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1. Risk of COVID-19 after natural infection or vaccinationResearch in context

Author

Anne-Marie Rick, Matthew B. Laurens, Ying Huang, Chenchen Yu, Thomas C.S. Martin, Carina A. Rodriguez, Christina A. Rostad, Rebone M. Maboa, Lindsey R. Baden, Hana M. El Sahly, Beatriz Grinsztejn, Glenda E. Gray, Cynthia L. Gay, Peter B. Gilbert, Holly E. Janes, James G. Kublin, Yunda Huang, Brett Leav, Ian Hirsch, Frank Struyf, Lisa M. Dunkle, Kathleen M. Neuzil, Lawrence Corey, Paul A. Goepfert, Stephen R. Walsh, Dean Follmann, Karen L. Kotloff, Atoya Adams, Eric Miller, Bruce G. Rankin, Steven Shinn, Marshall Nash, Sinikka L. Green, Colleen Jacobsen, Jayasree Krishnankutty, Sikhongi Phungwayo, Richard M. Glover, II, Stacy Slechta, Troy Holdeman, Robyn Hartvickson, Amber Grant, Terry L. Poling, Terry D. Klein, Thomas C. Klein, Tracy R. Klein, William B. Smith, Richard L. Gibson, Jennifer Winbigler, Elizabeth Parker, Priyantha N. Wijewardane, Eric Bravo, Jeffrey Thessing, Michelle Maxwell, Amanda Horn, Catherine Mary Healy, Christine Akamine, Laurence Chu, R. Michelle Chouteau, Michael J. Cotugno, George H. Bauer, Jr., Greg Hachigian, Masaru Oshita, Michael Cancilla, Kristen Kiersey, William Seger, Mohammed Antwi, Allison Green, Anthony Kim, Michael Desjardins, Jennifer A. Johnson, Amy Sherman, Judith Borger, Nafisa Saleem, Joel Solis, Martha Carmen Medina, Westly Keating, Edgar Garcia, Cynthia Bueno, Nathan Segall, Douglas S. Denham, Thomas Weiss, Ayoade Avworo, Parke Hedges, Cynthia Becher Strout, Rica Santiago, Yvonne Davis, Patty Howenstine, Alison Bondell, Kristin Marks, Tina Wang, Timothy Wilkin, Mary Vogler, Carrie Johnston, Michele P. Andrasik, Jessica G. Andriesen, Gail Broder, Niles Eaton, Huub G. Gelderblom, Rachael McClennen, Nelson Michael, Merlin Robb, Carrie Sopher, Vicki E. Miller, Fredric Santiago, Blanca Gomez, Insiya Valika, Amy Starr, Valeria D. Cantos, Sheetal Kandiah, Carlos del Rio, Nadine Rouphael, Srilatha Edupuganti, Evan J. Anderson, Andres Camacho-Gonzalez, Satoshi Kamidani, Meghan Teherani, David J. Diemert, Elissa Malkin, Marc Siegel, Afsoon Roberts, Gary Simon, Bindu Balani, Carolene Stephenson, Steven Sperber, Cristina Cicogna, Marcus J. Zervos, Paul Kilgore, Mayur Ramesh, Erica Herc, Kate Zenlea, Abram Burgher, Ann M. Milliken, Joseph D. Davis, Brendan Levy, Sandra Kelman, Matthew W. Doust, Denise Sample, Sandra Erickson, Shane G. Christensen, Christopher Matich, James Longe, John Witbeck, James T. Peterson, Alexander Clark, Gerald Kelty, Issac Pena-Renteria, Michael J. Koren, Darlene Bartilucci, Alpa Patel, Carolyn Tran, Christina Kennelly, Robert Brownlee, Jacob Coleman, Hala Webster, Carlos A. Fierro, Natalia Leistner, Amy Thompson, Celia Gonzalez, Lisa A. Jackson, Janice Suyehira, Milton Haber, Maria M. Regalado, Veronica Procasky, Alisha Lutat, Carl P. Griffin, Ripley R. Hollister, Jeremy Brown, Melody Ronk, Wayne L. Harper, Lisa Cohen, Lynn Eckert, Matthew Hong, Rambod Rouhbakhsh, Elizabeth Danford, John Johnson, Richard Calderone, Shishir K. Khetan, Oyebisi Olanrewaju, Nan Zhai, Kimberly Nieves, Allison O'Brien, Paul S. Bradley, Amanda Lilienthal, Jim Callis, Adam B. Brosz, Andrea Clement, Whitney West, Luke Friesen, Paul Cramer, Frank S. Eder, Ryan Little, Victoria Engler, Heather Rattenbury-Shaw, David J. Ensz, Allie Oplinger, Brandon J. Essink, Jay Meyer, Frederick Raiser, III, Kimberly Mueller, Keith W. Vrbicky, Charles Harper, Chelsie Nutsch, Wendell Lewis, III, Cathy Laflan, Jordan L. Whatley, Nicole Harrell, Amie Shannon, Crystal Rowell, Christopher Dedon, Mamodikoe Makhene, Gregory M. Gottschlich, Kate Harden, Melissa Gottschlich, Mary Smith, Richard Powell, Murray A. Kimmel, Simmy Pinto, Timothy P. Vachris, Mark Hutchens, Stephen Daniels, Margaret Wells, Mimi Van Der Leden, Peta-Gay Jackson-Booth, Mira Baron, Pamela Kane, Shannen Seversen, Mara Kryvicky, Julia Lord, Jamshid Saleh, Matthew Miles, Rafael Lupercio, John W. McGettigan, Jr., Walter Patton, Riemke Brakema, Karin Choquette, Jonlyn McGettigan, Judith L. Kirstein, Marcia Bernard, Mary Beth Manning, Joan Rothenberg, Toby Briskin, Denise Roadman, Sharita Tedder-Edwards, Howard I. Schwartz, Surisday Mederos, Shobha Swaminathan, Amesika Nyaku, Tilly Varughese, Michelle DallaPiazza, Sharon E. Frey, Irene Graham, Getahun Abate, Daniel Hoft, Leland N. Allen, III, Leslie A. Edwards, William S. Davis, Jr., Jessica M. Mena, Mark E. Kutner, Jorge Caso, Maria Hernandez Moran, Marianela Carvajal, Janet Mendez, Larkin T. Wadsworth, III, Michael R. Adams, Leslie Iverson, Joseph L. Newberg, Laura Pearlman, Paul J. Nugent, Michele D. Reynolds, Jennifer Bashour, Robert Schmidt, Neil P. Sheth, Kenneth Steil, Ramy J. Toma, William Kirby, Pink Folmar, Samantha Williams, Paul Pickrell, Stefanie Mott, Carol Ann Linebarger, Hussain Malbari, David Pampe, Veronica G. Fragoso, Lisa Holloway, Cecilia McKeown-Bragas, Teresa Becker, Barton G. Williams, William H. Jones, Jesse L. Clark, Steven Shoptaw, Michele Vertucci, Will Hernandez, Stephen A. Spector, Amaran Moodley, Jill Blumenthal, Lisa Stangl, Karen Deutsch, Kathleen M. Mullane, David Pitrak, Cheryl Nuss, Judy Pi, Carl Fichtenbaum, Margaret Powers-Fletcher, Michelle Saemann, Sharon Kohrs, Thomas B. Campbell, Andrew Lauria, Jose C. Mancilla, Hillary Dunlevy, Richard M. Novak, Andrea Wendrow, Scott Borgetti, Ben Ladner, Lisa Chrisley, Cheryl Young, Susanne Doblecki-Lewis, Maria L. Alcaide, Jose Gonzales-Zamora, Stephen Morris, David Wohl, Joseph Eron, Jr., Ian Frank, Debora Dunbar, David Metzger, Florence Momplaisir, Judith Martin, Alejandro Hoberman, Timothy Shope, Gysella Muniz, Richard Rupp, Amber Stanford, Megan Berman, Laura Porterfield, Michael Lewis, Elham Ghadishah, Joseph Yusin, Mai Pham, Clarence B. Creech, II, Shannon Walker, Stephanie Rolsma, Robert Samuels, Isaac Thomsen, Spyros A. Kalams, Greg Wilson, Gregg H. Lucksinger, Kevin Parks, Ryan Israelsen, Jaleh Ostovar, Kary Kelly, Jeffrey S. Overcash, Hanh Chu, Kia Lee, Luis I. De La Cruz, Steve Clemons, Elizabeth Everette, Suzanna Studdard, Gowdhami Mohan, Stefanie Tyson, Alyssa-Kay Peay, Danyel Johnson, Gregory J. Feldman, May-Yin Suen, Jacqueline Muenzner, Joseph Boscia, Farhan Siddiqui, John Sanders, James Peacock, Julio Nasim, Michael L. Levin, Julie Hussey, Marcy Kulic, Mark M. McKenzie, Teresa Deese, Erica Osmundsen, Christy Sweet, Valentine M. Ebuh, Elwaleed Elnagar, Georgette Ebuh, Genevieve Iwuala, Laurie J. Han-Conrad, Todd Simmons, Denis Tarakjian, Jeremy Ackermann, Mark S. Adams, José O. Alemán, Mohamed S. Al-Ibrahim, David R. Andes, Jeb Andrews, Roberto C. Arduino, Martín Bäcker, Diana Badillo, Emma Bainbridge, Teresa A. Batteiger, Jose A. Bazan, Roger J. Bedimo, Jorge A. Benitez, Annette R. Bennett, David I. Bernstein, Kristin Bialobok, Rebecca Boas, Judith Brady, Cynthia Brown, Catherine A. Bunce, Robert S. Call, Wesley Campbell, Ellie Carmody, Christopher Carpenter, Steven E. Carsons, Marvin Castellon, Mario Castro, Hannah Catan, Jennifer Chang, Mouna G. Chebib, Corey M. Chen, Margaret Cheng, Brian D.W. Chow, Annie Ciambruschini, Joseph P. Connor, James H. Conway, Maureen Cooney, Marcel Curlin, Claudia De La Matta Rodriguez, Jon F. Dedon, Emily Degan, Michelle Dickey, Craig Dietz, Jennifer L. Dong, Brenda Dorcely, Michael P. Dube, Carmel B. Dyer, Benjamin Eckhardt, Edward Ellerbeck, Evan C. Ewers, Amy Falk, Brittany Feijoo, Uriel R. Felsen, Tom Fiel, David Fitz-Patrick, Charles M. Fogarty, Stacy Ford, Lina M. Forero, Elizabeth Formentini, Doris Franco-Vitteri, Robert W. Frenck, Jr., Elie Gharib, Suzanne Gharib, Rola G. Rucker, James N. Goldenberg, Luis H. González, Brett Gray, Rusty Greene, Robert M. Grossberg, Juan V. Guanira-Carranza, Alfredo Gilberto Guerreros Benavides, Clint C. Guillory, Shauna H. Gunaratne, David Halpert, Holli Hamilton, William R. Hartman, Sheryl L. Henderson, Ramin Herati, Laura Hernandez Guarin, Robin Hilder, Ken Ho, Leila Hojat, Sybil G. Hosek, Jeffrey M. Jacobson, Melanie Jay, Diane H. Johnson, Kathleen S. Jones, Edward C. Jones-López, Jessica E. Justman, Scott Kahney, Lois Katz, Melinda Katz, Daniel Kaul, Michael C. Keefer, Ashley Kennedy, Jennifer Knishinsky, Laura Kogelman, Susan L. Koletar, Angelica Kottkamp, Maryrose Laguio-Vila, Raphael J. Landovitz, Jessica L. Lee, Albert Liu, Eneyda Giuvanela Llerena Zegarra, Anna S. Lok, James Lovell, Ronald Lubelchek, John Lucaj, Gary Luckasen, Annie Luetkemeyer, Njira Lucia Lugogo, Janine Maenza, Carlos Malvestutto, Monica Mauri, Ryan C. Maves, Kenneth H. Mayer, Michael J. McCartney, Margaret E. McCort, M. Juliana McElrath, Meredith McNairy, Fernando L. Merino, Eric A. Meyerowitz, Carol L. Mitchell, Cynthia L. Monaco, Sauda Muhammad, Sigridh Muñoz-Gómez, Sonal Munsiff, Paul Nee, Nicole L. Nollen, Asif Noor, Claudio Nuñez Lagos, Jason F. Okulicz, Patrick A. Oliver, Jessica Ortega, Steven Palmer, Lalitha Parameswaran, Purvi Parikh, Susan Parker, Reza Parungao, Juana R. Pavie, Rebecca P. Madan, Henry Peralta, Jennifer Petts, Kristen K. Pierce, E. Javier Pretell Alva, Lawrence J. Purpura, Vanessa Raabe, Sergio E. Recuenco, Tamara Richards, Sharon A. Riddler, Barbara Rizzardi, Rachel Rokser, Charlotte-Paige Rolle, Adam Rosen, Jeffrey Rosen, Lena R. Freese, María E. Santolaya, Linda M. Schipani, Adam Schwartz, Tiffany Schwasinger-Schmidt, Hyman Scott, Beverly E. Sha, Shivanjali Shankaran, Adrienne E. Shapiro, Stephan C. Sharp, Bo Shopsin, Matthew D. Sims, Stephanie Skipper, Derek M. Smith, Michael J. Smith, M. Mahdee Sobhanie, Brit Sovic, Stephanie Sterling, Robert Striker, Karla Beatriz Tafur Bances, Kawsar R. Talaat, Edward M. Tavel, Jr., Hong V. Tieu, Christian Tomaszewski, Ryan Tomlinson, Juan P. Torres, Julian A. Torres, John J. Treanor, Sade Tukuru, Robert J. Ulrich, Gregory C. Utz, Veronica Viar, Roberto A. Viau Colindres, Edward E. Walsh, Mary C. Walsh, Emmanuel B. Walter, Jessica L. Weidler, Yi H. Wu, Kinara S. Yang, Juan Luis Yrivarren Giorza, Arthur L. Zemanek, Kevin Zhang, Barry S. Zingman, Richard Gorman, Carmen A. Paez, Edith Swann, Simbarashe G. Takuva, Alex Greninger, Pavitra Roychoudhury, Robert W. Coombs, Keith R. Jerome, Flora Castellino, Xiaomi Tong, Corrina Pavetto, Teletha Gipson, Tina Tong, Marina Lee, James Zhou, Michael Fay, Kelly McQuarrie, Chimeremma Nnadi, Obiageli Sogbetun, Nina Ahmad, Ian De Proost, Cyrus Hoseyni, Paul Coplan, Najat Khan, Peter Ronco, Dawn Furey, Jodi Meck, Johan Vingerhoets, Boerries Brandenburg, Jerome Custers, Jenny Hendriks, Jarek Juraszek, Anne Marit de Groot, Griet Van Roey, Dirk Heerwegh, Ilse Van Dromme, Jorge F. Méndez Galván, Monica B. Carrascal, Adriana Sordo Duran, Laura Ruy Sanchez Guerrero, Martha Cecilia Gómora Madrid, Alejandro Quintín Barrat Hernández, Sharzhaad Molina Guizar, Denisse Alejandra González Estrada, Silvano Omar Martínez Pérez, Zindy Yazmín Zárate Hinojosa, Guillermo Miguel Ruiz-Palacios, Aurelio Cruz-Valdez, Janeth Pacheco-Flores, Anyela Lara, Secia Díaz-Miralrio, María José Reyes Fentanes, Jocelyn Zuleica Olmos Vega, Daniela Pineda Méndez, Karina Cano Martínez, Winniberg Stephany Alvarez León, Vida Veronica Ruiz Herrera, Eduardo Gabriel Vázquez Saldaña, Laura Julia Camacho Choza, Karen Sofia Vega Orozco, Sandra Janeth Ortega Domínguez, Jorge A. Chacón, Juan J. Rivera, Erika A. Cutz, Maricruz E. Ortegón, María I. Rivera, David Browder, Cortney Burch, Terri Moye, Paul Bondy, Lesley Browder, Rickey D. Manning, James W. Hurst, Rodney E. Sturgeon, Paul H. Wakefield, John A. Kirby, James Andersen, Szheckera Fearon, Rosa Negron, Amy Medina, John M. Hill, Vivek Rajasekhar, Hayes Williams, LaShondra Cade, Rhodna Fouts, Connie Moya, Corey G. Anderson, Naomi Devine, James Ramsey, Ashley Perez, David Tatelbaum, Michael Jacobs, Kathleen Menasche, Vincent Mirkil, Peter J. Winkle, Amina Z. Haggag, Michelle Haynes, Marysol Villegas, Sabina Raja, Robert Riesenberg, Stanford Plavin, Mark Lerman, Leana Woodside, Maria Johnson, C. Mary Healy, Jennifer A. Whitaker, Wendy A. Keitel, Robert L. Atmar, Gary Horwith, Robin Mason, Lisa Johnson, Tambra Dora, Deborah Murray, Logan Ledbetter, Beverly Ewing, Kathryn E. Stephenson, Chen S. Tan, Rebecca Zash, Jessica L. Ansel, Kate Jaegle, Caitlin J. Guiney, Jeffrey A. Henderson, Marcia O'Leary, Kendra Enright, Jill Kessler, Pete Ducheneaux, Asha Inniss, Donald M. Brandon, William B. Davis, Daniel T. Lawler, Yaa D. Oppong, Ryan P. Starr, Scott N. Syndergaard, Rozeli Shelly, Mashrur Islam Majumder, Danny Sugimoto, Jeffrey Dugas, Sr., Dolores Rijos, Sandra Shelton, Stephan Hong, Howard Schwartz, Nelia Sanchez-Crespo, Jennifer Schwartz, Terry Piedra, Barbara Corral, Carmen Medina, Michael E. Dever, Mitul Shah, Michael Delgado, Tameika Scott, Lisa S. Usdan, Lora J. McGill, Valerie K. Arnold, Carolyn Scatamacchia, Codi M. Anthony, Rajan Merchant, Anelgine C. Yoon, Janet Hill, Lucy Ng-Price, Teri Thompson-Seim, Ronald Ackerman, Jamie Ackerman, Florida Aristy, Nzeera Ketter, Jon Finley, Mildred Stull, Monica Murray, Zainab Rizvi, Sonia Guerrero, Yogesh K. Paliwal, Amit Paliwal, Sarah Gordon, Bryan Gordon, Cynthia Montano-Pereira, Christopher Galloway, Candice Montros, Lily Aleman, Samira Shairi, Wesley Van Ever, George H. Freeman, Esther L. Harmon, Marshall A. Cross, Kacie Sales, Catherine Q. Gular, Matthew Hepburn, Nathan Alderson, Shana Harshell, Siham Mahgoub, Celia Maxwell, Thomas Mellman, Karl M. Thompson, Glenn Wortman, Jeff Kingsley, April Pixler, LaKondria Curry, Sarah Afework, Austin Swanson, Jeffry Jacqmein, Maggie Bowers, Dawn Robison, Victoria Mosteller, Janet Garvey, Mary Easley, Rebecca J. Kurnat, Raymond Cornelison, Shanda Gower, William Schnitz, Destiny S. Heinzig-Cartwright, Derek Lewis, Fred E. Newton, Aeiress Duhart, Breanz Watkins, Brandy Ball, Jill York, Shelby Pickle, David B. Musante, William P. Silver, Linda R. Belhorn, Nicholas A. Viens, David Dellaero, Priti Patel, Kendra Lisec, Beth Safirstein, Luz Zapata, Lazaro Gonzalez, Evelyn Quevedo, Farah Irani, Joseph Grillo, Amy Potts, Julie White, Patrick Flume, Gary Headden, Brandie Taylor, Ashley Warden, Amy Chamberlain, Robert Jeanfreau, Susan Jeanfreau, Paul G. Matherne, Amy Caldwell, Jessica Stahl, Mandy Vowell, Lauren Newhouse, Vladimir Berthaud, Zudi-Mwak Takizala, Genevieve Beninati, Kimberly Snell, Sherrie Baker, James Walker, Tavane Harrison, Meagan Miller, Janet Otto, Roni Gray, Christine Wilson, Tiffany Nemecek, Hannah Harrington, Sally Eppenbach, Wendell Lewis, Tana Bourgeois, Lyndsea Folsom, Gregory Holt, Mehdi Mirsaeidi, Rafael Calderon, Paola Lichtenberger, Jalima Quintero, Becky Martinez, Lilly Immergluck, Erica Johnson, Austin Chan, Norberto Fas, LaTeshia Thomas-Seaton, Saadia Khizer, Jonathan Staben, Tatiana Beresnev, Maryam Jahromi, Mary A. Marovich, Julia Hutter, Martha Nason, Julie Ledgerwood, John Mascola, Mark Leibowitz, Fernanda Morales, Mike Delgado, Rosario Sanchez, Norma Vega, Germán Áñez, Gary Albert, Erin Coston, Chinar Desai, Haoua Dunbar, Mark Eickhoff, Jenina Garcia, Margaret Kautz, Angela Lee, Maggie Lewis, Alice McGarry, Irene McKnight, Joy Nelson, Patrick Newingham, Patty Price-Abbott, Patty Reed, Diana Vegas, Bethanie Wilkinson, Katherine Smith, Wayne Woo, Iksung Cho, Gregory M. Glenn, Filip Dubovsky, David L. Fried, Lynne A. Haughey, Ariana C. Stanton, Lisa Stevens Rameaka, David Rosenberg, Lee Tomatsu, Viviana Gonzalez, Millie Manalo, Bernard Grunstra, Donald Quinn, Phillip Claybrook, Shelby Olds, Amy Dye, Kevin D. Cannon, Mesha M. Chadwick, Bailey Jordan, Morgan Hussey, Hannah Nevarez, Colleen F. Kelley, Michael Chung, Caitlin Moran, Paulina Rebolledo, Christina Bacher, Elizabeth Barranco-Santana, Jessica Rodriguez, Rafael Mendoza, Karen Ruperto, Odette Olivieri, Enrique Ocaña, Paul E. Wylie, Renea Henderson, Natasa Jenson, Fan Yang, Amy Kelley, Kenneth Finkelstein, David Beckmann, Tanya Hutchins, Sebastian Garcia Escallon, Kristen Johnson, Teresa S. Sligh, Parul Desai, Vincent Huynh, Carlos Lopez, Erika Mendoza, Jeffrey Adelglass, Jerome G. Naifeh, Kristine J. Kucera, Waseem Chughtai, Shireen H. Jaffer, Matthew G. Davis, Jennifer Foley, Michelle L. Burgett, Tammi L. Shlotzhauer, Sarah M. Ingalsbe-Geno, Daniel Duncanson, Kelly Kush, Lori Nesbitt, Cora Sonnier, Jennifer McCarter, Michael B. Butcher, James Fry, Donna Percy, Karen Freudemann, Bruce C. Gebhardt, Padma N. Mangu, Debra B. Schroeck, Rajesh K. Davit, Gayle D. Hennekes, Benjamin J. Luft, Melissa Carr, Sharon Nachman, Alison Pellecchia, Candace Smith, Bruno Valenti, Maria I. Bermudez, Noris Peraita, Ernesto Delgado, Alicia Arrazcaeta, Natalie Ramirez, Carmen Amador, Horacio Marafioti, Lyly Dang, Lauren Clement, Jennifer Berry, Mohammed Allaw, Georgettea Geuss, Chelsea Miles, Zachary Bittner, Melody Werne, Cornell Calinescu, Shannon Rodman, Joshua Rindt, Erin Cooksey, Kristina Harrison, Deanna Cooper, Manisha Horton, Amanda Philyaw, William Jennings, Hilario Alvarado, Michele Baka, Malina Regalado, Linda Murray, Sherif Naguib, Justin Singletary, Sha-Wanda Richmond, Sarah Omodele, Emily Oppenheim, Reuben Martinez, Victoria Andriulis, Leonard Singer, Jeanne Blevins, Meagan Thomas, Christine Hull, Isabel Pereira, Gina Rivero, Tracy Okonya, Frances Downing, Paulina Miller, Margaret Rhee, Katherine Stapleton, Jeffrey Klein, Rosamond Hong, Suzanne Swan, Tami Wahlin, Elizabeth Bennett, Amy Salzl, Sharine Phan, Jewel J. White, Amanda Occhino, Ruth Paiano, Morgan McLaughlin, Elisa Swieboda, Veronica Garcia-Fragoso, Maria G. Becerra, Toni White, Christine B. Turley, Andrew McWilliams, Tiffany Esinhart, Natasha Montoya, Shamika Huskey, Leena Paul, Karen Tashima, Jennie Johnson, Marguerite Neill, Martha Sanchez, Natasha Rybak, Maria Mileno, Stuart H. Cohen, Monica Ruiz, Dean M. Boswell, Elizabeth E. Robison, Trina L. Reynolds, Sonja Neumeister, Carmen D. Zorrilla, Juana Rivera, Jessica Ibarra, Iris García, Dianca Sierra, Wanda Ramon, Suzanne Fiorillo, Rebecca Pitotti, Victoria R. Anderson, Jose Castillo Mancilla, Nga Le, Patricia L. Winokur, Dilek Ince, Theresa Hegmann, Jeffrey Meier, Jack Stapleton, Laura Stulken, Monica McArthur, Andrea Berry, Milagritos Tapia, Elizabeth Hammershaimb, Toni Robinson, Rosa MacBryde, Susan Kline, Joanne L. Billings, Winston Cavert, Les B. Forgosh, Timothy W. Schacker, Tyler D. Bold, Dima Dandachi, Taylor Nelson, Andres Bran, Grant Geiger, S. Hasan Naqvi, Diana F. Florescu, Richard Starlin, David Kline, Andrea Zimmer, Anum Abbas, Natasha Wilson, Joseph J. Eron, Michael Sciaudone, A. Lina Rosengren, John S. Kizer, Sarah E. Rutstein, Elizabeth Bruce, Claudia Espinosa, Lisa J. Sanders, Kami Kim, Denise Casey, Barbara S. Taylor, Thomas Patterson, Ruth S. Pinilla, Delia Bullock, Philip Ponce, Jan Patterson, R. Scott McClelland, Dakotah C. Lane, Anna Wald, Frank James, Elizabeth Duke, Kirsten Hauge, Jessica Heimonen, Erin A. Goecker, Youyi Fong, Carol Kauffman, Kathleen Linder, Kimberly Nofz, Andrew McConnell, Robert J. Buynak, Angella Webb, Taryn Petty, Stephanie Andree, Erica Sanchez, Nolan Mackey, Clarisse Baudelaire, Sarah Dzigiel, Adrienna Marquez, Kim Quillin, Michelle King, Vanessa Abad, Jennifer Knowles, Michael Waters, Karla Zepeda, Jordan Coslet, Dalia Tovar, Marian E. Shaw, Mark A. Turner, Cory J. Huffine, Esther S. Huffine, Julie A. Ake, Elizabeth Secord, Eric McGrath, Phillip Levy, Brittany Stewart, Charnell Cromer, Ayanna Walters, Grant Ellsworth, Caroline Greene, Sarah Galloway, Shashi Kapadia, Elliot DeHaan, Clint Wilson, Jason Milligan, Danielle Raley, Joseph Bocchini, Bruce McClenathan, Mary Hussain, Evelyn Lomasney, Evelyn Hall, Sherry Lamberth, Christy Schmeck, Vickie Leathers, Deborah A. Theodore, Angela R. Branche, Daniel S. Graciaa, Timothy J. Hatlen, Jacqueline Miller, Jerald Sadoff, Ann R. Falsey, and Magdalena E. Sobieszczyk

Subjects
COVID-19, Natural infection, Hybrid immunity, Vaccination, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Published
2023
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2. Parthenolide induces rapid thiol oxidation that leads to ferroptosis in hepatocellular carcinoma cells

Author

Francesca V. LoBianco, Kimberly J. Krager, Erica Johnson, Christopher O. Godwin, Antino R. Allen, Peter A. Crooks, Cesar M. Compadre, Michael J. Borrelli, and Nukhet Aykin-Burns

Subjects
hepatocellular carcinoma (HCC), parthenolide (PTL), thiol oxidation, lipid peroxidation, ferroptosis, glutathione, Toxicology. Poisons, RA1190-1270
Abstract

Hepatocellular carcinoma (HCC) is both a devastating and common disease. Every year in the United States, about 24,500 men and 10,000 women are diagnosed with HCC, and more than half of those diagnosed patients die from this disease. Thus far, conventional therapeutics have not been successful for patients with HCC due to various underlying comorbidities. Poor survival rate and high incidence of recurrence after therapy indicate that the differences between the redox environments of normal surrounding liver and HCC are valuable targets to improve treatment efficacy. Parthenolide (PTL) is a naturally found therapeutic with anti-cancer and anti-inflammatory properties. PTL can alter HCC’s antioxidant environment through thiol modifications leaving tumor cells sensitive to elevated reactive oxygen species (ROS). Investigating the link between altered thiol mechanism and increased sensitivity to iron-mediated lipid peroxidation will allow for improved treatment of HCC. HepG2 (human) and McARH7777 (rat) HCC cells treated with PTL with increasing concentrations decrease cell viability and clonogenic efficiency in vitro. PTL increases glutathione (GSH) oxidation rescued by the addition of a GSH precursor, N-acetylcysteine (NAC). In addition, this elevation in thiol oxidation results in an overall increase in mitochondrial dysfunction. To elucidate if cell death is through lipid peroxidation, using a lipid peroxidation sensor indicated PTL increases lipid oxidation levels after 6 h. Additionally, western blotting reveals glutathione peroxidase 4 (GPx4) protein levels decrease after treatment with PTL suggesting cells are incapable of preventing lipid peroxidation after exposure to PTL. An elevation in lipid peroxidation will lead to a form of cell death known as ferroptosis. To further establish ferroptosis as a critical mechanism of death for HCC in vitro, the addition of ferrostatin-1 combined with PTL demonstrates a partial recovery in a colony survival assay. This study reveals that PTL can induce tumor cell death through elevations in intracellular oxidation, leaving cells sensitive to ferroptosis.

Published
2022
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3. Traumatic Brain Injury in Honduras: The Use of a Paper‑based Surveillance System to Characterize Injuries Patterns

Author

Erica Johnson, Cristina Rodriguez, Juan C. Puyana, and Francisco J. Bonilla-Escobar

Subjects
Wounds And Injuries, Nervous System Trauma, Trauma Centers, Violence, Honduras, Traumatic Brain Injuries., Medicine (General), R5-920, Public aspects of medicine, RA1-1270
Abstract

Background: Traumatic brain injuries (TBI) are a leading cause of death and disability worldwide. Violence is the leading cause of mortality in Honduras. However, the incidence and impact of TBI in this low-middle income country (LMIC) is unknown. The aim of this study is to describe the epidemiology of TBI in Honduras, as captured by an injury surveillance tool in the country’s major referral center. Methods: We conducted a cross‑sectional review of all TBI‑related emergency department visits at the main referral hospital in Honduras from January to December 2013. We calculated descriptive statistics from Injury Surveillance System (InSS) data. Results: Of 17,971 total injuries seen in 2013, 20% were traumatic brain injuries (n=3,588). The main mechanisms of injury were falls (41.11%), road traffic (23.91%), blunt trauma (20.82%), penetrating knife injuries (5.85%), and firearm injuries (2.26%). Most TBI were classified as mild; 99.69% (Glasgow Coma Scale=15). Emergency room mortality was low (1.11%). The modified Kampala Trauma Score median was 8 (interquartile range 7-8). Conclusion: Mild TBI accounts for a significant percentage of all injuries presenting to a high-volume referral center in Honduras in 2013. Despite the high incidence of violence in this country, most TBI were accidental, secondary to road traffic accidents and falls. There is required further research with more recent data as well as with prospective data collection methods.

Published
2022
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5. Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far

Author

Maria Camila Cardenas, Sheila Farnan, Benjamin L. Hamel, Maria Camila Mejia Plazas, Elise Sintim-Aboagye, Dawn R. Littlefield, Supriya Behl, Sohan Punia, Elizabeth Ann L Enninga, Erica Johnson, Zelalem Temesgen, Regan Theiler, Clive M. Gray, and Rana Chakraborty

Subjects
HIV, breastfeeding, prevention of vertical transmission, antiretroviral therapy, infants, prophylaxis, Microbiology, QR1-502
Abstract

In 1989, one in four (25%) infants born to women living with HIV were infected; by the age of 2 years, there was 25% mortality among them due to HIV. These and other pieces of data prompted the development of interventions to offset vertical transmission, including the landmark Pediatric AIDS Clinical Trial Group Study (PACTG 076) in 1994. This study reported a 67.5% reduction in perinatal HIV transmission with prophylactic antenatal, intrapartum, and postnatal zidovudine. Numerous studies since then have provided compelling evidence to further optimize interventions, such that annual transmission rates of 0% are now reported by many health departments in the US and elimination has been validated in several countries around the world. Despite this success, the elimination of HIV’s vertical transmission on the global scale remains a work in progress, limited by socioeconomic factors such as the prohibitive cost of antiretrovirals. Here, we review some of the key trials underpinning the development of guidelines in the US as well as globally, and discuss the evidence through a historic lens.

Published
2023
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6. Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study

Author

Nestoras Mathioudakis, Moeen Aboabdo, Mohammed S Abusamaan, Christina Yuan, LaPricia Lewis Boyer, Scott J Pilla, Erica Johnson, Sanjay Desai, Amy Knight, Peter Greene, and Sherita H Golden

Subjects
Medical technology, R855-855.5
Abstract

BackgroundIatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. ObjectiveThis study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. MethodsUsing the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. ResultsA 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. ConclusionsThe design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia.

Published
2021
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7. The Mitochondrial Protein MitoNEET as a Probe for the Allostery of Glutamate Dehydrogenase

Author

Chimere Nnatubeugo, Erica Johnson, Sarah Gisondi, Felicia Roland, Werner J. Geldenhuys, Michael A. Menze, and Mary E. Konkle

Subjects
free fatty acids, beta-oxidation, mitochondria, green tea, hyperinsulinism, Organic chemistry, QD241-441
Abstract

The proteins glutamate dehydrogenase (GDH) and mitoNEET are both targets of drug development efforts to treat metabolic disorders, cancer, and neurodegenerative diseases. However, these two proteins differ starkly in the current knowledge about ligand binding sites. MitoNEET is a [2Fe-2S]-containing protein with no obvious binding site for small ligands observed in its crystal structures. In contrast, GDH is known to have a variety of ligands at multiple allosteric sites thereby leading to complex regulation in activity. In fact, while GDH can utilize either NAD(H) or NADP(H) for catalysis at the active site, only NAD(H) binds at a regulatory site to inhibit GDH activity. Previously, we found that mitoNEET forms a covalent bond with GDH in vitro and increases the catalytic activity of the enzyme. In this study we evaluated the effects of mitoNEET binding on the allosteric control of GDH conferred by inhibitors. We examined all effectors using NAD or NADP as the coenzyme to determine allosteric linkage by the NAD-binding regulatory site. We found that GDH activity, in the presence of the inhibitory palmitoyl-CoA and EGCG, can be rescued by mitoNEET, regardless of the coenzyme used. This suggests that mitoNEET rescues GDH by stabilizing the open conformation.

Published
2022
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8. A global repository of novel antimicrobial emergence events [version 2; peer review: 1 approved, 2 approved with reservations]

Author

Emma Mendelsohn, Noam Ross, Allison M. White, Karissa Whiting, Cale Basaraba, Brooke Watson Madubuonwu, Erica Johnson, Mushtaq Dualeh, Zach Matson, Sonia Dattaray, Nchedochukwu Ezeokoli, Melanie Kirshenbaum Lieberman, Jacob Kotcher, Samantha Maher, Carlos Zambrana-Torrelio, and Peter Daszak

Subjects
Medicine, Science
Abstract

Despite considerable global surveillance of antimicrobial resistance (AMR), data on the global emergence of new resistance genotypes in bacteria has not been systematically compiled. We conducted a study of English-language scientific literature (2006-2017) and ProMED-mail disease surveillance reports (1994-2017) to identify global events of novel AMR emergence (first clinical reports of unique drug-bacteria resistance combinations). We screened 24,966 abstracts and reports, ultimately identifying 1,757 novel AMR emergence events from 268 peer-reviewed studies and 26 disease surveillance reports (294 total). Events were reported in 66 countries, with most events in the United States (152), China (128), and India (127). The most common bacteria demonstrating new resistance were Klebsiella pneumoniae (344) and Escherichia coli (218). Resistance was most common against antibiotic drugs imipenem (89 events), ciprofloxacin (84) and ceftazidime (83). We provide an open-access database of emergence events with standardized fields for bacterial species, drugs, location, and date. We discuss the impact of reporting and surveillance bias on database coverage, and we suggest guidelines for data analysis. This database may be broadly useful for understanding rates and patterns of AMR evolution, identifying global drivers and correlates, and targeting surveillance and interventions.

Published
2021
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9. Alternating hemiparesis in the context of hemolytic uremic syndrome and COVID-19 positivity

Author

Hugh D. Simpson, Erica Johnson, Jeffrey Britton, and Sherri Braksick

Subjects
EEG, Hemolytic uremic syndrome, Hemiparesis, Hemiplegia, COVID19, Neurology. Diseases of the nervous system, RC346-429, Neurophysiology and neuropsychology, QP351-495
Abstract

Hemiparesis has been reported in hemolytic uremic syndrome (HUS), however electrophysiological findings associated with this syndrome have not been well-characterized, and alternating hemiparesis presentations have not been reported. We present detailed electrophysiological and clinical findings in a case of alternating hemiparesis corresponding to alternating focal contralateral delta slowing on prolonged EEG monitoring in a case of HUS with COVID-19 positivity. A 24-year-old woman was admitted with bloody diarrhea, acute kidney injury, and focal seizures initially presumed due to Escherichia coli 0157:H7 Shiga-like toxin-related hemolytic uremic syndrome (ST-HUS). After admission, the patient tested positive for COVID-19. Continuous EEG monitoring revealed diffuse polymorphic delta slowing. Around 24 hours into the admission, the delta slowing became focal in the right hemisphere and was associated with a left hemiparesis. Around three days later, the clinical and EEG pattern reversed, showing left hemisphere slowing and an associated right hemiparesis. Additionally, 14 Hz positive spikes were observed throughout the recording period. Neuroimaging, including CT and MRI, was negative for acute ischemia throughout. The patient subsequently recovered over several days with no residual neurologic abnormalities.

Published
2021
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10. Becoming Spanish in Florida: Georges Biassou and his 'Family' in St. Augustine

Author

Erica Johnson

Subjects
transnational, american studies, Social sciences (General), H1-99
Abstract

Historian Jane Landers has conducted extensive research on Georges Biassou and black society in Spanish Florida, and her various historical works provide most of what is known about Biassou's experiences there and the perceptions Spanish officials and Anglo American planters had of him. Alternatively, Erica Johnson approaches Biassou as a free man of color from a French colony adapting to life in a Spanish colony to further expand historical understanding of him and others like him.

Published
2017
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12. Randomized, Double-Blind, Placebo-Controlled Study on Decolonization Procedures for Methicillin-Resistant Staphylococcus aureus (MRSA) among HIV-Infected Adults.

Author

Amy Weintrob, Ionut Bebu, Brian Agan, Alona Diem, Erica Johnson, Tahaniyat Lalani, Xun Wang, Mary Bavaro, Michael Ellis, Katrin Mende, and Nancy Crum-Cianflone

Subjects
Medicine, Science
Abstract

HIV-infected persons have increased risk of MRSA colonization and skin and soft-tissue infections (SSTI). However, no large clinical trial has examined the utility of decolonization procedures in reducing MRSA colonization or infection among community-dwelling HIV-infected persons.550 HIV-infected adults at four geographically diverse US military HIV clinics were prospectively screened for MRSA colonization at five body locations every 6 months during a 2-year period. Those colonized were randomized in a double-blind fashion to nasal mupirocin (Bactroban) twice daily and hexachlorophene (pHisoHex) soaps daily for 7 days compared to placeboes similar in appearance but without specific antibacterial activity. The primary endpoint was MRSA colonization at 6-months post-randomization; secondary endpoints were time to MRSA clearance, subsequent MRSA infections/SSTI, and predictors for MRSA clearance at the 6-month time point.Forty-nine (9%) HIV-infected persons were MRSA colonized and randomized. Among those with 6-month colonization data (80% of those randomized), 67% were negative for MRSA colonization in both groups (p = 1.0). Analyses accounting for missing 6-month data showed no significant differences could have been achieved. In the multivariate adjusted models, randomization group was not associated with 6-month MRSA clearance. The median time to MRSA clearance was similar in the treatment vs. placebo groups (1.4 vs. 1.8 months, p = 0.35). There was no difference on subsequent development of MRSA infections/SSTI (p = 0.89). In a multivariable model, treatment group, demographics, and HIV-specific factors were not predictive of MRSA clearance at the 6-month time point.A one-week decolonization procedure had no effect on MRSA colonization at the 6-month time point or subsequent infection rates among community-dwelling HIV-infected persons. More aggressive or novel interventions may be needed to reduce the burden of MRSA in this population.ClinicalTrials.gov NCT00631566.

Published
2015
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13. Human cytomegalovirus vaccine based on the envelope gH/gL pentamer complex.

Author

Felix Wussow, Flavia Chiuppesi, Joy Martinez, John Campo, Erica Johnson, Christin Flechsig, Maegan Newell, Elaine Tran, Jose Ortiz, Corinna La Rosa, Andreas Herrmann, Jeff Longmate, Rana Chakraborty, Peter A Barry, and Don J Diamond

Subjects
Immunologic diseases. Allergy, RC581-607, Biology (General), QH301-705.5
Abstract

Human Cytomegalovirus (HCMV) utilizes two different pathways for host cell entry. HCMV entry into fibroblasts requires glycoproteins gB and gH/gL, whereas HCMV entry into epithelial and endothelial cells (EC) requires an additional complex composed of gH, gL, UL128, UL130, and UL131A, referred to as the gH/gL-pentamer complex (gH/gL-PC). While there are no established correlates of protection against HCMV, antibodies are thought to be important in controlling infection. Neutralizing antibodies (NAb) that prevent gH/gL-PC mediated entry into EC are candidates to be assessed for in vivo protective function. However, these potent NAb are predominantly directed against conformational epitopes derived from the assembled gH/gL-PC. To address these concerns, we constructed Modified Vaccinia Ankara (MVA) viruses co-expressing all five gH/gL-PC subunits (MVA-gH/gL-PC), subsets of gH/gL-PC subunits (gH/gL or UL128/UL130/UL131A), or the gB subunit from HCMV strain TB40/E. We provide evidence for cell surface expression and assembly of complexes expressing full-length gH or gB, or their secretion when the corresponding transmembrane domains are deleted. Mice or rhesus macaques (RM) were vaccinated three times with MVA recombinants and serum NAb titers that prevented 50% infection of human EC or fibroblasts by HCMV TB40/E were determined. NAb responses induced by MVA-gH/gL-PC blocked HCMV infection of EC with potencies that were two orders of magnitude greater than those induced by MVA expressing gH/gL, UL128-UL131A, or gB. In addition, MVA-gH/gL-PC induced NAb responses that were durable and efficacious to prevent HCMV infection of Hofbauer macrophages, a fetal-derived cell localized within the placenta. NAb were also detectable in saliva of vaccinated RM and reached serum peak levels comparable to NAb titers found in HCMV hyperimmune globulins. This vaccine based on a translational poxvirus platform co-delivers all five HCMV gH/gL-PC subunits to achieve robust humoral responses that neutralize HCMV infection of EC, placental macrophages and fibroblasts, properties of potential value in a prophylactic vaccine.

Published
2014
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20. Extracting novel antimicrobial emergence events from scientific literature and medical reports [version 1; peer review: 2 approved with reservations]

Author

Emma Mendelsohn, Noam Ross, Allison M. White, Karissa Whiting, Cale Basaraba, Brooke Watson Madubuonwu, Erica Johnson, Mushtaq Dualeh, Zach Matson, Sonia Dattaray, Nchedochukwu Ezeokoli, Melanie Kirshenbaum Lieberman, Jacob Kotcher, Samantha Maher, Carlos Zambrana-Torrelio, and Peter Daszak

Subjects
Data Note, Articles, Antimicrobial resistance, global health, open-access data
Abstract

Despite considerable global surveillance of antimicrobial resistance (AMR), data on the global emergence of new resistance genotypes in bacteria has not been systematically compiled. We conducted a study of English-language scientific literature (2006-2017) and disease surveillance reports (1994-2017) to identify global events of novel AMR emergence (first clinical reports of unique drug-bacteria resistance combinations). We screened 24,966 abstracts and reports, ultimately identifying 1,773 novel AMR emergence events from 294 articles. Events were reported in 66 countries, with most events in the United States (152), India (129), and China (128). The most common bacteria demonstrating new resistance were Klebsiella pneumoniae (352) and Escherichia coli (218). Resistance was most common against antibiotic drugs imipenem (89 events), ciprofloxacin (85) and ceftazidime (82). We provide an open-access database of emergence events with standardized fields for bacterial species, drugs, location, and date, and we discuss guidelines and caveats for data analysis. This database may be broadly useful for understanding rates and patterns of AMR evolution, identifying global drivers and correlates, and targeting surveillance and interventions.

Published
2020
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21. Mitochondrial CD36 expression is increased in endothelial cells exposed to elevated glucose in vitro

Author

Erica Johnson, Thanh Nguyen, and Ibra Fancher

Subjects
Physiology
Abstract

Background and Objective: Obesity is a multifactorial metabolic disease encompassing several cardiovascular risk factors including hyperglycemia. CD36 is a fatty acid translocase scavenger receptor and a glycoprotein which was previously shown to be upregulated by obesity and in response to elevated glucose. Furthermore, recent studies have identified the expression of CD36 in mitochondria of a variety of cell types which, following upregulation of mitoCD36 expression, would have significant impact on cellular respiration. Therefore, we aimed to determine the effect of elevated glucose on mitochondrial CD36 expression in endothelial cells in vitro. Methods: We treated human adipose microvascular endothelial cells (HAMECs) with high glucose (200 mg/dL) and mannitol (osmotic control; 200 mg/dL) for 24, 48, 72, or 96 hours. The control group was maintained in standard media containing 100 mg/dL glucose. Following treatments, CD36 expression was assessed via Western blot, qPCR, flow cytometry and immunocytochemistry (ICC). An antibody targeting an extracellular epitope of CD36 was used to identify membrane expression where appropriate. ICC was performed on distinct groups of nonpermeabilized and permeabilized cells to detect changes in membrane vs. internal expression, respectively. Mitochondria were isolated from HAMECs using positive selection of TOM40 via magnetic associated cell sorting. Statistics: A one-way Kruskal Wallis (p < 0.05) was used followed by Dunn Sidak post hoc tests to determine significant differences. Results: HAMECs exposed to elevated glucose exhibited an increase in CD36 expression in total cell lysates and in permeabilized cells after 72 hrs. However, no changes were detected in CD36 membrane expression or in CD36 gene expression in response to elevated glucose suggesting that internal expression of CD36 protein is increased through mechanisms independent of transcription under these conditions. To determine if CD36 expression was elevated specifically in mitochondria following exposure to elevated glucose, mitochondria were isolated and purified from HAMECs. CD36 expression was revealed to be increased in the mitochondrial fraction of glucose treated cells perhaps indicating alterations to mitochondrial respiration in the presence of sustained elevated glucose. Discussion and Conclusions: Our findings reveal that mitochondrial CD36 expression is elevated in endothelial cells exposed to sustained increases in glucose in vitro, which may impact mitochondrial respiration in the presence of other macronutrients like fatty acids. Ongoing studies in our lab are aimed at identifying the functional effects of increased mitoCD36 on endothelial cell respiration when challenged with fatty acids. This study was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under award number 2P20GM113125 (Ibra Fancher). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Published
2023
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22. Impairment of endothelial Kir channels in response to elevated glucose is independent of changes in channel expression

Author

Masoumeh Sadeghinejad, Erica Johnson, and Ibra Fancher

Subjects
Physiology
Abstract

Background and Objective. Obesity comprises a complex metabolic pathophysiology often associated with poor glycemic control. Our past studies detailed that impairment of inward rectifying potassium channels (Kir2.1) is a contributing factor to obesity-induced endothelial dysfunction, however, the major obesity-associated factors driving Kir2.1 impairment are unknown. As obesity is often associated with hyperglycemia, we aimed to determine the effect of elevated glucose on endothelial Kir2.1 channel function and expression in vitro. Method. We treated human adipose microvascular endothelial cells (HAMECs) with high glucose (200mg/dL), mannitol (200 mg/dL), or NaCl (300 mOsm/kg) for 72 hours. Control cells were maintained in standard media containing 100 mg/dL glucose. Following treatments, Kir currents were measured using whole-cell patch clamp electrophysiology and Kir2.1 expression was assessed using qPCR, Western immunoblotting, and immunocytochemistry (ICC). ICC was performed on nonpermeabilized HAMECs to detect membrane expression. Statistics: A Kruskal-Wallis one-way analysis of variance (p < 0.05) followed by Dunn Sidak post hoc analysis (*) was used to determine significant differences. Result. HAMECs exposed to elevated glucose exhibited reduced Kir current compared to control. Surprisingly, mannitol induced similar decreases in Kir current. As mannitol originally served as the osmotic control, we next tested the effect of osmotic stress on endothelial Kir current by exposing cells to elevated NaCl, which had no effect. Furthermore, increased glucose or mannitol did not influence channel KCNJ2 gene or total Kir2.1 protein expression, however, preliminary experiments indicate that the membrane expression of Kir2.1 may be increased following exposure to elevated sugars. Discussion and Conclusions. Our findings indicate that glucose and mannitol reduce endothelial Kir currents without affecting channel expression, suggesting that functional impairment of the channels is induced by elevated sugars. This is further supported by preliminary studies that indicate that membrane Kir2.1 expression is increased in response to elevated sugars, suggesting that a possible compensatory trafficking mechanism fails to restore Kir2.1 channel function despite an increased membrane presence. As the observed decreases in Kir channel current are not mediated by an increase in osmotic pressure under these conditions, we aim to next test if damage to the glycocalyx, which is established to occur in obesity and renders endothelial Kir channels dysfunctional, occurs in the presence of elevated sugars. This study was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under award number 2P20GM113125 (Ibra Fancher). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Published
2023
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26. 797. Investigation of HIV Clusters Among Hispanic/Latino Gay or Bisexual Men in Metro Atlanta, Georgia

Author

Carlos S Saldana, Rebecca Hershow, David Philpott, Rashida Hassan, Kathryn Curran, Jenna Gettings, Eleanor Garlow, Daniel Mauck, Valeria D Cantos, David P Holland, Dorian Freeman, Erica Johnson, Karrie Reed, Jose Adame, Humberto Orozco, and Pascale Wortley

Subjects
Infectious Diseases, Oncology
Abstract

Background In Metro Atlanta, Georgia, annual HIV diagnoses among Hispanic/Latino (H/L) adolescents and adults have increased since 2014 (Figure 1), and four HIV molecular clusters, consisting primarily of Hispanic/Latino gay or bisexual men and other men who have sex with men (HLGBM), were identified in 2021. In March 2022, the Georgia Department of Public Health, the Centers for Disease Control and Prevention, and four health districts of Metro Atlanta (Fulton, Gwinnett, DeKalb, and Cobb) launched an investigation to characterize the clusters, assess barriers to accessing HIV care and prevention services, and inform improvements to service delivery. Methods We described the four clusters using HIV surveillance data. We conducted semi-structured qualitative interviews with 29 HLGBM and 28 providers through purposive sampling. Iterative analyses were conducted daily, comparing findings across interviews to identify commonly mentioned barriers to accessing HIV care and prevention services. Results The four clusters varied in size (5–42 members) and proportion of H/L members (41–100%); one cluster included members reporting injection drug use (14%) (Table 1). Viral suppression among cluster members was high across clusters (87–100%). Overarching reported barriers to accessing medical services included lack of culturally and linguistically concordant services, fear of deportation, transportation, and financial barriers (Table 2). LGBTQ and HIV stigma, low STD/HIV awareness, low access to primary care and HIV screening in primary and urgent care settings, and limited community outreach and marketing were common barriers to accessing HIV prevention services. For pre-exposure prophylaxis (PrEP) specifically, fear of being perceived as promiscuous, limited PrEP knowledge, and concerns with side effects were barriers. Navigating the healthcare system was noted as the primary challenge in HIV care. Conclusion The investigation of four clusters affecting HLGBM identified opportunities to improve access to HIV prevention and PrEP services for this population. State and local partners are planning cluster response activities, including ways to provide low-barrier culturally and linguistically concordant services (Table 3). Disclosures All Authors: No reported disclosures.

Published
2022
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36. The genealogy of teaching clinical reasoning and diagnostic skill: the GEL Study

Author

Brian T. Garibaldi, Sanjay V. Desai, Gail Berkenblit, Stephen W. Russell, Donna M. Zulman, Christopher G. Myers, Anand Patel, Neera Ahuja, Paul O'Rourke, Erica Johnson, and Heather F. Sateia

Subjects
education, Clinical Biochemistry, Psychological intervention, Graduate medical education, Medicine (miscellaneous), Burnout, Clinical Reasoning, 01 natural sciences, 03 medical and health sciences, 0302 clinical medicine, Humans, 030212 general & internal medicine, 0101 mathematics, Burnout, Professional, Health Policy, Learning environment, 010102 general mathematics, Biochemistry (medical), Public Health, Environmental and Occupational Health, Clinical reasoning, Internship and Residency, United States, Genealogy, Test (assessment), Education, Medical, Graduate, Medical training, Clinical Competence, Psychology, Clinical skills
Abstract

The genealogy of graduate medical education in America begins at the bedside. However, today’s graduate medical trainees work in a training environment that is vastly different from medical training a century ago. The goal of the Graduate Medical Education Laboratory (GEL) Study, supported by the American Medical Association’s (AMA) “Reimagining Residency” initiative, is to determine the factors in the training environment that most contribute to resident well-being and developing diagnostic skills. We believe that increasing time at the bedside will improve clinical skill, increase professional fulfillment, and reduce workplace burnout. Our graduate medical education laboratory will test these ideas to understand which interventions can be shared among all training programs. Through the GEL Study, we aim to ensure resident readiness for practice as we understand, then optimize, the learning environment for trainees and staff.

Published
2020
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38. Religion and Revolution in Europe

Author

Bryan A. Banks and Erica Johnson Edwards

Abstract

The French Revolution and Napoleonic Empire altered the religious landscape of France, Europe, and the wider world. Revolutionaries reduced religion to a matter of opinion in the 10th Article of the Declaration of the Rights of Man and Citizen (1789), legitimizing their seizure of Catholic lands and disavowal of the religious and political hierarchy of Old Regime France and its empire in the process. This in turn ignited a dechristianization campaign, local conflicts between Catholics, Protestants, and Jewish communities, and counter-revolutionary war in France. The violence reverberated well beyond France’s borders, both throughout Europe and in imperial and non-imperial spaces. From Prussia to Portugal to Port-au-Prince, revolutionaries inspired violence against and in defence of religion, drove les religieux across borders and into the borderlands, and sparked debates over secularization (laïcization, in France) and the rights of individuals and collective, religious bodies for generations.

Published
2021
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40. Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study

Author

Mohammed S. Abusamaan, Christina T. Yuan, Peter S. Greene, Nestoras Mathioudakis, Amy M. Knight, Erica Johnson, Scott J. Pilla, LaPricia Lewis Boyer, Sanjay V. Desai, Sherita Hill Golden, and Moeen Aboabdo

Subjects
clinical decision support, Original Paper, business.industry, Stakeholder, Health Informatics, Human Factors and Ergonomics, Hypoglycemia, medicine.disease, Focus group, Clinical decision support system, inpatient, Session (web analytics), informatics alert, hypoglycemia, Informatics, Health care, medicine, Medical emergency, Thematic analysis, hospital, business
Abstract

Background Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. Objective This study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. Methods Using the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. Results A 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. Conclusions The design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia.

Published
2021

43. Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study (Preprint)

Author

Nestoras Mathioudakis, Moeen Aboabdo, Mohammed S Abusamaan, Christina Yuan, LaPricia Lewis Boyer, Scott J Pilla, Erica Johnson, Sanjay Desai, Amy Knight, Peter Greene, and Sherita H Golden

Abstract

BACKGROUND Iatrogenic hypoglycemia is a common occurrence among hospitalized patients and is associated with poor clinical outcomes and increased mortality. Clinical decision support systems can be used to reduce the incidence of this potentially avoidable adverse event. OBJECTIVE This study aims to determine the desired features and functionality of a real-time informatics alert to prevent iatrogenic hypoglycemia in a hospital setting. METHODS Using the Agency for Healthcare Research and Quality Five Rights of Effective Clinical Decision Support Framework, we conducted a mixed methods study using an electronic survey and focus group sessions of hospital-based providers. The goal was to elicit stakeholder input to inform the future development of a real-time informatics alert to target iatrogenic hypoglycemia. In addition to perceptions about the importance of the problem and existing barriers, we sought input regarding the content, format, channel, timing, and recipient for the alert (ie, the Five Rights). Thematic analysis of focus group sessions was conducted using deductive and inductive approaches. RESULTS A 21-item electronic survey was completed by 102 inpatient-based providers, followed by 2 focus group sessions (6 providers per session). Respondents universally agreed or strongly agreed that inpatient iatrogenic hypoglycemia is an important problem that can be addressed with an informatics alert. Stakeholders expressed a preference for an alert that is nonintrusive, accurate, communicated in near real time to the ordering provider, and provides actionable treatment recommendations. Several electronic medical record tools, including alert indicators in the patient header, glucose management report, and laboratory results section, were deemed acceptable formats for consideration. Concerns regarding alert fatigue were prevalent among both survey respondents and focus group participants. CONCLUSIONS The design preferences identified in this study will provide the framework needed for an informatics team to develop a prototype alert for pilot testing and evaluation. This alert will help meet the needs of hospital-based clinicians caring for patients with diabetes who are at a high risk of treatment-related hypoglycemia.

Published
2021
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45. Christianity’s role in colonial and revolutionary Haiti 1 (Article Commentary)

Author

Edwards, Erica Johnson and School of Humanities

Subjects
Literature::English [Humanities]
Abstract

On October 26, 2020, the US Senate confirmed Amy Coney-Barrett’s nomination to the US Supreme Court. In the lead up to her confirmation, while senators and the media focused heavily on her Catholic faith, some on social media drew attention to the two Haitian children she and her husband adopted following the 2010 earthquake in Haiti.2 The connections between Coney-Barret’s Christianity and the Haitian earthquake recalled Pat Robertson’s controversial claim that the earthquake was caused by a Haitian “pact with the devil” during the Haitian Revolution.3 Whatever else one might say about Robertson’s comments, they show his ignorance of the important but little-known role Christianity and the Catholic clergy played in eighteenth-century colonial Haiti. Published version

Published
2021

49. Verliebt, verheiratet, verwitwet, verhurt : Memoir über einen plötzlichen Tod und weibliche Selbstbestimmung

Author

Erica Johnson Debeljak and Erica Johnson Debeljak

Abstract

»Im Leben einer Frau gibt es bestimmte Augenblicke, in denen sie wie die Hand in einen Handschuh in weibliche Archetypen hineingleitet.« Es gibt Mädels, Jungfrauen, Ehefrauen, Mütter, Lebensgefährtinnen, Damen, Tanten, Huren, bessere Hälften, Großmütter, Diven, alte Jungfern. Und es gibt: Witwen. Die schwarz verschleierte Frau, deren Ehemann gestorben ist. Die Einsame, Übriggebliebene. Was wird aus ihr, nun, da sie allein ist? Wohin mit ihr? Als Aleš, ein berühmter und beliebter slowenischer Schriftsteller und Intellektueller, bei einem Autounfall tödlich verunglückt, ist das Leben von Erica Johnson Debeljak von einem Augenblick auf den nächsten nicht mehr dasselbe, sie wird zur Witwe. Auf akribische und doch gefühlvolle, auf sachliche und doch aufwühlende Weise verflicht sie ihre höchstpersönlichen Erfahrungen mit den Geschichten mythischer und historischer Witwenfiguren und zeigt auf, wie Frauen auch heute noch häufig in der Gesellschaft wahrgenommen werden – nämlich definiert durch die Beziehung zu einem Mann. Dieses Memoir ist mehr als ein gekonnt erzählter Trauerbericht oder eine Aneinanderreihung von Erinnerungen. Vielmehr liefert es eine Aufarbeitung und Neubestimmung einschlägiger Frauenrollen. Mit Sanftheit und brutaler Ehrlichkeit geschrieben, zeugt der Text von einer allmählich erwachsenden Selbstermächtigung und Emanzipation. So manche konventionelle Denkweise wird dabei in ein anderes, neues Licht gerückt. Der slowenische Bestseller wurde 2021 auf der Buchmesse Ljubljana zum Buch des Jahres gekürt.

Published
2023

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