Claudins provide tight junction barrier selectivity. The human CLDN5 gene contains a high-frequency single-nucleotide polymorphism (rs885985), where the G allele encodes for glutamine (Q) and the A allele encodes for an amber stop codon. Thus, these different CLDN5 alleles define nested open reading frames (ORFs) encoding claudin-5 proteins that are 303 or 218 amino acids in length. Interestingly, human claudin-16 and claudin-23 also have long ORFs. The long form of claudin-5 contrasts with the majority of claudin-5 proteins in the National Center for Biotechnology Information protein database, which are less than 220 amino acids in length. Screening of genotyped human lung tissue by immunoblot revealed only the 218–amino acid form of claudin-5 protein; the long-form claudin-5 protein was not detected. Moreover, when forcibly expressed in transfected cells, the long form of human claudin-5 was retained in intracellular compartments and did not localize to the plasma membrane, in contrast to the 218–amino acid form, which localized to intercellular junctions. This suggests that the 303–amino acid claudin-5 protein is rarely expressed, and, if so, is predicted to adversely affect cell function. Potential roles for upstream ORFs in regulating claudin-5 expression are also discussed.

Background African American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) has shown to be an effective modality for helping patients improve health behaviors and regulate emotional states. Motivational interviewing (MI) addresses participant engagement and motivation. Therefore, MI was combined with CBT as an approach to the process of learning using CBT skills to promote healthy lifestyle choices. We aimed to assess the effects of a culturally tailored CBT/MI intervention on glycemic control in AA participants and understand their perspectives, attitudes, and experiences while participating in this intervention. Methods Using a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged ≥ 18 years, identifying as AA and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. A CBT/MI intervention was administered in six sessions over 3 months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life, and cognitive ability. Post-CBT/MI intervention focus groups were conducted to determine patient perspectives regarding the intervention. Results Fourteen participants completed the study, their mean HbA1c improved from 10.0 to 8.9% (t(26) = 0.5, p-value = 0.06). The Diabetes Distress Scale demonstrated decreased distress overall (t(26) = 2.6; p-value = 0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26) = 2.2; p = 0.04). Themes identified in focus groups included (1) intervention group social support through information sharing, (2) mental health and personal identities in diabetes understanding and management, and (3) receptivity to CBT/MI intervention positively impacts self-efficacy through improved health literacy. Conclusion This group-based, culturally tailored CBT/MI intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan using a CBT/MI intervention may be useful in promoting healthy diabetes self-management. Trial registration ClinicalTrials.gov, NCT03562767. Registered on 19 June 2018

Background As awareness of perinatal health disparities grows, many birthing people of color are seeking racially and/or culturally concordant providers. We described preferences for, and perceptions of, racial and/or cultural concordance and cultural competence in the context of the doula–client relationship. Methods Seven focus group discussions (FGDs) with a total of 27 participants were conducted to investigate the perspectives of patients and doulas across Massachusetts, United States. An interdisciplinary stakeholder group informed the data collection instrument content and design. Two coders achieved 0.89 Kappa for inter‐rater reliability prior to coding the remaining transcripts. We used a modified grounded theory approach and Dedoose software for coding. Results Two major themes emerged. First, cultural competency in doula care is a learning process, with definitions consistent with terms such as “cultural humility” and “structural competency.” Doulas discussed listening to clients' needs rather than making assumptions, the importance of understanding privilege and power dynamics, and self‐initiating relevant education beyond formal doula training. Second, trust was most frequently cited as an indicator of successful doula–patient relationships. Conclusions Most study participants specified the importance of cultural humility in doula–client relationships. Doulas approaching the relationship humbly with a willingness to learn and challenge their own assumptions—regardless of the level of concordance—can make a meaningful impact on the perinatal experience.

BackgroundAfrican American (AA) adults are 60% more likely to be diagnosed with diabetes mellitus (DM) and experience more complications than non-Hispanic White adults. Cognitive behavioral therapy (CBT) is a technique that combines traditional care with cognitive and psychosocial techniques. We aimed to assess the effects of CBT integrated with motivational interviewing (MI) on glycemic control in AA participants and understand their perspectives, attitudes, and experiences toward CBT. MethodsUsing a randomized, parallel design pilot study (web-based group vs in-person group), 20 participants aged >18 years, identifying as AA, and having a glycosylated hemoglobin (HbA1c) > 8%, were recruited. CBT was administered in six sessions over three months. Participants completed baseline and follow-up assessments on measures for diabetes control (HbA1c), self-efficacy, generalized anxiety, depression, perceived stress, health-related quality of life and cognitive ability. Post-CBT focus groups were conducted to determine patient perspectives regarding the intervention. ResultsFourteen participants completed the study, their mean HbA1c improved from 8.5% to 7.7%. The Diabetes Distress Scale demonstrated decreased distress overall (t(26)=2.6; p- value=0.02). The Generalized Anxiety Disorder Scale demonstrated decreased generalized anxiety for all participants (t(26)=2.2; p =0.04). Themes identified in focus groups included: (1) intervention group social support through information sharing; (2) mental health and personal identities in diabetes understanding and management; (3) receptivity to CBT/MI Intervention positively impacts self-efficacy through improved health literacy. ConclusionGroup-based CBT intervention for type 2 DM care was positively received by AA participants and helped improve diabetes control, as demonstrated by the change in HbA1c. There were additional benefits of social support through group interactions and a stronger sense of self-efficacy due to health education. A comprehensive treatment plan like CBT, may be useful in promoting healthy diabetes self-management.Trial registrationThis trial is registered at ClinicalTrials.gov with the identifier NCT03562767. 70 Registered 19 June 2018, https://clinicaltrials.gov/ct2/show/NCT03562767?term=NCT03562767&draw=2&rank=1