Purpose The purpose of this study is to explore the impact and feasibility of a pilot Community Health Worker (CHW) intervention to improve diabetes management among Bangladeshi-American individuals with Type 2 diabetes living in New York City. Methods Participants were recruited at clinic- and community-based venues. The intervention consisted of six monthly, CHW facilitated group sessions on topics related to management of diabetes. Surveys were collected at baseline and follow-up time points. Study outcomes included clinical, behavioral, and satisfaction measures for participants, as well as qualitative measures from CHWs. Results Improvements were seen in diabetes knowledge, exercise and diet to control diabetes, frequency of checking feet, medication compliance, and self-efficacy of health and physical activity from baseline to 12 months. Additionally, there were decreases in A1C, weight, and BMI. Program evaluation revealed a high acceptability of the intervention, and qualitative findings indicated that CHWs helped overcome barriers and facilitated program outcomes through communal concordance, trust and leadership. Conclusions The intervention demonstrated high acceptability and suggested efficacy in improving diabetes management outcomes among Bangladeshi immigrants in an urban setting. The U.S. Bangladeshi population will continue to increase, and given the high rates of diabetes, as well as linguistic and economic barriers faced by this community, effective and culturally-tailored health interventions are needed to overcome barriers and provide support for diabetes management.

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Enterohemorrhagic Escherichia coli (EHEC) serotype O157:H7 colonizes the human intestine and is responsible for diarrheal outbreaks worldwide. Previously we showed that EHEC produces long polar fimbriae (LPF) and that maximum expression is observed during the exponential phase of growth at 37°C and pH 6.5. In this study, we analyzed the roles of several regulators in the expression of LPF using the ␤-galactosidase reporter system, and we found that H-NS functions as a transcriptional silencer while Ler functions as an antisilencer of LPF expression. Interestingly, deletion of the hns and ler genes in EHEC caused constitutive expression of the fusion reporter protein. Semiquantitative reverse transcription (RT)-PCR was also used to analyze LPF expression in the EHEC ler or hns mutant strain. The hns mutant exhibited an increase in lpf mRNA expression, while expression in the ler mutant was decreased, compared to that in the wild-type strain. Using primer extension analysis, we identified two potential transcriptional start sites within the regulatory region of lpf and located consensus hexamers of ؊10 (CAAGAT) and ؊35 (TTCAAA), which are commonly found in 70 -dependent promoters. Further, we determined whether H-NS and Ler interact directly with the lpf promoter region by using purified His-tagged proteins and electrophoretic mobility shift assays. Our data are the first to show direct binding interactions between the H-NS and Ler proteins within the regulatory sequence of the lpf operon. Based on the electrophoretic mobility shift assay, RT-PCR, primer extension, and ␤-galactosidase assay results, we concluded that the E. coli O157:H7 lpf operon possesses a promoter dependent on 70 , that H-NS binds to the regulatory sequence of lpfA and "silences" the transcription of lpf, and that Ler binds to the regulatory sequence and inhibits the action of the H-NS protein.Enterohemorrhagic Escherichia coli (EHEC) O157:H7 is a serious food-borne pathogen causing diarrhea that is often bloody and accompanied by severe abdominal cramps and can result in a life-threatening condition known as the hemolyticuremic syndrome (reviewed in reference 33). The organism can be found living in the intestines of healthy cattle, and eating contaminated meat, especially ground beef, has resulted in multiple outbreaks worldwide (23). Recent E. coli O157:H7 outbreaks have drawn attention to food-borne illnesses, and though official sources were saying that the overall number of cases is on the decline in the United States, consumption of produce, particularly leafy vegetables, is becoming increasingly associated with human infections. This alternate source of infection has set up new challenges for the scientific community in trying to identify novel determinants and regulatory mechanisms implicated in the colonization, survival, and/or pathogenic processes (9,10,40).During the infectious process, EHEC adheres to the intestinal epithelium, where it produces Shiga toxins responsible for the hemorrhagic symptoms. Adhesion of E. coli O157:H7 t...