United States Experience Research Articles

The Poetics of the Mundane in Frank O’Hara’s Selected Poems

The act of walking or strolling and exploring urban places of the metropolis is a dominant aspect in the poetry of Frank O’Hara (1926-1966), a prominent American poet and the leading figure of the New York School during the 1950s and 1960s. O’Hara is largely known for his poetic portrayal of the city stroller who enjoys city detouring as a pragmatic and poetic representation of the urban culture, city crowds, and everyday experiences of postmodern America. The paper’s purpose is to explore the poetic vision of O'Hara's art of strolling the metropolis not as a mere arbitrary self-isolation or escape from the anxieties of the post-industrialized world. Instead, it argues for the value of flânerie or the leisurely city sauntering as a cultural and artistic act of creating the poetics of the mundane. It is a poetics that detects the value of the quotidian and spatial meaning in the most seemingly ordinary places of the consumerist and capitalistic American culture. As the figure of the flâneur or stroller is discerned in O’Hara’s poetry, the study underlines the significance of his poetic advocacy of perceiving, exploring, and interacting with the dynamic as well as the gruesome and consumerist sides of the urban environment of the metropolis.

P-736 Twins, an instant family: beyond the risks and health in Central America

Abstract Study question Why do patients attending fertility centers in Centralamerica consider twins as the best possible outcome? Summary answer In Centralamerica patients expect to have twins after a fertility treatment. Preliminary results show that, from a specialist’s perspective, this expectation might be financially driven. What is known already Twins have fascinated humanity since early times. Every culture in the world has a different reaction to the birth of twins and has myths about them. Some myths are still present in current times and affect our decisions. After a fertility treatment, the likelihood of having twins increases, which has contributed to a worldwide increase of the twin birth rate. In spite of the risks, some patients prefer to have twins. Study design, size, duration This is a qualitative study based on anthropological theory and ethnographic research. Semi-structured interviews were conducted to infertility specialists during July of 2020 in Centralamerica. These six countries are a cultural region that shares historical and economic features which enables a socio-cultural anthropological research. The framework for the interview’s structure is the ecological paradigm from medical anthropology theory. In this paradigm the individual is seen as part of a context that influences their medical decisions. Participants/materials, setting, methods The participants were infertility specialist who had more than 3 years of experience and practice reproductive medicine in Central America. The method was a semi-structured interview via Zoom and was recorded and then transcribed with the software Transcriptions Version 1.2. The results were coded and analyzed with cognitive anthropology methods to identify cultural models in the speech. In ethical aspects, the confidentiality of the interviewee was considered important and was protected through informed consent. Main results and the role of chance The results of the interviews with infertility specialists indicate that they have difficulties explaining patients about the risks and complications of a multiple pregnancy. According to the physicians, many patients expect twins after a treatment. The patients have the idea that they will have “two for one” (“dos de un solo”) and believe that the raising of two babies will require less time and money. The birth of twins is considered a “double blessing” (“doble bendicion”) or a “double price” (“doble premio”). With one single treatment they hope to get the “ideal family” that consist of one girl and one boy (“tener la parejita”). The patients have preconceived ideas that are influenced by their environment, like family members, friends and the media. Central America was part of the mesoamerican region were maya and aztecs myths continue to influence the popular culture and people continued to believe that twins have special connections and could have a good sibling relationship. Physicians are not aware that the media and family have so much weight in the medical decisions of their patients only focus on the fact that patients underestimate the risks. Limitations, reasons for caution The reason for caution is that this is a local study that cannot be generalized in time and place. Wider implications of the findings The results would help to design interviews for patients with the final purpose of understanding their perceptions and attitudes toward twins. In a region with no public health policies regarding infertility treatments, the results can improve communication between the doctors and patients to reduce twin rates. Trial registration number (')

On the road again: A cross-sectional survey examining work schedules, commuting time, and driving-related outcomes among U.S. oil and gas extraction workers.

Oil and gas extraction (OGE) workers in the United States experience high fatality rates, with motor vehicle crashes the leading cause of death. Land-based OGE workers drive frequently to remote and temporary worksites. Limited information is available on factors that may influence crash risk for this workforce. A cross-sectional survey of 500 land-based OGE workers examined work schedules and hours, commuting, sleep, employer policies, and their relationship to potentially harmful events while driving. Over 60% of participants worked 12 or more hours per day. The mean daily roundtrip commuting time was 1.82 h. Longer daily commutes, nonstandard work schedules, less sleep on workdays, and lack of employer policies were associated with one or more risky driving-related outcomes. Implementation and evaluation of OGE employer policies and programs to limit long work hours, reduce long daily commutes, promote sufficient sleep, and reduce drowsy driving among U.S. OGE workers are needed.

Abstract 1167: Genomic comparison between African American men & European American men with prostate cancer

Abstract Compared to European American men (EAM), African American men (AAM) have 2-3 times higher prostate cancer (PCa) mortality rates. AAM diagnose with more aggressive PCa at an earlier age & clinically advanced disease compared to EAM. Studies suggested that tumor biology & cellular heterogeneity/gene profile, have a potential contribution to racial differences, which remain even when controlled for access to care and stage at presentation. Moreover, men of African ancestry from the Caribbean & South America experience incidence & mortality rates similar to AAM, suggesting a possible ancestral basis for some of these expected outcomes. Additionally, the association of the genomic findings with patient ancestry and with other characteristics such as tumor biology & transcriptomic alterations remains poorly understood. Here we hypothesize that African ancestry drives aggressive prostate cancer and leads to genetic alterations with upregulation of unique Immune-inflammatory signature in AAM of African descent. To assess our hypothesis, we performed genome-wide sequencing (WES & RNA Seq), for a total of (n= 72) patients obtained from treatment-naive PCa who self-reported their race. Out of those 72 samples, 47 samples RNA Seq match with WES. To verify the self-reported race, we used ADMIXTURE to generate a quantitative estimate of each individual ancestral composition. Most of our cohorts who self-reported as AAM, their ancestry assigned to African Ancestry (Ancestry proportion > 70%) with either Bantu subpopulation in Sub-Saharan area and/or Yoruba (Nigeria) subpopulation. Descriptive statistical analyses of the study population were conducted and stratified by race & pathology stage. Our results showed that AA men are diagnosed with PCa at a younger age and higher pathology stage. We ran differential gene expression (DGEs) using EdgR/DESeq2 and enriched pathways based on the patient's ancestry/race using GSEA & EdgR gene ontology function. Our DGEs analyses revealed that gene sets such as activation of the innate immune system and immune-inflammation pathway, as well as interleukin signaling, are positively enriched (p-value 0.05), while gene sets such as RNA Polymerase II transcription and metabolisms signaling are negatively enriched (p-value 0.05) in AAM. Moreover, our WES analysis showed that patients with high African Ancestry associated with AR-related mutation such as FOXA1, PTEN, TP53, EPHB2 with SPOP mutation (18% in AAM vs 8% in EAM) on top of these mutations. Interestingly, when we stratified patients based on PD-L1 expression, AAM with high PD-L1 (Immunogenic) has higher CD8+ T cells/PD-1+ expression than AAM patients with low PD-L1 (Non-Immunogenic). WES analysis showed that AAM with high PD-L1 express SPOP mutation. Our study's findings could lead to new therapeutic strategies using anti-inflammatory drugs and immune modulators to decrease the disease burden among men at high risk for PCa. Citation Format: Isra A. Elhussin, Jason White, Tiffany Dorsey, Moray J. Campbell, Melissa B. Davis, Stefan Ambs, Isaac Kim, Clayton Yates. Genomic comparison between African American men & European American men with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1167.

Practical Application of Altitude/Hypoxic Training for Olympic Medal Performance: The Team USA Experience

Practical Application of Altitude/Hypoxic Training for Olympic Medal Performance: The Team USA Experience

“They Didn’t Talk About Stuff like That”: Sexual Health Education Experiences of a Native American Tribe in the Gulf Coast

Native American groups in the United States experience extensive sexual and reproductive health disparities. However, the sexual health education and communication experiences of Native American groups are understudied. Thirty-one interviews were conducted with Native American women in the United States’ Gulf Coast about their sexual and reproductive health experiences. Women reported the following themes: (a) Lack of Formal Sex Education; (b) Young Pregnancy; (c) Lack of Knowledge about HIV/STDs; (d) Lack of Communication about Menstruation; (e) Communication Experiences about Sexual and Reproductive Health; and (f) Stigma Around Discussing Sexual and Reproductive Topics. The findings of this research indicate that there are gaps in sexual health education and highlight the ways female tribal members act as health leaders in their communities.

The role of doulas in respectful care for communities of color and Medicaid recipients.

Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed. Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance. Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.

Barriers to HIV Pre-Exposure Prophylaxis Uptake and Ways to Mitigate Them: Perspectives of Ghanaian Immigrants in the United States

African immigrants in the United States experience disparities in HIV incidence. Pre-exposure prophylaxis (PrEP) effectively prevents HIV infection, yet uptake is low among racial and ethnic minorities. To better understand PrEP adoption among African immigrants, in March 2020, we conducted interviews with Ghanaian immigrants (N = 40) to explore the barriers and ways to overcome these barriers to PrEP adoption. Participants described several barriers (e.g., low HIV knowledge and risk perception, fear of social judgment, cultural values, and norms), which may impede PrEP adoption. We categorized these barriers according to the levels of the socioecological model (individual, interpersonal, community, and organizational/structural factors). Participants also identified strategies to overcome the barriers, such as providing comprehensive education on HIV and PrEP. Our research provides foundational knowledge that can inform future PrEP research with Ghanaian and other African immigrants and offers important insights into factors that may impact PrEP adoption in this population.

“I Never Told My Story”: An Analysis of Stalking in Women’s Memoirs

AbstractOne in six women and one in 19 men in the USA experience stalking. The vast majority of stalkers are men. Popular culture and media coverage tend to offer a distorted image of stalking or ignore it completely. Women who have survived a stalker are often victim-blamed and made to feel shame. In this context of doubting women, this article analyzes three women’s memoirs—Kate Brennan’s In His Sights (2008), Jane Jeong Trenka’s The Language of Blood (2003), and Belle Yang’s Forget Sorrow (2010)—that create awareness about stalking. My discussion suggests that women skillfully use memoir’s flexibility to portray the intersections of various forms of oppression that nourish stalking; their testimonies craft community among survivors, provide advice about how to negotiate a legal system that ignores women’s experiences, and promote empathy.

Parenting a child with a chronic illness during a pandemic

BackgroundNearly 20% of children in the United States experience one or more chronic health conditions. Parents of a child with a special healthcare need (CSHCN) experience increased stress caring for a child with chronic illness. PurposeThe purpose of this descriptive study is to describe stress in parents of a child with chronic illness during the COVID-19 pandemic. MethodsParents of CSHCN (n = 34) were asked to fill out the Pediatric Inventory for Parents (PIP) and answer two questions related to caring for their child during the COVID-19 pandemic. ConclusionsThe means of the PIP-F (M = 146.6, SD = 20.5) and PIP-D (M = 141.9, SD = 23.9) were significantly higher than in previous studies. There is statistically significant positive correlation between parent stress and variables of age of the child and the length of time since diagnosis. In response to the questions about the impact of COVID, nearly all parents reported COVID increased their stress and reported their stress was related to isolation, lack of resources, and concern for the mental health of other children in the household. Practice implicationsCOVID-19 likely exacerbated feelings of stress for parents of children with chronic health conditions. Although unprecedented, COVID-19 shed light on the existing fragility and high stress of parents of CSHCN. Pediatric nurses not only care for children, but must be advocates for the mental health of their patient's parents.

0060 Sleep disparities by race/ethnicity during pregnancy: an Environmental influences on Child Health Outcomes (ECHO) study

Abstract Introduction Poor sleep during pregnancy is common and associated with increased risk of adverse perinatal outcomes. Racial/ethnic minoritized groups in the United States experience worse sleep than non-Hispanic Whites (nHW), likely due to downstream effects of systemic and structural discrimination. Nonetheless, the extent of sleep disparities in the perinatal period remains understudied. In this analysis we estimated the prevalence of subjective measures of sleep in a multi-racial/ethnic pregnant population from the Environmental influences on Child Health Outcomes (ECHO) program. Methods Participants self-reported their race and ethnicity and were grouped into four categories: 1)nHW, 2)non-Hispanic Black/African American (nHB/AA), 3)Hispanic, 4)non-Hispanic Asian (nHA). Our analysis examined trimester-specific nocturnal sleep duration, sleep quality, and sleep disturbances (derived from the Pittsburgh Sleep Quality Index and the ECHO maternal sleep health questionnaire) by race/ethnicity. A total of 1119,2409 and 1284 participants in the first (T1), second (T2) and third trimesters (T3) reported on sleep duration. 1107,1742 and 783 participants in T1,T2 and T3 reported on sleep quality. 1112,1758, and 787 participants in T1,T2 and T3 reported on sleep disturbances Linear or multinomial regression were used to estimate associations between race/ethnicity and each sleep domain by trimester, controlling for body mass index (BMI) and age. We repeated analyses within education strata (high school degree, GED/equivalent; some college and above) Results nHB/AA participants reported shorter sleep duration (T2: β=-0.55 [-0.80,-0.31]: T3: β=-0.65 [-0.99,-0.31]), and more sleep disturbances (T2:β=1.92 [1.09,2.75]; T3:β=1.41 [0.09,2.74]) compared to nHW. Hispanic participants reported longer duration compared to nHW (T1: β=0.22 [0.00004, 0.44];T2: β=0.61 [0.47,0.76];T3: β=0.46 [0.22,0.70]), better sleep quality (Compare to Very good quality OR for Fairly good T1: OR=0.48 [0.32,0.73], T2: OR=0.36 [0.26,0.48], T3: OR=0.31 [0.18,0.52]; Fairly bad T1:OR=0.27 [0.16,0.44], T2:OR=0.46 [0.31,0.67], T3: OR=0.31[0.17,0.55]), and fewer sleep disturbances (T2 β=-0.5 [-1.0,-0.12]; T3 β=-1.21 [-2.07,-0.35]). Differences persisted within the subsample of high SES women. Conclusion These findings highlight racial/ethnic disparities across multiple domains of sleep health during pregnancy. Given the stark racial/ethnic disparities in perinatal outcomes and their associations with sleep health, further research is warranted to investigate the determinants of these disparities, such as downstream effects of systemic and structural discrimination Support (If Any)

0510 Parent and Child Perception of Sleep for Children with Sensory Processing Difficulties

Abstract Introduction Roughly 5.3 million elementary children in the United States experience sensory processing (SP) difficulties, like sensitivity to touch and overstimulation with movement. These difficulties cause high levels of daytime stress and daytime dysfunction (e.g., difficulties with attention, academics, and emotional regulation). In typically developing children (without SP difficulties), high levels of daytime stress impact sleep; however, research has yet to explore sleep health in children with SP difficulties. Our study aims to use validated self- and parent-reported questionnaires to characterize differences in sleep health for children with and without SP difficulties. Methods Children (ages 6-10) with (n=22) and without (n=33) SP difficulties (per parent report; Autism and ADHD diagnosis excluded) were recruited for this convergent mixed-methods study. Sleep was assessed using validated self- and parent-report questionnaires, the Sleep Self-Report (SSR) and Children’s Sleep Habits Questionnaire (CSHQ), and through qualitative interviews with parents. Groups were compared using t-test and Mann-Whitney U tests, with significance set a priori at α=0.05. A rapid qualitative analysis produced themes and were integrated with the quantitative data. Results Parents of children with SP report significantly worse sleep quality on the CSHQ difficulties (MedianSP= 50.5, SDSP= 11.45) than parents of children without SP difficulties (MedianCON=43.0, SDCON=7.27, U= -2.92, p=.004). Children with SP deficits also report significantly worse sleep on the SSR (MSPD=42.18, SDSPD=8.26) compared to their peers (MCON=33.55, SDCON=6.71, t(53)= -4.26, p<.001). Qualitative themes highlight the higher prevalence of rigid, lengthy bedtime routines and adaptations within the sleep environment (e.g. specific pajamas, special bedding) to support sleep for children with SP difficulties. Parents of children with SP difficulties also report higher frequencies of an adult being in the room while the child falls asleep and co-sleeping in the middle of the night. Conclusion Parents and children both report poorer sleep in children with SP difficulties when compared to peers. Future studies should incorporate other sleep health measurement tools (e.g. actigraphy) to further understand areas to target for intervention. Support (If Any) Sensory Integration Education Network PhD Grant (PI: Hartman, 2021); University of Pittsburgh’s School of Health and Rehabilitation Science’s PhD Student Award (PI: Hartman, 2021).

Adding Insult to Injury: Arrests Reduce Attendance through Institutional Mechanisms

Students across the United States experience high levels of contact with the police. To clarify the causal relationships of this contact with educational outcomes and the mechanisms by which such relationships arise, we estimate the effects of arrest on student engagement with school using daily attendance data. Recently arrested students missed significantly more school than did students who would be arrested later in the school year. The effects of arrest on attendance can be attributed to suspensions and court appearances; we found little evidence of changes in absences due to health or skipping school. These results suggest that institutional, not student centric, mechanisms drive the relationship between arrest and educational outcomes. Were it not for institutional channels, particularly exclusionary discipline, arrested students would likely remain more engaged in school. Estimates are similar for white and black students, but black students are differentially affected because they are arrested at higher rates.

U.S. Immigrants and Mental Health: An Investigation of the Influence of Mental Health Stigma and Discrimination on Stress and Depression and Affordances Associated with Using Online Mental Health Applications and Online Support Groups

ABSTRACT Despite evidence that immigrants living in the United States experience significant threats to their mental health, they are less likely to seek and utilize mental health services than U.S.-born individuals. Online mental health resources may be an alternative to traditional mental health care for this population, but less is known about factors that influence immigrant mental health problems or how online technology affordances influence online mental health/therapy applications and online support communities with this population. Drawing upon minority stress theory and an affordance of health communication technology framework, the current study surveyed U.S. immigrants regarding the impact of mental health stigma and discrimination on stress and depression as well as predictors of immigrant use of online mental health/therapy applications and online mental health support communities. The study findings revealed that when controlling for number of years living in the United States, increased perceived mental health stigma was positively associated with greater perceived stress and depression. However, perceived discrimination did not predict stress or depression. Moreover, that higher perceived mental health stigma was a significant predictor of increased mental health mobile application use among immigrants, and greater weak-tie support preferences were predictive of increased online support community use. These findings are discussed alongside theoretical implications, practical considerations, limitations, and direction for future research.

Need for a New Corporate Model in a New Era: Implications for the Financial Sector

In the new era of Globalization, we are faced with several cases of 'ethical failures'. New questions are being raised with respect to the foundational premise of the 'Corporate model' that originated to maximize the return to shareholders. Though it has undergone transformation towards the stakeholder concept, it is weak in terms of its'ethical foundations. Executive greed as well as Corporate greed have overtaken the objective of 'wealth creation for society'. Wealth creation for the executives has taken primacy leading to many wrong decisions as indicated by the recent recession experience in America. Many American Corporations have fallen from grace. This indicates that there is a need to revisit the foundational concepts of the modem Corporations. Paper suggests the need for a new foundation in terms of a Tripod model, based on recognition of inter-linkages, interdependence and integration of Market, Society and Self. In this framework, Market, Society and Self are not only considered as Cocreators of wealth but 'Co-creators of Wealth with Grace'. For this 3 Rs (Resources, Responsibilities, Relationships) model is suggested. This model also leads us towards a new Performance Scorecard on the basis of 'Holistic Performance of The Corporation'. Paper also examines implications of 3 Rs model for Financial Sector for developing a new reporting system based on 3 Rs.

Access to dermatologic care in Indigenous American communities

To the Editor: American Indian and Alaska Native (AIAN) tribes in the United States experience poorer health outcomes compared with other Americans, including increased melanoma mortality1 and acne scarring.2 Several factors explain this disparity, including inadequate health literacy, disproportionate poverty, cultural differences, and decreased accessibility to dermatologic care. Although the density of dermatologists (3.4 per 100,000 individuals) across the United States has risen, it is still less than the 4 per 100,000 individuals recommended for achieving sufficient care.

Valuing African voices in Colleges/Schools of Education: introducing the Special Issue

Abstract This article is aimed at introducing the Special Issue on “African Experiences in America’s Colleges/Schools of Education.” It also introduces the voices that are from African nations–these professionals are educated and employed in various regions of the United States. While their experiences in Colleges/Schools of Education (C/SOEs) have been rewarding, they have encountered negative experiences that are results of racism and xenophobia. The question is, How can their negative encounters be reduced so that they can maximize their fullest potential as students, faculty, staff, administrators, and leaders? This article sets the stage for responses to this question.

Investment Income Withholding in the United States and Germany

In a reversal from its historical roots, the United States income tax system now taxes income from labor significantly more heavily than income from capital. It does so not only facially, through explicit preferences for income from capital, but also more subtly, through more hidden features of the tax system - specifically, enforcement strategies. This Article focuses on a prominent disparity in enforcement between the two forms of income: Wage income is subject to withholding while investment income is not. In its critical examination of this disparity, the Article first offers a brief history of withholding in the United States, in which withholding on wage income was eagerly embraced as a part of a patriotic war effort, while withholding on investment income was rejected again and again. The Article then contrasts the United States experience with that of Germany. Under Germany's remarkably robust constitutional principle of equality in taxation, the failure to withhold on interest income was held unconstitutional, and the German legislature was required to enact it. However, instead of leading to greater equality in tax enforcement, the new withholding law led to widespread evasion. The German experience is cited as a cautionary tale on the dangers of international tax competition. Yet, ultimately, it may prove to have been the tipping point for countries to engage in the cooperative behavior needed to overcome undesirable tax competition. The last Part of the Article draws upon lessons learned from past U.S. and German experiences to make the normative and practical case that now is the time to adopt investment income withholding in the United States.

Early United States experience with liver donation after circulatory determination of death using thoraco-abdominal normothermic regional perfusion: A multi-institutional observational study.

Mortality on the liver waitlist remains unacceptably high. Donation after circulatory determination of death (DCD) donors are considered marginal but are a potentially underutilized resource. Thoraco-abdominal normothermic perfusion (TA-NRP) in DCD donors might result in higher quality livers and offset waitlist mortality. We retrospectively reviewed outcomes of the first 13 livers transplanted from TA-NRP donors in the US. Nine centers transplanted livers from eight organ procurement organizations. Median donor age was 25 years; median agonal phase was 13 minutes. Median recipient age was 60 years; median lab MELD score was 21. Three patients (23%) met early allograft dysfunction (EAD) criteria. Three received simultaneous liver-kidney transplants; neither had EAD nor delayed renal allograft function. One recipient died 186 days post-transplant from sepsis but had normal presepsis liver function. One patient developed a biliary anastomotic stricture, managed endoscopically; no recipient developed clinical evidence of ischemic cholangiopathy (IC). Twelve of 13 (92%) patients are alive with good liver function at 439 days median follow-up; one patient has extrahepatic recurrent HCC. TA-NRP DCD livers in these recipients all functioned well, particularly with respect to IC, and provide a valuable option to decrease deaths on the waiting list.

Reevaluation of the Role of Blocked Oropsylla hirsuta Prairie Dog Fleas (Siphonaptera: Ceratophyllidae) in Yersinia pestis (Enterobacterales: Enterobacteriaceae) Transmission.

Prairie dogs in the western United States experience periodic epizootics of plague, caused by the flea-borne bacterial pathogen Yersinia pestis. An early study indicated that Oropsylla hirsuta (Baker), often the most abundant prairie dog flea vector of plague, seldom transmits Y. pestis by the classic blocked flea mechanism. More recently, an alternative early-phase mode of transmission has been proposed as the driving force behind prairie dog epizootics. In this study, using the same flea infection protocol used previously to evaluate early-phase transmission, we assessed the vector competence of O. hirsuta for both modes of transmission. Proventricular blockage was evident during the first two weeks after infection and transmission during this time was at least as efficient as early-phase transmission 2 d after infection. Thus, both modes of transmission likely contribute to plague epizootics in prairie dogs.