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Steffen HA, Swartz SR, Kenne KA, Wendt LH, Jackson JB, Rysavy MB. Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes. Am J Perinatol 2024. [PMID: 38387610 DOI: 10.1055/a-2274-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. STUDY DESIGN This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. RESULTS There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m2 (interquartile range 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. CONCLUSION Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. KEY POINTS · Sixty-one percent of delivering patients had a BMI330 kg/m2 at delivery.. · There was a higher cesarean rate with increasing delivery BMI.. · For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g..
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Affiliation(s)
- Haley A Steffen
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Samantha R Swartz
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Kimberly A Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa
| | - Linder H Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | | | - Mary B Rysavy
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas
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Dudley-Javoroski S, Cooper CS, Jackson JB, Zorn A, Carter KD, Shields RK. Tolerance for Ambiguity: Correlations With Medical and Physical Therapy Student Traits and Experiences Within the Learning Environment. Acad Med 2024:00001888-990000000-00731. [PMID: 38232084 DOI: 10.1097/acm.0000000000005631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE Health care professions trainees and clinicians who perceive ambiguous situations as sources of threat (low tolerance for ambiguity [TFA]) experience greater risk for mental health disorders and professional burnout. Physical therapists likely encounter substantial ambiguity because of the biopsychosocial nature of their main therapeutic strategies. The purpose of this study was to identify student traits and experiences within the learning environment that differentiate students with high and low TFA for medicine and physical therapy (PT), and to identify areas of interprofessional overlap and distinction. METHOD Graduation Questionnaire survey data from graduating PT (n = 2,727) and medical students (n = 33,159) from the 2019-2020 and 2020-2021 academic years were sorted according to student TFA score, and respondents in the highest and lowest TFA quartiles were retained for analysis. Difference-in-differences analysis was used to reduce the number of potential explanatory factors to a parimonious subset that was put into linear regression models. Inferential statistics were applied to all significant factors identified from the linear regression models. RESULTS For both professions, higher TFA was generally associated with more positive ratings of the learning environment (student-faculty interactions, faculty professionalism, satisfaction with career choice), lower experiences of exhaustion and disengagement (the 2 axes of academic burnout), and higher scores for the empathy domain of perspective-taking. Uniquely for medical students, low TFA was associated with lower empathy scores and a lower degree of interest in working with underserved individuals. CONCLUSIONS Findings suggest that for both professions, high TFA corresponded with better ratings of the educational experience and with traits that are advantageous for patient-centered practice and occupational resilience. Interventions to cultivate TFA among health care trainees may be an important way to meet the growing demand for humanistic health care professionals who are prepared to meet society's complex needs.
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Affiliation(s)
- Shauna Dudley-Javoroski
- S. Dudley-Javoroski is clinical associate professor, Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0002-0164-6212
| | - Christopher S Cooper
- C.S. Cooper is professor, Departments of Urology and Pediatrics, and senior associate dean for medical education, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0002-4169-2088
| | - J Brooks Jackson
- J.B. Jackson is professor, Department of Pathology, and vice president for medical affairs and dean, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0001-9458-135X
| | - Alithea Zorn
- A. Zorn is biostatistician, Department of Biostatistics and Center for Public Health Statistics, College of Public Health, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0003-4008-0618
| | - Knute D Carter
- K.D. Carter is clinical associate professor, Department of Biostatistics, and deputy director, Center for Public Health Statistics, College of Public Health, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0002-6710-4029
| | - Richard K Shields
- R.K. Shields is professor, chair, and department executive officer, Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa; ORCID: https://orcid.org/0000-0002-5838-9317
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Bujimalla PV, Kenne KA, Steffen HA, Swartz SR, Wendt LH, Skibbe AM, Jackson JB, Rysavy MB. Effects of rurality and distance to care on perinatal outcomes over a 1-year period during the COVID-19 pandemic. J Rural Health 2023. [PMID: 38151483 DOI: 10.1111/jrh.12820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE Our aim was to investigate the roles of rurality and distance to care on adverse perinatal outcomes and COVID-19 seroprevalence at the time of delivery over a 1-year period. METHODS Data were collected from the electronic medical record on all pregnant patients who delivered at a single, large, Midwest academic medical center over 1 year. Rurality was classified using standard Rural-Urban Commuting Area codes. Geographic Information System tools were used to map outcomes. Data were analyzed with univariate and multivariate models, controlling for Body Mass Index (BMI), insurance status, and parity. FINDINGS A total of 2,497 patients delivered during the study period; 20% of patients were rural (n = 499), 18.6% were micropolitan (n = 466), and 61.4% were metropolitan (n = 1,532). 10.4% of patients (n = 259) were COVID-19 seropositive. Rural patients did not experience higher rates of any measured adverse outcomes than metropolitan patients; micropolitan patients had increased odds of preterm labor (OR = 1.41, P = .022) and pre-eclampsia (OR = 1.78, P<.001). Patients living 30+ miles away from the medical center had increased odds of preterm labor (OR = 1.94, P<.001), pre-eclampsia (OR = 1.73, P = .002), and infant admission to the neonatal intensive care unit (OR = 2.12, P<.001), as well as lower gestational age at delivery (β = -9.2 days, P<.001) and birth weight (β = -206 grams, P<.001). CONCLUSION Distance to care, rather than rurality, was the key predictor of multiple adverse perinatal outcomes in this cohort of deliveries over a 1-year period. Our study suggests that rurality should not be used as a standalone indicator of access to care without further knowledge of the specific barriers affecting a given population.
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Affiliation(s)
| | - Kimberly A Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Haley A Steffen
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Samantha R Swartz
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
| | - Linder H Wendt
- Institute of Clinical and Translational Science, University of Iowa, Iowa City, Iowa, USA
| | - Adam M Skibbe
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, Iowa, USA
| | - J Brooks Jackson
- Department of Pathology, University of Iowa, Iowa City, Iowa, USA
| | - Mary B Rysavy
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, USA
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Becker GL, Amuge P, Ssebunya R, Motevalli M, Adaku A, Juma M, Wobudeya E, Elyanu P, Jackson JB, Kekitiinwa A, Blount RJ. Predictors of mortality in Ugandan children with TB, 2016-2021. Int J Tuberc Lung Dis 2023; 27:668-674. [PMID: 37608479 PMCID: PMC10443779 DOI: 10.5588/ijtld.22.0622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/13/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND: The burden of pediatric TB is high in Uganda. Our objective was to evaluate predictors of mortality during TB treatment among children at an urban and a rural referral hospital.METHODS: We designed a historical cohort study of TB cases at Mulago National Referral Hospital, Kampala; and Fort Portal Regional Referral Hospital, Fort Portal, Uganda, in children aged <15 years from 2016 to 2021. We used Kaplan-Meier models to estimate survival and fit multivariable Cox regression models to determine mortality hazards during TB treatment.RESULTS: We identified 1,658 children diagnosed with TB from 2016 to 2021. Of 1,623 children with known treatment outcomes, 127/1,623 (7.8%) died during TB treatment, 1,298/1,623 (78.3%) completed treatment, 150/1,623 (9.2%) were lost to follow-up, and two children failed treatment. Using Kaplan-Meier functions, the median time to death was 27 days following treatment initiation. In adjusted Cox models, predictors of mortality included HIV (aHR 1.68, 95% CI 1.01-2.81), moderate malnutrition (aHR 2.22, 95% CI 1.18-4.16), and severe malnutrition (aHR 2.92, 95% CI 1.75-4.87).CONCLUSION: Mortality was high at an urban and a rural referral hospital among children who initiated TB treatment from 2016 to 2021, with the majority of deaths occurring during the intensive phase of TB treatment. Malnutrition and HIV were significant predictors of death during treatment.
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Affiliation(s)
- G L Becker
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - P Amuge
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - R Ssebunya
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - M Motevalli
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - A Adaku
- Fort Portal Regional Referral Hospital, Fort Portal, Uganda
| | - M Juma
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - E Wobudeya
- Directorate of Pediatrics & Child Health, Mulago National Referral Hospital, Kampala, Uganda
| | - P Elyanu
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - J B Jackson
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - A Kekitiinwa
- Baylor College of Medicine Children's Foundation-Uganda, Kampala
| | - R J Blount
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Jiang ZH, Chen QY, Jia HH, Wang XY, Zhang LJ, Huang XQ, Harrison TJ, Jackson JB, Wu L, Fang ZL. Low host immune pressure may be associated with the development of hepatocellular carcinoma: a longitudinal analysis of complete genomes of the HBV 1762T, 1764A mutant. Front Oncol 2023; 13:1214423. [PMID: 37681020 PMCID: PMC10481955 DOI: 10.3389/fonc.2023.1214423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Background It has been reported that hepatitis B virus (HBV) double mutations (A1762T, G1764A) are an aetiological factor of hepatocellular carcinoma (HCC). However, it is unclear who is prone to develop HCC, among those infected with the mutant. Exploring HBV quasispecies, which are strongly influenced by host immune pressure, may provide more information about the association of viral factors and HCC. Materials and methods Nine HCC cases and 10 controls were selected from the Long An cohort. Serum samples were collected in 2004 and 2019 from subjects with HBV double mutations and the complete genome of HBV was amplified and sequenced using next-generation sequencing (NGS). Results The Shannon entropy values increased from 2004 to 2019 in most cases and controls. There was no significant difference in mean intrahost quasispecies genetic distances between cases and controls. The change in the values of mean intrahost quasispecies genetic distances of the controls between 2004 and 2019 was significantly higher than that of the cases (P<0.05). The viral loads did not differ significantly between cases and controls in 2004(p=0.086) but differed at diagnosed in 2019 (p=0.009). Three mutations occurring with increasing frequency from 2004 to 2019 were identified in the HCC cases, including nt446 C→G, nt514 A→C and nt2857T→C. Their frequency differed significantly between the cases and controls (P<0.05). Conclusions The change in the values of mean intrahost quasispecies genetic distances in HCC was smaller, suggesting that HBV in HCC cases may be subject to low host immune pressure. Increasing viral loads during long-term infection are associated with the development of HCC. The novel mutations may increase the risk for HCC.
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Affiliation(s)
- Zhi-Hua Jiang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Qin-Yan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Hui-Hua Jia
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
- School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Xue-Yan Wang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Lu-Juan Zhang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
| | - Xiao-Qian Huang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
- School of Preclinical Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Tim J. Harrison
- Division of Medicine, University College London Medical School, London, United Kingdom
| | - J. Brooks Jackson
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Li Wu
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Zhong-Liao Fang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi, China
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Kenne KA, Wendt L, Brooks Jackson J. Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors. Sci Rep 2022; 12:9878. [PMID: 35701486 PMCID: PMC9198100 DOI: 10.1038/s41598-022-13501-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/25/2022] [Indexed: 11/09/2022] Open
Abstract
Determine the prevalence of pelvic floor disorders (PFD) stratified by age, race, body mass index (BMI), and parity in adult women attending family medicine and general internal medicine clinics at an academic health system. The medical records of 25,425 adult women attending primary care clinics were queried using International Classification of Diseases-10th Revision codes (ICD-10 codes) for PFD [urinary incontinence (UI), pelvic organ prolapse (POP), and bowel dysfunction (anal incontinence (AI) and difficult defecation)]. Prevalence and odds ratios were calculated using univariate and multivariate analysis for age, race, BMI, and parity when available. Multivariate logistic regression models were used to assess the impact of age, race, BMI, and parity on the likelihood of being diagnosed with a PFD. A separate model was constructed for each of the three PFD categories (UI, POP, and bowel dysfunction) as well as a model assessing the likelihood of occurrence for any type of PFD. The percentage of women with at least one PFD was 32.0% with bowel dysfunction the most common (24.6%), followed by UI (11.1%) and POP (4.4%). 5.5% had exactly two PFD and 1.1% had all 3 categories of PFD. Older age and higher BMI were strongly and significantly associated with each of the three PFD categories, except for BMI and prolapse. Relative to White patients, Asian patients were at significantly lower risk for each category of PFD, while Black patients were at significantly lower risk for UI and POP, but at significantly greater risk for bowel dysfunction and the presence of any PFD. Higher parity was also significantly associated with pelvic organ prolapse. Using multivariate analyses, age, race, and BMI were all independently associated with PFD. PFD are highly prevalent in the primary care setting and should be screened for, especially in older and obese women. BMI may represent a modifiable risk factor.
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Affiliation(s)
- Kimberly A Kenne
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31674 PFP, Iowa City, IA, 42240, USA.
| | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31674 PFP, Iowa City, IA, 42240, USA
| | - J Brooks Jackson
- Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 31674 PFP, Iowa City, IA, 42240, USA
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Leon J, Merrill AE, Rogers K, Kurt J, Dempewolf S, Ehlers A, Jackson JB, Knudson CM. SARS-CoV-2 antibody changes in patients receiving COVID-19 convalescent plasma from normal and vaccinated donors. Transfus Apher Sci 2022; 61:103326. [PMID: 34862140 PMCID: PMC8608660 DOI: 10.1016/j.transci.2021.103326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 01/25/2023]
Abstract
Vaccination has been shown to stimulate remarkably high antibody levels in donors who have recovered from COVID-19. Our objective was to measure patient antibody levels before and after transfusion with COVID-19 Convalescent Plasma (CCP) and compare the antibody levels following transfusion of CCP from vaccinated and nonvaccinated donors. Plasma samples before and after transfusion were obtained from 25 recipients of CCP and COVID-19 antibody levels measured. Factors that effect changes in antibody levels were examined. In the 21 patients who received CCP from nonvaccinated donors, modest increases in antibody levels were observed. Patients who received two units were more likely to seroconvert than those receiving just one unit. The strongest predictor of changes in patient antibody level was the CCP dose, calculated by the unit volume multiplied by the donor antibody level. Using patient plasma volume and donor antibody level, the post-transfusion antibody level could be predicted with reasonable accuracy(R2> 0.90). In contrast, the 4 patients who received CCP from vaccinated donors all had dramatic increases in antibody levels following transfusion of a single unit. In this subset of recipients, antibody levels observed after transfusion of CCP were comparable to those seen in donors who had fully recovered from COVID-19. If available, CCP from vaccinated donors with very high antibody levels should be used. One unit of CCP from vaccinated donors increases patient antibody levels much more than 1 or 2 units of CCP from unvaccinated donors.
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Affiliation(s)
| | | | | | | | | | | | | | - C. Michael Knudson
- Corresponding author at: Department of Pathology, University of Iowa Hospitals and Clinics, 200 Hawkins Dr., C250 GH, United States
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Van Ert HA, Bohan DW, Rogers K, Fili M, Rojas Chávez RA, Qing E, Han C, Dempewolf S, Hu G, Schwery N, Sevcik K, Ruggio N, Boyt D, Pentella MA, Gallagher T, Jackson JB, Merrill AE, Knudson CM, Brown GD, Maury W, Haim H. Limited Variation between SARS-CoV-2-Infected Individuals in Domain Specificity and Relative Potency of the Antibody Response against the Spike Glycoprotein. Microbiol Spectr 2022; 10:e0267621. [PMID: 35080430 PMCID: PMC8791189 DOI: 10.1128/spectrum.02676-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/25/2022] Open
Abstract
The spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is arranged as a trimer on the virus surface, composed of three S1 and three S2 subunits. Infected and vaccinated individuals generate antibodies against spike, which can neutralize the virus. Most antibodies target the receptor-binding domain (RBD) and N-terminal domain (NTD) of S1; however, antibodies against other regions of spike have also been isolated. The interhost variability in domain specificity and relative neutralization efficacy of the antibodies is still poorly characterized. To this end, we tested serum and plasma samples collected from 85 coronavirus disease 2019 (COVID-19) convalescent subjects. Samples were analyzed using seven immunoassays that employ different domains, subunits, and oligomeric forms of spike to capture the antibodies. Samples were also tested for their neutralization of pseudovirus containing SARS-CoV-2 spike and of replication-competent SARS-CoV-2. While the total amount of anti-spike antibodies produced varied among convalescent subjects, we observed an unexpectedly fixed ratio of RBD- to NTD-targeting antibodies. The relative potency of the response (defined as the measured neutralization efficacy relative to the total level of spike-targeting antibodies) also exhibited limited variation between subjects and was not associated with the overall amount of antispike antibodies produced. These studies suggest that host-to-host variation in the polyclonal response elicited against SARS-CoV-2 spike in early pandemic subjects is primarily limited to the quantity of antibodies generated rather than their domain specificity or relative neutralization potency. IMPORTANCE Infection by SARS-CoV-2 elicits antibodies against various domains of the spike protein, including the RBD and NTD of subunit S1 and against subunit S2. The antibody responses of different infected individuals exhibit different efficacies to inactivate (neutralize) the virus. Here, we show that the observed variation in the neutralizing activity of the antibody responses in COVID-19 convalescent subjects is caused by differences in the amounts of antibodies rather than their recognition properties or the potency of their antiviral activity. These findings suggest that COVID-19 vaccine strategies that focus on enhancing the overall level of the antibodies will likely elicit a more uniformly efficacious protective response.
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Affiliation(s)
- Hanora A. Van Ert
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Dana W. Bohan
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Kai Rogers
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Mohammad Fili
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, Iowa, United States
| | - Roberth A. Rojas Chávez
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Enya Qing
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois, United States
| | - Changze Han
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Spencer Dempewolf
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Guiping Hu
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, Iowa, United States
| | - Nathan Schwery
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Kristina Sevcik
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Natalie Ruggio
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Devlin Boyt
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Michael A. Pentella
- State Hygienic Laboratory, The University of Iowa, Iowa City, Iowa, United States
| | - Tom Gallagher
- Department of Microbiology and Immunology, Loyola University Chicago, Maywood, Illinois, United States
| | - J. Brooks Jackson
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Anna E. Merrill
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - C. Michael Knudson
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, United States
| | - Grant D. Brown
- Department of Biostatistics, School of Public Health, The University of Iowa, Iowa City, Iowa, United States
| | - Wendy Maury
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
| | - Hillel Haim
- Department of Microbiology and Immunology, The University of Iowa, Iowa City, Iowa, United States
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Chen QY, Jia HH, Wang XY, Shi YL, Zhang LJ, Hu LP, Wang C, He X, Harrison TJ, Jackson JB, Wu L, Fang ZL. Analysis of entire hepatitis B virus genomes reveals reversion of mutations to wild type in natural infection, a 15 year follow-up study. Infect Genet Evol 2022; 97:105184. [PMID: 34902556 DOI: 10.1016/j.meegid.2021.105184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
It has been reported that some mutations in the genome of hepatitis B virus (HBV) may predict the outcome of the virus infection. However, evolutionary data derived from long-term longitudinal analysis of entire HBV genomes using next generation sequencing (NGS) remain rare. In this study, serum samples were collected from asymptomatic hepatitis B surface antigen (HBsAg) carriers from a long-term prospective cohort. The entire HBV genome was amplified by polymerase chain reaction (PCR) and sequenced using NGS. Twenty-eight time series serum samples from nine subjects were successfully analysed. The Shannon entropy (Sn) ranged from 0 to 0.89, with a median value of 0.76, and the genetic diversity (D) ranged from 0 to 0.013, with a median value of 0.004. Intrahost HBV viral evolutionary rates ranged from 2.39E-04 to 3.11E-03. Double mutations at nt1762(A → T) and 1764(G → A) and a stop mutation at nt1896(G → A) were seen in all sequences from subject BO129 in 2007. However, in 2019, most sequences were wild type at these positions. Deletions between nt 2920-3040 were seen in all sequences from subject TS115 in 2007 and 2013 but these were not present in 2004 or 2019. Some sequences from subject CC246 had predicted escape substitutions (T123N, G145R) in the surface protein in 2004, 2013 and 2019 but none of the sequences from 2007 had these changes. In conclusion, HBV mutations may revert to wild type in natural infection. Clinicians should be wary of predicting long-term prognoses on the basis of the presence of mutations.
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Affiliation(s)
- Qin-Yan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Hui-Hua Jia
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China; School of Preclinical Medicine, Guangxi Medical University, 22 ShuangYong Road, Nanning, Guangxi 530021, China
| | - Xue-Yan Wang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Yun-Liang Shi
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Lu-Juan Zhang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Li-Ping Hu
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Chao Wang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China
| | - Xiang He
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Tim J Harrison
- Division of Medicine, University College London Medical School, London, UK
| | - J Brooks Jackson
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Li Wu
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Zhong-Liao Fang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Guangxi Key Laboratory for the Prevention and Control of Viral Hepatitis, Nanning, Guangxi 530028, China.
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10
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Castaneda C, Marsden K, Maxwell T, Ten Eyck P, Kuwaye D, Kenne KA, Merryman AS, Steffen HA, Swartz SR, Merrill AE, Krasowski MD, Jackson JB, Rysavy MB. Prevalence of maternal obesity at delivery and association with maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2021; 35:8544-8551. [PMID: 34641757 DOI: 10.1080/14767058.2021.1988563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Maternal obesity has been linked to adverse outcomes for mothers and their offspring, including, but not limited to gestational hypertension (gHTN), gestational diabetes (GDM), pre-eclampsia, fetal macrosomia, and emergency cesarean section. Recent investigations have also shown that obesity, as defined by a body mass index (BMI) ≥ 30, especially severe obesity (BMI ≥ 40), is a risk factor for both hospitalization and death from COVID-19. OBJECTIVES The objective of this study is to determine the prevalence and association of maternal obesity at delivery with adverse antenatal, intrapartum, and neonatal outcomes in a cohort of consecutive delivering patients at a tertiary care center in Iowa from May to September 2020. A secondary objective is to determine if maternal obesity has any relationship to past or current COVID-19 infection status at the time of delivery. This is a secondary analysis of a prospective cohort study to analyze obstetric outcomes among COVID-19 infected and uninfected patients. METHODS We conducted a prospective cohort study using demographic and clinical data obtained from the electronic medical record. Excess plasma was collected from routine blood samples obtained at delivery admission to determine the seroprevalence of COVID-19 antibody using the DiaSorin and Roche antibody assays. Frequency variables were each calculated separately, and a comparison of maternal and neonatal outcomes was conducted using the generalized linear mixed modeling (GLMM) framework to account for varying distributions (normal and binary). RESULTS 1001 women delivered during the study period and 89.7% met criteria for being overweight or obese; 17.9% met criteria for severe obesity. Women with obesity had 49.8% lower odds of possessing private insurance, and women with severe obesity were less than half as likely to plan to breastfeed at the time of discharge. Women with obesity of any kind had a significantly increased odds of GDM and gHTN, and an increased risk of an infant with macrosomia, hypoglycemia, and NICU admission. No significant association was found between BMI and COVID-19 infection or disease severity. CONCLUSION This study provides insight into obstetric complications facing women with obesity, especially those with severe obesity. This report serves to highlight potential challenges, such as insurance status and labor complications, that impact women of high BMI to a greater degree when compared to their normal-weight counterparts.
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Affiliation(s)
| | | | - Timothy Maxwell
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Daren Kuwaye
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, USA
| | - Kimberly A Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Abbey S Merryman
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
| | - Haley A Steffen
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Anna E Merrill
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | | | | | - Mary B Rysavy
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, USA
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11
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Steffen HA, Swartz SR, Jackson JB, Kenne KA, Ten Eyck P, Merryman AS, Castaneda C, Marsden K, Maxwell T, Merrill AE, Krasowski MD, Rysavy MB. SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes. Am J Perinatol 2021; 38:614-621. [PMID: 33611783 PMCID: PMC11071687 DOI: 10.1055/s-0041-1723938] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. STUDY DESIGN This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. RESULTS In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26-33 years) and body mass index was 31.75 kg/m2 (IQR 27.7-37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. CONCLUSION In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. KEY POINTS · SARS-CoV-2 seroprevalence rate in pregnant population in Iowa is 5.8%.. · Infections are higher among minorities, non-English speakers, and patients without private insurance.. · No increased adverse maternal/neonatal outcomes observed for SARS-CoV-2 infected mothers..
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Affiliation(s)
| | | | | | - Kimberly A. Kenne
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | - Patrick Ten Eyck
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA
| | - Abbey S. Merryman
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
| | | | | | - Timothy Maxwell
- University of Iowa Carver College of Medicine, Iowa City, IA
| | | | | | - Mary B. Rysavy
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA
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12
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Knudson CM, Jackson JB. COVID-19 convalescent plasma; time for "goal directed therapy"? Transfusion 2021; 61:1654-1656. [PMID: 33723852 PMCID: PMC8250757 DOI: 10.1111/trf.16381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Charles Michael Knudson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics (UIHC), Iowa City, Iowa, USA
| | - J Brooks Jackson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics (UIHC), Iowa City, Iowa, USA
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13
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Merrill AE, Jackson JB, Ehlers A, Voss D, Krasowski MD. Head-to-Head Comparison of Two SARS-CoV-2 Serology Assays. J Appl Lab Med 2020; 5:1351-1357. [PMID: 32717056 PMCID: PMC7454580 DOI: 10.1093/jalm/jfaa125] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/06/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND While molecular techniques remain the gold standard for diagnosis of acute SARS-CoV-2 infection, serological tests have the unique potential to ascertain how much of the population has been exposed to the COVID-19 pathogen. There have been limited published studies to date documenting the performance of SARS-CoV-2 antibody assays. METHODS We compared the DiaSorin Liaison SARS-CoV-2 S1/S2 IgG and Roche Diagnostics Elecsys Anti-SARS-CoV-2 assays using 228 samples spanning patients with positive PCR for SARS-CoV-2, patients with compatible symptoms but negative PCR, pre-COVID specimens, and potential cross-reactives. RESULTS Both assays detected antibodies in 18/19 samples collected at least one week after a positive PCR result. Neither method consistently detected antibodies in specimens collected within one week of a positive PCR result (sensitivity < 50%), but antibodies were detected by only Roche in four samples in this time frame. Using 139 pre-COVID and 35 PCR-negative samples, the Roche and DiaSorin assays demonstrated specificities of 100.0% and 98.9%, respectively. Neither assay demonstrated cross-reactivity from other coronaviruses (229E, HKU1, NL63, OC43), respiratory pathogens (adenovirus, metapneumovirus, rhinovirus/enterovirus), or antibodies to other viruses (HIV, EBV, CMV, HBV, HCV, HAV). DISCUSSION Overall, the qualitative interpretations afforded by the Roche and DiaSorin assays agreed for 97% of samples evaluated. Minor discrepancies in sensitivity and specificity were observed between methods, with the differences in specificity more clinically significant for our low-prevalence population. For the DiaSorin assay, all disagreements with the Roche assay occurred in samples with quantitative signals near the cut-off determining positivity.
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Affiliation(s)
- Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Brooks Jackson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Alexandra Ehlers
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Dena Voss
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA
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14
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Abstract
See editorial on page 1123–1127, in this issue
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Affiliation(s)
- C Michael Knudson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics (UIHC), Iowa City, Iowa, USA
| | - J Brooks Jackson
- DeGowin Blood Center, Department of Pathology, University of Iowa Hospitals & Clinics (UIHC), Iowa City, Iowa, USA
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15
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Flys T, Nissley DV, Claasen CW, Jones D, Shi C, Guay LA, Musoke P, Mmiro F, Strathern JN, Jackson JB, Eshleman JR, Eshleman SH. Erratum to: Sensitive Drug-Resistance Assays Reveal Long-Term Persistence of HIV-1 Variants with the K103N Nevirapine (NVP) Resistance Mutation in Some Women and Infants after the Administration of Single-Dose NVP: HIVNET 012. J Infect Dis 2020; 221:855. [PMID: 31776582 DOI: 10.1093/infdis/jiz524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tamara Flys
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
| | - Dwight V Nissley
- Gene Regulation and Chromosome Biology Laboratory, Reverse Transcription and Molecular Biology Section, Basic Research Program, Science Applications International Corporation-Frederick.,National Cancer Institute-Frederick, Frederick, Maryland
| | | | - Dana Jones
- Gene Regulation and Chromosome Biology Laboratory, Reverse Transcription and Molecular Biology Section, Basic Research Program, Science Applications International Corporation-Frederick
| | - Chanjuan Shi
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
| | - Laura A Guay
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
| | - Philippa Musoke
- Department of Paediatrics, Makerere University, Kampala, Uganda
| | - Francis Mmiro
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda
| | | | - J Brooks Jackson
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
| | - James R Eshleman
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
| | - Susan H Eshleman
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore
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16
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Gauer JL, Jackson JB. The association between United States Medical Licensing Examination scores and clinical performance in medical students. Adv Med Educ Pract 2019; 10:209-216. [PMID: 31114422 PMCID: PMC6497117 DOI: 10.2147/amep.s192011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/28/2019] [Indexed: 06/01/2023]
Abstract
Purpose: United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores are frequently used to evaluate applicants to residency programs. Recent literature questions the value of USMLE scores for evaluation of residency applicants, in part due to a lack of evidence supporting a relationship with clinical performance. This study explored the relationship between USMLE scores and medical students' clinical performance, as measured by the count of honors grades received in core clinical clerkships. Methods: USMLE Step 1 and Step 2 CK scores and number of honors grades per student in seven core clinical clerkships were obtained from 1,511 medical students who graduated in 2013-2017 from two medical schools. The relationships between variables were analyzed using correlation coefficients, independent-samples t-tests, and hierarchical multiple regression. Results: Count of honors grades correlated with both Step 1 (R=0.480, P<0.001) and Step 2 CK (R=0.542, P<0.001). After correcting for gender, institution, and test-taking ability (using MCAT scores as a proxy for test-taking ability) in a hierarchical multiple regression model, Step 1 and Step 2 CK scores together explained 22.2% of the variance in count of honors grades. Conclusion: USMLE Step 1 and Step 2 CK scores moderately correlate with the number of honors grades per student in core clinical clerkships. This relationship is maintained even after correcting for gender, institution, and test-taking ability. These results indicate that USMLE scores have a positive linear association with clinical performance as a medical student.
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Affiliation(s)
| | - J Brooks Jackson
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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17
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Wagner CL, Hanumanthu VS, Talbot CC, Abraham RS, Hamm D, Gable DL, Kanakry CG, Applegate CD, Siliciano J, Jackson JB, Desiderio S, Alder JK, Luznik L, Armanios M. Short telomere syndromes cause a primary T cell immunodeficiency. J Clin Invest 2018; 128:5222-5234. [PMID: 30179220 DOI: 10.1172/jci120216] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
The mechanisms that drive T cell aging are not understood. We report that children and adult telomerase mutation carriers with short telomere length (TL) develop a T cell immunodeficiency that can manifest in the absence of bone marrow failure and causes life-threatening opportunistic infections. Mutation carriers shared T cell-aging phenotypes seen in adults 5 decades older, including depleted naive T cells, increased apoptosis, and restricted T cell repertoire. T cell receptor excision circles (TRECs) were also undetectable or low, suggesting that newborn screening may identify individuals with germline telomere maintenance defects. Telomerase-null mice with short TL showed defects throughout T cell development, including increased apoptosis of stimulated thymocytes, their intrathymic precursors, in addition to depleted hematopoietic reserves. When we examined the transcriptional programs of T cells from telomerase mutation carriers, we found they diverged from older adults with normal TL. Short telomere T cells upregulated DNA damage and intrinsic apoptosis pathways, while older adult T cells upregulated extrinsic apoptosis pathways and programmed cell death 1 (PD-1) expression. T cells from mice with short TL also showed an active DNA-damage response, in contrast with old WT mice, despite their shared propensity to apoptosis. Our data suggest there are TL-dependent and TL-independent mechanisms that differentially contribute to distinct molecular programs of T cell apoptosis with aging.
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Affiliation(s)
| | | | - C Conover Talbot
- Institute for Basic Biomedical Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Hamm
- Adaptive Biotechnologies, Seattle, Washington, USA
| | | | | | | | | | | | - Stephen Desiderio
- Institute for Basic Biomedical Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Sidney Kimmel Comprehensive Cancer Center, and.,Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Leo Luznik
- Department of Oncology and.,Sidney Kimmel Comprehensive Cancer Center, and
| | - Mary Armanios
- Department of Oncology and.,McKusick-Nathans Institute of Genetic Medicine.,Department of Pathology.,Sidney Kimmel Comprehensive Cancer Center, and.,Department of Molecular Biology and Genetics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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18
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Burns KH, Borowitz MJ, Carroll KC, Gocke CD, Hooper JE, Amukele T, Tobian AAR, Valentine A, Kahl R, Rodas-Eral V, Boitnott JK, Jackson JB, Sanfilippo F, Hruban RH. The Evolution of Earned, Transparent, and Quantifiable Faculty Salary Compensation: The Johns Hopkins Pathology Experience. Acad Pathol 2018; 5:2374289518777463. [PMID: 29978019 PMCID: PMC6024278 DOI: 10.1177/2374289518777463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/24/2018] [Accepted: 04/12/2018] [Indexed: 11/23/2022] Open
Abstract
Faculty value equitable and transparent policies for determining salaries and expect
their compensation to compare favorably to the marketplace. Academic institutions use
compensation to recruit and retain talented faculty as well as to reward accomplishment.
Institutions are therefore working to decrease salary disparities that appear arbitrary or
reflect long-standing biases and to identify metrics for merit-based remuneration. Ours is
a large academic pathology department with 97 tenure-track faculty. Faculty salaries are
comprised of 3 parts (A + B + C). Part A is determined by the type of appointment and
years at rank; part B recognizes defined administrative, educational, or clinical roles;
and part C is a bonus to reward and incentivize activities that forward the missions of
the department and medical school. A policy for part C allocations was first codified and
approved by department faculty in 1993. It rewarded performance using a semiquantitative
scale, based on subjective evaluations of the department director (chair) in consultation
with deputy directors (vice chairs) and division directors. Faculty could not directly
calculate their part C, and distributions data were not widely disclosed. Over the last 2
years (2015-2017), we have implemented a more objective formula for quantifying an earned
part C, which is primarily designed to recognize scholarship in the form of research
productivity, educational excellence, and clinical quality improvement. Here, we share our
experience with this approach, reviewing part C calculations as made for individual
faculty members, providing a global view of the resulting allocations, and considering how
the process and outcomes reflect our values.
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Affiliation(s)
- Kathleen H Burns
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen C Carroll
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jody E Hooper
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy Amukele
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allen Valentine
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rob Kahl
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vanessa Rodas-Eral
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John K Boitnott
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Brooks Jackson
- Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Ralph H Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Sanfilippo F, Burns KH, Borowitz MJ, Jackson JB, Hruban RH. The Johns Hopkins Department of Pathology Novel Organizational Model: A 25-Year-Old Ongoing Experiment. Acad Pathol 2018; 5:2374289518811145. [PMID: 30456297 PMCID: PMC6238201 DOI: 10.1177/2374289518811145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/27/2018] [Accepted: 09/24/2018] [Indexed: 11/30/2022] Open
Abstract
In 1993, the present Department of Pathology at Johns Hopkins was established with the leadership of a new chair (ie, referred to as department director at Hopkins) and upon the integration of 3 separate and independent departments at the Johns Hopkins School of Medicine (Pathology) and the Johns Hopkins Hospital (Pathology, Laboratory Medicine). This new department was organized into 17 divisions, each of which was expected to develop and maintain significant clinical, educational, and research programs of excellence. To facilitate performance and alignment across missions and parent organizations, a novel professional and administrative structure was created. Professionally, vice-chairs (ie, deputy directors) for research, teaching, and patient care were appointed to oversee and coordinate these activities across all units of the department. Likewise, to focus and enhance expertise, individual administrators were appointed for academic, clinical, and business affairs. A departmental executive committee was created consisting of the vice-chairs and administrators, which was presided over by the chair. Simultaneously, substantial effort was put into measuring and improving the organizational culture using evidence-based methods. Significant improvements were documented by the year 2000 in departmental performance in research, education, clinical service, culture, and finances. Under 2 successive leaders, the department has maintained its eminence across missions and financial performance. This 25-year experience supports the tenet that innovative and strategic organizational structures and functional alignments can provide sustainable competitive advantages in performance.
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Affiliation(s)
- Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Kathleen H. Burns
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael J. Borowitz
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J. Brooks Jackson
- Department of Pathology, University of Iowa School of Medicine, Iowa City, IA, USA
| | - Ralph H. Hruban
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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20
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Gauer JL, Jackson JB. Relationships of demographic variables to USMLE physician licensing exam scores: a statistical analysis on five years of medical student data. Adv Med Educ Pract 2018; 9:39-44. [PMID: 29391841 PMCID: PMC5768186 DOI: 10.2147/amep.s152684] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the associations of the demographic variables of gender, state of legal residency, student age, and undergraduate major with scores on the Medical College Admissions Test (MCAT) and the United States Medical Licensing Exam (USMLE) Step 1 and Step 2 Clinical Knowledge. METHODS The researchers collected and analyzed exam scores and demographic student data from participants of five graduating classes of students at the University of Minnesota Medical School (N = 1,067). RESULTS Significant differences (p < 0.05) were found for traditional-aged (defined as < 25 years old at matriculation) versus nontraditional-aged students on USMLE Step 1 scores (t[1065] = 2.91, p = 0.004) and USMLE Step 2 scores (t[1061] = 4.39, p < 0.001), both in favor of traditional-aged students. Significant differences were found for males versus females on MCAT Composite scores (t[1063] = 6.53, p < 0.001) and USMLE Step 1 scores (t[1065] = 5.14, p < 0.001), both in favor of males. There were no significant differences between science and nonscience majors or between Minnesota legal residents and nonresidents. CONCLUSION Traditional age and male gender were associated with higher exam scores, although patterns differed between tests, whereas undergraduate major and state of legal residency were not associated with higher exam scores.
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Affiliation(s)
- Jacqueline L Gauer
- Office of Medical Education, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - J Brooks Jackson
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
- Correspondence: J Brooks Jackson, University of Minnesota, MMC 293 C607, 420 Delaware Street, Minneapolis, MN 55455, USA, Tel +1 612 626 4949, Email
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21
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Gauer JL, Jackson JB. Association between the Medical College Admission Test scores and Alpha Omega Alpha Medical Honors Society membership. Adv Med Educ Pract 2017; 8:627-632. [PMID: 28979178 PMCID: PMC5608086 DOI: 10.2147/amep.s145839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Medical schools worldwide are faced with the challenge of selecting from among many qualified applicants. One factor that might help admissions committees identify future exceptional medical students is scores on standardized entrance exams. The purpose of this study was to determine the association between scores on the most commonly used standardized medical school entrance exam in the USA, the Medical College Admission Test (MCAT), and election to the US medical honors society, Alpha Omega Alpha (AOA). METHOD MCAT scores and AOA membership data were analyzed for all the students pursuing Doctor of Medicine degrees at the University of Minnesota Medical School and who graduated between 2012-2016 (n=1,309). RESULTS An independent-samples t-test found a significant difference (t=6.132, p<0.001) in MCAT scores between those who were elected to AOA (n=179) and those who were not (n=1,130). On average, students who were elected to AOA had composite MCAT scores of 1.65 points higher than those who were not. Percentages of students elected to AOA gradually but inconsistently increased with MCAT score. No student who scored <27 on the MCAT was elected to AOA. Among students with MCAT scores at the 99th percentile or above (scores of ≥38), 13 of 48 (27.1%) were elected to AOA. DISCUSSION Election to AOA during medical school was significantly associated with higher MCAT scores. Admissions committees should carefully consider the role of standardized entrance exam scores, in the context of a holistic review, when selecting for exceptional medical students.
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Affiliation(s)
| | - J Brooks Jackson
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN, USA
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Gauer JL, Jackson JB. The association of USMLE Step 1 and Step 2 CK scores with residency match specialty and location. Med Educ Online 2017; 22:1358579. [PMID: 28762297 PMCID: PMC5653932 DOI: 10.1080/10872981.2017.1358579] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 07/17/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND For future physicians, residency programs offer necessary extended training in specific medical specialties. Medical schools benefit from an understanding of factors that lead their students to match into certain residency specialties. One such factor, often used during the residency application process, is scores on the USA Medical Licensing Exam (USMLE). OBJECTIVES To determine the relationship between USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores and students' residency specialty match, and the association between both USMLE scores and state of legal residency (Minnesota) at the time of admission with students staying in-state or leaving the state for residency program. DESIGN USMLE scores and residency match data were analyzed from five graduating classes of students at the University of Minnesota Medical School (N = 1054). RESULTS A MANOVA found significant differences (p < 0.001) between residency specialties and both USMLE Step 1 and Step 2 CK scores, as well as the combination of the two. Students who matched in Dermatology had the highest mean USMLE scores overall, while students who matched in Family Medicine had the lowest mean scores. Students who went out of state for residency had significantly higher Step 1 scores (p = 0.027) than students who stayed in-state for residency, while there was no significant difference between the groups for Step 2 scores. A significant positive association was found between a student who applied as a legal resident of Minnesota and whether the student stayed in Minnesota for their residency program. CONCLUSIONS Residency specialty match was significantly associated with USMLE Step 1 and USMLE Step 2 CK scores, as was staying in-state or leaving the state for residency. Students who were legal residents of the state at the time of application were more likely to stay in-state for residency, regardless of USMLE score. ABBREVIATIONS CK: Clinical knowledge; COMLEX: Comprehensive Osteopathic Medical Licensing Examination; GME: Graduate medical education; NRMP: National Resident Matching Program; UME: Undergraduate medical education; USMLE: United States Medical Licensing Examination.
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Gauer JL, Wolff JM, Jackson JB. Do MCAT scores predict USMLE scores? An analysis on 5 years of medical student data. Med Educ Online 2016; 21:31795. [PMID: 27702431 PMCID: PMC5045966 DOI: 10.3402/meo.v21.31795] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/23/2016] [Accepted: 08/31/2016] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The purpose of this study was to determine the associations and predictive values of Medical College Admission Test (MCAT) component and composite scores prior to 2015 with U.S. Medical Licensure Exam (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, with a focus on whether students scoring low on the MCAT were particularly likely to continue to score low on the USMLE exams. METHOD Multiple linear regression, correlation, and chi-square analyses were performed to determine the relationship between MCAT component and composite scores and USMLE Step 1 and Step 2 CK scores from five graduating classes (2011-2015) at the University of Minnesota Medical School (N=1,065). RESULTS The multiple linear regression analyses were both significant (p<0.001). The three MCAT component scores together explained 17.7% of the variance in Step 1 scores (p<0.001) and 12.0% of the variance in Step 2 CK scores (p<0.001). In the chi-square analyses, significant, albeit weak associations were observed between almost all MCAT component scores and USMLE scores (Cramer's V ranged from 0.05 to 0.24). DISCUSSION Each of the MCAT component scores was significantly associated with USMLE Step 1 and Step 2 CK scores, although the effect size was small. Being in the top or bottom scoring range of the MCAT exam was predictive of being in the top or bottom scoring range of the USMLE exams, although the strengths of the associations were weak to moderate. These results indicate that MCAT scores are predictive of student performance on the USMLE exams, but, given the small effect sizes, should be considered as part of the holistic view of the student.
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Caturegli P, McCarthy EF, Jackson JB, Hruban RH. The Pathology Residency Program of the Johns Hopkins University School of Medicine: a model of its kind. Arch Pathol Lab Med 2015; 139:400-6. [PMID: 25724037 DOI: 10.5858/arpa.2013-0629-hp] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Department of Pathology of the Johns Hopkins University pioneered in the late 19th century the application of the scientific method to the study of medicine and fostered the development of residency training programs. OBJECTIVE To trace the history of the Johns Hopkins Pathology Residency Program and assess with quantifiable outcomes the performance of former residents. Design .- We reviewed archival and departmental records from September 1899 to June 2014 to create a database of pathology residents. We then analyzed resident in-service examinations, American Board of Pathology examinations, and career paths. RESULTS In 115 years the department trained 555 residents who came from 133 medical schools located in 23 countries. Residents performed well on the in-service examinations, obtaining mean scaled total scores that were significantly better (P = .02) than those of the national peer groups. Residents (371 of 396, 94%) passed their boards typically at the first attempt, a percentage pass that was higher than the national average for both anatomic (P < .001) and clinical (P = .002) pathology. Approximately half of the residents went into private practice, whereas a third followed an academic career. Of the latter group, 124 (75%) became professors of pathology, 31 (19%) chairs of pathology departments, 10 (6%) deans of medical schools, 5 (3%) were elected into the National Academy of Sciences, and 1 won the Nobel prize. CONCLUSIONS While maintaining its original core values, the Johns Hopkins Pathology Residency Program has trained physicians to be outstanding researchers, diagnosticians, and leaders in pathology.
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Affiliation(s)
- Patrizio Caturegli
- From the Department of Pathology, Johns Hopkins University, Baltimore, Maryland
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Amukele TK, Schroeder LF, Jackson JB, Elbireer A. Most clinical laboratory testing in Kampala occurs in high-volume, high-quality laboratories or low-volume, low-quality laboratories. A tale of two cities. Am J Clin Pathol 2015; 143:50-6. [PMID: 25511142 DOI: 10.1309/ajcpcya54dwzqpqt] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To describe key characteristics (laboratory quality, test volumes, and complexity) of clinical laboratories in Kampala, Uganda (population ~1.7 million). METHODS Cross-sectional survey using a standard questionnaire to document laboratory type and quality, as well as test menus and volumes. Quality was based on the World Health Organization-Africa Region checklist. RESULTS Of the 954 laboratories identified (a density of one laboratory per 1,781 persons), 779 (82%) performed only simple kit tests or light microscope examinations. The 95% (907/954) of laboratories for whom volumes were obtained performed an average aggregate of 13,189 tests daily, for a test utilization rate of around 2 tests per individual per year. Laboratories could be segregated into eight groups based on quality, test volume, and complexity. However, 90% of the testing was performed by just two groups: (1) low-volume (≤100 tests daily), low-quality laboratories performing simple tests or (2) high-volume (>100 tests daily), high-quality laboratories. Each of these two groups did 45% of the daily testing volume (90% combined). CONCLUSIONS Clinical laboratory density in Kampala (1/1,781 persons) is high, approaching that in the United States (1/1,347 persons). Low-volume/low-quality and high-volume/high-quality laboratories do 90% of the daily aggregate testing. Quality improvement (QI) schemes for Africa must be appropriate to low-volume laboratories as well as to the large laboratories that have been the focus of previous QI efforts.
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Affiliation(s)
- Timothy K. Amukele
- Makerere University–Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - J. Brooks Jackson
- Makerere University–Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ali Elbireer
- Makerere University–Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala, Uganda
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD
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Yang W, Laeyendecker O, Wendel SK, Zhang B, Sun S, Zhou JY, Ao M, Moore RD, Jackson JB, Zhang H. Glycoproteomic study reveals altered plasma proteins associated with HIV elite suppressors. Theranostics 2014; 4:1153-63. [PMID: 25285165 PMCID: PMC4183994 DOI: 10.7150/thno.9510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 08/21/2014] [Indexed: 11/25/2022] Open
Abstract
HIV elite suppressors (ES) or controllers are individuals achieving control of viremia by their natural immunological mechanisms without highly active antiretroviral therapy (HAART). Study of the mechanisms responsible for the immunological suppression of viremia in ES may lead to the detection of individuals with ES and the effective control of HIV infection. We hypothesize that plasma glycoproteins play essential roles in the immune system of ES since plasma proteins are critical and highly relevant in anti-viral immunity and most plasma proteins are glycoproteins. To examine glycoproteins associated with ES, plasma samples from ES individuals (n=20), and from individuals on HAART (n=20), with AIDS (n=20), and no HIV infection (n=10) were analyzed by quantitative glycoproteomics. We found that a number of glycoproteins changed between ES versus HAART, AIDS and HIV- individuals. In sharp contrast, the level of plasma glycoproteins in the HAART cohort showed fewer changes compared with AIDS and HIV- individuals. These results showed that although both ES and HAART effectively suppress viremia, ES appeared to profoundly affect immunologically relevant glycoproteins in plasma as consequence of or support for anti-viral immunity. Bioinformatic analysis revealed that altered proteins in ES plasma were mainly associated with inflammation. This analysis suggests that overlapping, while distinguishable, glycoprotein profiles for inflammation and immune activation appeared to be present between ES and non-ES (HAART+AIDS) cohorts, indicating different triggers for inflammation and immune activation between natural and treatment-related viral suppression.
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Lucas GM, Young A, Donnell D, Richardson P, Aramrattana A, Shao Y, Ruan Y, Liu W, Fu L, Ma J, Celentano DD, Metzger D, Jackson JB, Burns D. Hepatotoxicity in a 52-week randomized trial of short-term versus long-term treatment with buprenorphine/naloxone in HIV-negative injection opioid users in China and Thailand. Drug Alcohol Depend 2014; 142:139-45. [PMID: 24999060 PMCID: PMC4127183 DOI: 10.1016/j.drugalcdep.2014.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Buprenorphine/naloxone (BUP/NX), an effective treatment for opioid dependence, has been implicated in hepatic toxicity. However, as persons taking BUP/NX have multiple hepatic risk factors, comparative data are needed to quantify the risk of hepatoxicity with BUP/NX. METHODS We compared rates of alanine aminotransferase (ALT) elevation≥grade 3 (ALT≥5.1 times the upper limit of normal) and graded bilirubin elevations in HIV-negative opioid injectors randomized to long-term (52 weeks) or short-term (18 days) medication assisted treatment (LT-MAT and ST-MAT, respectively) with BUP/NX in a multisite trial conducted in China and Thailand. ALT and bilirubin were measured at baseline, 12, 26, 40 and 52 weeks, times temporally remote from BUP/NX exposure in the ST-MAT participants. RESULTS Among1036 subjects with at least one laboratory follow-up measurement, 76 (7%) participants experienced ALT elevation≥grade 3. In an intent-to-treat analysis, the risk of ALT events was similar in participants randomized to LT-MAT compared with ST-MAT (adjusted hazard ratio 1.25, 95% confidence interval 0.79 to 1.98). This finding was supported by an as-treated analysis, in which actual exposure to BUP/NX was considered. Hepatitis C seroconversion during follow-up was strongly associated with ALT events. Bilirubin elevations≥grade 2 occurred in 2% of subjects, with no significant difference between arms. CONCLUSIONS Over 52-week follow-up, the risk of hepatotoxicity was similar in opioid injectors receiving brief and prolonged treatment with BUP/NX. These data suggest that most hepatotoxic events observed during treatment with BUP/NX are due to other factors.
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Affiliation(s)
- Gregory M Lucas
- Johns Hopkins University School of Medicine, Department of Medicine, 1830 E. Monument St., Room 435A, Baltimore, MD 21287, United States.
| | - Alicia Young
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, 1100 Fairview Ave N, Seattle, WA 98109, United States
| | - Deborah Donnell
- Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, 1100 Fairview Ave N, Seattle, WA 98109, United States
| | - Paul Richardson
- Johns Hopkins School of Medicine, Department of Pathology, 600North Wolfe St., Baltimore, MD 21287, United States
| | - Apinun Aramrattana
- Chiang Mai University, Faculty of Medicine, Department of Family Medicine, 110 Intavaroros Road, Chiang Mai, Thailand
| | - Yiming Shao
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory for Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Wei Liu
- Guangxi Centers for Disease Control and Prevention, Guangxi Center for HIV/AIDS Prevention and Control, No. 18 Jinzhou Road, Nanning 530028, Guangxi, China
| | - Liping Fu
- Xinjiang Autonomous Region Center for Disease Control and Prevention, Jianquanyi Street no. 380, Urumqi 830002, Xinjiang, China
| | - Jun Ma
- Xinjiang Autonomous Region Center for Disease Control and Prevention, Jianquanyi Street no. 380, Urumqi 830002, Xinjiang, China
| | - David D Celentano
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 North Wolfe Street, Suite W6041, Baltimore, MD 21205, United States
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4000, Philadelphia, PA, 19104, United States
| | - J Brooks Jackson
- Johns Hopkins School of Medicine, Department of Pathology, 600North Wolfe St., Baltimore, MD 21287, United States
| | - David Burns
- National Institute of Allergy and Infectious Diseases, Division of AIDS, Prevention Sciences Branch, 6700 B Rockledge Drive, Room 5121, Bethesda, MD 20892, United States
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Yang W, Shah P, Toghi Eshghi S, Yang S, Sun S, Ao M, Rubin A, Jackson JB, Zhang H. Glycoform analysis of recombinant and human immunodeficiency virus envelope protein gp120 via higher energy collisional dissociation and spectral-aligning strategy. Anal Chem 2014; 86:6959-67. [PMID: 24941220 PMCID: PMC4215848 DOI: 10.1021/ac500876p] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
![]()
Envelope
protein gp120 of human immunodeficiency virus (HIV) is
armored with a dense glycan shield, which plays critical roles in
envelope folding, immune-evasion, infectivity, and immunogenicity.
Site-specific glycosylation profiling of recombinant gp120 is very
challenging. Therefore, glycoproteomic analysis of native viral gp120
is still formidable to date. This challenge promoted us to employ
a Q-Exactive mass spectrometer to identify low abundant glycopeptides
from virion-associated gp120. To search the HCD-MS data for glycopeptides,
a novel spectral-aligning strategy was developed. This strategy depends
on the observation that glycopeptides and the corresponding deglycosylated
peptides share very similar MS/MS pattern in terms of b- and y-ions
that do not contain the site of glycosylation. Moreover, glycopeptides
with an identical peptide backbone show nearly resembling spectra
regardless of the attached glycan structures. For the recombinant
gp120, this “copy–paste” spectral pattern of
glycopeptides facilitated identification of 2224 spectra using only
18 spectral templates, and after precursor mass correction, 1268 (57%)
spectra were assigned to 460 unique glycopeptides accommodating 19
N-linked and one O-linked glycosylation sites (glycosites). Strikingly,
we were able to observe five N- and one O-linked glycosites in native
gp120. We further revealed that except for Asn276 in the C2 region,
glycans were processed to contain both high mannose and hybrid/complex
glycans; an additional four N-linked glycosites were decorated with
high mannose type. Core 1 O-linked glycan Gal1GalNAc1 was seen for the O-linked glycosite at Thr499. This direct
observation of site-specific glycosylation of virion-derived gp120
has implications in HIV glycobiology and vaccine design.
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Affiliation(s)
- Weiming Yang
- Department of Pathology, School of Medicine, Johns Hopkins University , 1550 Orleans Street , Baltimore, Maryland 21205, United States
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Elbireer AM, Jackson JB, Sendagire H, Opio A, Bagenda D, Amukele TK. The good, the bad, and the unknown: quality of clinical laboratories in Kampala, Uganda. PLoS One 2013; 8:e64661. [PMID: 23737993 PMCID: PMC3667826 DOI: 10.1371/journal.pone.0064661] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
Background Clinical laboratories are crucial in addressing the high rates of communicable and non-communicable diseases seen in sub-Saharan Africa (SSA). However, the most basic information, such as the number and quality of clinical laboratories in SSA, is not available. The objective of this study was to create a practical method for obtaining this information in SSA towns and cities using an initial survey in Kampala, Uganda. Methods Kampala city was divided into 5 partially-overlapping regions. Each region was assigned to 2–3 surveyors who identified and surveyed laboratories in their respective regions; in person and on foot. A modified version of the World Health Organization - African Region (WHO/AFRO) Laboratory Strengthening Checklist was used to obtain baseline measures of quality for all clinical laboratories within Kampala city. The surveyors also measured other attributes of each laboratory, such as their affiliation (government, private etc), designation (national hospital, district hospital, standalone etc), staff numbers, and type of staff. Results The survey team identified and surveyed 954 laboratories in Kampala city. 96% of laboratories were private. Only 45 (5%) of the laboratories met or surpassed the lowest quality standards defined by the WHO/AFRO-derived laboratory strengthening tool (1-star). These 45 higher-quality laboratories were, on average, larger and had a higher number of laboratory-specific staff (technologists, phlebotomists etc) than the other 909 laboratories. 688 (72%) of the 954 laboratories were not registered with the Ministry of Health (MoH). Conclusions This comprehensive evaluation of the number, scope, and quality of clinical laboratories in Kampala is the first published survey of its kind in sub-Saharan Africa. The survey findings demonstrated that laboratories in Kampala that had qualified personnel and those that had higher testing volumes, tended to be of higher-quality.
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Affiliation(s)
- Ali M Elbireer
- Makerere University-Johns Hopkins University Clinical Core Laboratory at Infectious Diseases Institute, Kampala Uganda.
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Jackson JB, Tao X, Sneed L, Humphrey-Carothers F, Bernacki E. Cost of annual tuberculosis screening of healthcare workers with negative tuberculin skin test results. Infect Control Hosp Epidemiol 2013; 34:642-3. [PMID: 23651899 DOI: 10.1086/670628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) recommends annual screening for Mycobacterium tuberculosis infection using the tuberculin skin test (TST) for individuals working in hospitals with 200 or more inpatient beds that have at least 6 documented cases of active tuberculosis (TB) per year. The cost of annual TB screening programs is significant, but the cost per individual with TST conversion is unknown. Therefore, we evaluated the annual TB screening program at the Johns Hopkins Hospital and Medical School to determine (1) the proportion of individuals with TST conversion among individuals in the annual TB screening program with patient care exposure at the Johns Hopkins Hospital and Medical School, (2) which employment and demographic factors are associated with TST conversion, (3) the prevalence of active TB disease among those with TST conversion, and (4) the annual cost of subsequent screening of individuals with initial negative TST results and the screening cost per individual with TST conversion.TST results were reviewed for individuals participating in the annual TB screening program during the previous 4 years (2007–2010) at the Johns Hopkins Hospital and Medical School, which has experienced an average of 12 documented cases of active TB per year. TST was performed before employment and then annually for healthcare providers according to CDC guidelines and the manufacturer's directions. Individuals in the testing program included anyone who had patient contact, such as physicians, nurses, technologists, students, phlebotomists, nutritionists, pharmacists, and clerks. All initial testing was 2-step testing if the individual was initially reactive.
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Affiliation(s)
- J Brooks Jackson
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Jerrard GA, Liu J, Case RC, Motevalli M, Bolton SG, King KE, Beigel J, Brooks Jackson J. Implications of weight and body mass index for plasma donation and health. ISRN Hematol 2012; 2012:937585. [PMID: 23209921 PMCID: PMC3504381 DOI: 10.5402/2012/937585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/20/2012] [Indexed: 12/03/2022]
Abstract
This study determined the percentage of potential plasma donors who could donate plasma in the 3 allowable plasma volume limit categories as specified by the Food and Drug Administration (FDA), as well as the association of the body mass index (BMI) of these individuals with age, blood pressure, oral temperature, and pulse. Of 315 plasma donors analyzed, 107 (34.0%) weighed between 110 and 149 lbs (50.0–67.7 kg), 89 (28.2%) weighed between 150 and174 lbs (68.2–79.1 kg), and 119 (37.8%) weighed >175 lbs (79.5 kg), theoretically allowing collection of an additional 101.4 liters (16% more plasma) from both heavier categories based on FDA standards for plasma donor quantities. BMI was positively associated with age, mean arterial pressure (MAP), and pulse (Pearson's r = 0.36, 0.24, and 0.18, resp., P values <0.05), but not with oral temperature. Average BMI for females was higher than for males (+1.8, P = 0.01), and BMI for African Americans was higher than for White and Asian participants (+2.2 and +5.1, resp., Ps <0.05). A significant association was also found in the sex by race interaction with BMI (P = 0.0004). Follow-up analyses suggested a significant difference in BMI by sex among African Americans, higher BMI among African American females than Asian and White males, and higher BMI among White females than African American males (Ps <0.05).
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Affiliation(s)
- Genna A Jerrard
- Johns Hopkins Hospital, Carnegie 415, 600 North Wolfe Street, Baltimore, MD 21287, USA
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Amukele TK, Michael K, Hanes M, Miller RE, Jackson JB. External quality assurance performance of clinical research laboratories in sub-saharan Africa. Am J Clin Pathol 2012; 138:720-3. [PMID: 23086773 DOI: 10.1309/ajcp8pcm4jvleeqr] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Patient Safety Monitoring in International Laboratories (JHU-SMILE) is a resource at Johns Hopkins University that supports and monitors laboratories in National Institutes of Health-funded international clinical trials. To determine the impact of the JHU-SMILE quality assurance scheme in sub-Saharan African laboratories, we reviewed 40 to 60 months of external quality assurance (EQA) results of the College of American Pathologists (CAP) in these laboratories. We reviewed the performance of 8 analytes: albumin, alanine aminotransferase, creatinine, sodium, WBC, hemoglobin, hematocrit, and the human immunodeficiency virus antibody rapid test. Over the 40- to 60-month observation period, the sub-Saharan laboratories had a 1.63% failure rate, which was 40% lower than the 2011 CAP-wide rate of 2.8%. Seventy-six percent of the observed EQA failures occurred in 4 of the 21 laboratories. These results demonstrate that a system of remote monitoring, feedback, and audits can support quality in low-resource settings, even in places without strong regulatory support for laboratory quality.
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Hudgens MG, Taha TE, Omer SB, Jamieson DJ, Lee H, Mofenson LM, Chasela C, Kourtis AP, Kumwenda N, Ruff A, Bedri A, Jackson JB, Musoke P, Bollinger RC, Gupte N, Thigpen MC, Taylor A, van der Horst C. Pooled individual data analysis of 5 randomized trials of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission. Clin Infect Dis 2012; 56:131-9. [PMID: 22997212 DOI: 10.1093/cid/cis808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In resource-limited settings, mothers infected with human immunodeficiency virus type 1 (HIV-1) face a difficult choice: breastfeed their infants but risk transmitting HIV-1 or not breastfeed their infants and risk the infants dying of other infectious diseases or malnutrition. Recent results from observational studies and randomized clinical trials indicate daily administration of nevirapine to the infant can prevent breast-milk HIV-1 transmission. METHODS Data from 5396 mother-infant pairs who participated in 5 randomized trials where the infant was HIV-1 negative at birth were pooled to estimate the efficacy of infant nevirapine prophylaxis to prevent breast-milk HIV-1 transmission. Four daily regimens were compared: nevirapine for 6 weeks, 14 weeks, or 28 weeks, or nevirapine plus zidovudine for 14 weeks. RESULTS The estimated 28-week risk of HIV-1 transmission was 5.8% (95% confidence interval [CI], 4.3%-7.9%) for the 6-week nevirapine regimen, 3.7% (95% CI, 2.5%-5.4%) for the 14-week nevirapine regimen, 4.8% (95% CI, 3.5%-6.7%) for the 14-week nevirapine plus zidovudine regimen, and 1.8% (95% CI, 1.0%-3.1%) for the 28-week nevirapine regimen (log-rank test for trend, P < .001). Cox regression models with nevirapine as a time-varying covariate, stratified by trial site and adjusted for maternal CD4 cell count and infant birth weight, indicated that nevirapine reduces the rate of HIV-1 infection by 71% (95% CI, 58%-80%; P < .001) and reduces the rate of HIV infection or death by 58% (95% CI, 45%-69%; P < .001). CONCLUSIONS Extended prophylaxis with nevirapine or with nevirapine and zidovudine significantly reduces postnatal HIV-1 infection. Longer duration of prophylaxis results in a greater reduction in the risk of infection.
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Lucas GM, Beauchamp G, Aramrattana A, Shao Y, Liu W, Fu L, Jackson JB, Celentano DD, Richardson P, Metzger D. Short-term safety of buprenorphine/naloxone in HIV-seronegative opioid-dependent Chinese and Thai drug injectors enrolled in HIV Prevention Trials Network 058. Int J Drug Policy 2012; 23:162-5. [PMID: 21852093 PMCID: PMC3236277 DOI: 10.1016/j.drugpo.2011.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 06/19/2011] [Accepted: 06/21/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Buprenorphine/naloxone (BUP/NX) is not licenced for use in China or Thailand and there was little clinical experience with this drug combination in these countries at the inception of HIV Prevention Trial Network (HPTN) 058, a randomized trial comparing risk reduction counselling combined with either short-term or long-term medication assisted treatment with BUP/NX to prevent HIV infection and death amongst opioid-dependent injectors. METHODS We conducted a safety phase that included the first 50 subjects enrolled at each of the three initial study sites (N=150). Clinical and laboratory assessments were conducted at baseline and weekly for the first 4 weeks. Changes in laboratory parameters were estimated with random effects models. RESULTS BUP/NX was well tolerated by study subjects and opioid withdrawal scores decreased substantially during the 3-day induction. Two participants experienced grade 3 clinical adverse events, which were categorized as probably not related to the study drug. Grade 2 or 3 increases in alanine aminotransferase (ALT) occurred in 25 (17%) subjects. The magnitude of ALT increase over 4-week follow-up was strongly associated with baseline ALT elevation. CONCLUSIONS In Chinese and Thai opioid-dependent injectors, we found BUP/NX to be effective in reducing opioid withdrawal symptoms and safe during short-term use. ALT increases were observed over 4-week-follow-up, which are consistent with reports from Western populations. Long-term safety and efficacy evaluations are indicated.
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Affiliation(s)
- Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Eipl K, Nakabiito C, Bwogi K, Motevalli M, Roots A, Blagg L, Jackson JB. Seroprevalence of unexpected red blood cell antibodies among pregnant women in Uganda. Immunohematology 2012; 28:115-117. [PMID: 23421539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We conducted a population-based, cross-sectional study among pregnant women in Kampala, Uganda, to determine ABO and D blood types and to determine the percentage who have unexpected red blood cell (RBC) antibodies and their specificities. De-identified blood samples from routine testing of 1001 pregnant women at the Mulago Hospital antenatal clinics in Kampala were typed for ABO and D and screened for the presence of unexpected RBC antibodies with confirmation and subsequent antibody identification. Of the 1001 blood samples tested, 48.9 percent, 26.4 percent, 21.0 percent, and 3.8 percent tested positive for blood groups 0, A, B, and AB, respectively. Of these samples, 23 (2.3%)were negative forD, and 55 (5.5%) showed initial reactivity with at least one screening RBC. The RBC antibody screen was repeated on these 55 samples, and antibody identification was performed at the Johns Hopkins Hospital Blood Bank in Baltimore, Maryland. Twenty-one of the 55 samples were confirmed to have evidence of agglutination. Nine of the 21 samples demonstrated the presence of clinically significant RBC antibodies with anti-S being the most common, 8 samples demonstrated the presence of benign or naturally occurring antibodies, and 4 had only inconclusive reactivity. This study revealed a relatively high frequency of D and a low frequency of demonstrable clinically significant alloantibodies that may cause hemolytic disease of the newborn or hemolytic transfusion reactions among pregnant women in Kampala, with anti-S being the most frequent antibody specificity.
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Affiliation(s)
- K Eipl
- Department of Pathology, Makere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
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Elbireer AM, Opio AA, Brough RL, Jackson JB, Manabe YC. Strengthening Public Laboratory Service in Sub-Saharan Africa: Uganda Case Study. Lab Med 2011. [DOI: 10.1309/lm2obnyy9d0uxzjo] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Zeng P, Wang J, Huang Y, Guo X, Li J, Wen G, Yang T, Yun Z, He M, Liu Y, Yuan Y, Schulmann J, Glynn S, Ness P, Jackson JB, Shan H. The human immunodeficiency virus-1 genotype diversity and drug resistance mutations profile of volunteer blood donors from Chinese blood centers. Transfusion 2011; 52:1041-9. [PMID: 22044422 DOI: 10.1111/j.1537-2995.2011.03415.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The global human immunodeficiency virus (HIV)-1 epidemic is becoming increasingly diverse and complex. Molecular epidemiologic characteristics were studied for HIV-1-infected blood donors from five Chinese regions to determine genotype diversity and drug resistance mutations (DRMs) profile. STUDY DESIGN AND METHODS HIV-1 confirmed-reactive serum samples were collected from 172 blood donors from five blood centers during 2007 to 2010. HIV-1 Pol including whole protease and partial reverse transcriptase genes was amplified, sequenced, and analyzed for the subtype determination and drug resistance profile description. RESULT A total of 113 amplified sequences including 82 from Kunming blood center and 31 from four other blood centers had the following genotype characteristics: G (0.9%), B (2.7%), circulating recombinant form (CRF) 01_AE (32.7%), CRF07_BC (22.1%), and CRF08_BC (41.6%). Female donors represent 45.1% of all cases and 63.9% cases with DRMs. The prevalence of samples with potential low or higher resistance among Chinese blood donors is 4.4%. CONCLUSION HIV-1 infection in Chinese blood donors is genetically diverse and the subtype distribution reflects that from the high-risk populations. Our results support continuous molecular epidemiologic surveillance for HIV-1 in blood donors as a part of a comprehensive HIV control program.
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Affiliation(s)
- Peibin Zeng
- Institute of Blood Transfusion, Chinese Academy of Medical Sciences, Chengdu, Sichuan, China
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Khanim FL, Merrick BAME, Giles HV, Jankute M, Jackson JB, Giles LJ, Birtwistle J, Bunce CM, Drayson MT. Redeployment-based drug screening identifies the anti-helminthic niclosamide as anti-myeloma therapy that also reduces free light chain production. Blood Cancer J 2011; 1:e39. [PMID: 22829072 PMCID: PMC3255256 DOI: 10.1038/bcj.2011.38] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 08/22/2011] [Accepted: 09/05/2011] [Indexed: 12/26/2022] Open
Abstract
Despite recent therapeutic advancements, multiple myeloma (MM) remains incurable and new therapies are needed, especially for the treatment of elderly and relapsed/refractory patients. We have screened a panel of 100 off-patent licensed oral drugs for anti-myeloma activity and identified niclosamide, an anti-helminthic. Niclosamide, at clinically achievable non-toxic concentrations, killed MM cell lines and primary MM cells as efficiently as or better than standard chemotherapy and existing anti-myeloma drugs individually or in combinations, with little impact on normal donor cells. Cell death was associated with markers of both apoptosis and autophagy. Importantly, niclosamide rapidly reduced free light chain (FLC) production by MM cell lines and primary MM. FLCs are a major cause of renal impairment in MM patients and light chain amyloid and FLC reduction is associated with reversal of tissue damage. Our data indicate that niclosamides anti-MM activity was mediated through the mitochondria with rapid loss of mitochondrial membrane potential, uncoupling of oxidative phosphorylation and production of mitochondrial superoxide. Niclosamide also modulated the nuclear factor-κB and STAT3 pathways in MM cells. In conclusion, our data indicate that MM cells can be selectively targeted using niclosamide while also reducing FLC secretion. Importantly, niclosamide is widely used at these concentrations with minimal toxicity.
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Church JD, Huang W, Mwatha A, Musoke P, Jackson JB, Bagenda D, Omer SB, Donnell D, Nakabiito C, Eure C, Guay LA, Taylor A, Bakaki PM, Matovu F, McConnell M, Fowler MG, Eshleman SH. Analysis of HIV tropism in Ugandan infants. Curr HIV Res 2011; 8:498-503. [PMID: 21073438 DOI: 10.2174/157016210793499187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 10/12/2010] [Indexed: 11/22/2022]
Abstract
HIV-infected infants may have CXCR4-using (X4-tropic) HIV, CCR5-using (R5-tropic) HIV, or a mixture of R5-tropic and X4-tropic HIV (dual/mixed, DM HIV). The level of infectivity for R5 virus (R5-RLU) varies among HIV infected infants. HIV tropism and R5-RLU were measured in samples from HIV-infected Ugandan infants using a commercial assay. DM HIV was detected in 7/72 (9.7%) infants at the time of HIV diagnosis (birth or 6-8 weeks of age, 4/15 (26.7%) with subtype D, 3/57 (5.3 %) with other subtypes, P=0.013). A transition from R5-tropic to DM HIV was observed in only two (6.7%) of 30 infants over 6-12 months. Six (85.7%) of seven infants with DM HIV died, compared to 21/67 (31.3%) infants with R5-tropic HIV (p=0.09). Higher R5-RLU at 6-8 weeks was not associated with decreased survival. Infants with in utero infection had a higher median R5-RLU than infants who were HIV-uninfected at birth (p=0.025).
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Affiliation(s)
- Jessica D Church
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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James MM, Wang L, Musoke P, Donnell D, Fogel J, Towler WI, Khaki L, Nakabiito C, Jackson JB, Eshleman SH. Association of HIV diversity and survival in HIV-infected Ugandan infants. PLoS One 2011; 6:e18642. [PMID: 21533179 PMCID: PMC3077388 DOI: 10.1371/journal.pone.0018642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 03/13/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The level of viral diversity in an HIV-infected individual can change during the course of HIV infection, reflecting mutagenesis during viral replication and selection of viral variants by immune and other selective pressures. Differences in the level of viral diversity in HIV-infected infants may reflect differences in viral dynamics, immune responses, or other factors that may also influence HIV disease progression. We used a novel high resolution melting (HRM) assay to measure HIV diversity in Ugandan infants and examined the relationship between diversity and survival through 5 years of age. METHODS Plasma samples were obtained from 31 HIV-infected infants (HIVNET 012 trial). The HRM assay was used to measure diversity in two regions in the gag gene (Gag1 and Gag2) and one region in the pol gene (Pol). RESULTS HRM scores in all three regions increased with age from 6-8 weeks to 12-18 months (for Gag1: P = 0.005; for Gag2: P = 0.006; for Pol: P = 0.016). Higher HRM scores at 6-8 weeks of age (scores above the 75(th) percentile) were associated with an increased risk of death by 5 years of age (for Pol: P = 0.005; for Gag1/Gag2 (mean of two scores): P = 0.003; for Gag1/Gag2/Pol (mean of three scores): P = 0.002). We did not find an association between HRM scores and other clinical and laboratory variables. CONCLUSIONS Genetic diversity in HIV gag and pol measured using the HRM assay was typically low near birth and increased over time. Higher HIV diversity in these regions at 6-8 weeks of age was associated with a significantly increased risk of death by 5 years of age.
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Affiliation(s)
- Maria M. James
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Lei Wang
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration (MU-JHU), Baltimore, Maryland, United States of America, and Kampala, Uganda
- Makerere University School of Medicine, Kampala, Uganda
| | - Deborah Donnell
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Jessica Fogel
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - William I. Towler
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Leila Khaki
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University Research Collaboration (MU-JHU), Baltimore, Maryland, United States of America, and Kampala, Uganda
- Makerere University School of Medicine, Kampala, Uganda
| | - J. Brooks Jackson
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Susan H. Eshleman
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Taube JM, Kamira B, Motevalli M, Nakabiito C, Lukande R, Kelly DP, Erozan YS, Gravitt PE, Buresh ME, Mmiro F, Bagenda D, Guay LA, Jackson JB. Human papillomavirus prevalence and cytopathology correlation in young Ugandan women using a low-cost liquid-based Pap preparation. Diagn Cytopathol 2010; 38:555-63. [PMID: 19937939 DOI: 10.1002/dc.21249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Screening for HPV-driven cervical dysplasia and neoplasia is a significant public health concern in the developing world. The purpose of this study was to use a manual, low-cost liquid-based Pap preparation to determine HPV prevalence in HIV-positive and HIV-negative young women in Kampala, Uganda and to correlate cervical cytopathology with HPV-DNA genotype. About 196 post-partum women aged 18-30 years underwent rapid HIV testing and pelvic examination. Liquid-based cervical cytology samples were processed using a low-cost manual technique. A DNA collection device was used to collect specimens for HPV genotyping. HIV and HPV prevalence was 18 and 64%, respectively. Overall, 49% of women were infected with a high-risk HPV genotype. The most common high-risk HPV genotypes were 16 (8.2%), 33 (7.7%), 35 (6.6%), 45 (5.1%), and 58 (5.1%). The prevalence of HPV 18 was 3.6%. HIV-positive women had an HPV prevalence of 86% compared to 59% in HIV-negative women (P = 0.003). The prevalence of HPV 16/18 did not differ by HIV status. HIV-positive women were infected with a significantly greater number of HPV genotypes compared to HIV-negative women. By multivariate analysis, the main risk factor for HPV infection was coinfection with HIV. HIV-positive women were four times more likely to have abnormal cytology than HIV-negative women (43% vs. 11.6%, P < 0.001). These data highlight that HIV infection is a strong risk factor for HPV infection and resultant abnormal cervical cytology. Notably, the manual low-cost liquid-based Pap preparation is practical in this setting and offers an alternate method for local studies of HPV vaccine efficacy.
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Affiliation(s)
- Janis M Taube
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Laeyendecker O, Church JD, Oliver AE, Mwatha A, Owen SM, Donnell D, Brookmeyer R, Musoke P, Jackson JB, Guay L, Nakabiito C, Quinn TC, Eshleman SH. Pregnancy does not affect HIV incidence test results obtained using the BED capture enzyme immunoassay or an antibody avidity assay. PLoS One 2010; 5:e13259. [PMID: 20949006 PMCID: PMC2952593 DOI: 10.1371/journal.pone.0013259] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Accepted: 09/12/2010] [Indexed: 01/30/2023] Open
Abstract
Background Accurate incidence estimates are needed for surveillance of the HIV epidemic. HIV surveillance occurs at maternal-child health clinics, but it is not known if pregnancy affects HIV incidence testing. Methods We used the BED capture immunoassay (BED) and an antibody avidity assay to test longitudinal samples from 51 HIV-infected Ugandan women infected with subtype A, C, D and intersubtype recombinant HIV who were enrolled in the HIVNET 012 trial (37 baseline samples collected near the time of delivery and 135 follow-up samples collected 3, 4 or 5 years later). Nineteen of 51 women were also pregnant at the time of one or more of the follow-up visits. The BED assay was performed according to the manufacturer's instructions. The avidity assay was performed using a Genetic Systems HIV-1/HIV-2 + O EIA using 0.1M diethylamine as the chaotropic agent. Results During the HIVNET 012 follow-up study, there was no difference in normalized optical density values (OD-n) obtained with the BED assay or in the avidity test results (%) when women were pregnant (n = 20 results) compared to those obtained when women were not pregnant (n = 115; for BED: p = 0.9, generalized estimating equations model; for avidity: p = 0.7, Wilcoxon rank sum). In addition, BED and avidity results were almost exactly the same in longitudinal samples from the 18 women who were pregnant at only one study visit during the follow-up study (p = 0.6, paired t-test). Conclusions These results from 51 Ugandan women suggest that any changes in the antibody response to HIV infection that occur during pregnancy are not sufficient to alter results obtained with the BED and avidity assays. Confirmation with larger studies and with other HIV subtypes is needed.
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Affiliation(s)
- Oliver Laeyendecker
- Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
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Towler WI, James MM, Ray SC, Wang L, Donnell D, Mwatha A, Guay L, Nakabiito C, Musoke P, Jackson JB, Eshleman S. Analysis of HIV diversity using a high-resolution melting assay. AIDS Res Hum Retroviruses 2010; 26:913-8. [PMID: 20666583 DOI: 10.1089/aid.2009.0259] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV viruses are usually genetically homogeneous shortly after infection, and become more heterogeneous over time. We developed a high-resolution melting (HRM) assay to analyze HIV diversity without sequencing. Plasma samples from the HIVNET 012 trial were obtained from nine Ugandan mother-infant pairs. DNA amplified from the HIV gag region was analyzed to determine the number of degrees over which the DNA melted (HRM score). HRM gag DNA was also cloned and sequenced (50 clones/mother; 20 clones/infant). The median HRM score for infants (4.3, range 4.2-5.3) was higher than that for control plasmids (3.4, range 3.2-3.8, p < 0.001) and lower than that for mothers (5.7, range 4.4-7.7, p = 0.005, exact Wilcoxon rank sum test). The intraclass correlation coefficient reflecting assay reproducibility was 94% (95% CI: 89-98%). HRM scores were also compared to sequenced-based measures of HIV diversity; higher HRM scores were associated with higher genetic diversity (p < 0.001), complexity (p = 0.009), and Shannon entropy (p = 0.022), but not with length variation (p = 0.111). The HRM assay provides a novel, rapid method for assessing HIV diversity without sequencing. This assay could be applied to any region of the HIV genome or to other genetic systems that exhibit DNA diversity.
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Affiliation(s)
| | - Maria M. James
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stuart C. Ray
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lei Wang
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Anthony Mwatha
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Laura Guay
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clemensia Nakabiito
- Makerere University–Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda
| | - Philippa Musoke
- Makerere University–Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda
- Makerere University School of Medicine, Kampala, Uganda
| | | | - Susan Eshleman
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Piwowar-Manning EM, Tustin NB, Sikateyo P, Kamwendo D, Chipungu C, Maharaj R, Mushanyu J, Richardson BA, Hillier S, Brooks Jackson J. Validation of rapid HIV antibody tests in 5 African countries. ACTA ACUST UNITED AC 2010; 9:170-2. [PMID: 20530471 DOI: 10.1177/1545109710368151] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The sensitivity and specificity of 3 rapid HIV antibody tests were assessed at 5 clinical trial sites in Africa and 1 site in the United States using a minimum of 100 HIV antibody positive samples and 100 HIV antibody negative samples at each site. The overall sensitivity and specificity for the OraSure OraQuick, Abbott Determine, and Trinity Unigold tests were 99.3%, 99.8%, and 98.5%, respectively, and 99.3%, 99.4%, and 99.5%, respectively. There were no instances at any site in which false-negative or false-positive results were obtained for the same sample on more than 1 rapid test kit. The results of this study provide assurance that for these diverse sites in Africa, the accuracy of these kits is quite good. Given the excellent accuracy, relatively fast turnaround time, and minimal infrastructure required, these rapid tests for HIV antibody provide a very attractive and accurate testing format.
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Abstract
Brachiopods and coralline sponges are the dominant taxa of a series of parallel pantropical communities found in cryptic habitats of Recent coral reefs, where these organisms may cover almost the entire available surface area. It is suggested that the continued survival and success of these and other groups of considerable paleontological importance resulted from their occupation of cryptic reef habitats after competition with more rapidly growing hermatypic corals in the Middle Jurassic when scleractinian reefs first appeared.
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Abstract
The gradual closure of the Panamanian seaway and the resulting environmental change stimulated an increase in Caribbean molluscan diversity rather than the mass extinction hypothesized previously on the basis of inadequate data. Upheaval of molluscan faunas did occur suddenly throughout tropical America at the end of the Pliocene as a result of more subtle, unknown causes. There is no necessary correlation between the magnitude of regional shifts in abiotic conditions and the subsequent biological response.
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Abstract
Population dynamics of corals and other colonial animals are complicated by their modular construction and growth. Partial colony mortality, colony fission, and colony fusion distort any simple relationship between size and age among reef corals.
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Abstract
Species of ectoprocts and solitary encrusting animals were subjected in aquaria to homogenates of 11 sympatric species of sponges and colonial ascidians. Five of the nine sponge species and one of the two ascidian species exhibited species-specific allelochemical effects. Evidence suggests that alleochemical provide a wide-spread, specific, and complex mechanism for interference competition for space among natural populations of coral reef organisms. The existence of such species-specific mechanisms may provide a basis for maintenance of diversity in space-limited systems in the absence of high levels of predation and physical disturbance.
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Affiliation(s)
- J B Jackson
- Department of Earth and Planetary Sciences, The Johns University, Baltimore, Maryland 21218
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Boeke CE, Pauly ME, Stock HH, Pavlis S, Jackson JB. The association of gender, age, body mass index, and vital signs in healthy plateletapheresis donors. Transfus Apher Sci 2009; 41:175-8. [PMID: 19782645 DOI: 10.1016/j.transci.2009.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In order to determine the association between gender, age, body mass index and vital signs among healthy plateletapheresis donors, the mean and median values from the most recent donations of 236 plateletapheresis donors were calculated for age, body mass index (BMI), oral temperature, blood pressure (BP), and pulse. Values of these parameters were compared after stratification by gender, age, and BMI and multiple regression analysis between parameters performed. Gender, age, and BMI were associated with significant differences in vital signs of healthy plateletapheresis donors.
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Affiliation(s)
- Caroline E Boeke
- Department of Pathology, The Johns Hopkins University, Baltimore, MD 21287, USA
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