Recent studies indicate that milk from healthy mothers may harbor potential probiotics. Nonetheless, the distribution of bacterial profiles in human milk samples in Taiwan is not fully understood. Therefore, with the aim to address this question, in this study, milk samples were collected from 33 healthy mothers (D1 to D33) visiting our hospital during a 6-month period. The milk microbiota was analyzed by a molecular approach (Illumina MiSeq sequencing). The results indicate that the milk samples have a unique profile and patterns of bacterial abundance levels. Moreover, in colostrum and transitional-milk samples, we detected 154 and 127 bacterial species, respectively, and these sets shared 42.6% of the bacterial species. The most common bacterial species among all milk samples were Staphylococcus epidermidis, Streptococcus lactarius, and Staphylococcus hominis, suggesting that the skin contamination route plays an important role in the composition of the milk microbiota. Nevertheless, four Lactobacillus species, Lactobacillus helveticus, Lactobacillus iners, Lactobacillus zeae, and Lactobacillus gasseri, were present in only 7 samples (21% prevalence), and bifidobacterial species were quite rare taxa among the present samples. The Staphylococcus aureus was detected in a total of 15 samples (45% prevalence), suggesting that this species may be commonly present in milk samples. In conclusion, each milk sample revealed a unique profile and patterns of bacterial abundance levels, and our data do not support the idea that lactobacilli and bifidobacteria are common and abundant in modern milk samples. Because none of the donors of the milk samples showed mastitis or any discomfort during the sampling process or at follow-up inspection, the microbiota of these milk samples is not likely to negatively affect its host. This study provides new information on the proportions of commensal bacteria in human milk in Taiwan.

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In this study, we investigated how people evaluate behavioral interventions (BIs) that are targeted at themselves, aiming to promote their own health and wellbeing. We compared the impact on people's assessments of the acceptability of using BIs to change their own behavior of: the transparency of the BI (transparent or opaque); the designer of the BI (researchers, government policy-makers, advertisers); and three types of arguments regarding their efficacy (positive, positive + negative, negative). Our target BIs were actual interventions that have been used in a range of policy domains (diet, exercise, alcohol consumption, smoking, personal finances). We found that transparent BIs were considered more acceptable than opaque BIs. On average, all BIs were considered acceptable for changing participants’ own behavior, except for the opaque BI in the finance context; there was differential acceptability of BIs across contexts, with finance clearly least acceptable. However, the perceived effectiveness of the BIs was at least as influential a predictor of acceptability ratings as the ease of identification of the behavior change mechanism across the five contexts. Furthermore, effectiveness was partially mediated by desire to change, suggesting that people do think BIs make them better off, ‘as judged by themselves’.

Background: For decades, U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations vary from state-to-state ranging from autonomous practice to direct physician oversight. The purpose of this study was to determine if clinical outcomes of older rural adult patients vary by the level of practice autonomy that states grant to NPs. Methods: This cross-sectional study analyzed data from a sample of Rural Health Clinics (RHCs) (n = 503) located in eight Southeastern states. Independent t-tests were performed for each of five variables to compare patient outcomes of the experimental RHCs (those in “reduced practice” states) to those of the control RHCs (in “restricted practice” states). Results: After matching, no statistically significant difference was found in patient outcomes for RHCs in reduced practice states compared to those in restricted practice states. Yet, expanded scope of practice may improve provider supply, healthcare access and utilization, and quality of care (Martsolf et al., 2016). Conclusions: Although this study found no significant relationship between Advanced Registered Nurse Practitioner (ARNP) scope of practice and select patient outcome variables, there are strong indications that the quality of patient outcomes is not reduced when the scope of practice is expanded.

Recent reports have shown that food-borne or commensal bacteria can function as reservoirs of antibiotic resistance. However, the antibiotic susceptibility of bacterial isolates of most milk samples or the total bacterial counts (TBC) in human milk from healthy donors, are not fully understood in Taiwan. Thus, five healthy mothers were randomly recruited each month, and totally 30 mothers without any symptoms of infection were recruited over 6 months. Milk samples were then harvested and analyzed immediately after collection. The antibiotic susceptibility was analyzed in bacteria isolated from milk samples using nine clinically relevant antibiotics, such as oxacillin, ampicillin, cephalothin, amoxicillin, ciprofloxacin, erythromycin, clindamycin, gentamicin, and oxytetracycline. The Staphylococcus strains (48 isolates) found in milk resisted to 48.6 ± 20.1% selected antibiotics. Streptococcus-related isolates (8 isolates) exhibited resistance to 41.7 ± 26.4% selected antibiotics. Acinetobacter isolates (5 isolates) were resistant to 66.7 ± 13.6% antibiotics, and Enterococcus isolates (5 isolates) were resistant to 73.3 ± 6.1% tested antibiotics. Rothia-related isolates (4 isolates) were resisted to 58.2 ± 31.9% of tested antibiotics. In contrast, Corynebacterium isolates (5 isolates) were sensitive to 66%-100% of selected antibiotics. Furthermore, the TBC ranged from 40 to 710,000 CFU/ml, implying a wide spectrum of bacteria in milk from healthy mothers. Despite this, all milk donors were healthy during sampling, and they did not show any symptoms related to mastitis or subclinical mastitis. According to the previously described TBC criteria for the use of donated human milk, only 73% of the current milk samples could be accepted for the milk bank. In conclusion, the majority of the isolated bacterial strains from current human milk samples are multiresistant strains. In milk samples for preterm infants or milk banks, higher TBC levels or potentially antibiotic-resistant bacteria in some milk samples have supported people using approaches to disinfect human milk partially.

Over the last few years, faceted search emerged as an attractive alternative to the traditional "text box" search and has become one of the standard ways of interaction on many e-commerce sites. However, these applications of faceted search are limited to domains where the objects of interests have already been classified along several independent dimensions, such as price, year, or brand. While automatic approaches to generate faceted search interfaces were proposed, it is not yet clear to what extent the automatically-produced interfaces will be useful to real users, and whether their quality can match or surpass their manually-produced predecessors. The goal of this paper is to introduce an exploratory search interface called ImageSieve, which shares many features with traditional faceted browsing, but can function without the use of traditional faceted metadata. ImageSieve uses automatically extracted and classified named entities, which play important roles in many domains (such as news collections, image archives, etc.). We describe one specific application of ImageSieve for image search. Here, named entities extracted from the descriptions of the retrieved images are used to organize a faceted browsing interface, which then helps users to make sense of and further explore the retrieved images. The results of a user study of ImageSieve demonstrate that a faceted search system based on named entities can help users explore large collections and find relevant information more effectively.

Is the inferred preference from a choice to donate stronger when the choice was made under a mandated rather than the automatic default (nudged choice) legislative system?The answer to this is particularly important because families can, and do, veto the choices of their deceased relatives. In three studies, we asked American and European participants from countries that have either a default opt-in or default opt-out system to take on the role of a third party to judge the likelihood that an individual's "true wish" was to actually donate their organs, given that they were registered to donate on the organ donation register. In each study, participants were randomly assigned to one of the organ donation legislative systems (default opt-in, default opt-out, mandated choice or mandatory). Overall, regardless of which country participants came from, they perceived the donor's underlying preference to donate as stronger under the default optin and mandated choice systems as compared to the default opt-out and mandatory donor systems. We discuss the practical issues that result from using default systems in the domain of organ donation and propose potential ways to ameliorate the uncertainty around inferences of underlying preference from a nudged choice. Word count: 196