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

Becoming a Badass: Developing Positive Embodiment in Women

Becoming a Badass: Developing Positive in Embodiment in Women Nicole O’Connor Abstract Almost everyone hates their bodies (normative discontent), but women and girls are most likely to engage in extreme behaviors to adjust their appearance. The United States’ history as a heteronormative, white supremacist, patriarchal, capitalist society contributes to myths about weight and health leading to anti-fat bias and harm on fat bodies. A focus on body image has limited the scope of research and Niva Piran’s Developmental Theory of Embodiment offers an alternative framework for healing normative discontent. As a woman living in a large body, the author interviewed six women about their journey from self-hatred to self-acceptance. She found women can develop positive embodiment by developing a sense of self, participating in supportive relationships, and recognizing their body’s power in movement. Focusing on the body’s agency instead of the body’s appearance offers freedom from self-hatred

Consumers in Shock: How Federal Government Overregulation Led Mylan to Acquire a Monopoly over Epinephrine Autoinjectors

The philosophy that federal government intervention increases costs and decreases options and values available to consumers can be analyzed across a plethora of markets. This Note will focus on the epinephrine autoinjector market, specifically looking at Mylan\u27s epinephrine autoinjector known as the EpiPen. Today, the EpiPen is considered the “Kleenex” of epinephrine autoinjectors as it is estimated to control over ninety percent of the market share. From a Darwinist perspective it would appear that because the EpiPen controls most of the market, it must be the most superior product available to consumers. However, as this note will cover, this is likely not the case, and there is ample evidence to prove that EpiPen’s market success is largely due to government regulations and mandates. This Note will also focus on the 2014 United States District Court case JHP Pharmaceuticals v. Hospira, which dealt with labeling issues surrounding epinephrine autoinjectors. It is quite possible that safer, more efficient, and more affordable versions of the EpiPen may be available to consumers today if it were not for these government interventions. As this note will discuss, courts should decline to follow the overall ruling in JHP Pharmaceuticals v. Hospira because holding that a court is unable to decide a case based on a separate federal agency simply a waste of litigation. However, courts should consider the line of reasoning that where there is no proof that a non-FDA approved drug is any less safe than an FDA-approved drug, the non-approved drug should not be precluded from entering the market

Reduced A1C Levels Through Diabetes Self-Management Strategies in the Teen Population: A Systematic Review

This project utilized current evidence-based practices to improve the diabetes education in the endocrine clinic for the adolescent population ages 15-18. Based on a clinic audit, an average hA1C level of 8.1% was revealed. The goal was to decrease these levels from 8.1% to 7.9% within 90 days through the implementation of the revised diabetes brochure. Evidence suggests the following: DSME improves clinical outcomes and quality of life; an A1C level \u3e7% is associated with increased risks of complications ; teaching aimed at lowering glycemic levels have decreased numerous complications; there is a need to ensure age appropriate, family-centered care, along with ongoing diabetes education to be most successful; and lastly, research shows DSME improves A1C levels by as much as 1% and reduces the onset and/or advancement of diabetes complications. The implementation included a staff meeting to review goals/objectives, as well as a clinic in-service on teaching strategies/methods to ensure teen compliance is maintained. During the evaluation phase, data was analyzed by senior managers and the quality improvement team on November 16th 2015 to include: staff surveys, A1C levels from September to November, & patient/family survey and feedback questionnaires. The evaluation showed the following: increase in staff awareness of effective diabetes education, lowered A1C levels of 0.01%, and more teen compliance at home. It’s recommended to continue to improve diabetes education to allow the teen the ability to become a self-advocator, to self-manage the illness independently, and to better understand key components of the disease and its treatment to reduce the burden of morbidity and mortality, which ultimately will reduce health disparities in this vulnerable group of patients

Psychotherapeutic Treatment of Post-Traumatic Disorder in Rural Veterans

Post-traumatic stress disorder (PTSD) is a significant health issue among the veteran population. PTSD can lead to adverse outcomes such as suicide, violence, substance abuse, and an overall decreased quality of life. Psychotherapy has demonstrated effectiveness in treating PTSD. However, providers may not be aware which specific types of psychotherapy have achieved the strongest levels of evidence . Additional challenges exist in treating rural veterans because of barriers such as geographical distance and a shortage of mental health providers. These obstacles may place rural veterans at higher risk. The purpose of this project was to explore the current evidence that supports the use of psychotherapy in the treatment of PTSD and discuss how these strategies might be implemented for veterans in a rural setting. Shapiro\u27s Adaptive Information Processing Model served as a theoretical framework for this project . The methods used to conduct this project consisted of first performing a literature review of pertinent articles and current practice guidelines. Expert clinicians within the community were consulted to gain further insight and directly observe some clinical applications of these therapies. Collaborative efforts were made with contacts from the Department of Defense Centers of Excellence and an upper-Midwest rural health agency . A variety of web-based training modules related to the practice of psychotherapy for veterans with PTSD were also reviewed . The findings of this project revealed that cognitive behavioral-based therapies, such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy as well as eye movement desensitization and reprocessing (EMDR) demonstrate the greatest level of efficacy in treating PTSD. Technological advances such as telemental health services or virtual reality-based interventions may improve accessibility to rural veterans . Integrating PTSD treatment options into primary care settings, such as community-based clinics may also improve barriers to seeking treatment. These results have been disseminated to local providers via informational pamphlets and poster presentations. Several accessible, online training websites have also been included as resources that can assist providers in gaining increased knowledge and understanding specific to the psychotherapies discussed as well as issues pertinent to military culture and programs. By increasing providers\u27 awareness of these evidence-based practices, it is hopeful that better care can be offered to rural veterans in treating their symptoms of PTSD and improving overall quality of life

WILL FARMERS USE SAFER PESTICIDES?

Virtually all technology adoption studies are conducted ex post, yet policy makers often need to assess the likely level of adoption before the technology is introduced. This study uses data from a contingent valuation survey of Michigan corn growers to assess what factors would influence the adoption of two safer corn herbicides, one that is not carcinogenic and one that does not leach. Results indicate that price, risk perception, and sources of pest control information are all important. This suggests that public policies designed to change perceptions and improve information dissemination may encourage voluntary use of more environmentally friendly technologies.atrazine, cancer risk, contingent valuation, herbicides, nitrate leaching, public policy, technology adoption, Crop Production/Industries,

Introducing one-shot work into fluctuation relations

Two approaches to small-scale and quantum thermodynamics are fluctuation relations and one-shot statistical mechanics. Fluctuation relations (such as Crooks' Theorem and Jarzynski's Equality) relate nonequilibrium behaviors to equilibrium quantities such as free energy. One-shot statistical mechanics involves statements about every run of an experiment, not just about averages over trials. We investigate the relation between the two approaches. We show that both approaches feature the same notions of work and the same notions of probability distributions over possible work values. The two approaches are alternative toolkits with which to analyze these distributions. To combine the toolkits, we show how one-shot work quantities can be defined and bounded in contexts governed by Crooks' Theorem. These bounds provide a new bridge from one-shot theory to experiments originally designed for testing fluctuation theorems.Comment: 37 pages, 6 figure

Examining the Need for Psychosocial Services in Pediatric Non-Accidental Trauma

Child abuse is a significant issue within our society. In 2014, there were a reported 702,208 cases of child abuse and neglect across the country, with nearly 120,000 suffering from physical abuse. Research has shown the adverse physical and psychological consequences of child maltreatment. Despite what we know about the benefits of early intervention for this population, the degree of implementation of psychosocial interventions, specifically in a hospital setting, remains unclear. In an initial study that utilized archival data from the Loma Linda University Children’s Hospital (LLUCH) Trauma Registry Database, researchers found that the majority of children admitted to the hospital for non-accidental trauma (NAT) received minimal inpatient psychosocial services and psychosocial referrals at discharge. Given the gravity of these statistics, this doctoral project sought to verify the initial findings of the archival data through an in-depth chart review. A random sample of 20% (n=151) of the original 746 archival charts were selected. Subjects were previous pediatric patients at LLUCH who sustained a traumatic injury and whose case was identified as NAT. The results of the current study were consistent with previous findings and demonstrated that Pediatric Psychology saw 5.3% of children while inpatient and only 4.6% were referred for an inpatient consultation by a separate psychological service. Furthermore, a mere 3.3% of the sample received a psychosocial referral upon discharge. While the majority of the sample (87.4%) received a social work referral, only 52% of those children were actually seen. Finally, while the current study found higher rates of referrals to Child Protective Services (CPS; 82.8%) compared to the previous findings (67.6%), it highlighted that 17.2% of the sample was not referred to CPS despite the mandated referral. This study demonstrated that psychosocial services needed to address the impact of trauma are often not being provided at LLUCH. In an attempt to evaluate if this was a more pervasive problem, researchers reviewed the National Trauma Database and determined that the important search fields for psychosocial supports are not available. This data underscores the importance of improving the coordination of care between pediatric psychology, psychosocial services, and the medical field