A systematic review of m-health apps on managing side effects of breast cancer treatment.

PURPOSE: After breast cancer treatment, women with breast cancer may experience distress caused by treatment side effects, both in physical and psychological aspects. Technology use is increasing in favor among women. Therefore, it is essential to update the scientific evidence regarding mobile and web apps' effectiveness in managing the side effects of breast cancer treatments for breast cancer survivors. The purpose of this systematic review was to investigate the scientific evidence on the effectiveness of mobile and web apps in managing the side effects of breast cancer treatments among this group. METHODS: A literature search was conducted using ScienceDirect, Scopus, PubMed, CINAHL, and Cochrane. Published papers in English focused on mobile and web apps and the side effects of breast cancer treatment in breast cancer survivors were selected. The search reviewed studies from January 2011 to December 2021. From a total of 925 retrieved manuscripts, 11 studies were included for analysis. RESULTS: The findings showed that mobile apps were more frequently used and more likely to be an effective method for managing the side effects of breast cancer treatment among breast cancer survivors. The content in web or mobile apps for breast cancer survivors should include five categories: (1) information about cancer, (2) overview of cancer care, (3) opportunities for interaction with other people, (4) symptom management strategies, and (5) feedback about cancer treatment side effect management. However, a few studies examined the effects of a combination of mobile and web apps in managing breast cancer treatment side effects. Therefore, future research is needed to examine solo and combination use. In addition, more rigorous studies are warranted to examine these interventions. CONCLUSIONS: Nurses may refer survivors to these resources to obtain more information and effectively manage the signs and symptoms of breast cancer and its treatment side effects.

A Multiple Case Study of Latina Breast Cancer Survivors Returning to Work With Breast Cancer-Related Lymphedema: Adaptation, Resilience, and Quality of Life.

Introduction: Breast cancer-related lymphedema (BCRL), a side effect of cancer treatment, may negatively impact the ability to perform work. Factors such as delayed diagnosis, late-stage disease, and a high percentage of service occupations may challenge work choices for Latinas after BCRL diagnosis. Methods: Our multiple case study explored work experiences and quality of life (QOL) for Hispanic/Latina survivors. Participants completed demographic and short form-36 (SF-36) surveys. Semi-structured interviews focused on how work environment, self-management, and QOL were influenced by BCRL. Thematic analysis of cases used In Vivo and descriptive coding and constant cross-case comparative methods. Results: Analysis illustrated how Hispanic/Latina survivors perceive the influence of BCRL on work experience as requiring adaptation and personal resilience. Participants identified BCRL knowledge gap challenges and described coping with physical, psychosocial, and work activity changes. They described creative work adaptations and discussed BCRL's impact on both positive and negative interpersonal perceptions. Strong support from family, friends, and colleagues contributed to improved QOL and continued work activities. Conclusion: Future research should incorporate coping strategies and creative management of BCRL to optimize work activities across the lifespan. These strategies can provide guidance for the creation of survivorship care plans, education of healthcare professionals (HCPs), and lifelong occupational support.

Factors Impacting Management of Breast Cancer-Related Lymphedema (BCRL) in Hispanic/Latina Breast Cancer Survivors: A Literature Review.

INTRODUCTION: Breast cancer-related lymphedema (BCRL) is a treatment sequela with negative physical and psychological implications. BCRL is a lifetime concern for survivors and is currently incurable. With the increase in the Latino population in the United States, it is critical for the cancer care community to address factors that increase BCRL risk and negatively impact long-term quality of life. This literature review undertook to identify successful intervention strategies for BCRL among Latina survivors. METHODS: Multiple databases were searched for published articles from 2006 to 2020. PRISMA guidelines were utilized. Data were extracted related to physical activity, diet, and psychosocial stress concerns of Latinas at risk for or living with BCRL. RESULTS: Eleven interventions combined education and skill-building techniques to address physical activity, diet, and stress management for BCRL. Family involvement, peer-mentoring, culturally tailored education, and self-care skill development were identified as important for Latina survivors. CONCLUSION: Latina survivors may benefit from culturally tailored BCRL education programs and self-management interventions. Health care professionals and researchers should consider cultural influences when developing clinical intervention strategies to enhance outcomes for Latinas at risk for living with BCRL. In addition, including family members and/or peers in such strategies may be helpful to Latina survivors.

Peptides Derived from the Tight Junction Protein CLDN1 Disrupt the Skin Barrier and Promote Responsiveness to an Epicutaneous Vaccine.

Keratinocytes express many pattern recognition receptors that enhance the skin's adaptive immune response to epicutaneous antigens. We have shown that these pattern recognition receptors are expressed below tight junctions (TJ), strongly implicating TJ disruption as a critical step in antigen responsiveness. To disrupt TJs, we designed peptides inspired by the first extracellular loop of the TJ transmembrane protein CLDN1. These peptides transiently disrupted TJs in the human lung epithelial cell line 16HBE and delayed TJ formation in primary human keratinocytes. Building on these observations, we tested whether vaccinating mice with an epicutaneous influenza patch containing TJ-disrupting peptides was an effective strategy to elicit an immunogenic response. Application of a TJ-disrupting peptide patch resulted in barrier disruption as measured by increased transepithelial water loss. We observed a significant increase in antigen-specific antibodies when we applied patches with TJ-disrupting peptide plus antigen (influenza hemagglutinin) in either a patch-prime or a patch-boost model. Collectively, these observations demonstrate that our designed peptides perturb TJs in human lung as well as human and murine skin epithelium, enabling epicutaneous vaccine delivery. We anticipate that this approach could obviate currently used needle-based vaccination methods that require administration by health care workers and biohazard waste removal.

Lymphoedema therapists: a national and international survey.

The American Lymphedema Framework Project (AFLP) surveyed lymphoedema therapists in the US in 2009 to describe their preparation, patient population and care practices. In the autumn of 2018, the survey was expanded to trained therapists worldwide to describe and compare current and past therapist characteristics and practices. The updated 2009 survey was distributed via Qualtrics to US and international therapists. The current analysis includes over 950 completed surveys. Preliminary results showed: country: US (n=672/922 [73%]); Canada (n=92[10%]); United Kingdom (n=42[5%]); Australia (n=28[3%]); gender: identifying as female (n=633/676 [93%]); mean age: 47yrs (range 21-76); discipline: physical therapist [45%], occupational therapist [31%], massage therapist [24%]); mean practice years: 10.7yrs (range 0-41); and practice setting: hospital out-patient clinic (47%); private practice (38%); hospital in-patient (13%); home care/hospice (9%). Further 2009-2018 comparative analyses will be shared. Understanding characteristics and practices of lymphoedema therapists and patients will help stakeholders meet under- and unmet needs of this population.

Pearls and Pitfalls of Team Science.

Formidable health problems are often best addressed by teams of scientists with varied expertise. This diversity among team members and complexities in managing teams can lead to challenges in designing, funding, conducting, and reporting research. Team science difficulties can be addressed by sophisticated planning, frequent reassessment and realignment of team strategies with goals, and consistent transparent communication. This article addresses specific strategies to build and sustain research teams, manage team meetings, strategically develop publications and grants, thrive in the midst of disciplinary and individual team member differences, embrace new ideas and change to maintain creativity, and build future team scientists and projects. The potential value in team science justifies the effort required to build and maintain efficient and effective research teams.

Man Up Monday: An integrated public health approach to increase sexually transmitted infection awareness and testing among male students at a midwest university.

OBJECTIVE: This campaign sought to (a) increase awareness of sexual health and chlamydia testing; (b) motivate students, particularly sexually active men who do not pursue regular sexually transmitted infection (STI) testing, to get tested; and (c) improve the capacity of the student health center to provide free chlamydia testing and treatment for all students. PARTICIPANTS: Students enrolled at a 4-year public research university (N = 333). METHODS: Collaborative partnerships formed the foundation of a campus marketing and testing campaign, with treatment for students testing positive for chlamydia. RESULTS: A total of 333 students were tested over 5 consecutive Mondays, showing a chlamydia incidence of 9.6%. The incidence for females and males were 8.6% and 10.8%, respectively. CONCLUSIONS: The campaign was effective in reaching men, an at-risk population not traditionally emphasized in STI testing.

Developing and assessing curriculum on the physics of medical instruments.

Undergraduate educational settings often struggle to provide students with authentic biologically or medically relevant situations and problems that simultaneously improve their understanding of physics. Through exercises and laboratory activities developed in an elective Physics in Biomedicine course for upper-level biology or pre-health majors at Portland State University, we aim to teach fundamental physical concepts, such as light absorption and emission and atomic energy levels, through analysis of biological systems and medical devices. The activities address the properties of electromagnetic waves as they relate to the interaction with biological tissue and make links between physics and biomedical applications such as microscopy or laser eye surgery. We report on the effect that engaging students in tasks with actual medical equipment has had on their conceptual understanding of light and spectroscopy. These initial assessments indicate that students' understanding improves in some areas as a result of taking the course, but gains are not uniform and are relatively low for other topics. We also find a promising "nonshift" in student attitudes toward learning science as a result of taking the course. A long-term goal of this work is to develop these materials to the extent that they can eventually be imported into an introductory curriculum for life sciences majors.

An azobenzene photoswitch sheds light on turn nucleation in amyloid-ß self-assembly.

Amyloid-ß (Aß) self-assembly into cross-ß amyloid fibrils is implicated in a causative role in Alzheimer's disease pathology. Uncertainties persist regarding the mechanisms of amyloid self-assembly and the role of metastable prefibrillar aggregates. Aß fibrils feature a sheet-turn-sheet motif in the constituent ß-strands; as such, turn nucleation has been proposed as a rate-limiting step in the self-assembly pathway. Herein, we report the use of an azobenzene ß-hairpin mimetic to study the role turn nucleation plays on Aß self-assembly. [3-(3-Aminomethyl)phenylazo]phenylacetic acid (AMPP) was incorporated into the putative turn region of Aß42 to elicit temporal control over Aß42 turn nucleation; it was hypothesized that self-assembly would be favored in the cis-AMPP conformation if ß-hairpin formation occurs during Aß self-assembly and that the trans-AMPP conformer would display attenuated fibrillization propensity. It was unexpectedly observed that the trans-AMPP Aß42 conformer forms fibrillar constructs that are similar in almost all characteristics, including cytotoxicity, to wild-type Aß42. Conversely, the cis-AMPP Aß42 congeners formed nonfibrillar, amorphous aggregates that exhibited no cytotoxicity. Additionally, cis-trans photoisomerization resulted in rapid formation of native-like amyloid fibrils and trans-cis conversion in the fibril state reduced the population of native-like fibrils. Thus, temporal photocontrol over Aß turn conformation provides significant insight into Aß self-assembly. Specifically, Aß mutants that adopt stable ß-turns form aggregate structures that are unable to enter folding pathways leading to cross-ß fibrils and cytotoxic prefibrillar intermediates.

Turn nucleation perturbs amyloid ß self-assembly and cytotoxicity.

The accumulation of senile plaques composed of amyloid ß (Aß) fibrils is a hallmark of Alzheimer's disease, although prefibrillar oligomeric species are believed to be the primary neurotoxic congeners in the pathogenesis of Alzheimer's disease. Uncertainty regarding the mechanistic relationship between Aß oligomer and fibril formation and the cytotoxicity of these aggregate species persists. ß-Turn formation has been proposed to be a potential rate-limiting step during Aß fibrillogenesis. The effect of turn nucleation on Aß self-assembly was probed by systematically replacing amino acid pairs in the putative turn region of Aß (residues 24-27) with d-ProGly ((D)PG), an effective turn-nucleating motif. The kinetic, thermodynamic, and cytotoxic effects of these mutations were characterized. It was found that turn formation dramatically accelerated Aß fibril self-assembly dependent on the site of turn nucleation. The cytotoxicity of the three (D)PG-containing Aß variants was significantly lower than that of wild-type Aß40, presumably due to decreased oligomer populations as a function of a more rapid progression to mature fibrils; oligomer populations were not eliminated, however, suggesting that turn formation is also a feature of oligomer structures. These results indicate that turn nucleation is a critical step in Aß40 fibril formation.

Clarifying the influence of core amino acid hydrophobicity, secondary structure propensity, and molecular volume on amyloid-ß 16-22 self-assembly.

The self-assembly of amyloid peptides is influenced by hydrophobicity, charge, secondary structure propensity, and sterics. Previous experiments have shown that increasing hydrophobicity at the aromatic positions of the amyloid-ß 16-22 fragment (Aß(16-22)) without introducing steric restraints greatly increases the rate of self-assembly and thermodynamically stabilizes the resulting fibrils [Senguen et al., Mol. BioSyst., 2011, DOI: 10.1039/c0mb00080a]. Conversely, when increasing side chain hydrophobicity coincides with an increase in side chain volume, the increase in the rate of self-assembly is offset by a thermodynamic destabilization of the resulting amyloid fibrils when direct cross-strand side chain interactions occur. These findings indicate that steric effects also influence the self-assembly of amyloidogenic peptides. Herein, the aromatic Phe residues at positions 19, 20, and 19,20 of Aß(16-22) have been systematically replaced by Val, Leu, Ile, or hexafluoroleucine (Hfl) and amyloid formation has been characterized. The Val variants, despite the high ß-sheet propensity of Val, were thermodynamically destabilized (ΔΔG = +0.1-0.4 kcal mol(-1)) relative to the wild-type with the double mutant failing to self-assemble at the concentrations studied. Conversely, the Leu and Ile variants formed fibrils at enhanced rates relative to wild-type and exhibited similar, or in some cases enhanced thermodynamic stabilities relative to the wild-type (ΔΔG = 0-0.6 kcal mol(-1)). The more hydrophobic Hfl variants were greatly stabilized (ΔΔG = -0.3-2.1 kcal mol(-1)) relative to the wild-type. These data indicate that hydrophobicity and steric effects both influence peptide self-assembly processes, including nucleation and fibrillization rates and the thermodynamic stability of the resulting fibrils.

Probing aromatic, hydrophobic, and steric effects on the self-assembly of an amyloid-ß fragment peptide.

Aromatic amino acids have been shown to promote self-assembly of amyloid peptides, although the basis for this amyloid-inducing behavior is not understood. We adopted the amyloid-ß 16-22 peptide (Aß(16-22), Ac-KLVFFAE-NH(2)) as a model to study the role of aromatic amino acids in peptide self-assembly. Aß(16-22) contains two consecutive Phe residues (19 and 20) in which Phe 19 side chains form interstrand contacts in fibrils while Phe 20 side chains interact with the side chain of Va l18. The kinetic and thermodynamic effect of varying the hydrophobicity and aromaticity at positions 19 and 20 by mutation with Ala, Tyr, cyclohexylalanine (Cha), and pentafluorophenylalanine (F(5)-Phe) (order of hydrophobicity is Ala < Tyr < Phe < F(5)-Phe < Cha) was characterized. Ala and Tyr position 19 variants failed to undergo fibril formation at the peptide concentrations studied, but Cha and F(5)-Phe variants self-assembled at dramatically enhanced rates relative to wild-type. Cha mutation was thermodynamically stabilizing at position 20 (ΔΔG = -0.2 kcal mol(-1) relative to wild-type) and destabilizing at position 19 (ΔΔG = +0.2 kcal mol(-1)). Conversely, F(5)-Phe mutations were strongly stabilizing at both positions (ΔΔG = -1.3 kcal mol(-1) at 19, ΔΔG = -0.9 kcal mol(-1) at 20). The double Cha and F(5)-Phe mutants showed that the thermodynamic effects were additive (ΔΔG = 0 kcal mol(-1) for Cha 19,20 and -2.1 kcal mol(-1) for F(5)-Phe 19,20). These results indicate that sequence hydrophobicity alone does not dictate amyloid potential, but that aromatic, hydrophobic, and steric considerations collectively influence fibril formation.

Dental students' knowledge about elder abuse and neglect and the reporting responsibilities of dentists.

Dentists are in a unique position to detect elder abuse and neglect. Approximately 75 percent of all physical domestic violence results in injuries to the head, neck, and/or mouth area, clearly visible to the dental team during examinations and treatment. The goal of this project was to gather a comprehensive understanding of predoctoral dental students' perceptions of the culture of abuse and neglect and their level of fluency regarding their rights and responsibilities as mandated reporters. This article aims to inform dental educators of dental students' level of awareness of elder abuse and neglect in order to highlight content areas to be addressed in dental school curricula and clinical training. A twenty-four-item survey was administered to 291 predoctoral dental students at the University of California, Los Angeles School of Dentistry. The results are organized into three general areas: prior training and education; perceptions of the culture of abuse and neglect; and knowledge of mandated reporter legal responsibilities and protections. Overall, this study found that most students do not feel adequately trained to report a case of elder abuse. Data from this study suggest that dental students need education on the psychosocial aspects of older adulthood, as well as training in detecting and reporting elder abuse.

Viral nanoparticles donning a paramagnetic coat: conjugation of MRI contrast agents to the MS2 capsid.

A nanoparticle magnetic resonance imaging (MRI) contrast agent was developed by conjugation of more than 500 gadolinium chelate groups onto a viral capsid. The high density of paramagnetic centers and slow tumbling rate of modified MS2 capsids provided enhanced T1 relaxivities up to 7200 mM-1s-1 per particle. A bimodal imaging agent was generated by sequential conjugation of fluorescein and Gd3+ chelate. These results illustrate the potential for engineering natural protein assemblies to address bionanotechnology applications.