Medicine and Health Sciences Commons^™

Hospital Variation In Costs – A Challenge To The Value Proposition, Aaron B. Caughey, Jonathan M. Snowden

OHSU-PSU School of Public Health Faculty Publications and Presentations

Mini Commentary on 2017-OG-19978R1: Hospital Variation in Cost of Childbirth and Contributing Factors: A Cross-Sectional Study. To view this article visit https://doi.org/10.1111/1471-0528.15007.

Treatment And Prevention Of Opioid Use Disorder: Challenges And Opportunities, Dennis Mccarty, Kelsey C. Priest, P. Todd Korthuis

OHSU-PSU School of Public Health Faculty Publications and Presentations

Treatment for opioid use disorder in the United States evolved in response to changing federal policy and advances in science. Inpatient care began in 1935 with the US Public Health Service Hospitals in Lexington, Kentucky, and Fort Worth, Texas. Outpatient clinics emerged in the 1960s to provide aftercare. Research advances led to opioid agonist and opioid antagonist therapies. When patients complete opioid withdrawal, return to use is often rapid and frequently deadly. US and international authorities recommend opioid agonist therapy (i.e., methadone or buprenorphine). Opioid antagonist therapy (i.e., extended-release naltrexone) may also inhibit return to use. Prevention efforts emphasize public …

Patient-Provider Relationship And Perceived Provider Weight Bias Among American Indians And Alaska Natives, Kelly L. Gonzales, Ginny Garcia, Michelle M. Jacob, C. Muller, Lonnie A. Nelson, Spero M. Manson

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective The objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.

Methods Among a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north-west region of the USA, ordinary least squares regression analysis was completed to examine associations.

Results Better working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated …

Treatment Guidelines And Early Loss From Care For People Living With Hiv In Cape Town, South Africa: A Retrospective Cohort Study, Ingrid T. Katz, Richard Kaplan, Garrett Fitzmaurice, Dominick Leone, David R. Bangsberg, Linda-Gail Bekker, Catherine Orrell

OHSU-PSU School of Public Health Faculty Publications and Presentations

South Africa has undergone multiple expansions in antiretroviral therapy (ART) eligibility from an initial CD4+ threshold of ≤200 cells/μl to providing ART for all people living with HIV (PLWH) as of September 2016. We evaluated the association of programmatic changes in ART eligibility with loss from care, both prior to ART initiation and within the first 16 weeks of starting treatment, during a period of programmatic expansion to ART treatment at CD4+ ≤ 350 cells/μl.

Teaching Undergraduate Students To Visualize And Communicate Public Health Data With Infographics, Justin D. Shanks, Betty Izumi, Christina J. Sun, Allea Martin, Carmen Byker Shanks

OHSU-PSU School of Public Health Faculty Publications and Presentations

The purpose of this study was to explore the degree to which an infographic assignment facilitated student learning around health science issues, as well as the ways in which the assignment was an effective teaching tool. The objectives of the assignment were to (1) understand the purposes of and potential uses for infographics, (2) cultivate creative visual communication skills, and (3) disseminate a complex health topic to diverse audiences. The infographic assignment was developed at Montana State University and piloted at Portland State University. Students were assigned to small groups of three or four to create an infographic focused on …

Frequency Of Cannabis Use Among Primary Care Patients In Washington State, Gwen T. Lapham, Amy K. Lee, Ryan M. Caldeiro, Dennis Mccarty, Kendall C. Browne, Denise D. Walker, Daniel R. Kivlahan, Katharine A. Bradley

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background and Objectives—Over 12% of U.S. adults report past-year cannabis use, and among those who use daily, 25% or more have a cannabis use disorder. Use is increasing as legal access expands. Yet, cannabis use is not routinely assessed in primary care, and little is known about use among primary care patients and relevant demographic and behavioral health subgroups. This study describes the prevalence and frequency of past-year cannabis use among primary care patients assessed for use during a primary care visit.

Methods—This observational cohort study included adults who made a visit to primary care clinics with annual behavioral health …

Comparison Of Respondent-Reported And Sensor-Recorded Latrine Utilization Measures In Rural Bangladesh: A Cross-Sectional Study, Maryann G. Delea, Corey L. Nagel, Evan A. Thomas, Amal K. Halder, Nuhu Amin, Abul K. Shoab, Matthew C. Freeman, Leanne Unicomb, Thomas F. Clasen

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Health improvements realized through sanitation are likely achieved through high levels of facilities utilization by all household members. However, measurements of sanitation often rely on either the presence of latrines, which does not guarantee use, or respondent-reported utilization of sanitation facilities, which is prone to response bias. Overstatement of sanitation metrics limits the accuracy of program outcome measures, and has implications for the interpretation of related health impact data.

Methods: We conducted a cross-sectional study of 213 households in 14 village water, sanitation and hygiene committee clusters throughout rural Bangladesh and used a combined data- and relationship-scale approach …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 6: Prisma-Ci Extension Statement And Checklist, Jeanne-Marie Guise, Mary E. Butler, Christine Chang, Meera Viswanathan, Terri Pigott, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Complex interventions are widely used in health systems, public health, education, and communities and are increasingly the subject of systematic reviews. Oversimplification and inconsistencies in reporting about complex interventions can limit the usability of review findings. Rationale: Although guidance exists to ensure that reports of individual studies and systematic reviews adhere to accepted scientific standards, their design-specific focus leaves important reporting gaps relative to complex interventions in health care. This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventionsdPRISMA-CIdto help authors, publishers, and readers understand and apply …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 4: Selecting Analytic Approaches, Meera Viswanathan, Melissa L. Mcpheeters, M. Hassan Murad, Jeanne-Marie Guise, Emily E. Devine, Michele P. Dyson, Leila C. Kahwati, Jeremy M.V. Miles, Sally C. Morton

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. Rationale: This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances. Discussion: Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 7: Prisma-Ci Elaboration And Explanation, Jeanne-Marie Guise, Mary E. Butler, Christine Chang, Meera Viswanathan, Terri Pigott, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Rationale Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. Discussions The EE document explains the meaning and …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 2: Defining Complexity, Formulating Scope, And Questions, Michael P. Kelly, Jane Noyes, Robert Kane, Christine Chang, Stacey Uhl, Karen A. Robinson, Stacey Springs, Mary E. Butler, Jeanne-Marie Guise

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: The early stages of a systematic review set the scope and expectations. This can be particularly challenging for complex interventions given their multidimensional and dynamic nature. Rationale: This paper builds on concepts introduced in paper 1 of this series. It describes the methodological, practical, and philosophical challenges and potential approaches for formulating the questions and scope of systematic reviews of complex interventions. Furthermore, it discusses the use of theory to help organize reviews of complex interventions. Discussion: Many interventions in medicine, public health, education, social services, behavioral health, and community programs are complex, and they may not fit neatly …

Ahrq Series On Complex Intervention Systematic Reviews-Paper 1: An Introduction To A Series Of Articles That Provide Guidance And Tools For Reviews Of Complex Interventions, Jeanne-Marie Guise, Christine Chang, Mary E. Butler, Meera Viswanathan, Peter Tugwell

OHSU-PSU School of Public Health Faculty Publications and Presentations

An introduction to a series of articles that provide guidance and tools for reviews of complex interventions

Molecularly Targeted Drug Combinations Demonstrate Selective Effectiveness For Myeloid- And Lymphoidderived Hematologic Malignancies, Stephen E. Kurtz, Christopher A. Eide, Andy Kaempf, Vishesh Khanna

OHSU-PSU School of Public Health Faculty Publications and Presentations

Translating the genetic and epigenetic heterogeneity underlying human cancers into therapeutic strategies is an ongoing challenge. Large-scale sequencing efforts have uncovered a spectrum of mutations in many hematologic malignancies, including acute myeloid leukemia (AML), suggesting that combinations of agents will be required to treat these diseases effectively. Combinatorial approaches will also be critical for combating the emergence of genetically heterogeneous subclones, rescue signals in the microenvironment, and tumor-intrinsic feedback pathways that all contribute to disease relapse. To identify novel and effective drug combinations, we performed ex vivo sensitivity profiling of 122 primary patient samples from a variety of hematologic malignancies …

Supported Employment For Veterans With Traumatic Brain Injury: Provider Perspectives, Terri K. Pogoda, Kathleen F. Carlson, Katelyn E. Gormley, Sandra Resnick

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: In 2006, 13 sites were provided with one-time pilot funding to provide supported employment (SE) to Veterans with traumatic brain injury (TBI) history. In 2014, we surveyed SE providers at pilot and non-pilot sites that did not receive this funding. Our objectives were to identify any pilot and non-pilot site differences regarding current: (1) provision of SE to Veterans with TBI; (2) staffing and communication between the SE and polytrauma/TBI teams; and (3) provider perceptions on facilitators and barriers to providing, and suggestions for improving, SE.

Design: Mixed methods cross-sectional survey study.

Participants: Providers included a …

Household Water Insecurity, Missed Schooling, And The Mediating Role Of Caregiver Depression In Rural Uganda, Christine E. Cooper-Vince, Bernard Kakuhikire, Dagmar Vořechovská, Amy Q. Mcdonough, Jessica M. Perkins, Atheendar S. Venkataramani, Rumbidzai Mushavi, Charles Baguma, Scholastic Ashaba, David Bangsberg, Alexander C. Tsai

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: School attendance rates in sub-Saharan Africa are among the lowest worldwide, placing children at heightened risk for poor educational and economic outcomes. One understudied risk factor for missed schooling is household water insecurity, which is linked to depression among women and may increase children’s water-fetching burden at the expense of educational activities, particularly among children of depressed caregivers. In this study conducted in rural Uganda, we assessed the association between household water insecurity and child school participation and the mediating pathways behind these associations.

Method: We conducted a population-based, cross-sectional study of female household heads (N = 257) and …

Prevalence, Age Profile, And Associated Risk Factors For Hymenolepis Nana Infection In A Large Population-Based Study In Northern Peru, Percy M. Vilchez Barreto, Ricardo Gamboa, Saul Santivañez, Seth E. O'Neal, Claudio Muro, Andrés G. Lescano, Luz M. Moyano, Guillermo Gonzálvez, Hector H. García

OHSU-PSU School of Public Health Faculty Publications and Presentations

Hymenolepis nana, the dwarf tapeworm, is a common intestinal infection of children worldwide. We evaluated infection and risk factor data that were previously collected from 14,761 children aged 2-15 years during a large-scale program in northern Peru. We found that 1,124 of 14,761 children (7.61%) had H. nana infection, a likely underestimate given that only a single stool sample was examined by microscopy for diagnosis. The strongest association with infection was lack of adequate water (adjusted prevalence ratio [aPR] 2.22, 95% confidence interval [CI] 1.82-2.48) and sanitation infrastructure in the house (aPR 1.94, 95% CI 1.64-2.29). One quarter of …

The Role Of Relationship Dynamics And Gender Inequalities As Barriers To Hiv-Serostatus Disclosure: Qualitative Study Among Women And Men Living With Hiv In Durban, South Africa, Divya S. Bhatia, Abigail D. Harrison, Muriel Kubeka, Cecilia Milford, Angela Kaida, Francis Bajunirwe, Ira B. Wilson, Christina Psaros, Steven A, Safren, David R. Bangsberg, Jennifer A. Smit, Lynn T. Matthews

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment.

Methods: Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men …

Vitamin C To Decrease The Effects Of Smoking In Pregnancy On Infant Lung Function (Vcsip): Rationale, Design, And Methods Of A Randomized, Controlled Trial Of Vitamin C Supplementation In Pregnancy For The Primary Prevention Of Effects Of In Utero Tobacco Smoke Exposure On Infant Lung Function And Respiratory Health, Cindy T. Mcevoy, Kristin F. Milner, Ashley J. Scherman, Diane G. Schilling, Christina J. Tiller, Brittany Vuylsteke, Lyndsey E. Shorey-Kendrick, Eliot R. Spindel, Robert Schuff, Julie Mitchell, Dawn Peters, Jill Metz, David Haas, Keith Jackson, Robert S. Tepper, Cynthia D. Morris

OHSU-PSU School of Public Health Faculty Publications and Presentations

Despite strong anti-smoking efforts, at least 12% of American women cannot quit smoking when pregnant resulting in > 450,000 smoke-exposed infants born yearly. Smoking during pregnancy is the largest preventable cause of childhood respiratory illness including wheezing and asthma. Recent studies have shown a protective effect of vitamin C supplementation on the lung function of offspring exposed to in utero smoke in a non-human primate model and an initial human trial. Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function (VCSIP) is a randomized, double-blind, placebo-controlled trial to evaluate pulmonary function at 3 months of age …

Brief Report: Medication Sharing Is Rare Among African Hiv-1 Serodiscordant Couples Enrolled In An Efficacy Trial Of Oral Pre-Exposure Prophylaxis (Prep) For Hiv-1 Prevention, Kerry A. Thomson, Jessica Haberer, Mark A. Marzinke, Andrew Mujugira, Craig Hendrix, Connie Celum, Patrick Ndase, Alan Ronald, David Bangsberg, Jared Baeten

OHSU-PSU School of Public Health Faculty Publications and Presentations

Sharing of pre-exposure prophylaxis (PrEP) medications is a concern for PrEP implementation. For HIV-1 serodiscordant couples, sharing may undermine the HIV-1 prevention benefit and also cause antiretroviral resistance if taken by HIV-1 infected partners. Within a PrEP efficacy trial among HIV-1 serodiscordant couples, we assessed the occurrence of PrEP sharing by self-report and plasma tenofovir concentrations in HIV-1 infected partners. PrEP sharing was self-reported at < 0.01% of visits, and 0% -1.6% of randomly selected and 0% of purposively selected specimens from HIV-1 infected participants had detectable tenofovir concentrations (median: 66.5 ng/mL, range: 1.3-292 ng/mL). PrEP sharing within HIV-1 serodiscordant couples was extremely rare.

Measuring Personal Beliefs And Perceived Norms About Intimate Partner Violence: Population-Based Survey Experiment In Rural Uganda, Alexander C. Tsai, Bernard Kakuhikire, Jessica M. Perkins, Dagmar Vořechovská, Amy Q. Mcdonough, Elizabeth L. Ogburn, Jordan M. Downey, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Demographic and Health Surveys (DHS) conducted throughout sub-Saharan Africa indicate there is widespread acceptance of intimate partner violence, contributing to an adverse health risk environment for women. While qualitative studies suggest important limitations in the accuracy of the DHS methods used to elicit attitudes toward intimate partner violence, to date there has been little experimental evidence from sub-Saharan Africa that can be brought to bear on this issue.

Methods and Findings: We embedded a randomized survey experiment in a population-based survey of 1,334 adult men and women living in Nyakabare Parish, Mbarara, Uganda. The primary outcomes were …

Psychosocial Challenges Facing Women Living With Hiv During The Perinatal Period In Rural Uganda, Scholastic Ashaba, Angela Kaida, Jessica N. Coleman, Bridget F. Burns, Emma Dunkley, Kasey O'Neil, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, David R. Bangsberg, Lynn T. Matthews, Christina Psaros

OHSU-PSU School of Public Health Faculty Publications and Presentations

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum.

We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and …

Spatial Relationship Between Taenia Solium Tapeworm Carriers And Necropsy Cyst Burden In Pigs, Ian W. Pray, Viterbo Ayvar, Ricardo Gamboa, Claudio Muro, Luz M. Moyano, Victor Benavides, Robert H. Flecker, Hector H. Garcia, Seth E. O’Neal

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Taenia solium, a parasite that affects humans and pigs, is the leading cause of preventable epilepsy in the developing world. Geographic hotspots of pigs testing positive for serologic markers of T. solium exposure have been observed surrounding the locations of human tapeworm carriers. This clustered pattern of seropositivity in endemic areas formed the basis for geographically targeted control interventions, which have been effective at reducing transmission. In this study, we further explore the spatial relationship between human tapeworm carriers and infected pigs using necroscopic examination as a quantitative goldstandard diagnostic to detect viable T. solium cyst infection in pigs. …

Antimicrobial-Resistant Infections Among Postpartum Women At A Ugandan Referral Hospital, Lisa M. Bebell, Joseph Ngonzi, Joel Bazira, Yarine Fajardo, Adeline A. Boatin, Mark J. Siedner, Ingrid V. Bassett, Dan Nyehangane, Deborah Nanjebe, Jean-Pierre Van Geertruyden, Juliet Mwanga-Amumpaire, David R. Bangsberg, Laura E. Riley, Yap Boum Ii

OHSU-PSU School of Public Health Faculty Publications and Presentations

Introduction Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking.

Methods We performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care, measured vital signs after delivery, performed structured physical exam, symptom questionnaire, and microbiologic evaluation of febrile and hypothermic women. Malaria rapid diagnostic testing, blood and urine cultures were performed aseptically and processed at Epicentre Mbarara Research Centre. Antimicrobial susceptibility and breakpoints were determined using disk diffusion per EUCAST standards. Hospital diagnoses, treatments and outcomes were abstracted from …

Association Of Depressive Symptomology And Psychological Trauma With Diabetes Control Among Older American Indian Women: Does Social Support Matter?, R. Turner Goins, Carolyn Noonan, Kelly Gonzales, Blythe Winchester, Vickie L. Bradley

OHSU-PSU School of Public Health Faculty Publications and Presentations

Aims—Among older American Indian women with type 2 diabetes (T2DM), we examined the association between mental health and T2DM control and if social support modifies the association.

Methods—Survey data were linked to T2DM medical record information. Mental health measures were the Center for Epidemiologic Studies – Depression Scale and the National Anxiety Disorders Screening Day instrument. T2DM control was all HbA1c values taken post mental health measures.

Results—There was not a significant association between depressive symptomatology and higher HbA1c although increased depressive symptomatology was associated with higher HbA1c values among participants with low social support. There was a significant association …

Improving Antiretroviral Therapy Adherence In Resource-Limited Settings At Scale: A Discussion Of Interventions And Recommendations, Jessica E. Haberer, Lora Sabin, K. Rivet Amico, Catherine Orrell, Omar Galarraga, Alexander C. Tsai, Rachel C. Vreeman, Ira Wilson, Nadia A. Sam-Agudu, Terrence F. Blaschke, Bernard Vrijens, Claude Mellins, Robert H. Remien, Sheri D. Weiser, Elizabeth Lolwenthal, Michael J. Stirratt, Papa Salif Sow, Bruce Thomas, Nathan Ford, Edward Mills, Richard Lester, Jean B. Nachega, Bosco M. Bwana, Fred Ssewamala, Lawrence Mbuagbaw, Paula Munderi, Elvin H. Geng, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

INTRODUCTION:

Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings.

METHODS:

In …

Objective Monitoring Of Insecticide-Treated Bednet Use To Improve Malaria Prevention: Smartnet Development And Validation, Paul J. Krezanoski, Data Santorino, Jeffrey Campbell, David Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Malaria is a serious health concern for three billion people worldwide, killing nearly 600,000 people a year. Insecticide-treated bednets (ITNs) are an effective and valuable tool for preventing malaria and hundreds of millions of ITNs have been distributed throughout sub-Saharan Africa. Nevertheless, our current methods for measuring ITN use are inadequate to inform malaria prevention programs. The most common method, self-reported ITN use, is limited by 1) social desirability, 2) recall and 3) sampling bias. An acceptable objective and longitudinal method of assessing adherence to ITN use would improve our ability to better understand the determinants of ITN use and …

Assessing Ultrasonography As A Diagnostic Tool For Porcine Cysticercosis, Robert H. Flecker, Ian W. Pray, Saul J. Santivañez, Viterbo Ayvar, Ricardo Gamboa, Claudio Muro, Luz M. Moyano, Victor Benavides, Hector H. Garcia, Seth E. O'Neal

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background Taenia solium inflicts substantial neurologic disease and economic losses on rural communities in many developing nations. Ring-strategy is a control intervention that targets treatment of humans and pigs among clusters of households (rings) that surround pigs heavily infected with cysticerci. These pigs are typically identified by examining the animal's tongue for cysts. However, as prevalence decreases in intervened communities, more sensitive methods may be needed to identify these animals and to maintain control pressure. The purpose of this study was to evaluate ultrasonography as an alternative method to detect pigs heavily infected with T. solium cysts. Methodology/Principal Findings We …