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Search Results: 1 - 10 of 6160 matches for " Jennifer Grinsdale "
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Early Detection of Tuberculosis Outbreaks among the San Francisco Homeless: Trade-Offs Between Spatial Resolution and Temporal Scale
Brandon W. Higgs, Mojdeh Mohtashemi, Jennifer Grinsdale, L. Masae Kawamura
PLOS ONE , 2007, DOI: 10.1371/journal.pone.0001284
Abstract: Background San Francisco has the highest rate of tuberculosis (TB) in the U.S. with recurrent outbreaks among the homeless and marginally housed. It has been shown for syndromic data that when exact geographic coordinates of individual patients are used as the spatial base for outbreak detection, higher detection rates and accuracy are achieved compared to when data are aggregated into administrative regions such as zip codes and census tracts. We examine the effect of varying the spatial resolution in the TB data within the San Francisco homeless population on detection sensitivity, timeliness, and the amount of historical data needed to achieve better performance measures. Methods and Findings We apply a variation of space-time permutation scan statistic to the TB data in which a patient's location is either represented by its exact coordinates or by the centroid of its census tract. We show that the detection sensitivity and timeliness of the method generally improve when exact locations are used to identify real TB outbreaks. When outbreaks are simulated, while the detection timeliness is consistently improved when exact coordinates are used, the detection sensitivity varies depending on the size of the spatial scanning window and the number of tracts in which cases are simulated. Finally, we show that when exact locations are used, smaller amount of historical data is required for training the model. Conclusion Systematic characterization of the spatio-temporal distribution of TB cases can widely benefit real time surveillance and guide public health investigations of TB outbreaks as to what level of spatial resolution results in improved detection sensitivity and timeliness. Trading higher spatial resolution for better performance is ultimately a tradeoff between maintaining patient confidentiality and improving public health when sharing data. Understanding such tradeoffs is critical to managing the complex interplay between public policy and public health. This study is a step forward in this direction.
Cost-effectiveness of tuberculosis evaluation and treatment of newly-arrived immigrants
Travis C Porco, Bryan Lewis, Elliot Marseille, Jennifer Grinsdale, Jennifer M Flood, Sarah E Royce
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-157
Abstract: Using a stochastic simulation for tuberculosis reactivation, transmission, and follow-up for a hypothetical cohort of 1000 individuals, we calculated the incremental cost-effectiveness of follow-up and evaluation interventions. We utilized published literature, California Reports of Verified Cases of Tuberculosis (RVCTs), demographic estimates from the California Department of Finance, Medicare reimbursement, and Medi-Cal reimbursement rates. Our target population was legal immigrants to the United States, our time horizon is twenty years, and our perspective was that of all domestic health-care payers. We examined the intervention to offer latent tuberculosis therapy to infected individuals, to increase the yield of domestic evaluation, and to increase the starting and completion rates of LTBI therapy with INH (isoniazid). Our outcome measures were the number of cases averted, the number of deaths averted, the incremental dollar cost (year 2004), and the number of quality-adjusted life-years saved.Domestic follow-up of B-notification patients, including LTBI treatment for latently infected individuals, is highly cost-effective, and at times, cost-saving. B-notification follow-up in California would reduce the number of new tuberculosis cases by about 6–26 per year (out of a total of approximately 3000). Sensitivity analysis revealed that domestic follow-up remains cost-effective when the hepatitis rates due to INH therapy are over fifteen times our best estimates, when at least 0.4 percent of patients have active disease and when hospitalization of cases detected through domestic follow-up is no less likely than hospitalization of passively detected cases.While the current immigration screening program is unlikely to result in a large change in case rates, domestic follow-up of B-notification patients, including LTBI treatment, is highly cost-effective. If as many as three percent of screened individuals have active TB, and early detection reduces the rate of hospi
Feasibility, acceptability, and cost of tuberculosis testing by whole-blood interferon-gamma assay
Puneet Dewan, Jennifer Grinsdale, Sally Liska, Ernest Wong, Robert Fallstad, L Masae Kawamura
BMC Infectious Diseases , 2006, DOI: 10.1186/1471-2334-6-47
Abstract: Patients seen at six community clinics serving homeless, immigrant, or injection-drug user (IDU) populations were routinely offered IGRA (Quantiferon-TB). Per guidelines, we excluded patients who were <17 years old, HIV-infected, immunocompromised, or pregnant. We reviewed medical records for IGRA results and completion of medical evaluation for TB, and at two clinics reviewed TB screening logs for instances of IGRA refusal or phlebotomy failure.Between November 1, 2003 and February 28, 2005, 4143 persons were evaluated by IGRA. 225(5%) specimens were not tested, and 89 (2%) were IGRA-indeterminate. Positive or negative IGRA results were available for 3829 (92%). Of 819 patients with positive IGRA results, 524 (64%) completed diagnostic evaluation within 30 days of their IGRA test date. Among 503 patients eligible for IGRA testing at two clinics, phlebotomy was refused by 33 (7%) and failed in 40 (8%). Including phlebotomy, laboratory, and personnel costs, IGRA use cost $33.67 per patient tested.IGRA implementation in a routine TB control program setting was feasible and acceptable among homeless, IDU, and immigrant patients in San Francisco, with results more frequently available than the historically described performance of TST. Laboratory-based diagnosis and surveillance for M. tuberculosis infection is now possible.Providers in the United States and Europe have for many years relied on the tuberculin skin test (TST) to detect infection with Mycobacterium tuberculosis in patients. The limitations of the TST are well documented, including placement variability, inter-reader variability, boosting, and difficulty in interpreting results in patients previously vaccinated with bacille Calmette Guerin (BCG) or with non-tuberculosis mycobacterial (NTM) infection. [1,2] Patients may find the test inconvenient because they must return in 48–72 hours for result reading and interpretation. TST use poses operational challenges, such as the training and retraining of numerou
Pyrazinamide Resistance, Mycobacterium tuberculosis Lineage and Treatment Outcomes in San Francisco, California
Jonathan M. Budzik, Leah G. Jarlsberg, Julie Higashi, Jennifer Grinsdale, Phil C. Hopewell, Midori Kato-Maeda, Payam Nahid
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0095645
Abstract: Background Pyrazinamide (PZA) is a first line agent for the treatment of active tuberculosis. PZA is also considered a potent companion drug for newer regimens under development. There are limited data on the demographic, clinical, and pathogen characteristics of PZA resistant tuberculosis. Methods Using a retrospective cohort study design, we evaluated all PZA resistant M. tuberculosis (M.tb) and M. bovis cases reported in San Francisco from 1991 to 2011. Demographic, clinical, and molecular data were analyzed. M.tb lineage was determined for all PZA resistant strains and compared to PZA susceptible strains. Results PZA resistance was identified in 1.8% (50 of 2,842) of mycobacterial isolates tested, corresponding to a case rate of 0.3 per 100,000 in the population. Monoresistant PZA infection was associated with the Hispanic population ([OR], 6.3; 95% [CI], 1.97–20.16) and 48% of cases were due to M. bovis. Infection with monoresistant PZA was also associated with extrapulmonary disease ([OR], 6.0; 95% [CI], 2.70–13.26). There was no statistically significant difference between treatment failure and mortality rates in patients infected with PZA monoresistance compared to pansusceptible controls (4% vs. 8%, p = 0.51), or those with PZA and MDR resistance (PZA-MDR) compared to MDR controls (18% vs. 29%, p = 0.40). PZA resistance was not associated with M.tb lineage. Conclusions Across two decades of comprehensive epidemiologic data on tuberculosis in San Francisco County, PZA resistance was uncommon. PZA resistance caused predominantly extrapulmonary disease and was more common in Hispanics compared to other ethnicities, with nearly half the cases attributed to M. bovis. No association was found between PZA monoresistance and M.tb lineage. Treatment outcomes were not adversely influenced by the presence of PZA resistance.
Use of Whole Genome Sequencing to Determine the Microevolution of Mycobacterium tuberculosis during an Outbreak
Midori Kato-Maeda, Christine Ho, Ben Passarelli, Niaz Banaei, Jennifer Grinsdale, Laura Flores, Jillian Anderson, Megan Murray, Graham Rose, L. Masae Kawamura, Nader Pourmand, Muhammad A. Tariq, Sebastien Gagneux, Philip C. Hopewell
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0058235
Abstract: Rationale Current tools available to study the molecular epidemiology of tuberculosis do not provide information about the directionality and sequence of transmission for tuberculosis cases occurring over a short period of time, such as during an outbreak. Recently, whole genome sequencing has been used to study molecular epidemiology of Mycobacterium tuberculosis over short time periods. Objective To describe the microevolution of M. tuberculosis during an outbreak caused by one drug-susceptible strain. Method and Measurements We included 9 patients with tuberculosis diagnosed during a period of 22 months, from a population-based study of the molecular epidemiology in San Francisco. Whole genome sequencing was performed using Illumina’s sequencing by synthesis technology. A custom program written in Python was used to determine single nucleotide polymorphisms which were confirmed by PCR product Sanger sequencing. Main results We obtained an average of 95.7% (94.1–96.9%) coverage for each isolate and an average fold read depth of 73 (1 to 250). We found 7 single nucleotide polymorphisms among the 9 isolates. The single nucleotide polymorphisms data confirmed all except one known epidemiological link. The outbreak strain resulted in 5 bacterial variants originating from the index case A1 with 0–2 mutations per transmission event that resulted in a secondary case. Conclusions Whole genome sequencing analysis from a recent outbreak of tuberculosis enabled us to identify microevolutionary events observable during transmission, to determine 0–2 single nucleotide polymorphisms per transmission event that resulted in a secondary case, and to identify new epidemiologic links in the chain of transmission.
Green Tea: A Potential Alternative Anti-Infectious Agent Catechins and Viral Infections  [PDF]
Jennifer Tran
Advances in Anthropology (AA) , 2013, DOI: 10.4236/aa.2013.34028

Tea is the second most consumed beverage in the world, following water. Black, oolong, and green tea are products of a perennial tree or shrub called Camellia sinensis. Camellia sinensis is native to Mainland China and is referenced in Chinese literature at least 5000 years ago. Since its discovery, green tea has been heralded as having several health benefits associated with its consumption. Traditionally, green tea has been used for a variety of medicinal purposes, such as the prevention and treatment of a variety of cancers, mental alertness, weight loss, lowering cholesterol level, and UV protection. Studies have shown that catechins, the polyphenols found in tealeaves, are effective as anti-infectious agents by affecting the infection process instead of specifically targeting the virus. This treatment strategy has the potential of reducing the prevalence of drug-resistant viruses and the reliance on anti-viral drug therapies. This paper will explore the efficacy of green tea in preventing infections by the hepatitis B and C, influenza and human immunodeficiency virus.

Anaphylaxis and Undiagnosed Aspirin Exacerbated Respiratory Disease in the Ambulatory Surgery Center: A Case Report  [PDF]
Jennifer Wu
Open Journal of Anesthesiology (OJAnes) , 2015, DOI: 10.4236/ojanes.2015.512043
Abstract: Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.
Nanoparticle Technology as a Double-Edged Sword: Cytotoxic, Genotoxic and Epigenetic Effects on Living Cells  [PDF]
Mytych Jennifer, Wnuk Maciej
Journal of Biomaterials and Nanobiotechnology (JBNB) , 2013, DOI: 10.4236/jbnb.2013.41008
Abstract: Nanoparticles are considered as powerful tools in nanotechnological applications. Due to their unique physicochemical properties, their interactions with different biological systems have been shown. Nanomaterials have been successfully used as coating materials or treatment and diagnosis tools. Nevertheless, toxic effects of nanoparticles in vitro and in vivo have also been reported. Here, we summarize the current state of knowledge on exposure routes, cellular uptake and toxicological activities of the commonly used nanoparticles. In this context, we discuss the mechanisms of toxicity of nanoparticles involving perturbation of redox milieu homeostasis and cellular signaling pathways.
The Impact of Cervical Cancer Treatment on Sexual Function and Intimate Relationships: Is Anyone Listening?  [PDF]
Jennifer L. Hunter
Open Journal of Obstetrics and Gynecology (OJOG) , 2014, DOI: 10.4236/ojog.2014.48069

The purpose of this research was to describe women’s narrative accounts of the impact of cervical cancer treatment on their sexual function and intimate relationships, and to evaluate what changes in care and education are needed to enhance quality of life and intimacy after treatment. The research approach was a narrative design, using semi-structured, in-depth interviews. Narratives were examined within and across interviews, and thematic content analysis completed. The study was done in a gynecologic oncology clinic at a public hospital in the Midwest United States. The sample consisted of twelve women, ranging in age from 27 to 59, who had completed the cervical cancer treatment with chemo-radiation or radiation and surgery, and were now followed by their gynecologic oncologists. Across narratives, five major themes were identified, including unexpected physical complications, not “getting back to normal,” emotional pain and isolation, lack of available information, and inadequate health care provider response to treatment complications and sexual relationship problems. Women’s stories reveal that sex and intimacy issues for cervical cancer survivors remain within a culture of silence. In many situations, health professionals did not provide information that realistically prepared women and partners for probable consequences of treatment, did not assess sexual issues before or after treatment, did not recognize various symptoms as being complications of cancer treatment, did not make referrals, and/or recognized complications, but accepted them as “normal” and without solution. Ethical implications for health professionals and the need for education, communication, and the development of new lines of research are discussed.

Twiddler’s Syndrome in a Patient with Dystonic Tremor Treated with DBS  [PDF]
Jennifer Samuelsson, Patric Blomstedt
Open Journal of Modern Neurosurgery (OJMN) , 2014, DOI: 10.4236/ojmn.2014.44034
Abstract: Background and Importance: Twiddler’s syndrome is a rare complication of DBS. This condition occurs when the IPG is consciously or inadvertently rotated in its pocket, resulting in torsion and possible dislodgement of implanted electrodes, with subsequent loss of function. Methods: Here we present a patient diagnosed with Twiddler’s syndrome. The patient presented with straining cables at the neck five months after bilateral Gpi DBS and an x-ray demonstrated Twiddler’s syndrome. Initial revision with preventive measures proved futile. After some time the condition recurred, now with dislocation of one of the intracerebral electrodes. In a second revision the IPG was placed under the pectoralis muscle, which has so far prevented further rotation. Results and Conclusion: While Twiddler’s syndrome is fairly uncommon, it remains to be a risk associated with DBS, recognizing the potential risks and signs might allow for preventive measures avoiding dislocation of the intracerebral electrodes.
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