Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs
A growing body of evidence suggests that contaminated environments may harbor a greater proportion of antibiotic-resistant microorganisms than unpolluted reference sites. Here, we report the screening of 427 Escherichia coli strains isolated from 11 locations on nine streams draining the US Departme...
Gespeichert in:
Veröffentlicht in: | Microbial ecology 2016-11, Vol.72 (4), p.840-850 |
---|---|
Hauptverfasser: | , , , |
Format: | Artikel |
Sprache: | eng |
Schlagworte: | |
Online-Zugang: | Volltext |
Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
container_end_page | 850 |
---|---|
container_issue | 4 |
container_start_page | 840 |
container_title | Microbial ecology |
container_volume | 72 |
creator | McArthur, J. V. Fletcher, D. E. Tuckfield, R. Cary Baker-Austin, C. |
description | A growing body of evidence suggests that contaminated environments may harbor a greater proportion of antibiotic-resistant microorganisms than unpolluted reference sites. Here, we report the screening of 427 Escherichia coli strains isolated from 11 locations on nine streams draining the US Department of Energy’s Savannah River Site against a panel of five antibiotics. Streams were chosen to capture a wide range of watersheds from minimally disturbed to highly impacted. Overall, higher levels of resistance were found in waterborne E. coli that also generally exhibited low spatial variability. However, 3 of 11 locations also demonstrated elevated resistance levels in sediments. Two of these occurred in highly disturbed tributaries with no obvious sources of antimicrobials. To further investigate these patterns, we screened a subset of isolates obtained from three streams against 23 antibiotics or antibiotic combinations. A large proportion of these isolates (>40 %) demonstrated resistance to 10 or more antimicrobials, suggesting that environmental multi-antibiotic resistance may be prevalent in this bacterial commensal. Only 4 of 87 viable isolates were tested susceptible to all 23 antibiotics and combinations. Among these multi-antibiotic-resistant isolates, several demonstrated resistance to all structural classes of antimicrobial agents tested, including frontline antibiotics such as gatifloxacin and ciprofloxacin. |
doi_str_mv | 10.1007/s00248-015-0678-4 |
format | Article |
fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1837320567</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>48723270</jstor_id><sourcerecordid>48723270</sourcerecordid><originalsourceid>FETCH-LOGICAL-c427t-ce064de03b4554484a57766af7811cc9ec3ecb60a4aae6fd44160149b0c6b7d03</originalsourceid><addsrcrecordid>eNqNkUtrFTEUgIMo9rb6A1woATfdRE8ek2SW5VJtoT7wAe5CJjfjzWVmck0ySP-9GaYWcSGusjjf-cLhQ-gZhVcUQL3OAExoArQhIJUm4gHaUMEZoVp8e4g2AG1DuGT6BJ3mfACgSjL-GJ0w2XBgGjZo-GhL8WnKOPb43TyUQC6mEroQS3Dkk88hFzsVfJnd3qfg9sHibRwC7lMc8eeSvB0z_hnKHr-P-KrSMd0ursUyBpdiF-yAr6fjXPIT9Ki3Q_ZP794z9PXN5ZftFbn58PZ6e3FDnGCqEOdBip0H3ommEUIL2yglpe2VptS51jvuXSfBCmu97HdCUAlUtB042akd8DN0vnqPKf6YfS5mDNn5YbCTj3M2VHPFGTRS_QfKpOQtZ21FX_6FHuKcpnrIImSUK6llpehK1dNzTr43xxRGm24NBbNUM2s1U6uZpZoRdefFnXnuRr-73_idqQJsBXIdTd99-uPrf1ifr0uHJcq9VGjFOFPAfwH2qat4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1832137686</pqid></control><display><type>article</type><title>Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs</title><source>MEDLINE</source><source>SpringerLink Journals</source><source>JSTOR</source><creator>McArthur, J. V. ; Fletcher, D. E. ; Tuckfield, R. Cary ; Baker-Austin, C.</creator><creatorcontrib>McArthur, J. V. ; Fletcher, D. E. ; Tuckfield, R. Cary ; Baker-Austin, C.</creatorcontrib><description>A growing body of evidence suggests that contaminated environments may harbor a greater proportion of antibiotic-resistant microorganisms than unpolluted reference sites. Here, we report the screening of 427 Escherichia coli strains isolated from 11 locations on nine streams draining the US Department of Energy’s Savannah River Site against a panel of five antibiotics. Streams were chosen to capture a wide range of watersheds from minimally disturbed to highly impacted. Overall, higher levels of resistance were found in waterborne E. coli that also generally exhibited low spatial variability. However, 3 of 11 locations also demonstrated elevated resistance levels in sediments. Two of these occurred in highly disturbed tributaries with no obvious sources of antimicrobials. To further investigate these patterns, we screened a subset of isolates obtained from three streams against 23 antibiotics or antibiotic combinations. A large proportion of these isolates (>40 %) demonstrated resistance to 10 or more antimicrobials, suggesting that environmental multi-antibiotic resistance may be prevalent in this bacterial commensal. Only 4 of 87 viable isolates were tested susceptible to all 23 antibiotics and combinations. Among these multi-antibiotic-resistant isolates, several demonstrated resistance to all structural classes of antimicrobial agents tested, including frontline antibiotics such as gatifloxacin and ciprofloxacin.</description><identifier>ISSN: 0095-3628</identifier><identifier>EISSN: 1432-184X</identifier><identifier>DOI: 10.1007/s00248-015-0678-4</identifier><identifier>PMID: 26530280</identifier><language>eng</language><publisher>New York: Springer Science + Business Media</publisher><subject>Aminoglycosides - pharmacology ; Anti-Bacterial Agents - pharmacology ; Antibiotic resistance ; Antibiotics ; Antimicrobial agents ; beta-Lactam Resistance - genetics ; beta-Lactams - pharmacology ; Biomedical and Life Sciences ; Ciprofloxacin - pharmacology ; Drug Combinations ; Drug Resistance, Multiple, Bacterial - physiology ; E coli ; Ecology ; ENVIRONMENTAL MICROBIOLOGY ; Escherichia coli ; Escherichia coli - drug effects ; Escherichia coli - isolation & purification ; Fluoroquinolones - pharmacology ; Geoecology/Natural Processes ; Geologic Sediments - microbiology ; Harbors ; Life Sciences ; Microbial Ecology ; Microbial Sensitivity Tests ; Microbiology ; Microorganisms ; Nature Conservation ; Rivers - microbiology ; Streams ; Water Microbiology ; Water Quality/Water Pollution</subject><ispartof>Microbial ecology, 2016-11, Vol.72 (4), p.840-850</ispartof><rights>Springer Science+Business Media New York 2015</rights><rights>Springer Science+Business Media New York 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c427t-ce064de03b4554484a57766af7811cc9ec3ecb60a4aae6fd44160149b0c6b7d03</citedby><cites>FETCH-LOGICAL-c427t-ce064de03b4554484a57766af7811cc9ec3ecb60a4aae6fd44160149b0c6b7d03</cites><orcidid>0000-0002-9892-9744</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/48723270$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/48723270$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27903,27904,41467,42536,51297,57995,58228</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26530280$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>McArthur, J. V.</creatorcontrib><creatorcontrib>Fletcher, D. E.</creatorcontrib><creatorcontrib>Tuckfield, R. Cary</creatorcontrib><creatorcontrib>Baker-Austin, C.</creatorcontrib><title>Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs</title><title>Microbial ecology</title><addtitle>Microb Ecol</addtitle><addtitle>Microb Ecol</addtitle><description>A growing body of evidence suggests that contaminated environments may harbor a greater proportion of antibiotic-resistant microorganisms than unpolluted reference sites. Here, we report the screening of 427 Escherichia coli strains isolated from 11 locations on nine streams draining the US Department of Energy’s Savannah River Site against a panel of five antibiotics. Streams were chosen to capture a wide range of watersheds from minimally disturbed to highly impacted. Overall, higher levels of resistance were found in waterborne E. coli that also generally exhibited low spatial variability. However, 3 of 11 locations also demonstrated elevated resistance levels in sediments. Two of these occurred in highly disturbed tributaries with no obvious sources of antimicrobials. To further investigate these patterns, we screened a subset of isolates obtained from three streams against 23 antibiotics or antibiotic combinations. A large proportion of these isolates (>40 %) demonstrated resistance to 10 or more antimicrobials, suggesting that environmental multi-antibiotic resistance may be prevalent in this bacterial commensal. Only 4 of 87 viable isolates were tested susceptible to all 23 antibiotics and combinations. Among these multi-antibiotic-resistant isolates, several demonstrated resistance to all structural classes of antimicrobial agents tested, including frontline antibiotics such as gatifloxacin and ciprofloxacin.</description><subject>Aminoglycosides - pharmacology</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antimicrobial agents</subject><subject>beta-Lactam Resistance - genetics</subject><subject>beta-Lactams - pharmacology</subject><subject>Biomedical and Life Sciences</subject><subject>Ciprofloxacin - pharmacology</subject><subject>Drug Combinations</subject><subject>Drug Resistance, Multiple, Bacterial - physiology</subject><subject>E coli</subject><subject>Ecology</subject><subject>ENVIRONMENTAL MICROBIOLOGY</subject><subject>Escherichia coli</subject><subject>Escherichia coli - drug effects</subject><subject>Escherichia coli - isolation & purification</subject><subject>Fluoroquinolones - pharmacology</subject><subject>Geoecology/Natural Processes</subject><subject>Geologic Sediments - microbiology</subject><subject>Harbors</subject><subject>Life Sciences</subject><subject>Microbial Ecology</subject><subject>Microbial Sensitivity Tests</subject><subject>Microbiology</subject><subject>Microorganisms</subject><subject>Nature Conservation</subject><subject>Rivers - microbiology</subject><subject>Streams</subject><subject>Water Microbiology</subject><subject>Water Quality/Water Pollution</subject><issn>0095-3628</issn><issn>1432-184X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkUtrFTEUgIMo9rb6A1woATfdRE8ek2SW5VJtoT7wAe5CJjfjzWVmck0ySP-9GaYWcSGusjjf-cLhQ-gZhVcUQL3OAExoArQhIJUm4gHaUMEZoVp8e4g2AG1DuGT6BJ3mfACgSjL-GJ0w2XBgGjZo-GhL8WnKOPb43TyUQC6mEroQS3Dkk88hFzsVfJnd3qfg9sHibRwC7lMc8eeSvB0z_hnKHr-P-KrSMd0ursUyBpdiF-yAr6fjXPIT9Ki3Q_ZP794z9PXN5ZftFbn58PZ6e3FDnGCqEOdBip0H3ommEUIL2yglpe2VptS51jvuXSfBCmu97HdCUAlUtB042akd8DN0vnqPKf6YfS5mDNn5YbCTj3M2VHPFGTRS_QfKpOQtZ21FX_6FHuKcpnrIImSUK6llpehK1dNzTr43xxRGm24NBbNUM2s1U6uZpZoRdefFnXnuRr-73_idqQJsBXIdTd99-uPrf1ifr0uHJcq9VGjFOFPAfwH2qat4</recordid><startdate>20161101</startdate><enddate>20161101</enddate><creator>McArthur, J. V.</creator><creator>Fletcher, D. E.</creator><creator>Tuckfield, R. Cary</creator><creator>Baker-Austin, C.</creator><general>Springer Science + Business Media</general><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7SN</scope><scope>7T7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BKSAR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>F1W</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>H95</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L.G</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>P64</scope><scope>PCBAR</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>RC3</scope><scope>7X8</scope><scope>7TV</scope><orcidid>https://orcid.org/0000-0002-9892-9744</orcidid></search><sort><creationdate>20161101</creationdate><title>Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs</title><author>McArthur, J. V. ; Fletcher, D. E. ; Tuckfield, R. Cary ; Baker-Austin, C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c427t-ce064de03b4554484a57766af7811cc9ec3ecb60a4aae6fd44160149b0c6b7d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aminoglycosides - pharmacology</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antimicrobial agents</topic><topic>beta-Lactam Resistance - genetics</topic><topic>beta-Lactams - pharmacology</topic><topic>Biomedical and Life Sciences</topic><topic>Ciprofloxacin - pharmacology</topic><topic>Drug Combinations</topic><topic>Drug Resistance, Multiple, Bacterial - physiology</topic><topic>E coli</topic><topic>Ecology</topic><topic>ENVIRONMENTAL MICROBIOLOGY</topic><topic>Escherichia coli</topic><topic>Escherichia coli - drug effects</topic><topic>Escherichia coli - isolation & purification</topic><topic>Fluoroquinolones - pharmacology</topic><topic>Geoecology/Natural Processes</topic><topic>Geologic Sediments - microbiology</topic><topic>Harbors</topic><topic>Life Sciences</topic><topic>Microbial Ecology</topic><topic>Microbial Sensitivity Tests</topic><topic>Microbiology</topic><topic>Microorganisms</topic><topic>Nature Conservation</topic><topic>Rivers - microbiology</topic><topic>Streams</topic><topic>Water Microbiology</topic><topic>Water Quality/Water Pollution</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>McArthur, J. V.</creatorcontrib><creatorcontrib>Fletcher, D. E.</creatorcontrib><creatorcontrib>Tuckfield, R. Cary</creatorcontrib><creatorcontrib>Baker-Austin, C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Ecology Abstracts</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Databases</collection><collection>ProQuest Natural Science Collection</collection><collection>Earth, Atmospheric & Aquatic Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ASFA: Aquatic Sciences and Fisheries Abstracts</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) 1: Biological Sciences & Living Resources</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Aquatic Science & Fisheries Abstracts (ASFA) Professional</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Earth, Atmospheric & Aquatic Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Pollution Abstracts</collection><jtitle>Microbial ecology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>McArthur, J. V.</au><au>Fletcher, D. E.</au><au>Tuckfield, R. Cary</au><au>Baker-Austin, C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs</atitle><jtitle>Microbial ecology</jtitle><stitle>Microb Ecol</stitle><addtitle>Microb Ecol</addtitle><date>2016-11-01</date><risdate>2016</risdate><volume>72</volume><issue>4</issue><spage>840</spage><epage>850</epage><pages>840-850</pages><issn>0095-3628</issn><eissn>1432-184X</eissn><abstract>A growing body of evidence suggests that contaminated environments may harbor a greater proportion of antibiotic-resistant microorganisms than unpolluted reference sites. Here, we report the screening of 427 Escherichia coli strains isolated from 11 locations on nine streams draining the US Department of Energy’s Savannah River Site against a panel of five antibiotics. Streams were chosen to capture a wide range of watersheds from minimally disturbed to highly impacted. Overall, higher levels of resistance were found in waterborne E. coli that also generally exhibited low spatial variability. However, 3 of 11 locations also demonstrated elevated resistance levels in sediments. Two of these occurred in highly disturbed tributaries with no obvious sources of antimicrobials. To further investigate these patterns, we screened a subset of isolates obtained from three streams against 23 antibiotics or antibiotic combinations. A large proportion of these isolates (>40 %) demonstrated resistance to 10 or more antimicrobials, suggesting that environmental multi-antibiotic resistance may be prevalent in this bacterial commensal. Only 4 of 87 viable isolates were tested susceptible to all 23 antibiotics and combinations. Among these multi-antibiotic-resistant isolates, several demonstrated resistance to all structural classes of antimicrobial agents tested, including frontline antibiotics such as gatifloxacin and ciprofloxacin.</abstract><cop>New York</cop><pub>Springer Science + Business Media</pub><pmid>26530280</pmid><doi>10.1007/s00248-015-0678-4</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9892-9744</orcidid></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0095-3628 |
ispartof | Microbial ecology, 2016-11, Vol.72 (4), p.840-850 |
issn | 0095-3628 1432-184X |
language | eng |
recordid | cdi_proquest_miscellaneous_1837320567 |
source | MEDLINE; SpringerLink Journals; JSTOR |
subjects | Aminoglycosides - pharmacology Anti-Bacterial Agents - pharmacology Antibiotic resistance Antibiotics Antimicrobial agents beta-Lactam Resistance - genetics beta-Lactams - pharmacology Biomedical and Life Sciences Ciprofloxacin - pharmacology Drug Combinations Drug Resistance, Multiple, Bacterial - physiology E coli Ecology ENVIRONMENTAL MICROBIOLOGY Escherichia coli Escherichia coli - drug effects Escherichia coli - isolation & purification Fluoroquinolones - pharmacology Geoecology/Natural Processes Geologic Sediments - microbiology Harbors Life Sciences Microbial Ecology Microbial Sensitivity Tests Microbiology Microorganisms Nature Conservation Rivers - microbiology Streams Water Microbiology Water Quality/Water Pollution |
title | Patterns of Multi-Antibiotic-Resistant Escherichia Coli from Streams with No History of Antimicrobial Inputs |
url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T19%3A30%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-jstor_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Patterns%20of%20Multi-Antibiotic-Resistant%20Escherichia%20Coli%20from%20Streams%20with%20No%20History%20of%20Antimicrobial%20Inputs&rft.jtitle=Microbial%20ecology&rft.au=McArthur,%20J.%20V.&rft.date=2016-11-01&rft.volume=72&rft.issue=4&rft.spage=840&rft.epage=850&rft.pages=840-850&rft.issn=0095-3628&rft.eissn=1432-184X&rft_id=info:doi/10.1007/s00248-015-0678-4&rft_dat=%3Cjstor_proqu%3E48723270%3C/jstor_proqu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1832137686&rft_id=info:pmid/26530280&rft_jstor_id=48723270&rfr_iscdi=true |