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A Generalized-Growth Model To Characterize The Early Ascending Phase Of Infectious Disease Outbreaks, Cecile Viboud, Lone Simonsen, Gerardo Chowell

Global Health Faculty Publications

Background

A better characterization of the early growth dynamics of an epidemic is needed to dissect the important drivers of disease transmission, refine existing transmission models, and improve disease forecasts.

Materials and methods

We introduce a 2-parameter generalized-growth model to characterize the ascending phase of an outbreak and capture epidemic profiles ranging from sub-exponential to exponential growth. We test the model against empirical outbreak data representing a variety of viral pathogens in historic and contemporary populations, and provide simulations highlighting the importance of sub-exponential growth for forecasting purposes.

Results

We applied the generalized-growth model to 20 infectious disease outbreaks representing …

Putting Prep Into Practice: Lessons Learned From Early-Adopting U.S. Providers' Firsthand Experiences Providing Hiv Pre-Exposure Prophylaxis And Associated Care, S. K. Calabrese, Manya Magnus, K. H. Mayer, D. S. Krakower, A. I. Eldahan, L. A. Gaston Hawkins, +5 Additional Authors

Epidemiology Faculty Publications

Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or …

Household Clustering Of Escherichia Coli Sequence Type 131 Clinical And Fecal Isolates According To Whole Genome Sequence Analysis, James R. Johnson, Gregg Davis, Connie Clabots, Brian D. Johnston, Stephen Porter, Lance B. Price, +10 Additional Authors

Environmental and Occupational Health Faculty Publications

Background. Within-household sharing of strains from the resistance-associated H30R1 and H30Rx subclones of Escherichia coli sequence type 131 (ST131) has been inferred based on conventional typing data, but has been assessed minimally using whole genome sequence (WGS) analysis.

Methods. Thirty-three clinical and fecal isolates of ST131-H30R1 and ST131-H30Rx, from 20 humans and pets in six households, underwent WGS analysis for comparison with 52 published ST131 genomes. Phylogenetic relationships were inferred using a bootstrapped maximum likelihood tree based on core genome sequence polymorphisms. Accessory traits were compared between phylogenetically similar isolates.

Results. In the WGS-based …

Cost Of Management Of Severe Pneumonia In Young Children: Systematic Analysis, Shanshan Zhang, Peter M. Sammon, Isobel King, Ana Lucia Andrade, Cristiana M. Toscano, Sheila N. Araujo, Anushua Sinha, Shabir A. Madh, Gulam Khandaker, Jiehui Kevin Yin, Robert Booy, Tanvir M. Huda, Qazi S. Rahman, Shams El Arifeen, Angela Gentile, Norberto Giglio, Mejbah U. Bhuiyan, Katharine Sturm Ramirez, Bradford D. Gessner, Mardiati Nadjib, Phyllis J. Carosone– Link, Eric Af Simões, Jason A. Child, Imran Ahmed, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.
Methods: We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions …

Assessment Of Micronutrient Status In Pregnant Malawian Women Before And After Treatment For Moderate Malnutrition, Cambria M. Glosz

Master's Theses

Background: Multiple micronutrient deficiencies are prevalent in pregnant women in developing countries and can result in adverse effects to both the mother and infant. Multiple micronutrient supplements or supplementary foods may be a way to combat micronutrient deficiencies.

Objective: To assess change in micronutrient and protein levels in moderately malnourished pregnant Malawian women after receiving one of three nutritional interventions.

Methods: Serum retinol, 25-hydroxyvitamin D, ferritin, vitamin B₁₂, folate, zinc, albumin and C-reactive protein concentrations were measured in pregnant women with MUAC >20.6 cm and

Results: Baseline micronutrient concentrations indicated high rates of deficiency …

Prep Advocacy Project: Increasing The Adoption Of Pre-­Exposure Prophylaxis (Prep) In San Luis Obispo County, Leona Rajaee

Journalism

The following study investigates the need for Pre­exposure Prophylaxis (PrEP) in San Luis Obispo (SLO) County in order to develop an effective health outreach and advocacy program that could increase the adoption of PrEP treatment and in turn decrease new HIV transmissions in the community studied. The sponsor of this study is the Access Support Network (ASN), a non­profit organization that provides supportive services for individuals living with HIV/AIDS. ASN launched this study after observing the effectiveness of PrEP in metropolitan cities. At the same time, ASN also noticed a rise in new HIV transmissions, particularly among injecting drug users …

Experiences Of Nurses And Midwives During The Ebola Outbreak In Liberia, West Africa, Erhuvwukorotu S. Kollie

Loma Linda University Electronic Theses, Dissertations & Projects

The 2014 – 2015 Ebola outbreak in the West African region resulted in many deaths and has been responsible for devastating health and socioeconomic upheaval. The decision of nurses and midwives whether or not to render care during outbreaks is vital for the containment of the disease. The purpose of this study was to explore the experiences of nurses and midwives during the Ebola outbreak in Liberia. A grounded theory method based on Corbin and Strauss (2015) and Charmaz (2014) was used, resulting in a conceptual model describing the process involved in the work decisions made by the study participants. …

A Novel Point-Of-Care Testing Strategy For Sexually Transmitted Infections Among Pregnant Women In High-Burden Settings: Results Of A Feasibility Study In Papua New Guinea, Steven G. Badman, Lisa M. Vallely, Pamela Toliman, Grace Kariwiga, Bomesina Lote, William Pomat, Caroline Holmer, Rebecca Guy, Stanley Luchters, Chris Morgan

Population Health, East Africa

Background: Sexually transmitted and genital infections in pregnancy are associated with an increased risk of adverse maternal and neonatal health outcomes. High prevalences of sexually transmitted infections have been identified among antenatal attenders in Papua New Guinea. Papua New Guinea has amongst the highest neonatal mortality rates worldwide, with preterm birth and low birth weight major contributors to neonatal mortality. The overall aim of our study was to determine if a novel point-of-care testing and treatment strategy for the sexually transmitted and genital infections Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Bacterial vaginosis (BV) in pregnancy is …

Calcium Phosphate As A Key Material For Socially Responsible Tissue Engineering, Vuk Uskoković, Victoria M. Wu

Pharmacy Faculty Articles and Research

Socially responsible technologies are designed while taking into consideration the socioeconomic, geopolitical and environmental limitations of regions in which they will be implemented. In the medical context, this involves making therapeutic platforms more accessible and affordable to patients in poor regions of the world wherein a given disease is endemic. This often necessitates going against the reigning trend of making therapeutic nanoparticles ever more structurally complex and expensive. However, studies aimed at simplifying materials and formulations while maintaining the functionality and therapeutic response of their more complex counterparts seldom provoke a significant interest in the scientific community. In this review …

Husband’S Support Towards Unmet Need Of Hiv Positive-Infected Women Of Childbearing Age, Sophia Sophia, Anita Deborah Anwar, Bony Wiem Lestari

Kesmas

Jutaan wanita usia subur (WUS) dengan HIV positif di negara berkembang saat ini tidak menggunakan kontrasepsi untuk menunda atau mengakhiri kehamilan. Pencegahan kehamilan yang tidak diinginkan pada WUS dengan HIV positif sangat penting untuk meningkatkan kualitas hidup ibu dan anak. Tujuan penelitian ini untuk menganalisis faktor-faktor yang berpengaruh terhadap unmet need pada WUS dengan HIV positif. Metode penelitian adalah cross sectional dengan sampel berjumlah 130 WUS dengan HIV positif yang diambil secara consecutive sampling. Penelitian dilakukan pada 24 Maret - 30 Juni 2015 di Klinik Mawar Kota Bandung. Pengumpulan data dilakukan melalui wawancara dengan menggunakan kuesioner, kemudian data dianalisis dengan …

Identification And Use Of Indicator Data To Develop Models For Marine-Sourced Risks In Massachusetts Bay, Marin M. Kress

Graduate Doctoral Dissertations

The coastal watersheds around Massachusetts Bay are home to millions of people, many of whom recreate in coastal waters and consume locally harvested shellfish. Epidemiological data on food-borne illness and illnesses associated with recreational water exposure are known to be incomplete. Of major food categories, seafood has the highest recorded rate of associated foodborne illness. In total, the health impacts from these marine-sourced risks are estimated to cost millions of dollars each year in medical expenses or lost productivity. When recorded epidemiological data is incomplete it may be possible to estimate abundance or prevalence of specific pathogens or toxins in …

External Validation And Cost Effectiveness Analysis Of The Non-Lb Framingham Cardiovascular Disease Risk Assessment Algorithm In The Atherosclerosis Risk In Communities Dataset, Jacob K. Kariuki

Graduate Doctoral Dissertations

Background: In recent years, non-Laboratory based (non-LB) risk assessment algorithms have been developed to facilitate absolute cardiovascular disease (CVD) risk assessment in resource constrained primary care settings. The non-LB Framingham algorithm, which substitutes body mass index (BMI) for lipids, has the best discrimination and calibration among the published algorithms, but its external validity and cost-effectiveness have not been determined.

Purpose: External validation and comparative effectiveness analysis of the non-LB versus laboratory based (LB) Framingham algorithm in a racially diverse population, and simulated cost-effectiveness analysis focusing on a black sample.

Methods: Secondary data analysis was performed using the Atherosclerosis Risk in …

The Frequency Of Influenza And Bacterial Co-Infection: A Systematic Review And Meta-Analysis., Eili Y. Klein, Bradley Monteforte, Alisha Gupta, Wendi Jiang, Larissa May, Yu-Hsiang Hsieh, Andrea Freyer Dugas

Emergency Medicine Faculty Publications

AIM: Co-infecting bacterial pathogens are a major cause of morbidity and mortality in influenza. However, there remains a paucity of literature on the magnitude of co-infection in influenza patients.

METHOD: A systematic search of MeSH, Cochrane Library, Web of Science, SCOPUS, EMBASE, and PubMed was performed. Studies of humans in which all individuals had laboratory confirmed influenza, and all individuals were tested for an array of common bacterial species, met inclusion criteria.

RESULTS: Twenty-seven studies including 3,215 participants met all inclusion criteria. Common etiologies were defined from a subset of eight articles. There was high heterogeneity in the results (I(2) …

Human Papillomavirus Infection In Rwanda At The Moment Of Implementation Of A National Hpv Vaccination Programme, Fidele Ngabo, Silvia Franceschi, Iacopo Baussano, M. Chantal Umulisa, Peter Snijders, Anne Uyterlinde, Fulvio Lazzarato, Vanessa Tenet, Maurice Gatera, Agnes Binagwaho, Gary Clifford

Dartmouth Scholarship

Cervical cancer is the most common female cancer in Rwanda that, in 2011, became the first African country to implement a national vaccination programme against human papillomavirus (HPV). To provide a robust baseline for future evaluations of vaccine effectiveness, cervical cell specimens were obtained from 2508 women aged 18–69 years from the general population in Kigali, Rwanda, during 2013/14. 20 % of women were HIV-positive. Samples were used for liquid-based cytology and HPV testing (44 types) with GP5+/6+ PC.

Improving Hpv Vaccine Series Compliance With Text Message Reminders In Military Women, Alisha J. Keating, Susan Instone, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Project Purpose: The purpose of the project was to improve the rate of Human Papillomavirus (HPV) vaccination compliance among military women aged 18-26 years utilizing clinical reminder via text messages.

Background: Specific populations have been particularly effected by low HPV vaccine completion rates including active duty military women. The incidence of high risk sexual behavior in this population is noted to be higher than the general public and sexually transmitted infection (STI) rates are seven times higher in active duty military women compared to the general public. In addition, HPV is the most prevalent STI in this population with an …

General Models For Ecological Drivers Of Poverty, Calistus Ngeh Ngonghala

Biology and Medicine Through Mathematics Conference

No abstract provided.

Hiv Vaccines: Progress, Limitations And A Crispr/Cas9 Vaccine, Omar A. Garcia Martinez

Biology: Student Scholarship & Creative Works

ABSTRACT: The HIV-1 pandemic continues to thrive due to ineffective HIV-1 vaccines. Historically, the world’s most infectious diseases, such as polio and smallpox, have been eradicated or have come close to eradication due to the advent of effective vaccines. Highly active antiretroviral therapy is able to delay the onset of AIDS but can neither rid the body of HIV-1 proviral DNA nor prevent further transmission. A prophylactic vaccine that prevents the various mechanisms HIV-1 has to evade and attack our immune system is needed to end the HIV-1 pandemic. Recent advances in engineered nuclease systems, like the CRISPR/Cas9 system, have …

Beyond The Three Delays: A Case Study Of Haiti's Maternal Health Sector, Stephanie Rapp

Capstone Collection

This research seeks to understand how the maternal health sector in Haiti can be understood and perhaps improved through the framework of the Three Delays, developed by Thaddeus and Maine (1994). These delays are (1) the delay in the decision to seek care, (2) the delay in reaching a health facility, and (3) the delay in receiving adequate care at a health facility. The findings of this capstone strongly demonstrated that global health practitioners in Haiti often opt for technical solutions, but in fact there are numerous shadow delays preventing these solutions from taking hold and ameliorating maternal mortality. Tensions …

Toward A Common Secure Future: Four Global Commissions In The Wake Of Ebola, Lawrence O. Gostin, Oyewale Tomori, Suwit Wibulpolprasert, Ashish K. Jha, Julio Frenk, Suerie Moon, Joy Phumaphi, Peter Piot, Barbara Stocking, Victor J. Dzau, Gabriel M. Leung

Georgetown Law Faculty Publications and Other Works

The world is becoming increasingly vulnerable to pandemics resulting from globalization, urbanization, intense human/animal interchange, and climate change. A series of global health crises have emerged since 2000, ranging from Severe Acute Respiratory Syndrome (SARS) and its phylogenetic cousin Middle East Respiratory Syndrome (MERS), to pandemic Influenza A (H1N1), Ebola, and the ongoing Zika virus epidemic. The Ebola epidemic gave rise to four global commissions proposing a bold new agenda for global health preparedness and response for future infectious disease threats.

Four global commissions reviewing the recent Ebola virus disease epidemic response consistently recommended strengthening national health systems, consolidating and …

Improving Policies Impacting School Absenteeism Due To Influenza Using Agent-Based Simulation Modeling., Galina V. Miller

Purdue P-12 Networking Summit & Poster Session

No abstract provided.

A Yellow Fever Epidemic: A New Global Health Emergency?, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

The worst yellow fever epidemic in Angola since 1986 is rapidly spreading, including the capital, Luanda. In Angola, the epidemic began in December 2015 and the laboratory-confirmed outbreak was reported to the World Health Organization (WHO) on January 21, 2016. Angola has had 2023 suspected cases and 258 deaths as of April 26, 2016. China, the Democratic Republic of Congo, and Kenya also have reported cases arising from infected travelers from Angola. Namibia and Zambia also share a long border with Angola, with considerable population movement between the countries. Similar to other recent epidemics, quick and effective action to stop …

Exploring Emergency Communication Experiences In Response To The 2010 Haiti Earthquake: Lessons Learned From International Donors And Local Government Agencies, Pierre Marie Barbara Roussel

Theses & Dissertations

Background:

In almost every disaster situation, the use of standardized communication procedures among humanitarian relief agencies has been identified as one of the efficient practices to minimize the mismanagement of resources and thus to maximize the response effort among actors to reduce the incidence impact on the public and to increase their resilience capabilities.

Agencies have access to several guidelines to follow during domestic disasters, but there have been very few manuals developed to guide relief organizations on best practices during international large and complex natural disasters such as the 2010 Haiti earthquake.

Haiti has experienced over its history several …

Using Homeland Security Exercise Evaluation Program To Execute A Mass Prophylaxis Exercise In A Rural Community., Brian K. Smith

Theses & Dissertations

This project explores the execution of point of distribution exercises in a rural community. Harrison County Iowa is a rural county with a population over 15,000 located approximately 45 minutes north of the Omaha metro area. The project explored the existing point of distribution plans and inventory for the Harrison County Home and Public Health Department. Prior to this project, many staff at Harrison County Home and Public Health Department had no experience with table top or full scale exercises. The mass prophylaxis point of distribution plan had not been updated, and staff had not received training on the point …

Establishment Of Comprehensive Training Center In Tajikistan, Umeda Sadykova

Theses & Dissertations

There is a notable increase in the number of natural and manmade disasters all over the world in the past two decades. Emergency preparedness is a field that is drawing increased attention in many countries. Tajikistan is a disaster prone country with unforgiving nature and weak preparedness infrastructure/system. Tajikistan’s weak emergency preparedness system can be attributed to two main reasons; lack of coordination between the government and international emergency organizations, and the paucity of well trained and organized network of emergency professionals. This study drafted a proposal to establish a comprehensive training center in Tajikistan. This training center will be …

Learning From Geographic Variation And Change In Preparedness: The 2016 National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index tracks the nation's progress in preparing for disasters and other emergencies that create health risks for large groups of people. Recent improvements in the Index computational methodologies and measures allow results to be compared validly across states and over time. The Index aggregates more than 130 individual measures from nearly 60 data sources into valid composite measures for 6 domains and 19 subdomains that reflect core functional areas of emergency preparedness and response. Improvements in normalization, weighting, imputation, and confidence interval construction enhance the validity and reliability of Index estimates …

Saudi Arabians’ Health Beliefs Pertaining To Middle East Respiratory Syndrome – Coronavirus (Mers-Cov): Knowledge, Attitudes, And Practices (Kap) Assessment, Zahrah Alnakli

Graduate Theses & Dissertations

Background: Middle East Respiratory Syndrome (MERS-CoV) causes respiratory illness and has been linked to high morbidity (N=583) and mortality (N=1359) since it was first found in Saudi Arabia in 2012. Camels have been identified as the likely source of the infection of MERS in Egypt, Qatar, and Saudi Arabia. Currently, there is no available treatment for MERS; however, prevention and education have been established as the best practices for prevention by the World Health Organization, United States (U.S.) Centers for Disease Control and Prevention, and The Ministry of Health in Saudi Arabia.

Purpose: This study explores awareness and health behaviors …

Cd4 T Cell-Derived Ifn-Γ Plays A Minimal Role In Control Of Pulmonary Mycobacterium Tuberculosis Infection And Must Be Actively Repressed By Pd-1 To Prevent Lethal Disease, Shunsuke Sakai, Keith D. Kauffman, Michelle A. Sallin, Arlene H. Sharpe, Howard A. Young, Vitaly V. Ganusov, Daniel L. Barber

United States Public Health Resources

IFN-γ–producing CD4 T cells are required for protection against Mycobacterium tuberculosis (Mtb) infection, but the extent to which IFN-γ contributes to overall CD4 T cell-mediated protection remains unclear. Furthermore, it is not known if increasing IFN-γ production by CD4 T cells is desirable in Mtb infection. Here we show that IFN-γ accounts for only ~30% of CD4 T cell-dependent cumulative bacterial control in the lungs over the first six weeks of infection, but >80% of control in the spleen. Moreover, increasing the IFN-γ–producing capacity of CD4 T cells by ~2 fold exacerbates lung infection and leads to the early death …

Aging American Prisons: Length Of Stay, Dying Behind Bars, And Implications For Public Health, Stephanie G. Barger

Sociology and Criminology Undergraduate Honors Theses

One notable consequence of mass incarceration is the growing population of elderly prison inmates in the U.S. This growth raises questions concerning the causes and implications of such a change, as housing older prisoners places a financial strain on state and federal correctional systems. Because this added cost is largely a result of medical needs, the growing elderly inmate population has raised questions about the impact of incarceration on health. This study investigates the causes of this “graying” of American prisons and its potential effects on correctional and community health. Using National Corrections Reporting Program data from 1990 to 2009, …

Environmental Vegetation : A Possible Association With Cardiovascular Disease Risk., Ray Anthony Yeager Ii

Electronic Theses and Dissertations

The built environment affects numerous aspects of human health and wellbeing, including risk of cardiovascular disease (CVD), the leading cause of morbidity and mortality in both the U.S. and worldwide. The amount and quality of environmental vegetation, is an important aspect of the built environment that affects known CVD risk factors, including psychosocial stress, health behaviors, and exposure to air pollutants. Nevertheless, little evidence on the role of potential mechanisms and geographic scale in these relationships exists. Of previous studies that describe associations between vegetation and CVD outcomes, limited investigation has been performed to assess these observed relationships in differing …

Legal, Structural, And Ethical Barriers To Prevention And Treatment Of Hiv/Aids: A Review Of Malaysia And Kazakhstan, Amanda S. Volk

Public Health Undergraduate Program

The HIV/AIDS epidemic in nations that use Islamic scripture in law has faced several challenges. The conservative ethical and political approach to the epidemic has been ineffective in halting the spread of and treating the existence of HIV/AIDS. It is expected that there will be several structural barriers to obtaining care, treatment, and prevention services for HIV/AIDS in these nations particularly for vulnerable populations such as Men who have Sex with Men (MSM), People Who Inject Drugs (PWID), and sex workers. This research will investigate and analyze research, laws, politics, ethics, and structure in the nations of Malaysia and Kazakhstan …