IMPORTANCE Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. Fecal occult blood testing (FOBT) is one recommended screening modality that may overcome cost and access barriers. However, the ability of FOBT to reduce CRC mortality depends on high rates of adherence to annual screening. OBJECTIVE To determine whether a multifaceted intervention increases adherence to annual FOBT compared with usual care. DESIGN, SETTING, AND PARTICIPANTS Patient-level randomized controlled trial conducted in a network of community health centers. Included were 450 patients who had previously completed a home FOBT from March 2011 through February 2012 and had a negative test result: 72% of participants were women; 87% were Latino; 83% stated that Spanish was their preferred language; and 77% were uninsured. INTERVENTIONS Usual care at participating health centers included computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates. The intervention group also received (1) a mailed reminder letter, a free FIT with low-literacy instructions, and a postage-paid return envelope; (2) an automated telephone and text message reminding them that they were due for screening and that a FIT was being mailed to them; (3) an automated telephone and text reminder 2 weeks later for those who did not return the FIT; and (4) personal telephone outreach by a CRC screening navigator after 3 months. MAIN OUTCOMES AND MEASURES Completion of FOBT within 6 months of the date the patient was due for annual screening. RESULTS Intervention patients were much more likely than those in usual care to complete FOBT (82.2% vs 37.3%; P < .001). Of the 185 intervention patients completing screening, 10.2% completed prior to their due date (intervention was not given), 39.6% within 2 weeks (after initial intervention), 24.0% within 2 to 13 weeks (after automated call/text reminder), and 8.4% between 13 and 26 weeks (after personal call). CONCLUSIONS AND RELEVANCE This intervention greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01453894

INTRODUCTION:Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66 % were female, 62.1 % were Latino, and 70.7 % were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7 % vs. 14.8 %; p<0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.KEY WORDS: health disparities; cancer prevention; care delivery system.

Two broiler lines A and B were fed experimental diets from 21 to 42 days with an objective to determine Pectoralis major protein turnover (PT) as affected by the dietary amino acid (AA) levels and ambient temperature. Experimental diets (n = 9 replicate pens per diet) were formulated to 3,150 kcal/kg with five levels of digestible lysine (dLys) −80, 90, 100, 110 and 120% of recommended AA level giving g dlys/Mcal values of 2.53, 2.85, 3.17, 3.48 and 3.80 respectively. All other AA was formulated to a fixed ratio to dLys. Fractional synthesis or degradation rates (FSR or FDR) of P. major were measured on day 36 and day 42 for all dietary treatment levels for both broiler lines using stable isotope of AA (15N‐phenylalanine) as metabolic tracer. Experimental feeding studies were conducted once in hot season (24‐hr mean ~ 85.3°F; 80.9% RH) and repeated in cool season (24‐hr mean ~ 71.6°F; 61.7% RH) of the year. The FSR values increased (p < .05) as digestible AA in diet increased for both broiler lines in hot season until break point FSR occurring at 106.2% AA level. The average FSR values measured were higher for Line B at day 36 (20.98%/D for Line B vs. 20.69%/D for Line A) and at day 42 (16.07%/D for Line B vs. 12.47% D for Line A). FDR values observed at day 36 and day 42 were not different between lines (p > .05). Similar trends but elevated values of FSR and FDR in cool season than in hot season were recorded for both the lines. Line B showed the higher mixed muscle protein accretion (%/D) than Line A by actually increasing the FSR which was correlated by higher lean mass deposition and higher feed intake (p < .05). The overall findings indicated that PT response in P. major due to effects of digestible AA levels and ambient temperature was different and line‐specific.

Selection for quantitative traits in meat broilers such as breast yield and growth rate exert physiological pressure leading to ante mortem histological and biochemical alterations in muscle tissues. The poultry industry has recently witnessed a myopathy condition affecting Pectoralis major (breast muscle) of broilers, called woody breast (WB), an etiology still unclear to scientific community. A study was conducted to characterize the WB myopathy in a meat broiler line at its finishing phase (d 41) in terms of heat production (HP), microbiota and plasma metabolites. Two treatment groups were studied-WB affected (myopathy) and normal (non-myopathy) broiler; n = 20 in each group. Indirect calorimetry was utilized for HP measurement. Furthermore, body composition (BC) analysis was also performed using dual-energy x-ray absorptiometry (DEXA). Microbiota in ileal digesta was studied with PCR amplified 16s rRNA gene. LC-MS targeted metabolomics was performed to understand differential expression of plasma metabolites. Results showed that there was difference in fasting HP (P < 0.05) between these two treatment groups, with non-myopathy broiler producing more heat which was indicative of higher body protein content validated by higher protein: fat ratio by BC results. Less protein content in myopathy bird could be due to probable higher mixed muscle degradation occurring in lean tissue as marked by elevated 3-methylhistidine expression in plasma. Microbiota results showed unclassified Lactobacillus as predominant genus with higher abundance occurring in myopathy group; whereas at species level, L. acidipiscis was predominant bacteria for non-myopathy broiler. Differentially significant metabolites (P < 0.05) identified from plasma metabolome between these two treatment groups were homocysteine, cyclic GMP, trimethylamine N-oxide (TMAO), tyramine, carnitine, and acetylcarnitine, which were all associated to cardiovascular system. The findings suggest that more research in meat broilers could be opted toward delivering reduced vascularity issues to alleviate this myopathy condition.

BackgroundColorectal cancer (CRC) is common and leads to significant morbidity and mortality. Although screening with fecal occult blood testing (FOBT) or endoscopy has been shown to decrease CRC mortality, screening rates remain suboptimal. Screening rates are particularly low for people with low incomes and members of underrepresented minority groups. FOBT should be done annually to detect CRC early and to reduce CRC mortality, but this often does not occur. This paper describes the design of a multifaceted intervention to increase long-term adherence to FOBT among poor, predominantly Latino patients, and the design of a randomized controlled trial (RCT) to test the efficacy of this intervention compared to usual care.MethodsIn this RCT, patients who are due for repeat FOBT are identified in the electronic health record (EHR) and randomized to receive either usual care or a multifaceted intervention. The usual care group includes multiple point-of-care interventions (e.g., standing orders, EHR reminders), performance measurement, and financial incentives to improve CRC screening rates. The intervention augments usual care through mailed CRC screening test kits, low literacy patient education materials, automated phone and text message reminders, in-person follow up calls from a CRC Screening Coordinator, and communication of results to patients along with a reminder card highlighting when the patient is next due for screening. The primary outcome is completion of FOBT within 6 months of becoming due.DiscussionThe main goal of the study is to determine the comparative effectiveness of the intervention compared to usual care. Additionally, we want to assess whether or not it is possible to achieve high rates of adherence to CRC screening with annual FOBT, which is necessary for reducing CRC mortality. The intervention relies on technology that is increasingly widespread and declining in cost, including EHR systems, automated phone and text messaging, and FOBTs for CRC screening. We took this approach to ensure generalizability and allow us to rapidly disseminate the intervention through networks of community health centers (CHCs) if the RCT shows the intervention to be superior to usual care.Trial registrationClinicalTrials.gov NCT01453894

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Two meat-type broiler strains, strain A and strain B, were reared in floor pens (25 birds/pen; 45 pens/strain) for pectoralis (P) major collagen and mixed muscle protein turnover ( PT ) study from 0–56 D using primary breeder nutrition and husbandry guidelines. Forty broilers (n = 10/strain for collagen PT; n = 10/strain for mixed muscle PT) were selected at each sampling age at day 21, 28, 35, 42, and 56 and infused with 1- 13 C proline ( Pro ) and 15 N-phenylalanine ( Phe ) which are used as amino acid tracers for collagen and mixed muscle PT measurements, respectively. Muscle and plasma samples were collected, and enrichments of 1- 13 C Pro and 15 N-Phe were determined using mass spectrometry. Fractional synthesis rate ( FSR ) and fractional degradation rate ( FDR ) were measured for collagen and mixed muscle using precursor-product principle. At day 42, after separating the sampled broilers as myopathy (woody breast [ WB ] score > 1) and nonmyopathy (WB = 0), plasma metabolites were screened for differential 3-methyhistidine ( 3-MH ) expression for both strains. Data were analyzed using one-way ANOVA using t test. Results showed that collagen and mixed muscle FSR and FDR in pectoralis major decreased ( P < 0.05) for both strains as the broilers aged. FSR for collagen and FDR for mixed muscle were higher for strain B than those for strain A ( P < 0.05). Total collagen was higher ( P < 0.05) for strain B. Differentially expressed 3-MH in plasma was higher ( P < 0.05) for myopathy-affected broilers indicating greater muscle degradation occurring in myopathy-affected broiler types for both strains. 3-MH Expression in plasma was higher for strain B than for strain A. The research findings showing an increased collagen content per unit muscle weight in pectoralis major in strain B (than in strain A) could be due to higher mixed muscle FDR and increased collagen FSR occurring during the grow-out period. The increased degradation of muscle fibers and probable replacement of muscle-specific protein with connective tissue, mainly collagen, was an evident pathophysiological phenomenon occurring in myopathy-affected broilers.

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