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McLaughlin A, Burns R, Ryan M, Abbasi W, Harvey L, Hicks J, Sinha P, Assoumou SA. Comparing COVID-19-related Morbidity and Mortality Between Patients
With and Without Substance Use Disorders: A Retrospective Cohort
Study. Subst Abuse 2023; 17:11782218231160014. [PMID: 36968974 PMCID: PMC10034287 DOI: 10.1177/11782218231160014] [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] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/09/2023] [Indexed: 03/24/2023]
Abstract
Objectives: People with substance use disorders (SUD) are suggested to have higher risk
of hospitalization, intubation, or death from coronavirus disease 2019
(COVID-19), although data are mixed. Little is known about other
COVID-19-related complications in this group. We compared morbidity and
mortality among individuals with and without SUD who were admitted to an
urban safety net hospital with COVID-19 early in the pandemic,
contemporaneous to other published studies on this subject. Methods: We performed a retrospective study of patients ⩾18 years old admitted with
COVID-19 from March 16th to April 8th, 2020. SUD included alcohol, opioid,
cocaine, amphetamine, and benzodiazepine use disorders and was identified
using diagnostic codes, free text clinical documentation, and urine drug
screens. The primary outcome was inpatient mortality. Secondary outcomes
included clinical complications (eg, secondary infections, venous
thromboembolism) and resource utilization (eg, mechanical ventilation,
length of stay). We used multivariable regression to assess the relationship
between SUD and mortality. Results: Of 409 patients, the mean age was 56 years and 13.7% had SUD. Those with SUD
were more likely to be male, have experienced homelessness, have pulmonary
disease or hepatitis C, or use tobacco or cannabis. After multivariable
analysis, SUD was not associated with mortality (aOR 1.03; 95% CI,
0.31-3.10). Secondary outcomes were also similar between groups. Conclusions: Our findings suggest that persons with and without SUD have similar
COVID-19-related outcomes. Previously reported increased COVID-19
complications may be from medical comorbidities.
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Affiliation(s)
- Angela McLaughlin
- Section of Infectious Diseases,
Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Angela McLaughlin, Section of Infectious
Diseases, Boston Medical Center, 801 Massachusetts Avenue, Crosstown Center, 2nd
Floor, Boston, MA 02118, USA.
| | - Rebecca Burns
- Internal Medicine Residency Program,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Morgan Ryan
- Department of Biostatistics, Boston
University School of Public Health, Boston, MA, USA
| | - Wafaa Abbasi
- Boston University School of Medicine,
Boston, MA, USA
| | - Leah Harvey
- Section of Infectious Diseases,
Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Grayken Center for Addiction,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jacqueline Hicks
- Department of Biostatistics, Boston
University School of Public Health, Boston, MA, USA
| | - Pranay Sinha
- Section of Infectious Diseases,
Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Sabrina A Assoumou
- Section of Infectious Diseases,
Department of Medicine, Boston Medical Center, Boston, MA, USA
- Section of Infectious Diseases,
Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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2
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Qquellon J, Vargas SK, Eguiluz M, Vasquez F, Durand D, Allan-Blitz LT, Konda KA, Ochoa TJ, Caceres CF, Klausner JD. Extra-genital Neisseria gonorrhoeae infections with genetic mutations conferring ciprofloxacin resistance among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2023; 34:245-250. [PMID: 36637128 PMCID: PMC9950594 DOI: 10.1177/09564624221147326] [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: 08/17/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND The increasing prevalence of drug-resistant Neisseria gonorrhoeae (NG) infections has caused great concern. Ciprofloxacin remains the empiric antimicrobial recommended to treat NG infections in Peru disregarding the susceptibility profile of circulating NG strains. We report the prevalence of individuals infected with NG strains presenting mutations in the gyrA gene that confers ciprofloxacin resistance. METHODS We conducted a descriptive study assessing extragenital swab samples collected from a cohort of men who have sex with men and transgender women in Lima, Peru. Anal and pharyngeal NG positive swabs for Aptima Combo 2 assay (Hologic Inc., USA) were used for DNA extraction. We performed TaqMan real time PCR assays to detect a point mutation at codon Ser91 of the gyrase A (gyrA) gene. RESULTS From 156 individuals who had at least one positive sample for NG reported by the Aptima assay, 80 individuals had at least one amplified DNA for the gyrA gene. We found that 67 of them (84.0%) were infected with a gyrA-mutated NG strain at the Ser91 codon. CONCLUSIONS We report a high prevalence of gyrA mutation conferring ciprofloxacin resistance among individuals with extragenital NG infection. Empirical treatment of NG needs to be urgently updated in Peru in concordance with international guidelines.
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Affiliation(s)
- Jazmin Qquellon
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Silver K Vargas
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- School of Public Health and
Administration, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Maria Eguiluz
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Francesca Vasquez
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - David Durand
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Lao-Tzu Allan-Blitz
- Division of Global Health Equity,
Department of Medicine, Brigham and Women’s
Hospital, Boston, MA, USA
| | - Kelika A Konda
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
- Division of Infectious Diseases,
David Geffen School of Medicine, University of
California, Los Angeles, CA, USA
| | - Theresa J Ochoa
- Instituto de Medicina Tropical
“Alexander Von Humboldt”, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Carlos F Caceres
- Center for Interdisciplinary
Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano
Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Department of Population and Public
Health Sciences, Keck School of Medicine, University of Southern
California, Los Angeles, CA, USA
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3
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Wirtz AL, Adams D, Poteat TC, Beckham SW, Miller M, Brown C, Reisner SL. SARS-CoV-2 Infection and Testing Experiences in a Nationwide Sample of Transgender and Gender-Diverse Adults, June-December 2021. Public Health Rep 2023; 138:357-368. [PMID: 36560869 PMCID: PMC9790855 DOI: 10.1177/00333549221138853] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES COVID-19 surveillance data are rarely collected or disaggregated by gender identity in the United States. We quantified COVID-19 testing experiences and SARS-CoV-2 infection history among transgender and gender-diverse (TGD) people to inform testing strategies and public health responses. METHODS From June 14 through December 16, 2021, TGD adults enrolled in a US nationwide online survey with optional SARS-CoV-2 antibody testing. We used multinomial regression analyses to identify correlates of suspected and confirmed SARS-CoV-2 infection (vs no known infection). We identified correlates of inability to access COVID-19 testing when needed using generalized linear models for binomial variables. RESULTS Participants (N = 2092) reported trans masculine (30.5%), trans feminine (27.3%), and nonbinary (42.2%) gender identities. Ten percent of respondents had a confirmed history of SARS-CoV-2 infection, and 29.8% had a history of suspected SARS-CoV-2 infection. Nonbinary gender (adjusted prevalence ratio [aPR] = 1.68; 95% CI, 1.12-2.53), experiencing homelessness (aPR = 1.65; 95% CI, 1.05-2.60), and food insecurity (aPR = 1.45; 95% CI, 1.03-2.04) were associated with confirmed SARS-CoV-2 infection. Food insecurity (aPR = 1.38; 95% CI, 1.10-1.72), chronic physical health condition (aPR = 1.44; 95% CI, 1.15-1.80), chronic mental health condition (aPR = 3.65; 95% CI, 2.40-5.56), and increased anticipated discrimination scores (aPR = 1.03; 95% CI, 1.01-1.05) were associated with suspected SARS-CoV-2 infection. Thirty-four percent (n = 694 of 2024) of participants reported an inability to access COVID-19 testing when needed, which was associated with Latinx or Hispanic ethnicity, inconsistent telephone access, homelessness, disability, and transportation limitations. The majority (79.4%) reported a complete COVID-19 vaccine course at the time of participation. CONCLUSIONS Inclusion of TGD people in public health surveillance and tailored public health strategies to address TGD communities' social and structural vulnerabilities may reduce barriers to COVID-19 testing.
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Affiliation(s)
- Andrea L. Wirtz
- Center for Public Health and Human
Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Dee Adams
- Center for Public Health and Human
Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Tonia C. Poteat
- Department of Social Medicine,
University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - S. Wilson Beckham
- Department of Health, Behavior and
Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marissa Miller
- Trans Solutions Research and Resource
Center, Indianapolis, IN, USA
| | - Carter Brown
- Black Transgender Advocacy Coalition,
Carrollton, TX, USA
| | - Sari L. Reisner
- Division of Endocrinology, Diabetes and
Hypertension, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical
School, Boston, MA, USA
- Department of Epidemiology, Harvard
T.H. Chan School of Public Health, Boston, MA, USA
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4
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Singh RR, Singh DR, Yen EY. Worsening premature death burden gap from systemic sclerosis in men and black persons: A US nationwide population-based study. J Scleroderma Relat Disord 2023; 8:20-26. [PMID: 36743809 PMCID: PMC9896199 DOI: 10.1177/23971983221140538] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
Objective Male sex and black race incur poor prognosis in systemic sclerosis (SSc). There is no nationwide population-based assessment of premature SSc death burden by sex and race. Methods This is a population-based study comprising all recorded SSc deaths across the United States. We constructed histograms depicting the number of SSc deaths for each age by sex and race, and calculated the cumulative percent death at each age and the median age of death. We determined the odds ratios for the risk of premature death from SSc by sex and race. We then calculated the percent of total SSc deaths for different age groups by sex and race from 1970 to 2015. We performed chi-square test with Yates's correction and quantified the odds ratio (OR) with 95% confidence interval (CI). Results The median age of SSc death was 63 years in males versus 68 years in females, and 57 years in blacks versus 70 years in whites. The odds for SSc death before 65 years age was 1.8 (95% CI, 1.6-2.0) for males compared with females and 5.1 (95% CI, 4.4-6.0) for blacks compared with whites. The higher odds for premature death in males than in females was similar for both races. Differences in the proportions of premature deaths from 1970 to 2015 increased between males and females (-5% to 17%) and between blacks and whites (14% to 36%). Conclusion Males and black persons die of SSc at younger ages. The worsening premature death burden gap between the two sexes and races over the last five decades is troublesome.
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Affiliation(s)
- Ram Raj Singh
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
- Molecular Toxicology Interdepartmental
Program, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center,
University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Department of Pathology and Laboratory
Medicine, University of California at Los Angeles (UCLA), Los Angeles, CA, USA
- Ram Raj Singh, Autoimmunity and Tolerance
Laboratory, Division of Rheumatology, Department of Medicine, University of
California at Los Angeles (UCLA), David Geffen School of Medicine, 1000 Veteran
Avenue, Room 32-59, Los Angeles, CA 90095-1670, USA.
| | - Devanshu R Singh
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
- Johns Hopkins Whiting School of
Engineering, Baltimore, MD, USA
| | - Eric Y Yen
- Autoimmunity and Tolerance Laboratory,
Division of Rheumatology, Department of Medicine, University of California at Los
Angeles (UCLA), David Geffen School of Medicine, Los Angeles, CA, USA
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5
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Willie TC, Sharpless L, Monger M, Kershaw TS, Mahoney WB, Stockman JK. Enhancing domestic violence advocates' ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention. Womens Health (Lond) 2022; 18:17455065211070548. [PMID: 35001751 PMCID: PMC8744168 DOI: 10.1177/17455065211070548] [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] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/15/2021] [Accepted: 12/14/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. SETTING A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. METHODS Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. RESULTS Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates' intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. CONCLUSION This group-based intervention enhanced domestic violence advocates' acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Laurel Sharpless
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Mauda Monger
- MLM Center for Health Education and
Equity Consulting Services, Jackson, MS, USA
| | - Trace S Kershaw
- Department of Social and Behavioral
Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Wendy B Mahoney
- Mississippi Coalition Against Domestic
Violence, Jackson, MS, USA
| | - Jamila K Stockman
- Division of Infectious Diseases and
Global Public Health, Department of Medicine, University of California San Diego, La
Jolla, CA, USA
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6
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Díaz-Pascual F, Lempp M, Nosho K, Jeckel H, Jo JK, Neuhaus K, Hartmann R, Jelli E, Hansen MF, Price-Whelan A, Dietrich LEP, Link H, Drescher K. Spatial alanine metabolism determines local growth dynamics of Escherichia coli colonies. eLife 2021; 10:e70794. [PMID: 34751128 PMCID: PMC8579308 DOI: 10.7554/elife.70794] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 05/28/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
Bacteria commonly live in spatially structured biofilm assemblages, which are encased by an extracellular matrix. Metabolic activity of the cells inside biofilms causes gradients in local environmental conditions, which leads to the emergence of physiologically differentiated subpopulations. Information about the properties and spatial arrangement of such metabolic subpopulations, as well as their interaction strength and interaction length scales are lacking, even for model systems like Escherichia coli colony biofilms grown on agar-solidified media. Here, we use an unbiased approach, based on temporal and spatial transcriptome and metabolome data acquired during E. coli colony biofilm growth, to study the spatial organization of metabolism. We discovered that alanine displays a unique pattern among amino acids and that alanine metabolism is spatially and temporally heterogeneous. At the anoxic base of the colony, where carbon and nitrogen sources are abundant, cells secrete alanine via the transporter AlaE. In contrast, cells utilize alanine as a carbon and nitrogen source in the oxic nutrient-deprived region at the colony mid-height, via the enzymes DadA and DadX. This spatially structured alanine cross-feeding influences cellular viability and growth in the cross-feeding-dependent region, which shapes the overall colony morphology. More generally, our results on this precisely controllable biofilm model system demonstrate a remarkable spatiotemporal complexity of metabolism in biofilms. A better characterization of the spatiotemporal metabolic heterogeneities and dependencies is essential for understanding the physiology, architecture, and function of biofilms.
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Affiliation(s)
| | - Martin Lempp
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
| | - Kazuki Nosho
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
| | - Hannah Jeckel
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
- Department of Physics,
Philipps-Universität MarburgMarburgGermany
- Biozentrum, University of
BaselBaselSwitzerland
| | - Jeanyoung K Jo
- Department of Biological Sciences,
Columbia UniversityNew YorkUnited
States
| | - Konstantin Neuhaus
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
- Department of Physics,
Philipps-Universität MarburgMarburgGermany
- Biozentrum, University of
BaselBaselSwitzerland
| | - Raimo Hartmann
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
| | - Eric Jelli
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
- Department of Physics,
Philipps-Universität MarburgMarburgGermany
| | | | - Alexa Price-Whelan
- Department of Biological Sciences,
Columbia UniversityNew YorkUnited
States
| | - Lars EP Dietrich
- Department of Biological Sciences,
Columbia UniversityNew YorkUnited
States
| | - Hannes Link
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
- Interfaculty Institute for Microbiology
and Infection Medicine, Eberhard Karls Universität
TübingenTübingenGermany
| | - Knut Drescher
- Max Planck Institute for Terrestrial
MicrobiologyMarburgGermany
- Department of Physics,
Philipps-Universität MarburgMarburgGermany
- Biozentrum, University of
BaselBaselSwitzerland
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7
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Singh P, Shah M, Bruckner TA. Child Undernutrition following the Introduction of a Large-Scale Toilet Construction Campaign in India. J Nutr 2021; 151:2455-2464. [PMID: 34143878 PMCID: PMC8436001 DOI: 10.1093/jn/nxab150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/25/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lack of toilets and the widespread practice of open defecation may contribute to India's large burden of child undernutrition. OBJECTIVES We examine whether a large national sanitation campaign launched in 2014, the Swachh Bharat Mission (SBM), precedes a reduction in stunting and wasting among under 5-y-old (u5) children in India. METHODS In this observational study, we used district-level data from before (2013-2014) and after (2015-2016) SBM from 3 national surveys to derive, as our outcomes, the percentage of u5 children per district who are stunted and wasted. We defined our exposures as 1) binary indicator of SBM and 2) percentage of households with toilets per district. Our analytic sample comprised nearly all 640 Indian districts (with ∼1200 rural/urban divisions per district per time point). Linear regression analyses controlled for baseline differences in districts, linear time trends by state, and relevant covariates. RESULTS Relative to pre-SBM, u5 stunting declines by 0.06% (95% CI: -0.10, -0.01; P = 0.009) with every percentage increase in households with toilets post-SBM. Rural regions and districts with higher pre-SBM toilet availability show greater decline in u5 stunting post-SBM. CONCLUSIONS An increase in toilet availability on a national scale, precipitated by the SBM sanitation campaign, is associated with a reduction in undernutrition among u5 children in India over the early phase of the campaign.
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Affiliation(s)
- Parvati Singh
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
| | - Manisha Shah
- Department of Public Policy, Luskin School of Public Affairs,
University of California, Los Angeles, Los
Angeles, CA, USA
| | - Tim A Bruckner
- Program in Public Health, University of
California, Irvine, Irvine, CA,
USA
- Center for Population, Inequality and Policy, University of
California, Irvine, Irvine, CA,
USA
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8
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James LP, Salomon JA, Buckee CO, Menzies NA. The Use and Misuse of Mathematical Modeling for Infectious Disease Policymaking: Lessons for the COVID-19 Pandemic. Med Decis Making 2021; 41:379-385. [PMID: 33535889 PMCID: PMC7862917 DOI: 10.1177/0272989x21990391] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 08/13/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
Mathematical modeling has played a prominent and necessary role in the current coronavirus disease 2019 (COVID-19) pandemic, with an increasing number of models being developed to track and project the spread of the disease, as well as major decisions being made based on the results of these studies. A proliferation of models, often diverging widely in their projections, has been accompanied by criticism of the validity of modeled analyses and uncertainty as to when and to what extent results can be trusted. Drawing on examples from COVID-19 and other infectious diseases of global importance, we review key limitations of mathematical modeling as a tool for interpreting empirical data and informing individual and public decision making. We present several approaches that have been used to strengthen the validity of inferences drawn from these analyses, approaches that will enable better decision making in the current COVID-19 crisis and beyond.
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Affiliation(s)
| | - Joshua A. Salomon
- Center for Health Policy and Center
for Primary Care and Outcomes Research, Stanford University,
Stanford, CA, USA
| | - Caroline O. Buckee
- Center for Communicable Disease
Dynamics, Harvard T. H. Chan School of Public Health, Boston,
MA, USA
| | - Nicolas A. Menzies
- Department of Global Health and
Population, Harvard T. H. Chan School of Public Health, Boston,
MA, USA
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9
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Sutiwisesak R, Hicks ND, Boyce S, Murphy KC, Papavinasasundaram K, Carpenter SM, Boucau J, Joshi N, Le Gall S, Fortune SM, Sassetti CM, Behar SM. A natural polymorphism of Mycobacterium tuberculosis in the esxH gene disrupts immunodomination by the TB10.4-specific CD8 T cell response. PLoS Pathog 2020; 16:e1009000. [PMID: 33075106 PMCID: PMC7597557 DOI: 10.1371/journal.ppat.1009000] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/19/2020] [Revised: 10/29/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
CD8 T cells provide limited protection against Mycobacterium
tuberculosis (Mtb) infection in the mouse model. As Mtb causes
chronic infection in mice and humans, we hypothesize that Mtb impairs T cell
responses as an immune evasion strategy. TB10.4 is an immunodominant antigen in
people, nonhuman primates, and mice, which is encoded by the
esxH gene. In C57BL/6 mice, 30–50% of pulmonary CD8 T cells
recognize the TB10.44−11 epitope. However, TB10.4-specific CD8 T
cells fail to recognize Mtb-infected macrophages. We speculate that Mtb elicits
immunodominant CD8 T cell responses to antigens that are inefficiently presented
by infected cells, thereby focusing CD8 T cells on nonprotective antigens. Here,
we leverage naturally occurring polymorphisms in esxH, which
frequently occur in lineage 1 strains, to test this “decoy hypothesis”. Using
the clinical isolate 667, which contains an EsxHA10T polymorphism, we
observe a drastic change in the hierarchy of CD8 T cells. Using isogenic
Erd.EsxHA10T and Erd.EsxHWT strains, we prove that
this polymorphism alters the hierarchy of immunodominant CD8 T cell responses.
Our data are best explained by immunodomination, a mechanism by which
competition for APC leads to dominant responses suppressing subdominant
responses. These results were surprising as the variant epitope can bind to
H2-Kb and is recognized by TB10.4-specific CD8 T cells. The
dramatic change in TB10.4-specific CD8 responses resulted from increased
proteolytic degradation of A10T variant, which destroyed the
TB10.44-11epitope. Importantly, this polymorphism affected T cell
priming and recognition of infected cells. These data support a model in which
nonprotective CD8 T cells become immunodominant and suppress subdominant
responses. Thus, polymorphisms between clinical Mtb strains, and BCG or H37Rv
sequence-based vaccines could lead to a mismatch between T cells that are primed
by vaccines and the epitopes presented by infected cells. Reprograming host
immune responses should be considered in the future design of vaccines. An important question for vaccine developers is the relative potency of CD4 vs.
CD8 T cells against Mtb, as strategies differ for eliciting these different T
cell subsets. Despite robust antigen-specific pulmonary CD8 T cell responses,
CD4 T cells mediate more protection than CD8 T cells in the murine model. Most
CD8 T cells recognize a single antigen, TB10.4, which is encoded by the
esxH gene. Based on finding that
TB10.44−11-specific CD8 T cells poorly recognize Mtb-infected
macrophages, we hypothesized that Mtb evades detection by CD8 T cells and
focuses the CD8 T cell response on non-protective antigen. We termed these
antigens “decoy antigens.” To test this hypothesis, we took advantage of a
natural variant of the esxH gene, which contains an A10T
polymorphism within the TB10.44−11 epitope. This polymorphism
drastically alters the hierarchy of CD8 T cell responses elicited by Mtb. These
data suggest that immunodomination by the TB10.4 epitope acts to suppress
subdominant CD8 T cell responses to other Mtb antigens, impairing the CD8 T cell
response to other Mtb antigens, some of which might be presented by Mtb-infected
macrophages and be targets of protective immunity. Importantly, this single
amino acid polymorphism, which does not significantly alter MHC-binding or T
cell recognition, alters the half-life of the epitope and consequently, has a
profound effect on CD8 T cell priming and recognition of infected cells. These
data also provide a mechanism that could be exploited to manipulate the
hierarchy of immunodominant responses.
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Affiliation(s)
- Rujapak Sutiwisesak
- Immunology and Microbiology Program, Graduate School of Biomedical
Science, University of Massachusetts Medical School, Worcester, Massachusetts,
United States of America
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Nathan D. Hicks
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan
School of Public Health, Boston, Massachusetts, United States of
America
| | - Shayla Boyce
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Kenan C. Murphy
- Immunology and Microbiology Program, Graduate School of Biomedical
Science, University of Massachusetts Medical School, Worcester, Massachusetts,
United States of America
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Kadamba Papavinasasundaram
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Stephen M. Carpenter
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Julie Boucau
- Ragon Institute of Massachusetts General Hospital, Massachusetts
Institute of Technology and Harvard University, Cambridge, MA, United States of
America
| | - Neelambari Joshi
- Ragon Institute of Massachusetts General Hospital, Massachusetts
Institute of Technology and Harvard University, Cambridge, MA, United States of
America
| | - Sylvie Le Gall
- Ragon Institute of Massachusetts General Hospital, Massachusetts
Institute of Technology and Harvard University, Cambridge, MA, United States of
America
| | - Sarah M. Fortune
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan
School of Public Health, Boston, Massachusetts, United States of
America
| | - Christopher M. Sassetti
- Immunology and Microbiology Program, Graduate School of Biomedical
Science, University of Massachusetts Medical School, Worcester, Massachusetts,
United States of America
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
| | - Samuel M. Behar
- Immunology and Microbiology Program, Graduate School of Biomedical
Science, University of Massachusetts Medical School, Worcester, Massachusetts,
United States of America
- Department of Microbiology and Physiological Systems, University of
Massachusetts Medical School, Worcester, Massachusetts, United States of
America
- * E-mail:
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10
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Schneider KE, Park JN, Allen ST, Weir BW, Sherman SG. Knowledge of Good Samaritan Laws and Beliefs About Arrests Among Persons Who Inject Drugs a Year After Policy Change in Baltimore, Maryland. Public Health Rep 2020; 135:393-400. [PMID: 32264789 PMCID: PMC7238711 DOI: 10.1177/0033354920915439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Delivering and receiving prompt medical care during an overdose are imperative to ensure survival. Good Samaritan laws encourage people to call 911 during an overdose by providing immunity from selected drug arrests (eg, low-level possession). However, it is unclear whether persons who inject drugs (PWID) are aware of and understand these laws and their implications. We examined awareness among PWID of the 2015 Good Samaritan law in Maryland and their beliefs about whether they could be arrested for calling 911 or having an overdose. METHODS We surveyed 298 PWID in Baltimore, Maryland. We estimated the proportion who knew what the Good Samaritan law addressed and who believed they could be arrested for calling 911 or overdosing. We used a multivariate model to assess the association between harm-reduction services and knowledge of the Good Samaritan law or beliefs about getting arrested for calling 911 or overdosing. RESULTS Of PWID, 56 of 298 (18.8%) knew what the Good Samaritan law addressed, 43 of 267 (16.1%) believed they could be arrested for calling 911, and 32 of 272 (11.8%) believed they could be arrested for having an overdose. After adjusting for demographic characteristics, accessing the syringe services program was associated with accurate knowledge and the belief that PWID could be arrested for calling 911; however, training in overdose reversal was not associated. CONCLUSIONS Most PWID were unaware of the Good Samaritan law; this lack of awareness is a barrier to preventing overdose deaths. Educating PWID about Good Samaritan laws is essential, and such education should include police to ensure that law enforcement is congruent with Good Samaritan laws and does not perpetuate mistrust between police and PWID.
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Affiliation(s)
- Kristin E. Schneider
- Department of Mental Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | - Ju Nyeong Park
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sean T. Allen
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian W. Weir
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
| | - Susan G. Sherman
- Department of Health, Behavior and Society, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Shirey KA, Lai W, Brown LJ, Blanco JCG, Beadenkopf R, Wang Y, Vogel SN, Snyder GA. Select targeting of intracellular Toll-interleukin-1 receptor resistance domains for protection against influenza-induced disease. Innate Immun 2020; 26:26-34. [PMID: 31955622 PMCID: PMC6974880 DOI: 10.1177/1753425919846281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/17/2018] [Revised: 03/01/2019] [Accepted: 03/22/2019] [Indexed: 12/20/2022] Open
Abstract
TLRs are a family of PRRs that respond to PAMPs or host-derived Danger-Associated Molecular Patterns (DAMPs) to initiate host inflammation and immune responses. TLR dimerization and recruitment of adapter molecules is critical for intracellular signaling and is mediated through intracellular Toll-Interleukin 1 Receptor Resistance (TIR) domain interactions. Human TIR domains, including reported structures of TIR1, TIR2, TIR6, TIR10, TIRAP, and MyD88, contain Cysteine (Cys) interactions or modifications that are disproportionally at, or near, reported biological TIR interfaces, or in close proximity to functionally important regions. Therefore, we hypothesized that intracellular TIR Cys regulation may have greater functional importance than previously appreciated. Expression of mutant TLR4-C747S or treatment of TLR4 reporter cells with a small molecule, Cys-binding inhibitor of TLR4, TAK-242, abrogated LPS signaling in vitro . Using TAK-242, mice were protected from lethal influenza challenge as previously reported for extracellular TLR4 antagonists. Molecular modeling and sequence analysis of the region surrounding TLR4-Cys747 indicate conservation of a WxxxE motif identified among bacterial and NAD+-consuming TIRs, as well as within the TIRs domains of surface TLRs 1, 2, 4, 6, and 10. Together, these data support the hypothesis that critical Cys within the TIR domain are essential for TLR4 functionality.
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Affiliation(s)
- Kari Ann Shirey
- Department of Microbiology and Immunology, University of
Maryland School of Medicine, USA
| | - Wendy Lai
- Department of Microbiology and Immunology, University of
Maryland School of Medicine, USA
| | - Lindsey J Brown
- Institute of Human Virology, Department of Medicine, University
of Maryland School of Medicine, USA
| | | | - Robert Beadenkopf
- Institute of Human Virology, Department of Medicine, University
of Maryland School of Medicine, USA
| | - Yajing Wang
- Institute of Human Virology, Department of Medicine, University
of Maryland School of Medicine, USA
- China Pharmaceutical University, Nanjing, P.R. China
| | - Stefanie N Vogel
- Department of Microbiology and Immunology, University of
Maryland School of Medicine, USA
| | - Greg A Snyder
- Department of Microbiology and Immunology, University of
Maryland School of Medicine, USA
- Institute of Human Virology, Department of Medicine, University
of Maryland School of Medicine, USA
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12
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Abstract
Inflammasomes act as sensors of infection or damage to initiate immune responses.
While extensively studied in rodents, understanding of livestock inflammasomes
is limited. The NLRP1 inflammasome sensor in rodents is activated by
Toxoplasma gondii, Bacillus anthracis
lethal toxin (LT), and potentially other zoonotic pathogens. LT activates NLRP1
by N-terminal proteolysis, inducing macrophage pyroptosis and a pro-inflammatory
cytokine response. In contrast, NLRP1 in macrophages from humans and certain
rodent strains is resistant to LT cleavage, and pyroptosis is not induced.
Evolution of NLRP1 sequences towards those leading to pyroptosis is of interest
in understanding innate immune responses in different hosts. We characterized
NLRP1 in cattle (Bos taurus) and American bison (Bison
bison). Bovine NLRP1 is not cleaved by LT, and cattle and bison
macrophages do not undergo toxin-induced pyroptosis. Additionally, we found a
predicted Nlrp1 splicing isoform in cattle macrophages lacking
the N-terminal domain. Resistance to LT in bovine and human NLRP1 correlates
with evolutionary sequence similarity to rodents. Consistent with LT-resistant
rodents, bovine macrophages undergo a slower non-pyroptotic death in the
presence of LPS and LT. Overall, our findings support the model that NLRP1
activation by LT requires N-terminal cleavage, and provide novel information on
mechanisms underlying immune response diversity.
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Affiliation(s)
- Catherine E Vrentas
- Infectious Bacterial Diseases Unit, National Animal Disease
Center, Agricultural Research Service, US Department of Agriculture, Ames,
USA
- Catherine E Vrentas, Infectious Bacterial
Diseases Unit, National Animal Disease Center, Agricultural Research Service, US
Department of Agriculture, Ames, IA 50010, USA.
| | - Paola M Boggiatto
- Infectious Bacterial Diseases Unit, National Animal Disease
Center, Agricultural Research Service, US Department of Agriculture, Ames,
USA
| | - Steven C Olsen
- Infectious Bacterial Diseases Unit, National Animal Disease
Center, Agricultural Research Service, US Department of Agriculture, Ames,
USA
| | - Stephen H Leppla
- Laboratory of Parasitic Diseases, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, Bethesda, USA
| | - Mahtab Moayeri
- Laboratory of Parasitic Diseases, National Institute of Allergy
and Infectious Diseases, National Institutes of Health, Bethesda, USA
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13
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Bartelt LA, Bolick DT, Mayneris-Perxachs J, Kolling GL, Medlock GL, Zaenker EI, Donowitz J, Thomas-Beckett RV, Rogala A, Carroll IM, Singer SM, Papin J, Swann JR, Guerrant RL. Cross-modulation of pathogen-specific pathways enhances malnutrition during enteric co-infection with Giardia lamblia and enteroaggregative Escherichia coli. PLoS Pathog 2017; 13:e1006471. [PMID: 28750066 PMCID: PMC5549954 DOI: 10.1371/journal.ppat.1006471] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [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: 01/13/2017] [Accepted: 06/14/2017] [Indexed: 12/17/2022] Open
Abstract
Diverse enteropathogen exposures associate with childhood malnutrition. To
elucidate mechanistic pathways whereby enteric microbes interact during
malnutrition, we used protein deficiency in mice to develop a new model of
co-enteropathogen enteropathy. Focusing on common enteropathogens in
malnourished children, Giardia lamblia and enteroaggregative
Escherichia coli (EAEC), we provide new insights into
intersecting pathogen-specific mechanisms that enhance malnutrition. We show for
the first time that during protein malnutrition, the intestinal microbiota
permits persistent Giardia colonization and simultaneously
contributes to growth impairment. Despite signals of intestinal injury, such as
IL1α, Giardia-infected mice lack pro-inflammatory intestinal
responses, similar to endemic pediatric Giardia infections.
Rather, Giardia perturbs microbial host co-metabolites of
proteolysis during growth impairment, whereas host nicotinamide utilization
adaptations that correspond with growth recovery increase. EAEC promotes
intestinal inflammation and markers of myeloid cell activation. During
co-infection, intestinal inflammatory signaling and cellular recruitment
responses to EAEC are preserved together with a
Giardia-mediated diminishment in myeloid cell activation.
Conversely, EAEC extinguishes markers of host energy expenditure regulatory
responses to Giardia, as host metabolic adaptations appear
exhausted. Integrating immunologic and metabolic profiles during co-pathogen
infection and malnutrition, we develop a working mechanistic model of how
cumulative diet-induced and pathogen-triggered microbial perturbations result in
an increasingly wasted host. Malnourished children are exposed to multiple sequential, and oftentimes,
persistent enteropathogens. Intestinal microbial disruption and inflammation are
known to contribute to the pathogenesis of malnutrition, but how co-pathogens
interact with each other, with the resident microbiota, or with the host to
alter these pathways is unknown. Using a new model of enteric co-infection with
Giardia lamblia and enteroaggregative Escherichia
coli in mice fed a protein deficient diet, we identify host growth
and intestinal immune responses that are differentially mediated by
pathogen-microbe interactions, including parasite-mediated changes in intestinal
microbial host co-metabolism, and altered immune responses during co-infection.
Our data model how early life cumulative enteropathogen exposures progressively
disrupt intestinal immunity and host metabolism during crucial developmental
periods. Furthermore, studies in this co-infection model reveal new insights
into environmental and microbial determinants of pathogenicity for presently
common, but poorly understood enteropathogens like Giardia
lamblia, that may not conform to existing paradigms of microbial
pathogenesis based on single pathogen-designed models.
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Affiliation(s)
- Luther A. Bartelt
- Division of Infectious Diseases, Department of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of
America
- Center for Gastrointestinal Biology and Disease, Department of Medicine,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United
States of America
- * E-mail:
| | - David T. Bolick
- Division of Infectious Diseases and International Health, Department of
Medicine, University of Virginia, Charlottesville, Virginia, United States of
America
| | - Jordi Mayneris-Perxachs
- Division of Computational and Systems Medicine, Department of Surgery and
Cancer, Imperial College London, United Kingdom
| | - Glynis L. Kolling
- Division of Infectious Diseases and International Health, Department of
Medicine, University of Virginia, Charlottesville, Virginia, United States of
America
| | - Gregory L. Medlock
- Department of Biomedical Engineering, University of Virginia,
Charlottesville, Virginia, United States of America
| | - Edna I. Zaenker
- Division of Infectious Diseases and International Health, Department of
Medicine, University of Virginia, Charlottesville, Virginia, United States of
America
| | - Jeffery Donowitz
- Division of Pediatric Infectious Diseases, Children’s Hospital of
Richmond at Virginia Commonwealth University, Richmond, Virginia, United States
of America
| | - Rose Viguna Thomas-Beckett
- Division of Infectious Diseases, Department of Medicine, University of
North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of
America
| | - Allison Rogala
- Center for Gastrointestinal Biology and Disease, Department of Medicine,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United
States of America
| | - Ian M. Carroll
- Center for Gastrointestinal Biology and Disease, Department of Medicine,
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United
States of America
| | - Steven M. Singer
- Department of Biology, Georgetown University, Washington, DC, United
States of America
| | - Jason Papin
- Department of Biomedical Engineering, University of Virginia,
Charlottesville, Virginia, United States of America
| | - Jonathan R. Swann
- Division of Computational and Systems Medicine, Department of Surgery and
Cancer, Imperial College London, United Kingdom
| | - Richard L. Guerrant
- Division of Infectious Diseases and International Health, Department of
Medicine, University of Virginia, Charlottesville, Virginia, United States of
America
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