Medicine and Health Sciences Commons^™

Hiv Testing Implementation In Two Urban Cities: Practice, Policy, And Perceived Barriers., Camden J Hallmark, Jennifer Skillicorn, Thomas P Giordano, Jessica A Davila, Marlene Mcneese, Nestor Rocha, Avemaria Smith, Stacey Cooper, Amanda D. Castel

Epidemiology Faculty Publications

BACKGROUND: Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

METHODS: We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.

RESULTS: In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% …

Assessing Function And Endurance In Adults With Spinal And Bulbar Muscular Atrophy: Validity Of The Adult Myopathy Assessment Tool., Michael O. Harris-Love, Lindsay Fernandez-Rhodes, Galen Joe, Joseph A. Shrader, Angela Kokkinis, Alison La Pean Kirschner, Sungyoung Auh, Cheunju Chen, Li Li, Ellen Levy, Todd E. Davenport, Nicholas A. Di Prospero, Kenneth H. Fischbeck

Exercise and Nutrition Sciences Faculty Publications

Purpose. The adult myopathy assessment tool (AMAT) is a performance-based battery comprised of functional and endurance subscales that can be completed in approximately 30 minutes without the use of specialized equipment. The purpose of this study was to determine the construct validity and internal consistency of the AMAT with a sample of adults with spinal and bulbar muscular atrophy (SBMA).

Methods. AMAT validity was assessed in 56-male participants with genetically confirmed SBMA (mean age, 53 ± 10 years). The participants completed the AMAT and assessments for disease status, strength, and functional status. Results. Lower AMAT scores were associated with longer …

Review Of Hyperuricemia As New Marker For Metabolic Syndrome, Laura Billiet, Sarah Doaty, James D. Katz, Manuel T. Velasquez

Global Health Faculty Publications

Hyperuricemia has long been established as the major etiologic factor in gout. In recent years, a large body of evidence has accumulated that suggests that hyperuricemia may play a role in the development and pathogenesis of a number of metabolic, hemodynamic, and systemic pathologic diseases, including metabolic syndrome, hypertension, stroke, and atherosclerosis. A number of epidemiologic studies have linked hyperuricemia with each of these disorders. In some studies, therapies that lower uric acid may prevent or improve certain components of the metabolic syndrome. There is an association between uric acid and the development of systemic lupus erythematosus; the connection between …

Using A Theory Of Change Approach To Analyze Global Health Diplomacy Practice In Myanmar, Sangeeta Mookherji, Holly Greb, Rebecca Katz

Global Health Faculty Publications

The current picture of global health diplomacy (GHD) is one of increasing complexity, with multiple actors striving for multiple objectives, using a multitude of strategies and activities. Analysis and documentation of GHD practice is urgently needed to help identify the opportunities GHD provides for jointly improving global health and international relations, as well as possible unintended consequences. Systematic analysis of GHD practice is challenging without a conceptual framework. We identified a Theory of Change approach as one way to conceptualize GHD practice and potential impacts that could also depict its complexity and identify relationships and pathways for measuring success. We …

Internet And Telephonic Ivr Mixed-Mode Survey For Longitudinal Studies: Choice, Retention, And Data Equivalency, Santosh K. Verma, Theodore K. Courtney, David A. Lombardi, Wen-Ruey Chang, Yueng-Hsiang Huang, Melanye J. Brennan, Melissa J. Perry

Environmental and Occupational Health Faculty Publications

Purpose

This study examined data equivalency and loss to follow-up rates from Internet and interactive voice response (IVR) system surveys in a prospective-cohort study.

Methods

475 limited-service restaurant workers participating in the 12-week study were given a choice to report their weekly slipping experience by either IVR or Internet. Demographic differences, loss to follow-up, self-reported rates of slipping, and selection of first and last choices were compared.

Results

Loss to follow-up rates were slightly higher for those choosing the IVR mode. Rates of slipping and selection of first and last choices were not significantly different between survey modes. Propensity to …

Developing A Dissemination Model To Improve Intervention Reach Among West Virginia Youth Smokers, Kimberly Horn, Traci Jarrett, Andrew Anesett-Rothermel, Nancy O'Hara Tompkins, Geri Dino

Prevention and Community Health Faculty Publications

The Not-On-Tobacco program is an evidence-based teen smoking cessation program adopted by the American Lung Association (ALA). Although widely disseminated nationally via ALA Master Trainers, in recent years, adoption and implementation of the N-O-T program in West Virginia has slowed. West Virginia, unfortunately, has one of the highest smoking rates in the US. Although it is a goal of public health science, dissemination of evidence-based interventions is woefully understudied. The present manuscript reviews a theoretical model of dissemination of the Not-On-Tobacco program in West Virginia. Based on social marketing, diffusion of innovations, and social cognitive theories, the nine-phase model incorporates …

Medicaid Reimbursement For Naloxone: A Toolkit For Advocates, Naomi Seiler, Katie B. Horton, Mary-Beth Malcarney

Health Policy and Management Faculty Publications

Naloxone is an opioid antagonist drug used to counter the effects of an opiate overdose. It can be administered in medical settings, such as an emergency room, or prescribed as a take‑home medication to be used in case of an emergency. Currently, most types of insurance will cover and reimburse for naloxone administered directly in a medical setting. However, coverage of prescription take‑home naloxone is limited. The Medicaid program provides health insurance for a large and growing number of Americans. Therefore, securing coverage for take‑home naloxone—including costs of counseling/training and for the medicine itself—within Medicaid should be a critical priority …

The Importance Of Early Identification And Treatment Of Childhood Onset Bipolar Disorder: Creating Specialty Care, Robert M. Post

Psychiatry and Behavioral Sciences Faculty Publications

No abstract provided.

Estimation And Uncertainty Analysis Of Impacts Of Future Heat Waves On Mortality In The Eastern United States, Jianyong Wu, Ying Zhou, Yang Gao, Joshua S. Fu, Brent A. Johnson, Cheng Huang, Young-Min Kim, Yang Liu

Global Health Faculty Publications

Background: Climate change is anticipated to influence heat-related mortality in the future. However, estimates of excess mortality attributable to future heat waves are subject to large uncertainties and have not been projected under the latest greenhouse gas emission scenarios.

Objectives: We estimated future heat wave mortality in the eastern United States (approximately 1,700 counties) under two Representative Concentration Pathways (RCPs) and investigated sources of uncertainty.

Methods: Using dynamically downscaled hourly temperature projections for 2057–2059, we projected heat wave days that were defined using four heat wave metrics and estimated the excess mortality attributable to them. We apportioned the sources of …

Synthesizing Data And Models For The Spread Of Mers-Cov, 2013: Key Role Of Index Cases And Hospital Transmission, Gerardo Chowell, Seth Blumberg, Lone Simonsen, Mark A. Miller, Cecile Viboud

Global Health Faculty Publications

The outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) has caused 209 deaths and 699 laboratory-confirmed cases in the Arabian Peninsula as of June 11, 2014. Preparedness efforts are hampered by considerable uncertainty about the nature and intensity of human-to-human transmission, with previous reproduction number estimates ranging from 0.4 to 1.5. Here we synthesize epidemiological data and transmission models for the MERS-CoV outbreak during April–October 2013 to resolve uncertainties in epidemic risk, while considering the impact of observation bias. We match the progression of MERS-CoV cases in 2013 to a dynamic transmission model that incorporates community and hospital compartments, and …

Competency-Based Medical Education In Two Sub-Saharan African Medical Schools., Elsie Kiguli-Malwadde, E Oluwabunmi Olapade-Olaopa, Sarah Kiguli, Candice Chen, Nelson K. Sewankambo, Adesola O. Ogunniyi, Solome Mukwaya, Francis Omaswa

Health Services Management and Leadership Faculty Publications

Background

Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME).

Institutional reviews

This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes …

Himmelfarb Library Liaison Letter - January 2014, George Washington University, Himmelfarb Health Sciences Library

Himmelfarb Library Liaison Letters

No abstract provided.

Prescribing Multiple Neurostimulants During Rehabilitation For Severe Brain Injury., Amy A. Herrold, Theresa Louise-Bender Pape, Ann Guernon, Trudy Mallinson, Eileen Collins, Neil Jordan

Clinical Research and Leadership Faculty Publications

Background. Despite a lack of clear evidence, multiple neurostimulants are commonly provided after severe brain injury (BI). The purpose of this study is to determine if the number of neurostimulants received during rehabilitation was associated with recovery of full consciousness or improved neurobehavioral function after severe BI.

Method. Data from 115 participants were extracted from a neurobehavioral observational study database for this exploratory, retrospective analysis. Univariate optimal data analysis was conducted to determine if the number of neurostimulants influenced classification of four outcomes: recovery of full consciousness during rehabilitation, recovery of full consciousness within one year of injury, and meaningful …

Towards “Collaborative Ethics” For Translational Medical Research Teams, Perry W. Payne, Shawneequa L. Callier, Attila J. Hertelendy

Clinical Research and Leadership Faculty Publications

No abstract provided.

Humidity And Gravimetric Equivalency Adjustments For Nephelometer-Based Particulate Matter Measurements Of Emissions From Solid Biomass Fuel In Cookstoves, Sutyajeet Soneja, Chen Chen, James M. Tielsch, Joanne Katz, Scott L. Zeger, William Checkley, Frank C. Curriero, Patrick L. Breysse

Global Health Faculty Publications

Great uncertainty exists around indoor biomass burning exposure-disease relationships due to lack of detailed exposure data in large health outcome studies. Passive nephelometers can be used to estimate high particulate matter (PM) concentrations during cooking in low resource environments. Since passive nephelometers do not have a collection filter they are not subject to sampler overload. Nephelometric concentration readings can be biased due to particle growth in high humid environments and differences in compositional and size dependent aerosol characteristics. This paper explores relative humidity (RH) and gravimetric equivalency adjustment approaches to be used for the

pDR-1000 used to assess indoor PM …

Primary Care-Based Educational Interventions To Decrease Risk Factors For Metabolic Syndrome For Adults With Major Psychotic And/Or Affective Disorders: A Systematic Review, Cynthia Nover, Sarah S. Jackson

Epidemiology Faculty Publications

Background

Individuals with major psychotic and/or affective disorders are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous pharmacological and non-pharmacological interventions have been tested in inpatient and outpatient mental health settings to decrease these risk factors. This review focuses on primary care-based non-pharmacological (educational or behavioral) interventions to decrease metabolic syndrome risk factors in adults with major psychotic and/or affective disorders.

Methods

The authors conducted database searches of PsychINFO, MEDLINE and the Cochrane Database of Systematic Reviews, as well as manual searches and gray literature searches to identify included studies.

Results

The authors were …

A Mechanism Linking Id2-Tgfβ Crosstalk To Reversible Adaptive Plasticity In Neuroblastoma, Lina Chakrabarti, Bi-Dar Wang, Norman H. Lee, Anthony D. Sandler

Pharmacology and Physiology Faculty Publications

The ability of high-risk neuroblastoma to survive unfavorable growth conditions and multimodal therapy has produced an elusive childhood cancer with remarkably poor prognosis. A novel phenomenon enabling neuroblastoma to survive selection pressure is its capacity for reversible adaptive plasticity. This plasticity allows cells to transition between highly proliferative anchorage dependent (AD) and slow growing, anoikis-resistant anchorage independent (AI) phenotypes. Both phenotypes are present in established mouse and human tumors. The differential gene expression profile of the two cellular phenotypes in the mouse Neuro2a cell line delineated pathways of proliferation in AD cells or tyrosine kinase activation/ apoptosis inhibition in AI …

Septins Of Platyhelminths: Identification, Phylogeny, Expression And Localization Among Developmental Stages Of Schistosoma Mansoni, Ana E. Zeraik, Gabriel Rinaldi, Victoria H. Mann, Anastas Popratiloff, Ana P.U. Araujo, Ricardo Demarco, Paul J. Brindley

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Septins are a family of eukaryotic GTP binding proteins conserved from yeasts to humans. Originally identified in mutants of budding yeast, septins participate in diverse cellular functions including cytokinesis, organization of actin networks, cell polarity, vesicle trafficking and many others. Septins assemble into heteroligomers to form filaments and rings. Here, four septins of Schistosoma mansoni are described, which appear to be conserved within the phylum Platyhelminthes. These orthologues were related to the SEPT5, SEPT10 and SEPT7 septins of humans, and hence we have termed the schistosome septins SmSEPT5, SmSEPT10, SmSEPT7.1 and SmSEPT7.2. Septin transcripts were detected throughout the developmental cycle …

Differential Diagnosis: Approaches And Pitfalls - A Pediatric Case-Based Session For 3rd Year Medical Students, Zev Waldman, Mary Ottolini

E-Learning Modules

This ninety minute session seeks to provide a systematic framework for medical students relatively new to the differential diagnosis process. Via a combined lecture/case-based approach, the session presents basic clinical reasoning concepts and specific heuristics to guide the differential process followed by an opportunity to apply the tools to simulated pediatric cases. It also introduces the concept of cognitive biases and presents strategies to mitigate their effects. The session has been successfully used with third year medical students during the first week of their pediatrics clerkship. However, with minor adaptation, a similar approach could be used at other levels of …

The Epidemic Of Extended-Spectrum-Β-Lactamase-Producing Escherichia Coli St131 Is Driven By A Single Highly Pathogenic Subclone, H30-Rx, Lance B. Price, James R. Johnson, Maliha Aziz, Connie Clabots, Brian Johnston, Veronika Tchesnokova, Lora Nordstrom, Maria Billig, Sujay Chattopadhyay, Marc Stegger, Paal S. Andersen, Talima Pearson, Kim Riddell, Peggy Rogers, Delia Scholes, Barbara Kahl, Paul Keim, Evgeni V. Sokurenko

Environmental and Occupational Health Faculty Publications

The Escherichia coli sequence type 131 (ST131) clone is notorious for extraintestinal infections, fluoroquinolone resistance, and extended-spectrum beta-lactamase (ESBL) production, attributable to a CTX-M-15-encoding mobile element. Here, we applied pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing to reconstruct the evolutionary history of the ST131 clone. PFGE-based cluster analyses suggested that both fluoroquinolone resistance and ESBL production had been acquired by multiple ST131 sublineages through independent genetic events. In contrast, the more robust whole-genome-sequence-based phylogenomic analysis revealed that fluoroquinolone resistance was confined almost entirely to a single, rapidly expanding ST131 subclone, designated H30-R. Strikingly, 91% of the CTX-M-15-producing isolates also …

Strengthening Immigrants' Health Access: Current Opportunities, Leighton C. Ku

Health Policy and Management Issue Briefs

This brief summarizes key opportunities helping the nation’s newcomers in gaining health insurance coverage and health access that are possible under the current law. Provisions of the Affordable Care Act (ACA) will help millions of legal immigrants gain access to affordable health insurance coverage. At the same time, however, immigrants will also face new responsibilities. Like citizens, lawfully present immigrants will be responsible for having health insurance coverage or paying a tax penalty, although some are exempt. Rules about immigrants’ access to health insurance benefits are often complicated because they depend on specific immigration categories, as well as eligibility for …

The Ciliary Protein Cystin Forms A Regulatory Complex With Necdin To Modulate Myc Expression, Maoqing Wu, Chaozhe Yang, Binli Tao, Su Bu, Lisa Guay-Woodford

Pediatrics Faculty Publications

Cystin is a novel cilia-associated protein that is disrupted in the cpk mouse, a well-characterized mouse model of autosomal recessive polycystic kidney disease (ARPKD). Interestingly, overexpression of the Myc gene is evident in animal models of ARPKD and is thought to contribute to the renal cystic phenotype. Using a yeast two-hybrid approach, the growth suppressor protein necdin, known to modulate Myc expression, was found as an interacting partner of cystin. Deletion mapping demonstrated that the C-terminus of cystin and both termini of necdin are required for their mutual interaction. Speculating that these two proteins may function to regulate gene expression, …

The Impact Of A Large-Scale Power Outage On Hemodialysis Center Operations, Mahshid Abir, Sophia Jan, Lindsay Jubelt, Raina M. Merchant, Nicole Lurie

Emergency Medicine Faculty Publications

INTRODUCTION:

On June 29, 2012, mid-Atlantic storms resulted in a large-scale power outage affecting up to three million people across multiple (US) states. Hemodialysis centers are dependent on electricity to provide dialysis care to end-stage renal disease patients. The objective of thisstudy was to determine how the power outage impacted operations in a sample of hemodialysis centers in the impacted regions.

METHODS:

The sample consisted of all hemodialysis centers located in the District of Columbia and a total of five counties with the largest power losses in West Virginia, Virginia, and Maryland. A semi-structured interview guide was developed, and …

Higher Plasma Cxcl12 Levels Predict Incident Myocardial Infarction And Death In Chronic Kidney Disease: Findings From The Chronic Renal Insufficiency Cohort Study, Nehal N. Mehta, Gregory J. Matthews, Parasuram Krishnamoorthy, Rhia Shah, Catherine Mclaughlin, Dominic S. Raj, +18 Additional Authors

Medicine Faculty Publications

Aims

Genome-wide association studies revealed an association between a locus at 10q11, downstream from CXCL12, and myocardial infarction (MI). However, the relationship among plasma CXCL12, cardiovascular disease (CVD) risk factors, incident MI, and death is unknown.

Methods and Results

We analysed study-entry plasma CXCL12 levels in 3687 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study, a prospective study of cardiovascular and kidney outcomes in chronic kidney disease (CKD) patients. Mean follow-up was 6 years for incident MI or death. Plasma CXCL12 levels were positively associated with several cardiovascular risk factors (age, hypertension, diabetes, hypercholesterolaemia), lower estimated glomerular filtration rate …

Multiple Hypotheses Testing Procedures In Clinical Trials And Genomic Studies, Qing Pan

Epidemiology Faculty Publications

We review and compare multiple hypothesis testing procedures used in clinical trials and those in genomic studies. Clinical trials often employ global tests, which draw an overall conclusion for all the hypotheses, such as SUM test, Two-Step test, Approximate Likelihood Ratio test (ALRT), Intersection-Union Test (IUT), and MAX test. The SUM and Two-Step tests are most powerful under homogeneous treatment effects, while the ALRT and MAX test are robust in cases with non-homogeneous treatment effects. Furthermore, the ALRT is robust to unequal sample sizes in testing different hypotheses. In genomic studies, stepwise procedures are used to draw marker-specific conclusions and …

A Profile Of Community Health Center Patients: Implications For Policy, Peter Shin, Carmen Alvarez, Jessica Sharac, Sara J. Rosenbaum, Amanda Van Vleet, Julia Paradise, Rachel Garfield

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Community health centers are a key source of comprehensive primary care in medically underserved communities across the country, and their role is expected to grow as health coverage expands under the Affordable Care Act (ACA). To sharpen understanding of the health center patient population, this brief compares it to the overall low-income population, using data from the Health Center Patient Survey and the National Health Interview Survey,respectively. The pre-ACA profile of health center patients that emerges sets the stage for measuring change following implementation of the reform law and can inform health center policy, planning, and assessment moving forward.

Hospital Ships Adrift? Part 2: The Role Of U.S. Navy Hospital Ship Humanitarian Assistance Missions In Building Partnerships, Derek J. Licina, Sangeeta Mookherji, Gene Migliaccio, Cheryl Ringer

Global Health Faculty Publications

Introduction US Navy hospital ships are used as a foreign policy instrument to achieve various objectives that include building partnerships. Despite substantial resource investment by the Department of Defense (DoD) in these missions, their impact is unclear. The purpose of this study was to understand how and why hospital ship missions influence partnerships among the different participants.

Methods An embedded case study was used and included the hospital ship Mercy's mission to Timor-Leste in 2008 and 2010 with four units of analysis: the US government, partner nation, host nation, and nongovernmental organizations. Key stakeholders representing each unit were interviewed using …

Molecular Epidemiology Of Escherichia Coli Sequence Type 131 And Its H30 And H30-Rx Subclones Among Extended-Spectrum-Β-Lactamase-Positive And -Negative E. Coli Clinical Isolates From The Chicago Region, 2007 To 2010, Ritu Banerjee, Ari Robicsek, Michael A. Kusikowski, Stephen Porter, Brian D. Johnston, Evgeni Sokurenko, Veronika Tchesnokova, Lance B. Price, James R. Johnson

Environmental and Occupational Health Faculty Publications

We assessed Escherichia coli ST131 and its H30 and H30-Rx subclones for virulence genes, antimicrobial resistance, and extended-spectrum beta-lactamase (ESBL) type. Although both subclones were associated with ESBL production, H30-Rx isolates had higher resistance scores and were associated specifically with CTX-M-15. Three virulence genes (iha, sat, and iutA) were more prevalent among H30 than non-H30 ST131 isolates. Thus, the H30 and H30-Rx subclones are more antimicrobial resistant and have virulence profiles that are distinct from those of non-H30 ST131 isolates.

Myocarditis After Trimethoprim/Sulfamethoxazole Treatment For Ehrlichiosis, Seema U. Nayak, Gary L. Simon

Medicine Faculty Publications

The manifestations of human monocytic ehrlichiosis range from a mild febrile syndrome to a severe multisystem illness. Myocardial involvement is uncommon. We report a woman, 78 years of age, who was treated with trimethoprim/sulfamethoxazole after a tick bite, in whom myocarditis was subsequently diagnosed. She recovered completely after doxycycline therapy.

Clinical And Laboratory Features Distinguishing Juvenile Polymyositis And Muscular Dystrophy, Gulnara Mamyrova, James D. Katz, Robert V. Jones, Ira N. Targoff, Peter A. Lachenbruch, Olcay Y. Jones, Frederick W. Miller, Lisa G. Rider

Pathology Faculty Publications

OBJECTIVE:

To differentiate juvenile polymyositis (PM) and muscular dystrophy, both of which may present with chronic muscle weakness and inflammation.

METHODS:

We studied 39 patients with probable or definite juvenile PM and 9 patients with muscular dystrophies who were initially misdiagnosed as having juvenile PM. Differences in demographic, clinical, and laboratory results; outcomes; and treatment responses were evaluated by Fisher's exact and rank sum tests. Random forests classification analysis and logistic regression were performed to examine significant differences in multivariable models.

RESULTS:

Clinical features and serum muscle enzyme levels were similar between juvenile PM and dystrophy patients, except 89% of …