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Background In the United States, 38.4 million people have been diagnosed with diabetes, and it continues to rise. The increasing rate of diabetes has become a significant public health challenge due, in part, to the association between diabetes and decreased levels of physical and emotional well-being. Currently, there are few assessments of the impact of diabetes self-management programs on individuals with diabetes quality of life and social vulnerability. This study examined pre- to post-program quality of life outcomes for participants in a community-based diabetes-self management and support (DSMS) program and assessed the association between the change in quality of life pre- to post-program and social vulnerability. Methods Health Extension for Diabetes (HED) is a 4-month, community-based DSMS program delivered in the Southeast region of the United States. HED includes standardized education and personalized support to help participants manage their diabetes. The 12-Item Short Form Health Survey (SF-12) was utilized to assess participants’ physical and mental quality of life pre- and post-program participation. The Centers for Disease Control and Prevention’s (CDC) Social Vulnerability Index (SVI) was used to determine individuals’ social vulnerability level (low: 0–0.25, low-to-moderate: 0.2501–0.5, moderate-to-high: 0.501–0.75, high: 0.7501–1.0). Wilcoxon sign-ranked tests assessed changes in SF-12 pre- and post-HED and linear regressions examined the association between quality of life and social vulnerability level. Results SF-12 scores indicated significant positive changes in physical and mental quality of life for all program participants ( N  = 1,006). All SVI subgroups were observed to have significant improvements in physical health scores. Individuals with moderate-to-high and high SVI scores showed significant improvement in mental health scores, while individuals with low and low-to-moderate SVI scores did not. Conclusion Participants of the community-based diabetes self-management and support program experienced improvements in quality of life across varying levels of social vulnerability, as measured by the SVI. While integrating upstream social determinants of health considerations into DSMS program design and delivery addresses health disparities, future research should consider the implementation of more general mental health resources to address the psychological burden associated with living with chronic disease.

Background Real-time PCR (qPCR) diagnostics developed for use in human clinical settings have been implemented to identify new animal hosts of the gastrointestinal protozoan Dientamoeba fragilis . The gut microbiome varies between species; unrecognised cross-reactivity could occur when applying these assays to new animal hosts. The use of qPCR diagnostics was assessed for the identification of new animal hosts of the gastrointestinal protozoan Dientamoeba fragilis . Methods Forty-nine cattle, 84 dogs, 39 cats and 254 humans were screened for D. fragilis using two qPCR assays: EasyScreen (Genetic Signatures) and a laboratory-based assay commonly used in Europe. The reliability of the identifications made by these assays were assessed using melt curve analysis of qPCR products, conventional PCR targeting the SSU rDNA sequencing and NGS amplicon sequencing of qPCR product. Results PCR products from the D. fragilis identified in cattle had a 9 °C cooler melt curve than when detected in humans. This melt curve discrepancy, indicative of cross-reactivity with an unknown organism, was investigated further. DNA sequencing determined that Simplicimonas sp. was the genera responsible for this cross-reactivity in cattle specimens. Dientamoeba fragilis was not detected in either dogs or cats. There was a discrepancy in the number of positive samples detected using the two qPCR assays when applied to human samples. The EasyScreen assay detected 24 positive samples; the laboratory-based assay detected an additional 34 positive samples. Of the discrepant samples, 5 returned sequence data for D. fragilis , and 29 were unsupported (false) positive samples. Conclusions Analysis of the melt curve after the qPCR reaction is a valuable technique to help differentiate samples containing D. fragilis compared to cross-reactions with non-target organisms. The identification of new animal hosts requires further evidence from either microscopy or DNA sequencing to confirm the presence of D. fragilis . Additionally, to reduce the risk of false-positive results due to non-specific amplification, we recommend reducing the number of PCR cycles to less than 40. Based on these results, we consider the ramifications of this identified cross-reactivity to the known host species distribution of D. fragilis . Graphical Abstract

Little is known about the life cycle and mode of transmission of Dientamoeba fragilis. Recently it was suggested that fecal–oral transmission of cysts may play a role in the transmission of D. fragilis. In order to establish an infection, D. fragilis is required to remain viable when exposed to the pH of the stomach. In this study, we investigated the ability of cultured trophozoites to withstand the extremes of pH. We provide evidence that trophozoites of D. fragilis are vulnerable to highly acidic conditions. We also investigated further the ultrastructure of D. fragilis cysts obtained from mice and rats by transmission electron microscopy. These studies of cysts showed a clear cyst wall surrounding an encysted parasite. The cyst wall was double layered with an outer fibrillar layer and an inner layer enclosing the parasite. Hydrogenosomes, endoplasmic reticulum and nuclei were present in the cysts. Pelta-axostyle structures, costa and axonemes were identifiable and internal flagellar axonemes were present. This study therefore provides additional novel details and knowledge of the ultrastructure of the cyst stage of D. fragilis.

Despite improvements in revascularization after a myocardial infarction, coronary disease remains a major contributor to global mortality. Neutrophil infiltration and activation contributes to tissue damage, via the release of myeloperoxidase (MPO) and formation of the damaging oxidant hypochlorous acid. We hypothesized that elevation of thiocyanate ions (SCN − ), a competitive MPO substrate, would modulate tissue damage. Oral dosing of rats with SCN − , before acute ischemia–reperfusion injury (30 min occlusion, 24 h or 4 week recovery), significantly reduced the infarct size as a percentage of the total reperfused area (54% versus 74%), and increased the salvageable area (46% versus 26%) as determined by MRI imaging. No difference was observed in fractional shortening, but supplementation resulted in both left-ventricle end diastolic and left-ventricle end systolic areas returning to control levels, as determined by echocardiography. Supplementation also decreased antibody recognition of HOCl-damaged myocardial proteins. SCN − supplementation did not modulate serum markers of damage/inflammation (ANP, BNP, galectin-3, CRP), but returned metabolomic abnormalities (reductions in histidine, creatine and leucine by 0.83-, 0.84- and 0.89-fold, respectively), determined by NMR, to control levels. These data indicate that elevated levels of the MPO substrate SCN − , which can be readily modulated by dietary means, can protect against acute ischemia–reperfusion injury.

Introduction: Rates of N-methylamphetamine (methamphetamine) use in rural areas of the US have been steadily increasing, particularly among individuals who are already struggling with opioid use disorder. Despite this alarming trend, there remains a significant gap in our understanding of how methamphetamine use affects treatment response for those undergoing treatment with medications for opioid use disorder (MOUD). This study aimed to explore the predictive role of methamphetamine urinalysis (UA) results at intake in treatment retention and in opioid and methamphetamine use over time among individuals seeking MOUD treatment in four clinics located in rural areas. The study was conducted across four clinics situated in rural areas, where access to addiction treatment services is known to be limited. Methods: Clinical data for this study were collected between January and December 2019. A substantial number of participants were enrolled from those patients initiating treatment in 2019 in four clinics in rural Oregon. Data included intake demographics, attendance, and monthly opioid and methamphetamine UA results over a 1-year period. Our primary outcomes were opioid and methamphetamine use, and treatment retention over a 1-year period. Objective verification of opioid and methamphetamine use was determined using UA results collected once per month. Treatment retention was determined considering the number of days elapsed from treatment intake to treatment dropout. Generalized estimating equations were used to compare methamphetamine and opioid use over time, and Kaplan–Maier survival analysis was used to compare treatment retention by methamphetamine UA result at intake. Results: A total of 554 patients enrolled at one of the four rural MOUD clinics, of whom 277 (50%) had a negative methamphetamine and 277 (50%) had a positive methamphetamine UA result at intake. Participants were mostly White individuals (89.5%), half of participants were male (54.5%), and the mean age was 36.8 years (standard deviation 10.8 years). About a third were unemployed (32.3%), more than a quarter reported legal problems (26.2%), and 5.4% were currently homeless. Compared to those testing negative for methamphetamine, patients initiating MOUD treatment with a positive methamphetamine UA were more likely to be unemployed (36.5% v 28.2%; p=0.048) and to have a positive opioid UA result at intake (88.4% v 45.8%; p<0.001). A negative methamphetamine UA result at intake was associated with fewer positive methamphetamine UA results over time (p=0.022), but was not associated with either better treatment response for opioid use over time (p=0.849) or treatment retention (p=0.51). Conclusion: While patients who had negative methamphetamine UA results when initiating MOUD treatment had higher rates of methamphetamine abstinence over time, methamphetamine UA results at intake did not predict worse treatment outcomes in terms of opioid use and treatment retention for patients receiving MOUD in rural areas. Our findings highlight demographic and profile differences between patients who use methamphetamine in MOUD rural settings, and they identify significant gaps in existing knowledge regarding the effects of methamphetamine use on MOUD treatment response. Such findings underscore a critical need for further research to be conducted, specifically among rural populations seeking MOUD treatment.

Our study supports the notion that BCC disparities occur among POC compared to NHW. This includes variations in epidemiologic factors such as sex and past medical history, primary tumour location, and pathologic characteristics. Further research should be conducted to identify additional differences in skin cancer presentation in POC to reduce the gaps in skin cancer knowledge and care. Abstract Introduction Basal cell carcinoma (BCC) is the most common malignancy in the United States. The majority of cases are identified in Non-Hispanic Whites (NHW) and are far less demonstrated in patients of colour (POC). However, the Hispanic population represents a large and growing proportion of the US population, and skin cancer diagnoses in Hispanics are rising. Thus, the goal of this study is to examine clinicopathologic differences between BCC in Hispanics versus NHW. Methods A retrospective chart review of Hispanic and NHW patients with BCC at Los Angeles County + USC Medical Center from January 2018 to March 2020 was performed. In total, 101 BCC samples from the first 100 patients identified of Hispanic ancestry, as well as 50 BCC samples identified from the first 50 patients identifying as NHW, were included for analysis. Patient characteristics (age, sex, medical history, and ethnicity), as well as tumour characteristics (location, subtype, tumour depth, and perineural invasion), were collected. We used between subjects t-tests for continuous variables, and chi-square tests for categorical variables. Results In total, 151 specimens were collected amongst 122 subjects (79 Hispanics and 43 NHW patients). Among NHW, the majority of patients (74.4%) were men, but among the Hispanic population, the majority (68.4%) were female (p < 0.001). Prior history of other skin cancer was more common among NHW (67.4%) than Hispanics (31.6%) (p=<0.001). The Hispanic population had a significantly higher proportion of head and neck tumours (p = 0.0004) but a lower proportion of extremity tumours (p = 0.001) compared to NHW. Pigmented BCC was significantly more common among Hispanic patients (p < 0.01). Finally, within the Hispanic group, there was a significant association between sex and histology (p = 0.004), with Hispanic men demonstrating more aggressive mix histology compared to Hispanic women. Discussion Our study supports the notion that BCC disparities occur among POC compared to NHW. This includes variations in epidemiologic factors such as sex and past medical history, primary tumour location, and pathologic characteristics. Further research should be conducted to identify additional differences in skin cancer presentation in POC to reduce the gaps in skin cancer knowledge and care.

IntroductionSocial determinants of health (SDoH) are key risk factors impacting diabetes outcomes. The American Diabetes Association has identified five principal SDoH categories influencing diabetes outcomes: socioeconomic status, neighborhood and physical environment, food environment, healthcare, and social context. Currently, no concise and valid instruments exist to measure the burden of SDoH factors for individuals with diabetes. To fill this gap, we developed the Diabetes Index for Social Determinants of Health (DISDOH).Research design and methodsParticipants with type 1 and type 2 diabetes were recruited from the regional Health Extension for Diabetes (HED) programme and a national crowdsourcing platform. Item development through a diabetes expert stakeholder group yielded a pool of 16 items, which were further refined through piloting with individuals living with diabetes. Principal component analysis was conducted with a sample of 440 HED participants, identifying a 5-factor solution. Confirmatory factor analysis supported this 5-factor solution using 215 individuals with type 1 and type 2 diabetes. Reliability and validity of DISDOH were also assessed.ResultsThe five DISDOH domains demonstrated acceptable internal consistency estimates: Domain 1, socioeconomic status (a=0.660); Domain 2, neighborhood and physical environment (a=0.812); Domain 3, food environment (a=0.801); Domain 4, health context (a=0.812); and Domain 5, social context (a=0.708). DISDOH showed strong convergent validity with related SDoH measures, and divergent validity was supported by weak or non-significant correlations with distinct constructs.ConclusionsDISDOH is the first validated, diabetes-specific SDoH assessment designed for brief, practical use in clinical and community settings. Unlike existing instruments, which are often lengthy and not tailored to diabetes management, DISDOH offers a concise yet comprehensive approach to identifying social risk factors that impact diabetes self-care and outcomes.

Introduction A learning health system (LHS) necessitates collaboration to produce translational health research. This experience report examines the integration of Clemson University scholars into clinical departments of Prisma Health–Upstate in South Carolina, highlighting their experiences working alongside clinician mentors to inform and facilitate research translation. Particularly, this study aims to explore the interpersonal and structural factors influencing the success of an embedded scholar program, focusing on enablers and barriers to collaboration, knowledge integration, and mentorship within the LHS. Methods Nine embedded scholar and 12 mentor semi‐structured interviews were conducted. This qualitative study initially used an inductive technique to analyze responses thematically. After thematic saturation was achieved, deductive analysis was utilized to further organize enablers and barriers across the following five categories: (1) Scholar Integration, (2) Scholar Autonomy, (3) Mentor Support, (4) Programmatic Outcomes, and (5) Institutional Dynamics. Results We found 10 major program‐related enablers and barriers to successfully embedding scholars. These were clinical environment adaptation, mentor interaction, research management, balance of independence, role clarity, resource provision, research application and quality, scholar development, organizational support, and policy and procedure alignment. Findings reveal that effective mentorship, organizational alignment, and resource availability are critical enablers of program success, while misaligned expectations, limited institutional support, and insufficient scholar integration into clinical environments are barriers. Conclusion Evaluating specific components of embedded scholar programs can uncover best practices and innovation opportunities in the LHS. These provide a great opportunity to enhance the mentorship mechanisms between clinical mentors and embedded researchers. As research on embedded scholars in a LHS progresses, fostering structured mentoring relationships may serve as an impetus to bridge the gap between research and clinical practice. Further study is needed to operationalize these relationships effectively.