Transient microbiota exposures activate dormant Escherichia coli infection in the bladder and drive severe outcomes of recurrent disease

Pathogens often inhabit the body asymptomatically, emerging to cause disease in response to unknown triggers. In the bladder, latent intracellular Escherichia coli reservoirs are regarded as likely origins of recurrent urinary tract infection (rUTI), a problem affecting millions of women worldwide. However, clinically plausible triggers that activate these reservoirs are unknown. Clinical studies suggest that the composition of a woman's vaginal microbiota influences her susceptibility to rUTI, but the mechanisms behind these associations are unclear. Several lines of evidence suggest that the urinary tract is routinely exposed to vaginal bacteria, including Gardnerella vaginalis, a dominant member of the vaginal microbiota in some women. Using a mouse model, we show that bladder exposure to G. vaginalis triggers E. coli egress from latent bladder reservoirs and enhances the potential for life-threatening outcomes of the resulting E. coli rUTI. Transient G. vaginalis exposures were sufficient to cause bladder epithelial apoptosis and exfoliation and interleukin-1-receptor-mediated kidney injury, which persisted after G. vaginalis clearance from the urinary tract. These results support a broader view of UTI pathogenesis in which disease can be driven by short-lived but powerful urinary tract exposures to vaginal bacteria that are themselves not "uropathogenic" in the classic sense. This "covert pathogenesis" paradigm may apply to other latent infections, (e.g., tuberculosis), or for diseases currently defined as noninfectious because routine culture fails to detect microbes of recognized significance

The female body in question: a study of Monique Wittig's writings with particular reference to L'Opoponax

PhDThis thesis is a comprehensive study of Monique Wittig's fiction, in which I explore the links between womanhood, sisterhood and writing. Particular attention is paid to L'Opoponax (1964), in which I argue that Wittig suggests a way out of the impasse of Freudian theories of femininity. This is achieved at all levels: stylistic, formal and thematic. I begin by defining my psychoanalytic and literary contexts (Freud, Klein and Irigaray for the former, contemporary French, English and American women's writing for the latter), in order to introduce the major debates connected with the concept of the female body and its representation in Western culture. I then show how the Freudian drama of sexual difference - namely, castration anxiety as it affects the little girl - is both powerfully evoked and systematically sidestepped in L'Opoponax, with its focus on relationships between women. Using Klein and Irigaray, I describe the problems arising within the mother/daughter dyad. I suggest that L'Opoponax hints at a healed relationship but also leaves much unsorted; this is seen to pull against the radical innovations of later texts, particularly Le Corps lesbien, accounting for some of the violence to be found there. The question of the mother versus the woman is thus not fully closed, but creates a space within which the amantes, female lovers, can begin to live and move. I end by replacing this question within its wider context as it is a crucial one for the future development of feminist writing

Resilience of a eucalypt forest woody understorey to long-term (34–55 years) repeated burning in subtropical Australia

We investigated the effects of annual burning since 1952, triennial burning since 1973, fire exclusion since 1946 and infrequent wildfire (one fire in 61 years) on woody understorey vegetation in a dry sclerophyll eucalypt forest, south-eastern Queensland, Australia. We determined the influence of these treatments, and other site variables (rainfall, understorey density, topsoil C : N ratio, tree basal area, distance to watercourse and burn coverage) on plant taxa density, richness and composition. The richness of woody understorey taxa 0–1 m in height was not affected by burning treatments, but richness of woody plants 1–7.5 m in height was lower in the annually burnt treatment than in the triennially burnt treatment from 1989 to 2007. Fire frequency and other site variables explained 34% of the variation in taxa composition (three taxon groups and 10 species), of which 33% of the explained variance was explained by fire treatment and 46% was explained by other site variables. Annual burning between 1974 and 1993 was associated with lower understorey densities mainly due to reduced densities of eucalypts 1–7.5 m in height. Triennial burning during the same period was associated with higher densities of eucalypts 0–7.5 m in height relative to the annually burnt and unburnt treatments. Most woody taxa persisted in the frequently burnt treatments through resprouting mechanisms (e.g. lignotuberous regeneration), and fire patchiness associated with low-intensity burning was also found to be important. Persistence of plants <1 m tall demonstrates the resilience of woody taxa to repeated burning in this ecosystem, although they mainly exist in a suppressed growth state under annual burning

The Relationship between Parental Educational Attainment and Perceived Racial Discrimination among African-American Female Adolescents

Background: Perceived racial discrimination acts as a considerable stressor for African- Americans and is associated with adverse health outcomes among adults and adolescents. The relationship between perceived discrimination and socioeconomic dimensions has been studied among adult African-American populations to assess the role of social patterning in reports of discrimination. However, less is known about the relationship between parental educational attainment and adolescents’ perceived discrimination. Methods: We explored the relationship between parental educational attainment and adolescents’ reports of racial discrimination using written surveys from 135 African-American female adolescents seeking family planning services at an urban hospital-based adolescent clinic in Pennsylvania. Dimensions of perceived discrimination that were captured in this study included personal experiences, vicarious racial discrimination, and perceived discrimination against African-Americans as a group. Parental educational attainment was categorized as “some or completed high school/GED” and “some or completed college.” To account for missing parental education data, a sensitivity analysis was performed in which missing data were recoded into parental education categories and used in chi-square cross tabulations. Results: Most of the sample (mean age = 17.04; SD = 1.33) had completed high school or were currently enrolled in school, and were living in single-parent homes. Close to half (41.5%) of respondents did not know their father’s educational attainment, and 17.8% did not know their mother’s educational attainment. To account for missing education data, a sensitivity analysis was performed, which revealed no significant association between parental educational attainment and adolescents’ perceived discrimination. However, although the respondents in our study do not appear to experience frequent discrimination, 85.9% reported at least one dimension of discrimination measured in this study. Conclusions: The large percentage of African-American female adolescents who reported at least one dimension of discrimination implies an added burden and vulnerability to social stressors in their life

Advancing equity in challenging times: A qualitative study of telehealth expansion and changing patient–provider relationships in primary care settings during the COVID-19 pandemic

Objective The patient–provider relationship is critical for achieving high-quality care and better health outcomes. During the COVID-19 pandemic, primary care practices rapidly transitioned to telehealth. While telehealth provided critical access to services for many, not all patients could optimally utilize it, raising concerns about its potential to exacerbate inequities in patient–provider relationships. We investigated technical and workforce-related barriers to accessing telehealth and the impacts on patient–provider relationships for vulnerable populations. Methods Qualitative, semi-structured interviews from May 2021 to August 2021 with 31 individuals (medical directors, physicians, and medical assistants) working at 20 primary care practices in Massachusetts, North Carolina, and Texas. Thematic analysis to better understand how barriers to using telehealth complicated patient–provider relationships. Results Interviewees shared challenges for providers and patients that had a negative effect on patient–provider relationships, particularly for vulnerable patients, including older adults, lower socio-economic status patients, and those with limited English proficiency. Providers faced logistical challenges and disruptions in team-based care, reducing care coordination. Patients experienced technological challenges that made accessing and engaging in telehealth difficult. Interviewees shared challenges for patient–provider relationships as commonly used telephone-only telehealth reduced channels for non-verbal communication. Conclusion This study indicates that barriers to virtual interaction with patients compared to in-person care likely led to weaker personal relationships that may have longer-term effects on engagement with and trust in the healthcare system, particularly among vulnerable patient groups. Additional support and resources should be available to primary care providers to optimize telehealth utilization

Creating Connections: An Early Look at the Integration of Behavioral Health and Primary Care into Accountable Care Organizations

Despite the potential benefits of models that integrate behavioral health and primary care, fiscal, structural, and cultural barriers prevent organizations from pursuing them. Accountable care organizations (ACOs) may be better positioned to implement integrated care because of modified reimbursement structures with an emphasis on care coordination. This report showcases integration approaches at two ACOs. The first uses a colocation plus collaboration model that improves connectivity between providers through proximity and improved sharing of information. The second uses a model that adds behavioral health specialists to the primary care team to bolster the capacity of PCPs in managing mental health and substance abuse conditions. We identify two factors that enable successful implementation: participation in an ACO and selection of an appropriate model of integration. External partners can support the spread of integrated models of care through education and collaborative learning

Bladder exposure to Gardnerella activates host pathways necessary for Escherichia coli recurrent UTI

Recurrent urinary tract infections (rUTI) are a costly clinical problem affecting millions of women worldwide each year. The majority of rUTI cases are caused by uropathogeni