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By Robert Birnbaum | Published: October 4, 2000
Andre Dubus III has worked as a private investigator, corrections counselor and bounty hunter — and various other jobs. As an actor, he has appeared in numerous stage plays and three independent films. He is also a general contractor and carpenter. Andre also teaches writing at Tufts University and Emerson College in the Boston area and is the author of one story collection, The Cage Keeper: And Other Stories, and two novels, Bluesman and most recently, House of Sand and Fog (which was a finalist for the 1999 National Book Award). Dubus has garnered other distinctions, including a Pushcart Prize and a 1985 National Magazine Award for Fiction. He has also been published in Best American Essays 1994, the Boston Globe, the Los Angeles Times Book Review and numerous literary reviews. Andre Dubus III is the son of the acclaimed and recently deceased writer Andre Dubus. He lives in Newburyport, MA, with his wife and three children.
Robert Birnbaum: Why would you want to become a writer?
Andre Dubus III: Um. [You mean] because of the daddy thing? Well, it was not a conscious choice. I did not want to be a writer. Matter of fact, I resisted it up until my 20s. In school…in public school nobody knew who my father was. And I didn't know who my father was. Like most kids, I didn't know what my father did. And I didn't care. And in my late teens I read his first novel, The Lieutenant. I was about 15 or 16, and I remember putting it down thinking, "That was really good. My dad does something really interesting." I felt no desire to do it myself. The thing that I was best at in school were reading and writing subjects. Teachers would encourage me to do more.
The first school I went to was Bradford College, where my father taught…There was the first time I got a real dose of adulation about my dad. And attention towards me about it. The questions were, "Why don't you write? You write really well." I said, "No, I'm not doing what my father does." Of course, I didn't know I felt that way until I said it out loud. I always felt sorry for those guys, you'd see those trucks 'Ralph & Sons.' So to answer your question, I never wanted to be one. That's the last thing I wanted to be. No friggin' way.
I went to the University of Texas at Austin ultimately, and studied sociology and political science and economics and all that. I was a Marxist. I was heading to Wisconsin to get my Ph.D. in Marxist social science. And then I was going to go to law school, and I was heading toward some sort of human service. I was bullied as a kid. I went to fourteen different schools before I got out of high school. I began to fight back in my teens. I had a lot of rage. And when I got more educated about the history of the world, I could see that it's nothing but the history of bullying other people. It's more than that, but that's a lot of what it is. I got hip to American imperialism and I wanted to fight it. That's what I thought I was doing when I left college. It was a very rational decision. (I know this is a long-winded answer.)
I went back home to the East to live for a year — I just wanted to do something physical — because I was too good in school. I had a 3.8 average and I thought I should get out of the books a little bit. I wanted to work in a factory instead. I hired on a construction job with my younger brother in Salem. I lived in Lynn, I was doing boxing there, at the Lynn boys club. I was reading social theory at night (Max Weber). I started to date this girl from Bradford, who was taking one of my father's fiction writing classes. And she had a crush on this writer, in her class. I was jealous. She'd come back flushed. I said, "You know what writers are like? They drink a lot. They jump each other's wives. He's probably an asshole." I was just jealous and insecure. And then I was at my father's house and happened to see this guy's manuscript (in my father's office). I picked it up. And I read this four-page story. And it was beautiful (he's a good friend of mine now). I was inspired. This weird thing. First, she had a crush on him, and then I had a crush on him. It was really beautiful. I felt this wonderful sense of…
I hadn't been reading fiction in years, I wasn't an English major. In my off time I was reading social theory. And I was inspired. Artistically inspired. I was 21 and a combination of inspiration and a lowly combination of wanting to impress my girlfriend or to show her I could be sensitive, too. That weird mix. So I started to write a story. Spent three months on it. Had never taken a writing class. Never thought of writing. When I put it down and finished the story — a little story about my grandmother and grandfather in Louisiana where I lived for a while — it was a bad story. It was a first story in every way. But I really felt hooked. And for the first time I felt like myself. I was 21 years old, and for the first time I felt like me. It was a really a rare major life event. I put down the pencil, went for a drive in my beat-up Toyota around the back roads of Boxford. And everything looked crystal clear and pristine. And I was all confused because it seemed like I should be writing more. I wasn't confused about the daddy thing; that never bothered me. It was a surprise to me.
So I went to the University of Wisconsin at Madison. Stayed four days and quit. I really liked it there. It's like the beautiful woman you meet and talk to for five minutes and never see her again. You think, maybe I should've called. Talked a little longer. So that's a long-winded answer. I was reading masterpiece short stories in my hotel and talking to demographers and other sociologists at parties at night. I thought, "These are nice people, but I don't want to be a sociologist. What am I doing going into debt studying this? I just want to know more stuff. That's all." So I quit.
RB: How did you end up at Austin?
AD: The honest answer is that I was involved with an Iranian girl. This is 20 years ago. I was obsessed with her, and we were in a deep and tumultuous relationship, and I couldn't break up with her, and so in my 19-year-old romanticism I applied to five universities, all state colleges, west of the Mississippi. And [Texas] was one of the five. I took a train trip and visited all five campuses, and when I got off at the Austin train station I saw a billboard of Mexican food, Lone Star beer and underneath it was a cactus. And there was a pretty senorita on the billboard. It would have beat a bottle of Lone Star. I didn't have to see anything more. So I said, "That's where I'm going. This is where I'm going."
RB: In 1977, you must have been a pioneer in discovering the charms of Austin, Texas. Were there many Easterners there?
AD: Yeah. It wasn't hip yet. It wasn't a hip place to be. It was a great place. I love Austin…I haven't been back since. It's a beautiful place, and I loved my time there. It was rich culturally…Let me finish about the father thing. It only became an issue for me when I began to publish. Then I got this real father-shadow-son stuff. It was very distracting and a real pain in the ass in my 20s. It's a lot less of a pain now because I don't give a shit. I don't care.
RB: You don't strike me as someone who would use 'III' in their name.
AD: I don't. I don't even like it. I could have changed my name. I could have dropped 'Andre' or dropped 'Dubus.' Initialized. The reason I couldn't goes back to why I kept writing. I felt like me for the first time. I think that's what Joseph Campbell was talking about when he said that's what people are looking for, to feel the rapture of life, they don't do that until they do that thing that leaves them feeling more like themselves. So I couldn't put an inauthentic name on it. Although I do feel like Andre III is a little inauthentic because that "III" is just something — it's there, that's my name, but I've never used it. I don't like it. It sounds aristocratic and I didn't grow up with any money. But that's it, too bad, there are worse hands to get dealt. I just hope people will get past it. I'm not past it when people keep hitting me over the head with it. It's understandable, and I guess I'll have to talk about this my whole life. So, I've sort of surrendered to that.
RB: Your "career path" has taken some interesting turns, but you appear to have taken on the writer's life wholeheartedly. You teach at Emerson and Tufts…
AD: You mean I'm completely in a literary world. Yeah, I am. I didn't go to any graduate writing program. I hadn't taken any writing classes. Right after I sold my first book in the late '80s, I thought it was time I got some schooling. So I went to Vermont's Low Residency Program for a year. It wasn't a good year for them, and it wasn't a good year for me, and I didn't get a lot out of it. But what I did get was bombarded — because in the writing world my father is known and he's respected, as he should be, he's one of my favorite writers, and I revere his work completely. People would bombard me with this stuff. It was like being Elvis, Jr., Frank Sinatra, Jr., Hank Williams, Jr. How did I become a crown prince of this king? Who wants this? Let me out of here. But what could I do? Stop writing? I may as well just kill myself. Change my name? I may as well just kill myself. So screw 'em all, I'm going to keep doing it. But I had to leave. It was too much. I'm surprised that I'm in the whole scene now. But I'm glad I'm there, it feels dangerous, to me, to hide from it and run away from it. In politics the whole idea is to shine a light on the skeleton in your closet. Let's just shine a light on it and talk about it…
RB: Do you think that you can teach people to write?
AD: No. Yes and no. I got into it because I was doing construction and the same friend (ironically) whose story I had seen years earlier and inspired me was teaching at Emerson. He did this all on his own. I wasn't complaining about not having enough writing time. He deduced that if I was working twelve hours a day doing construction, I wasn't writing enough. He gave the head of the department at Emerson my book and said, "You ought to hire this guy." So they called me and offered me a job. So I went. I'd never been in a writing class, and I hadn't taught one. So I didn't know where to go. Unfortunately or maybe fortunately, my life has been lived largely in this spontaneous ad-libbed way. Very improvisational. So here I am, a writing teacher, and I don't know what I'm talking about.
I have seen that the writing classroom, the writing workshop can be far more dangerous…destructive than helpful. The way to make it good and the way I can keep doing it without feeling like a cynic…a good writing teacher is simply a good guide. Our job is not to make your stories the way we want them. Our job isn't to fix your stories or write them the way we write them. Our job is to point out what feels true and authentic in the work and what feels forced and contrived. Let you, the writer, go back from the workshop — a successful workshop has more questions than answers — and you should leave with a deeper sense of what you're doing well and a deeper sense of what you can work harder on. And then go back to work. In that sense, I've seen great improvement. I work hard on making it a very controlled environment. So people can't write the stories for the writer. You can't trash a writer. You have to be honest. Every semester I get writers who are much more gifted than I am. And more gifted than others. And you can see they have this natural ability. I've seen over the years that doesn't make a whit of difference. You need something else. One thing I think a person needs — you've got to be a real worker bee. Marge Piercy says, "Work is its own cure. You have to like it more than being loved." If you've got that, forget the talent.
RB: What about the seemingly 20th-century phenomenon of 'writer's block'?
AD: What's also going on…it's just a theory. I think capitalism has done a weird thing to it as well. [In] The Gift by Lewis B. Hyde, basically the whole premise is that the artistic thing is a gift. From whoever. To the person who writes, essentially a gift to the culture. All these are gifts to us. And we do a weird thing to the alchemy of gift when we price it. My own theory about writer's block is that it's a real episode of self-consciousness. You're more watching yourself writing than you are writing. You're watching yourself writing, you've got the voice of the critics in your head, you've got the publisher's deadline, you've got the advance you have or haven't gotten in your head. All this is working against you. We've become these little factories. In the same way we talk about performance anxiety — about sexual relations. What a weird way to talk about making love! What a completely perverted way to talk about making love! But in this very visual surface culture it make sense that you start to watch yourself as you are making love to your wife. What the hell is that? It's the opposite of being in the moment, in the Zen sense. So my own two cents on that is that now that's also part of the mix…is that now these writers are these little factories, these little businesses.
RB: And there is also 'wannabeism.' So many people want to be a certain thing. Though they don't want to work for it. But they want the perks and the lifestyle. And to be part of the camp. It would seem that there is something attractive about being a writer. Although if you ask many writers, they'll tell you it's misery.
AD: Another thing that writing programs can do if honest and well done and constructive — and frankly if they're loving. By loving I don't mean soft — I mean tell the truth constructively. You can guide the writer who wants to be a writer more than write to that understanding.
RB: Thirty years ago, how many writing programs were there?
AD: Very few. It's a huge industry now. It began at Harvard. I forget the professors' names, but it was 1912 or so. They were looking for a more innovative way to teach literature. So they said, "Why don't we just have them write their own and see how hard it is?" That was the first creative writing class, and it metamorphosed. When my father went to the University of Iowa [Writer's] workshop in the '60s it was one of six or eight. Now there are 200. It leaves a bad taste in my mouth. I don't think it's a good development. It smells like a racket to me.
RB: It seems to have paralleled the development of the MBA programs. It seems like they are factories. Add to that the economics of publishing are not hopeful for most writers…
AD: Admissions people ought to say, "It's not a degree that's gonna get you a job. You're gonna be in debt, and you're gonna have to still be waiting tables to pay this off. All it can give you, if you're lucky enough to get the right teachers, is that you can compress the apprenticeship period and learn more, faster. That's it."
RB: And maybe you can get a teaching job.
AD: Maybe. But you probably won't. Another thing that these things do give is a community. A lot of people don't grow up with a writer in the family as I did. And it's nice to know one or two or three people you like that you can share your work with and talk to at three in the morning about how hard it's going. That's a valuable thing to get.
RB: Don't writing programs work against that? Isn't there a lot of competition and jealousy?
AD: Yeah, it's a real dark side of it. It really is. I tell my students I am not remotely interested in their careers. Or their academic lives. I'm not. I wish them all well.
RB: Students asking you where they should look for a job or how to groom themselves for a position…
AD: I wouldn't know how to tell them. I don't have any connections. I might know a few people who might know a few people who can talk to some other people and maybe you could get an interview with somebody for a job at the University of Maine or something.
I try to dissuade anybody from looking at this as a way to be a writer. It's an insincere approach to this art form. I assume — and I tell this to my students — that they are here because they want to try and create art. Something beautiful in and of itself, that lives on its own. That will affect someone that will never love them. And let's try and work and find what those tools are. Good luck. I hope wonderful things happen. But you may as well get into the lesson now that the real prize is just doing it. Everything else is gravy. Even then it's not such gravy. Now you get reviewed. Anyone can say whatever they want. It's not all good. They have this idea, I probably had it, too, that when you have this hard-covered book all a sudden you've arrived. No, now you just have another level of difficulty. Which is the nature of mature living. It's the nature of adulthood. Reach this, and now bigger obstacles. Now I can climb a bigger mountain. Well, good here's the biggest mountain I've ever seen, right in front of me. You climb that. There's another mountain. And this one's got lightning at the top and lava. And there's a big hole…
RB: Everybody expects plateaus and sanctuaries in life.
AD: It is not like that. That expectation leads to marital failures and poor parenting choices. I'm not above any of it. I do it, too. But I do think we're better off not doing it. I'm not a Zen Buddhist, but the more I hear about it the more I like it. This whole notion of being present in the moment, accepting what is, sounds very healthy and sounds like the way to go.
RB: You dated an Iranian woman around the time of the revolution. Did you know much about Iran?
AD: Not until I met her. I hadn't heard of Iran. Like most teenage Americans, I was ignorant of all geography. She said she was from Persia. She explained it all to me. We were in a relationship for three or four years. In so far as you can have a relationship with a Persian girl who is loyal to her Shiite Muslim heritage. Which she was. Very interesting to go from late '60s-early '70s free love to dating a Muslim.
RB: She had been recently expatriated?
AD: Yeah. Her father was a retired Iranian colonel in the Shah's air force. And that's where I learned about the Shah. I learned about how corrupt the regime was. I learned more after I left that relationship and studied more about the CIA involvement in all sorts of cultures. And just how terrible the Shah was. How terrible the CIA was. And the fact that my friend was actually a part of that culture was interesting.
RB: And twenty years later this shows up in House of Sand and Fog. Complicated experience, the life of the Iranian exile…
AD: It's much more a thing of face and pride. Much more about pride than comfort. For Americans it would be more about, "Hey, where's the cash?" We like all that status stuff, but not as much as the Iranians.
RB: You explored the complexity of this Iranian exile family's life. No one else has done that in American literature…
AD: I didn't think of that before. I was relieved that an Iranian reviewer in San Francisco actually gave it a thumbs-up. She had some problems with my Farsi. Which is understandable. I tried to get right but some of my colloquialisms were mixed up. I'll have to fix that for the paperback.
RB: How long did it take you to write this book?
AD: Four years. And this is having three children, working at, usually three campuses. And having a carpentry job. So on a good day, I get two hours in. I try to get no less than 90 minutes a day. I wrote most of this book longhand, in pencil, in my car. 'Cause we live in a small half-house — with little kids it gets pretty loud. I didn't have an office. I wrote most of it in my car in a graveyard near my house. It was very quiet. All year long. Crank up the heat in the winter. Bug spray in the summer. It took me three years to write the story and another year to type up 22 notebooks. And another six months of extensive revision after it was acquired by Norton.
RB: Extensive, meaning?
AD: "Murdering my darlings." Like Faulkner. Cutting a lot that I liked. I tend to overwrite and then shave. My whole way of writing — nothing new or original — I try not to outline or think ahead, I try to let the characters go where they're going to go. And I see where they go. And sometimes I write down a bunch of dead-end roads to find what it is.
RB: Were there always just three voices?
AD: Yeah. Actually I thought it was going to be two voices. Then Lester came in and completely surprised me. Him coming into the story was a complete surprise. I had no idea this guy was ever going to show up. Usually I can't trace the genesis or origin of the stories. But in this one I could see some of the things that were knocking around in my subconscious for a few years. When I worked as a private investigator in Colorado, I worked for the U.S. Marshal who looked like the Lester I hopefully described in the book. A kind of lean, dark, masculine, yet something strong about him. He had a crooked mustache and he always looked sad. And he carried a big-assed gun. I could never get that out of my head. He showed up ten years later in this.
RB: Are you happy with this book?
AD: Yeah. I'm never completely happy. I'm always a little haunted by everything that I write. There's always that feeling of 'just give me one more year.' But this one, I know it's the most accomplished I've done. There's no doubt in my mind. I've never worked harder. I found a new stamina for working and revision. I've always tried to revise and never take the short route in work. Whereas before I felt I could run eight or 10 miles, now I feel like pushed the 18 or 20 mile range. So I feel it's a solid book and it's the first time I'm looking forward to people reading it. Before I wouldn't go out of my way to say I have a book…I'm really curious about what people think.
RB: The fate of the protagonist's son, was that a given from the inception of this story?
AD: Nope. I can tell you that that was the hardest part of writing this. Sustaining the two voices. And trying to stay out of it. I was open to them never meeting. I did not want to contrive the action. So I just waited to see what happened. When things begin to escalate with her [Kathy's] addiction. Which surprised me, too. I believed when she said she didn't have an alcohol problem. And she starts to go over the edge and then Lester gets involved and things are escalating. I started to have a bad feeling. All along the way, I was completely open to — certainly there's going to be a moment for some sanity, and there will be some moments for reconciliation, some moments for some talk. Some moments to work this thing out.
Frankly, I have a blessed life — I'm blessed with three healthy children, thank god. I have a really solid marriage. I have a creative outlet, and I make enough money to feed us. What the hell else more do I want? I don't want to write a tragedy. I didn't want to. But I also didn't want to steer it. I think it's important to allow it to be what it's going to be. So to answer your question. No, I did not know it was coming, and if I did I don't know if I could have written it, because I must have had to kill a part of myself to write that. Truman Capote says, "A writer should write as cool and detached as a surgeon." I must have just have just anesthetized myself to stay in the scene and write it clearly. It only was after a year when I read the galleys that I allowed myself to feel the grief. In looking at it there's a sense of guilt. Like, "C'mon man couldn't you have done something nicer for these people?" Our job as writers is to try and find the particular truth of this particular experience. I think what happens happened. I have to let it say what it says…Not to say that we are all just conduits. We do have a lot of selectivity…little microchoices. But in order for it to go somewhere deep we have turn it over more to our intuition or gut.
RB: When you start out with the character Kathy, you don't see her as a terminal loser with nothing going for her?
AD: No. I did see her as being on the down side of things. In a bad lull. I got the idea for that part of the story from a newspaper clipping about a woman who was kicked out of her house for failure to pay back taxes that she didn't owe. She was an older woman. I actually brought this clipping to my first writing class at Emerson in 1990 to show these 18-year-olds that here's a good place to get story ideas, these news briefs. Because you don't know anything. Imagination has to fill in the details. Man shoots 15 dogs. Drinks 15 Pepsis. What's that about? So I showed this clip about a woman being evicted and said someone should write about it. Well nobody did. I put it away, and I never forgot it. So I picked it up, and it never quite came together. Then I saw a clipping that the man who bought the house was named Mohammed. So that was sperm and egg. Something started to multiply and divide. I started to write about Kathy from the point of view of an older woman, but she very quickly metamorphosed into a younger woman who had these problems. Again, it was very subconscious, and it went back to an idea I had years ago. No, I wasn't aware she was such a loser until I got deeper into her point of view. I didn't know how unreliable she was, what a loose cannon she was. I always thought it was the colonel who was the loose cannon…
RB: He turns out to be the most sympathetic character.
AD: He was for me.
RB: Not only because of the plot. He showed civility and humanity and decency.
AD: That was a challenge, too. Because I did and do judge that whole scene [the Shah's reign] as corrupt and awful. And what we did with our covert money to support oil profits for a few. It's an old story with us. For a handful of white men we sacrificed thousands. So one of the challenges was not to prejudge this guy as a bad guy or I'd never get into his skin. Characters won't let us in if we do that. Hemingway had a great thing to say about that. He said, "The job is not to judge but to seek to understand." And it was easier for me because I knew a man like the colonel.
RB: Did many Iranians separate themselves from the Savak (the Shah's secret police) the way the Germans separated themselves from the SS?
AD: Yeah. I love the analogy to the Third Reich. It got to be this, well that's them, and this is me, and I'm not them. Well. But you are. You're in the culture. You stand up, and your family gets shot. So it's understandable, the lack of courage.
RB: The colonel as an outsider provides interesting commentary on American social values and behavior.
AD: The funny thing is — what I love about writing is — I didn't have a notebook and put it in his mouth. I was him driving home, looking at the houses, looking at the TV lights. Thinking about Americans. And, of course Persians don't sit in front of the TV for dinner. They sit and they talk. For three hours. I think it's a real sickness to have those TVs on our dinner tables. It kills community, it kills families. It does more damage than we say. Of course, my opinions probably come through but they were him [the colonel] I was pleased to see it.
RB: Any interest in House of Sand and Fog as a movie?
AD: Yeah, there's been some real preliminary interest. I actually had a producer call a month before it came out. Yeah, there's some interest.
RB: Is that pro forma nowadays?
AD: This went out as a manuscript to some studio. And I thought, "Well that's weird." I have a friend who never sold her book, but sold the picture manuscript to Costa Gravas for big bucks. So she sort of won and lost. It seems pretty dangerous and weird.
RB: Do you read?
AD: I don't read as much as I would like right now. That's got to do with a busy life and three little kids. I'm not complaining — I'm blessed and I'm rich for it. It is the big missing chunk in my creative life. I probably read, if I'm lucky, a book a month. I liked to read about two a week. I read thousands of manuscript pages, and that feeds me. Somebody said, "The writer who doesn't read, flourishes on the vine." I realized after I finished the book that reading Richard Price's Clockers gave me the idea to do this novel with two voices.
RB: Boston is a community thick with fiction writers. Do you hang out and/or know a lot of writers around town?
AD: No. I'm kind of out of the scene, really. I not really a Boston boy. A lot of the established writers I've met through my father. They're friends of his and have become friends of mine. And I meet people at Emerson where I teach. But, the writers I know are usually in my classes. Lot of my friends are in performing arts. My wife's a dancer and choreographer, so a lot of them are actors and dancers, newspaper reporters, carpenters. I do a lot of carpentry work. So a lot of my friends are plumbers and electricians. It's an amazingly rich community. In Newburyport, they had a fundraiser for the library. They invited all the published writers…30 showed up. I had no idea. Just in that 20-mile radius.
RB: How much do you think about the business?
AD: This can sound disingenuous with a book coming out and national tour, which is a new thing for me, and I'm enjoying it. I do think it's important to not think about that when you're writing. It's wonderful to publish, and it's very gratifying to hold that book. But I do think you really just have to concentrate on the work. And it can be very distracting, harmful to creativity to get wrapped up in thinking about sales and marketing. I know writers who abandon promising and exciting projects because they made the prejudgment that they would never sell. I think that's like having a child and thinking, "I'll never get so-and-so in to this school; we're just going to move." How do you know that's going to happen in 20 years? You have to be in the moment. Write your damn book, and if you sell it, great. But it is a tough time.
RB: What do you intend to do for your tour audiences?
AD: Read from the book. Answer questions. I find it so hard to read from novels. I'd really rather read a short essay or a short story. I want to give 'em a whole experience. If the novel is a face, then I just give them a little piece of the nose. Hope that you can like the face…
RB: Given the explosion of author touring in the past few years, why hasn't anyone tried to do something more than the predictable short reading followed by the Q & A?
AD: You mean like take off our clothes and dance? I've also acted consistently, on stage and small films throughout the last 20 years. I started doing both at the same time. It was very confusing in my 20s, I didn't know if I was supposed to be an actor or a writer. It's an American thing to think you have to make a decision. "What are you?" I do think there's this pressure…When it comes to this reading thing, I try not to perform for a reason. It seems to me that this is a weird thing to do. Have these readings. Really, the experience is the book. We're not performers. Some writers are also gifted speakers…and if they can do it wonderfully, good. It's a weird thing to do. When I go to a reading I'm not really there to hear someone read something which is better when I read to myself anyway — usually most written work is better to read to yourself quietly than to hear read aloud. I'm really there to ask some questions. I try to keep my readings to 15 minutes and then talk for 30. Talk about writing, talk about the life. I'd like to get more time to talk…I try not to perform, I try not to be the monkey and the organ player…what gives me concern is that I want people to forget I wrote the book. It's one of my fears about being Andre the Third, is that people get so interested in that story, or so wrapped up in what's it like to have the same name and to be the son of the master writer, that they won't read the book. So I want to disappear. I almost want to have anonymous on that book. Pynchon and these guys who don't ever do interviews, who disappear–I think they're on to something. You can be a little too elusive. I simply want people to forget who wrote the book and to practically forget they're reading a book. Because I worked hard for them to get lost in the book. I do worry that my showing up will be a distraction.
RB: What do you see for the future in your life of writing? Is it possible that you might do something else?
AD: It's possible. That's a healthy way to look at it. I think we get caught up at looking at ourselves as writers. We lock ourselves into that noun and then stop growing in other ways. I can't imagine not writing because I just don't feel like myself when I don't. I also do some acting. When I'm not acting I feel fine. I can go years. I can't go three or four days without writing and not feel a little askew. There's some weird thing that happens when you get some commercial success or worldly recognition. A friend said, "What you've been working for all these years has finally happened." A very American response. My first thought was, "Have I been working for this?" And I thought, "Well, no." This is nice, I won't say no to it. But I have been working on trying to write better. That's it. I've been working on trying to write better stuff. If this is one of the by products of that. Great. But I've really been working on improving my use of abstract language. On not being so literal. On allowing different kinds of characters to come in. Been working on the thing. So when you say what do you see for the future, I hope that writing is part of it. I try not to think about writing more books. Right now there's this pressure… I'm working on weird length 50-page stories that are coming out of me. They take a year each. They're kind of hard to publish.
RB: You have no commitment to a particular form: novel, short story, essay, novella?
AD: I really don't. I've published two novels, but I've probably written five. They're what I like to read most, even though I come from a short-story-writing family. I get more turned on by a big, fat book. I really like getting lost in a big, fat novel. Someone once said to me that you try and write what you like. I don't know if my natural palette or canvas is the novel, but I hope that when I start something it will be a novel. Not because they're easier to sell, but because I like novels… I try to stay focused on career. My wife is a creative artist. We want to do a play together. We want to write it and act in it. I know that if I don't do these things — and it feels like writing is a daily part of it — I won't be myself. I hope that all that's in the future, because to imagine without it is to imagine me no longer living. It's that serious for me. It's that essential a part of who I feel I am. When the world starts knocking; tours, interviews, book publication, it's always a little disorienting and confusing. Frankly, Rocky II is about that. Budd Schulberg wrote about it. I forget the title. But the whole premise is that in America success is failure and failure is success. How when you get that golden wand it will really do a number on your creativity, your muse, your spirit. And it can be very disorienting; unless you are fully grounded in some other ways, it can really throw you. I try not to think of the outside world too much. Which goes back to your first question, why even try being a writer. I do it for the doing. It's like a yoga practice. And every few years if I'm lucky there'll be a book. And it does feel like a piece of good fortune because it does feel like a completion of the act. If you're gonna be in your garage working on your songs, why not open the doors one day and play it for someone?
Copyright 2000 by Robert Birnbaum
All photos by Red Diaz / Duende Publishing
Posted in Author Interviews and tagged Andre Dubus III, House of Sand and Fog, Novelists, Robert Birnbaum. Bookmark the permalink. Trackbacks are closed, but you can post a comment.
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"I'm never going to blend in," says former Miss Belgium and World Beauty Fitness & Fashion competitor Ludnie Faustin, and we couldn't be happier. We asked the bodybuilder, fitness model and personal trainer where she works out, shops and lets loose for her sacred weekly cheat meal.
Shopping fix: Crossroads Trading Co.
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Pro trainers Ludnie Faustin and Joe Hannon melt your body into shape at this intense, high-energy weekly training session in the park. Join a lively group on Saturday mornings for cardio and resistance training in the sunshine. Eventbrite link updates every week. Embrace the pain.


About ALLANTOIN: Allantoin is a naturally ocurring nitrogenous compound used as a skin conditioning agent.
This ingredient may be derived from animals. From PETA's Caring Consumer: Uric acid from cows, most mammals. Also in many plants (especially comfrey). In cosmetics (especially creams and lotions) and used in treatment of wounds and ulcers. Derivatives: Alcloxa, Aldioxa. Alternatives: extract of comfrey root, synthetics.
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text:
Q: jenkins pipeline not build remotely I am trying to build a job by pipeline to my other slave in the master
the pipeline is like this
pipeline {
    agent {
        label "virtual"
    }
    stages {
        stage("test one") {
            steps {
                echo " test test test"
            }
        }
        stage("test two") {
            steps {
                echo " testttttttttt "
            }
        }
    }
}

they syntax not getting the error but it doesn't build on my slave server,
but when I run on freestyle job by Restrict where this project can be run with that label then execute sheel by echo "test test"
it was built on my slave server,
what is wrong with my pipeline ? do I missing something?
after build
Running in Durability level: MAX_SURVIVABILITY
[Pipeline] Start of Pipeline
[Pipeline] node
Running on virtual in /home/virtual/jenkins/workspace/demoo
[Pipeline] {
[Pipeline] stage
[Pipeline] { (test one)
[Pipeline] echo
 test test test
[Pipeline] }
[Pipeline] // stage
[Pipeline] stage
[Pipeline] { (test two)
[Pipeline] echo
 testttttttttt
[Pipeline] }
[Pipeline] // stage
[Pipeline] }
[Pipeline] // node
[Pipeline] End of Pipeline

A: Add the path you want in the Remote root directory (yellow column) as shown below:-

A: The build works like you did it already. The steps will be executed on the slave. If you add something like clone a repository to your step, your workspace directory will be created.
Pipeline and Freestylejobs are working here different. The Freestylejob will make the directory in workspace as soon as it runs at the first time. The Pipelinejob will create the directory as soon as it needs this this directory.
I created a simple Pipeline:
pipeline {
    agent {
        label "linux"
    }
    stages {
        stage("test one") {
            steps {
                sh "echo 'test test test' > text.txt"
            }
        }
    }
}

I converted your echo to a sh command because my Slave is a linux slave. The sh step creates a text.txt file. As soon as I run this job, the directory will be created:
[<user>@<server> test-pipeline]$ pwd
/var/lib/jenkins/workspace/test-pipeline
[<user>@<server> test-pipeline]$ ls -l
total 4
-rw-r----- 1 <user> <group> 15 Oct  7 16:49 text.txt

redpajama_set_name: RedPajamaStackExchange


text:
Q: R: Identify (partial) matching cells I have a table with several thousand rows and hundreds of columns. Instead of filtering the table, I need to identify the cells that (partially) match several keywords.
All I could find so far is the function  WhichCells {SeuratObject} - alas I cannot get it to work.
For example
Column1 <- c("Temperature", "Water", "Sun", "tree fighter", "rainbow")
Column2 <- c(60.1, 106, 78.6, 21.5, 71)
Column3 <- c("Another cell", NA, "more content", NA, "Thanks!")

df <- data.frame(Column1, Column2, Column3)
df

pattern <- c("temp", "content", 55, "heart", "thanks")

The desired result would look like
pattern   Column    Row
1    temp Column1   1
2 content Column3   3
3  thanks Column3   5

Note: rows could also be returned as rownames.
Please, could anyone give advice how to solve this? Thanks a lot!

A: Here, it is part of the answer but you should do some adjustment to take into account upper/lower case :
pattern <- c("Temp", "content", 55, "heart", "Thanks")

detectpattern <- function(df, pattern){
    colindex <- which(apply(df, 1, str_detect, pattern = pattern))
    rowindex <- which(apply(df, 2, str_detect, pattern = pattern))
    return(c(pattern, colindex, rowindex))
}

for (pat in pattern){
    print(detectpattern(df = df, pattern = pat))
}

A: You may try
df %>%
  tibble::rownames_to_column(., var = "Row") %>%
  melt(id.vars = "Row", value.name = "patterns", variable.name = "Column") %>%
  mutate(check = ((sapply(pattern, function(x) {str_detect(patterns, regex(x, ignore_case = T)) %>% as.numeric} ))%>% rowSums(., na.rm=TRUE))) %>%
  filter(check == 1) %>% select(-check)

  Row  Column     patterns
1   1 Column1  Temperature
2   3 Column3 more content
3   5 Column3      Thanks!


Will you stand up for a child? Attend a free informational meeting and learn more about supporting foster parents in Hall County. Join us on Monday, May 21 at 6pm in the Reception Hall. Contact Misty Leach mleach@gfumc.com for more info or RSVP below.


JALANDHAR CANT JRC to JHAJHA JAJ train timings, routes, stops, and complete info.
As of now, 3 trains run between from JALANDHAR CANT (JRC) to JHAJHA (JAJ).
The fastest train from JALANDHAR CANT (JRC) to JHAJHA (JAJ) is HIMGIRI EXPRESS (12332) that departs at 02:20 and arrives to at 05:35. It takes approximately 27:15 hours.


Literary translation is not one of our fields, but, being April the month when World Book Day is celebrated and in the year of the 400th anniversary of Cervantes and Shakespeare deaths (even if they did not exactly die on the same day); we had no excuse not to talk about it.
UNESCO has been compiling data about languages and books on its Index Translationum. Here you can get statistics about the most translated writers, source and target languages, countries or publishers that publish translated books in a given country of your choice.
Today we want to share with you some interesting data from this Index.
Surprised for not finding Cervantes among the top 10? Guess what; he is not even on the top 50. It is not strange, as this list evolves with society and modern writers, who have probably published more books, get better rankings. This is the case of bestsellers Danielle Steel and Stephen King. The most famous (and most translated) book by Cervantes is Don Quixote, so probably this is the only book that has been considered for the ranking. Why Shakespeare does appear in the top 10? Probably because he had more books than the Spanish writer and by the second half of the 17th century the Spanish empire was declining, which fostered the evolution of the English empire. Therefore, English culture was more widely spread by then.
As you can see, English is first in the ranking. Most of the most translated authors were English speakers, so the relationship between writers and languages is evident.
Surprised to find Polish and Swedish on this ranking? As experts in translation from and into Nordic languages, we have a hypothesis: the Nobel Prize in Literature. We think that the winner will have its book translated into Swedish so readers in the country awarding the price will have access to such work.
Hurrah! We can finally find Cervantes in a ranking, but not in the first position. Not having Spain's most universal writer in the first positions is quite reasonable. 400 years ago there were many fewer readers (not to mention translators). Therefore, if we compare him with authors from the 20th century, when reading and translation are more frequent activities, any writer of previous centuries, no matter how important he/she is, will always have a low ranking. Also, remember that UNESCO has been compiling data "only" since 1979, so all previous translations before that year are not included; probably many translations from Cervantes works were done before that year.
What can we learn from all these data? Literature and translation help us to discover and unify countries, cultures, traditions and to leave thousands of adventures. No matter if we are in the literary translation field or not, at Jensen Localization we will always support the combination of both worlds. Long life translation!


text:
Support/Advertise
Donna Talerico, Regional Painter of Note
October 4th, 2014	| Published in September 2014
It is ironic that painter Donna Talerico's maiden name is Artis. Although she doesn't use it professionally, she ended up pursuing a successful career as an artist after many years as a fashion illustrator.
Born in West Virginia, Talerico cites her maternal grandmother Helena Daming as one of her major influences. A 1919 war bride, Daming came from Luxembourg to Matewan, West Virginia with fluency in several languages, including French, Flemish and German and told stories about Europe. Talerico was fascinated and eventually planned trips to France when she could afford the airfare.
A resident of the gaslight district in Clifton for 45 years, Talerico, now 67, was graduated from Marshall University in West Virginia with a BBA in marketing and retailing. Her first job was as a buyer trainee at Mabley & Carew. But her interest in art came as early as her childhood when she drew with crayons. She even made clothes for paper dolls.
In high school, she asked a teacher – "Isn't there a fashion illustrator job?" The answer was 'no.' Undeterred, Talerico went to work as a fashion illustrator at former downtown retail stores, such as McAlpin's, Shillito's and Pogue's. Self-taught, she spent 20 years doing black and white illustrations, all in pen and ink. The field, however, practically disappeared when photography took the place of illustration. "My job was becoming extinct," she said.
Laid off in the late 1990's, Talerico received a call from a friend to attend a painting course in southern France in 1998. She accepted, and it changed her life. In Soreze, she met San Francisco artist/teacher Carole Watanabe, instructor of a beginning painting class in acrylics.
"I didn't think I would be a painter," said Talerico. "I had no experience with color." But, she was already a designer; she knew composition. Talerico began painting. Back in the United States, she made room for a small studio in her house.
As with her earlier career, Talerico continued learning painting and French on her own. Although she took a few art classes as electives in college, she did not hold a degree in art. Influenced both by the Impressionists and the Fauves, she painted intuitively with broad strokes of color. Other painters in history whom she admired include Edouard Manet, Chaime Soutine, Richard Diebenkorn, Jr., and Alfred Sisley.
By 1999, Talerico felt comfortable enough in having an art show at the former Petersen's Restaurant on Ludlow Ave. in Clifton. She sold four paintings; enough to support her blossoming career. She never looked back.
Regularly traveling to Paris, Collioure on the Mediterranean and Provence in southern France, she used to bring her paints and easel. Now, she takes many digital pictures and works from them in her studio in the Pendleton Art Center. She finds Pendleton a positive venue for over 200 other artists, in one of the largest groups of artists' studios around. She also exhibits, however, in various galleries throughout the United States. Closer to home, she is a member of the 5th St. Gallery co-op.
Talerico has several bodies of work, including French scenes, landscapes and new abstractions. Currently, she is focusing on abstract art. "It seeps into your bones, somehow," said Talerico. "I can evolve in my work to looser abstracts, using less detail and becoming more fluid", which is evident in her new group of paintings with an Expressionist direction. "We'll Always Have Paris," an upcoming solo show, opens October 11 at Hayley Gallery in Columbus with 20 of her paintings.
While she started with paintings of French scenes, those of cafes, became her bread and butter. She often utilizes a solitary female, often walking with her back towards us, both in cafes, in gallerias, on French streets, symbolizing a woman of her hard won independence. These paintings are slyly feminist. She enjoys skewing her perspectives, which she learned from looking at Manet, and her palette is often pastel or bolder, but she induces ebullience in the viewer. In 2011, she held a solo show entitled "All Dressed Up and Somewhere to Go – Paris 2011" at The Carnegie in Covington.
"I have to paint in the ways that please me," said Talerico, but she also paints for her clients, who enjoy her Parisian café scenes. Her marketing efforts include an email promotion list, Final Friday open house at the Pendleton and a solid customer base. During the holidays, she makes quite a few small paintings, one a day, which she offers both in her studio and over the internet: these tend to sell out every year.
Now, with a new direction, Talerico continues to paint – and loves it.
–Laura Hobson
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US news and current affairs website Huffington Post - which was bought by AOL for $315m in February - is to launch a UK edition in the summer.
In asurprise announcement at the MediaGuardian Changing Media Summit, founder Arianna Huffington explained that the new investment meant that they could finally expand outside the US.
The blogosphere is in decline says NY Times: are Facebook and Twitter killing off blogs?


Written and Endorsed by Science and Business Professionals in the Research Triangle Park in North Carolina, USA.
Lisbeth Borbye received a PhD in Genetics at the University of Copenhagen and was a post-doctoral fellow in the Human Genome Project. Since 1995 Dr. Borbye has held appointments in both academic and industry settings involving a range of technological, managerial, editorial and educational disciplines. The most prominent of these is the establishment and directorship of the professional Master's program in Microbial Biotechnology at North Carolina State University, a new type of education which seeks to integrate business and science to meet industry and society's needs. Dr. Borbye is a pioneer in establishing alliances between industry and academia. She has published numerous journal articles and holds several patents. In addition, she recently published the book entitled "Secrets to Success in Industry careers - Essential Skills in Science and Business" (Academic Press).
Helps students gain industry knowledge and "vocabulary"


text:
Tommaso Cai 1
1 Dept. of Urology, Santa Chiara Regional Hospital, Trento, Italy
Introduction: Recurrent uncomplicated urinary tract infections (UTI) have a high impact on patients' quality of life and high direct and indirect costs for public health. Therefore, optimal management should be of high priority.
Methods: Current international guidelines were reviewed, and a systematic literature search was performed in Medline, Cochrane, and Embase.
Results: Several risks factors have been identified and used in everyday clinical practice to plan the correct strategy for recurrence prevention. Among all factors, the most important are: sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment. Moreover, other risk factors such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear, as well as irregular bowel function should be taken into account.
Conclusions: Recurrent UTI show a high impact on clinical practice. Risk factors are generally related to both virulence of pathogens and patient's behavior or condition. A recently developed nomogram can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.
Recurrent uncomplicated urinary tract infections (rUTI) are defined as at least 3 episodes of a UTI in 12 months, or at least 2 episodes in 6 months.
rUTI have a high impact on public health due to high direct and indirect costs.
Sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment are the most important risk factors for rUTI in young women.
Atrophic vaginitis due to estrogen deficiency, cystocoele, increased post-void urine volume and functional status deterioration are the most important risk factors in old women.
The assessment of all risk factors and the use of a recently validated nomogram could be interesting for identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.
Recurrent uncomplicated urinary tract infections (rUTI) may present a big social and economic burden for women of all ages [1]. Therefore, optimal management of rUTI should be of high priority. This chapter addresses the definitions and the risk factors of recurrent uncomplicated urinary tract infections (rUTI), with particular attention to the following issues: difference between relapse and reinfections, risk factors in premenopausal and postmenopausal women, and the role of a validated nomogram and questionnaires for the calculation of the risk of a new episode of rUTI. The chapter does not address recurrent UTI in case of significant underlying anatomical or functional abnormalities of the urinary tract, which need a different approach.
This chapter incorporates the 2016 Guidelines on Urological Infections of the European Association of Urology (EAU) and the latest Infectious Diseases Society of America Guideline for the Management of Asymptomatic Bacteriuria [2], [3]. Furthermore, the previous version of the ICUD textbook on Urological infections has been updated and was included [4]. Moreover, a systematic literature search was performed in Medline, Cochrane, and Embase. The systematic literature search covered the period from 1979 to 2019. The following keywords were used: recurrent urinary tract infections, epidemiology, and risk factors. The limitations used included adults aged ≥18 years, clinical studies, review article, English, and peer reviewed. A total of 561 publications were identified and screened by title and abstract. Finally, 7 papers were included in the review (Table 1). The studies were rated according to the level of evidence (LoE) and the grade of recommendation (GoR) using ICUD standards (EAU guidelines 2020 [2]) (Table 1)).
Table 1: Studies evaluated after systematic review (1979–2019)
Author [Reference]
Manuscript type
Enrolled patients
Level of evidence
Grade of recommendation
Scholes et al. [16]
Case-control study
Women with rUTI
Hooton [10]
Jackson et al. [12]
Prospective cohort study
Postmenopausal women
Minardi et al. [15]
Cai et al. [24]
Sihra at al. [20]
3.1 Definition, context and clinical application
Recurrent urinary tract infections (rUTI) are defined as at least 3 episodes of a UTI in 12 months, or at least 2 episodes in 6 months [1], [2], [3], [5]. Recurrent UTI can be divided into two subgroups:
relapses
reinfections.
Relapse: is defined as a UTI caused by the same microorganism after adequate treatment [3]. Reinfection: is defined as a recurrence of a UTI caused by a different microorganism, or a recurrent UTI caused by a previously isolated microorganism after treatment and a subsequent negative urine culture [3], [5].
This classification shows important clinical issues: relapses signify that the original infection has never been eradicated. The organism cultured is identical to that from the previous episode, and symptoms usually recur within 2 weeks of the end of treatment for the previous episode. If the previous episode was treated with short-course therapy, the first thought should be that there was subclinical pyelonephritis and that a longer course of treatment is needed. If a longer course is followed by another relapse, 'imaging' (CT scan or ultrasound) is advisable to look for an anatomic abnormality [6], [7].
3.2 Epidemiology of rUTI
After an initial urinary tract infection, approximately 20–30% of women with a UTI will have a second UTI within 6 months, and 3% will experience a third UTI during that time period [8]. Recurrent UTI are common among young healthy women even though they generally have anatomically and physiologically normal urinary tracts and are associated with considerable morbidity and expense [9], [10]. In detail, it is estimated that in young women overall, there are 0.5 episodes of acute cystitis per person per year, and the incidence decreases with age [11]. In postmenopausal women, it is estimated that there are 0.07 episodes of acute cystitis per person per year [7], [12], [13]. Most recurrences occur within the first 3 months after the primary infection. When the initial infection is caused by Escherichia coli, there is a higher risk of reinfection within the first 6 months [13], [14].
3.3 Risk factors
Risk factors are different between young (premenopausal) and old (postmenopausal) women. This difference shows important clinical relevance.
3.3.1 Young women
In young healthy women, sexual intercourse is the risk factor most highly associated with recurrent UTI [10]. Other risk factors in young women include spermicide use, having a new sexual partner, having a mother with a history of UTI, and having had a UTI during childhood [15]. There are several behaviors that are thought to increase the risk of recurrent UTI, but their association with UTI has not been clearly demonstrated in trials [10]. These include reduced fluid intake, habitually delaying urination, delaying post-coital urination, wiping from back to front after defecation, douching, and wearing occlusive underwear [10]. Finally, dysfunctional voiding patterns in which there is increased tone of the external sphincter during micturition can also be associated with recurrent UTI in otherwise urologically normal women [15].
Any lifetime sexual activity and any sexual activity during the past year were the variables most strongly associated with the risk of recurrence in young women [16]. In detail, sexual intercourse in the past month has been associated with a risk of more than 9 times to develop UTI [OR 10.3 (5.8 to 18.3)] [16]. In particular, young women with recurrent UTI were more likely to report exposure to spermicides and to oral contraceptives [16]. Both intercourse and spermicide exposure increase periurethral Escherichia coli colonization, and such colonization occurs more frequently and for prolonged periods in women with rUTI [17], [18].
History of UTI in the mother and a history of early UTI onset in the woman herself
The history of UTI in the mother and a history of early UTI onset in the young woman herself were associated with a 2–4-fold increase in the risk of recurrence. These two variables were the most strongly associated with the risk of recurrence, after the strongest variable, recent frequency of sexual intercourse [16]. In particular, Kunin showed that girls who experienced these infections during childhood were more prone to bacteriuria and symptomatic infections as adults [19].
Bowel function and water intake
Fecal-perineal-urethral contamination is the most probable explanation for infections caused by enteric bacteria in women, as shown by several authors evaluating the genotype of Escherichia coli strains causing UTI in women [20]. Loening-Baucke et al., evaluating a cohort of 234 chronically constipated and encopretic children with a mean follow-up of 15 months, showed that constipation treatment resulted in the disappearance of daytime urinary incontinence in 89%, and night-time urinary incontinence in 63% of patients, as well as disappearance of rUTI in all patients who had no anatomical abnormality of the urinary tract [21]. With regard to water intake, literature data are discordant. Eckford et al. documented a reduction of recurrent UTI in premenopausal women with adequate hydratation with urine osmolality <1105, using an osmolality probe at home, whereas other studies did not find the same correlation [22]. Nygaard et al. surveyed female teachers and found that women who drank less had a 2.21-fold higher risk (95% CI 1.45–3.38) of UTI compared to women who drank the volume they desired at work [23].
Asymptomatic bacteriuria treatment
Recently, Cai et al. found that antibiotic treatment of asymptomatic bacteriuria in young women with recurrent UTI is not only unnecessary, but harmful [24], [25]. In fact, they found that in women who had undergone antibiotic treatment, the rate of E. coli decreased over time, whereas the prevalence of E. faecalis increased gradually, suggesting that E. faecalis should be an important defense mechanism that effectively interferes with the establishment of many important enteric pathogens, such as E. coli [24].
3.3.2 Old women
The incidence of UTI in women increases with advancing age [15]. In a placebo-controlled, double-blind study, Raz et al. showed a correlation between reduced estrogenic hormone levels after menopause and the development of recurrent UTI, highlighting the fact that estrogens stimulate proliferation of Lactobacillus in the vaginal epithelium, causing reduction of vaginal pH, thereby preventing vaginal colonization by Enterobacteriaceae [26]. Recently, Lüthje et al. highlighted that estrogen induced the expression of antimicrobial peptides, thereby enhancing the antimicrobial capacity of the urothelium and restricting bacterial multiplication [27]. Furthermore, they suggested the application of estrogen in postmenopausal women suffering from recurrent UTI [27]. Moreover, in older women, risk factors include urinary incontinence, history of UTI before menopause, blood group antigen nonsecretor status, and having a cystocele and an increased post-void residual.
3.3 Nomogram and tools for risk of recurrence calculation
Hooton et al. developed a simple risk prediction model by using the information about the number of days with intercourse and contraceptive use (diaphragm and spermicide) for predicting the risk of UTI recurrence [7]. They found that an unmarried, 24-year-old female university student who had sexual intercourse without a diaphragm and spermicide on three of the past seven days had a risk of UTI that was 2.6-fold greater than that of a similar student who had not had intercourse in the previous week [7]. This study highlights the role of recurrence risk prediction tools in the management of women with UTI. In 2014, Cai T et al., for the first time, developed and validated an easy nomogram based on several parameters both from the patients and the bacteria for predicting the recurrence of UTI risk [28]. The nomogram was evaluated by calculating concordance probabilities, as well as testing calibration of predicted urinary tract infection recurrence with observed urinary tract infections. Nomogram variables included: number of partners [29], bowel function, type of pathogens isolated (gram-positive/-negative), hormonal status, number of previous urinary tract infection recurrences and previous treatment of asymptomatic bacteriuria. The nomogram accurately predicts the recurrence risk of urinary tract infection at 12 months, and can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy (Figure 1) [28]. In order to calculate the recurrence probability, the patient values are identified on each axis, then for each one, a vertical line upwards to the "points" axis is drawn. This determines how many points each variable generates. All points for all variables are added, and this sum is placed on the 'total points' line. Then a vertical line downwards from this point is drawn, and the recurrence risk probability at 12 months is identified [28].
Figure 1: LUTIRE nomogram [27]
Recurrent UTI represent a major social and economic burden for women of all ages. Risk factors for recurrent UTI are generally related to both virulence of pathogens (such as Escherichia coli adherent to vaginal and bladder epithelial cells, asymptomatic bacteriuria treatment) and patient's behavior or condition (such as use of a spermicide or a diaphragm, delayed postcoital micturition, or the ABO-blood-group non-secretor phenotype). A recently developed nomogram can assist in identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.
This chapter was first published in GMS Infectious Diseases [30].
[1] Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res. 2018 Feb;18(1):107-17. DOI: 10.1080/14737167.2017.1359543
[2] Bonkat G, Bartoletti R, Bruyère R, Cai T, Geerlings SE, Köves B, Schubert S, Wagenlehner F. EAU Guidelines on Urological Infections. Arnhem: European Association of Urology; 2020. Available from: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urological-infections-2020.pdf
[3] Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar;40(5):643-54. DOI: 10.1086/427507
[4] Naber KG, Scaeffer AJ, Heyns CF, Matsumoto T, Shoskes DA, Bjerklund Johansen TE, editors. Urogenital infections. Arnhem: European Association of Urology; 2010. Available from: http://www.icud.info/PDFs/ICUD%20Urogenital%20Infections.pdf
[5] Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;2004(3):CD001209. DOI: 10.1002/14651858.CD001209.pub2
[6] Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med. 1993 Oct;329(18):1328-34. DOI: 10.1056/NEJM199310283291808
[7] Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE, Stergachis A, Stamm WE. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996 Aug;335(7):468-74. DOI: 10.1056/NEJM199608153350703
[8] Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon. 2003 Feb;49(2):53-70. DOI: 10.1067/mda.2003.7
[9] American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008 Mar;111(3):785-94. DOI: 10.1097/AOG.0b013e318169f6ef
[10] Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001 Apr;17(4):259-68. DOI: 10.1016/s0924-8579(00)00350-2
[11] Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019 May;11:1756287219832172. DOI: 10.1177/1756287219832172
[12] Jackson SL, Boyko EJ, Scholes D, Abraham L, Gupta K, Fihn SD. Predictors of urinary tract infection after menopause: a prospective study. Am J Med. 2004 Dec;117(12):903-11. DOI: 10.1016/j.amjmed.2004.07.045
[13] Epp A, Larochelle A; Urogynaecology Committee; Family Physicians Advisory Committee. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010 Nov;32(11):1082-90. DOI: 10.1016/S1701-2163(16)34717-X
[14] Gupta K, Stamm WE. Pathogenesis and management of recurrent urinary tract infections in women. World J Urol. 1999 Dec;17(6):415-20. DOI: 10.1007/s003450050168
[15] Minardi D, Parri G, d'Anzeo G, Fabiani A, El Asmar Z, Muzzonigro G. Perineal ultrasound evaluation of dysfunctional voiding in women with recurrent urinary tract infections. J Urol. 2008 Mar;179(3):947-51. DOI: 10.1016/j.juro.2007.10.078
[16] Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000 Oct;182(4):1177-82. DOI: 10.1086/315827
[17] Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE. Escherichia coli bacteriuria and contraceptive method. JAMA. 1991 Jan;265(1):64-9. DOI: 10.1001/jama.1991.03460010064032
[18] Hooton TM, Roberts PL, Stamm WE. Effects of recent sexual activity and use of a diaphragm on the vaginal microflora. Clin Infect Dis. 1994 Aug;19(2):274-8. DOI: 10.1093/clinids/19.2.274
[19] Kunin CM. The natural history of recurrent bacteriuria in schoolgirls. N Engl J Med. 1970 Jun;282(26):1443-8. DOI: 10.1056/NEJM197006252822601
[20] Sihra N, Goodman A, Zakri R, Sahai A, Malde S. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018 Dec;15(12):750-76. DOI: 10.1038/s41585-018-0106-x
[21] Loening-Baucke V. Urinary incontinence and urinary tract infection and their resolution with treatment of chronic constipation of childhood. Pediatrics. 1997 Aug;100(2 Pt 1):228-32. DOI: 10.1542/peds.100.2.228
[22] Eckford SD, Keane DP, Lamond E, Jackson SR, Abrams P. Hydration monitoring in the prevention of recurrent idiopathic urinary tract infections in pre-menopausal women. Br J Urol. 1995 Jul;76(1):90-3. DOI: 10.1111/j.1464-410x.1995.tb07839.x
[23] Nygaard I, Linder M. Thirst at work – an occupational hazard? Int Urogynecol J Pelvic Floor Dysfunct. 1997;8(6):340-3. DOI: 10.1007/BF02765593
[24] Cai T, Mazzoli S, Mondaini N, Meacci F, Nesi G, D'Elia C, Malossini G, Boddi V, Bartoletti R. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis. 2012 Sep;55(6):771-7. DOI: 10.1093/cid/cis534
[25] Cai T, Nesi G, Mazzoli S, Meacci F, Lanzafame P, Caciagli P, Mereu L, Tateo S, Malossini G, Selli C, Bartoletti R. Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infections. Clin Infect Dis. 2015 Dec;61(11):1655-61. DOI: 10.1093/cid/civ696
[26] Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993 Sep;329(11):753-6. DOI: 10.1056/NEJM199309093291102
[27] Lüthje P, Brauner H, Ramos NL, Ovregaard A, Gläser R, Hirschberg AL, Aspenström P, Brauner A. Estrogen supports urothelial defense mechanisms. Sci Transl Med. 2013 Jun;5(190):190ra80. DOI: 10.1126/scitranslmed.3005574
[28] Cai T, Mazzoli S, Migno S, Malossini G, Lanzafame P, Mereu L, Tateo S, Wagenlehner FM, Pickard RS, Bartoletti R. Development and validation of a nomogram predicting recurrence risk in women with symptomatic urinary tract infection. Int J Urol. 2014 Sep;21(9):929-34. DOI: 10.1111/iju.12453
[29] Foxman B, Gillespie B, Koopman J, Zhang L, Palin K, Tallman P, Marsh JV, Spear S, Sobel JD, Marty MJ, Marrs CF. Risk factors for second urinary tract infection among college women. Am J Epidemiol. 2000 Jun;151(12):1194-205. DOI: 10.1093/oxfordjournals.aje.a010170
[30] Cai T. Recurrent uncomplicated urinary tract infections: definitions and risk factors. GMS Infect Dis. 2021;9:Doc03. DOI: 10.3205/id000072
Cai T. Recurrent uncomplicated urinary tract infections: definitions and risk factors. Version: 2021-05-04. In: Bjerklund Johansen TE, Wagenlehner FME, Matsumoto T, Cho YH, Krieger JN, Shoskes D, Naber KG, editors. Urogenital Infections and Inflammations. Berlin: German Medical Science GMS Publishing House; 2017-. DOI: 10.5680/lhuii000064
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