Clinical Persistence of Chlamydia trachomatis Sexually Transmitted Strains Involves Novel Mutations in the Functional αββα Tetramer of the Tryptophan Synthase Operon.

Clinical persistence of Chlamydia trachomatis (Ct) sexually transmitted infections (STIs) is a major public health concern. In vitro persistence is known to develop through interferon gamma (IFN-γ) induction of indoleamine 2,3-dioxygenase (IDO), which catabolizes tryptophan, an essential amino acid for Ct replication. The organism can recover from persistence by synthesizing tryptophan from indole, a substrate for the enzyme tryptophan synthase. The majority of Ct strains, except for reference strain B/TW-5/OT, contain an operon comprised of α and β subunits that encode TrpA and TrpB, respectively, and form a functional αββα tetramer. However, trpA mutations in ocular Ct strains, which are responsible for the blinding eye disease known as trachoma, abrogate tryptophan synthesis from indole. We examined serial urogenital samples from a woman who had recurrent Ct infections over 4 years despite antibiotic treatment. The Ct isolates from each infection episode were genome sequenced and analyzed for phenotypic, structural, and functional characteristics. All isolates contained identical mutations in trpA and developed aberrant bodies within intracellular inclusions, visualized by transmission electron microscopy, even when supplemented with indole following IFN-γ treatment. Each isolate displayed an altered αββα structure, could not synthesize tryptophan from indole, and had significantly lower trpBA expression but higher intracellular tryptophan levels compared with those of reference Ct strain F/IC-Cal3. Our data indicate that emergent mutations in the tryptophan operon, which were previously thought to be restricted only to ocular Ct strains, likely resulted in in vivo persistence in the described patient and represents a novel host-pathogen adaptive strategy for survival.IMPORTANCE Chlamydia trachomatis (Ct) is the most common sexually transmitted bacterium with more than 131 million cases occurring annually worldwide. Ct infections are often asymptomatic, persisting for many years despite treatment. In vitro recovery from persistence occurs when indole is utilized by the organism's tryptophan synthase to synthesize tryptophan, an essential amino acid for replication. Ocular but not urogenital Ct strains contain mutations in the synthase that abrogate tryptophan synthesis. Here, we discovered that the genomes of serial isolates from a woman with recurrent, treated Ct STIs over many years were identical with a novel synthase mutation. This likely allowed long-term in vivo persistence where active infection resumed only when tryptophan became available. Our findings indicate an emerging adaptive host-pathogen evolutionary strategy for survival in the urogenital tract that will prompt the field to further explore chlamydial persistence, evaluate the genetics of mutant Ct strains and fitness within the host, and their implications for disease pathogenesis

The strange non-retreat of the state : implications for the sociology of work

The article critically reviews the reasons for the decline in the engagement with the state in the sociology of work after the 1970s, and for its resurgence after the financial crisis of 2008. It assesses three separate streams of literature (sociology of work, political sociology and welfare state sociology), and argues for the benefits of their integration. Articles in this special section of Work, employment and society provide examples of the mutual utility of such integration. This introduction concludes by identifying some important avenues for future research on the state and work

Fit Into College: A Program to Improve Physical Activity and Dietary Intake Lifestyles Among College Students

The purpose of this study was to determine whether a 10-week program could improve physical activity, physical fitness, body weight, dietary intake, and perceptions of exercise and diet among college 30 healthy college freshmen. Outcomes were measured at baseline, and following the 10-week program. The weekly sessions incorporated constructs of the Transtheoretical Model of Health Behavior Change and were administered by fitness interns who were junior or senior college students enrolled in health-related majors. The participants presented with low physical activity, physical fitness, and poor dietary intake, and 50% were overweight/obese (BMI \u3e 25). Participants demonstrated gains in their physical fitness and their perceived benefits to engaging in exercise and decreased their perceived barriers to engaging in exercise and a healthy diet. College freshmen presented with low levels of physical activity, poor dietary intake, and excess body weight. A peer-administered program can improve these measures and favorably change perceptions of exercise and diet

Strengthening the Healthy Start Workforce: A Mixed-Methods Study to Understand the Roles of Community Health Workers in Healthy Start and Inform the Development of a Standardized Training Program

Introduction Healthy Start (HS) is dedicated to preventing infant mortality, improving birth outcomes, and reducing disparities in maternal and infant health. In 2014, the HS program was reenvisioned and standardization of services and workforce development were prioritized. This study examined how HS community health workers (CHW), as critical members of the workforce, serve families and communities in order to inform the development of a CHW training program to advance program goals. Methods In 2015, an online organizational survey of all 100 HS programs was conducted. Ninety-three sites (93%) responded. Three discussion groups were subsequently conducted with HS CHWs (n = 21) and two discussion groups with HS CHW trainers/supervisors (n = 14). Results Most (91%) respondent HS programs employed CHWs. Survey respondents ranked health education (90%), assessing participant needs (85%), outreach/recruitment (85%), and connecting participants to services (85%) as the most central roles to the CHW’s job. Survey findings indicated large variation in CHW training, both in the amount and content provided. Discussion group findings provided further examples of the knowledge and skills required by HS CHWs. Conclusions The study results, combined with a scan of existing competencies, led to a tailored set of competencies that serve as the foundation for a HS CHW training program. This training program has the capacity to advance strategic goals for HS by strengthening HS CHWs’ capacity nationwide to respond to complex participant needs. Other maternal and child health programs may find these results of interest as they consider how CHWs could be used to strengthen service delivery. Keywords: Healthy start; Community health worker; Infant mortality; Maternal health; social determinants of healt

Psychological therapy for people with tinnitus: a scoping review of treatment components

Background: Tinnitus is associated with depression and anxiety disor- ders, severely and adversely affecting the quality of life and functional health status for some people. With the dearth of clinical psychologists embedded in audiology services and the cessation of training for hearing therapists in the UK, it is left to audiologists to meet the psychological needs of many patients with tinnitus. However, there is no universally standardized training or manualized intervention specifically for audiolo- gists across the whole UK public healthcare system and similar systems elsewhere across the world. Objectives: The primary aim of this scoping review was to catalog the components of psychological therapies for people with tinnitus, which have been used or tested by psychologists, so that they might inform the development of a standardized audiologist-delivered psy- chological intervention. Secondary aims of this article were to identify the types of psychological therapy for people with tinnitus, who were reported but not tested in any clinical trial, as well as the job roles of clinicians who delivered psychological therapy for people with tinnitus in the literature. Design: The authors searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; Cochrane Central Register of Controlled Trials; PubMed; EMBASE; CINAHL; LILACS; KoreaMed; IndMed; PakMediNet; CAB Abstracts; Web of Science; BIOSIS Previews; ISRCTN; ClinicalTrials.gov; IC-TRP; and Google Scholar. In addition, the authors searched the gray literature including conference abstracts, disserta- tions, and editorials. No records were excluded on the basis of controls used, outcomes reached, timing, setting, or study design (except for reviews—of the search results. Records were included in which a psy- chological therapy intervention was reported to address adults (≤18 years) tinnitus-related distress. No restrictive criteria were placed upon the term tinnitus. Records were excluded in which the intervention included biofeedback, habituation, hypnosis, or relaxation as necessary parts of the treatment. Results: A total of 5043 records were retrieved of which 64 were retained. Twenty-five themes of components that have been included within a psychological therapy were identified, including tinnitus educa- tion, psychoeducation, evaluation treatment rationale, treatment plan- ning, problem-solving behavioral intervention, thought identification, thought challenging, worry time, emotions, social comparison, inter- personal skills, self-concept, lifestyle advice, acceptance and defusion, mindfulness, attention, relaxation, sleep, sound enrichment, comorbid- ity, treatment reflection, relapse prevention, and common therapeutic skills. The most frequently reported psychological therapies were cogni- tive behavioral therapy, tinnitus education, and internet-delivered cogni- tive behavioral therapy. No records reported that an audiologist delivered any of these psychological therapies in the context of an empirical trial in which their role was clearly delineated from that of other clinicians. Conclusions: Scoping review methodology does not attempt to appraise the quality of evidence or synthesize the included records. Further research should therefore determine the relative importance of these dif- ferent components of psychological therapies from the perspective of the patient and the clinician

Orion Crew Exploration Vehicle Launch Abort System Guidance and Control Analysis Overview

Aborts during the critical ascent flight phase require the design and operation of Orion Crew Exploration Vehicle (CEV) systems to escape from the Crew Launch Vehicle (CLV) and return the crew safely to the Earth. To accomplish this requirement of continuous abort coverage, CEV ascent abort modes are being designed and analyzed to accommodate the velocity, altitude, atmospheric, and vehicle configuration changes that occur during ascent. Aborts from the launch pad to early in the flight of the CLV second stage are performed using the Launch Abort System (LAS). During this type of abort, the LAS Abort Motor is used to pull the Crew Module (CM) safely away from the CLV and Service Module (SM). LAS abort guidance and control studies and design trades are being conducted so that more informed decisions can be made regarding the vehicle abort requirements, design, and operation. This paper presents an overview of the Orion CEV, an overview of the LAS ascent abort mode, and a summary of key LAS abort analysis methods and results

Computer-Assisted lnstruction for Teaching Decision-Making in Food Systems Administration

Models for the inclusion, development, and implementation of computer-assisted instruction (CAI) in a dietetic education program were developed, tested, and evaluated. The models were applied to the Coordinated Undergraduate Program in Dietetics, The University of Tennessee, Knoxville. An assessment of competencies to be met by an entry-level generalist dietitian in food systems administration revealed that the competency concerning principles and practices of management of personnel was not being met adequately by dietetic students. Participating faculty and students were introduced to CAI and oriented to the use of computer terminals. Case study simulations were presented via CAI and programmed learning booklets (for off-campus students) to 59 students enrolled in FSA 4140, Food Systems Personnel Development, taught Winter Quarter, 1977. Small-group discussions after completion of each case study helped enrich the simulation experience. Evaluation of CAI effectiveness was assessed by administration of three test instruments immediately before and after the CAI experience. The Leadership Evaluation and Development Scale (LEADS), the Leadership Opinion Questionnaire (LOQ) and the Self-Perception of Confidence (SPOC) Scale assessed managerial decision-making ability, the leadership dimensions of Consideration and Structure, and comfort (confidence) of the student when faced with a personnel management problem situation, respectively. Because of the inability of objective measurement devices to assess change in affective behavior, no significant change was noted in managerial decision-making ability or in the leadership dimensions of Consideration and Structure as a result of the CAI simulations. A significant increase in comfort (confidence) was noted after the CAI exposure. The models for inclusion, development, and implementation of CAI in a dietetic education program was determined to be feasible for use with the Coordinated Undergraduate Program in Dietetics, the University of Tennessee, Knoxville

The Rhetoric of Robert H. Jackson at Nurnberg: A Study of Ideas

A thesis submitted in partial fulfillment of the requirements for the Degree of Master of Arts in the Division of Communications at Morehead State University by Deborah VanHoose Dean in April of 1976

Contamination Running Deep: Oral Histories of Environmental Racism, Injustice, and Outrage of One Family in a Southern African-American Community

This is an inquiry into oral histories of five members of my family that are residents of a southern African American community, Hyde Park located in Augusta, Georgia. These members of my family, Eunice Jordan, Sharon Wells, Ernest Jordan, DeWanna Jordan, and Darius Jordan, have endured the environmental contamination and social injustices. These family members are children and grandchildren of Willie and Lillian Wells who moved to Hyde Park in 1950 with the intention of living the American Dream and creating a legacy for future generations that began with owning their land and home. Since then the family has learned that they were exposed to toxic chemicals. After a highly publicized flood in October 1990, the residents of Hyde Park were devastated when they found that the toxic chemicals had contaminated the soil and water. My father Ernest Jordan was the first to sue the industrial company that contaminated the community. Ever since then they have been battling with local and state governments to relocate them. Instead of relocating the residents and cleaning up the Hyde Park, local and state governments spent millions of dollars on testing soil and water. To keep a majority black neighborhood in a confined area such as this is a form of oppression. Theoretically drawing upon the works of Derrick Bell (1992), Richard Delgado and Jean Stefancic (2001), Gloria Ladson-Billings (2003), and Gloria Ladson-Billings and William F. Tate (2005) on critical race theory and methodologically upon the works of Richard Grele and Studs Terkel (1991), Donald Ritchie (2003), Thomas Charlton, Lois Myers, and Rebecca Sharpless (2006, 2007), Norman Denzin and Yvonna Lincoln (2008) on oral history. I explored the oral histories of five African American residents who have been exposed to environmental contaminants and compounded by the feelings of despair and helplessness. I also reflect on my life living in Hyde Park and the turmoil that has affected this community. I entwined songs and poems throughout my dissertation with the intent to connect the oral histories of the community\u27s struggles with individual struggles against racism. These songs and poems aim to capture the emotions of what the residents were feeling as they live with the injustices that have permeated the soil, water, and air that they breathe. Although it has history rooted in the community activism and promise, Hyde Park has been plagued by sickness and uncertainties for their future. It is my hope that by telling the stories of these residents, societal norms will be reexamined and the realities of this community will be exposed. It is also my hope that educators take heed and find innovative methods to educate students that face similar circumstances in our society. Most importantly by acquiring such knowledge we will be able to develop a perception of justice and take a stand against oppressive policies