Raising the alarm: fosfomycin resistance associated with non-susceptible inner colonies imparts no fitness cost to the primary bacterial uropathogen.

IMPORTANCE: While fosfomycin resistance is rare, the observation of non-susceptible subpopulations among clinical Escherichia coli isolates is a common phenomenon during antimicrobial susceptibility testing (AST) in American and European clinical labs. Previous evidence suggests that mutations eliciting this phenotype are of high biological cost to the pathogen during infection, leading to current recommendations of neglecting non-susceptible colonies during AST. Here, we report that the most common route to fosfomycin resistance, as well as novel routes described in this work, does not impair virulence in uropathogenic E. coli, the major cause of urinary tract infections, suggesting a re-evaluation of current susceptibility guidelines is warranted.

Physician Workforce Partnerships in Rural American Indian/Alaska Native Communities and the Potential of Post-Graduate Fellowships.

Rural American Indian and Alaska Native (AI/AN) communities face physician vacancy rates over 25%. A variety of programs aim to address those gaps, from early-life STEM initiatives for AI/ANs to physician loan repayment programs. However, unfilled clinical positions and underrepresentation of AI/AN physicians persist. We review existing workforce initiatives, then demonstrate that three recently developed clinical fellowship programs fill an important gap. The fellowships, led by faculty at large academic health centers, place fellows in clinical positions in rural AI/AN communities in partnership with tribal health systems and/or the Indian Health Service. In addition to providing clinical care, the fellowships seek to enhance health systems' capacity development through community-centered initiatives that include training and health promotion. Other academic health centers should consider working together with tribal communities to assess whether replication of the models could reduce local physician staffing gaps and health disparities.

Determinants of termination of breastfeeding within the first 2 years of life in India: evidence from the National Family Health Survey-2.

The present study assesses socio-demographic and health service determinants of termination of breastfeeding within the first 2 years of life in India by analysing data from the nationally representative National Family Health Survey-2 using Cox regression modelling techniques. While the likelihood of stopping breastfeeding increased with increasing household wealth status, it declined with increasing maternal age at childbirth. The likelihood of stopping breastfeeding was significantly higher among female children compared with male children, and the gender differential was attenuated by increasing maternal educational status. Overall, findings of the present study suggest that breastfeeding promotion programmes in India should focus on certain high-risk mother-child pairs such as female infants, first-born babies, babies born in the private sector and in urban areas, as well as mothers who are literate, have a higher wealth status, are aged less than 20 years and belong to Sikh or Christian communities. Qualitative studies to understand cultural factors or norms and causal pathways responsible for the association of identified factors and early termination of breastfeeding, especially household wealth status and maternal education, are also called for.