The Cost of Virulence: Retarded Growth of Salmonella Typhimurium Cells Expressing Type III Secretion System 1

Virulence factors generally enhance a pathogen's fitness and thereby foster transmission. However, most studies of pathogen fitness have been performed by averaging the phenotypes over large populations. Here, we have analyzed the fitness costs of virulence factor expression by Salmonella enterica subspecies I serovar Typhimurium in simple culture experiments. The type III secretion system ttss-1, a cardinal virulence factor for eliciting Salmonella diarrhea, is expressed by just a fraction of the S. Typhimurium population, yielding a mixture of cells that either express ttss-1 (TTSS-1+ phenotype) or not (TTSS-1− phenotype). Here, we studied in vitro the TTSS-1+ phenotype at the single cell level using fluorescent protein reporters. The regulator hilA controlled the fraction of TTSS-1+ individuals and their ttss-1 expression level. Strikingly, cells of the TTSS-1+ phenotype grew slower than cells of the TTSS-1− phenotype. The growth retardation was at least partially attributable to the expression of TTSS-1 effector and/or translocon proteins. In spite of this growth penalty, the TTSS-1+ subpopulation increased from <10% to approx. 60% during the late logarithmic growth phase of an LB batch culture. This was attributable to an increasing initiation rate of ttss-1 expression, in response to environmental cues accumulating during this growth phase, as shown by experimental data and mathematical modeling. Finally, hilA and hilD mutants, which form only fast-growing TTSS-1− cells, outcompeted wild type S. Typhimurium in mixed cultures. Our data demonstrated that virulence factor expression imposes a growth penalty in a non-host environment. This raises important questions about compensating mechanisms during host infection which ensure successful propagation of the genotype

Decentralized clinical trials in the trial innovation network: Value, strategies, and lessons learned

New technologies and disruptions related to Coronavirus disease-2019 have led to expansion of decentralized approaches to clinical trials. Remote tools and methods hold promise for increasing trial efficiency and reducing burdens and barriers by facilitating participation outside of traditional clinical settings and taking studies directly to participants. The Trial Innovation Network, established in 2016 by the National Center for Advancing Clinical and Translational Science to address critical roadblocks in clinical research and accelerate the translational research process, has consulted on over 400 research study proposals to date. Its recommendations for decentralized approaches have included eConsent, participant-informed study design, remote intervention, study task reminders, social media recruitment, and return of results for participants. Some clinical trial elements have worked well when decentralized, while others, including remote recruitment and patient monitoring, need further refinement and assessment to determine their value. Partially decentralized, or “hybrid” trials, offer a first step to optimizing remote methods. Decentralized processes demonstrate potential to improve urban-rural diversity, but their impact on inclusion of racially and ethnically marginalized populations requires further study. To optimize inclusive participation in decentralized clinical trials, efforts must be made to build trust among marginalized communities, and to ensure access to remote technology

Enhancing Undergraduate Research Opportunities in the Biological Sciences at UW-Eau Claire Using Student Perceptions of Course-Related and Independent Research Experiences

Color poster with text and graphs.The goal of the project was to generate knowledge concering undergraduate research experiences in biology and biochemistry at the University of Wisconsin--Eau Claire to inform an effort aimed at enhancing the undergraduate research experience in these fields.University of Wisconsin--Eau Claire Office of Research and Sponsored Program

Keepers of the Forest : the Menominee Indian Tribe of Wisconsin's Sustainable Forestry.

Color poster with text and images describing research conducted by Jasmine Wiley, advised by Rick St. Germaine.We researched the Menominee Indian Tribe of Wisconsin's practice of sustainable forestry on their reservation in Northeastern Wisconsin. Our research follows the growth of the forestry industry on the reservation from before contact up to present day.University of Wisconsin--Eau Claire Office of Research and Sponsored Programs

How Shore Orientation and Substrate Type Structure Lichen Communities in the Boundary Waters Canoe Area Wilderness.

Color poster with text, images, and diagrams.Rock inhabiting lichens are important pioneer species in the aquatic-terrestial transition zone of lakeshore habitats. To investigate how substrate type, slope and aspect influenced lichen communities, we surveyed the rocky shores of glacial lakes within the Boundary Waters Canoe Area Wilderness (BWCAW)of northern Minnesota.University of Wisconsin--Eau Claire Office of Research and Sponsored Programs

Communicating Diagnostic Test Results: A Family Medicine Residency Clinic QI Project

Great variance existed between how test results were being communicated to patients in our residency clinics, decreasing patient satisfaction and posing a threat to patient safety. The purpose of this quality improvement study was to create a standard work flow for communicating both critical and normal test results to patients that will be used across our residency clinics by both residents and faculty, utilize our support staff to the top of licensing, and improve patient satisfaction, patient safety, and prevent clinical inertia

Identifying disparities in colorectal cancer screening rates in Milwaukee-based academic and non-academic clinics

Conclusion: The African American/Black race per the Centers for Disease Control & Prevention has the highest CRC death making early CRC screening an imperative. While the Wisconsin Collaborative for Healthcare Quality ranks Aurora Health Care as 8th out of 20 systems in Wisconsin (77.6% Q3 2014-Q2 2015) local data analysis identified age as the largest disparity gap. Analyzing local population data REAL/Gender provides key insights into support initiatives to reduce health disparity gaps and further our progress toward achieving the Triple Aim for health care

Identifying and Targeting Age-Related Colorectal Cancer Screening Rate Disparities in Family Medicine Residency Clinics

Background: Health care systems continuously seek to improve patient care through population-level analysis of clinical quality metrics and patient characteristics to identify disparities in care. Nationally, disparities in colorectal cancer (CRC) screening rates have been identified with lower screening rates reported for patients who are uninsured and/or lower socioeconomic status, African American/black, Asian, and non-English-speaking Hispanic patients. No age-related CRC screening rate disparities with associated interventions have been reported. Purpose: Determine and address CRC screening disparities in care provided to eligible patients \u3e 50 years old in two primary care residency clinics. Methods: Retrospective analysis using REAL-G (race, ethnicity, age, preferred language, gender) categories and insurance coverage was completed on a 12-month data set to identify presence of CRC screening disparities. Barriers to CRC screening for largest disparity gap were then identified by clinic staff at two family medicine residency clinics (a third primary care clinic in same zip code and service region were used for nonintervention comparison) using the Institute for Healthcare Improvement fishbone approach. The project team, informed by the literature, then identified and implemented targeted interventions, monitoring progress during a 6-month period. Interventions included provider education with periodic reminders regarding system-approved CRC screening options and a workflow-based intervention. Postintervention analysis was completed using same preintervention approach. Results: The largest CRC screening disparity for region and clinics was associated with age, with screening gaps ranging from 13% to 15% between populations aged 50–54 years versus \u3e 65 years. CRC screening rate disparities by race, ethnicity, and gender were less than 10%. Postintervention, one targeted clinic had a 6% increase in the CRC screening rates in the target population (age: 50–54) while a second targeted clinic had a 1% increase in screening rates during this period. The comparison primary care residency clinic had a 1% decline in CRC screening rates. Differences in insurance utilization types for CRC screening rates by clinic were noted. Differences between targeted clinic screening rates were attributed to successful workflow implementation and provider/staff champions. Conclusion: Analyzing population data at a micro/clinic level using REAL-G categories can inform targeted interventions that aim to reduce health disparity gaps