To identify factors that regulate gut microbiota density and the impact of varied microbiota density on health, we assayed this fundamental ecosystem property in fecal samples across mammals, human disease, and therapeutic interventions. Physiologic features of the host (carrying capacity) and the fitness of the gut microbiota shape microbiota density. Therapeutic manipulation of microbiota density in mice altered host metabolic and immune homeostasis. In humans, gut microbiota density was reduced in Crohn’s disease, ulcerative colitis, and ileal pouch-anal anastomosis. The gut microbiota in recurrent Clostridium difficile infection had lower density and reduced fitness that were restored by fecal microbiota transplantation. Understanding the interplay between microbiota and disease in terms of microbiota density, host carrying capacity, and microbiota fitness provide new insights into microbiome structure and microbiome targeted therapeutics.Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

PurposeHealth disparities related to breast and cervical cancer among African American and African-born Muslim women in the United States have been identified in previous literature. Our study aimed at exploring the breast and cervical screening rates and factors that influence this population's disposition to adhere to cancer screening exams.MethodsMixed methods were used to collect data with African American and African-born Muslim women in New York City. Data were collected from a total of 140 women; among them, 40 participated in four focus groups.FindingsFocus groups revealed nine themes: healthcare practices; lack of knowledge/misconceptions; negative perceptions and fear; time; modesty; role of religion; role of men; role of community; stigma and shame. Among 130 women who reported their cancer screening status, 72.3% of those age 21 and over were adherent to cervical cancer screening; 20.0% never had a Pap test. Among women age 40 and over, 80.2% reported adherence to recommended mammogram; 12.8% never had one. Among women under age 40, 52.2% had their last clinical breast exam (CBE) less than three years ago. Among women age 40 and over, 75.0% were adherent to yearly CBE.ConclusionsWhile rates of screenings were above the national average and higher than expected, specific barriers and facilitators related to religious and health beliefs and attitudes that influence the decision to adhere to screening were revealed. These factors should be further explored and addressed to inform future research and strategies for promoting regular breast and cervical cancer screenings.

Highlights MS patients were more anxious, depressed and stressed during the COVID-19 pandemic than their caregivers and the general population. Younger patients, those with high EDSS scores and those who believed that MS patients are at high risk for COVID-19 infection were more anxious. The patients’ knowledge about the factors that may affect the risk for COVID-19 infection was poor. Though they were more anxious, they were not more committed – in contrast to what would be expected - to follow the basic preventive measures for staying safe during the pandemic than the general population.

Summary 34To identify factors that regulate the absolute microbiota and the impact of varied microbiota density on health, we assayed 35 gut microbiota density across mammals, disease, and therapeutic interventions. Physiologic features of the host (carrying 36 capacity) and the fitness of the gut microbiota shape microbiota density. Therapeutic manipulation of microbiota density in 37 mice altered host metabolic and immune homeostasis. In humans, gut microbiota density was reduced in Crohn's disease, 38 ulcerative colitis, and ileal pouch-anal anastomosis. The gut microbiota in recurrent Clostridium difficile infection had lower 39 density and reduced fitness that were restored by fecal microbiota transplantation. Understanding the interplay between 40 microbiota and disease through the conceptual framework of microbiota density, host carrying capacity, and microbiota fitness 41 could provide biomarkers to identify candidates for microbiota therapeutics and monitor their response.

Objective: Cancer mortality in the U.S. Deep South exceeds national levels. A cross-sectional survey was undertaken across Alabama to discern cancer beliefs and screening practices, and compare data from racial/ethnic minority versus majority and rural versus urban respondents. Methods: Using population-based methods, we approached 5,633 Alabamians (ages 50-80) to complete a 58-item survey (administered in-person, via telephone, or the web). Descriptive statistics were used to summarize findings; two-tailed, chi-square and t-tests (α<0.05) were used to compare minority-majority and rural-urban subgroups. Results: The response rate was 15.2%; respondents identified as minority (n=356) or majority (n=486), and rural (n=671) or urban (n=183). Mean (SD) age was 63.7 (10.2) and >90% indicated stable housing, and healthcare coverage and access. Rural and minority versus urban and majority respondents were significantly more likely to have lower education, employment, and income, respectively. Most respondents equated cancer as a “death sentence” and were unable to identify the age at which cancer screening should begin. Few rural-urban subgroup differences were noted, though significant differences were observed between minority versus majority subgroups for mammography (36.7% versus 49.6%, p<.001) and colorectal cancer screening (34.5% vs. 47.9%, p <0.001). Furthermore, while minorities were significantly more likely to report ever having a colonoscopy (82.1% versus 76.1%, p =0.041) and to have received fecal occult blood testing within the past year (17.2% versus 12.2%, p =0.046), routine adherence to screening was <20% across all subgroups. Discussion: Cancer early detection education is needed across Alabama to improve cancer screening, and particularly needed among racial/ethnic minorities to raise cancer awareness.