 0.14. 66.5% of patients were African American, 27.3%, Hispanic, and 4.3% White. The average rise in creatinine from baseline was 1.36 ± 0.08 mg/dl. 27.2% of patients met the diagnostic criteria of HRS. 92.3% of patients with HRS received intravenous fluids and 75.4% received intravenous albumin within 48 h of acute creatinine rise. The in-hospital mortality rate was 14.1, 23.3, and 41.5% for patients with pre-renal azotemia, ARF, and HRS, respectively (P < 0.01). CONCLUSION This study demonstrates that with present tools, there is significantly higher mortality in HRS despite guideline-based treatment. Biomarkers for early diagnosis of HRS are necessary to avoid delays in initiation of HRS treatment while establishing the diagnosis. As well, worldwide standardization of the treatment of HRS will be important if the outcome is to be improved.

Introduction: Gypsies, Travellers and Roma (referred to here as Travellers) experience significantly poorer health and have shorter life expectancy than the general population. They are also less likely to access health services including immunisation. To improve immunisation rates, we need to understand what helps and hinders individuals in these communities in taking up immunisations. This study has two aims: (1) Investigate the barriers and facilitators to acceptability and uptake of immunisations among six Traveller communities in the UK; (2) Identify potential interventions to increase uptake in these Traveller communities. \ud \ud \ud Methods and analysis: A three-phase qualitative study with six Traveller communities. PHASE 1: In each community, we will explore up to 45 Travellers’ views about the influences on their immunisation behaviours and ideas for improving uptake in their community. PHASE 2: In each community, we will investigate 6–8 service providers’ perspectives on barriers and facilitators to childhood and adult immunisations for Traveller communities with whom they work, and ideas to improve uptake. Interview data will be analysed using the Framework approach. PHASE 3: The findings will be discussed and interventions prioritised in six workshops, each with 10–12 phase 1 and 3–4 phase 2 participants. \ud \ud \ud Ethics and dissemination: This research received approval from NRES Committee Yorkshire and The Humber-Leeds East (Ref. 13/YH/02). It will produce (1) findings on the barriers and facilitators to uptake of immunisations in six Traveller communities; (2) a prioritised list of potentially feasible and acceptable interventions for increasing uptake in these communities; and (3) methodological development in undertaking research with diverse Traveller communities. The study has the potential to inform new ways of delivering services to ensure high immunisation uptake. Findings will be disseminated to participants, relevant UK organisations with responsibility for the implementation of immunisation policy and Traveller health/welfare; and submitted for publication in academic journals. \ud \ud \ud Trial registration number ISRCTN20019630

The Home Health Aide (HHA) industry is challenged with low wages, little possibility of career advancement, and high turnover rates. Jewish Home Lifecare, Home Assistance Personnel Inc. (HAPI) is a home care aide agency that has developed a Peer Mentor HHA program. Peer Mentor HHAs mentor newly hired/trained HHAs within our agency. This career path leads to higher paying work that allows for growth of our workforce for the identified growing care need and positively impacts HHA retention.

Peripherin-2, the product of the rds gene, is a tetraspanin protein. In this study, we show that peripherin-2 forms a complex with melanoregulin (MREG), the product of the Mreg locus. Genetic studies suggest that MREG is involved in organelle biogenesis. In this study, we explore the role of this protein in processes associated with the formation of disk membranes, specialized organelles of photoreceptor rod cells. MREG antibodies were generated and found to be immunoreactive with a 28 kDa protein in retinal extracts, bovine OS, ARPE-19 cells, and rat RPE. MREG colocalized with peripherin-2 in WT (CB6F1/J) and in rds+/− retinas. Western blots of serial tangential sections confirmed the close association of these two proteins within the IS and basal outer segment of rods. Immunoprecipitation (IP) of OS extracts showed formation of a complex between MREG and peripherin-2–ROM-1 hetero-oligomers. This interaction was confirmed with pulldown analyses in which the GST–PerCter protein selectively pulled down His–MREG and His–MREG selectively pulled down PerCter. Biacore analysis using peptide inhibitors and per-2 truncation mutant studies allowed us to map the MREG binding site on per-2 to the last five residues of the C-terminus (Gln341–Gly346), and kinetic data predicted a KD of 80 nM for PerCter–MREG binding. Finally, the effect of MREG on photoreceptor specific membrane fusion was assayed using a disk–plasma membrane cell free assay. Preincubation of target membranes with MREG resulted in a dose-dependent inhibition of fusion with an IC50 in the submicromolar range. Collectively, these results suggest that this newly identified protein regulates peripherin-2 function.

Falls are the leading cause of injury, death, and disability among people older than 65. When elders fall, they sustain such injuries as hip, spine, hand, and/or pelvic fractures. The prognosis after such a fall is poor--only half of older adults hospitalized for hip fractures are able to return home or live independently again. Even without injury, falls cause a loss of confidence that results in reduced physical activity, increased dependency, and social withdrawal. As a home care agency dealing with a geriatric population, our goal was to develop a user-friendly fall prevention program that would promote multidisciplinary assessment and intervention. We have developed a preventive approach through which clinicians and patients can collaborate on preventing falls in the home and maintaining our patients' first priority: quality of life.

11045 Background: Most breast cancers that occur in BRCA1 mutation carriers tend to lack ER, progesterone receptors and Her2/neu. Foulkes et al.(Clin Can Res 2004; 10: 2029) reported an increase in BRCA1-associated ER+ tumors with increasing age. Little is known about the clinical factors that predict for ER status in this population. Understanding these factors and whether ER+ cancers are sporadic may have important implications for chemoprevention and treatment strategies. Methods: BRCA1mutation carriers who developed an invasive breast cancer from 1973–2008 were identified through the Cancer Risk and Prevention programs at 4 Boston-area hospitals. Clinical characteristics were abstracted from medical and research records. ER status was obtained from pathology reports, and ER staining was repeated when data was missing or when ER was listed as “weak”. Logistic regression was used to model ER positivity for the first invasive breast cancer. Potential predictors included menopausal status, age at cancer diagnosis, prior use of hormone replacement therapy, Ashkenazi-Jewish descent, age at first live birth, tobacco use, and alcohol use. Results: 170 BRCA1 mutation carriers were identified; 56 with ER+ and 114 with ER- first invasive cancers. Menopausal status was found to be a significant predictor of ER status; 18/56 (32%) with ER+ breast cancer were postmenopausal vs.14/114 (12%) with ER- cancer (odds ratio = 0.30, p = 0.002). Age >= 50 was significant in univariate analysis, 14/ 56 (25%) ER+ vs. 11/ 114 (10%) ER- cancers (p=0.01), but not in multiple regression. Conclusions: While most breast cancers in BRCA1 carriers are ER-, we found postmenopausal BRCA1carriers significantly more likely to develop an ER+ tumor than premenopausal carriers. As mutation carriers are likely to become surgically menopausal before age 50, and menopause and age are correlated, additional data will be needed to sort out the relative contribution of each factor to ER status. An understanding of this issue could have important implications for chemoprevention strategies. Molecular analysis of the ER+ breast cancers in our BRCA1+ cohort is underway to investigate whether ER+ breast cancers are manifestations of the BRCA1 mutation or sporadic. No significant financial relationships to disclose.

The authors conducted two multicenter, randomized, double-blinded, controlled Phase III clinical trials to study the efficacy and safety of phentolamine mesylate (PM) in shortening the duration and burden of soft-tissue anesthesia. The study involved 484 subjects who received one of four commercially available local anesthetic solutions containing vasoconstrictors for restorative or scaling procedures.On completion of the dental procedure, subjects randomly received a PM or a sham injection (an injection in which a needle does not penetrate the soft tissue) in the same site as the local anesthetic injection. The investigators measured the duration of soft-tissue anesthesia by using standardized lip- and tongue-tapping procedures every five minutes for five hours. They also evaluated functional measures and subject-perceived altered function, sensation, appearance and safety.Median recovery times in the lower lip and tongue for subjects in the PM group were 70 minutes and 60 minutes, respectively. Median recovery times in the lower lip and tongue for subjects in the sham group were 155 minutes and 125 minutes, respectively. Upper lip median recovery times were 50 minutes for subjects in the PM group and 133 minutes for subjects in the sham group. These differences were significant (P.0001). Recovery from actual functional deficits and subject-perceived altered function, sensation and appearance also showed significant differences between the PM and the sham groups.PM was efficacious and safe in reducing the duration of local anesthetic- induced soft-tissue numbness and its associated functional deficits.Clinicians can use PM to accelerate reversal of soft-tissue anesthesia and the associated functional deficits.

Introduction Most breast cancers that occur in women with germline BRCA1 mutations are estrogen receptor-negative (ER-) and also typically lack expression of progesterone receptor (PR) and HER2 overexpression. We undertook a study to assess the clinical factors that predict for an estrogen receptor positive (ER+) breast cancer in BRCA1 mutation carriers and to characterize the pathologic features of these tumors. Methods Clinical characteristics of BRCA1 carriers with 58 ER+ and 114 ER- first invasive breast cancers were compared. Pathologic features of BRCA1 ER+ cancers were compared to those of BRCA1 ER- cancers and to age-matched ER+ sporadic cancers. Results BRCA1 carriers aged ≥ 50 at diagnosis of first invasive breast cancer were more likely to have an ER+ cancer compared to those aged < 50 (57% vs 29%, P = 0.005). ER+ BRCA1 cancers were less likely than ER- BRCA1 cancers to have "BRCA-associated" features such as high mitotic activity, geographic necrosis/fibrotic focus, and pushing margins (RR 0.06, 0.22, 0.24; P < 0.001, 0.02, 0.03 respectively). When compared to sporadic ER+ cancers, ER+ BRCA1 cancers were more often of invasive ductal type (RR 2.4, P = 0.03), with a high mitotic rate (RR 5.0, P = 0.006) and absent or mild lymphocytic infiltrate (RR 10.2, P = 0.04). Conclusions BRCA1 carriers who are older at first breast cancer diagnosis are more likely to have ER+ tumors than younger BRCA1 carriers. These ER+ cancers appear pathologically "intermediate" between ER- BRCA1 cancers and ER+ sporadic breast cancers raising the possibility that either some ER+ BRCA1 cancers are incidental or that there is a unique mechanism by which these cancers develop.