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The role animal food plays in the introduction of antimicrobial-resistant bacteria into the human food chain is not well understood. We conducted an analysis of 1025 samples (647 pet food and 378 animal feed) collected across the United States during 2005–2011 for two indicator organisms (Escherichia coli and Enterococcus spp.). The overall prevalence ranged from 12.5% for E. coli to 45.2% for Enterococcus spp., and 11.2% of samples harbored both organisms. Regardless of bacterial genus, animal feed had significantly higher prevalence than pet food (p < 0.001). A general downward trend in prevalence was observed from 2005 to 2009 followed by an upward trend thereafter. Among E. coli isolates (n = 241), resistance was highest to tetracycline (11.2%) and below 5% for fourteen other antimicrobials. Among Enterococcus spp. isolates (n = 1074), Enterococcus faecium (95.1%) was the predominant species. Resistance was most common to tetracycline (30.1%) and ciprofloxacin (10.7%), but below 10% for thirteen other antimicrobials. Multidrug-resistant organisms were observed among both E. coli and Enterococcus spp. isolates at 3.3%. Compared to National Antimicrobial Resistance Monitoring System (NARMS) 2011 retail meat and animal data, the overall resistance for both organisms was much lower in animal food. These findings help establish a historic baseline for the prevalence and antimicrobial resistance among U.S. animal food products and future efforts may be needed to monitor changes over time.

Small extracellular vesicles (sEVs), also referred as exosomes, have emerged as valuable indicators of cancer progression and response to treatment. They offer prospective targets for therapeutic interventions as well as insightful information about the fundamental mechanisms underlying the development of cancer. sEVs have garnered significant attention as a useful tool for liquid biopsies used in non-invasive cancer diagnosis. We discussed their potential in predicting treatment outcomes, monitoring disease progression, and classifying cancer stages and subtypes. sEVs can also shed light on how resistance to several cancer treatments, such as drug resistance, radiation resistance, chemotherapy resistance, and immunotherapy resistance develops. sEV-based cancer diagnostics have initiated clinical trials, underscoring their potential clinical value. Additionally, significant progress has been made in the development of techniques for isolating and enriching sEVs, enabling the sensitive and efficient detection of sEV proteins and nucleic acids. These advancements have resulted in enhanced sensitivity and specificity, facilitating the identification of biomarkers with low expression levels. In conclusion, sEV biomarkers offer significant potential for the diagnosis and monitoring of cancer. The utilization of sEVs in liquid biopsies presents a non-invasive method for acquiring tumour-specific information. Ongoing research and advancements in sEV-based diagnostics and therapeutics are crucial for unlocking the complete potential of sEV biomarkers in clinical settings.

Background Biologically plausible mechanisms link traffic-related air pollution to metabolic disorders and potentially to obesity. Here we sought to determine whether traffic density and traffic-related air pollution were positively associated with growth in body mass index (BMI = kg/m 2 ) in children aged 5–11 years. Methods Participants were drawn from a prospective cohort of children who lived in 13 communities across Southern California (N = 4550). Children were enrolled while attending kindergarten and first grade and followed for 4 years, with height and weight measured annually. Dispersion models were used to estimate exposure to traffic-related air pollution. Multilevel models were used to estimate and test traffic density and traffic pollution related to BMI growth. Data were collected between 2002–2010 and analyzed in 2011–12. Results Traffic pollution was positively associated with growth in BMI and was robust to adjustment for many confounders. The effect size in the adjusted model indicated about a 13.6% increase in annual BMI growth when comparing the lowest to the highest tenth percentile of air pollution exposure, which resulted in an increase of nearly 0.4 BMI units on attained BMI at age 10. Traffic density also had a positive association with BMI growth, but this effect was less robust in multivariate models. Conclusions Traffic pollution was positively associated with growth in BMI in children aged 5–11 years. Traffic pollution may be controlled via emission restrictions; changes in land use that promote jobs-housing balance and use of public transit and hence reduce vehicle miles traveled; promotion of zero emissions vehicles; transit and car-sharing programs; or by limiting high pollution traffic, such as diesel trucks, from residential areas or places where children play outdoors, such as schools and parks. These measures may have beneficial effects in terms of reduced obesity formation in children.

BackgroundOlder people are at risk for health decline and loss of independence. Lifestyle interventions offer potential for reducing such negative outcomes. The aim of this study was to determine the effectiveness and cost-effectiveness of a preventive lifestyle-based occupational therapy intervention, administered in a variety of community-based sites, in improving mental and physical well-being and cognitive functioning in ethnically diverse older people.MethodsA randomised controlled trial was conducted comparing an occupational therapy intervention and a no-treatment control condition over a 6-month experimental phase. Participants included 460 men and women aged 60–95 years (mean age 74.9±7.7 years; 53% <$12 000 annual income) recruited from 21 sites in the greater Los Angeles metropolitan area.ResultsIntervention participants, relative to untreated controls, showed more favourable change scores on indices of bodily pain, vitality, social functioning, mental health, composite mental functioning, life satisfaction and depressive symptomatology (ps<0.05). The intervention group had a significantly greater increment in quality-adjusted life years (p<0.02), which was achieved cost-effectively (US $41 218/UK £24 868 per unit). No intervention effect was found for cognitive functioning outcome measures.ConclusionsA lifestyle-oriented occupational therapy intervention has beneficial effects for ethnically diverse older people recruited from a wide array of community settings. Because the intervention is cost-effective and is applicable on a wide-scale basis, it has the potential to help reduce health decline and promote well-being in older people.Trial Registrationclinicaltrials.gov identifier: NCT0078634.

La presente investigación tuvo como objetivo analizar el uso del Facebook como un recurso pedagógico para el aprendizaje colaborativo en el curso de Dibujo Geométrico. Este estudio optó por una metodología de enfoque mixto. Para el recojo de información se utilizaron los instrumentos de encuesta y entrevista semiestructurada, los que permitieron obtener y analizar importantes datos cuantitativos y cualitativos. La muestra constó de 35 alumnos y 5 docentes de la Facultad de Arte y Diseño de una universidad de Lima Metropolitana. Los resultados indican que Facebook es una herramienta de comunicación potente e inmediata, la cual provee herramientas necesarias para compartir información. También se le considera como una herramienta de carácter colectivo que permite difundir mensajes a todos los miembros por igual y como complemento de las clases presenciales. La interacción entre los alumnos y los docentes se consideró lo más importante dentro del aprendizaje colaborativo, entre lo que se puede mencionar el envío de material visual y las consultasfuera de clase por parte de los estudiantes.

Abstract Objective Develop a consensus for the nomenclature and definition of adrenal histopathologic features in unilateral primary aldosteronism (PA). Context Unilateral PA is the most common surgically treated form of hypertension. Morphologic examination combined with CYP11B2 (aldosterone synthase) immunostaining reveals diverse histopathologic features of lesions in the resected adrenals. Patients and Methods Surgically removed adrenals (n = 37) from 90 patients operated from 2015 to 2018 in Munich, Germany, were selected to represent the broad histologic spectrum of unilateral PA. Five pathologists (Group 1 from Germany, Italy, and Japan) evaluated the histopathology of hematoxylin-eosin (HE) and CYP11B2 immunostained sections, and a consensus was established to define the identifiable features. The consensus was subsequently used by 6 additional pathologists (Group 2 from Australia, Brazil, Canada, Japan, United Kingdom, United States) for the assessment of all adrenals with disagreement for histopathologic diagnoses among group 1 pathologists. Results Consensus was achieved to define histopathologic features associated with PA. Use of CYP11B2 immunostaining resulted in a change of the original HE morphology-driven diagnosis in 5 (14%) of 37 cases. Using the consensus criteria, group 2 pathologists agreed for the evaluation of 11 of the 12 cases of disagreement among group 1 pathologists. Conclusion The HISTALDO (histopathology of primary aldosteronism) consensus is useful to standardize nomenclature and achieve consistency among pathologists for the histopathologic diagnosis of unilateral PA. CYP11B2 immunohistochemistry should be incorporated into the routine clinical diagnostic workup to localize the likely source of aldosterone production.

Implication of Genetic Variants Near TCF7L2 , SLC30A8 , HHEX , CDKAL1 , CDKN2A/B , IGF2BP2 , and FTO in Type 2 Diabetes and Obesity in 6,719 Asians Maggie C.Y. Ng 1 , Kyong Soo Park 2 , Bermseok Oh 3 , Claudia H.T. Tam 1 , Young Min Cho 2 , Hyoung Doo Shin 4 , Vincent K.L. Lam 1 , Ronald C.W. Ma 1 , Wing Yee So 1 , Yoon Shin Cho 3 , Hyung-Lae Kim 3 , Hong Kyu Lee 2 , Juliana C.N. Chan 1 5 and Nam H. Cho 6 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China 2 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea 3 Center for Genome Science, National Institute of Health, Seoul, Korea 4 Laboratory of Genomic Diversity, Department of Life Science, Sogang University, Seoul, Korea 5 Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China 6 Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Korea Corresponding author: Maggie C.Y. Ng, maggieng{at}cuhk.edu.hk Abstract OBJECTIVE— Recent genome-wide association studies have identified six novel genes for type 2 diabetes and obesity and confirmed TCF7L2 as the major type 2 diabetes gene to date in Europeans. However, the implications of these genes in Asians are unclear. RESEARCH DESIGN AND METHODS— We studied 13 associated single nucleotide polymorphisms from these genes in 3,041 patients with type 2 diabetes and 3,678 control subjects of Asian ancestry from Hong Kong and Korea. RESULTS— We confirmed the associations of TCF7L2 , SLC30A8 , HHEX , CDKAL1 , CDKN2A / CDKN2B , IGF2BP2 , and FTO with risk for type 2 diabetes, with odds ratios ranging from 1.13 to 1.35 (1.3 × 10 −12 < P unadjusted < 0.016). In addition, the A allele of rs8050136 at FTO was associated with increased BMI in the control subjects ( P unadjusted = 0.008). However, we did not observe significant association of any genetic variants with surrogate measures of insulin secretion or insulin sensitivity indexes in a subset of 2,662 control subjects. Compared with subjects carrying zero, one, or two risk alleles, each additional risk allele was associated with 17% increased risk, and there was an up to 3.3-fold increased risk for type 2 diabetes in those carrying eight or more risk alleles. Despite most of the effect sizes being similar between Asians and Europeans in the meta-analyses, the ethnic differences in risk allele frequencies in most of these genes lead to variable attributable risks in these two populations. CONCLUSIONS— Our findings support the important but differential contribution of these genetic variants to type 2 diabetes and obesity in Asians compared with Europeans. Footnotes Published ahead of print at http://diabetes.diabetesjournals.org on 13 May 2008. M.C.Y.N., K.S.P., and B.O. contributed equally to this work. H.K.L., J.C.N.C., and N.H.C. contributed equally to this work. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Accepted April 30, 2008. Received November 8, 2007. DIABETES

The comparison of psychosocial needs across different cultural settings can identify cultural and service impacts on psychosocial outcomes. We compare psychosocial needs in Hong Kong Chinese and German Caucasian women with breast cancer. Completed questionnaires were collected from 348 Chinese and 292 German women with breast cancer for assessing unmet psychosocial needs (Supportive Care Needs Survey Short Form), psychological distress (the Hospital Anxiety and Depression scale), and listed physical and psychological symptoms. Only 11% of the participants reported not needing help for any of the 34 items. More German (14%) than Chinese women (8%) reported no unmet needs (χ 2  = 6.16, P  = .013). With both samples combined, the Health System and Information domain unmet needs were the most prevalent, apart from one Psychological need domain item, “Fear about the cancer spreading.” Chinese and German samples differed significantly in prevalence and patterns of unmet psychosocial needs. Multivariate adjustment for demographic, clinical, and sample characteristics, psychological distress, and symptoms showed that significantly greater unmet Health system and Information, and Patient care and support domain needs, associated with the presence of symptoms (β = .232, P  < .001), high HADS Anxiety (β = .187, P  < .001), higher education attainment (β = .120, P  = .002), and Chinese sample membership (β = .280, P  < .001). Greater unmet Psychological, Physical and Daily Living, and Sexuality domain needs were associated with the presence of symptoms, psychological distress, and German group membership, among others. German women reported more anxiety (t = 10.45, P  < .001) and depression (t = 3.71, P  < .001). In post hoc analyses, German, but not Chinese women reporting greater anxiety and depression had greater unmet Psychological and Sexuality domain needs ( P  < .001). It can be concluded that culture-specific differences in supportive care needs exist. Hong Kong Chinese women prioritize needs for information about their disease and treatment, whereas German Caucasian women prioritize physical and psychological support. Planning for cancer supportive care services or interventions to reduce unmet needs must consider cultural and/or health service contexts.

Obese patients are more likely to develop periprosthetic joint infection (PJI) after primary total joint arthroplasty. This study compared the clinical and microbiological characteristics of non-obese, obese and severely obese patients with early PJI, in order to ultimately optimize antibiotic prophylaxis and other prevention measures for this specific patient category. We retrospectively evaluated patients with early PJI of the hip and knee treated with debridement, antibiotics and implant retention (DAIR) between 2006 and 2016 in three Dutch hospitals. Only patients with primary arthroplasties indicated for osteoarthritis were included. Early PJI was defined as an infection that developed within 90 days after index surgery. Obesity was defined as a BMI ≥30kg/m2 and severe obesity as a BMI ≥35kg/m2. A total of 237 patients were analyzed, including 64 obese patients (27.0%) and 62 severely obese patients (26.2%). Compared with non-obese patients, obese patients had higher rates of polymicrobial infections (60.3% vs 33.3%, p<0.001) with more often involvement of Enterococcus species (27.0% vs 11.7%, p = 0.003). Moreover, severely obese patients had more Gram-negative infections, especially with Proteus species (12.9% vs 2.3%, p = 0.001). These results were only found in periprosthetic hip infections, comprising Gram-negative PJIs in 34.2% of severely obese patients compared with 24.7% in obese patients and 12.7% in non-obese patients (p = 0.018). Our results demonstrate that obese patients with early periprosthetic hip infections have higher rates of polymicrobial infections with enterococci and Gram-negative rods, which stresses the importance of improving preventive strategies in this specific patient category, by adjusting antibiotic prophylaxis regimens, improving disinfection strategies and optimizing postoperative wound care.

Mesopelagic zone (MZ) carbon budgets comparing supply with demand can be difficult to constrain due to the temporal and spatial offsets between key sources and sinks, their associated uncertainties, and potential sampling biases. To address these challenges, the EXport Processes in the Ocean from RemoTe Sensing (EXPORTS) campaign increased the number and variety of simultaneous measurements to monitor temporal variability in the MZ carbon budget using both a Lagrangian frame of reference and long-term autonomous observations. In this study, we collate a comprehensive combination of new and previously published organic carbon supply and demand measurements collected from the surface (5 m) to the upper MZ, defined here as depths from 100 to 500 m. Cruise-based measurements were collected near the subarctic North Pacific's Ocean Station Papa (OSP) during the August 2018 EXPORTS field campaign. The supply of organic carbon into the upper MZ averaged 3.0 mmolCm-2d-1, with roughly equal contributions from passively sinking particles and from active diel vertical migration of zooplankton. Upper-MZ carbon demand, in the form of respiration, averaged 5.7 mmolCm-2d-1, with the greatest fraction of demand from free-living bacterioplankton and minor contributions from zooplankton and particle-attached bacterioplankton. Estimates of ship-based upper-MZ demand exceeded ship-based supply. Moreover, the upper-MZ carbon demand may have been even higher based on trends in dissolved oxygen concentration from a glider and a biogeochemical float operating from August to November 2018. This imbalance could be resolved by the production and export of organic carbon prior to our measurement period. Net community production (NCP) rates measured during the preceding spring and early summer of 2018, based on long-term mooring estimates of dissolved inorganic carbon concentrations, were higher than those measured during the EXPORTS field campaign. Seasonal trends in upper-MZ backscattering measurements in the vicinity of OSP, in addition to long-term decreases in dissolved organic carbon, suggest that the excess in organic carbon demand in the upper MZ could be accounted for by the release, disaggregation, and subsequent slow degradation of particles from NCP earlier in the year. The OSP upper-MZ carbon budget presented here demonstrates that studies attempting to constrain the fate of exported particulate organic carbon require the integration of samples over short (days to weeks; ships) and long (months; remote observations) timescales. Finally, based on this carbon mass balance approach, we highlight that studies attempting to test strategies of carbon dioxide removal through particle export should consider comparing multiple sampling platforms and monitoring over short and long timescales.