IntroductionMainly case reports have shown that N. meningitidis, typically a resident of the oropharynx and the causative agent of meningococcal meningitis and meningococcemia, is capable of invading ...and colonising the urogenital tract. This can result in urethritis, akin to the syndrome caused by N. gonorrhoeae, the etiologic agent of gonorrhoea. Recently, meningococcal strains associated with outbreaks of urethritis were reported to share genetic characteristics with gonococcus, raising the question of the extent to which these strains contain features that promote adaptation to the genitourinary niche, making them “gonococcus-like” and distinguishing them from other N. meningitidis.MethodsA total of 31 urethritis-associated N. meningitidis, representing multiple serogroups and independently collected over a decade and 3 continents, underwent genome sequencing and analysis. The genomes were compared with serogroup-matched N. meningitidis strains isolated from carriage and invasive disease and N. gonorrhoeae strains isolated from men with urethritis. ResultsIntact nitrite reductase (AniA), disrupted factor-H binding protein (fHbp), and the lack of capsule are features previously speculated to promote urogenital colonisation. However, we found that a considerable number (n=11) of meningococcal urethritis isolates harbour mutations in AniA predicted to result in truncated peptides and a minority (n=4) of these isolates contained alleles associated with frameshifted fHbp. We noted substantial diversity in the capsule biosynthetic locus, including intact, disrupted, and absent capsules, indicating urogenital colonisation is possible across a range of capsular phenotypes.ConclusionThe meningococcal urethritis strains in this study do not share the allelic patterns of AniA, fHbp, or the capsule locus previously reported for urethritis-associated N. meningitidis. The allelic patterns likely reflect diversity in the underlying meningococcal population, rather than novel adaptation to the urogenital tract.
Not only since the Covid-19 pandemic, rural areas have
received new attention as supposedly healthier and attractive places of
residence. Regions previously characterized as shrinking are ...experiencing a
highly selective influx of urban middle-class households and an increase in
real estate and rental prices. These influxes and housing market
developments raise the question of value increase and displacement.
English-speaking, and especially British, human geographers have been
studying the phenomenon of ”rural gentrification” for several decades. This
article therefore aims to systematize this state of the art in terms of its
conceptual framework and empirical objects. Based on this, the article
explains possible connections for German research on rural gentrification
and discusses starting points for future research.
The author describes how, during the COVID-19 pandemic, clinicians embraced telehealth for vulnerable children struggling with intense feelings, learning challenges, and isolation. She suggests that ...generating playful engagement, however difficult without the toys and comforts of the traditional office, remains crucial. She discusses the stresses of the telehealth experience and the importance of identifying and mobilizing a child's initiative and agency in this setting. She asserts that, when clinicians maintain empathy and share how they imagine children's experiences, a joining can occur that lessens the children's sense of isolation and emotional hurdles. She then conculdes that, if a clinician's imaginative self becomes engaged with that of a child, spontaneity and forward movement are possible even when employing the medium of telehealth. Key words: clinician's empathy; imaginative play; sense of agency; telehealth.
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