Chinese American and Non-Hispanic White Breast Cancer Patients' Knowledge and Use of BRCA Testing

Breast cancer is the most commonly diagnosed cancer among Chinese American women. Knowing the BRCA1 and BRCA2 (BRCA1/2) gene mutation status can improve breast cancer patients' health outcomes by guiding targeted treatment towards preventing breast cancer recurrence and other BRCA-related cancers. Nevertheless, it is unclear if there is a disparity in knowledge and use of BRCA testing among Chinese American breast cancer patients. This cross-sectional study investigated the possible presence of differences in the knowledge and the use of BRCA testing between Chinese American and Non-Hispanic White (NHW) breast cancer patients. We surveyed 45 Chinese American and 48 NHW adult breast cancer patients who had been diagnosed with breast cancer within the previous two years through telephone interviews. The results showed that race was not statistically related to the use of BRCA testing. BRCA testing utilization was associated with family history (p < 0.05) and age (p < 0.05). However, Chinese American participants' understanding of BRCA testing was significantly lower than that of NHW participants (p = 0.030). Our findings suggest that a disparity exists in BRCA testing knowledge between Chinese American and NHW breast cancer patients. Genetic education and counseling are needed to improve BRCA testing knowledge and uptake among Chinese American breast cancer patients.

Exploring Racial Differences in Treatment Decision-making in Chinese Immigrant and White American Breast Cancer Patients: the Role of Patient-Provider Communication

Chinese immigrant cancer patients report suboptimal patient-provider communication, which increases the likelihood of decisional conflict and unsatisfactory treatment decision-making (TDM) outcomes (e.g., low satisfaction and perceived control over cancer care). This cross-sectional study explored whether (1) communication and decisional conflict factors associated with TDM outcomes differed between Chinese immigrant and non-Hispanic White breast cancer patients, and (2) the association between patient-provider communication and the outcomes were mediated by TDM factors, regardless of race. Ninety-eight breast cancer patients, diagnosed at stage I-III participated in cross-sectional survey interviews. TDM outcomes and possible predictors of the outcomes (e.g., patient-provider communication, decisional conflict, preference for who makes the treatment decision) were assessed. Linear regression and mediational testing were performed to examine associations among variables of interest. Of the 98, 85 were included for analysis. Chinese patients with limited English proficiency (n = 37) had poorer patient-provider communication, higher decisional conflict, and preferred providers to make decisions than non-Hispanic White patients (n = 48; all p < .05). They also had lower satisfaction with their TDM process after controlling for predictors (e.g., patient-provider communication) (p < .001). There were no significant racial differences in perceived control, controlling for covariates. Regardless of race, patients who reported quality patient-provider communication reported less decisional conflict. These patients also reported increased satisfaction and perceived control. The disparities Chinese immigrant cancer patients experienced in the TDM process may be related to their cultural communication style with providers. Facilitating Chinese patients' communication and partnership with providers may reduce decisional conflicts and increase their TDM outcomes.

Rapid quasi-periodic oscillations in the relativistic jet of BL Lacertae

Blazars are active galactic nuclei (AGN) with relativistic jets whose non-thermal radiation is extremely variable on various timescales^1-3. This variability seems mostly random, although some quasi-periodic oscillations (QPOs), implying systematic processes, have been reported in blazars and other AGN. QPOs with timescales of days or hours are especially rare⁴ in AGN and their nature is highly debated, explained by emitting plasma moving helically inside the jet⁵, plasma instabilities^6,7 or orbital motion in an accretion disc^7,8. Here we report results of intense optical and γ-ray flux monitoring of BL Lacertae (BL Lac) during a dramatic outburst in 2020 (ref. ⁹). BL Lac, the prototype of a subclass of blazars¹⁰, is powered by a 1.7 × 10⁸ M_Sun (ref. ¹¹) black hole in an elliptical galaxy (distance = 313 megaparsecs (ref. ¹²)). Our observations show QPOs of optical flux and linear polarization, and γ-ray flux, with cycles as short as approximately 13 h during the highest state of the outburst. The QPO properties match the expectations of current-driven kink instabilities⁶ near a recollimation shock about 5 parsecs (pc) from the black hole in the wake of an apparent superluminal feature moving down the jet. Such a kink is apparent in a microwave Very Long Baseline Array (VLBA) image.

Longitudinal Effects of an Intergenerational mHealth Program for Older Type 2 Diabetes Patients in Rural Taiwan

PURPOSE

The purpose of the study is to test the longitudinal efficacy of a mHealth intervention (Intergenerational Mobile Technology Opportunities Program, IMTOP) for older type 2 diabetes mellitus (T2DM) patients in rural Taiwan. Few mHealth programs targeted rural older adults and the longitudinal effects are unknown.

METHODS

Ninety-seven T2DM patients aged 55+ were recruited from an outpatient in Hualien, Taiwan. The intervention comprised 8-week technology and diabetes self-management training and 4-week technical support. College student tutors facilitated T2DM patients to learn technology. Participants used a diabetes self-management app to track health behaviors. Outcomes measured at baseline and at 4 and 8 months including patient-reported self-care behaviors, T2DM symptoms, clinical outcomes, health resource utilization, and medical expenditure. Linear mixed-effect regressions of repeated measures were conducted for each outcome.

RESULTS

At 4 months, improvements in self-care behaviors were reported in diet, exercise, smoking, and blood glucose testing. Patients paid less endocrinology clinic visits, spent less on endocrinology medications, and improvements in fasting blood glucose and total cholesterol were observed. At 8 months, the statistical significance of improvements in diet and smoking were maintained, and the averaged endocrinology clinic visits remained less than baseline. However, more frequent occurrence of diabetes symptoms were reported at both follow-ups.

CONCLUSIONS

IMTOP had lasting effects on diet and decreased smoking behavior, clinic visits, and medication costs over 8 months. Self-monitoring through an app increased awareness and may explain the increased reporting of diabetes symptoms. IMTOP is a promising model for promoting T2DM self-management in rural areas.

Incarceration history, social network composition, and substance use among homeless youth in Los Angeles

Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth's social network composition and substance use, however, has been neglected. Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California. Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth's sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth's incarceration history and substance use. Results: Incarceration history was positively associated with youth's cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth's cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth's heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth's methamphetamine, heroin, and injection drug use. Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.

Cultivation of auricular chondrocytes in poly(ethylene glycol)/poly(ε-caprolactone) hydrogel for tracheal cartilage tissue engineering in a rabbit model

Tissue engineering has the potential to overcome the limitations of tracheal reconstruction. To tissue-engineer a tracheal cartilage, auricular chondrocytes were encapsulated in a photocurable poly(ethylene glycol)/poly(ε-caprolactone) (PEG/PCL) hydrogel. Chondrogenic genes, including Sox9, Acan and Col2a1, were up-regulated in auricular chondrocytes after 2 weeks of in vitro cultivation in the PEG/PCL hydrogel. Co-cultivation of 70 % auricular chondrocytes and 30 % bone marrow mesenchymal stem cells (BMSCs) accelerated the chondrogenic genes' expression in the PEG/PCL hydrogel. Cartilaginous matrix markers, including proteoglycans and collagen type II, were detected in the chondrocytes-encapsulated PEG/PCL hydrogel after 4 weeks of in vitro cultivation. The higher expression level of cartilaginous matrix markers was observed in the PEG/PCL hydrogel with co-cultivation of 70 % chondrocytes and 30 % BMSCs. After 4 weeks of ectopic cultivation in rabbits, the cylindrical PEG/PCL structure was sustained with the use of a luminal silicon stent. However, without the stent, the construct collapsed under a compression force. No fibrosis or vessel ingrowth were found in the PEG/PCL hydrogel after 4 weeks of ectopic cultivation, whereas the auricular chondrocytes showed proteoglycans' accumulation and collagen type II production. Rabbit auricular chondrocytes could survive and retain chondrogenic ability in the PEG/PCL hydrogel under both in vitro and in vivo conditions. While the PEG/PCL hydrogel did not show sufficient mechanical properties for supporting the cylindrical shape of the construct, the high chondrogenesis level of chondrocytes in the PEG/PCL hydrogel displayed the potential of this material for tracheal tissue engineering.

Knowledge, Attitudes, and Clinical Practices for Patients With Dementia Among Mental Health Providers in China: City and Town Differences

Mental health providers are the major resource families rely on when experiencing the effects of dementia. However, mental health resources and manpower are inadequate and unevenly distributed between cities and towns in China. This study was conducted to examine similarities and differences in knowledge, attitudes, and clinical practices concerning dementia and working with family caregivers from mental health providers' perspectives in city versus town settings. Data were collected during focus group discussions with 40 mental health providers in the Xicheng (city) and Daxing (town) districts in Beijing, China in 2011. Regional disparities between providers' knowledge of early diagnosis of dementia and related counseling skills were identified. Regional similarities included training needs, dementia-related stigma, and low awareness of dementia among family caregivers. Culturally sensitive education specific to dementia for mental health providers and a specialized dementia care model for people with dementia and their family caregivers are urgently needed. Implications for geriatric practitioners and educators are discussed.

Does productive role occupancy prevent depression among older rural Chinese adults? A latent difference score analysis

OBJECTIVES

Depression has been reported as common among older rural Chinese adults, who often face limited access to healthcare services and resources. Empirical studies conducted in the West have shown beneficial effects of productive engagement on psychological well-being. However, the mechanisms by which engagement in productive activities leads to and results from improved mental health remain unclear.

METHOD

Utilizing role enhancement and social resource theories, the present study investigated the relationship between productive role occupancy and depression among older Chinese adults in rural areas over 8 years. Using four waves of data from the Well-Being of Elderly in Anhui Province of China study, we employed bivariate latent different score analysis to examine the temporal sequence of productive role occupancy and depression among 1696 older adults.

RESULTS

Findings indicated that trajectories of productive role occupancy and depression rose across the four waves. There is evidence for self-feedback effects in productive role occupancy and depression. Depression had a significant effect on subsequent changes in productive role occupancy (β = -0.042, p = 0.000), whereas productive role occupancy had no significant effect on subsequent changes in depression.

CONCLUSION

The mental well-being of participants worsened over time. Engaging in productive activities had no effect on mental health status, and rural older adults with poor mental health were less likely to engage in productive activities over time. Findings suggest that psychological well-being as a personal resource significantly affects how productively Chinese adults age in late life.

Health literacy issues in the care of Chinese American immigrants with diabetes: a qualitative study

OBJECTIVES

To investigate why first-generation Chinese immigrants with diabetes have difficulty obtaining, processing and understanding diabetes related information despite the existence of translated materials and translators.

DESIGN

This qualitative study employed purposive sampling. Six focus groups and two individual interviews were conducted. Each group discussion lasted approximately 90 min and was guided by semistructured and open-ended questions.

SETTING

Data were collected in two community health centres and one elderly retirement village in Los Angeles, California.

PARTICIPANTS

29 Chinese immigrants aged ≥45 years and diagnosed with type 2 diabetes for at least 1 year.

RESULTS

Eight key themes were found to potentially affect Chinese immigrants' capacity to obtain, communicate, process and understand diabetes related health information and consequently alter their decision making in self-care. Among the themes, three major categories emerged: cultural factors, structural barriers, and personal barriers.

CONCLUSIONS

Findings highlight the importance of cultural sensitivity when working with first-generation Chinese immigrants with diabetes. Implications for health professionals, local community centres and other potential service providers are discussed.

Intensity of grandparent caregiving and life satisfaction among rural Chinese older adults: a longitudinal study using latent difference score analysis

This study examined how life satisfaction and grandparent caregiving intensity changed over time among rural Chinese older adults, and whether there was a leading predictor between grandparent caregiving intensity and life satisfaction. Using 4 waves of data from the Well-being of Elderly in Anhui Province of China (N = 1704), we applied latent difference score analysis to explore this relationship. Results indicated that grandparent caregiving intensity decreased and life satisfaction increased over time. There was a lagged effect between grandparent caregiving intensity and life satisfaction, and life satisfaction demonstrated a leading prediction role between these 2 variables. This study confirmed the potentially rewarding aspect of grandparent caregiving, which may lead to greater life satisfaction. The results also revealed that psychological well-being among grandparents is very important for performing activities, such as caregiving.

Levels of beta-mannan in soybean meal

Beta-mannan, also known as beta-galactomannan, is found in a number of feed ingredients for poultry. Of these, soybean meal (SBM) is by far the most commonly used, being the primary source of protein in poultry feeds in most countries. Although beta-mannan has clearly been shown to be deleterious to poultry and animal performance, a survey of its concentration in SBM has yet to be reported. Thirty-six samples of SBM, identified as either dehulled or nondehulled, were obtained from commercial sources in a number of countries and assayed for beta-mannan content. Results confirmed that all samples of SBM assayed contained at least 1.0% beta-mannan and that concentrations are higher in nondehulled (1.61 +/- 0.20%) than in dehulled samples (1.26 +/- 0.14%).

An evaluation of endo-β-D-mannanase (Hemicell) effects on broiler performance and energy use in diets varying in β-mannan content

Two experiments were conducted to evaluate the effects of a commercial endo-beta-D-mannanase (Hemicell) on overall performance, MEn, net energy for gain, and some serum parameters of broilers fed diets varying in beta-mannan level (experiment 1) and to evaluate effects of enzyme level on the same variables in broilers fed diet high in beta-mannan (experiment 2). As a semipurified beta-mannan source, guar gum was used to alter the dietary beta-mannan level. In experiment 1, guar gum was added at 0, 0.5, 1, and 2% in a corn-soy-based starter diet with (0.05%) and without endo-beta-D-mannanase supplementation in a 4 x 2 factorial design. Enzyme supplementation improved (P < 0.01) feed efficiency at control and each guar gum inclusion level, whereas 2% guar gum supplementation reduced (P < 0.01) BW and increased (P < 0.01) 14-d feed:gain ratio. Enzyme supplementation also increased dietary MEn and net energy gain. In experiment 2, endo-beta-D-mannanase was added at 0, 0.5, 1, and 1.5% in a corn-soy-based starter diet containing 1% guar gum. Increasing endo-beta-D-mannanase supplementation did not affect (P > 0.10) final BW but improved 14-d feed:gain ratio at all inclusion levels. As in the first experiment, ME improved (P < 0.05) with increasing enzyme inclusion. Dietary endo-beta-D-mannanase inclusion significantly reduced water:feed ratio and total dry fecal output (P < 0.01). Taken together, the results of these 2 experiments indicate that endo-beta-D-mannanase supplementation may improve the utilization of nutrients in diets containing beta-mannan.

Beneficial Effect of β-Mannanase Feed Enzyme on Performance of Chicks Challenged with Eimeria sp. and Clostridium perfringens

Two experiments were conducted to determine the effect of a beta-mannanase feed enzyme on the performance of broiler chicks subject to a necrotic enteritis disease challenge model involving oral inoculation of Eimeria sp. and Clostridium pefringens. Beta-mannanase is known to improve productive performance when added to poultry and swine diets. In both experiments, disease challenge in the absence of feed additives demonstrated significant reductions in performance as measured by weight gain, feed conversion, and the incidence of coccidial lesion scores. Significant mortality was also observed in challenged groups in Experiment 1. The disease challenge model was therefore judged as highly effective. Additions of a commonly used antibiotic, bacitracin methylene disalicilate (BMD), and coccidiostat, salinomycin, were highly effective in partially counteracting negative effects of the disease challenge. In both experiments, addition of beta-mannanase significantly improved performance and reduced lesion scores in disease-challenged groups. The degree of improvement was somewhat less than that afforded by a combination of BMD and salinomycin in Experiment 1 but was not different from that afforded by BMD alone in Experiment 2. We conclude that the beta-mannanase enzyme can play a role in circumstances where the use of antibiotics is not desired.

Effects of beta-mannanase in corn-soybean meal diets on laying hen performance

Recently, a patented enzyme product (beta-Mannanase, Hemicell) has been shown to improve feed conversion in corn-soybean diets fed to broilers and swine. The mechanism of beta-Mannanase is to degrade beta-mannan, which is an antinutritional factor existing in many legumes, including soybean and canola meals. The objective of this study was to determine whether or not performance can be improved by including beta-Mannanase in diets of commercial laying hens, 18 through 66 wk of age. A 2 x 2 x 2 factorial arrangement of treatments was employed. There were two energy sequences of 2,926-2,907-2,885 and 2,827-2,808-2,786 kcal ME/kg, which changed at 33 and 43 wk of age respectively; two dietary enzyme levels (0 and 110 units/g); and two Hy-Line strains (W36 and W77). Hen-day production, hen-housed production, BW, feed intake, mortality, egg weight, and specific gravity data were collected biweekly. Data were analyzed in four cycles (each with six 2-wk periods) and also for the whole experiment. beta-Mannanase increased egg weight from 51.4 to 51.7 g/egg (P < 0.05) in the first 12-wk cycle. This effect was consistent across energy levels. beta-Mannanase significantly improved hen-day and hen-housed production after the first cycle. Hen-day production of the beta-Mannanase group was 0.70, 1.07, and 1.5% greater than the control for cycles two, three, and four, respectively (P < 0.01). After 30 wk of age, average hen-day production of hens fed the low-energy diets with beta-Mannanase was similar or superior to that of hens fed the high-energy diets without the enzyme. The study indicates that beta-Mannanase is capable of increasing egg weight in commercial layers at early stages of production, and increasing egg production, particularly delaying the postpeak decline in productivity.

Site-directed mutagenesis and the role of the oxyanion hole in subtilisin

Oligonucleotide-directed mutagenesis was used to investigate the nature of transition state stabilization in the catalytic mechanism of the serine protease, subtilisin BPN'. The gene for this extracellular enzyme from Bacillus amyloliquefaciens has been cloned and expressed in Bacillus subtilis. In the transition state complex, the carbonyl group of the peptide bond to be hydrolyzed is believed to adopt a tetrahedral configuration rather than the ground-state planar configuration. Crystallographic studies suggest that stabilization of this activated complex is accomplished in part through the donation of a hydrogen bond from the amide side group of Asn-155 to the carbonyl oxygen of the peptide substrate. To specifically test this hypothesis, leucine was introduced at position 155. Leucine is isosteric with asparagine but is incapable of donating a hydrogen bond to the tetrahedral intermediate. The Leu-155 variant was found to have an unaltered Km but a greatly reduced catalytic rate constant, kcat, (factor of 200-300 smaller) when assayed with a peptide substrate. These kinetic results are consistent with the Asn-155 mediating stabilization of the activated complex and lend further experimental support for the transition-state stabilization hypothesis of enzyme catalysis.

Sequential utilization of mixed monosaccharides by yeasts

Four yeasts (Saccharomyces cerevisiae, Schizosaccharomyces pombe, Candida utilus, and Rhodotorula toruloides) were tested for their ability to grow and consume D-glucose, D-xylose, D-xylulose, and D-xylitol. Sequential utilization of substrates was observed when D-glucose as mixed with D-xylulose as the carbon source. Catabolite inhibition was tentatively concluded to be responsible for this regulatory mechanism. D-Glucose was also found to inhibit the utilization of D-xylose and D-xylitol in C. utilus and R. toruloides. D-Xylose, D-xylitol, and D-xylulose were consumed simultaneously by R. toruloides and C. utilus.

Enzymatic and Microbial Preparation of d -Xylulose from d -Xylose

A high- d -xylulose mixture ( d -xylose- d -xylulose = 33:67) was prepared from the cold ethanol extract of preisomerized d -xylose solution ( d -xylose- d -xylulose = 77:23). Fusarium oxysporum f. sp. lini and Aspergillus niger were demonstrated to preferentially utilize d -xylose in the mixture of d -xylose and d -xylulose. Chromatographically pure d -xylulose was thus obtained in 90% yield. A high- d -xylulose mixture was also incubated with Rhodotorula toruloides, Klebsiella pneumoniae, Candida utilis , or Mucor rouxii. d -Xylose and d -xylulose were simultaneously consumed. When borate was added to the mixture, a d -xylulose-borate complex was formed, and it could be used to protect d -xylulose from being utilized.

Use of immobilized carboxypeptidase Y (I-CPY) as a catalyst for deblocking in peptide synthesis

CPY is a metal-free carboxypeptidase from yeast with broad specificity [1]. In addition to exopeptidase activity at acid pH, the enzyme is an effective esterase at alkaline pH. N-alpha-acetyl-L-tyrosine ethyl ester is hydrolyzed faster by CPY than by chymotrypsin. These observations suggested that the immobilized form of the enzyme would be of value in removing ester groups from the C-terminal ends of peptides. In this report we describe sequential synthesis using I-CPY and alpha-COOH deblocking of peptides made by conventional methods.