28 results on '"Kendall, Emily A."'
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2. Decline in prevalence of tuberculosis following an intensive case finding campaign and the COVID-19 pandemic in an urban Ugandan community
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Kendall, Emily A, Kitonsa, Peter J, Nalutaaya, Annet, Robsky, Katherine O, Erisa, Kamoga Caleb, Mukiibi, James, Cattamanchi, Adithya, Kato-Maeda, Midori, Katamba, Achilles, and Dowdy, David
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BackgroundSystematic screening is a potential tool for reducing the prevalence of tuberculosis (TB) and counteracting COVID-19-related disruptions in care. Repeated community-wide screening can also measure changes in the prevalence of TB over time.MethodsWe conducted serial, cross-sectional TB case finding campaigns in one community in Kampala, Uganda, in 2019 and 2021. Both campaigns sought sputum for TB testing (Xpert MTB/RIF Ultra) from all adolescents and adults. We estimated the prevalence of TB among screening participants in each campaign and compared characteristics of people with TB across campaigns. We simultaneously enrolled and characterised community residents who were diagnosed with TB through routine care and assessed trends in facility-based diagnosis.ResultsWe successfully screened 12 033 community residents (35% of the estimated adult/adolescent population) in 2019 and 11 595 (33%) in 2021. In 2019, 0.94% (95% CI: 0.77% to 1.13%) of participants tested Xpert positive (including trace). This proportion fell to 0.52% (95% CI: 0.40% to 0.67%) in 2021; the prevalence ratio was 0.55 (95% CI: 0.40 to 0.75)). There was no change in the age (median 26 vs 26), sex (56% vs 59% female) or prevalence of chronic cough (49% vs 54%) among those testing positive. By contrast, the rate of routine facility-based diagnosis remained steady in the 8 months before each campaign (210 (95% CI: 155 to 279) vs 240 (95% CI: 181 to 312) per 100 000 per year).ConclusionsFollowing an intensive initial case finding campaign in an urban Ugandan community in 2019, the burden of prevalent TB as measured by systematic screening had decreased by 45% in 2021, despite the intervening COVID-19 pandemic.
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- 2024
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3. Do chest x-ray-positive, sputum-negative individuals warrant more attention during tuberculosis screening?
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Kendall, Emily A and Wong, Emily B
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TUBERCULOSIS ,ATTENTION - Published
- 2023
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4. Do chest x-ray-positive, sputum-negative individuals warrant more attention during tuberculosis screening?
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Kendall, Emily A and Wong, Emily B
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- 2023
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5. Estimated Transmission Outcomes and Costs of SARS-CoV-2 Diagnostic Testing, Screening, and Surveillance Strategies Among a Simulated Population of Primary School Students
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Bilinski, Alyssa, Ciaranello, Andrea, Fitzpatrick, Meagan C., Giardina, John, Shah, Maunank, Salomon, Joshua A., and Kendall, Emily A.
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IMPORTANCE: In addition to illness, the COVID-19 pandemic has led to historic educational disruptions. In March 2021, the federal government allocated $10 billion for COVID-19 testing in US schools. OBJECTIVE: Costs and benefits of COVID-19 testing strategies were evaluated in the context of full-time, in-person kindergarten through eighth grade (K-8) education at different community incidence levels. DESIGN, SETTING, AND PARTICIPANTS: An updated version of a previously published agent-based network model was used to simulate transmission in elementary and middle school communities in the United States. Assuming dominance of the delta SARS-CoV-2 variant, the model simulated an elementary school (638 students in grades K-5, 60 staff) and middle school (460 students grades 6-8, 51 staff). EXPOSURES: Multiple strategies for testing students and faculty/staff, including expanded diagnostic testing (test to stay) designed to avoid symptom-based isolation and contact quarantine, screening (routinely testing asymptomatic individuals to identify infections and contain transmission), and surveillance (testing a random sample of students to identify undetected transmission and trigger additional investigation or interventions). MAIN OUTCOMES AND MEASURES: Projections included 30-day cumulative incidence of SARS-CoV-2 infection, proportion of cases detected, proportion of planned and unplanned days out of school, cost of testing programs, and childcare costs associated with different strategies. For screening policies, the cost per SARS-CoV-2 infection averted in students and staff was estimated, and for surveillance, the probability of correctly or falsely triggering an outbreak response was estimated at different incidence and attack rates. RESULTS: Compared with quarantine policies, test-to-stay policies are associated with similar model-projected transmission, with a mean of less than 0.25 student days per month of quarantine or isolation. Weekly universal screening is associated with approximately 50% less in-school transmission at one-seventh to one-half the societal cost of hybrid or remote schooling. The cost per infection averted in students and staff by weekly screening is lowest for schools with less vaccination, fewer other mitigation measures, and higher levels of community transmission. In settings where local student incidence is unknown or rapidly changing, surveillance testing may detect moderate to large in-school outbreaks with fewer resources compared with schoolwide screening. CONCLUSIONS AND RELEVANCE: In this modeling study of a simulated population of primary school students and simulated transmission of COVID-19, test-to-stay policies and/or screening tests facilitated consistent in-person school attendance with low transmission risk across a range of community incidence. Surveillance was a useful reduced-cost option for detecting outbreaks and identifying school environments that would benefit from increased mitigation.
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- 2022
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6. Antigen-based rapid diagnostic testing or alternatives for diagnosis of symptomatic COVID-19: A simulation-based net benefit analysis.
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Kendall, Emily A., Arinaminpathy, Nimalan, Sacks, Jilian A., Manabe, Yukari C., Dittrich, Sabine, Schumacher, Samuel G., and Dowdy, David W.
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Background: SARS-CoV-2 antigen-detection rapid diagnostic tests can diagnose COVID-19 rapidly and at low cost, but lower sensitivity compared with reverse-transcriptase polymerase chain reaction (PCR) has limited clinical adoption.Methods: We compared antigen testing, PCR testing, and clinical judgment alone for diagnosing symptomatic COVID-19 in an outpatient setting (10% COVID-19 prevalence among the patients tested, 3-day PCR turnaround) and a hospital setting (40% prevalence, 24-hour PCR turnaround). We simulated transmission from cases and contacts, and relationships between time, viral burden, transmission, and case detection. We compared diagnostic approaches using a measure of net benefit that incorporated both clinical and public health benefits and harms of intervention.Results: In the outpatient setting, we estimated that using antigen testing instead of PCR to test 200 individuals could be equivalent to preventing all symptomatic transmission from one person with COVID-19 (one "transmission-equivalent"). In a hospital, net benefit analysis favored PCR, and testing 25 patients with PCR instead of antigen testing achieved one transmission-equivalent of benefit. In both settings, antigen testing was preferable to PCR if PCR turnaround time exceeded 2 days. Both tests provided greater net benefit than management based on clinical judgment alone, unless intervention carried minimal harm and was provided equally regardless of diagnostic approach.Conclusions: For diagnosis of symptomatic COVID-19, we estimated that speed of diagnosis with antigen testing is likely to outweigh its lower accuracy compared to PCR wherever PCR turnaround time is 2 days or longer. This advantage may be even greater if antigen tests are also less expensive. [ABSTRACT FROM AUTHOR]- Published
- 2021
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7. Antigen-based Rapid Diagnostic Testing or Alternatives for Diagnosis of Symptomatic COVID-19
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Kendall, Emily A., Arinaminpathy, Nimalan, Sacks, Jilian A., Manabe, Yukari C., Dittrich, Sabine, Schumacher, Samuel G., and Dowdy, David W.
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Supplemental Digital Content is available in the text.
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- 2021
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8. Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise
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Coussens, Anna K, Zaidi, Syed M A, Allwood, Brian W, Dewan, Puneet K, Gray, Glenda, Kohli, Mikashmi, Kredo, Tamara, Marais, Ben J, Marks, Guy B, Martinez, Leo, Ruhwald, Morten, Scriba, Thomas J, Seddon, James A, Tisile, Phumeza, Warner, Digby F, Wilkinson, Robert J, Esmail, Hanif, Houben, Rein M G J, Alland, David, Behr, Marcel A, Beko, Busisiwe B, Burhan, Erlina, Churchyard, Gavin, Cobelens, Frank, Denholm, Justin T, Dinkele, Ryan, Ellner, Jerrold J, Fatima, Razia, Haigh, Kate A, Hatherill, Mark, Horton, Katherine C, Kendall, Emily A, Khan, Palwasha Y, MacPherson, Peter, Malherbe, Stephanus T, Mave, Vidya, Mendelsohn, Simon C, Musvosvi, Munyaradzi, Nemes, Elisa, Penn-Nicholson, Adam, Ramamurthy, Dharanidharan, Rangaka, Molebogeng X, Sahu, Suvanand, Schwalb, Alvaro, Shah, Divya K, Sheerin, Dylan, Simon, Donald, Steyn, Adrie J C, Thu Anh, Nguyen, Walzl, Gerhard, Weller, Charlotte L, Williams, Caroline ML, Wong, Emily B, Wood, Robin, Xie, Yingda L, and Yi, Siyan
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The current active–latent paradigm of tuberculosis largely neglects the documented spectrum of disease. Inconsistency with regard to definitions, terminology, and diagnostic criteria for different tuberculosis states has limited the progress in research and product development that are needed to achieve tuberculosis elimination. We aimed to develop a new framework of classification for tuberculosis that accommodates key disease states but is sufficiently simple to support pragmatic research and implementation. Through an international Delphi exercise that involved 71 participants representing a wide range of disciplines, sectors, income settings, and geographies, consensus was reached on a set of conceptual states, related terminology, and research gaps. The International Consensus for Early TB (ICE-TB) framework distinguishes disease from infection by the presence of macroscopic pathology and defines two subclinical and two clinical tuberculosis states on the basis of reported symptoms or signs of tuberculosis, further differentiated by likely infectiousness. The presence of viable Mycobacterium tuberculosisand an associated host response are prerequisites for all states of infection and disease. Our framework provides a clear direction for tuberculosis research, which will, in time, improve tuberculosis clinical care and elimination policies.
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- 2024
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9. Barrier contraception methods
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Kendall, Emily and Lebari, Dornubari
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Barrier contraceptive methods are the oldest type of reversible contraception still available. They work by preventing the egg and the sperm coming into contact with one another, thereby preventing fertilisation. Some barrier contraceptive methods have the added benefit of preventing transmission of sexual infections. The main types of barrier contraceptives are the male and female condoms, diaphragms and cervical caps. This article aims to provide an overview of the different barrier methods for contraception, their efficacy, and advantages and disadvantages.
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- 2019
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10. Expected effects of adopting a 9 month regimen for multidrug-resistant tuberculosis: a population modelling analysis.
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Kendall, Emily A, Fojo, Anthony T, and Dowdy, David W
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MULTIDRUG-resistant tuberculosis ,THERAPEUTICS - Abstract
Summary Background In May, 2016, WHO endorsed a 9 month regimen for multidrug-resistant tuberculosis that is cheaper and potentially more effective than the conventional, longer (20–24 month) therapy. We aimed to investigate the population-level implications of scaling up this new regimen. Methods In this population modelling analysis, we developed a dynamic transmission model to simulate the introduction of this short-course regimen as an instantaneous switch in 2016. We projected the corresponding percentage reduction in the incidence of multidrug-resistant tuberculosis by 2024 compared with continued use of longer therapy. In the primary analysis in a representative southeast Asian setting, we assumed that the short-course regimen would double treatment access (through savings in resources or capacity) and achieve long-term efficacy at levels seen in preliminary cohort studies. We then did extensive sensitivity analyses to explore a range of alternative scenarios. Findings Under the optimistic assumptions in the primary analysis, the incidence of multidrug-resistant tuberculosis in 2024 would be 3·3 (95% uncertainty range 2·2–5·6) per 100 000 population with the short-course regimen and 4·3 (2·9–7·6) per 100 000 population with continued use of longer therapy—ie, the short-course regimen could reduce incidence by 23% (10–38). Incidence would be reduced by 14% (4–28) if the new regimen affected only treatment effectiveness and by 11% (3–24) if it affected only treatment availability. Under more pessimistic assumptions, the short-course regimen would have minimal effect and even potential for harm—eg, when 30% of patients are ineligible for the new regimen because of second-line drug resistance, we projected a change in incidence of −2% (−20 to +28). The new regimen's effect was greater in settings with more ongoing transmission of multidrug-resistant tuberculosis, but results were otherwise similar across settings with different levels of tuberculosis incidence and prevalence of multidrug resistance. Interpretation The short-course regimen has potential to substantially lessen the multidrug-resistant tuberculosis epidemic, but this effect depends on its long-term efficacy, its ability to expand treatment access, and the role of second-line drug resistance. Funding US National Institutes of Health and Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]
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- 2017
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11. Symptom-based vs asymptomatic testing for controlling SARS-CoV-2 transmission in low- and middle-income countries: A modelling analysis.
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Baik, Yeonsoo, Cilloni, Lucia, Kendall, Emily, Dowdy, David, and Arinaminpathy, Nimalan
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Diagnostic testing plays a critical role in the global COVID-19 response. Polymerase chain reaction (PCR) tests are highly accurate, but in resource-limited settings, limited capacity has led to testing delays; whereas lateral flow assays (LFAs) offer opportunities for rapid and affordable testing. We examined the potential epidemiological impact of different strategies for LFA deployment. We developed a deterministic compartmental model of SARS-CoV-2 transmission, parameterised to resemble a large Indian city. We assumed that PCR would be used to test symptomatic individuals presenting to outpatient settings for care. We examined how the second epidemic wave in India could have been mitigated by LFA deployment in its early stages by comparing two strategies: (i) community-based screening, using LFAs to test a proportion of the population, irrespective of symptoms (in addition to symptom-driven PCR), and (ii) symptom-driven outpatient testing, using LFAs to replace PCR. Model projections suggest that a stock of 25 million LFAs, used over a 600-day period in a city of 20 million people, would reduce the cumulative symptomatic incidence of COVID-19 by 0.44% if used for community-based screening, and by 13% if used to test symptomatic outpatients, relative to a no-LFA, PCR-only scenario. Sensitivity analysis suggests that outpatient testing would be more efficient in reducing transmission than community-based screening, when at least 5% of people with symptomatic COVID-19 seek care, and at least 10% of SARS-CoV-2 infections develop symptoms. Under both strategies, however, 2% of the population would be unnecessarily isolated. In this emblematic setting, LFAs would reduce transmission most efficiently when used to test symptomatic individuals in outpatient settings. To avoid large numbers of unnecessary isolations, mass testing with LFAs should be considered as a screening tool, with follow-up confirmation. Future work should address strategies for targeted community-based LFA testing, such as contact tracing. • Rapid and affordable testing can be critical in the response to the SARS-CoV-2 pandemic in resource-limited settings. • We assess whether a rapid diagnostic tool would be more efficient in outpatients settings or in the general community. • Using LFAs in outpatient settings has a greater impact than using them in the general community because it detects symptomatic cases and reduces diagnostic delays. • In both outpatient and community strategies, using confirmatory testing, such as PCR, could avoid unnecessary isolations. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis.
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Kendall, Emily A, Fofana, Mariam O, and Dowdy, David W
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TUBERCULOSIS ,DRUG resistance ,LUNG diseases ,MYCOBACTERIAL diseases ,EPIDEMICS - Abstract
Summary Background Multidrug-resistant (MDR) tuberculosis can be acquired through de-novo mutation during tuberculosis treatment or through transmission from other individuals with active MDR tuberculosis. Understanding the balance between these two mechanisms is essential when allocating resources for MDR tuberculosis. We aimed to create a dynamic transmission model of an MDR tuberculosis epidemic to estimate the contributions of treatment-related acquisition and person-to-person transmission of resistance to incident MDR tuberculosis cases. Methods In this modelling analysis, we constructed a dynamic transmission model of an MDR tuberculosis epidemic, allowing for both treatment-related acquisition and person-to-person transmission of resistance. We used national tuberculosis notification data to inform Bayesian estimates of the proportion of each country's 2013 MDR tuberculosis incidence that resulted from MDR transmission rather than treatment-related MDR acquisition. Findings Global estimates of 3·5% MDR tuberculosis prevalence among new tuberculosis notifications and 20·5% among re-treatment notifications translate into an estimate that resistance transmission rather than acquisition accounts for a median 95·9% (95% uncertainty range [UR] 68·0–99·6) of all incident MDR tuberculosis, and 61·3% (16·5–95·2) of incident MDR tuberculosis in previously treated individuals. The estimated proportion of MDR tuberculosis resulting from transmission varied substantially with different countries' notification data—ranging from 48% (95% UR 30–75) in Bangladesh to 99% (91–100) in Uzbekistan. Estimates were most sensitive to estimates of the transmissibility of MDR strains, the probability of acquiring MDR during tuberculosis treatment, and the responsiveness of MDR tuberculosis to first-line treatment. Interpretation Notifications of MDR prevalence from most high-burden settings are consistent with most incident MDR tuberculosis resulting from transmission rather than new treatment-related acquisition of resistance. Merely improving the treatment of drug-susceptible tuberculosis is unlikely to greatly reduce future MDR tuberculosis incidence. Improved diagnosis and treatment of MDR tuberculosis—including new tests and drug regimens—should be highly prioritised. Funding National Institutes of Health and the Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]
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- 2015
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13. Expected effects of adopting a 9 month regimen for multidrug-resistant tuberculosis: a population modelling analysis
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Kendall, Emily A, Fojo, Anthony T, and Dowdy, David W
- Abstract
In May, 2016, WHO endorsed a 9 month regimen for multidrug-resistant tuberculosis that is cheaper and potentially more effective than the conventional, longer (20–24 month) therapy. We aimed to investigate the population-level implications of scaling up this new regimen.
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- 2017
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14. Scientific advances and the end of tuberculosis: a report from the LancetCommission on Tuberculosis
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Reid, Michael, Agbassi, Yvan Jean Patrick, Arinaminpathy, Nimalan, Bercasio, Alyssa, Bhargava, Anurag, Bhargava, Madhavi, Bloom, Amy, Cattamanchi, Adithya, Chaisson, Richard, Chin, Daniel, Churchyard, Gavin, Cox, Helen, Denkinger, Claudia M, Ditiu, Lucica, Dowdy, David, Dybul, Mark, Fauci, Anthony, Fedaku, Endalkachew, Gidado, Mustapha, Harrington, Mark, Hauser, Janika, Heitkamp, Petra, Herbert, Nick, Herna Sari, Ani, Hopewell, Philip, Kendall, Emily, Khan, Aamir, Kim, Andrew, Koek, Irene, Kondratyuk, Sergiy, Krishnan, Nalini, Ku, Chu-Chang, Lessem, Erica, McConnell, Erin V, Nahid, Payam, Oliver, Matt, Pai, Madhukar, Raviglione, Mario, Ryckman, Theresa, Schäferhoff, Marco, Silva, Sachin, Small, Peter, Stallworthy, Guy, Temesgen, Zelalem, van Weezenbeek, Kitty, Vassall, Anna, Velásquez, Gustavo E, Venkatesan, Nandita, Yamey, Gavin, Zimmerman, Armand, Jamison, Dean, Swaminathan, Soumya, and Goosby, Eric
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- 2023
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15. Would pan-tuberculosis treatment regimens be cost-effective?
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Kendall, Emily A, Brigden, Grania, Lienhardt, Christian, and Dowdy, David W
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PANCREATIC cancer ,TUBERCULOSIS complications ,PREVENTION - Published
- 2018
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16. Burden of transmitted multidrug resistance in epidemics of tuberculosis: a transmission modelling analysis
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Kendall, Emily A, Fofana, Mariam O, and Dowdy, David W
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Multidrug-resistant (MDR) tuberculosis can be acquired through de-novo mutation during tuberculosis treatment or through transmission from other individuals with active MDR tuberculosis. Understanding the balance between these two mechanisms is essential when allocating resources for MDR tuberculosis. We aimed to create a dynamic transmission model of an MDR tuberculosis epidemic to estimate the contributions of treatment-related acquisition and person-to-person transmission of resistance to incident MDR tuberculosis cases.
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- 2015
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17. Would pan-tuberculosis treatment regimens be cost-effective?
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Kendall, Emily A, Brigden, Grania, Lienhardt, Christian, and Dowdy, David W
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- 2018
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18. GUY FAWKES'S DANGEROUS REMEDY: THE UNCONSTITUTIONALITY OF GOVERNMENT-ORDERED ASSASSINATION AGAINST U.S. CITIZENS AND ITS IMPLICATIONS FOR DUE PROCESS IN AMERICA.
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KENDALL, EMILY C.
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ASSASSINATION ,DUE process of law ,CONSTITUTIONAL law ,TERRORIST plots - Abstract
The article discusses the unconstitutionality of government-ordered assassination against the U.S. citizens and its implications for due process in the country. It informs that U.S. President Barack Obama's administration has sanctioned the killing of the U.S. citizens involved in terrorist plots in January 2010 without due process of law. It mentions that this overreaching of governmental power threatens the due process that the U.S. Constitution guarantees to each citizen of the country.
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- 2012
19. Early Neurologic Abnormalities Associated with Human T-Cell Lymphotropic Virus Type 1 Infection in a Cohort of Peruvian Children.
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Kendall, Emily A., González, Elsa, Espinoza, Iván, Tipismana, Martín, Verdonck, Kristien, Clark, Daniel, Vermund, Sten H., and Gotuzzo, Eduardo
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Objective: Because human T-cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) may occur in some children infected with HTLV-1, we sought to determine the prevalence of neurologic abnormalities and any associations of neurologic abnormalities with infective dermatitis in these children. Study design: We enrolled 58 children infected with HTLV-1 and 42 uninfected children (ages 3 to 17) of mothers infected with HTLV-1 in a family study in Lima, Peru. We obtained medical and developmental histories, surveyed current neurologic symptoms, and conducted a standardized neurologic examination without prior knowledge of HTLV-1 status. Results: HTLV-1 infection was associated with reported symptoms of lower extremity weakness/fatigue (odds ratio [OR], 6.1; confidence interval [CI], 0.7 to 281), lumbar pain (OR, 1.7; 95% CI, 0.4 to 8), and paresthesia/dysesthesia (OR, 2.6; CI, 0.6 to 15.8). HTLV-1 infection was associated with lower-extremity hyperreflexia (OR, 3.1; CI, 0.8 to 14.2), ankle clonus (OR, 5.0; CI, 1.0 to 48.3), and extensor plantar reflex (OR undefined; P = .2). Among children infected with HTLV-1, a history of infective dermatitis was associated with weakness (OR, 2.7; CI, 0.3 to 33), lumbar pain (OR, 1.3; CI, 0.2 to 8), paresthesia/dysesthesia (OR, 2.9; CI, 0.5 to 20), and urinary disturbances (OR, 5.7; CI, 0.5 to 290). Conclusions: Abnormal neurologic findings were common in Peruvian children infected with HTLV-1, and several findings were co-prevalent with infective dermatitis. Pediatricians should monitor children infected with HTLV-1 for neurologic abnormalities. [Copyright &y& Elsevier]
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- 2009
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20. Protecting Children in America and Abroad: How the Recent Abandonment of HIV Waivers Will Affect International Adoption.
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Kendall, Emily Chrissy
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UNITED States immigration policy ,INTERNATIONAL adoption ,HIV-positive children ,ADOPTED children ,CHILD protection services ,CHILD services - Abstract
The article discusses the potential impact of the move of the U.S. Citizenship and Immigration Services (USCIS) to refute HIV waiver requirement on international adoption. It states that the said de-classification of HIV-positive immigrants could severely change the aspect of intercountry adoption. It examines the possible dangers and benefits which may be brought by the policy change to American children and adopted ones in the country.
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- 2010
21. Development of Immunoglobulin M Memory to Both a T-Cell-Independent and a T-Cell-Dependent Antigen following Infection with Vibrio choleraeO1 in Bangladesh
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Kendall, Emily A., Tarique, Abdullah A., Hossain, Azim, Alam, Mohammad Murshid, Arifuzzaman, Mohammad, Akhtar, Nayeema, Chowdhury, Fahima, Khan, Ashraful I., LaRocque, Regina C., Harris, Jason B., Ryan, Edward T., Qadri, Firdausi, and Calderwood, Stephen B.
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ABSTRACTVibrio choleraeO1 can cause severe watery diarrhea that can be life-threatening without treatment. Infection results in long-lasting protection against subsequent disease. Development of memory B cells of the immunoglobulin G (IgG) and IgA isotypes to V. choleraeO1 antigens, including serotype-specific lipopolysaccharide (LPS) and the B subunit of cholera toxin (CTB), after cholera infection has been demonstrated. Memory B cells of the IgM isotype may play a role in long-term protection, particularly against T-cell-independent antigens, but IgM memory has not been studied in V. choleraeO1 infection. Therefore, we assayed acute- and convalescent-phase blood samples from cholera patients for the presence of memory B cells that produce cholera antigen-specific IgM antibody upon polyclonal stimulation in in vitro culture. We also examined the development of serological and antibody-secreting cell responses following infection. Subjects developed significant IgM memory responses by day 30 after infection, both to the T-cell-independent antigen LPS and to the T-cell-dependent antigen CTB. No significant corresponding elevations in plasma IgM antibodies or circulating IgM antibody-secreting cells to CTB were detected. In 17 subjects followed to day 90 after infection, significant persistence of elevated IgM memory responses was not observed. The IgM memory response to CTB was negatively correlated with the IgG plasma antibody response to CTB, and there was a trend toward negative correlation between the IgM memory and IgA plasma antibody responses to LPS. We did not observe an association between the IgM memory response to LPS and the vibriocidal titer.
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- 2010
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22. Development of Immunoglobulin M Memory to Both a T-Cell-Independent and a T-Cell-Dependent Antigen following Infection with Vibrio cholerae O1 in Bangladesh
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Kendall, Emily A., Tarique, Abdullah A., Hossain, Azim, Alam, Mohammad Murshid, Arifuzzaman, Mohammad, Akhtar, Nayeema, Chowdhury, Fahima, Khan, Ashraful I., LaRocque, Regina C., Harris, Jason B., Ryan, Edward T., Qadri, Firdausi, and Calderwood, Stephen B.
- Abstract
Vibrio cholerae O1 can cause severe watery diarrhea that can be life-threatening without treatment. Infection results in long-lasting protection against subsequent disease. Development of memory B cells of the immunoglobulin G (IgG) and IgA isotypes to V. cholerae O1 antigens, including serotype-specific lipopolysaccharide (LPS) and the B subunit of cholera toxin (CTB), after cholera infection has been demonstrated. Memory B cells of the IgM isotype may play a role in long-term protection, particularly against T-cell-independent antigens, but IgM memory has not been studied in V. cholerae O1 infection. Therefore, we assayed acute- and convalescent-phase blood samples from cholera patients for the presence of memory B cells that produce cholera antigen-specific IgM antibody upon polyclonal stimulation in in vitro culture. We also examined the development of serological and antibody-secreting cell responses following infection. Subjects developed significant IgM memory responses by day 30 after infection, both to the T-cell-independent antigen LPS and to the T-cell-dependent antigen CTB. No significant corresponding elevations in plasma IgM antibodies or circulating IgM antibody-secreting cells to CTB were detected. In 17 subjects followed to day 90 after infection, significant persistence of elevated IgM memory responses was not observed. The IgM memory response to CTB was negatively correlated with the IgG plasma antibody response to CTB, and there was a trend toward negative correlation between the IgM memory and IgA plasma antibody responses to LPS. We did not observe an association between the IgM memory response to LPS and the vibriocidal titer.
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- 2010
23. Memory T-Cell Responses to Vibrio choleraeO1 Infection
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Weil, Ana A., Arifuzzaman, Mohammad, Bhuiyan, Taufiqur R., LaRocque, Regina C., Harris, Aaron M., Kendall, Emily A., Hossain, Azim, Tarique, Abdullah A., Sheikh, Alaullah, Chowdhury, Fahima, Khan, Ashraful I., Murshed, Farhan, Parker, Kenneth C., Banerjee, Kalyan K., Ryan, Edward T., Harris, Jason B., Qadri, Firdausi, and Calderwood, Stephen B.
- Abstract
ABSTRACTVibrio choleraeO1 can cause diarrheal disease that may be life-threatening without treatment. Natural infection results in long-lasting protective immunity, but the role of T cells in this immune response has not been well characterized. In contrast, robust B-cell responses to V. choleraeinfection have been observed. In particular, memory B-cell responses to T-cell-dependent antigens persist for at least 1 year, whereas responses to lipopolysaccharide, a T-cell-independent antigen, wane more rapidly after infection. We hypothesize that protective immunity is mediated by anamnestic responses of memory B cells in the gut-associated lymphoid tissue, and T-cell responses may be required to generate and maintain durable memory B-cell responses. In this study, we examined B- and T-cell responses in patients with severe V. choleraeinfection. Using the flow cytometric assay of the specific cell-mediated immune response in activated whole blood, we measured antigen-specific T-cell responses using V. choleraeantigens, including the toxin-coregulated pilus (TcpA), a V. choleraemembrane preparation, and the V. choleraecytolysin/hemolysin (VCC) protein. Our results show that memory T-cell responses develop by day 7 after infection, a time prior to and concurrent with the development of B-cell responses. This suggests that T-cell responses to V. choleraeantigens may be important for the generation and stability of memory B-cell responses. The T-cell proliferative response to VCC was of a higher magnitude than responses observed to other V. choleraeantigens.
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- 2009
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24. Memory T-Cell Responses to Vibrio cholerae O1 Infection
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Weil, Ana A., Arifuzzaman, Mohammad, Bhuiyan, Taufiqur R., LaRocque, Regina C., Harris, Aaron M., Kendall, Emily A., Hossain, Azim, Tarique, Abdullah A., Sheikh, Alaullah, Chowdhury, Fahima, Khan, Ashraful I., Murshed, Farhan, Parker, Kenneth C., Banerjee, Kalyan K., Ryan, Edward T., Harris, Jason B., Qadri, Firdausi, and Calderwood, Stephen B.
- Abstract
Vibrio cholerae O1 can cause diarrheal disease that may be life-threatening without treatment. Natural infection results in long-lasting protective immunity, but the role of T cells in this immune response has not been well characterized. In contrast, robust B-cell responses to V. cholerae infection have been observed. In particular, memory B-cell responses to T-cell-dependent antigens persist for at least 1 year, whereas responses to lipopolysaccharide, a T-cell-independent antigen, wane more rapidly after infection. We hypothesize that protective immunity is mediated by anamnestic responses of memory B cells in the gut-associated lymphoid tissue, and T-cell responses may be required to generate and maintain durable memory B-cell responses. In this study, we examined B- and T-cell responses in patients with severe V. cholerae infection. Using the flow cytometric assay of the specific cell-mediated immune response in activated whole blood, we measured antigen-specific T-cell responses using V. cholerae antigens, including the toxin-coregulated pilus (TcpA), a V. cholerae membrane preparation, and the V. cholerae cytolysin/hemolysin (VCC) protein. Our results show that memory T-cell responses develop by day 7 after infection, a time prior to and concurrent with the development of B-cell responses. This suggests that T-cell responses to V. cholerae antigens may be important for the generation and stability of memory B-cell responses. The T-cell proliferative response to VCC was of a higher magnitude than responses observed to other V. cholerae antigens.
- Published
- 2009
25. Antigen-Specific Memory B-Cell Responses to Vibrio choleraeO1 Infection in Bangladesh
- Author
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Harris, Aaron M., Bhuiyan, M. Saruar, Chowdhury, Fahima, Khan, Ashraful I., Hossain, Azim, Kendall, Emily A., Rahman, Atiqur, LaRocque, Regina C., Wrammert, Jens, Ryan, Edward T., Qadri, Firdausi, Calderwood, Stephen B., and Harris, Jason B.
- Abstract
ABSTRACTCholera, caused by Vibrio cholerae, is a noninvasive dehydrating enteric disease with a high mortality rate if untreated. Infection with V. choleraeelicits long-term protection against subsequent disease in countries where the disease is endemic. Although the mechanism of this protective immunity is unknown, it has been hypothesized that a protective mucosal response to V. choleraeinfection may be mediated by anamnestic responses of memory B cells in the gut-associated lymphoid tissue. To characterize memory B-cell responses to cholera, we enrolled a cohort of 39 hospitalized patients with culture-confirmed cholera and evaluated their immunologic responses at frequent intervals over the subsequent 1 year. Memory B cells to cholera antigens, including lipopolysaccharide (LPS), and the protein antigens cholera toxin B subunit (CTB) and toxin-coregulated pilus major subunit A (TcpA) were enumerated using a method of polyclonal stimulation of peripheral blood mononuclear cells followed by a standard enzyme-linked immunospot procedure. All patients demonstrated CTB, TcpA, and LPS-specific immunoglobulin G (IgG)and IgA memory responses by day 90. In addition, these memory B-cell responses persisted up to 1 year, substantially longer than other traditional immunologic markers of infection with V. cholerae. While the magnitude of the LPS-specific IgG memory B-cell response waned at 1 year, CTB- and TcpA-specific IgG memory B cells remained significantly elevated at 1 year after infection, suggesting that T-cell help may result in a more durable memory B-cell response to V. choleraeprotein antigens. Such memory B cells could mediate anamnestic responses on reexposure to V. cholerae.
- Published
- 2009
- Full Text
- View/download PDF
26. Antigen-Specific Memory B-Cell Responses to Vibrio cholerae O1 Infection in Bangladesh
- Author
-
Harris, Aaron M., Bhuiyan, M. Saruar, Chowdhury, Fahima, Khan, Ashraful I., Hossain, Azim, Kendall, Emily A., Rahman, Atiqur, LaRocque, Regina C., Wrammert, Jens, Ryan, Edward T., Qadri, Firdausi, Calderwood, Stephen B., and Harris, Jason B.
- Abstract
Cholera, caused by Vibrio cholerae, is a noninvasive dehydrating enteric disease with a high mortality rate if untreated. Infection with V. cholerae elicits long-term protection against subsequent disease in countries where the disease is endemic. Although the mechanism of this protective immunity is unknown, it has been hypothesized that a protective mucosal response to V. cholerae infection may be mediated by anamnestic responses of memory B cells in the gut-associated lymphoid tissue. To characterize memory B-cell responses to cholera, we enrolled a cohort of 39 hospitalized patients with culture-confirmed cholera and evaluated their immunologic responses at frequent intervals over the subsequent 1 year. Memory B cells to cholera antigens, including lipopolysaccharide (LPS), and the protein antigens cholera toxin B subunit (CTB) and toxin-coregulated pilus major subunit A (TcpA) were enumerated using a method of polyclonal stimulation of peripheral blood mononuclear cells followed by a standard enzyme-linked immunospot procedure. All patients demonstrated CTB, TcpA, and LPS-specific immunoglobulin G (IgG)and IgA memory responses by day 90. In addition, these memory B-cell responses persisted up to 1 year, substantially longer than other traditional immunologic markers of infection with V. cholerae. While the magnitude of the LPS-specific IgG memory B-cell response waned at 1 year, CTB- and TcpA-specific IgG memory B cells remained significantly elevated at 1 year after infection, suggesting that T-cell help may result in a more durable memory B-cell response to V. cholerae protein antigens. Such memory B cells could mediate anamnestic responses on reexposure to V. cholerae.
- Published
- 2009
27. Drug-resistant tuberculosis in 2017: at a crossroads.
- Author
-
Dowdy, David W, Theron, Grant, Tornheim, Jeffrey A, and Kendall, Emily A
- Subjects
MULTIDRUG-resistant tuberculosis ,TUBERCULOSIS transmission ,POINT-of-care testing ,PREVENTION - Published
- 2017
- Full Text
- View/download PDF
28. Drug-resistant tuberculosis in 2017: at a crossroads
- Author
-
Dowdy, David W, Theron, Grant, Tornheim, Jeffrey A, and Kendall, Emily A
- Published
- 2017
- Full Text
- View/download PDF
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