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Introduction: Social determinants of health, including one’s neighborhood environment, are a fundamental cause of health inequities. Low neighborhood socioeconomic status (NSES) is associated with adverse psychosocial and physical health profiles, yet limited data exists among Asian Americans. Our study aim was to determine the association between NSES with depressive symptoms and psychological distress among Asian American adults in New York City (NYC). Methods: The NYC Community Health Survey (CHS) is a population based annual telephone survey used to track the health of NYC residents. It is conducted in five languages including Mandarin and Cantonese. Data are weighted to be representative of NYC as a whole. Our sample included data from 4,557 Asian American participants of the 2017-2020 CHS cycles who were geolinked to their respective neighborhoods, conceptualized as the community district (CD). From publically available CD profiles, we constructed a NSES factor score from four indicators: proportion of the CD unemployed, in poverty, with a high rent burden, and with less than a high school education. Psychosocial health was measured using the Kessler-6 (K6) for nonspecific psychological distress and the 8-item Patient Health Questionnaire (PHQ8) for depressive symptoms, with higher scores indicating worse psychosocial health. We used hierarchical linear models to determine the association between NSES tertile with outcomes stratified by Asian sub-group or region (Chinese, Indian subcontinent, or other Asian). Models were adjusted for individual level age, sex, income, and education. All analyses accounted for the complex survey design of the CHS. Results: Among NYC Asian American residents, 52.1% were women, 45% were age 25-44 years, 25% had less than a high school education, and 56% lived below 200% of the federal poverty level. Among Chinese residents of NYC, living in a neighborhood of low compared with high NSES, was associated with lower PH8 score (beta: -0.65, 95% CI: -1.10, -0.19). Among residents of NYC with heritage from the Indian subcontinent, living in a neighborhood of low compared with high NSES, was associated with a higher K6 score (beta: 1.27, 95% CI: 0.59, 1.95). Associations were not significant among other Asians or for other outcomes. Conclusion: Our results indicate a heterogeneous association between NSES with psychosocial health among Asian Americans of NYC, persisting beyond individual-level SES. Low NSES was associated with adverse psychosocial health among Asians from the Indian subcontinent but better psychosocial health among Chinese Americans. Further examination into potential sources of resilience such as social cohesion, for Chinese American residents residing in low resourced neighborhoods, is warranted.

Supplemental Digital Content is available in the text., Problem Value-added medical education (VAME) has been difficult to implement due to student and educator constraints. The COVID-19 pandemic caused mass transitions to online learning, removed students from clinical settings, and underscored students’ desires for meaningful VAME opportunities. The authors introduced the Stanford Frontline COVID-19 Consult Service (SFCS), through which off-service medical and physician assistant (PA) students provided assistance to clinicians in the form of rapid research regarding COVID-19 clinical questions. Approach The SFCS, a student-derived VAME initiative, was implemented from March to May 2020 by Stanford University medical students, PA students, and faculty. SFCS aligned with not only the interests of clinicians and students but also national accreditation standards. Students attended weekly editorial meetings, didactic sessions on literature reviews and information management, and they underwent rigorous training on the peer review process. After 2 months, the authors expanded the service to local community clinicians. Outcomes The SFCS enrolled 16 students, was supported by 13 faculty members, and produced 87 peer-reviewed evidence syntheses. Of the 16 SFCS students, 13 (81%) completed evaluations; of 128 Stanford Primary Care and Population Health clinicians, 48 (38%) completed evaluations. Overall student satisfaction with the SFCS was 4.9/5 (standard deviation [SD] 0.3). Self-assessed achievement of SFCS learning objectives exceeded 90% for all objectives. Overall faculty satisfaction with the SFCS was 4.4/5 (SD 0.8). Most faculty (40/46 [87%]) planned to use the database to answer future COVID-19 questions. Next Steps The SFCS is a novel, student-initiated VAME curriculum focused on increasing students’ meaningful contributions to patient care. The authors will track SFCS students throughout their clerkships to gauge clerkship performance/preparedness, and they will develop training for integrating VAME into preclerkship curricula at other institutions. Given its adaptive, student-driven design, the VAME framework used to develop the SFCS empowers students to create their own personalized, experiential learning.

Background Narrative Medicine may mitigate physician burnout by increasing empathy and self-compassion, and by encouraging physicians to deeply connect with patient stories/experiences. However, Narrative Medicine has been difficult to implement on hectic inpatient teaching services that are often the most emotionally taxing for residents. Objective To evaluate programmatic and learner outcomes of a novel narrative medicine curriculum implementation during inpatient medicine rotations for medical residents. Programmatic outcomes included implementation lessons. Learner outcomes included preliminary understanding of impact on feelings of burnout. Additionally, we developed a generalizable narrative medicine framework for program implementation across institutions. Methods We developed and implemented a monthly 45-min Narrative Medicine workshop on Stanford’s busiest and emotionally-demanding inpatient rotation (medical oncology). Using the Physician Wellbeing Inventory (PWBI, range 1–7; 3–4 = high burnout risk; ≥4, high burnout), we anonymously assessed resident burnout during pre-implementation control year (2017–2018, weeks 1 and 4), and implementation year (2018–2019, weeks 1 and 4). We interviewed program directors and facilitators regarding curriculum implementation challenges/facilitators. Results Residents highly rated the narrative medicine curriculum, and the residency program renewed the course for 3 additional years. We identified success factors for programmatic success including time neutrality, control of session, learning climate, building trust, staff partnership, and facilitators training. During control year, resident burnout was initially high (n = 16; mean PBWI = 3.0, SD: 1.1) and increased by the final week (n = 15; PBWI = 3.4, SD: 1.6). During implementation year, resident burnout was initially similar (n = 13; PBWI = 3.1, SD: 1.9) but did not rise as much by rotation end (n = 24; PBWI = 3.3, SD: 1.6). Implementation was underpowered to detect small effect sizes. Based on our our experience and literature review, we propose an educational competency framework potentially helpful to facilitate inpatient narrative medicine workshops, as a blueprint for other institutions. Conclusions Inpatient Narrative Medicine is feasible to implement during a challenging inpatient rotation and may have important short-term effects in mitigating burnout rise, with more study needed. We share teaching tools and propose a competency framework which may be useful to support development of inpatient narrative medicine curricula across institutions.

Health systems are challenged to provide equitable access to coronavirus disease 2019 (COVID-19) outpatient care during the pandemic. Infected patients may have difficulties accessing regular care and rely on emergency rooms. With the goal to improve system efficiencies and access to care, Stanford launched a designated outpatient COVID-19 "Care and Respiratory Observation of Patients With Novel Coronavirus" clinic in April 2020 in which all adult Stanford patients with newly diagnosed severe acute respiratory syndrome coronavirus 2 were offered follow-up for 2-3 weeks through video, telephone, and in-person encounters. Patients were triaged into risk categories and received home pulse oximeters based on a standardized protocol. Between April 15, 2020, and March 26, 2021, the Care and Respiratory Observation of Patients With Novel Coronavirus clinic enrolled 1317 patients. The clinic provided evaluation of Patients under Investigation, management of acute COVID-19 symptoms, care for COVID-19 patients after hospital discharge, clinical advice, and opportunities for research. The authors share crucial implementation lessons related to team agility, care personalization, and resource optimization.

In response to the COVID-19 pandemic, primary care practices across the United States have transitioned from in-person visits to virtual visits. However, there is limited information regarding the facilitators and barriers to the implementation of such a transition. The objective of this study was to evaluate the short-term implications of rapid transition to video visits at Stanford Primary Care through qualitative interviews with key stakeholders., Background: The coronavirus disease 2019 pandemic spurred health systems across the world to quickly shift from in-person visits to safer video visits. Objective: To seek stakeholder perspectives on video visits' acceptability and effect 3 weeks after near-total transition to video visits. Design: Semistructured qualitative interviews. Setting: 6 Stanford general primary care and express care clinics at 6 northern California sites, with 81 providers, 123 staff, and 97 614 patient visits in 2019. Participants: Fifty-three program participants (overlapping roles as medical providers [n = 20], medical assistants [n = 16], nurses [n = 4], technologists [n = 4], and administrators [n = 13]) were interviewed about video visit transition and challenges. Intervention: In 3 weeks, express care and primary care video visits increased from less than 10% to greater than 80% and from less than 10% to greater than 75%, respectively. New video visit providers received video visit training and care quality feedback. New system workflows were created to accommodate the new visit method. Measurements: Nine faculty, trained in qualitative research methods, conducted 53 stakeholder interviews in 4 days using purposeful (administrators and technologists) and convenience (medical assistant, nurses, and providers) sampling. A rapid qualitative analytic approach for thematic analysis was used. Results: The analysis revealed 12 themes, including Pandemic as Catalyst; Joy in Medicine; Safety in Medicine; Slipping Through the Cracks; My Role, Redefined; and The New Normal. Themes were analyzed using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to identify critical issues for continued program utilization. Limitations: Evaluation was done immediately after deployment. Although viewpoints may have evolved later, immediate evaluation allowed for prompt program changes and identified broader issues to address for program sustainability. Conclusion: After pandemic-related systems transformation at Stanford, critical issues to sustain video visit long-term viability were identified. Specifically, technology ease of use must improve and support multiparty videoconferencing. Providers should be able to care for their patients, regardless of geography. Providers need decision-making support with virtual examination training and home-based patient diagnostics. Finally, ongoing video visit reimbursement should be commensurate with value to the patients' health and well-being. Primary Funding Source: Stanford Department of Medicine and Stanford Health Care.

Background: Asian American individuals comprise the fastest-growing race and ethnic group in the United States. Certain subgroups may be at disproportionately high cardiovascular risk. This analysis aimed to identify cardiovascular and cerebrovascular disease mortality trends in Asian American subgroups. Methods: Age-standardized mortality rates (ASMR), average annual percent change of ASMR calculated by regression, and proportional mortality ratios of ischemic heart disease, heart failure, and cerebrovascular disease were calculated by sex in non-Hispanic Asian American subgroups (Chinese, Filipino, Asian Indian, Japanese, Korean, and Vietnamese), non-Hispanic White, and Hispanic individuals from US death certificates, 2003 to 2017. Results: Among 618 004 non-Hispanic Asian American, 30 267 178 non-Hispanic White, and 2 292 257 Hispanic deaths from all causes, ASMR from ischemic heart disease significantly decreased in all subgroups of Asian American women and in non-Hispanic White and Hispanic women; significantly decreased in Chinese, Filipino, Japanese, and Korean men and non-Hispanic White and Hispanic men and remained stagnant in Asian Indian and Vietnamese men. The highest 2017 ASMR from ischemic heart disease among Asian American decedents was in Asian Indian women (77 per 100 000) and men (133 per 100 000). Heart failure ASMR remained stagnant in Chinese, Korean, and non-Hispanic White women, and Chinese and Vietnamese men. Heart failure ASMR significantly increased in both sexes in Filipino, Asian Indian, and Japanese individuals, Vietnamese women, and Korean men, with highest 2017 ASMR among Asian American subgroups in Asian Indian women (14 per 100 000) and Asian Indian men (15 per 100 000). Cerebrovascular disease ASMR decreased in Chinese, Filipino, and Japanese women and men between 2003 and 2017, and remained stagnant in Asian Indian, Korean, and Vietnamese women and men. The highest cerebrovascular disease ASMR among Asian American subgroups in 2017 was in Vietnamese women (46 per 100 000) and men (47 per 100 000). Conclusions: There was heterogeneity in cardiovascular and cerebrovascular mortality among Asian American subgroups, with stagnant or increasing mortality trends in several subgroups between 2003 and 2017.

Background: Limited disaggregated Asian subgroup data exists on the impact of social determinants of health (SDOH) on optimal cardiovascular (CV) health. Hypothesis: Compared to non-Hispanic whites (NHW), Asian subgroups have a greater likelihood of optimal CV health, but this observation may be attenuated after controlling for SDOH. Methods: We analyzed results from the National Health Interview Survey (2013-2018), a nationally representative sample. Self-reported SDOH variables include demographics, food security, healthcare access, financial security, and neighborhood cohesion. We conducted stepwise, multivariable logistic regression, analyzing the association between race/ethnicity and CV risk profile score iteratively controlling for SDOH, based on the presence of CV risk factors (RF): diabetes mellitus, hypertension, obesity, smoking, insufficient physical activity, and high cholesterol. CV risk profile sum was categorized as optimal (0-1 RF) or sub-optimal (≥ 2 RF). Results: Our study sample included 112,380 individuals [mean age 49.1 (SD 18.6)]: 92.7% NHW, 1.6% Asian Indian, 1.5% Chinese, 1.6% Filipino, and 2.6% other Asian. The final model, adjusted for all domains of SDOH, showed that odds for optimal CV health for Filipinos compared to NHW were not significant (OR= 1.06, 95% CI: 0.90, 1.24, p = 0.47). After adjusting for all SDOH, Chinese had the highest odds of optimal CV health compared to NHWs (OR=2.47, 95% CI: 2.08, 2.94, p < 0.001), while the greatest change was observed for Asian Indians [Model 1: OR 1.94 (95% CI 1.7, 2.22) versus Model 5: OR 1.7 (95% CI 1.47, 1.96)]. Conclusion: Asian Indian, Chinese, and other Asian subgroups had a higher likelihood of optimal CV health compared to NHWs after controlling for SDOH but no significant differences were observed for Filipinos. This association was modestly attenuated only for Asian Indians after controlling for all SDOH. Future research should focus on the modifying effects that race/ethnicity may have on the association between SDOH and optimal CV health.

Introduction: Limited disaggregated Asian subgroup data exist on the association between cardiovascular (CV) risk factors and acculturation level. Hypothesis: The association between acculturation levels and CV risk factors will differ by Asian subgroups. Methods: We used the National Health Interview Survey, a nationally representative US survey, years 2014-18. Acculturation was defined using the sum of: (a) years in the US (b) citizenship (c) English proficiency. An acculturation index was created and categorized as low, moderate, or high (scores of 0-1, 2 and ≥ 3, respectively). Self-reported risk factors included high cholesterol, obesity, tobacco use, physical activity level, diabetes and hypertension. Age-adjusted, weighted proportions were used to compare the prevalence of CV risk factors between Asian subgroups using Rao-Scott Chi Square. Results: Study sample consisted of 10,891 adults, representing 7.5 million US adults ≥ 18 years (46 % male; mean age 48.3 [SD 15.7]). The distribution by race/ethnicity was Asian Indian 15.1%, Chinese 12.9%, Filipino 10.2%, other Asian 18.2%, and NHW 43.7%. We found a positive association between prevalence of high cholesterol and acculturation level among all Asian subgroups, with increases of 50 to 90% when comparing low vs high acculturation ( Table ). Filipinos had a higher prevalence of obesity and tobacco use associated with higher acculturation level (p< 0.05), but this was not observed among other Asian subgroups. In contrast, physical activity levels were higher among Asian subgroups with higher acculturation levels. No differences were seen for prevalence of hypertension or diabetes based on acculturation level. Conclusion: This study demonstrates that acculturation level was associated with higher prevalence of CV risk factors with significant variability among Asian subgroups. It highlights the need for more studies to better understand these differences based on acculturation level and can help inform targeted, culturally specific interventions.

Introduction: Ultra-processed food (UPF) consumption is linked to adverse health outcomes, including cardiovascular disease and all-cause mortality. Asian Americans (AAs) are the fastest growing ethnic group in the United States (US), yet their dietary patterns have seldom been described. Objectives: To characterize UPF consumption among AAs and determine whether acculturation is associated with increased UPF consumption. Methods: The National Health and Nutrition Examination Survey (NHANES) is an annual, cross-sectional survey representative of the US population. We examined NHANES dietary data, combining years in which AAs were over-sampled (2011-2018). We included 2,404 AAs ≥ 18 years old with valid 24-hour dietary recall data. Using day 1 dietary recalls, we characterized UPF consumption as the percentage of caloric intake from UPFs, using the NOVA classification system. This framework classifies foods from any culture based on degree of industrial processing. Acculturation was characterized by nativity, nativity/years in the US, home language, and an acculturation index (based on a sum of levels related to nativity/years in the US and home language). We assessed the relationship between each acculturation measure and UPF consumption using linear regression analyses adjusted for age, sex, marital status, education, income, self-reported health, and self-reported diet quality. All analyses accounted for the complex survey design. Results: Among all AAs, the percentage of caloric intake attributable to UPFs was 39.3% (95% CI: 38.1-40.5). In adjusted regression analyses, UPF consumption was 14% (95% CI: 9.5-17.5; p Conclusions: Among AAs, UPF consumption was common, and acculturation was strongly associated with greater proportional UPF intake. As the US-born AA population continues to grow, UPF consumption in this group is likely to increase. Further research is necessary to characterize trends in dietary patterns across disaggregated AA subgroups to better inform culturally tailored dietary interventions.

Background: Stroke is the 5th leading cause of death in the US. National stroke mortality among Asian subgroups has never been reported. Our objective is to disaggregate national stroke mortality data among the largest Asian American groups by sex and characterize mortality trends across a 12-year period. Methods: We extracted National Vital Statistics System mortality data from 2006 to 2017 for 6 Asian subgroups and non-Hispanic Whites (NHWs). Stroke mortality was classified by ICD-10, including ischemic stroke (I630-699), intracerebral hemorrhage (I610-629), and subarachnoid hemorrhage (I601-609). 2006-2017 American Community Survey population data was extracted to calculate age-standardized mortality rates (AMRs) stratified by sex and race. Results: Participants included 2,593 Asian Indians, 7,585 Filipinos, 8,212 Chinese, 2,551 Koreans, 3,179 Vietnamese, 4,667 Japanese, and 781,966 NHWs. Mortality from hemorrhagic strokes exceeded ischemic stroke in groups except NHW (Figure 1A). From 2006-2017, deaths from ischemic stroke increased for all groups, with higher mortality in Filipino males compared to females (figure 1B). Deaths from subarachnoid hemorrhage increased only in the Vietnamese subgroup (figure 1D). A similar trend was observed for intracerebral hemorrhage in Vietnamese males (figure 1C). Conclusion: Disaggregation of US stroke mortality revealed important variations within the 6 largest Asian subgroups, including increased ischemic stroke mortality in all subgroups and increased hemorrhagic stroke mortality among Vietnamese. Considerations for this variation include differences in risk factor prevalence (cigarette smoking, obstructive sleep apnea) and social determinants of health. Future studies must collect disaggregated Asian subgroup data to provide tailored interventions to further reduce stroke mortality. Figures: See below

Background: Asian Americans (AA) are the fastest growing ethnic group in the United States with high proportions of immigrants. Nativity is important as cancer risk factors vary by country. We sought to understand differences in cancer mortality among AAs by nativity (foreign-born vs. U.S.-born). Methods: Ninety-eight thousand eight hundred and twenty-six AA (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) decedents with cancer-related deaths from U.S. death certificates (2008–2017) were analyzed. Thirteen cancers that contribute significantly to Asian-American cancer mortality were selected and categorized by etiology: tobacco-related, screen-detected, diet-/obesity-related, and infection-related. Ten-year age-adjusted mortality rates [AAMR; 95% confidence interval (CI); per 100,00] and standardized mortality ratios (SMR; 95% CI) using foreign-born as the reference group were calculated. Results: Overall, foreign-born AAs had higher mortality rates than U.S.-born. Japanese U.S.-born males had the highest tobacco-related mortality rates [foreign-born AAMR: 43.02 (38.72, 47.31); U.S.-born AAMR: 55.38 (53.05, 57.72)]. Screen-detected death rates were higher for foreign-born than U.S.-born, except for among Japanese males [SMR 1.28 (1.21–1.35)]. Diet-/obesity-related AAMRs were higher among females than males and highest among foreign-born females. Foreign-born males and females had higher infection-related AAMRs than U.S.-born; the highest rates were foreign-born males—Korean [AAMR 41.54 (39.54, 43.53)] and Vietnamese [AAMR 41.39 (39.68, 43.09)]. Conclusions: We observed substantial heterogeneity in mortality rates across AA groups and by nativity. Contrary to the Healthy Immigrant Effect, most foreign-born Asians were dying at higher rates than U.S.-born AAs. Impact: Disaggregated analysis of AA cancers, targeted and culturally tailored cancer screening, and treatments for infections among foreign-born Asians is critical for cancer prevention efforts.

Asians have been shown to have a 60% higher prevalence of diabetes than Non-Hispanic Whites (NHWs), with the risk being substantially worse for Asian Indians and Filipinos. The age of diagnosis of diabetes for these subgroups can be a critical indicator of health disparities and may explain the difference in prevalence.

In this manuscript, we discuss critical health outcome differences between the 6 major Asian American subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese) and highlight the critical issues that contribute to the Asian American health disparity gap. We also propose approaches to address these critical issues, with approaches shown effective in other populations.By considering these approaches, we hope that stakeholders of Asian American health outcomes can steer current health research agendas and efforts towards improving Asian health equity.

PurposeBreast cancer is the second leading cause of female cancer mortality in the United States and breast cancer mortality in Asian Americans (AA) is rising by 1.5% per year. However, aggregated AA breast cancer death rates may mask important mortality differences in major AA groups.Population & Setting11,388 AA and 473,927 non-Hispanic White (NHW) females based on the United States Centers for Disease Control and Prevention National Vital Statistics System database 2003-2017.MethodsAge-adjusted mortality rates (AAMR) were used to estimate trends in breast cancer mortality in Asian Indians, Chinese, Filipinas, Japanese, Koreans, Vietnamese, and non-Hispanic Whites from 2003–2017, with attention to annual percentage change (APC) and proportional mortality rates (PMR).ResultsFrom 2003-2017, breast cancer deaths comprised 14.4% in NHWs, 13.7% in aggregate AAs, 19.8% in Asian Indians, and 18.6% of all cancer deaths in Filipinas. While NHW breast cancer mortality rate significantly decreased (APC -2.1; CI -2.6, -1.6; p < 0.001) from 2003 to 2017, aggregate AA mortality rates were unchanged (APC 3.07; CI -0.37, 7.8; p = 0.071). However, when disaggregated, breast cancer mortality in Filipina (APC 1.9; CI 0.8, 3.0; p < 0.002), Chinese (APC 2.1; CI 1.3, 3.0; p < 0.001), and Korean (APC 2.6; CI 1.0, 4.1; p = 0.004) women significantly increased. Breast cancer mortality rates in Japanese women decreased (APC -1.9; CI -5.9, 2.1; p = 0.3).ConclusionWhile the proportion of women dying from breast cancer were similar in NHWs and aggregate Asians, when disaggregated, Filipina, Korean, and Chinese women had increased mortality rates over the past 15 years. During this time, breast cancer mortality in NHW and Japanese women decreased. Understanding disaggregated breast cancer mortality rates in Asians may improve culturally-tailored outreach, prevention, and treatment strategies to reduce cancer deaths from this critical disease.

Objective Asian Indians are among the fastest growing United States (US) ethnic subgroups. We characterized mortality trends for leading causes of death among foreign-born and US-born Asian Indians in the US between 2005–2017. Study design and setting Using US standardized death certificate data, we examined leading causes of death in 73,470 Asian Indians and 20,496,189 non-Hispanic whites (NHWs) across age, gender, and nativity. For each cause, we report age-standardized mortality rates (AMR), longitudinal trends, and absolute percent change (APC). Results We found that Asian Indians’ leading causes of death were heart disease (28% mortality males; 24% females) and cancer (18% males; 22% females). Foreign-born Asian Indians had higher all-cause AMR compared to US-born (AMR 271 foreign-born, CI 263–280; 175.8 US-born, CI 140–221; p Conclusions Foreign-born Asian Indians were 2.2 times more likely to die of heart disease and 1.6 times more likely to die of cancer. Asian Indian male AMR was 49% greater than female on average, although AMR was consistently lower for Asian Indians when compared to NHWs.

Introduction: Medical assistants (MAs) were once limited to obtaining vital signs and office work. Now, MAs are foundational to team-based care, interacting with patients, systems, and teams in many ways. The transition to Virtual Health during the COVID-19 pandemic resulted in a further rapid and unique shift of MA roles and responsibilities. We sought to understand the impact of this shift and to place their new roles in the context of national professional competency standards. Methods: In this qualitative, grounded theory study we conducted semi-structured interviews with 24 MAs at 10 primary care sites at a major academic medical center on their experiences during the shift from in-person to virtual care. MAs were selected by convenience sample. Coding was done in Dedoose version 8.335. Consensus-based inductive and deductive approaches were used for interview analysis. Identified MA roles were compared to national MA, Institute of Medicine, physician, and nursing professional competency domains. Results: Three main themes emerged: Role Apprehension, Role Expansion, and Adaptability/Professionalism. Nine key roles emerged in the context of virtual visits: direct patient care (pre-visit and physical care), panel management, health systems ambassador, care coordination, patient flow coordination, scribing, quality improvement, and technology support. While some prior MA roles were limited by the virtual care shift, the majority translated directly or expanded in virtual care. Identified roles aligned better with Institute of Medicine, physician, and nursing professional competencies, than current national MA curricula. Conclusions: The transition to Virtual Health decreased MA’s direct clinical work and expanded other roles within interprofessional care, notably quality improvement and technology support. Comparison of the current MA roles with national training program competencies identified new leadership and teamwork competencies which could be expanded during MA training to better support MA roles on inter-professional teams.

Due to the energy crisis and exhaustion in the amount of fossil fuels left, there is an urge to increase the penetration of renewables in the grid. This paper deals with the design and control of a hybrid microgrid (HMG) in the presence of variable renewable energy sources. The DC sub-grid consists of a permanent magnet synchronous generator (PMSG) wind turbine, solar PV array with a perturb-and-observe (P&O) MPPT algorithm, boost converter, and battery energy storage system (BESS) with DC loads. The AC sub-grid consists of a PMSG wind turbine and a fuel cell with an inverter circuit synchronized to the grid to meet its load demand. A bidirectional interlinking converter (IC) connects the AC sub-grid and DC sub-grid, which facilitates power exchange between them. The decentralized control of converters allows all the renewables to operate in coordination independently without communication between them. The proposed control algorithm of the IC enables it to act as an active power filter in addition to the power exchange operation. The active power filtering feature of the IC helps to retain the power quality of the microgrid as per IEEE 519 standards by providing reactive power support and reducing the harmonic levels to less than 5%. The HMG with the proposed algorithm can operate in both grid-connected and islanded modes. While operating in grid-connected mode, power exchange between DC and AC sub-grids takes place and all the load demands are met. If it is in islanded mode, a diesel generator supports the AC sub-grid to meet the critical load demands and the BESS supports the DC microgrid. The proposed model is designed and simulated using MATLAB-SIMULINK and its results are analyzed. The efficacy of the proposed control is highlighted by comparing it with the existing controls and testing the HMG for load variations.

Asian Americans (AAs) are heterogeneous, and aggregation of diverse AA populations in national reporting may mask high-risk groups. Gastrointestinal (GI) cancers constitute one-third of global cancer mortality, and an improved understanding of GI cancer mortality by disaggregated AA subgroups may inform future primary and secondary prevention strategies. Using national mortality records from the United States from 2003 to 2017, we report age-standardized mortality rates, standardized mortality ratios and annual percent change trends from GI cancers (esophageal, gastric, colorectal, liver and pancreatic) for the six largest AA subgroups (Asian Indians, Chinese, Filipinos, Japanese, Koreans and Vietnamese). Non-Hispanic Whites (NHWs) are used as the reference population. We found that mortality from GI cancers demonstrated nearly 3-fold difference between the highest (Koreans, 61 per 100 000 person-years) and lowest (Asian Indians, 21 per 100 000 person-years) subgroups. The distribution of GI cancer mortality demonstrates high variability between subgroups, with Korean Americans demonstrating high mortality from gastric cancer (16 per 100 000), and Vietnamese Americans demonstrating high mortality from liver cancer (19 per 100 000). Divergent temporal trends emerged, such as increasing liver cancer burden in Vietnamese Americans, which exacerbated existing mortality differences. There exist striking differences in the mortality burden of GI cancers by disaggregated AA subgroups. These data highlight the need for disaggregated data reporting, and the importance of race-specific and personalized strategies of screening and prevention.

Phosphodiesterases (PDE) are a diverse family of enzymes (11 isoforms so far identified) responsible for the degradation of cyclic adenosine monophosphate (cAMP) and cyclic guanosine monophosphate (cGMP) which are involved in several cellular and biochemical functions. Phosphodiesterase 4 (PDE4) is the major isoform within this group and is highly expressed in the mammalian brain. An inverse association between PDE4 and cAMP levels is the key mechanism in various pathophysiological conditions like airway inflammatory diseases-chronic obstruction pulmonary disease (COPD), asthma, psoriasis, rheumatoid arthritis, and neurological disorders etc. In 2011, roflumilast, a PDE4 inhibitor (PDE4I) was approved for the treatment of COPD. Subsequently, other PDE4 inhibitors (PDE4Is) like apremilast and crisaborole were approved by the Food and Drug Administration (FDA) for psoriasis, atopic dermatitis etc. Due to the adverse effects like unbearable nausea and vomiting, dose intolerance and diarrhoea, PDE4 inhibitors have very less clinical compliance. Efforts are being made to develop allosteric modulation with high specificity to PDE4 isoforms having better efficacy and lesser adverse effects. Interestingly, repositioning PDE4Is towards neurological disorders including Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), multiple sclerosis (MS) and sleep disorders, is gaining attention. This review is an attempt to summarize the data on the effects of PDE4 overexpression in neurological disorders and the use of PDE4Is and newer allosteric modulators as therapeutic options. We have also compiled a list of on-going clinical trials on PDE4 inhibitors in neurological disorders.

Portulaca leaves serve as an alternative bioresource for edible PUFAs. Transcriptome data provide information to explore Portulaca as a model system for galactolipids, leaf lipid metabolism, and PUFA-rich designer lipids. Poly-unsaturated fatty acids (PUFAs) are gaining importance due to their innumerable health benefits, and hence, understanding their biosynthesis in plants has attained prominence in recent years. The most common source of PUFAs is of marine origin. Although reports have identified Portulaca oleracea (purslane) as a leaf source of omega-3 fatty acids in the form of alpha-linolenic acid (ALA), the mechanism of ALA accumulation and its distribution into various lipids has not been elucidated. Here, we present the lipid profiles of leaves and seeds of several accessions of P. oleracea. Among the nineteen distinct accessions, the RR04 accession has the highest amount of ALA and is primarily associated with galactolipids. In addition, we report the transcriptome of RR04, and we have mapped the potential genes involved in lipid metabolism. Phosphatidylcholine (PC) is the major site of acyl editing, which is catalyzed by lysophosphatidylcholine acyltransferase (LPCAT), an integral membrane protein that plays a major role in supplying oleate to the PC pool for further unsaturation. Our investigations using mass spectrometric analysis of leaf microsomal fractions identified LPCAT as part of a membrane protein complex. Both native and recombinant LPCAT showed strong acyltransferase activity with various acyl-CoA substrates. Altogether, the results suggest that ALA-rich glycerolipid biosynthetic machinery is highly active in nutritionally important Portulaca leaves. Furthermore, lipidome, transcriptome, and mass spectrometric analyses of RR04 provide novel information for exploring Portulaca as a potential resource and a model system for studying leaf lipid metabolism.

Cell size and morphology are key adaptive features that influence almost all aspects of cellular physiology such as cell cycle and lipid metabolism. Here we report the role of a transcription factor Suppressor Phenotype of Ty elements insertion 10 (SPT10) of Saccharomyces cerevisiae in regulating cell cycle, cell size and lipid metabolism in concert, in addition to its defined role of histone gene expression. Morphological and biochemical analyses of spt10Δ strain show an abnormal cell size, cell cycle and lipid levels. The expression of Spt10p in spt10Δ strain helps the cell revert to typical wild-type phenotypes. SPT10 controls lipid metabolism by negatively regulating the expression of lipid biosynthetic genes, and positively regulating the expression of the lipid hydrolyzing genes. Spt10p helps in maintaining the cell size by regulating the amount of carbon flux into the phospholipid constituents of the cell membranes. On the contrary, storage lipids have no role in regulating the cell size. An exogenous supply of phosphatidic acid increases the cell size, proving the positive impact of the phospholipids on cell size modulation. SPT10 affects cell cycle, cell size and lipid metabolism by an orchestrated transcriptional regulation of the corresponding genes.

Asian American (AA) diets are naturally adapted to the NOVA dietary recommendations, favoring minimally processed foods. Yet the relationship between dietary intake and metabolic health, among AAs is largely unknown. We examined the association between ultra-processed foods and cardiometabolic health (obesity, hypertension, high cholesterol, and diabetes), among US adults 50 or older reporting a single ethnicity, using the National Health and Nutrition Examination Survey (2001-2018). From multivariable adjusted logistic regression models, the highest compared to the lowest quartile of ultra-processed food intake was associated with obesity only, among AAs (OR: 2.15, 95% CI: 1.04, 4.45), followed by non-Hispanic blacks (OR: 1.73, 95% CI: 1.40, 2.14), non-Hispanic whites (OR: 1.41, 95% CI: 1.19, 1.68), and Hispanics (OR: 1.34, 95% CI: 1.08, 1.65). AAs are more likely than other ethnic/racial groups to be obese when consuming ultra-processed foods. Cultural adaptation of current North American-focused dietary recommendations should drive AA preventive dietary recommendations.

Buglossoides arvensis is an emerging oilseed crop that is rich in stearidonic acid (SDA) and has several potential applications in human health and nutrition. The molecular basis of SDA biosynthesis in this plant remains unknown due to lack of genomic information. To unravel key genes involved in SDA-rich triacylglycerol (TAG) biosynthesis, we performed transcriptome sequencing of pooled mRNA from five different developmental stages of B. arvensis seeds using Illumina NextSeq platform. De novo transcriptome assembly generated 102,888 clustered transcripts from 39.83 million high-quality reads. Of these, 62.1% and 55.54% of transcripts were functionally annotated using Uniprot-Viridiplantae and KOG databases, respectively. A total of 10,021 SSR-containing sequences were identified using the MISA tool. Deep mining of transcriptome assembly using in silico tools led to the identification of genes involved in fatty acid and TAG biosynthesis. Expression profiling of 17 key transcripts involved in fatty acid desaturation and TAG biosynthesis showed expression patterns specific to the development stage that positively correlated with polyunsaturated fatty acid accumulation in the developing seeds. This first comprehensive transcriptome analysis provides the basis for future research on understanding molecular mechanisms of SDA-rich TAG accumulation in B. arvensis and aids in biotechnological production of SDA in other oilseed crops.

Mammalian alpha/beta hydrolase domain (ABHD) family of proteins have emerged as key regulators of lipid metabolism and are found to be associated with human diseases. Human α/β-hydrolase domain containing protein 11 (ABHD11) has recently been predicted as a potential biomarker for human lung adenocarcinoma. In silico analyses of the ABHD11 protein sequence revealed the presence of a conserved lipase motif GXSXG. However, the role of ABHD11 in lipid metabolism is not known. To understand the biological function of ABHD11, we heterologously expressed the human ABHD11 in budding yeast, Saccharomyces cerevisiae. In vivo [14C]acetate labeling of cellular lipids in yeast cells overexpressing ABHD11 showed a decrease in triacylglycerol content. Overexpression of ABHD11 also alters the molecular species of triacylglycerol in yeast. Similar activity was observed in its yeast homolog, Ygr031w. The role of the conserved lipase motif in the hydrolase activity was proven by the mutation of all conserved amino acid residues of GXSXG motif. Collectively, our results demonstrate that human ABHD11 and its yeast homolog YGR031W have a pivotal role in the lipid metabolism.

Foodomics is a science of this millennium and encompasses the advanced technologies of omics in the field of food science. With change in food habits and food culture, increased transportation of food, processing and storage, the quality of food is always a cause of concern. While traditional food testing laboratories depended on chemical analysis of the food samples, recent trends in omics allow to understand and comprehend the changes in the food at the genomic, transcriptomic and metabolomic level. These techniques, apart from assuring quality of the food, also contribute towards food safety methods in terms of checking for adulteration and identification of food spoilage. These are very important to ensure prevention of food borne pathogens and diseases. Foodomics also helps in profiling a food sample for all its macro and micro constituents, in ascertaining the role of nutraceuticals and functional foods in human health, in the functionality and metabolism of food, in safety and traceability of foods. While there are many research publications on the various aspects of food where foodomics can be applied, this chapter is an effort to provide, in a concise manner, the advantages of this new field and its applications in the area of food science and technology.

As of mid-April, Coronavirus Disease 2019 (COVID-19) has infected over 2 million people and resulted in nearly 150,000 deaths worldwide. This pandemic is principally a global health emergency, but the disease burden unavoidably impacts social dynamics and economic stability. While many countries have acted with swift and unified responses aimed at curbing exponential spread of the virus, pandemic interventions in the United States have been decentralized, particularly in the implementation of stay-at-home orders. To date, 8 states have not enacted statewide shelter-in-place measures and the country lacks a cohesive plan for lifting established stay-at-home orders. A thorough accounting of the evidence surrounding the impacts of stay-at-home measures can help guide both policy decisions and individuals’ actions. In this essay, we provide a multidisciplinary review of the effects and implementation of stay-at-home orders. We examine the epidemiological, health, economic, political, and legal issues relevant to assessing the costs and benefits of stay-at-home orders. We conclude that the evidence is in favor of implementing stay-at-home orders and maintaining them for the near future. The burden of these measures is less onerous than the health, economic, and political consequences associated with an acute spike in infections that would result from prematurely lifting aggressive public health interventions. To our knowledge, we present the most in-depth review of the evidence necessary to rigorously evaluate the full breadth of societal consequences associated with stay-at-home orders during the COVID-19 pandemic.

The endoplasmic reticulum (ER) is a multi functional organelle and plays a crucial role in protein folding and lipid biosynthesis. The SEC59 gene encodes dolichol kinase, required for protein glycosylation in the ER. The mutation of sec59-1 caused a protein N-glycosylation defect mediated ER stress resulting in increased levels of phospholipid, neutral lipid and sterol, whereas growth was reduced. In the sec59-1∆ cell, the N-glycosylation of vacuolar carboxy peptidase-Y (CPY) was significantly reduced; whereas the ER stress marker Kar2p and unfolded protein response (UPR) were significantly increased. Increased levels of Triacylglycerol (TAG), sterol ester (SE), and lipid droplets (LD) could be attributed to up-regulation of DPP1, LRO1, and ARE2 in the sec 59-1∆ cell. Also, the diacylglycerol (DAG), sterol (STE), and free fatty acids (FFA) levels were significantly increased, whereas the genes involved in peroxisome biogenesis and Pex3-EGFP levels were reduced when compared to the wild-type. The microarray data also revealed increased expression of genes involved in phospholipid, TAG, fatty acid, sterol synthesis, and phospholipid transport resulting in dysregulation of lipid homeostasis in the sec59-1∆ cell. We conclude that SEC59 dependent N-glycosylation is required for lipid homeostasis, peroxisome biogenesis, and ER protein quality control.

Brown adipose tissue (BAT) is the site of non-shivering thermogenesis in mammals, wherein energy is dissipated as heat. We observed that aqueous extract of black sesame seed triggers an increase in the expression of Uncoupling Protein 1 (UCP1) in brown adipocytes from mice. The active component from the extract was purified and identified to be sesaminol diglucoside (SDG). SDG treatment decreased mass of white fat pads and serum glucose levels and increased UCP1 levels in BAT thereby protecting mice against high fat induced weight gain. Further in silico and in vitro studies revealed that these effects are due to the agonist like behaviour of SDG towards beta 3 adrenergic receptors (β3-AR). Together, our results suggest that SDG induces BAT mediated thermogenesis through β3-AR and protects mice against diet-induced obesity.