Drawing on the Strengths of Community Health Workers to Address Sexually Transmitted Infections: Roles, Medicaid Reimbursement, and Partnerships

Rates of bacterial sexually transmitted infections (STIs) in the United States are high and, largely, still soaring. Though chlamydia cases have decreased slightly since 2017, gonorrhea and syphilis have increased by 25% and 68%, respectively, and congenital syphilis has increased by 184%. Bacterial STI can lead to pain, infertility, and even, in the case of syphilis and congenital syphilis, death. With appropriate detection and treatment, all of these STIs are curable. And yet a range of barriers between communities and the healthcare system perpetuate the STI epidemic. Community health workers (CHWs) could play a key role in helping bridge the gap between the public health and healthcare systems and communities to provide STI education, prevention, detection and treatment services. The Medicaid program, which covers 89 million Americans, is slowly beginning to include CHWs into payment models. However, to date, CHWs’ potential to help address STIs has not been fully explored. This study was undertaken to identify ways that CHWs could be integrated into the STI field with the support of Medicaid coverage and in collaboration with the existing STI workforce

Chromatin profiling across the human tumour necrosis factor gene locus reveals a complex, cell type-specific landscape with novel regulatory elements

The TNF locus on chromosome 6p21 encodes a family of proteins with key roles in the immune response whose dysregulation leads to severe disease. Transcriptional regulation is important, with cell type and stimulus-specific enhancer complexes involving the proximal TNF promoter. We show how quantitative chromatin profiling across a 34 kb region spanning the TNF locus has allowed us to identify a number of novel DNase hypersensitive sites and characterize more distant regulatory elements. We demonstrate DNase hypersensitive sites corresponding to the lymphotoxin alpha (LTA) and tumour necrosis factor (TNF) promoter regions, a CpG island in exon 4 of lymphotoxin beta (LTB), the 3′ end of nuclear factor of kappa light polypeptide gene enhancer in B-cells inhibitor-like 1 (NFKBIL1) and 3.4 kb upstream of LTA. These sites co-localize to highly conserved DNA sequences and show evidence of cell type specificity when lymphoblastoid, Jurkat, U937, HeLa and HEK293T cell lines are analysed using Southern blotting. For Jurkat T cells, we define histone modifications across the locus. Peaks of acetylated histone H3 and H4, together with tri-methyl K4 of histone H3, correspond to hypersensitive sites, notably in exon 4 of LTB. We provide evidence of a functional role for an intergenic DNase I hypersensitive site distal to LTA in Jurkat cells based on reporter gene analysis, with evidence of recruitment of upstream stimulatory factors (USF) transcription factors

Literatures of resistance under U.S. “cultural siege”: Kazuo Ishiguro’s narratives of occupation

Through close readings of An Artist of the Floating World and The Remains of the Day, supported by references to his other works, this article argues that Japanese-British writer Kazuo Ishiguro’s novels betray an understated but distinct anti-American sentiment. Much has been made of the narcissism of Ishiguro’s narrators and their attempts to manipulate historical and personal records to serve their own purposes. However, one of those purposes that have gone undetected is a willful political resistance to the postwar Americanization of Japan and Europe. In other words, the article argues that the novels discussed are, in fact, works of propaganda and, further, that they evidence, with a high degree of subtlety and linguistic sophistication, Ishiguro’s own concerns that world literature and world culture more broadly were, as a result of World War II, subsumed into the American model, becoming homogenized

Increasing Access to STI Services in the Medicaid Program

The United States is undergoing an epidemic of sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis. All three bacterial infections are detectable and treatable, yet they often go diagnosed. Untreated chlamydia and gonorrhea can lead to serious pelvic infections and infertility; untreated syphilis can result in severe complications, including death. Congenital syphilis is increasing as well, with a concurrent rise in stillbirth and newborn deaths. Increased resources and heightened attention are urgently needed to supplement the work of the public health infrastructure, for which STI funding has remained stagnant for two decades. Fortunately, the Medicaid program is well situated to improve STI services on a broad scale. The federal-state health insurance program covers 73 million people, and is the primary payer for family planning services for low-income women. Medicaid eligibility overlaps significantly with STI risk, and the program already covers a disproportionate share of STI-related visits

Emergence and loss of assortative mating in sympatric speciation

We have studied an agent model which presents the emergence of sexual barriers through the onset of assortative mating, a condition that might lead to sympatric speciation. In the model, individuals are characterized by two traits, each determined by a single locus A or B. Heterozygotes on A are penalized by introducing an adaptive difference from homozygotes. Two niches are available. Each A homozygote is adapted to one of the niches. The second trait, called the marker trait has no bearing on the fitness. The model includes mating preferences, which are inherited from the mother and subject to random variations. A parameter controlling recombination probabilities of the two loci is also introduced. We study the phase diagram by means of simulations, in the space of parameters (adaptive difference, carrying capacity, recombination probability). Three phases are found, characterized by (i) assortative mating, (ii) extinction of one of the A alleles and (iii) Hardy-Weinberg like equilibrium. We also make perturbations of these phases to see how robust they are. Assortative mating can be gained or lost with changes that present hysteresis loops, showing the resulting equilibrium to have partial memory of the initial state and that the process of going from a polymorphic panmictic phase to a phase where assortative mating acts as sexual barrier can be described as a first-order transition. (C) 2009 Published by Elsevier Ltd