Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 53 Records) |
Query Trace: Ghosh S [original query] |
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Tuberculosis preventive treatment update - U.S. President's Emergency Plan for AIDS Relief, 36 Countries, 2016-2023
Ajiboye AS , O'Connor S , Smith JP , Ahmedov S , Coggin WL , Charles M , Ghosh S , Pierre P , Shah N , Teran RA , Moonan PK , Date A . MMWR Morb Mortal Wkly Rep 2024 73 (11) 233-238 Tuberculosis (TB) is the leading cause of death among persons with HIV. In 2022, an estimated 167,000 TB-related deaths occurred globally among persons with HIV. TB preventive treatment (TPT) helps prevent TB disease and is recommended for persons at high risk for developing TB, including those with HIV. TPT, when taken with antiretroviral treatment (ART), can reduce TB-attributable deaths among persons with HIV. In 2018, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program committed to offer one course of TPT to all eligible clients receiving ART. This analysis describes trends in TPT initiation and completion among PEPFAR-supported programs in 36 countries in Africa, Central and South America, and Asia during fiscal years (FYs) 2017-2023. Overall, TPT initiation rates peaked in FY19, a possible sign of programmatic saturation. TPT initiation among clients who had been on ART <6 months reached 59%, and overall completion rates up to 87% were reported. Approximately 13 million persons with HIV have completed TPT since FY17, but widespread adoption of shorter regimens, patient-centered approaches, and electronic medical record systems might be needed to ensure full TPT coverage. Through PEPFAR's partnership with national HIV programs, TPT has become the standard of care for persons with HIV. |
Epidemiology and risk factors of norovirus infections among diarrhea patients admitted to tertiary care hospitals in Bangladesh
Satter SM , Abdullah Z , Fariha F , Karim Y , Rahman MM , Balachandran N , Ghosh PK , Hossain ME , Mirza SA , Hall AJ , Gastañaduy PA , Rahman M , Vinjé J , Parashar UD . J Infect Dis 2023 228 (7) 818-828 BACKGROUND: Norovirus is a major cause of endemic acute gastroenteritis (AGE) worldwide. We described the epidemiology, risk factors, and genotypic distribution of noroviruses among hospitalized patients of all ages in Bangladesh. METHODS: From March 2018 to October 2021, 1250 AGE case patients and controls (age, sex, season, and site matched) were enrolled at 10 hospitals. Demographic and clinical information was collected; real-time reverse-transcriptase polymerase chain reaction (RT-PCR) used to test stool specimens, and positive samples were genotyped. RESULTS: Norovirus was detected in 9% of cases (111 of 1250) and 15% (182 of 1250) of controls. Eighty-two percent of norovirus-positive cases were in children <5 years old. Norovirus-positive AGE hospitalizations occurred year-round, with peaks in April and October. Risk factors for norovirus included age <5 years (adjusted odds ratio, 3.1 [95% confidence interval, 1.9-5.2]) and exposure to a patient with AGE in the 10 days before enrollment (3.8 [1.9-7.2]). GII.3[P16] and GII.4 Sydney[P16] were the predominant genotypes. CONCLUSIONS: We highlight the burden of norovirus in hospital settings. Young age and recent exposure to a patient with AGE were risk factors for norovirus. A high prevalence of norovirus among controls might represent asymptomatic reinfections or prolonged shedding from a previous infection; carefully designed longitudinal studies are needed to improve our understanding of norovirus infections in Bangladesh. |
Lab on a chip for detecting Clara cell protein 16 (CC16) for potential screening of the workers exposed to respirable silica aerosol
Ahn C , Lee T , Shin JH , Lee JS , Thiyagarajan Upaassana V , Ghosh S , Ku BK . Microfluid Nanofluidics 2023 27 (11) 1-10 Early detection of pulmonary responses to silica aerosol exposure, such as lung inflammation as well as early identification of silicosis initiation, is of great importance in disease prevention of workers. In this study, to early screen the health condition of the workers who are exposed to respirable silica dusts, an immunoassay lab on a chip (LOC) was designed, developed and fully characterized for analyzing Clara cell protein 16 (CC16) in serum which has been considered as one of the potential biomarkers of lung inflammation or lung damage due to the respirable silica dusts. Sandwich immunoassay of CC16 was performed on the LOC developed with a custom-designed portable analyzer using artificial serums spiked with CC16 protein first and then human serums obtained from the coal mine workers exposed to the respirable silica-containing dusts. The dynamic range of CC16 assay performed on the LOC was in a range of 0.625–20 ng/mL, and the achieved limit of detection (LOD) was around 0.35 ng/mL. The assay results of CC16 achieved from both the developed LOC and the conventional 96 well plate showed a reasonable corelation. The correlation between the conventional reader and the developed portable analyzer was found to be reasonable, resulting in R 2 ~ 0.93. This study shows that the LOC developed for the early detection of CC16 can be potentially applied for the development of a field-deployable point-of-care testing (POCT) for the early monitoring of the field workers who are exposed to silica aerosol. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. |
Influenza-associated respiratory illness among five cohorts of pregnant women and their young infants (0-6months), Bangladesh, 2013-2017
Akhtar Z , Ghosh P , Bhuiyan M , Sturm-Ramirez K , Rahman M , Howlader M , Dawood F , Chowdhury F , Iuliano D . Influenza Other Respir Viruses 2023 17 (8) e13175 BACKGROUND: Pregnant women with their infants are considered at higher risk for influenza-associated complications, and the World Health Organization (WHO) recommends influenza vaccination during pregnancy to protect them, including their infants (0-6 months). There are limited data on the influenza burden among pregnant women and their infants (0-6 months), and there are no routine influenza vaccinations in Bangladesh. METHODS: Five annual cohorts (2013-2017) of pregnant women were enrolled from the eight sub-districts of Bangladesh before the influenza season (May-September); they were contacted weekly to identify new onset of influenza-like illness (ILI) (subjective or measured fever and cough) and acute respiratory illness (ARI) (at least two of these symptoms: cough, rhinorrhea, or difficulty in breathing) among their infants from birth to 6 months of age. We collected nasopharyngeal swabs from ILI and ARI cases, tested by real-time reverse transcription polymerase chain reaction (rRT-PCR) for influenza virus (including types and subtypes) and estimated influenza incidence (95% CI)/10000 pregnant women-months or infant-months, respectively. RESULTS: We enrolled 9020 pregnant women, followed for 26,709 pregnancy-months, and detected 1241 ILI episodes. We also followed 8963 infants for 51,518 infant-months and identified 5116 ARI episodes. Influenza positivity was 23% for ILI and 3% for ARI cases. The overall incidence (2013-2017) of influenza among pregnant women was 158.5/10000 pregnant women-months (95% CI: 141.4-177.6) and that among infants was 21.9/10000 infant-months (95% CI: 18.2-26.5). CONCLUSIONS: Although the data was collected more than 5 years ago, as the only baseline data, our findings illustrate evidence of influenza burden among pregnant women and infants (0-6 months), which may support preventive policy decisions in Bangladesh. |
Appreciative inquiry and the co-creation of an evaluation framework for Extension for Community Healthcare Outcomes (ECHO) implementation: A two-country experience
Ghosh S , Struminger BB , Singla N , Roth BM , Kumar A , Anand S , Mtete E , Lusekelo J , Massawe I , Jarpe-Ratner E , Seweryn SM , Risley K , Moonan PK , Pinsker E . Eval Program Plann 2022 92 102067 Persistent gaps exist in healthcare workers' capacity to address HIV and tuberculosis in Asia and Africa due to constraints in resources and knowledge. Project ECHO (Extension for Community Healthcare Outcomes) leverages video-enabled technology to build workforce capacity and promote collaboration through mentorship and case-based learning. To understand current perceptions of ECHO participants and develop a comprehensive evaluation framework for ECHO implementation, we utilized modified appreciative inquiry guided focus group discussions (FGD) in India and Tanzania and called it SCORE (Strengths, Challenges, Opportunities, Results, and Evaluation). Content and thematic analysis of transcripts from FGDs and key-informant interviews triangulated perceptions of diverse stakeholders about ECHO implementation and identified key elements for development of the framework. The perceived strengths (S) were capacity building and establishing communities of practice. The perceived challenges (C) included securing resources, engaging leadership, and building systems for monitoring impact. Improved internet connectivity, addressing logistical challenges, encouraging session interactivity, and having strategic scale-up plans were perceived opportunities (O). Additionally, gathering measurable results (R) led to development of a comprehensive evaluation (E) framework. Contextualizing and facilitating SCORE with qualitative analysis of findings 6-12months post-ECHO implementation may serve as a best practice to assess mid-course corrections to improve ECHO implementation quality. |
Evaluation of Sputum-Culture Results for Tuberculosis Patients in the United States-Affiliated Pacific Islands
Ghosh S , Felix D , Kammerer JS , Talarico S , Brostrom R , Starks A , Silk B . Asia Pac J Public Health 2021 34 10105395211060119 Sputum-culture confirmation guides tuberculosis (TB) diagnosis and patient management but has previously been reported to be low in the US-Affiliated Pacific Islands (USAPI). We evaluated factors associated with positive sputum-culture results by analyzing TB case surveillance and laboratory data, including sputa quality and quantity for diagnostic specimens from the USAPI. A lower proportion of sputum specimens were reported as culture positive from the USAPI (42%), compared with Hawaii (58%) and the United States (55%). Few (3%) sputa collected from TB patients in the USAPI had both optimal quality and quantity; 40% had optimal quality (mucoid), and 7% had optimal quantity (>5 mL). Suboptimal sputum specimen quality and quantity contributed to fewer sputum-culture positive results in the USAPI. Improving sputum collection and handling might lead to more culture positive results and ultimately improve patient care and TB control in USAPI. |
A Protocol for a Comprehensive Monitoring and Evaluation Framework With a Compendium of Tools to Assess Quality of Project ECHO (Extension for Community Healthcare Outcomes) Implementation Using Mixed Methods, Developmental Evaluation Design
Ghosh S , Roth BM , Massawe I , Mtete E , Lusekelo J , Pinsker E , Seweryn S , Moonan PK , Struminger BB . Front Public Health 2021 9 714081 Introduction: The United States Centers for Disease Control and Prevention (CDC), through U.S. President's Emergency Plan for AIDS Relief (PEPFAR), supports a third of all people receiving HIV care globally. CDC works with local partners to improve methods to find, treat, and prevent HIV and tuberculosis. However, a shortage of trained medical professionals has impeded efforts to control the HIV epidemic in Sub-Saharan Africa and Asia. The Project Extension for Community Healthcare Outcomes (ECHO(TM)) model expands capacity to manage complex diseases, share knowledge, disseminate best practices, and build communities of practice. This manuscript describes a practical protocol for an evaluation framework and toolkit to assess ECHO implementation. Methods and Analysis: This mixed methods, developmental evaluation design uses an appreciative inquiry approach, and includes a survey, focus group discussion, semi-structured key informant interviews, and readiness assessments. In addition, ECHO session content will be objectively reviewed for accuracy, content validity, delivery, appropriateness, and consistency with current guidelines. Finally, we offer a mechanism to triangulate data sources to assess acceptability and feasibility of the evaluation framework and compendium of monitoring and evaluation tools. Expected impact of the study on public health: This protocol offers a unique approach to engage diverse group of stakeholders using an appreciative inquiry process to co-create a comprehensive evaluation framework and a compendium of assessment tools. This evaluation framework utilizes mixed methods (quantitative and qualitative data collection tools), was pilot tested in Tanzania, and has the potential for contextualized use in other countries who plan to evaluate their Project ECHO implementation. |
Seasonal influenza during the COVID-19 pandemic in Bangladesh
Akhtar Z , Chowdhury F , Rahman M , Ghosh PK , Ahmmed MK , Islam MA , Mott JA , Davis W . PLoS One 2021 16 (8) e0255646 INTRODUCTION: During the 2019 novel coronavirus infectious disease (COVID-19) pandemic in 2020, limited data from several countries suggested reduced seasonal influenza viruses' circulation. This was due to community mitigation measures implemented to control the pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used sentinel surveillance data to identify changes in the 2020 influenza season compared with previous seasons in Bangladesh. METHODS: We used hospital-based influenza surveillance (HBIS) data of Bangladesh that are generated year-round and are population-representative severe acute respiratory infection (SARI) data for all age groups from seven public and two private tertiary care level hospitals data from 2016 to 2019. We applied the moving epidemic method (MEM) by using R language (v4.0.3), and MEM web applications (v2.14) on influenza-positive rates of SARI cases collected weekly to estimate an average seasonal influenza curve and establish epidemic thresholds. RESULTS: The 2016-2019 average season started on epi week 18 (95% CI: 15-25) and lasted 12.5 weeks (95% CI: 12-14 weeks) until week 30.5. The 2020 influenza season started on epi week 36 and ended at epi week 41, lasting for only five weeks. Therefore, influenza epidemic started 18 weeks later, was 7.5 weeks shorter, and was less intense than the average epidemic of the four previous years. The 2020 influenza season started on the same week when COVID-19 control measures were halted, and 13 weeks after the measures were relaxed. CONCLUSION: Our findings suggest that seasonal influenza circulation in Bangladesh was delayed and less intense in 2020 than in previous years. Community mitigation measures may have contributed to this reduction of seasonal influenza transmission. These findings contribute to a limited but growing body of evidence that influenza seasons were altered globally in 2020. |
Evaluation of Loopamp Leishmania Detection Kit and Leishmania Antigen ELISA for Post-Elimination Detection and Management of Visceral Leishmaniasis in Bangladesh
Hossain F , Picado A , Owen SI , Ghosh P , Chowdhury R , Maruf S , Khan MAA , Rashid MU , Nath R , Baker J , Ghosh D , Adams ER , Duthie MS , Hossain MS , Basher A , Nath P , Aktar F , Cruz I , Mondal D . Front Cell Infect Microbiol 2021 11 670759 With reduced prevalence of visceral leishmaniasis (VL) in the Indian subcontinent (ISC), direct and field deployable diagnostic tests are needed to implement an effective diagnostic and surveillance algorithm for post-elimination VL control. In this regard, here we investigated the diagnostic efficacies of a loop-mediated isothermal amplification (LAMP) assay (Loopamp™ Leishmania Detection Kit, Eiken Chemical CO., Ltd, Japan), a real-time quantitative PCR assay (qPCR) and the Leishmania antigen ELISA (CLIN-TECH, UK) with different sampling techniques and evaluated their prospect to incorporate into post-elimination VL control strategies. Eighty clinically and rK39 rapid diagnostic test confirmed VL cases and 80 endemic healthy controls were enrolled in the study. Peripheral blood and dried blood spots (DBS) were collected from all the participants at the time of diagnosis. DNA was extracted from whole blood (WB) and DBS via silica columns (QIAGEN) and boil & spin (B&S) methods and tested with qPCR and Loopamp. Urine was collected from all participants at the time of diagnosis and was directly subjected to the Leishmania antigen ELISA. 41 patients were followed up and urine samples were collected at day 30 and day 180 after treatment and ELISA was performed. The sensitivities of the Loopamp-WB(B&S) and Loopamp-WB(QIA) were 96.2% (95% CI 89·43-99·22) and 95% (95% CI 87·69-98·62) respectively. The sensitivity of Loopamp-DBS(QIA) was 85% (95% CI 75·26- 92·00). The sensitivities of the qPCR-WB(QIA) and qPCR-DBS(QIA) were 93.8% (95% CI 86·01-97·94) and 72.5% (95% CI 61·38-81·90) respectively. The specificity of all molecular assays was 100%. The sensitivity and specificity of the Leishmania antigen ELISA were 97.5% (95% CI 91·47-99·70) and 91.95% (95% CI 84·12-96·70) respectively. The Leishmania antigen ELISA depicted clinical cure at day 180 in all the followed-up cases. Efficacy and sustainability identify the Loopamp-WB(B&S) and the Leishmania antigen ELISA as promising and minimally invasive VL diagnostic tools to support VL diagnostic and surveillance activities respectively in the post-elimination era. |
Risk of intussusception after monovalent rotavirus vaccine (Rotavac) in Indian infants: A self-controlled case series analysis
Das MK , Arora NK , Poluru R , Tate JE , Gupta B , Sharan A , Aggarwal MK , Haldar P , Parashar UD , Zuber PLF , Bonhoeffer J , Ray A , Wakhlu A , Vyas BR , Iqbal Bhat J , Goswami JK , Mathai J , Kameswari K , Bharadia L , Sankhe L , Ajayakumar MK , Mohan N , Jena PK , Sarangi R , Shad R , Debbarma SK , Shyamala J , Ratan SK , Sarkar S , Kumar V , Maure CG , Dubey AP , Gupta A , Sam CJ , Mufti GN , Trivedi H , Shad J , Lahiri K , R K , Luthra M , Behera N , P P , Rajamani G , Kumar R , Sarkar R , Santosh Kumar A , Sahoo SK , Ghosh SK , Mane S , Dash A , Charoo BA , Tripathy BB , Rajendra Prasad G , S HK , K J , Sarkar NR , Arunachalam P , Mohapatra SSG , Garge S . Vaccine 2021 39 (1) 78-84 BACKGROUND: An association between rotavirus vaccination and intussusception has been documented in post-licensure studies in some countries. We evaluated the risk of intussusception associated with monovalent rotavirus vaccine (Rotavac) administered at 6, 10 and 14 weeks of age in India. METHODS: Active prospective surveillance for intussusception was conducted at 22 hospitals across 16 states from April 2016 through September 2017. Data on demography, clinical features and vaccination were documented. Age-adjusted relative incidence for 1-7, 8-21, and 1-21 days after rotavirus vaccination in children aged 28-364 days at intussusception onset was estimated using the self-controlled case-series (SCCS) method. Only Brighton Collaboration level 1 cases were included. RESULTS: Out of 670 children aged 2-23 months with intussusception, 311 (46.4%) children were aged 28-364 days with confirmed vaccination status. Out of these, 52 intussusception cases with confirmed receipt of RVV were included in the SCCS analysis. No intussusception case was observed within 21 days of dose 1. Only one case occurred during 8-21 days after the dose 2. Post-dose 3, two cases in 1-7 days and 7 cases during 8-21 days period were observed. There was no increased risk of intussusception during 1-7 days after the doses 1 and 2 (zero cases observed) or dose 3 (relative incidence [RI], 1.71 [95% confidence interval {CI} 0.0-5.11]). Similarly, no increased risk during 8-21 days after the dose 1 (zero cases observed), dose 2 (RI, 0.71 [95% CI, 0.0-3.28]) or dose 3 (RI, 2.52 [95% CI, 0.78-5.61]). The results were similar for 1-21 day periods after the doses separately or pooled. CONCLUSIONS: The risk of intussusception during the first 21 days after any dose of rotavirus vaccine (Rotavac) was not higher among the Indian infants than the background risk, based on limited SCCS analysis of 52 children. |
Minimal SARS-CoV-2 Transmission After Implementation of a Comprehensive Mitigation Strategy at a School - New Jersey, August 20-November 27, 2020.
Volpp KG , Kraut BH , Ghosh S , Neatherlin J . MMWR Morb Mortal Wkly Rep 2021 70 (11) 377-381 During fall 2020, many U.S. kindergarten through grade 12 (K-12) schools closed campuses and instituted remote learning to limit in-school transmission of SARS-CoV-2, the virus that causes COVID-19 (1,2). A New Jersey grade 9-12 boarding school with 520 full-time resident students, 255 commuter students, and 405 faculty and staff members implemented a comprehensive mitigation strategy that included universal masking, testing, upgraded air-handling equipment to improve ventilation, physical distancing of ≥6 ft, contact tracing, and quarantine and isolation protocols to prevent and control transmission of SARS-CoV-2 among students, faculty, and staff members. Mandatory twice-weekly screening using real-time reverse transcription-polymerase chain reaction (RT-PCR) testing of all students and staff members during August 20-November 27, 2020, resulted in the testing of 21,449 specimens. A total of 19 (5%) of 405 faculty and staff members and eight (1%) of 775 students received positive test results; only two identified cases were plausibly caused by secondary transmission on campus. Comprehensive mitigation approaches including frequent testing and universal masking can help prevent outbreaks in in-person high school settings even when community transmission is ongoing. |
SOX2 mediates carbon nanotube-induced fibrogenesis and fibroblast stem cell acquisition
Kiratipaiboon C , Voronkova M , Ghosh R , Rojanasakul LW , Dinu CZ , Chen YC , Rojanasakul Y . ACS Biomater Sci Eng 2020 6 (9) 5290-5304 Certain nanosized particles like carbon nanotubes (CNTs) are known to induce pulmonary fibrosis, but the underlying mechanisms are unclear, and efforts to prevent this disease are lacking. Fibroblast-associated stem cells (FSCs) have been suggested as a critical driver of fibrosis induced by CNTs by serving as a renewable source of extracellular matrix-producing cells; however, a detailed understanding of this process remains obscure. Here, we demonstrated that single-walled CNTs induced FSC acquisition and fibrogenic responses in primary human lung fibroblasts. This was indicated by increased expression of stem cell markers (e.g., CD44 and ABCG2) and fibrogenic markers (e.g., collagen and α-SMA) in CNT-exposed cells. These cells also showed increased sphere formation, anoikis resistance, and aldehyde dehydrogenase (ALDH) activities, which are characteristics of stem cells. Mechanistic studies revealed sex-determining region Y-box 2 (SOX2), a self-renewal associated transcription factor, as a key driver of FSC acquisition and fibrogenesis. Upregulation and colocalization of SOX2 and COL1 were found in the fibrotic lung tissues of CNT-exposed mice via oropharyngeal aspiration after 56 days. The knockdown of SOX2 by gene silencing abrogated the fibrogenic and FSC-inducing effects of CNTs. Chromatin immunoprecipitation assays identified SOX2-binding sites on COL1A1 and COL1A2, indicating SOX2 as a transcription factor in collagen synthesis. SOX2 was also found to play a critical role in TGF-β-induced fibrogenesis through its collagen-and FSC-inducing effects. Since many nanomaterials are known to induce TGF-β, our findings that SOX2 regulate FSCs and fibrogenesis may have broad implications on the fibrogenic mechanisms and treatment strategies of various nanomaterial-induced fibrotic disorders. |
Association of biosecurity and hygiene practices with environmental contamination with influenza A viruses in live bird markets, Bangladesh
Chowdhury S , Azziz-Baumgartner E , Kile JC , Hoque MA , Rahman MZ , Hossain ME , Ghosh PK , Ahmed SSU , Kennedy ED , Sturm-Ramirez K , Gurley ES . Emerg Infect Dis 2020 26 (9) 2087-2096 In Bangladesh, live bird market environments are frequently contaminated with avian influenza viruses. Shop-level biosecurity practices might increase risk for environmental contamination. We sought to determine which shop-level biosecurity practices were associated with environmental contamination. We surveyed 800 poultry shops to describe biosecurity practices and collect environmental samples. Samples from 205 (26%) shops were positive for influenza A viral RNA, 108 (14%) for H9, and 60 (8%) for H5. Shops that slaughtered poultry, kept poultry overnight, remained open without rest days, had uneven muddy floors, held poultry on the floor, and housed sick and healthy poultry together were more frequently positive for influenza A viruses. Reported monthly cleaning seemed protective, but disinfection practices were not otherwise associated with influenza A virus detection. Slaughtering, keeping poultry overnight, weekly rest days, infrastructure, and disinfection practices could be targets for interventions to reduce environmental contamination. |
Is India's public health care system prepared for cervical cancer screening: Evaluating facility readiness from the fourth round of the District Level Household and Facility Survey (DLHS-4)
Dhillon PK , Hallowell B , Agrawal S , Ghosh A , Yadav A , Van Dyne E , Senkomago V , Patel SA , Saraf D , Hariprasad R , Dumka N , Mehrotra R , Saraiya M . Prev Med 2020 138 106147 India's cervical cancer screening was launched in 2016 and we evaluated baseline facility readiness using nationally representative data from the 2012-13 District Level Household and Facility Survey on 4 tiers of the public health care system - 18,367 sub-health centres (SHC's), 8540 primary health centres (PHC's), 4810 community health centres and 1540 district/sub-divisional hospitals. To evaluate facility readiness we used the Improving Data for Decision Making in Global Cervical Cancer Programmes toolkit on six domains - potential staffing, infrastructure, equipment and supplies, infection prevention, medicines and laboratory testing, and data management. Composite scores were created by summing responses within domains, standardizing scores across domains at each facility level, and averaging across districts/states. Overall, readiness scores were low for cervical cancer screening. At SHC's, the lowest scores were observed in 'infrastructure' (0.55) and 'infection prevention' (0.44), while PHC's had low 'potential staffing' scores (0.50) due to limited manpower to diagnose and treat (cryotherapy) potential cases. Scores were higher for tiers conducting diagnostic work-up and treatment/referral. The highest scores were in 'potential staffing' except for PHC's, while the lowest scores were in 'infection & prevention' and 'medicines and laboratory'. Goa and Maharashtra were consistently top 5 ranking states for readiness. Substantial heterogeneity in facility readiness for cervical cancer screening spans states and tiers of India's public healthcare system. Infrastructure and staffing are large barriers to screening at PHCs, which are crucial for referral of high-risk patients. Our results suggest focus areas in cervical cancer screening at the district level for policy makers. |
Temporal trends and demographic risk factors for hospital admissions due to carbon monoxide poisoning in England
Roca-Barcelo A , Crabbe H , Ghosh R , Freni-Sterrantino A , Fletcher T , Leonardi G , Hoge C , Hansell AL , Piel FB . Prev Med 2020 136 106104 Unintentional non-fire related (UNFR) carbon monoxide (CO) poisoning is a preventable cause of morbidity and mortality. Epidemiological data on UNFR CO poisoning can help monitor changes in the magnitude of this burden, particularly through comparisons of multiple countries, and to identify vulnerable sub-groups of the population which may be more at risk. Here, we collected data on age- and sex- specific number of hospital admissions with a primary diagnosis of UNFR CO poisoning in England (2002-2016), aggregated to small areas, alongside area-level characteristics (i.e. deprivation, rurality and ethnicity). We analysed temporal trends using piecewise log-linear models and compared them to analogous data obtained for Canada, France, Spain and the US. We estimated age-standardized rates per 100,000 inhabitants by area-level characteristics using the WHO standard population (2000-2025). We then fitted the Besag York Mollie (BYM) model, a Bayesian hierarchical spatial model, to assess the independent effect of each area-level characteristic on the standardized risk of hospitalization. Temporal trends showed significant decreases after 2010. Decreasing trends were also observed across all countries studied, yet France had a 5-fold higher risk. Based on 3399 UNFR CO poisoning hospitalizations, we found an increased risk in areas classified as rural (0.69, 95% CrI: 0.67; 0.80), highly deprived (1.77, 95% CrI: 1.66; 2.10) or with the largest proportion of Asian (1.15, 95% CrI: 1.03; 1.49) or Black population (1.35, 95% CrI: 1.20; 1.80). Our multivariate approach provides strong evidence for the identification of vulnerable populations which can inform prevention policies and targeted interventions. |
Effectiveness of a behavior change intervention with hand sanitizer use and respiratory hygiene in reducing laboratory-confirmed influenza among schoolchildren in Bangladesh: A cluster randomized controlled trial
Biswas D , Ahmed M , Roguski K , Ghosh PK , Parveen S , Nizame FA , Rahman MZ , Chowdhury F , Rahman M , Luby SP , Sturm-Ramirez K , Iuliano AD . Am J Trop Med Hyg 2019 101 (6) 1446-1455 Schoolchildren are commonly linked to influenza transmission. Handwashing with soap has been shown to decrease infections; however, improving handwashing practices using soap and water is difficult in low-resource settings. In these settings, alternative hygiene options, such as hand sanitizer, could improve handwashing promotion to reduce influenza virus infections. We conducted a cluster randomized control trial in 24 primary schools in Dhaka to assess the effectiveness of hand sanitizer and a respiratory hygiene education intervention in reducing influenza-like illness (ILI) and laboratory-confirmed influenza during June-September 2015. Twelve schools were randomly selected to receive hand sanitizer and respiratory hygiene education, and 12 schools received no intervention. Field staff actively followed children daily to monitor for new ILI episodes (cough with fever) through school visits and by phone if a child was absent. When an illness episode was identified, medical technologists collected nasal swabs to test for influenza viruses. During the 10-week follow-up period, the incidence of ILI per 1,000 student-weeks was 22 in the intervention group versus 27 in the control group (P-value = 0.4). The incidence of laboratory-confirmed influenza was 53% lower in the intervention schools (3/1,000 person-weeks) than in the control schools (6/1,000 person-weeks) (P-value = 0.01). Hand sanitizer and respiratory hygiene education can help to reduce the risk of influenza virus transmission in schools. |
Acquisition of cancer stem cell-like properties in human small airway epithelial cells after a long-term exposure to carbon nanomaterials
Kiratipaiboon C , Stueckle TA , Ghosh R , Rojanasakul LW , Chen YC , Dinu CZ , Rojanasakul Y . Environ Sci Nano 2019 6 (7) 2152-2170 Cancer stem cells (CSCs) are a key driver of tumor formation and metastasis, but how they are affected by nanomaterials is largely unknown. The present study investigated the effects of different carbon-based nanomaterials (CNMs) on neoplastic and CSC-like transformation of human small airway epithelial cells and determined the underlying mechanisms. Using a physiologically relevant exposure model (long-term/low-dose) with system validation using a human carcinogen, asbestos, we demonstrated that single-walled carbon nanotubes, multi-walled carbon nanotubes, ultrafine carbon black, and crocidolite asbestos induced particle-specific anchorage-independent colony formation, DNA-strand breaks, and p53 downregulation, indicating the genotoxicity and carcinogenic potential of CNMs. The chronic CNM-exposed cells exhibited CSC-like properties as indicated by 3D spheroid formation, anoikis resistance, and CSC marker expression. Mechanistic studies revealed specific self-renewal and epithelial-mesenchymal transition (EMT)-related transcription factors that are involved in the cellular transformation process. Pathway analysis of gene signaling networks supports the role of SOX2 and SNAI1 signaling in CNM-mediated transformation. These findings support the potential carcinogenicity of high aspect ratio CNMs and identified molecular targets and signaling pathways that may contribute to disease development. |
Highly sensitive lab on a chip (LOC) immunoassay for early diagnosis of respiratory disease caused by respirable crystalline silica (RCS)
Upaassana VT , Ghosh S , Chakraborty A , Birch ME , Joseph P , Han J , Ku BK , Ahn CH . Anal Chem 2019 91 (10) 6652-6660 Respirable crystalline silica (RCS) produced in mining and construction industries can cause life-threatening diseases such as silicosis, lung cancer, and chronic obstructive pulmonary disease (COPD). These diseases could be more effectively treated and prevented if RCS-related biomarkers were identified and measured at an early stage of disease progression, which makes development of a point of care test (POCT) platform extremely desirable for early diagnosis. In this work, a new, highly sensitive lab on a chip (LOC) immunoassay has been designed, developed, and characterized for tumor necrosis factor alpha (TNF-alpha), a protein biomarker that causes lung inflammation due to RCS exposure. The designed LOC device is composed of four reservoirs for sample, enzyme conjugated detection antibody, wash buffer, and chemiluminescence substrate in liquid form, along with three spiral reaction chambers for test, positive control, and negative control. All reservoirs and spiral microchannels were connected in series and designed to perform sequential delivery of immunoassay reagents with minimal user intervention. The developed LOC measured TNF-alpha concentrations as low as 16 pg/mL in plasma from RCS-exposed rats and also had a limit of detection (LOD) of 0.5 pg/mL in spiked artificial serum. In addition, the analysis time was drastically reduced to about 30 min, as opposed to hours in conventional methods. Successful implementation of a highly sensitive, chemiluminescence-based immunoassay on a preloaded LOC with proper quality control, as reported in this work, can pave the way toward developing a new rapid POCT platform for in-field clinical diagnosis. |
Bacillus Calmette-Guerin cases reported to the National Tuberculosis Surveillance System, United States, 2004-2015
Wansaula Z , Wortham JM , Mindra G , Haddad MB , Salinas JL , Ashkin D , Morris SB , Grant GB , Ghosh S , Langer AJ . Emerg Infect Dis 2019 25 (3) 451-456 Mycobacterium bovis bacillus Calmette-Guerin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004-2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions. |
Detection of highly pathogenic avian influenza A(H5N6) viruses in waterfowl in Bangladesh.
Yang G , Chowdury S , Hodges E , Rahman MZ , Jang Y , Hossain ME , Jones J , Stark TJ , Di H , Cook PW , Ghosh S , Azziz-Baumgartner E , Barnes JR , Wentworth DE , Kennedy E , Davis CT . Virology 2019 534 36-44 Bangladesh has reported repeated outbreaks of highly pathogenic avian influenza (HPAI) A(H5) viruses in poultry since 2007. Because of the large number of live poultry markets (LPM) relative to the population density of poultry throughout the country, these markets can serve as sentinel sites for HPAI A(H5) detection. Through active LPM surveillance during June 2016-June 2017, HPAI A(H5N6) viruses along with 14 other subtypes of influenza A viruses were detected. The HPAI A(H5N6) viruses belonged to clade 2.3.4.4 and were likely introduced into Bangladesh around March 2016. Human infections with influenza clade 2.3.4.4 viruses in Bangladesh have not been identified, but the viruses had several molecular markers associated with potential human infection. Vigilant surveillance at the animal-human interface is essential to identify emerging avian influenza viruses with the potential to threaten public and animal health. |
Trichomonas vaginalis virus (TVV) among women with trichomoniasis and associations with demographics, clinical outcomes, and metronidazole resistance
Graves KJ , Ghosh AP , Schmidt N , Augostini P , Secor WE , Schwebke JR , Martin DH , Kissinger PJ , Muzny CA . Clin Infect Dis 2019 69 (12) 2170-2176 BACKGROUND: Trichomonas vaginalis virus (TVV) is a non-segmented, 4.5-5.5 kbp, double-stranded RNA virus infecting T. vaginalis. The objectives of this study were to examine TVV prevalence in U.S. Trichomonas vaginalis isolates and associations with patient demographics, clinical outcomes, and metronidazole resistance. METHODS: Archived T. vaginalis isolates from the enrollment visit of 355 women participating in a T. vaginalis treatment trial in Birmingham, AL were thawed and grown in culture. Total RNA was extracted using Trizol reagent. Contaminating single stranded RNA was precipitated using 4.0M LiCl and centrifugation. Samples were analyzed by gel electrophoresis to visualize a 4.5kbp band representative of TVV. In vitro testing for metronidazole resistance was also performed on 25/47 isolates from the test of cure visit. RESULTS: TVV was detected in 142/355 (40%) isolates at the enrollment visit. Women with TVV+ isolates were significantly older (p = 0.01), more likely to smoke (p = 0.04), and less likely to report a history of gonorrhea (p = 0.04). There was no association between the presence of clinical symptoms or repeat T. vaginalis infection with TVV+ isolates (p = 0.14 and p = 0.44, respectively). Of 25 Test of cure isolates tested for metronidazole resistance, 0/10 TVV+ isolates demonstrated resistance while 2/15 TVV- isolates demonstrated mild-moderate resistance (p = 0.23). CONCLUSIONS: In one of the largest U.S. studies of T. vaginalis isolates tested for TVV, prevalence was 40%. However, there was no association of TVV+ isolates with clinical symptoms, repeat infections, or metronidazole resistance. These results suggest that TVV may be a commensal to T. vaginalis. |
Collaborative efforts to forecast seasonal influenza in the United States, 2015-2016
McGowan CJ , Biggerstaff M , Johansson M , Apfeldorf KM , Ben-Nun M , Brooks L , Convertino M , Erraguntla M , Farrow DC , Freeze J , Ghosh S , Hyun S , Kandula S , Lega J , Liu Y , Michaud N , Morita H , Niemi J , Ramakrishnan N , Ray EL , Reich NG , Riley P , Shaman J , Tibshirani R , Vespignani A , Zhang Q , Reed C . Sci Rep 2019 9 (1) 683 Since 2013, the Centers for Disease Control and Prevention (CDC) has hosted an annual influenza season forecasting challenge. The 2015-2016 challenge consisted of weekly probabilistic forecasts of multiple targets, including fourteen models submitted by eleven teams. Forecast skill was evaluated using a modified logarithmic score. We averaged submitted forecasts into a mean ensemble model and compared them against predictions based on historical trends. Forecast skill was highest for seasonal peak intensity and short-term forecasts, while forecast skill for timing of season onset and peak week was generally low. Higher forecast skill was associated with team participation in previous influenza forecasting challenges and utilization of ensemble forecasting techniques. The mean ensemble consistently performed well and outperformed historical trend predictions. CDC and contributing teams will continue to advance influenza forecasting and work to improve the accuracy and reliability of forecasts to facilitate increased incorporation into public health response efforts. |
Establishing baseline cervical cancer screening coverage - India, 2015-2016
Van Dyne EA , Hallowell BD , Saraiya M , Senkomago V , Patel SA , Agrawal S , Ghosh A , Saraf D , Mehrotra R , Dhillon PK . MMWR Morb Mortal Wkly Rep 2019 68 (1) 14-19 Cervical cancer is the second leading cause of new cancer cases and cancer-related deaths among women in India, with an estimated 96,922 new cases and 60,078 deaths each year.* Despite the availability of effective low-cost screening options in India, limited access to screening and treatment services, diagnosis at a later stage, and low investment in health care infrastructure all contribute to the high number of deaths (1). In 2016 the Ministry of Health and Family Welfare of India recommended cervical cancer screening using visual inspection with acetic acid every 5 years for women aged 30-65 years (per World Health Organization [WHO] guidelines) (2,3). To establish a baseline for cervical cancer screening coverage, survey data were analyzed to estimate the percentage of women aged 30-49 years who had ever been screened for cervical cancer (defined as ever having had a cervix examination). Cervical cancer screening was estimated using data from the Fourth National Family Health Survey(dagger) (NFHS-4), a nationally representative survey conducted at the district level during 2015-2016, which included 699,686 Indian women aged 15-49 years. Lifetime cervical cancer screening prevalence was low (29.8%) and varied by geographic region, ranging from 10.0% in the Northeast Region to 45.2% in the Western Region. Prevalence of screening was higher among women with higher levels of education and household wealth, those who had ever been married, and urban residents. This screening prevalence can be used as a baseline indicator for cervical cancer screening in India in accordance with the WHO Noncommunicable Diseases Global Monitoring Framework during state-based programmatic rollout and program evaluation (4). |
Skin sensitization testing needs and data uses by US regulatory and research agencies
Strickland J , Daniel AB , Allen D , Aguila C , Ahir S , Bancos S , Craig E , Germolec D , Ghosh C , Hudson NL , Jacobs A , Lehmann DM , Matheson J , Reinke EN , Sadrieh N , Vukmanovic S , Kleinstreuer N . Arch Toxicol 2018 93 (2) 273-291 United States regulatory and research agencies may rely upon skin sensitization test data to assess the sensitization hazards associated with dermal exposure to chemicals and products. These data are evaluated to ensure that such substances will not cause unreasonable adverse effects to human health when used appropriately. The US Consumer Product Safety Commission, the US Environmental Protection Agency, the US Food and Drug Administration, the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, and the US Department of Defense are member agencies of the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM). ICCVAM seeks to identify opportunities for the use of non-animal replacements to satisfy these testing needs and requirements. This review identifies the standards, test guidelines, or guidance documents that are applicable to satisfy each of these agency's needs; the current use of animal testing and flexibility for using alternative methodologies; information needed from alternative tests to fulfill the needs for skin sensitization data; and whether data from non-animal alternative approaches are accepted by these US federal agencies. |
Evaluating latent tuberculosis infection diagnostics using latent class analysis
Stout JE , Wu Y , Ho CS , Pettit AC , Feng PJ , Katz DJ , Ghosh S , Venkatappa T , Luo R . Thorax 2018 73 (11) 1062-1070 BACKGROUND: Lack of a gold standard for latent TB infection has precluded direct measurement of test characteristics of the tuberculin skin test and interferon-gamma release assays (QuantiFERON Gold In-Tube and T-SPOT.TB). OBJECTIVE: We estimated test sensitivity/specificity and latent TB infection prevalence in a prospective, US-based cohort of 10 740 participants at high risk for latent infection. METHODS: Bayesian latent class analysis was used to estimate test sensitivity/specificity and latent TB infection prevalence among subgroups based on age, foreign birth outside the USA and HIV infection. RESULTS: Latent TB infection prevalence varied from 4.0% among foreign-born, HIV-seronegative persons aged <5 years to 34.0% among foreign-born, HIV-seronegative persons aged >/=5 years. Test sensitivity ranged from 45.8% for the T-SPOT.TB among foreign-born, HIV-seropositive persons aged >/=5 years to 80.7% for the tuberculin skin test among foreign-born, HIV-seronegative persons aged >/=5 years. The skin test was less specific than either interferon-gamma release assay, particularly among foreign-born populations (eg, the skin test had 70.0% specificity among foreign-born, HIV-seronegative persons aged >/=5 years vs 98.5% and 99.3% specificity for the QuantiFERON and T-SPOT.TB, respectively). The tuberculin skin test's positive predictive value ranged from 10.0% among foreign-born children aged <5 years to 69.2% among foreign-born, HIV-seropositive persons aged >/=5 years; the positive predictive values of the QuantiFERON (41.4%) and T-SPOT.TB (77.5%) were also low among US-born, HIV-seropositive persons aged >/=5 years. CONCLUSIONS: These data reinforce guidelines preferring interferon-gamma release assays for foreign-born populations and recommending against screening populations at low risk for latent TB infection. TRIAL REGISTRATION NUMBER: NCT01622140. |
Surveillance for Heartland and Bourbon viruses in Eastern Kansas, June 2016
Savage HM , Godsey MS Jr , Tatman J , Burkhalter KL , Hamm A , Panella NA , Ghosh A , Raghavan RK . J Med Entomol 2018 55 (6) 1613-1616 In June 2016, we continued surveillance for tick-borne viruses in eastern Kansas following upon a larger surveillance program initiated in 2015 in response to a fatal human case of Bourbon virus (BRBV) (Family Orthomyxoviridae: Genus Thogotovirus). In 4 d, we collected 14,193 ticks representing four species from four sites. Amblyomma americanum (L.) (Acari: Ixodidae) accounted for nearly all ticks collected (n = 14,116, 99.5%), and the only other species identified were Amblyomma maculatum Koch (Acari: Ixodidae), Dermacentor variabilis (Say) (Acari: Ixodidae) and Ixodes scapularis Say (Acari: Ixodidae). All ticks were tested for both BRBV and Heartland virus (Family Bunyaviridae: Genus Phlebovirus) in 964 pools. Five Heartland virus positive tick pools were detected and confirmed by real-time reverse transcription PCR (rRT-PCR), while all pools tested negative for BRBV. Each Heartland positive pool was composed of 25 A. americanum nymphs with positive pools collected at three different sites in Bourbon County. A. americanum is believed to be the primary vector of both Heartland and BRBVs to humans based upon multiple detections of virus in field-collected ticks, its abundance, and its aggressive feeding behavior on mammals including humans. However, it is possible that A. americanum encounters viremic vertebrate hosts of BRBV less frequently than viremic hosts of Heartland virus, or that BRBV is less efficiently passed among ticks by co-feeding, or less efficiently passed vertically from infected female ticks to their offspring resulting in lower field infection rates. |
Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice
Sagili KD , Satyanarayana S , Chadha SS , Wilson NC , Kumar AMV , Moonan PK , Oeltmann JE , Chadha VK , Nagaraja SB , Ghosh S , Lo TQ , Volkmann T , Willis M , Shringarpure K , Reddy RC , Kumar P , Nair SA , Rao R , Yassin M , Mwangala P , Zachariah R , Tonsing J , Harries AD , Khaparde S . Glob Health Action 2018 11 (1) 1445467 BACKGROUND: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. OBJECTIVES: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. METHODS: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes. RESULTS: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. CONCLUSIONS: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects. |
Candida pneumonia with severe clinical course, recovery with antifungal therapy and unusual pathologic findings: A case report
Dermawan JKT , Ghosh S , Keating MK , Gopalakrishna KV , Mukhopadhyay S . Medicine (Baltimore) 2018 97 (2) e9650 BACKGROUND: Candida is frequently isolated from the respiratory tract and usually reflects airway colonization. True Candida pneumonia is rare. Our aim is to document a case of Candida pneumonia confirmed by cultures, molecular techniques, and surgical lung biopsy, and to highlight a previously unreported pathologic manifestation of this infection. CASE SUMMARY: A 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) presented with dry cough, low-grade fever, and progressive dyspnea. He was eventually diagnosed with sarcoidosis based on bilateral lung infiltrates and granulomas in a transbronchial biopsy. His condition worsened after immunosuppression, prompting surgical lung biopsy, which revealed suppurative granulomas containing Candida albicans, confirmed by cultures and polymerase chain reaction. Despite multiple episodes of respiratory failure and a prolonged course in intensive care, he recovered fully after antifungal therapy and is currently alive with COPD-related dyspnea 3 years after his initial presentation. CONCLUSION: Candida can rarely cause clinically significant pneumonia in adults, and should be considered in the differential diagnosis of suppurative granulomas in the lung. |
Evaluation of 24-locus MIRU-VNTR genotyping in Mycobacterium tuberculosis cluster investigations in four jurisdictions in the United States, 2006-2010.
Teeter LD , Kammerer JS , Ghosh S , Nguyen DTM , Vempaty P , Tapia J , Miramontes R , Cronin WA , Graviss EA . Tuberculosis (Edinb) 2017 106 9-15 The U.S. Centers for Disease Control and Prevention (CDC) uses a combination of spacer oligonucleotide typing (spoligotyping) and mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR) analyses as part of the National TB Genotyping Service (NTGS). The NTGS expansion from 12-locus MIRU-VNTR (MIRU12) to 24-locus MIRU-VNTR (MIRU24) in 2009 enhanced the ability to discriminate Mycobacterium tuberculosis strains. In the current study, we investigated the MIRU24 concordance among epidemiologic-linked tuberculosis (TB) patients in four U.S. health jurisdictions. We also evaluated the programmatic benefits of combining MIRU24 and spoligotyping with epidemiologic evidence in identifying potential recent TB transmission. We examined 342 TB patients in 42 spoligotype/MIRU12 (PCRType) clusters (equivalent to 46 spoligotype/MIRU24 [GENType] clusters) to identify epidemiologic links among cases. GENType clusters, when compared to PCRType clusters, had 12 times higher odds of epidemiologic links being identified if patients were younger than 25 years and 3 times higher odds if patients resided in the same zip code, or had HIV infection. Sixty (18%) fewer PCRType-clustered patients would need investigations if clusters are defined using GENType instead of PCRType. An important advantage of defining clusters by MIRU24 is resource savings related to the reduced number of clustered cases needing investigation. |
Biomarkers of exposure to new and emerging tobacco delivery products
Schick SF , Blount BC , Jacob P 3rd , Saliba NA , Bernert JT , El Hellani A , Jatlow P , Pappas RS , Wang L , Foulds J , Ghosh A , Hecht SS , Gomez JC , Martin JR , Mesaros C , Srivastava S , St Helen G , Tarran R , Lorkiewicz PK , Blair IA , Kimmel HL , Doerschuk CM , Benowitz NL , Bhatnagar A . Am J Physiol Lung Cell Mol Physiol 2017 313 (3) ajplung.00343.2016 Accurate and reliable measurements of exposure to tobacco products are essential for identifying and confirming patterns of tobacco product use and for assessing their potential biological effects in both human populations and experimental systems. Due to the introduction of new tobacco-derived products and the development of novel ways to modify and use conventional tobacco products, precise and specific assessments of exposure to tobacco are now more important than ever. Biomarkers that were developed and validated to measure exposure to cigarettes are being evaluated to assess their utility for measuring exposure to these new products. Here, we review current methods for measuring exposure to new and emerging tobacco products, such as electronic cigarettes, little cigars, water pipe and cigarillos. Rigorously validated biomarkers specific to these new products are yet to be identified. Here, we discuss the strengths and limitations of current approaches, including whether or not they provide reliable exposure estimates. We provide specific guidance for choosing practical and economical biomarkers for different study designs and experimental conditions. Our goal is to help both new and experienced investigators measure exposure to tobacco products accurately, while avoiding common experimental errors. By identifying the capacity gaps in biomarker research on new and emerging tobacco products, we hope to provide researchers, policy makers and funding agencies with a clear action plan for conducting and promoting research on the patterns of use and health effects of these products. |
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