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Nderitu D, Emerson C. The indigenous African cultural value of human tissues and implications for bio-banking. Dev World Bioeth 2024; 24:66-73. [PMID: 36689701 DOI: 10.1111/dewb.12390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/02/2022] [Accepted: 12/17/2022] [Indexed: 01/24/2023]
Abstract
Bio-banking in research elicits numerous ethical issues related to informed consent, privacy and identifiability of samples, return of results, incidental findings, international data exchange, ownership of samples, and benefit sharing etc. In low and middle income (LMICs) countries the challenge of inadequate guidelines and regulations on the proper conduct of research compounds the ethical issues. In addition, failure to pay attention to underlying indigenous worldviews that ought to inform issues, practices and policies in Africa may exacerbate the situation. In this paper we discuss how the African context presents unique and outstanding cultural thought systems regarding the human body and biological materials that can be put into perspective in bio-bank research. We give the example of African ontology of nature presented by John Samwel Mbiti as foundational in adding value to the discourse about enhancing relevance of bio-bank research in the African context. We underline that cultural rites of passage performed on the human body in majority of communities in Africa elicit quintessential perspective on beliefs about handling of human body and human biological tissues. We conclude that acknowledgement and inclusion of African indigenous worldviews regarding the human body is essential in influencing best practices in biobank research in Africa.
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Kapulu M, Manda-Taylor L, Balasingam S, Means G, Ayiro Malungu M, Bejon P, Chi PC, Chiu C, Church EC, Correa-Oliveira R, Day N, Durbin A, Egesa M, Emerson C, Jambo K, Mathur R, Metzger W, Mumba N, Nazziwa W, Olotu A, Rodgers J, Sinyiza F, Talaat K, Kamerling I, Weller C, Baay M, Neels P. Fourth Controlled Human Infection Model (CHIM) meeting - CHIMs in endemic countries, May 22-23, 2023. Biologicals 2024; 85:101747. [PMID: 38350825 DOI: 10.1016/j.biologicals.2024.101747] [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: 12/06/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024] Open
Abstract
Earlier meetings laid the foundations for Controlled Human Infection Models (CHIMs), also known as human challenge studies and human infection studies, including Good Manufacturing Practice (GMP) production of the challenge agent, CHIM ethics, environmental safety in CHIM, recruitment, community engagement, advertising and incentives, pre-existing immunity, and clinical, immunological, and microbiological endpoints. The fourth CHIM meeting focused on CHIM studies being conducted in endemic countries. Over the last ten years we have seen a vast expansion of the number of countries in Africa performing CHIM studies, as well as a growing number of different challenge organisms being used. Community and public engagement with assiduous ethical and regulatory oversight has been central to successful introductions and should be continued, in more community-led or community-driven models. Valuable initiatives for regulation of CHIMs have been undertaken but further capacity building remains essential.
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Affiliation(s)
| | | | | | - Gary Means
- Bill & Melinda Gates Foundation, Seattle, USA.
| | | | | | | | | | | | | | - Nicholas Day
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
| | - Anna Durbin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Moses Egesa
- MRC/UVRI and LSHTM Uganda Research Unit, Uganda; London School of Hygiene and Tropical Medicine, UK.
| | - Claudia Emerson
- McMaster University, Institute on Ethics & Policy for Innovation, Canada.
| | | | - Roli Mathur
- Bioethics Unit, Indian Council of Medical Research, India.
| | | | - Noni Mumba
- KEMRI-Wellcome Trust Research Programme, Kenya.
| | | | | | | | - Frank Sinyiza
- National Health Sciences Research Committee, Malawi.
| | - Kawsar Talaat
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | | | | | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium.
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Taitingfong RI, Triplett C, Vásquez VN, Rajagopalan RM, Raban R, Roberts A, Terradas G, Baumgartner B, Emerson C, Gould F, Okumu F, Schairer CE, Bossin HC, Buchman L, Campbell KJ, Clark A, Delborne J, Esvelt K, Fisher J, Friedman RM, Gronvall G, Gurfield N, Heitman E, Kofler N, Kuiken T, Kuzma J, Manrique-Saide P, Marshall JM, Montague M, Morrison AC, Opesen CC, Phelan R, Piaggio A, Quemada H, Rudenko L, Sawadogo N, Smith R, Tuten H, Ullah A, Vorsino A, Windbichler N, Akbari OS, Long K, Lavery JV, Evans SW, Tountas K, Bloss CS. Exploring the value of a global gene drive project registry. Nat Biotechnol 2023; 41:9-13. [PMID: 36522496 DOI: 10.1038/s41587-022-01591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Riley I Taitingfong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Cynthia Triplett
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Center for Empathy and Technology, Institute for Empathy and Compassion, University of California, San Diego, La Jolla, CA, USA
| | - Váleri N Vásquez
- Energy and Resources Group, Rausser College of Natural Resources, University of California, Berkeley, Berkeley, CA, USA
- Department of Electrical Engineering and Computer Sciences, College of Engineering, University of California, Berkeley, Berkeley, CA, USA
| | - Ramya M Rajagopalan
- Center for Empathy and Technology, Institute for Empathy and Compassion, University of California, San Diego, La Jolla, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Robyn Raban
- School of Biological Sciences, Department of Cell and Developmental Biology, University of California, San Diego, La Jolla, CA, USA
| | - Aaron Roberts
- Institute on Ethics and Policy for Innovation, McMaster University, Hamilton, Ontario, Canada
| | - Gerard Terradas
- Department of Entomology, the Center for Infectious Disease Dynamics and the Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | | | - Claudia Emerson
- Institute on Ethics and Policy for Innovation, McMaster University, Hamilton, Ontario, Canada
| | - Fred Gould
- Genetic Engineering and Society Center, North Carolina State University, Raleigh, NC, USA
| | - Fredros Okumu
- Environmental Health and Ecological Science Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Cynthia E Schairer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Hervé C Bossin
- Medical Entomology Laboratory, William A. Robinson Polynesian Research Center, Institut Louis Malardé, Papeete, Tahiti, French Polynesia
| | - Leah Buchman
- Department of Entomology, Texas A&M University, College Station, TX, USA
| | | | - Anna Clark
- Department of Anatomy, University of Otago, Dunedin, Aotearoa New Zealand
| | - Jason Delborne
- Genetic Engineering and Society Center, North Carolina State University, Raleigh, NC, USA
- Department of Forestry and Environmental Resources, North Carolina State University, Raleigh, NC, USA
| | - Kevin Esvelt
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Joshua Fisher
- Pacific Islands Fish and Wildlife Office, United States Fish and Wildlife Service, Honolulu, HI, USA
| | | | - Gigi Gronvall
- Johns Hopkins Center for Health Security and Department of Environmental Health and Engineering, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - Nikos Gurfield
- Vector Control Program, Department of Environmental Health and Quality, County of San Diego, San Diego, CA, USA
| | - Elizabeth Heitman
- Program in Ethics in Science and Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Natalie Kofler
- Scientific Citizenship Initiative, Harvard Medical School, Boston, MA, USA
| | - Todd Kuiken
- Genetic Engineering and Society Center, North Carolina State University, Raleigh, NC, USA
| | - Jennifer Kuzma
- Genetic Engineering and Society Center, North Carolina State University, Raleigh, NC, USA
- School of Public and International Affairs, North Carolina State University, Raleigh, NC, USA
| | - Pablo Manrique-Saide
- Laboratorio para el Control Biológico de Aedes aegypti, Unidad Colaborativa de Bioensayos Entomológicos, Campus de Ciencias Biológicas y Agropecuarias, Universidad Autónoma de Yucatán, Mérida, México
| | - John M Marshall
- Divisions of Biostatistics & Epidemiology, School of Public Health, UC Berkeley, Berkeley, CA, USA
- Innovative Genomics Institute, UC Berkeley, Berkeley, CA, USA
| | | | - Amy C Morrison
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, Davis, CA, USA
| | - Chris C Opesen
- Department of Sociology and Anthropology, School of Social Sciences, Makerere University, Kampala, Uganda
| | | | - Antoinette Piaggio
- Animal and Plant Health Inspection Service, Wildlife Services, United States Department of Agriculture National Wildlife Research Center, Fort Collins, CO, USA
| | - Hector Quemada
- Department of Biological Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Larisa Rudenko
- Massachusetts Institute of Technology, Cambridge, MA, USA
- BioPolicy Solutions, LLC, Cambridge, MA, USA
| | | | - Robert Smith
- Science, Technology & Innovation Studies, School of Social & Political Science, The University of Edinburgh, Edinburgh, UK
| | - Holly Tuten
- Illinois Natural History Survey, Prairie Research Institute, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Anika Ullah
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Adam Vorsino
- Pacific Islands Fish and Wildlife Office, United States Fish and Wildlife Service, Honolulu, HI, USA
| | | | - Omar S Akbari
- School of Biological Sciences, Department of Cell and Developmental Biology, University of California, San Diego, La Jolla, CA, USA
| | - Kanya Long
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - James V Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Center for Ethics, Emory University, Atlanta, GA, USA
| | - Sam Weiss Evans
- Program on Science, Technology & Society, Harvard University, Cambridge, MA, USA
| | - Karen Tountas
- GeneConvene Global Collaborative, Science Division, Foundation for the National Institutes of Health, North Bethesda, MD, USA
| | - Cinnamon S Bloss
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Center for Empathy and Technology, Institute for Empathy and Compassion, University of California, San Diego, La Jolla, CA, USA.
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Ramsay T, Robinson B, Coche I, Hackett K, Emerson C. Ethical aspects of GMO regulation in the EU: Regulating new plant breeding techniques as GM has negative effects on sustainability, diversity and inclusion: Regulating new plant breeding techniques as GM has negative effects on sustainability, diversity and inclusion. EMBO Rep 2022; 23:e55583. [PMID: 35900903 PMCID: PMC9442288 DOI: 10.15252/embr.202255583] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 07/30/2023] Open
Abstract
Plant breeding plays a crucial role for the EU to live up to its values and promises of sustainability, innovation and diversity and inclusion. The current regulations, however, make it de facto impossible to use new breeding technologies.
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Jamrozik E, Littler K, Bull S, Emerson C, Kang G, Kapulu M, Rey E, Saenz C, Shah S, Smith PG, Upshur R, Weijer C, Selgelid MJ. Key criteria for the ethical acceptability of COVID-19 human challenge studies: Report of a WHO Working Group. Vaccine 2020; 39:633-640. [PMID: 33341309 PMCID: PMC7598752 DOI: 10.1016/j.vaccine.2020.10.075] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022]
Abstract
This report of the WHO Working Group for Guidance on Human Challenge Studies in COVID-19 outlines ethical standards for COVID-19 challenge studies. It includes eight Key Criteria related to scientific justification, risk-benefit assessment, consultation and engagement, co-ordination of research, site selection, participant selection, expert review, and informed consent. The document aims to provide comprehensive guidance to scientists, research ethics committees, funders, policymakers, and regulators in deliberations regarding SARS-CoV-2 challenge studies by outlining criteria that would need to be satisfied in order for such studies to be ethically acceptable.
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Affiliation(s)
- Euzebiusz Jamrozik
- The Ethox Centre & Wellcome Centre for Ethics and the Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK; Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia; Royal Melbourne Hospital Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Katherine Littler
- Global Health Ethics Unit, World Health Organization, Geneva, Switzerland
| | - Susan Bull
- The Ethox Centre & Wellcome Centre for Ethics and the Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Claudia Emerson
- Institute on Ethics & Policy for Innovation, Department of Philosophy, McMaster University, Hamilton, Ontario, Canada
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India
| | - Melissa Kapulu
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Elena Rey
- Centro Internacional de Entrenamiento e Investigaciones Médicas - CIDEIM. Cali, Colombia; Universidad Icesi. Cali, Colombia
| | - Carla Saenz
- Department of Health Systems and Services, Pan American Health Organization, USA
| | - Seema Shah
- Lurie Children's Hospital & Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Peter G Smith
- London School of Hygiene and Tropical Medicine, London, UK
| | - Ross Upshur
- Division of Clinical Public Health, Dalla Lana School of Public Health, Toronto, Canada
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, Canada
| | - Michael J Selgelid
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
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Hayward L, Guo D, Wagner K, King O, Emerson C. FSHD / OPMD / MYOTONIC DYSTROPHY. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Unnecessary hesitancy on human vaccine tests-Response. Science 2020; 369:151. [PMID: 32646992 DOI: 10.1126/science.abc9380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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8
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Shah SK, Miller FG, Darton TC, Duenas D, Emerson C, Lynch HF, Jamrozik E, Jecker NS, Kamuya D, Kapulu M, Kimmelman J, MacKay D, Memoli MJ, Murphy SC, Palacios R, Richie TL, Roestenberg M, Saxena A, Saylor K, Selgelid MJ, Vaswani V, Rid A. Ethics of controlled human infection to address COVID-19. Science 2020; 368:832-834. [PMID: 32381590 DOI: 10.1126/science.abc1076] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Seema K Shah
- Author affiliations are listed in the supplementary materials.
| | | | - Thomas C Darton
- Author affiliations are listed in the supplementary materials
| | - Devan Duenas
- Author affiliations are listed in the supplementary materials
| | - Claudia Emerson
- Author affiliations are listed in the supplementary materials
| | | | | | - Nancy S Jecker
- Author affiliations are listed in the supplementary materials
| | - Dorcas Kamuya
- Author affiliations are listed in the supplementary materials
| | - Melissa Kapulu
- Author affiliations are listed in the supplementary materials
| | | | - Douglas MacKay
- Author affiliations are listed in the supplementary materials
| | | | - Sean C Murphy
- Author affiliations are listed in the supplementary materials
| | | | - Thomas L Richie
- Author affiliations are listed in the supplementary materials
| | | | - Abha Saxena
- Author affiliations are listed in the supplementary materials
| | | | | | - Vina Vaswani
- Author affiliations are listed in the supplementary materials
| | - Annette Rid
- Author affiliations are listed in the supplementary materials
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Ndakidemi E, Emerson C, Medley A, Ngowi B, Ng'eno B, Munuo G, Kohi W, Modi S. Health care worker perspectives on TB case finding and HIV services among pediatric TB patients in Tanzania. Int J Tuberc Lung Dis 2020; 23:811-816. [PMID: 31439112 DOI: 10.5588/ijtld.18.0445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Tuberculosis (TB) and human immunodeficiency virus (HIV) infection in children are of concern due to the high morbidity and mortality they engender. Tanzania is working to improve TB and HIV case identification and treatment, as well as linkage of TB and HIV care in pediatric patients.METHODS: In-depth interviews were conducted in March 2016 at 10 high TB burden clinics in five districts of Tanzania to identify the barriers to pediatric TB diagnosis and HIV care. Health care workers (HCWs) at TB clinics who provided informed consent were administered interviews which were analyzed.RESULTS: Of 41 HCWs interviewed, 26 reported receiving pediatric TB training. Barriers to TB diagnosis included low community awareness, stigma and late presentation to the clinic. Barriers to HIV testing included children attending the TB clinic with someone who was not their parent/guardian and shortages of HIV rapid test kits. HCWs stressed the need for improved community education because it was perceived that some caregivers did not understand the importance of prompt TB and HIV treatment in children (although most were eager for a resolution of their child's illness).CONCLUSIONS: Efforts are needed to ensure effective TB and HIV diagnosis and treatment of children, provision of broader HCW and community education, enhanced TB-HIV contact tracing, and ensuring a continuous supply of HIV rapid test kits.
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Affiliation(s)
- E Ndakidemi
- Infosmart Research and Consulting Tanzania, Dar es Salaam, Tanzania
| | - C Emerson
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - A Medley
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - B Ngowi
- National Institute for Medical Research Muhimbili Research Centre, Dar es Salaam
| | - B Ng'eno
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - W Kohi
- Community Development, Gender, Elderly and Children; National Tuberculosis and Leprosy Programme, Tanzania Ministry of Health, Dar es Salaam, Tanzania
| | - S Modi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
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Mathebula U, Emerson C, Agizew T, Pals S, Boyd R, Mathoma A, Basotli J, Rankgoane-Pono G, Serumola C, Date A, Auld AF, Finlay A. Improving sputum collection processes to increase tuberculosis case finding among HIV-positive persons in Botswana. Public Health Action 2020; 10:11-16. [PMID: 32368518 DOI: 10.5588/pha.19.0051] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/26/2019] [Indexed: 11/10/2022] Open
Abstract
SETTING Twenty-two human immunodeficiency virus (HIV) clinics in Botswana. OBJECTIVE To compare sputum collection rates, sputum quality and volume, and tuberculosis (TB) diagnosis rates before and after field efforts to improve sputum collection among individuals newly diagnosed with HIV with TB symptoms. DESIGN Newly diagnosed individuals living with HIV attending 22 HIV clinics in Botswana were screened for TB from August 2012 to March 2014. Starting in May 2013, a field intervention composed of the introduction of a tracking log for presumed TB patients, and patient instructions and sputum induction to improve sputum collection rates was implemented. RESULTS Prior to the intervention, sputum collection rates were 44.1% (384/870). Subsequently, sputum collection increased to 58.3% (579/993) (P < 0.001). Sputum quality and volume also improved. Although rates of TB diagnosis increased from 9.7% (84/870) to 12.5% (120/993), this difference was not significant (P = 0.143). CONCLUSION Sputum collection rates among presumptive TB cases, as well as sputum quality and volume improved after implementation of the field intervention. To improve sputum collection rates, efforts at the program level should be ongoing.
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Affiliation(s)
- U Mathebula
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana
| | - C Emerson
- Division of Global HIV and Tuberculosis, CDC, Atlanta, GA, USA
| | - T Agizew
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana
| | - S Pals
- Division of Global HIV and Tuberculosis, CDC, Atlanta, GA, USA
| | - R Boyd
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana.,Division of Tuberculosis Elimination, CDC, Atlanta, GA, USA
| | - A Mathoma
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana
| | - J Basotli
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana
| | | | - C Serumola
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana
| | - A Date
- Division of Global HIV and Tuberculosis, CDC, Atlanta, GA, USA
| | - A F Auld
- Division of Global HIV and Tuberculosis, CDC, Atlanta, GA, USA
| | - A Finlay
- Centers for Disease Control and Prevention (CDC), Gaborone, Botswana.,Division of Tuberculosis Elimination, CDC, Atlanta, GA, USA
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Emerson C, Ng'eno B, Ngowi B, Pals S, Kohi W, Godwin M, Date A, Modi S. Assessment of routine screening of pediatric contacts of adults with tuberculosis disease in Tanzania. Public Health Action 2019; 9:148-152. [PMID: 32042606 DOI: 10.5588/pha.19.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/02/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
Setting Ten selected healthcare facilities in Tanzania, March-April 2016. Objective To assess the implementation of screening among pediatric contacts of adults with tuberculosis (TB) disease. Design Using a mixed-methods approach, we conducted a questionnaire study among sputum smear-positive adult TB patients and abstracted data from their patient cards to assess the implementation of a child contact management (CCM) intervention. We also conducted in-depth interviews with healthcare workers (HCWs) to solicit their views on clinical practices and challenges in CCM. Results A total of 141 adult smear-positive TB patients reported 396 children living in households; detailed information on 346 (87.4%) was available. Only 37 (10.7%) children were clinically assessed for TB, 5 (13.5%) were diagnosed with TB, and 22 started on isoniazid preventive therapy (IPT) (59.0%). Of the 320 children whose caregivers responded to whether their children had undergone human immunodeficiency virus (HIV) testing, 55 (17.2%) had been tested and one (1.8%) was HIV-positive. Forty-one HCWs described passive CCM without use of contact or IPT registers. Conclusion We identified gaps in the implementation of TB screening, IPT provision, and HIV testing in pediatric contacts of adults with sputum smear-positive TB. Systematic efforts, including increasing HCW training and educating the community, may improve implementation.
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Affiliation(s)
- C Emerson
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Ng'eno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Ngowi
- National Institute for Medical Research Muhimbili Research Centre, Dar es Salaam, Tanzania
| | - S Pals
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Kohi
- Tanzania Ministry of Health, Community Development, Gender, Elderly and Children: National Tuberculosis and Leprosy Programme, Dar es Salaam, Tanzania
| | - M Godwin
- Centers for Disease Control and Prevention Tanzania, Dar es Salaam, Tanzania
| | - A Date
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Modi
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Thizy D, Emerson C, Gibbs J, Hartley S, Kapiriri L, Lavery J, Lunshof J, Ramsey J, Shapiro J, Singh JA, Toe LP, Coche I, Robinson B. Guidance on stakeholder engagement practices to inform the development of area-wide vector control methods. PLoS Negl Trop Dis 2019; 13:e0007286. [PMID: 31022177 PMCID: PMC6483156 DOI: 10.1371/journal.pntd.0007286] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Delphine Thizy
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Claudia Emerson
- Institute on Ethics and Policy for Innovation, Faculty of Humanities, McMaster University, Hamilton, Ontario, Canada
| | - Johanna Gibbs
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Sarah Hartley
- Department of Science, Innovation, Technology, and Entrepreneurship, University of Exeter, Exeter, Devon, United Kingdom
| | - Lydia Kapiriri
- Department of Health, Ageing and Society, McMaster University, Hamilton, Ontario, Canada
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Center for Ethics, Emory University, Atlanta, Georgia, United States of America
| | - Jeantine Lunshof
- MIT Media Lab, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
- Department of Genetics, Harvard Medical School, Boston, Massachusetts, United States of America
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janine Ramsey
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Julie Shapiro
- Keystone Policy Center, Keystone, Colorado, United States of America
| | - Jerome Amir Singh
- Center for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lea Pare Toe
- Research Institute of Health Sciences, Ouagadougou, Burkina Faso
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James S, Collins FH, Welkhoff PA, Emerson C, Godfray HCJ, Gottlieb M, Greenwood B, Lindsay SW, Mbogo CM, Okumu FO, Quemada H, Savadogo M, Singh JA, Tountas KH, Touré YT. Pathway to Deployment of Gene Drive Mosquitoes as a Potential Biocontrol Tool for Elimination of Malaria in Sub-Saharan Africa: Recommendations of a Scientific Working Group †. Am J Trop Med Hyg 2018; 98:1-49. [PMID: 29882508 PMCID: PMC5993454 DOI: 10.4269/ajtmh.18-0083] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [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: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gene drive technology offers the promise for a high-impact, cost-effective, and durable method to control malaria transmission that would make a significant contribution to elimination. Gene drive systems, such as those based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein, have the potential to spread beneficial traits through interbreeding populations of malaria mosquitoes. However, the characteristics of this technology have raised concerns that necessitate careful consideration of the product development pathway. A multidisciplinary working group considered the implications of low-threshold gene drive systems on the development pathway described in the World Health Organization Guidance Framework for testing genetically modified (GM) mosquitoes, focusing on reduction of malaria transmission by Anopheles gambiae s.l. mosquitoes in Africa as a case study. The group developed recommendations for the safe and ethical testing of gene drive mosquitoes, drawing on prior experience with other vector control tools, GM organisms, and biocontrol agents. These recommendations are organized according to a testing plan that seeks to maximize safety by incrementally increasing the degree of human and environmental exposure to the investigational product. As with biocontrol agents, emphasis is placed on safety evaluation at the end of physically confined laboratory testing as a major decision point for whether to enter field testing. Progression through the testing pathway is based on fulfillment of safety and efficacy criteria, and is subject to regulatory and ethical approvals, as well as social acceptance. The working group identified several resources that were considered important to support responsible field testing of gene drive mosquitoes.
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Affiliation(s)
- Stephanie James
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Fredros O. Okumu
- Ifakara Health Institute, Ifakara, Tanzania
- University of Glasgow, Glasgow, Scotland
- University of the Witwatersrand, Johannesburg, South Africa
| | - Hector Quemada
- Donald Danforth Plant Science Center, Saint Louis, Missouri
| | - Moussa Savadogo
- New Partnership for Africa’s Development, Ouagadougou, Burkina Faso
| | - Jerome A. Singh
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Karen H. Tountas
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Yeya T. Touré
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Affiliation(s)
- Claudia Emerson
- Institute on Ethics and Policy for Innovation, McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | - Stephanie James
- Foundation for the National Institutes of Health, North Bethesda, MD 20852, USA.
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Emerson C, Lipke V, Kapata N, Mwananyambe N, Mwinga A, Garekwe M, Lanje S, Moshe Y, Pals SL, Nakashima AK, Miller B. Evaluation of a TB infection control implementation initiative in out-patient HIV clinics in Zambia and Botswana. Int J Tuberc Lung Dis 2018; 20:941-7. [PMID: 27287648 DOI: 10.5588/ijtld.15.0892] [Citation(s) in RCA: 10] [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: 11/10/2022] Open
Abstract
SETTING Out-patient human immunodeficiency virus (HIV) care and treatment clinics in Zambia and Botswana, countries with a high burden of HIV and TB infection. OBJECTIVE To develop a tuberculosis infection control (TB IC) training and implementation package and evaluate the implementation of TB IC activities in facilities implementing the package. DESIGN Prospective program evaluation of a TB IC training and implementation package using a standardized facility risk assessment tool, qualitative interviews with facility health care workers and measures of pre- and post-test performance. RESULTS A composite measure of facility performance in TB IC improved from 32% at baseline to 50% at 1 year among eight facilities in Zambia, and from 27% to 80% at 6 months among 10 facilities in Botswana. Although there was marked improvement in indicators of managerial, administrative and environmental controls, key ongoing challenges remained in ensuring access to personal protective equipment and implementing TB screening in health care workers. CONCLUSION TB IC activities at out-patient HIV clinics in Zambia and Botswana improved after training using the implementation package. Continued infrastructure support, as well as monitoring and evaluation, are needed to support the scale-up and sustainability of TB IC programs in facilities in low-resource countries.
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Affiliation(s)
- C Emerson
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - V Lipke
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - N Kapata
- Zambia Ministry of Health, Lusaka, Zambia
| | | | - A Mwinga
- Zambia AIDS Related Tuberculosis (ZAMBART) Project, Lusaka, Zambia
| | - M Garekwe
- Botswana Ministry of Health, Gaborone, Botswana
| | - S Lanje
- CDC Botswana, Gaborone, Botswana
| | - Y Moshe
- African Comprehensive HIV/AIDS Partnership (ACHAP), Gaborone, Botswana
| | - S L Pals
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - A K Nakashima
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - B Miller
- Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Miotto P, Tessema B, Tagliani E, Chindelevitch L, Starks AM, Emerson C, Hanna D, Kim PS, Liwski R, Zignol M, Gilpin C, Niemann S, Denkinger CM, Fleming J, Warren RM, Crook D, Posey J, Gagneux S, Hoffner S, Rodrigues C, Comas I, Engelthaler DM, Murray M, Alland D, Rigouts L, Lange C, Dheda K, Hasan R, Ranganathan UDK, McNerney R, Ezewudo M, Cirillo DM, Schito M, Köser CU, Rodwell TC. A standardised method for interpreting the association between mutations and phenotypic drug resistance in Mycobacterium tuberculosis. Eur Respir J 2017; 50:1701354. [PMID: 29284687 PMCID: PMC5898944 DOI: 10.1183/13993003.01354-2017] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [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: 07/06/2017] [Accepted: 10/13/2017] [Indexed: 11/24/2022]
Abstract
A clear understanding of the genetic basis of antibiotic resistance in Mycobacterium tuberculosis is required to accelerate the development of rapid drug susceptibility testing methods based on genetic sequence.Raw genotype-phenotype correlation data were extracted as part of a comprehensive systematic review to develop a standardised analytical approach for interpreting resistance associated mutations for rifampicin, isoniazid, ofloxacin/levofloxacin, moxifloxacin, amikacin, kanamycin, capreomycin, streptomycin, ethionamide/prothionamide and pyrazinamide. Mutation frequencies in resistant and susceptible isolates were calculated, together with novel statistical measures to classify mutations as high, moderate, minimal or indeterminate confidence for predicting resistance.We identified 286 confidence-graded mutations associated with resistance. Compared to phenotypic methods, sensitivity (95% CI) for rifampicin was 90.3% (89.6-90.9%), while for isoniazid it was 78.2% (77.4-79.0%) and their specificities were 96.3% (95.7-96.8%) and 94.4% (93.1-95.5%), respectively. For second-line drugs, sensitivity varied from 67.4% (64.1-70.6%) for capreomycin to 88.2% (85.1-90.9%) for moxifloxacin, with specificity ranging from 90.0% (87.1-92.5%) for moxifloxacin to 99.5% (99.0-99.8%) for amikacin.This study provides a standardised and comprehensive approach for the interpretation of mutations as predictors of M. tuberculosis drug-resistant phenotypes. These data have implications for the clinical interpretation of molecular diagnostics and next-generation sequencing as well as efficient individualised therapy for patients with drug-resistant tuberculosis.
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Affiliation(s)
- Paolo Miotto
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Belay Tessema
- Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia
| | - Elisa Tagliani
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Angela M Starks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Claudia Emerson
- Institute on Ethics & Policy for Innovation, Department of Philosophy, McMaster University, Hamilton, ON, Canada
| | | | - Peter S Kim
- Office of AIDS Research, National Institutes of Health, Rockville, MD, USA
| | | | - Matteo Zignol
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Christopher Gilpin
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Priority Area Infections, Research Center Borstel, Borstel, Germany
- German Center for Infection Research, Borstel, Germany
| | - Claudia M Denkinger
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
| | - Joy Fleming
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
| | - Robin M Warren
- DST/NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Derrick Crook
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
- National Infection Service, Public Health England, London, UK
| | - James Posey
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sven Hoffner
- Microbiology, Tumour and Cell Biology, Karolinska Institute, Stockholm, Sweden
- Public Health Agency of Sweden, Solna, Sweden
| | | | - Iñaki Comas
- Tuberculosis Genomics Unit, Biomedicine Institute of Valencia (IBV-CSIC), Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Community (FISABIO), Valencia, Spain
- CIBER (Centros de Investigación Biomédica en Red) in Epidemiology and Public Health, Madrid, Spain
| | | | - Megan Murray
- Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA
| | - David Alland
- Center for Emerging Pathogens, Rutgers-New Jersey Medical School, Newark, NJ, USA
| | - Leen Rigouts
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christoph Lange
- Division of Clinical Infectious Diseases and German Center for Infection Research Tuberculosis Unit, Research Center Borstel, Borstel, Germany
- International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ruth McNerney
- Department of Medicine, Division of Pulmonology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | - Daniela M Cirillo
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Claudio U Köser
- Department of Genetics, University of Cambridge, Cambridge, UK
| | - Timothy C Rodwell
- Foundation for Innovative New Diagnostics, Campus Biotech, Geneva, Switzerland
- Department of Medicine, University of California, San Diego, CA, USA
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Lipke V, Emerson C, McCarthy C, Briggs-Hagen M, Farley J, Verani AR, Riley PL. Highlighting the need for more infection control practitioners in low- and middle-income countries. Public Health Action 2016; 6:160-163. [PMID: 27695677 DOI: 10.5588/pha.16.0027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 03/25/2016] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Many low- and middle-income countries struggle to implement, monitor and evaluate the efficacy of infection control (IC) measures within health care facilities. This hampers their ability to prevent nosocomial infections, identify emerging pathogens and rapidly alert officials to possible outbreaks. The lack of dedicated and trained IC practitioners (ICPs) is a serious deficit in the health care workforce, and is worsened by the lack of institutions that offer IC training. Discussion: While no single individual can entirely eliminate the risk of nosocomial transmission, there is literature to support the value of designated IC persons. Recommendations from the World Health Organization in 2008 and 2009 describe the need for this specialized cadre of workers, but many countries lack the national regulations to authorize, train and manage such professionals at the national or local level. This article provides an overview of how ICPs are trained and credentialed in several countries, and discusses approaches countries can use to train ICPs. Conclusion: Trained ICPs can help prevent future outbreaks and control nosocomial transmission of diseases in health care facilities. For this to occur, supportive national policies, availability of training institutions and local administrative support will be required.
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Affiliation(s)
- V Lipke
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C Emerson
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C McCarthy
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Briggs-Hagen
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J Farley
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - A R Verani
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - P L Riley
- Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Starks AM, Avilés E, Cirillo DM, Denkinger CM, Dolinger DL, Emerson C, Gallarda J, Hanna D, Kim PS, Liwski R, Miotto P, Schito M, Zignol M. Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform. Clin Infect Dis 2016; 61Suppl 3:S141-6. [PMID: 26409275 DOI: 10.1093/cid/civ610] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 01/29/2023] Open
Abstract
Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease.
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Affiliation(s)
- Angela M Starks
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Daniela M Cirillo
- Istituti di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Claudia Emerson
- Centre for Ethical, Social, and Cultural Risk, Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Ontario, Canada
| | - Jim Gallarda
- Bill & Melinda Gates Foundation, Seattle, Washington
| | | | - Peter S Kim
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Paolo Miotto
- Istituti di Ricovero e Cura a Carattere Scientifico, San Raffaele Scientific Institute, Milan, Italy
| | | | - Matteo Zignol
- Global TB Programme, TB Monitoring and Evaluation, World Health Organization, Geneva, Switzerland
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Abstract
Mumps epididymo-orchitis has not been recorded as a cause of testicular symptoms without systemic features (including parotitis). The aim of the present study was to assess if we were missing cases in the genitourinary clinic during a previous outbreak of mumps in the community. During a prospective pilot study from November 2005 to February 2006, all patients presenting with symptoms or signs of epididymo-orchitis were studied. These patients were assessed for previous exposure to mumps virus or vaccine, and any current evidence of systemic illness. All patients included had a full sexual health screen (loop test, chlamydia polymerase chain reaction [PCR], gonorrhoea culture, HIV and Venereal Disease Research Laboratory [test]/ Treponema pallidum particle agglutination assay), urinary tract infection excluded by urinalysis and mid-stream specimen of urine (MSSU) and mumps serology (Immunoglobulin M [IgM] and Immunoglobulin G [IgG]) performed. Twenty-three patients met inclusion criteria. Their ages ranged from 16 to 50 years, average 30.8 years. All had symptoms of these, 18 had testicular pain, eight swelling, (four had both pain and swelling) and three also had dysuria. On examination, 12 had tenderness, seven swelling, (two both tenderness and swelling) and six had no signs. Seventeen denied history of mumps, one patient had a record of vaccination and five described fever. None had parotid swelling. Three patients were chlamydia PCR positive, two had candida cultured, three had non-specific urethritis (>10 polymorphonuclear leucocyte/high powered field) and 13 had negative sexually transmitted infection screen (one known HIV-positive). Three had positive IgM mumps serology and two were IgG-positive. It is important to include mumps in the differential of epididymo-orchitis and to be aware of outbreaks in the community that may present with genital symptoms, as the management and partner notification will be different.
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Affiliation(s)
- C Emerson
- Royal Victoria Hospital, Belfast, Northern Ireland.
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van Panhuis WG, Paul P, Emerson C, Grefenstette J, Wilder R, Herbst AJ, Heymann D, Burke DS. A systematic review of barriers to data sharing in public health. BMC Public Health 2014; 14:1144. [PMID: 25377061 PMCID: PMC4239377 DOI: 10.1186/1471-2458-14-1144] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [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: 06/11/2014] [Accepted: 10/07/2014] [Indexed: 11/25/2022] Open
Abstract
Background In the current information age, the use of data has become essential for decision making in public health at the local, national, and global level. Despite a global commitment to the use and sharing of public health data, this can be challenging in reality. No systematic framework or global operational guidelines have been created for data sharing in public health. Barriers at different levels have limited data sharing but have only been anecdotally discussed or in the context of specific case studies. Incomplete systematic evidence on the scope and variety of these barriers has limited opportunities to maximize the value and use of public health data for science and policy. Methods We conducted a systematic literature review of potential barriers to public health data sharing. Documents that described barriers to sharing of routinely collected public health data were eligible for inclusion and reviewed independently by a team of experts. We grouped identified barriers in a taxonomy for a focused international dialogue on solutions. Results Twenty potential barriers were identified and classified in six categories: technical, motivational, economic, political, legal and ethical. The first three categories are deeply rooted in well-known challenges of health information systems for which structural solutions have yet to be found; the last three have solutions that lie in an international dialogue aimed at generating consensus on policies and instruments for data sharing. Conclusions The simultaneous effect of multiple interacting barriers ranging from technical to intangible issues has greatly complicated advances in public health data sharing. A systematic framework of barriers to data sharing in public health will be essential to accelerate the use of valuable information for the global good. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1144) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Willem G van Panhuis
- University of Pittsburgh Graduate School of Public Health, DeSoto street 130, 703 Parran Hall, Pittsburgh, PA 15261, USA.
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21
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Willison DJ, Ondrusek N, Dawson A, Emerson C, Ferris LE, Saginur R, Sampson H, Upshur R. What makes public health studies ethical? Dissolving the boundary between research and practice. BMC Med Ethics 2014; 15:61. [PMID: 25104180 PMCID: PMC4133954 DOI: 10.1186/1472-6939-15-61] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 07/31/2014] [Indexed: 11/23/2022] Open
Abstract
Background The generation of evidence is integral to the work of public health and health service providers. Traditionally, ethics has been addressed differently in research projects, compared with other forms of evidence generation, such as quality improvement, program evaluation, and surveillance, with review of non-research activities falling outside the purview of the research ethics board. However, the boundaries between research and these other evaluative activities are not distinct. Efforts to delineate a boundary – whether on grounds of primary purpose, temporality, underlying legal authority, departure from usual practice, or direct benefits to participants – have been unsatisfactory. Public Health Ontario has eschewed this distinction between research and other evaluative activities, choosing to adopt a common framework and process to guide ethical reflection on all public health evaluative projects throughout their lifecycle – from initial planning through to knowledge exchange. Discussion The Public Health Ontario framework was developed by a working group of public health and ethics professionals and scholars, in consultation with individuals representing a wide range of public health roles. The first part of the framework interprets the existing Canadian research ethics policy statement (commonly known as the TCPS 2) through a public health lens. The second part consists of ten questions that guide the investigator in the application of the core ethical principles to public health initiatives. The framework is intended for use by those designing and executing public health evaluations, as well as those charged with ethics review of projects. The goal is to move toward a culture of ethical integrity among investigators, reviewers and decision-makers, rather than mere compliance with rules. The framework is consonant with the perspective of the learning organization and is generalizable to other public health organizations, to health services organizations, and beyond. Summary Public Health Ontario has developed an ethics framework that is applicable to any evidence-generating activity, regardless of whether it is labelled research. While developed in a public health context, it is readily adaptable to other health services organizations and beyond.
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Affiliation(s)
- Donald J Willison
- University of Toronto, Dalla Lana School of Public Health, 155 College Street, 6th Floor, Toronto, ON M5T 3 M7, Canada.
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22
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Emerson C. The anatomy lesson: resection. Med J Aust 2014. [DOI: 10.5694/mja14.00248] [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: 11/17/2022]
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Sacks R, Coyne K, Cybulska B, Dhairyawan R, Forster G, Emerson C, Mears A, Mears A, Shah R, Spice W. P165 GUM/HIV trainees' experience and training needs in the management of patients disclosing sexual violence: Abstract P165 Table 1. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Affiliation(s)
- G Taylor
- Department of General Surgery, Mater Hospital Royal Victoria Hospital, Belfast, UK
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Sfetcu O, Irvine N, Ngui SL, Emerson C, McCaughey C, Donaghy P. Hepatitis A outbreak predominantly affecting men who have sex with men in Northern Ireland, October 2008 to July 2009. Euro Surveill 2011; 16:19808. [PMID: 21392487] [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: 05/30/2023] Open
Abstract
We describe an outbreak of hepatitis A which evolved in Northern Ireland between October 2008 and July 2009, against a background of large concurrent hepatitis A outbreaks in various parts of Europe. Thirty-eight cases were defined as outbreak cases using a stratified case definition; 36 were males with a median age of 29 years and of the 28 males whose sexual orientation was known, 26 were men who have sex with men(MSM). Detailed descriptive epidemiology data collected through standardised questionnaires, together with sequencing of a 289 bp fragment of the VP1/2PA region of the virus, significantly aided the understanding of the spread of the outbreak when non-MSM cases occurred. The sequence of the outbreak strain, genotype IA, was indistinguishable from that involved in a large outbreak in the Czech Republic. Although seeded in a generally susceptible Northern Ireland population, the outbreak remained mostly contained in MSM, showing this sub-population to be the most vulnerable despite ongoing hepatitis A vaccination programmes in genito-urinary medicine clinics.
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Affiliation(s)
- O Sfetcu
- Health Protection Service, Public Health Agency, Northern Ireland, United Kingdom.
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26
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Sfetcu O, Irvine N, Ngui SL, Emerson C, McCaughey C, Donaghy P. Hepatitis A outbreak predominantly affecting men who have sex with men in Northern Ireland, October 2008 to July 2009. Euro Surveill 2011. [DOI: 10.2807/ese.16.09.19808-en] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe an outbreak of hepatitis A which evolved in Northern Ireland between October 2008 and July 2009, against a background of large concurrent hepatitis A outbreaks in various parts of Europe. Thirty-eight cases were defined as outbreak cases using a stratified case definition; 36 were males with a median age of 29 years and of the 28 males whose sexual orientation was known, 26 were men who have sex with men (MSM). Detailed descriptive epidemiology data collected through standardised questionnaires, together with sequencing of a 289 bp fragment of the VP1/2PA region of the virus, significantly aided the understanding of the spread of the outbreak when non-MSM cases occurred. The sequence of the outbreak strain, genotype IA, was indistinguishable from that involved in a large outbreak in the Czech Republic. Although seeded in a generally susceptible Northern Ireland population, the outbreak remained mostly contained in MSM, showing this sub-population to be the most vulnerable despite ongoing hepatitis A vaccination programmes in genito-urinary medicine clinics.
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Affiliation(s)
- O Sfetcu
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Protection Service, Public Health Agency, Northern Ireland, United Kingdom
| | - N Irvine
- Health Protection Service, Public Health Agency, Northern Ireland, United Kingdom
| | - S L Ngui
- Virus Reference Department (VRD), Health Protection Agency, London, United Kingdom
| | - C Emerson
- Genito-Urinary Medicine Clinic, Royal Hospitals, Belfast HSC Trust, Northern Ireland, United Kingdom
| | - C McCaughey
- Regional Virus Laboratory, Royal Hospitals, Belfast HSC Trust, Northern Ireland, United Kingdom
| | - P Donaghy
- Health Protection Service, Public Health Agency, Northern Ireland, United Kingdom
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Perry M, Morrissey D, Emerson C, Teatino R, Shaikh Z, Mitchell S, O'Driscoll G, Ahmad M, Maffulli N. Achilles tendon thickness, ultrasound signs and symptoms in skaters, gymnasts, elite soccer players, club athletes and healthy sedentary adults - a cross-sectional study. Br J Sports Med 2011. [DOI: 10.1136/bjsm.2010.081554.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
The training programme for specialist registrars in genitourinary medicine (GU) lists sexual dysfunction (SD) as ‘beyond essential, core curriculum’ despite many GU medicine clinics offering this service. A cross-sectional study was performed of all trainees on the British Association for Sexual Health and HIV mailing list. Data collected included frequency of clinics attended and involvement, any training and interest in future training. A total of 39/76 (51%) responses were received. In total, 20/39 (51%) work in departments with no SD clinic provision, and 12/39 have had some training in SD. In routine GU medicine consultation, 85% trainees are consulted regarding SD at least monthly. In all, 19/39 (49%) work in areas with weekly SD clinics; however, only three trainees were involved. Thirty-four out of 39 (87%) expressed interest in training and 31/39 (79%) respondents would like to see SD training added to the SpR curriculum. Fifty-one percent of juniors work in units without SD provision. Even when SD clinics occur, only three trainees are routinely involved and a large training opportunity is being missed. Despite this, 12/39 trainees have sought out extra training in the form of seminars, courses and meetings. Eighty-five percent wished to have SD as part of the core curriculum as they may ultimately work in an area where these skills are required.
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Affiliation(s)
- C Emerson
- Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6AB
| | | | - P Green
- University Hospital of South Manchester, UK
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Gibson E, Brazil K, Coughlin MD, Emerson C, Fournier F, Schwartz L, Szala-Meneok KV, Weisbaum KM, Willison DJ. Who's minding the shop? The role of Canadian research ethics boards in the creation and uses of registries and biobanks. BMC Med Ethics 2008; 9:17. [PMID: 19014594 PMCID: PMC2636819 DOI: 10.1186/1472-6939-9-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 11/14/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The amount of research utilizing health information has increased dramatically over the last ten years. Many institutions have extensive biobank holdings collected over a number of years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to permit research uses of these samples. Research Ethics Boards (REBs) in Canada and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to registries and biobanks. METHODS Chairs of 34 REBS and/or REB Administrators affiliated with Faculties of Medicine in Canadian universities were interviewed. Interviews consisted of structured questions dealing with diabetes-related scenarios, with open-ended responses and probing for rationales. The two scenarios involved the development of a diabetes registry using clinical encounter data across several physicians' practices, and the addition of biological samples to the registry to create a biobank. RESULTS There was a wide range of responses given for the questions raised in the scenarios, indicating a lack of clarity about the role of REBs in registries and biobanks. With respect to the creation of a registry, a minority of sites felt that consent was not required for the information to be entered into the registry. Whether patient consent was required for information to be entered into the registry and the duration for which the consent would be operative differed across sites. With respect to the creation of a biobank linked to the registry, a majority of sites viewed biobank information as qualitatively different from other types of personal health information. All respondents agreed that patient consent was needed for blood samples to be placed in the biobank but the duration of consent again varied. CONCLUSION Participants were more attuned to issues surrounding biobanks as compared to registries and demonstrated a higher level of concern regarding biobanks. As registries and biobanks expand, there is a need for critical analysis of suitable roles for REBs and subsequent guidance on these topics. The authors conclude by recommending REB participation in the creation of registries and biobanks and the eventual drafting of comprehensive legislation.
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Affiliation(s)
- Elaine Gibson
- Health Law Institute, Dalhousie University, Halifax, Canada
| | - Kevin Brazil
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
- St. Joseph's Health System Research Network, Hamilton, Canada
- Division of Palliative Care, Family Medicine, McMaster University, Hamilton, Canada
| | - Michael D Coughlin
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Claudia Emerson
- Program on Ethics and Commercialization, McLaughlin-Rotman Centre for Global Health, University Health Network and University of Toronto, Toronto, Canada
| | - Francois Fournier
- Centre de bioéthique, Institut de Recherches Cliniques de Montréal, Montreal, Canada
| | - Lisa Schwartz
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
| | | | - Karen M Weisbaum
- Department of Family Medicine, Queen's University, Kingston, Canada
| | - Donald J Willison
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
- Centre for Evaluation of Medicines, St. Joseph's Health Care, Hamilton, Canada
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Willison DJ, Emerson C, Szala-Meneok KV, Gibson E, Schwartz L, Weisbaum KM, Fournier F, Brazil K, Coughlin MD. Access to medical records for research purposes: varying perceptions across research ethics boards. J Med Ethics 2008; 34:308-314. [PMID: 18375687 DOI: 10.1136/jme.2006.020032] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Variation across research ethics boards (REBs) in conditions placed on access to medical records for research purposes raises concerns around negative impacts on research quality and on human subject protection, including privacy. AIM To study variation in REB consent requirements for retrospective chart review and who may have access to the medical record for data abstraction. METHODS Thirty 90-min face-to-face interviews were conducted with REB chairs and administrators affiliated with faculties of medicine in Canadian universities, using structured questions around a case study with open-ended responses. Interviews were recorded, transcribed and coded manually. RESULTS Fourteen sites (47%) required individual patient consent for the study to proceed as proposed. Three (10%) indicated that their response would depend on how potentially identifying variables would be managed. Eleven sites (38%) did not require consent. Two (7%) suggested a notification and opt-out process. Most stated that consent would be required if identifiable information was being abstracted from the record. Among those not requiring consent, there was substantial variation in recognising that the abstracted information could potentially indirectly re-identify individuals. Concern over access to medical records by an outside individual was also associated with requirement for consent. Eighteen sites (60%) required full committee review. Sixteen (53%) allowed an external research assistant to abstract information from the health record. CONCLUSIONS Large variation was found across sites in the requirement for consent for research involving access to medical records. REBs need training in best practices for protecting privacy and confidentiality in health research. A forum for REB chairs to confidentially share concerns and decisions about specific studies could also reduce variation in decisions.
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Affiliation(s)
- D J Willison
- Centre for Evaluation of Medicines, St Joseph's Healthcare, McMaster University, 105 Main Street East, P1, Hamilton, ON L8N 1G8, Canada.
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Abstract
Eradication of Mycobacterium bovis relies on accurate detection of infected animals, including potential domestic and wildlife reservoirs. Available diagnostic tests lack the sensitivity and specificity necessary for accurate detection, particularly in infected wildlife populations. Recently, an in vitro diagnostic test for cattle which measures plasma interferon-gamma (IFN-gamma) levels in blood following in vitro incubation with M. bovis purified protein derivative has been enveloped. This test appears to have increased sensitivity over traditional testing. Unfortunately, it does not detect IFN-gamma from Cervidae. To begin to address this problem, the IFN-gamma gene from elk (Cervus elaphus) was cloned, sequenced, expressed, and characterized. cDNA was cloned from mitogen stimulated peripheral blood mononuclear cells. The predicted amino acid (aa) sequence was compared to known sequences from cattle, sheep, goats, red deer (Cervus elaphus), humans, and mice. Biological activity of the recombinant elk IFN-gamma (rElkIFN-gamma) was confirmed in a vesicular stomatitis virus cytopathic effect reduction assay. Production of monoclonal antibodies to IFN-gamma epitopes conserved between ruminant species could provide an important tool for the development of reliable, practical diagnostic assays for detection of a delayed type hypersensitivity response to a variety of persistent infectious agents in ruminants, including M. bovis and Brucella abortus. Moreover, development of these reagents will aid investigators in studies to explore immunological responses of elk that are associated with resistance to infectious diseases.
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Affiliation(s)
- S J Sweeney
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman 99164-7040, USA
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Allen TM, O'Connor DH, Jing P, Dzuris JL, Mothé BR, Vogel TU, Dunphy E, Liebl ME, Emerson C, Wilson N, Kunstman KJ, Wang X, Allison DB, Hughes AL, Desrosiers RC, Altman JD, Wolinsky SM, Sette A, Watkins DI. Tat-specific cytotoxic T lymphocytes select for SIV escape variants during resolution of primary viraemia. Nature 2000; 407:386-90. [PMID: 11014195 DOI: 10.1038/35030124] [Citation(s) in RCA: 449] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) infections are characterized by early peaks of viraemia that decline as strong cellular immune responses develop. Although it has been shown that virus-specific CD8-positive cytotoxic T lymphocytes (CTLs) exert selective pressure during HIV and SIV infection, the data have been controversial. Here we show that Tat-specific CD8-positive T-lymphocyte responses select for new viral escape variants during the acute phase of infection. We sequenced the entire virus immediately after the acute phase, and found that amino-acid replacements accumulated primarily in Tat CTL epitopes. This implies that Tat-specific CTLs may be significantly involved in controlling wild-type virus replication, and suggests that responses against viral proteins that are expressed early during the viral life cycle might be attractive targets for HIV vaccine development.
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Affiliation(s)
- T M Allen
- Wisconsin Regional Primate Research Center, University of Wisconsin, Madison 53715-1299, USA
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Emerson C, Gibbs L, Harper S, Woodruff C. Effect of telephone followups on post vasectomy office visits. Urol Nurs 2000; 20:125-7, 131. [PMID: 11998122] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Vasectomies are considered minor outpatient procedures. Yet, many patients return to their urologist's office for rechecks because of complications or the need for reassurance of normal healing sequela. This study suggests that use of a tool for telephone followup can increase patient satisfaction and benefit urologic practice by curtailing the incidence of needless followup visits.
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Affiliation(s)
- C Emerson
- Kennesaw State University, Kennesaw, GA, USA
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Lichtenwalner A, Patton D, Emerson C, Anderson D, Ek M. Ovarian teratoma in a pigtailed macaque (Macaca nemestrina). Contemp Top Lab Anim Sci 1997; 36:86-8. [PMID: 16426029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- A Lichtenwalner
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle 98195, USA
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Abstract
A variety of differentiated cell types can be converted to skeletal muscle following transfection with the myogenic regulatory gene MyoD1. To determine whether MyoD1 is a dominant muscle regulator in vivo, mouse fertilized eggs were microinjected with a beta-actin/MyoD1 gene. Ectopic expression of MyoD1 during mouse embryogenesis led to embryonic lethalities, the cause of which is not known. Transgenic embryos died before midgestation. The majority of tested embryos between 7.5 and 9.5 days, although retarded compared to control littermates, differentiated normally into tissues representative of all three germ layers. In most transgenic embryos there was no indication of myogenic conversion. The expression of the introduced gene was detected in all ectodermal and mesodermal tissues but was absent in all endodermal cells. Forced expression of MyoD1 was associated with the activation of myogenin and MLC2 (but not myf5 or MRF4) genes in non-muscle cell types, demonstrating the dominant regulatory function of MyoD1 during development. These results demonstrate that ectopic MyoD1 expression and activation of myogenin and MLC2 have no significant effects in the determination of cell lineages or the developmental fate of differentiated mesodermal and ectodermal cell lineages.
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Affiliation(s)
- A Faerman
- Institute of Animal Science, ARO, Volcani Center, Bet Dagan, Israel
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Emerson E, Emerson C. Barriers to the effective implementation of habilitative behavioral programs in an institutional setting. Ment Retard 1987; 25:101-6. [PMID: 3587008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Kramer JW, Bistline D, Sheridan P, Emerson C. Identification of hippuric acid crystals in the urine of ethylene glycol-intoxicated dogs and cats. J Am Vet Med Assoc 1984; 184:584. [PMID: 6706806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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