33 results on '"Molly Deutsch-Feldman"'
Search Results
2. Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone
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Maria Lahuerta, Roberta Sutton, Anthony Mansaray, Oliver Eleeza, Brigette Gleason, Adewale Akinjeji, Mohamed F. Jalloh, Mame Toure, Getachew Kassa, Steven R. Meshnick, Molly Deutsch-Feldman, Lauren Parmley, Michael Friedman, Samuel Juana Smith, Miriam Rabkin, and Laura Steinhardt
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Malaria ,Sierra Leone ,Infants ,IPTi ,Evaluation ,Coverage ,Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. Methods This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. Results Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p
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- 2021
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3. Risk-Factors for Exposure Associated With SARS-CoV-2 Detection After Recent Known or Potential COVID-19 Exposures Among Patients Seeking Medical Care at a Large Urban, Public Hospital in Fulton County, Georgia — A Cross-Sectional Investigation
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Sarah E. Smith-Jeffcoat, Sadia Sleweon, Mitsuki Koh, George M. Khalil, Marcos C. Schechter, Paulina A. Rebolledo, Vyjayanti Kasinathan, Adam Hoffman, Rebecca Rossetti, Talya Shragai, Kevin O'Laughlin, Catherine C. Espinosa, Bettina Bankamp, Michael D. Bowen, Ashley Paulick, Amy S. Gargis, Jennifer M. Folster, Juliana da Silva, Caitlin Biedron, Rebekah J. Stewart, Yun F. Wang, Hannah L. Kirking, Jacqueline E. Tate, CDC COVID-19 Emergency Response GA-10 Field, Halie K. Miller, AdeSubomi O. Adeyemo, Anne C. Moorman, Brenda L. Bauman, Kahaliah Joseph, Michelle O'Hegarty, Nazia Kamal, Mila Cohen, Amadea Britton, Courtney T. Callahan, Jamila Fonseka, Elfriede Agyemang, Miriam J. Lawson, Molly Deutsch-Feldman, Tejpratap S. P. Tiwari, Samira Sami, and Hong Tao
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SARS-CoV-2 ,COVID-19 ,risk factors ,exposure ,underrepresented ,Public aspects of medicine ,RA1-1270 - Abstract
We aimed to describe frequency of COVID-19 exposure risk factors among patients presenting for medical care at an urban, public hospital serving mostly uninsured/Medicare/Medicaid clients and risk factors associated with SARS-CoV-2 infection. Consenting, adult patients seeking care at a public hospital from August to November 2020 were enrolled in this cross-sectional investigation. Saliva, anterior nasal and nasopharyngeal swabs were collected and tested for SARS-CoV-2 using RT-PCR. Participant demographics, close contact, and activities ≤14 days prior to enrollment were collected through interview. Logistic regression was used to identify risk factors associated with testing positive for SARS-CoV-2. Among 1,078 participants, 51.8% were male, 57.0% were aged ≥50 years, 81.3% were non-Hispanic Black, and 7.6% had positive SARS-CoV-2 tests. Only 2.7% reported COVID-19 close contact ≤14 days before enrollment; this group had 6.79 adjusted odds of testing positive (95%CI = 2.78–16.62) than those without a reported exposure. Among participants who did not report COVID-19 close contact, working in proximity to ≥10 people (adjusted OR = 2.17; 95%CI = 1.03–4.55), choir practice (adjusted OR = 11.85; 95%CI = 1.44–97.91), traveling on a plane (adjusted OR = 5.78; 95%CI = 1.70–19.68), and not participating in an essential indoor activity (i.e., grocery shopping, public transit use, or visiting a healthcare facility; adjusted OR = 2.15; 95%CI = 1.07–4.30) were associated with increased odds of testing positive. Among this population of mostly Black, non-Hispanic participants seeking care at a public hospital, we found several activities associated with testing positive for SARS-CoV-2 infection in addition to close contact with a case. Understanding high-risk activities for SARS-CoV-2 infection among different communities is important for issuing awareness and prevention strategies.
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- 2022
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4. Improving institutional research ethics capacity assessments: lessons from sub-Saharan Africa
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Molly Deutsch-Feldman, Joseph Ali, Nancy Kass, Nthabiseng Phaladze, Charles Michelo, Nelson Sewankambo, and Adnan A. Hyder
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research ethics ,lmic ,capacity assessment ,Medical philosophy. Medical ethics ,R723-726 ,Social sciences (General) ,H1-99 - Abstract
The amount of biomedical research being conducted around the world has greatly expanded over the past 15 years, with particularly large growth occurring in low- and middle-income countries (LMICs). This increased focus on understanding and responding to disease burdens around the world has brought forth a desire to help LMIC institutions enhance their own capacity to conduct scientifically and ethically sound research. In support of these goals the Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has, for the past six years, partnered with three research institutions in Africa (University of Botswana, Makerere University in Uganda, and the University of Zambia) to support research ethics capacity. Each partnership began with a baseline evaluation of institutional research ethics environments in order to properly tailor capacity strengthening activities and help direct limited institutional resources. Through the course of these partnerships we have learned several lessons regarding the evaluation process and the framework used to complete the assessments (the Octagon Model). We believe that these lessons are generalizable and will be useful for groups conducting such assessments in the future.
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- 2020
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5. The changing landscape of Plasmodium falciparum drug resistance in the Democratic Republic of Congo
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Molly Deutsch-Feldman, Ozkan Aydemir, Margaret Carrel, Nicholas F. Brazeau, Samir Bhatt, Jeffrey A. Bailey, Melchior Kashamuka, Antoinette K. Tshefu, Steve M. Taylor, Jonathan J. Juliano, Steven R. Meshnick, and Robert Verity
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Malaria ,Drug resistance ,Spatial-temporal modeling ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Drug resistant malaria is a growing concern in the Democratic Republic of the Congo (DRC), where previous studies indicate that parasites resistant to sulfadoxine/pyrimethamine or chloroquine are spatially clustered. This study explores longitudinal changes in spatial patterns to understand how resistant malaria may be spreading within the DRC, using samples from nation-wide population-representative surveys. Methods We selected 552 children with PCR-detectable Plasmodium falciparum infection and identified known variants in the pfdhps and pfcrt genes associated with resistance. We compared the proportion of mutant parasites in 2013 to those previously reported from adults in 2007, and identified risk factors for carrying a resistant allele using multivariate mixed-effects modeling. Finally, we fit a spatial-temporal model to the observed data, providing smooth allele frequency estimates over space and time. Results The proportion of co-occurring pfdhps K540E/A581G mutations increased by 16% between 2007 and 2013. The spatial-temporal model suggests that the spatial range of the pfdhps double mutants expanded over time, while the prevalence and range of pfcrt mutations remained steady. Conclusions This study uses population-representative samples to describe the changing landscape of SP resistance within the DRC, and the persistence of chloroquine resistance. Vigilant molecular surveillance is critical for controlling the spread of resistance.
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- 2019
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6. Spatial and epidemiological drivers of Plasmodium falciparum malaria among adults in the Democratic Republic of the Congo
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Jonathan J Juliano, Jonathan B Parr, Steven R Meshnick, Molly Deutsch-Feldman, Nicholas F Brazeau, Kyaw L Thwai, Jeremie Muwonga, Melchior Kashamuka, Antoinette Tshefu Kitoto, Ozkan Aydemir, Jeffrey A Bailey, Jessie K Edwards, Robert Verity, Michael Emch, and Emily W Gower
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Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background Adults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013–2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity.Methods Plasmodium falciparum infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity.Results A total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76–0.95) and modern housing (PR=0.58, 95% CI=0.49–0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83–0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas.Conclusions The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.
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- 2020
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7. Tuberculosis Outbreak in a State Prison System — Washington, 2021–2022
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Randy M. Stalter, Monica Pecha, Lana Dov, David Miller, Zainab Ghazal, Jonathan Wortham, Sandy Althomsons, Molly Deutsch-Feldman, Rebekah Stewart, Derrick Felix, Sophia Hsu, and Lara B. Strick
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Health (social science) ,Health Information Management ,Epidemiology ,Health, Toxicology and Mutagenesis ,General Medicine - Published
- 2023
8. Nationwide tuberculosis outbreak in the USA linked to a bone graft product: an outbreak report
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Noah G, Schwartz, Alfonso C, Hernandez-Romieu, Pallavi, Annambhotla, Thomas D, Filardo, Sandy P, Althomsons, Rebecca J, Free, Ruoran, Li, W, Wyatt Wilson, Molly, Deutsch-Feldman, Marci, Drees, Emily, Hanlin, Kelly, White, Kimberly A, Lehman, Tyler C, Thacker, Scott A, Brubaker, Brychan, Clark, Sridhar V, Basavaraju, Isaac, Benowitz, Janet, Burton Glowicz, Lauren S, Cowan, Angela M, Starks, Sapna, Bamrah Morris, Philip, LoBue, Rebekah J, Stewart, Jonathan M, Wortham, and Maryam B, Haddad
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Male ,Infectious Diseases ,Humans ,Tuberculosis ,Organ Transplantation ,Mycobacterium tuberculosis ,United States ,Phylogeny ,Tissue Donors ,Disease Outbreaks - Abstract
Mycobacterium tuberculosis transmission through solid organ transplantation has been well described, but transmission through transplanted tissues is rare. We investigated a tuberculosis outbreak in the USA linked to a bone graft product containing live cells derived from a single deceased donor.In this outbreak report, we describe the management and severity of the outbreak and identify opportunities to improve tissue transplant safety in the USA. During early June, 2021, the US Centers for Disease Control and Prevention (CDC) worked with state and local health departments and health-care facilities to locate and sequester unused units from the recalled lot and notify, evaluate, and treat all identified product recipients. Investigators from CDC and the US Food and Drug Administration (FDA) reviewed donor screening and tissue processing. Unused product units from the recalled and other donor lots were tested for the presence of M tuberculosis using real-time PCR (rt PCR) assays and culture. M tuberculosis isolates from unused product and recipients were compared using phylogenetic analysis.The tissue donor (a man aged 80 years) had unrecognised risk factors, symptoms, and signs consistent with tuberculosis. Bone was procured from the deceased donor and processed into 154 units of bone allograft product containing live cells, which were distributed to 37 hospitals and ambulatory surgical centres in 20 US states between March 1 and April 2, 2021. From March 3 to June 1, 2021, 136 (88%) units were implanted into 113 recipients aged 24-87 years in 18 states (some individuals received multiple units). The remaining 18 units (12%) were located and sequestered. 87 (77%) of 113 identified product recipients had microbiological or imaging evidence of tuberculosis disease. Eight product recipients died 8-99 days after product implantation (three deaths were attributed to tuberculosis after recognition of the outbreak). All 105 living recipients started treatment for tuberculosis disease at a median of 69 days (IQR 56-81) after product implantation. M tuberculosis was detected in all eight sequestered unused units tested from the recalled donor lot, but not in lots from other donors. M tuberculosis isolates from unused product and recipients were more than 99·99% genetically identical.Donor-derived transmission of M tuberculosis via bone allograft resulted in substantial morbidity and mortality. All prospective tissue and organ donors should be routinely assessed for tuberculosis risk factors and clinical findings. When these are present, laboratory testing for M tuberculosis should be strongly considered.None.
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- 2022
9. Tuberculosis Among Native Hawaiian and Other Pacific Islander Persons: United States and U.S.-Affiliated Pacific Islands, 2010–2019
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Molly Deutsch-Feldman, Yuri P. Springer, Derrick Felix, Clarisse A. Tsang, Richard Brostrom, and Maryam Haddad
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Health (social science) ,Health Information Management ,Health Policy ,Public Health, Environmental and Occupational Health - Abstract
In recent years, tuberculosis (TB) incidence in the United States has declined overall but remained high among Native Hawaiian and Other Pacific Islander (NH/PI) persons. Few studies have examined the epidemiology of TB among NH/PI persons, particularly in the U.S.-Affiliated Pacific Islands (USAPI). We describe TB incidence and characteristics of NH/PI patients during 2010-2019.We used data from the National Tuberculosis Surveillance System to characterize TB cases reported among NH/PI persons born in the 50 U.S. states (defined to include District of Columbia) and the USAPI. We calculated annual TB incidence among NH/PI patients, stratified by place of birth (U.S. states or USAPI). Using Asian persons born outside the United States-persons historically grouped with NH/PI persons as one racial category-as the reference, we compared demographic, clinical, and socio-behavioral characteristics of NH/PI TB patients.During 2010-2019, 4359 TB cases were reported among NH/PI patients born in the U.S. states (TB incidence among NH/PI persons is high, particularly among persons born in the USAPI, emphasizing the need to enhance TB prevention strategies in these communities. Interventions should be tailored toward those who experience the highest risk, including NH/PI children and adolescents.
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- 2022
10. The epidemiology of Plasmodium vivax among adults in the Democratic Republic of the Congo
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Corinna Keeler, Molly Deutsch-Feldman, Steven R. Meshnick, Kyaw L. Thwai, Valerie Gartner, Oliver J Watson, Jonathan J. Juliano, Jessie K. Edwards, Cedar L Mitchell, Ben Redelings, Michael Emch, Antoinette Tshefu, Andrew P. Morgan, Jonathan B. Parr, Nicholas F Brazeau, Gregory A. Wray, Andreea Waltmann, Joris L. Likwela, Robert Verity, Pere Gelabert, Lucy van Dorp, and Melchior K. Mwandagalirwa
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0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Adolescent ,Epidemiology ,Science ,030231 tropical medicine ,Plasmodium vivax ,General Physics and Astronomy ,Parasitemia ,General Biochemistry, Genetics and Molecular Biology ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Risk Factors ,parasitic diseases ,medicine ,Malaria, Vivax ,Prevalence ,Humans ,Mass Screening ,Clade ,Multidisciplinary ,biology ,Age Factors ,General Chemistry ,biology.organism_classification ,medicine.disease ,Malaria ,Phylogenetics ,030104 developmental biology ,Carriage ,Cross-Sectional Studies ,Carrier State ,Democratic Republic of the Congo ,Forward propagation ,Female ,Demographic health survey ,Demography - Abstract
Reports of P. vivax infections among Duffy-negative hosts have accumulated throughout sub-Saharan Africa. Despite this growing body of evidence, no nationally representative epidemiological surveys of P. vivax in sub-Saharan Africa have been performed. To overcome this gap in knowledge, we screened over 17,000 adults in the Democratic Republic of the Congo (DRC) for P. vivax using samples from the 2013-2014 Demographic Health Survey. Overall, we found a 2.97% (95% CI: 2.28%, 3.65%) prevalence of P. vivax infections across the DRC. Infections were associated with few risk-factors and demonstrated a relatively flat distribution of prevalence across space with focal regions of relatively higher prevalence in the north and northeast. Mitochondrial genomes suggested that DRC P. vivax were distinct from circulating non-human ape strains and an ancestral European P. vivax strain, and instead may be part of a separate contemporary clade. Our findings suggest P. vivax is diffusely spread across the DRC at a low prevalence, which may be associated with long-term carriage of low parasitemia, frequent relapses, or a general pool of infections with limited forward propagation., Plasmodium vivax generally accounts for a low proportion of malaria cases in Africa, but population-level data on the distribution of infections is limited. Here, the authors use data from the Democratic Republic of the Congo and show that the prevalence is low (~3%) and diffusely spread.
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- 2021
11. Notes from the Field: HIV Outbreak During the COVID-19 Pandemic Among Persons Who Inject Drugs — Kanawha County, West Virginia, 2019–2021
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Rebecca B. Hershow, Suzanne Wilson, Robert A. Bonacci, Molly Deutsch-Feldman, Olivia O. Russell, Sherri Young, Shannon McBee, Erica Thomasson, Shawn Balleydier, Miracle Boltz, Vicki Hogan, Amy Atkins, Nancy Worthington, Robert McDonald, Monica Adams, Anne Moorman, Danae Bixler, Stephen Kowalewski, Melinda Salmon, R. Paul McClung, Alexandra M. Oster, and Kathryn G. Curran
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Adult ,Male ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,HIV Infections ,General Medicine ,West Virginia ,Disease Outbreaks ,Drug Users ,Health Information Management ,Humans ,Female ,Substance Abuse, Intravenous ,Notes from the Field - Abstract
During October 2019, the West Virginia Bureau for Public Health (WVBPH) noted that an increasing number of persons who inject drugs (PWID) in Kanawha County received a diagnosis of HIV. The number of HIV diagnoses among PWID increased from less than five annually during 2016-2018 to 11 during January-October 2019 (Figure). Kanawha County (with an approximate population of 180,000*) has high rates of opioid use disorder and overdose deaths, which have been increasing since 2016
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- 2022
12. Tuberculosis — United States, 2020
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Robert H. Pratt, Molly Deutsch-Feldman, Julie L. Self, Sandy F. Price, and Clarisse A. Tsang
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Adult ,Pediatrics ,medicine.medical_specialty ,Health (social science) ,Tuberculosis ,Adolescent ,Epidemiology ,Health, Toxicology and Mutagenesis ,Emigrants and Immigrants ,Disease ,01 natural sciences ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Weight loss ,Health care ,Pandemic ,Ethnicity ,Humans ,Medicine ,Full Report ,030212 general & internal medicine ,0101 mathematics ,Young adult ,Child ,Aged ,business.industry ,Transmission (medicine) ,Incidence ,Incidence (epidemiology) ,Racial Groups ,010102 general mathematics ,COVID-19 ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Child, Preschool ,Population Surveillance ,Centers for Disease Control and Prevention, U.S ,medicine.symptom ,business - Abstract
Tuberculosis (TB) disease incidence has decreased steadily since 1993 (1), a result of decades of work by local TB programs to detect, treat, and prevent TB disease and transmission. During 2020, a total of 7,163 TB cases were provisionally reported to CDC's National Tuberculosis Surveillance System (NTSS) by the 50 U.S. states and the District of Columbia (DC), a relative reduction of 20%, compared with the number of cases reported during 2019.* TB incidence per 100,000 persons was 2.2 during 2020, compared with 2.7 during 2019. Since 2010, TB incidence has decreased by an average of 2%-3% annually (1). Pandemic mitigation efforts and reduced travel might have contributed to the reported decrease. The magnitude and breadth of the decrease suggest potentially missed or delayed TB diagnoses. Health care providers should consider TB disease when evaluating patients with signs and symptoms consistent with TB (e.g., cough of >2 weeks in duration, unintentional weight loss, and hemoptysis), especially when diagnostic tests are negative for SARS-CoV-2, the virus that causes COVID-19. In addition, members of the public should be encouraged to follow up with their health care providers for any respiratory illness that persists or returns after initial treatment. The steep, unexpected decline in TB cases raises concerns of missed cases, and further work is in progress to better understand factors associated with the decline.
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- 2021
13. Distribution and Temporal Dynamics of Plasmodium falciparum Chloroquine Resistance Transporter Mutations Associated With Piperaquine Resistance in Northern Cambodia
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Soklyda Chann, Mariusz Wojnarski, Brian Vesely, Piyaporn Saingam, Prom Satharath, Nonlawat Boonyalai, Chaiyaporn Chaisatit, Paphavee Lertsethtakarn, Michele D. Spring, Somethy Sok, Zalak Shah, Panita Gosi, Huy Rekol, Matthew Adams, Biraj Shrestha, David L. Saunders, Molly Deutsch-Feldman, Andrew P. Morgan, Darapiseth Sea, Chantida Praditpol, Philip L. Smith, Shannon Takala-Harrison, Dysoley Lek, Chanthap Lon, Jessica T. Lin, Norman C. Waters, Stuart D. Tyner, Charlotte A. Lanteri, and Suwanna Chaorattanakawee
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0301 basic medicine ,Plasmodium falciparum ,030106 microbiology ,Drug Resistance ,Protozoan Proteins ,Real-Time Polymerase Chain Reaction ,medicine.disease_cause ,Piperazines ,Antimalarials ,Major Articles and Brief Reports ,03 medical and health sciences ,Chloroquine ,Piperaquine ,parasitic diseases ,Prevalence ,medicine ,Animals ,Immunology and Allergy ,Malaria, Falciparum ,Allele ,Whole genome sequencing ,Mutation ,biology ,Mefloquine ,fungi ,Membrane Transport Proteins ,medicine.disease ,biology.organism_classification ,Virology ,030104 developmental biology ,Infectious Diseases ,Quinolines ,Cambodia ,Biomarkers ,Malaria ,medicine.drug - Abstract
Background Newly emerged mutations within the Plasmodium falciparum chloroquine resistance transporter (PfCRT) can confer piperaquine resistance in the absence of amplified plasmepsin II (pfpm2). In this study, we estimated the prevalence of co-circulating piperaquine resistance mutations in P. falciparum isolates collected in northern Cambodia from 2009 to 2017. Methods The sequence of pfcrt was determined for 410 P. falciparum isolates using PacBio amplicon sequencing or whole genome sequencing. Quantitative polymerase chain reaction was used to estimate pfpm2 and pfmdr1 copy number. Results Newly emerged PfCRT mutations increased in prevalence after the change to dihydroartemisinin-piperaquine in 2010, with >98% of parasites harboring these mutations by 2017. After 2014, the prevalence of PfCRT F145I declined, being outcompeted by parasites with less resistant, but more fit PfCRT alleles. After the change to artesunate-mefloquine, the prevalence of parasites with amplified pfpm2 decreased, with nearly half of piperaquine-resistant PfCRT mutants having single-copy pfpm2. Conclusions The large proportion of PfCRT mutants that lack pfpm2 amplification emphasizes the importance of including PfCRT mutations as part of molecular surveillance for piperaquine resistance in this region. Likewise, it is critical to monitor for amplified pfmdr1 in these PfCRT mutants, as increased mefloquine pressure could lead to mutants resistant to both drugs.
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- 2021
14. Evaluation of Abbott BinaxNOW Rapid Antigen Test for SARS-CoV-2 Infection at Two Community-Based Testing Sites — Pima County, Arizona, November 3–17, 2020
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Brian Emery, Olivia Almendares, Houping Wang, Jessica L. Prince-Guerra, Khalilullah Sheiban, Jennifer M Folster, Julie Kudrna, Christine Atherstone, Julie Villanueva, Shannon Rogers, Theresa Cullen, John Neatherlin, Tracy Powell, Shilpi Jain, Caitlin Bohannon, Adam MacNeil, Reynolds M Salerno, Sean A Buono, Alexandra Tejada-Strop, Jacqueline E. Tate, Kenneth Komatsu, Mark Anderson, Marla Petway, Dale A. Rose, Margaret A. Honein, Yan Zeng, Valerie A. Stevens, Kristen Knipe, Ariella P. Dale, Magdalena Medrzycki, William A. Bower, Natalie J. Thornburg, Molly Deutsch-Feldman, Paul A. Rota, Suganthi Suppiah, Li Juan Hao, David P. Bui, Justine Pompey, Azaibi Tamin, Patricia L. Shewmaker, Jennifer L Harcourt, Wendi Kuhnert-Tallman, Hannah L Kirking, Jayleen K L Gunn, Leisha D. Nolen, and Phili Wong
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Emergency Use Authorization ,medicine.medical_specialty ,Health (social science) ,Epidemiology ,Viral culture ,business.industry ,Health, Toxicology and Mutagenesis ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,010102 general mathematics ,General Medicine ,01 natural sciences ,Asymptomatic ,Pre- and post-test probability ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Antigen ,Rapid antigen test ,Internal medicine ,medicine ,Nucleic Acid Amplification Tests ,030212 general & internal medicine ,0101 mathematics ,medicine.symptom ,business - Abstract
Rapid antigen tests, such as the Abbott BinaxNOW COVID-19 Ag Card (BinaxNOW), offer results more rapidly (approximately 15-30 minutes) and at a lower cost than do highly sensitive nucleic acid amplification tests (NAATs) (1). Rapid antigen tests have received Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for use in symptomatic persons (2), but data are lacking on test performance in asymptomatic persons to inform expanded screening testing to rapidly identify and isolate infected persons (3). To evaluate the performance of the BinaxNOW rapid antigen test, it was used along with real-time reverse transcription-polymerase chain reaction (RT-PCR) testing to analyze 3,419 paired specimens collected from persons aged ≥10 years at two community testing sites in Pima County, Arizona, during November 3-17, 2020. Viral culture was performed on 274 of 303 residual real-time RT-PCR specimens with positive results by either test (29 were not available for culture). Compared with real-time RT-PCR testing, the BinaxNOW antigen test had a sensitivity of 64.2% for specimens from symptomatic persons and 35.8% for specimens from asymptomatic persons, with near 100% specificity in specimens from both groups. Virus was cultured from 96 of 274 (35.0%) specimens, including 85 (57.8%) of 147 with concordant antigen and real-time RT-PCR positive results, 11 (8.9%) of 124 with false-negative antigen test results, and none of three with false-positive antigen test results. Among specimens positive for viral culture, sensitivity was 92.6% for symptomatic and 78.6% for asymptomatic individuals. When the pretest probability for receiving positive test results for SARS-CoV-2 is elevated (e.g., in symptomatic persons or in persons with a known COVID-19 exposure), a negative antigen test result should be confirmed by NAAT (1). Despite a lower sensitivity to detect infection, rapid antigen tests can be an important tool for screening because of their quick turnaround time, lower costs and resource needs, high specificity, and high positive predictive value (PPV) in settings of high pretest probability. The faster turnaround time of the antigen test can help limit transmission by more rapidly identifying infectious persons for isolation, particularly when used as a component of serial testing strategies.
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- 2021
15. Household Prevalence of Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale in the Democratic Republic of the Congo, 2013–2014
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Antoinette Tshefu, Melchior K. Mwandagalirwa, Hillary M. Topazian, Jonathan B. Parr, Cedar L Mitchell, Nicholas F Brazeau, Eric Sompwe, Jonathan J. Juliano, Jérémie Muwonga, and Molly Deutsch-Feldman
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Adult ,0301 basic medicine ,Microbiology (medical) ,Plasmodium falciparum ,Plasmodium ovale ,03 medical and health sciences ,0302 clinical medicine ,parasitic diseases ,Prevalence ,Humans ,Medicine ,030212 general & internal medicine ,Malaria, Falciparum ,Child ,Online Only Articles ,biology ,business.industry ,biology.organism_classification ,Cross-Sectional Studies ,030104 developmental biology ,Infectious Diseases ,Democratic Republic of the Congo ,Plasmodium vivax ,business ,Demography - Abstract
In a cross-sectional molecular study in the Democratic Republic of the Congo, 78% of households had ≥1 member infected with Plasmodium falciparum, Plasmodium vivax, and/or Plasmodium ovale spp.; 47% of children and 33% of adults tested positive for ≥1 species. Risk factors varied by species and age group.
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- 2020
16. The Burden of Malaria in the Democratic Republic of the Congo
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Nicholas F Brazeau, Antoinette Tshefu, Corinna Keeler, Jonathan B. Parr, Steven R. Meshnick, Molly Deutsch-Feldman, Michael Emch, Melchior Kashamuka, Jessie K. Edwards, and Varun Goel
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Adult ,Longitudinal study ,Adolescent ,030231 tropical medicine ,Young Adult ,Major Articles and Brief Reports ,03 medical and health sciences ,0302 clinical medicine ,Cost of Illness ,Environmental health ,Prevalence ,medicine ,Humans ,Immunology and Allergy ,Longitudinal Studies ,030212 general & internal medicine ,Child ,Aged ,Aged, 80 and over ,biology ,business.industry ,Infant ,Plasmodium falciparum ,Middle Aged ,medicine.disease ,biology.organism_classification ,Malaria ,Cross-Sectional Studies ,Infectious Diseases ,Child, Preschool ,Democratic Republic of the Congo ,Health survey ,business - Abstract
Despite evidence that older children and adolescents bear the highest burden of malaria, large malaria surveys focus on younger children. We used polymerase chain reaction data from the 2013–2014 Demographic and Health Survey in the Democratic Republic of Congo (including children aged
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- 2020
17. Low Complexity of Infection Is Associated With Molecular Persistence of Plasmodium falciparum in Kenya and Tanzania
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Hillary M. Topazian, Kara A. Moser, Billy Ngasala, Peter O. Oluoch, Catherine S. Forconi, Lwidiko E. Mhamilawa, Ozkan Aydemir, Oksana Kharabora, Molly Deutsch-Feldman, Andrew F. Read, Madeline Denton, Antonio Lorenzo, Nicole Mideo, Bernhards Ogutu, Ann M. Moormann, Andreas Mårtensson, Boaz Odwar, Jeffrey A. Bailey, Hoseah Akala, John Michael Ong'echa, and Jonathan J. Juliano
- Abstract
BackgroundPlasmodium falciparum resistance to artemisinin-based combination therapies (ACTs) is a threat to malaria elimination. ACT-resistance in Asia raises concerns for emergence of resistance in Africa. While most data show high efficacy of ACT regimens in Africa, there have been reports describing declining efficacy, as measured by both clinical failure and prolonged parasite clearance times.MethodsThree hundred children aged 2–10 years with uncomplicated P. falciparum infection were enrolled in Kenya and Tanzania after receiving treatment with artemether-lumefantrine. Blood samples were taken at 0, 24, 48, and 72 h, and weekly thereafter until 28 days post-treatment. Parasite and host genetics were assessed, as well as clinical, behavioral, and environmental characteristics, and host anti-malarial serologic response.ResultsWhile there was a broad range of clearance rates at both sites, 85% and 96% of Kenyan and Tanzanian samples, respectively, were qPCR-positive but microscopy-negative at 72 h post-treatment. A greater complexity of infection (COI) was negatively associated with qPCR-detectable parasitemia at 72 h (OR: 0.70, 95% CI: 0.53–0.94), and a greater baseline parasitemia was marginally associated with qPCR-detectable parasitemia (1,000 parasites/uL change, OR: 1.02, 95% CI: 1.01–1.03). Demographic, serological, and host genotyping characteristics showed no association with qPCR-detectable parasitemia at 72 h. Parasite haplotype-specific clearance slopes were grouped around the mean with no association detected between specific haplotypes and slower clearance rates.ConclusionsIdentifying risk factors for slow clearing P. falciparum infections, such as COI, are essential for ongoing surveillance of ACT treatment failure in Kenya, Tanzania, and more broadly in sub-Saharan Africa.
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- 2022
- Full Text
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18. Performance Characteristics of the Abbott BinaxNOW SARS-CoV-2 Antigen Test in Comparison to Real-Time Reverse Transcriptase PCR and Viral Culture in Community Testing Sites during November 2020
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Adam MacNeil, Reynolds M Salerno, Valerie A. Stevens, Sean A Buono, Molly Deutsch-Feldman, Jennifer L Harcourt, Caitlin Bohannon, Julie Kudrna, Christine Atherstone, John Neatherlin, Olivia Almendares, Jennifer M Folster, Marla Petway, Natalie J. Thornburg, Justine Pompey, Yan Zeng, Jacqueline E. Tate, Theresa Cullen, Azaibi Tamin, Jayleen K L Gunn, Leisha D. Nolen, Suganthi Suppiah, Tracy Powell, Kristen Knipe, Ariella P. Dale, Khalilullah Sheiban, Wendi Kuhnert-Tallman, LiJuan Hao, Kenneth Komatsu, Mark Anderson, David P. Bui, Jessica L. Prince-Guerra, Julie Villanueva, Margaret A. Honein, William A. Bower, Paul A. Rota, Dale A. Rose, and Hannah L Kirking
- Subjects
Microbiology (medical) ,medicine.medical_specialty ,business.industry ,Viral culture ,Reverse Transcriptase Polymerase Chain Reaction ,SARS-CoV-2 ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Antigen test ,Sensitivity and Specificity ,Real-time polymerase chain reaction ,Antigen ,Internal medicine ,Exposure period ,medicine ,Nucleic Acid Amplification Tests ,Humans ,Symptom onset ,business ,Antigens, Viral - Abstract
Point-of-care antigen tests are an important tool for SARS-CoV-2 detection. Antigen tests are less sensitive than real-time reverse-transcriptase PCR (rRT-PCR). Data on the performance of the BinaxNOW antigen test compared to rRT-PCR and viral culture by symptom and known exposure status, timing during disease or exposure period and demographic variables are limited. During November 3rd-17th, 2020, we collected paired upper respiratory swab specimens to test for SARS-CoV-2 by rRT-PCR and Abbott BinaxNOW (BinaxNOW) antigen test at two community testing sites in Pima County, Arizona. We administered a questionnaire to capture symptoms, known exposure status and previous SARS-CoV-2 test results. Specimens positive by either test were analyzed by viral culture. Previously we showed overall BinaxNOW sensitivity was 52.5%. Here we showed BinaxNOW sensitivity increased to 65.7% among currently symptomatic individuals reporting a known exposure. BinaxNOW sensitivity was lower among participants with a known exposure and previously symptomatic (32.4%) or never symptomatic (47.1%) within 14 days of testing. Sensitivity was 71.1% in participants within a week of symptom onset. In participants with a known exposure, sensitivity was highest 8-10 days post-exposure (75%). The positive predictive value for recovery of virus in cell culture was 56.7% for BinaxNOW-positive and 35.4% for rRT-PCR-positive specimens. Result reporting time was 2.5 hours for BinaxNOW and 26 hours for rRT-PCR. Point-of-care antigen tests have a shorter turn-around time compared to laboratory-based nucleic acid amplification tests, which allows for more rapid identification of infected individuals. Antigen test sensitivity limitations are important to consider when developing a testing program.
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- 2021
19. Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone
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Molly Deutsch-Feldman, Mame Toure, Getachew Kassa, Lauren Parmley, Anthony Mansaray, Miriam Rabkin, Michael Friedman, Laura C. Steinhardt, Adewale Akinjeji, Brigette Gleason, Mohamed F Jalloh, Oliver Eleeza, Roberta Sutton, Maria Lahuerta, Samuel Juana Smith, and Steven R. Meshnick
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Adult ,Male ,medicine.medical_specialty ,Coverage ,lcsh:Arctic medicine. Tropical medicine ,lcsh:RC955-962 ,030231 tropical medicine ,Drug Administration Schedule ,Child health ,Sierra Leone ,lcsh:Infectious and parasitic diseases ,Sierra leone ,Pentavalent vaccine ,Antimalarials ,Young Adult ,03 medical and health sciences ,Household survey ,symbols.namesake ,0302 clinical medicine ,Environmental health ,parasitic diseases ,medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,Poisson regression ,Evaluation ,Aged ,business.industry ,Research ,National scale-up ,Public health ,Health Systems Plans ,Infant ,Interrupted Time Series Analysis ,Middle Aged ,medicine.disease ,Malaria ,IPTi ,Infectious Diseases ,symbols ,Female ,Parasitology ,Measles vaccine ,business ,Infants - Abstract
Background Intermittent preventive treatment of malaria in infants (IPTi) with sulfadoxine-pyrimethamine (SP) is a proven strategy to protect infants against malaria. Sierra Leone is the first country to implement IPTi nationwide. IPTi implementation was evaluated in Kambia, one of two initial pilot districts, to assess quality and coverage of IPTi services. Methods This mixed-methods evaluation had two phases, conducted 3 (phase 1) and 15–17 months (phase 2) after IPTi implementation. Methods included: assessments of 18 health facilities (HF), including register data abstraction (phases 1 and 2); a knowledge, attitudes and practices survey with 20 health workers (HWs) in phase 1; second-generation sequencing of SP resistance markers (pre-IPTi and phase 2); and a cluster-sample household survey among caregivers of children aged 3–15 months (phase 2). IPTi and vaccination coverage from the household survey were calculated from child health cards and maternal recall and weighted for the complex sampling design. Interrupted time series analysis using a Poisson regression model was used to assess changes in malaria cases at HF before and after IPTi implementation. Results Most HWs (19/20) interviewed had been trained on IPTi; 16/19 reported feeling well prepared to administer it. Nearly all HFs (17/18 in phase 1; 18/18 in phase 2) had SP for IPTi in stock. The proportion of parasite alleles with dhps K540E mutations increased but remained below the 50% WHO-recommended threshold for IPTi (4.1% pre-IPTi [95%CI 2–7%]; 11% post-IPTi [95%CI 8–15%], p versus 80.4% for second pentavalent vaccine, given simultaneously); 274/444 (62.5%) children ≥ 14 weeks old received the second IPTi dose (versus 65.4% for third pentavalent vaccine); and 83/217 (36.4%) children ≥ 9 months old received the third IPTi dose (versus 52.2% for first measles vaccine dose). HF register data indicated no change in confirmed malaria cases among infants after IPTi implementation. Conclusions Kambia district was able to scale up IPTi swiftly and provide necessary health systems support. The gaps between IPTi and childhood vaccine coverage need to be further investigated and addressed to optimize the success of the national IPTi programme.
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- 2021
20. Comparison of Capillary Versus Venous Blood for the Diagnosis of Plasmodium falciparum Malaria Using Rapid Diagnostic Tests
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Moses Ntaro, Edgar Mulogo, Dan Nyehangane, Jonathan J. Juliano, Rabbison Muhindo, Emma Baguma, Molly Deutsch-Feldman, Abalinda Mary Gorret, and Ross M. Boyce
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Male ,0301 basic medicine ,medicine.medical_specialty ,030106 microbiology ,030231 tropical medicine ,Polymerase Chain Reaction ,Sensitivity and Specificity ,Veins ,Major Articles and Brief Reports ,03 medical and health sciences ,Rapid screening test ,0302 clinical medicine ,Internal medicine ,parasitic diseases ,medicine ,Humans ,Immunology and Allergy ,Sample Type ,Prospective Studies ,Malaria, Falciparum ,Child ,Reference standards ,biology ,business.industry ,Diagnostic test ,Plasmodium falciparum ,Venous blood ,medicine.disease ,biology.organism_classification ,Capillaries ,Infectious Diseases ,Child, Preschool ,Clinical diagnosis ,Female ,business ,Malaria - Abstract
We enrolled 250 febrile children in western Uganda to compare the results of malaria rapid diagnostic tests (RDTs) when using capillary vs venous blood. Participants were tested with 4 different RDT types. Polymerase chain reaction testing was performed as the reference standard. Sensitivity and specificity were broadly similar across RDT types and sampling method. Agreement between sample type was high, ranging from 0.95 to 0.99. When following the manufacturer’s recommended interpretation, only 5 tests would have resulted in a different clinical diagnosis. These results demonstrate that malaria RDTs perform similarly when using capillary or venous blood in febrile children with Plasmodium falciparum malaria.
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- 2021
21. Spatial and epidemiological drivers of Plasmodium falciparum malaria among adults in the Democratic Republic of the Congo
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Jessie K. Edwards, Emily W. Gower, Antoinette Tshefu Kitoto, Kyaw L. Thwai, Nicholas F Brazeau, Melchior Kashamuka, Jeffrey A. Bailey, Jérémie Muwonga, Steven R. Meshnick, Jonathan B. Parr, Ozkan Aydemir, Jonathan J. Juliano, Molly Deutsch-Feldman, Robert Verity, and Michael Emch
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medicine.medical_specialty ,Cross-sectional study ,030231 tropical medicine ,Psychological intervention ,law.invention ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,0302 clinical medicine ,law ,Environmental health ,Epidemiology ,medicine ,Malaria risk ,lcsh:RC109-216 ,030212 general & internal medicine ,lcsh:R5-920 ,biology ,business.industry ,Health Policy ,Public Health, Environmental and Occupational Health ,Plasmodium falciparum ,biology.organism_classification ,medicine.disease ,Transmission (mechanics) ,Rural area ,business ,lcsh:Medicine (General) ,Malaria - Abstract
BackgroundAdults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013–2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity.MethodsPlasmodium falciparum infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity.ResultsA total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76–0.95) and modern housing (PR=0.58, 95% CI=0.49–0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83–0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas.ConclusionsThe DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.
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- 2020
22. The Epidemiology of Plasmodium vivax Among Adults in the Democratic Republic of the Congo: A Nationally-Representative, Cross-Sectional Survey
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Benjamin D. Redelings, Melchior K. Mwandagalirwa, Jonathan B. Parr, Nicholas F Brazeau, Gartner, Jessie K. Edwards, Jonathan J. Juliano, Meshnick, Gregory A. Wray, Cedar L Mitchell, Kyaw L. Thwai, Oliver J Watson, Andrew P. Morgan, Antoinette Tshefu, Molly Deutsch-Feldman, Robert Verity, Andreea Waltmann, Joris L. Likwela, and Michael Emch
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0303 health sciences ,medicine.medical_specialty ,Critical gap ,education.field_of_study ,biology ,Cross-sectional study ,Plasmodium vivax ,Population ,medicine.disease ,biology.organism_classification ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Geography ,030220 oncology & carcinogenesis ,Epidemiology ,parasitic diseases ,medicine ,Malaria risk ,Clade ,education ,Malaria ,030304 developmental biology ,Demography - Abstract
BackgroundReports of P. vivax infections among Duffy-negative hosts have begun to accumulate throughout sub-Saharan Africa. Despite this growing body of evidence, no nationally representative epidemiological surveys of P. vivax in sub-Saharan Africa nor population genetic analyses to determine the source of these infections have been performed.MethodsTo overcome this critical gap in knowledge, we screened nearly 18,000 adults in the Democratic Republic of the Congo (DRC) for P. vivax using samples from the 2013-2014 Demographic Health Survey. Infections were identified by quantitative PCR and confirmed with nested-PCR. P. vivax mitochondrial genomes were constructed after short-read sequencing. Risk factors, spatial distributions and population genetic analyses were explored.FindingsOverall, we found a 2.96% (95% CI: 2.28%, 3.65%) prevalence of P. vivax infections across the DRC. Nearly all infections were among Duffy-negative adults (486/489). Infections were not associated with typical malaria risk-factors and demonstrated small-scale heterogeneity in prevalence across space. Mitochondrial genomes suggested that DRC P. vivax is an older clade that shares its most recent common ancestor with South American isolates.InterpretationP. vivax is more prevalent across the DRC than previously believed despite widespread Duffy-negativity. Comparison to global and historical P. vivax sequences suggests that historic DRC P. vivax may have been transported to the New World on the wave of European expansion. Our findings suggest congolese P. vivax is an innocuous threat given its relatively flat distribution across space, lack of malaria risk factors, and potentially ancestral lineage.FundingNational Institutes of Health and the Wellcome Trust.
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- 2020
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23. Spatial and epidemiological drivers of P. falciparum malaria among adults in the Democratic Republic of the Congo
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Michael Emch, Ozkan Aydemir, Jonathan B. Parr, Kyaw L. Thwai, Jérémie Muwonga, Melchior Kashamuka, Steven R. Meshnick, Antoinette Tshefu, Nicholas F Brazeau, Molly Deutsch-Feldman, Jessie K. Edwards, Jonathan J. Juliano, Robert Verity, Emily W. Gower, and Jeffrey A. Bailey
- Subjects
2. Zero hunger ,medicine.medical_specialty ,business.industry ,Transmission (medicine) ,Public health ,030231 tropical medicine ,1. No poverty ,Psychological intervention ,Drug resistance ,medicine.disease ,World health ,3. Good health ,03 medical and health sciences ,0302 clinical medicine ,Environmental health ,parasitic diseases ,Epidemiology ,medicine ,030212 general & internal medicine ,Rural area ,business ,Malaria - Abstract
BackgroundMalaria remains a significant public health problem in sub-Saharan Africa. Adults are frequently infected and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors amongst adults using samples from the nationally representative, cross-sectional 2013-2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of Congo (DRC). We further explored differences in risk factors by urbanicity.MethodsPlasmodium falciparum infection was determined by polymerase chain reaction (PCR). Covariates were drawn from the DHS to model individual, community, and environmental level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity.ResultsA total of 16,126 adults were included. Overall prevalence of malaria was 30.3% (SE = 1.1) by PCR; province-level prevalence ranged from 6.7-58.3%. Only 17% of individuals lived in households with at least one bednet for every two people, as recommended by the World Health Organization. Protective factors included increasing within-household bednet coverage (PR = 0.85, 95% CI = 0.76 - 0.95) and modern housing (PR = 0.58, 95% CI = 0.49 - 0.69). Community level protective factors included: increased average education and wealth (PR = 0.77, 95% CI = 0.65-0.91; PR - 0.84, 95% CI = 0.80 - 0.89). Education, wealth, and modern housing showed protective associations in cities but not in rural areas.ConclusionsThe DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Differences in risk factors by urbanicity may be due to differences in transmission intensity or access to resources.
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- 2020
24. Spatial and epidemiological drivers of
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Molly, Deutsch-Feldman, Nicholas F, Brazeau, Jonathan B, Parr, Kyaw L, Thwai, Jeremie, Muwonga, Melchior, Kashamuka, Antoinette, Tshefu Kitoto, Ozkan, Aydemir, Jeffrey A, Bailey, Jessie K, Edwards, Robert, Verity, Michael, Emch, Emily W, Gower, Jonathan J, Juliano, and Steven R, Meshnick
- Subjects
Adult ,Cross-Sectional Studies ,PCR ,Plasmodium falciparum ,Democratic Republic of the Congo ,malaria ,Humans ,epidemiology ,Malaria, Falciparum ,cross-sectional survey ,Original Research - Abstract
Background Adults are frequently infected with malaria and may serve as a reservoir for further transmission, yet we know relatively little about risk factors for adult infections. In this study, we assessed malaria risk factors among adults using samples from the nationally representative, cross-sectional 2013–2014 Demographic and Health Survey (DHS) conducted in the Democratic Republic of the Congo (DRC). We further explored differences in risk factors by urbanicity. Methods Plasmodium falciparum infection was determined by PCR. Covariates were drawn from the DHS to model individual, community and environmental-level risk factors for infection. Additionally, we used deep sequencing data to estimate the community-level proportions of drug-resistant infections and included these estimates as potential risk factors. All identified factors were assessed for differences in associations by urbanicity. Results A total of 16 126 adults were included. Overall prevalence of malaria was 30.3% (SE=1.1) by PCR; province-level prevalence ranged from 6.7% to 58.3%. Only 17% of individuals lived in households with at least one bed-net for every two people, as recommended by the WHO. Protective factors included increasing within-household bed-net coverage (Prevalence Ratio=0.85, 95% CI=0.76–0.95) and modern housing (PR=0.58, 95% CI=0.49–0.69). Community-level protective factors included increased median wealth (PR=0.87, 95% CI=0.83–0.92). Education, wealth, and modern housing showed protective associations in cities but not in rural areas. Conclusions The DRC continues to suffer from a high burden of malaria; interventions that target high-risk groups and sustained investment in malaria control are sorely needed. Areas of high prevalence should be prioritised for interventions to target the largest reservoirs for further transmission.
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- 2020
25. Improving institutional research ethics capacity assessments: lessons from sub-Saharan Africa
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Nelson K. Sewankambo, Joseph Ali, Nthabiseng Phaladze, Nancy E. Kass, Adnan A. Hyder, Molly Deutsch-Feldman, and Charles Michelo
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lcsh:R723-726 ,Economic growth ,Research ethics ,Health (social science) ,Sub saharan ,Process (engineering) ,Health Policy ,Bioethics ,capacity assessment ,LMIC ,Philosophy ,Institutional research ,Capacity strengthening ,Political science ,General partnership ,lcsh:H1-99 ,lcsh:Social sciences (General) ,lcsh:Medical philosophy. Medical ethics ,Baseline (configuration management) ,Research Articles ,Research Article - Abstract
The amount of biomedical research being conducted around the world has greatly expanded over the past 15 years, with particularly large growth occurring in low- and middle-income countries (LMICs). This increased focus on understanding and responding to disease burdens around the world has brought forth a desire to help LMIC institutions enhance their own capacity to conduct scientifically and ethically sound research. In support of these goals the Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has, for the past six years, partnered with three research institutions in Africa (University of Botswana, Makerere University in Uganda, and the University of Zambia) to support research ethics capacity. Each partnership began with a baseline evaluation of institutional research ethics environments in order to properly tailor capacity strengthening activities and help direct limited institutional resources. Through the course of these partnerships we have learned several lessons regarding the evaluation process and the framework used to complete the assessments (the Octagon Model). We believe that these lessons are generalizable and will be useful for groups conducting such assessments in the future.
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- 2018
26. Rapid assessment of institutional research ethics capacity: a case study from Zambia
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Adnan A. Hyder, Molly Deutsch-Feldman, Joseph Ali, Bornwell Sikateyo, Charles Michelo, and Nancy E. Kass
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Research ethics ,Health (social science) ,030504 nursing ,Management science ,business.industry ,Health Policy ,Identity (social science) ,06 humanities and the arts ,Bioethics ,Public relations ,0603 philosophy, ethics and religion ,03 medical and health sciences ,Institutional research ,Work (electrical) ,Relevance (information retrieval) ,060301 applied ethics ,Sociology ,0305 other medical science ,business ,Baseline (configuration management) ,Strengths and weaknesses - Abstract
Recently, there has been a remarkable increase in biomedical research being conducted in low and middle-income countries. This increase has brought attention to the need for high quality research ethics systems within these countries and a greater focus on research ethics training. Though most programs tend to concentrate on training individuals, less attention has focused on institutions as the target of such training. In this paper we demonstrate a rapid approach to evaluating institutional research capacity. The method adapts the Octagon Model, which evaluates institutional research ethics using eight domains: basic values and identity, organization of activities, implementation, relevance, proper skills, financing and administration, target groups, and working environment. The framework was applied to the University of Zambia in order to conduct a baseline assessment of university research ethics capacity. Internal and external assessments were conducted. The domains of working environment and proper skills scored highest, while relevance, target groups and identity scored lower. Consistent with previous work, a systems approach to evaluating institutional research development capacity can provide a rapid assessment of an institutional bioethics program. This case study reveals the strengths and weaknesses of the university’s research ethics program and provides a framework for future capacity growth.
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- 2017
27. The changing landscape of Plasmodium falciparum drug resistance in the Democratic Republic of Congo
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Steven R Meshnick, Margaret Carrel, Samir Bhatt, Jeffrey A. Bailey, Antoinette Tshefu, Robert Verity, Jonathan J. Juliano, Molly Deutsch-Feldman, Ozkan Aydemir, Melchior Kashamuka, Nicholas F Brazeau, and Steve M. Taylor
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medicine.medical_treatment ,Spatial-temporal modeling ,Drug Resistance ,Protozoan Proteins ,Drug resistance ,0302 clinical medicine ,Gene Frequency ,Chloroquine ,Prevalence ,030212 general & internal medicine ,Longitudinal Studies ,Malaria, Falciparum ,Genetics ,biology ,Middle Aged ,3. Good health ,Drug Combinations ,Infectious Diseases ,Pyrimethamine ,Democratic Republic of the Congo ,medicine.drug ,Research Article ,Adult ,Adolescent ,Sulfadoxine ,030231 tropical medicine ,Plasmodium falciparum ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Antimalarials ,Young Adult ,Spatio-Temporal Analysis ,parasitic diseases ,medicine ,Humans ,lcsh:RC109-216 ,Allele frequency ,Alcohol Dehydrogenase ,Membrane Transport Proteins ,biology.organism_classification ,medicine.disease ,Malaria ,Cross-Sectional Studies ,Parasitology ,Mutation - Abstract
Background Drug resistant malaria is a growing concern in the Democratic Republic of the Congo (DRC), where previous studies indicate that parasites resistant to sulfadoxine/pyrimethamine or chloroquine are spatially clustered. This study explores longitudinal changes in spatial patterns to understand how resistant malaria may be spreading within the DRC, using samples from nation-wide population-representative surveys. Methods We selected 552 children with PCR-detectable Plasmodium falciparum infection and identified known variants in the pfdhps and pfcrt genes associated with resistance. We compared the proportion of mutant parasites in 2013 to those previously reported from adults in 2007, and identified risk factors for carrying a resistant allele using multivariate mixed-effects modeling. Finally, we fit a spatial-temporal model to the observed data, providing smooth allele frequency estimates over space and time. Results The proportion of co-occurring pfdhps K540E/A581G mutations increased by 16% between 2007 and 2013. The spatial-temporal model suggests that the spatial range of the pfdhps double mutants expanded over time, while the prevalence and range of pfcrt mutations remained steady. Conclusions This study uses population-representative samples to describe the changing landscape of SP resistance within the DRC, and the persistence of chloroquine resistance. Vigilant molecular surveillance is critical for controlling the spread of resistance.
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- 2019
28. Efficiency of a Malaria Reactive Test-and-Treat Program in Southern Zambia: A Prospective, Observational Study
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Jailos Lubinda, Harry Hamapumbu, William J. Moss, Jennifer C. Stevenson, Timothy Shields, Michael Musonda, Tamaki Kobayashi, Kelly M. Searle, Philip E. Thuma, Ben Katowa, and Molly Deutsch-Feldman
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Adult ,Male ,Adolescent ,030231 tropical medicine ,Protozoan Proteins ,Zambia ,Antigens, Protozoan ,Sensitivity and Specificity ,03 medical and health sciences ,0302 clinical medicine ,Virology ,Malaria elimination ,Environmental health ,parasitic diseases ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,Prospective Studies ,Malaria, Falciparum ,Prospective cohort study ,Child ,Index case ,Rapid diagnostic test ,business.industry ,Articles ,medicine.disease ,Dried blood spot ,Malaria ,Infectious Diseases ,Test and treat ,Parasitology ,Observational study ,Female ,business - Abstract
To improve malaria surveillance and achieve elimination, the Zambian National Malaria Elimination Program implemented a reactive test-and-treat program in Southern Province in 2013 in which individuals with rapid diagnostic test (RDT)-confirmed malaria are followed-up at their home within 1 week of diagnosis. Individuals present at the index case household and those residing within 140 m of the index case are tested with an RDT and treated with artemether-lumefantrine if positive. This study evaluated the efficiency of this reactive test-and-treat strategy by characterizing infected individuals missed by the RDT and the current screening radius. The radius was expanded to 250 m, and a quantitative polymerase chain reaction (qPCR) test was performed on dried blood spot specimens. From January 2015 through March 2016, 145 index cases were identified at health centers and health posts. A total of 3,333 individuals residing in 525 households were screened. Excluding index cases, the parasite prevalence was 1.1% by RDT (33 positives of 3,016 participants) and 2.4% by qPCR (73 positives of 3,016 participants). Of the qPCR-positive cases, 62% of 73 individuals tested negative by RDT. Approximately half of the infected individuals resided within the index case household (58% of RDT-positive individuals and 48% of qPCR-positive individuals). The low sensitivity of the RDT and the high proportion of secondary cases within the index case household decreased the efficiency of this reactive test-and-treat strategy. Reactive focal drug administration in index case households would be a more efficient approach to treating infected individuals associated with a symptomatic case.
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- 2018
29. Ethics considerations in global mobile phone-based surveys of noncommunicable diseases : A conceptual exploration
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Joseph Ali, Alain B. Labrique, George Pariyo, Kara Gionfriddo, Dustin G. Gibson, Bridget Pratt, Adnan A. Hyder, and Molly Deutsch-Feldman
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Telemedicine ,020205 medical informatics ,noncommunicable diseases ,research ethics ,Internet privacy ,Stakeholder engagement ,Health Informatics ,02 engineering and technology ,Health informatics ,03 medical and health sciences ,0302 clinical medicine ,Viewpoint ,Risk Factors ,Surveys and Questionnaires ,0202 electrical engineering, electronic engineering, information engineering ,Global health ,Medicine ,Humans ,030212 general & internal medicine ,mHealth ,Research ethics ,business.industry ,Management science ,Digital health ,ethics ,Mobile phone ,business ,mobile phone survey ,bioethics ,Cell Phone - Abstract
Mobile phone coverage has grown, particularly within low- and middle-income countries (LMICs), presenting an opportunity to augment routine health surveillance programs. Several LMICs and global health partners are seeking opportunities to launch basic mobile phone–based surveys of noncommunicable diseases (NCDs). The increasing use of such technology in LMICs brings forth a cluster of ethical challenges; however, much of the existing literature regarding the ethics of mobile or digital health focuses on the use of technologies in high-income countries and does not consider directly the specific ethical issues associated with the conduct of mobile phone surveys (MPS) for NCD risk factor surveillance in LMICs. In this paper, we explore conceptually several of the central ethics issues in this domain, which mainly track the three phases of the MPS process: predata collection, during data collection, and postdata collection. These include identifying the nature of the activity; stakeholder engagement; appropriate design; anticipating and managing potential harms and benefits; consent; reaching intended respondents; data ownership, access and use; and ensuring LMIC sustainability. We call for future work to develop an ethics framework and guidance for the use of mobile phones for disease surveillance globally.
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- 2017
30. Effects of handling and vehicle injections on adrenocorticotropic and corticosterone concentrations in Sprague-Dawley compared with Lewis rats
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Molly, Deutsch-Feldman, Roberto, Picetti, Katharine, Seip-Cammack, Yan, Zhou, and Mary Jeanne, Kreek
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Male ,Hypothalamo-Hypophyseal System ,Pituitary-Adrenal System ,Handling, Psychological ,Prolactin ,Rats ,Rats, Sprague-Dawley ,Adrenocorticotropic Hormone ,Species Specificity ,Rats, Inbred Lew ,Husbandry ,Animals ,Corticosterone ,Injections, Intraperitoneal - Abstract
The hypothalamic–pituitary–adrenal (HPA) axis is a key factor in the trajectory of the addiction-like cycle (a pattern of behavior characterized by escalating drug use, withdrawal, and relapse) in preclinical and clinical studies. Concentrations of HPA hormones change in laboratory animals in response to standard experimental procedures, including handling and vehicle injections. We compared HPA activity in adult male Lewis (inbred) and Sprague–Dawley (outbred) rats, 2 common strains in rodent models of addiction, after different schedules of handling and saline injections, to explore the extent to which HPA responses differ by strain and whether interindividual differences underlie addiction vulnerability. The 4 treatment conditions were no, short, or long handling and saline injections. In handled groups, rats were handled for 1 to 2 min for 3 times daily and were euthanized after 7 d (short handling) or 14 d (long handling). The injection schedule in the saline injection group mimicked that in a model of binge-like cocaine exposure. Across all treatment groups, concentrations of adrenocorticotropic hormone were higher in Sprague–Dawley than in Lewis rats. In Sprague–Dawley rats, corticosterone concentrations decreased after continued handling but remained constant in Lewis rats. Interindividual variability in hormone levels was greater in Sprague–Dawley than Lewis rats, although corticosterone variability decreased after continued handling. Prolactin did not differ between groups of either Sprague–Dawley and Lewis rats before or after handling. This study underscores the importance of prolonged handling before experimenter-provided drug-administration paradigms and of strain-associated differences that may affect study outcomes.
- Published
- 2015
31. Self-Administrationof Oxycodone by Adolescent and Adult Mice Differentially Affects Hypothalamic Mitochondrial Metabolism Gene Expression
- Author
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Ann Ho, Mary Jeanne Kreek, A.J. Brownstein, Yong Zhang, Keiichi Niikura, Molly Deutsch-Feldman, Michele Buonora, and Jurgott
- Subjects
Messenger RNA ,medicine.medical_specialty ,Prescription drug ,business.industry ,Reductase ,Omics ,Endocrinology ,Hypothalamus ,Internal medicine ,Gene expression ,medicine ,business ,Oxycodone ,Gene ,medicine.drug - Abstract
Objective: Illicit prescription drug use among adolescents is a pressing public health concern: 12% of high school students report using prescription opioids with many progressing to use heroin. However, little is known about the effects of these drugs on the adolescent brain compared to the adult brain. This study examined the effect of adolescent oxycodone self-administration on gene expression specifically related to mitochondrial energy metabolism in the hypothalamus as the hypothalamus is involved in the regulation of feeding, reproduction and stress-induced drug seeking behavior. Methods: Adolescent and adult mice self-administered oxycodone (0.25mg/kg/infusion) or served as yoked saline controls 2 hours daily for 14 days. The hypothalamic mRNAs were analyzed with qPCR using a commercially available “mitochondrial energy metabolism” PCR array containing 84 genes. Results: mRNA levels of the ubiquinol-cytochrome c reductase, complex III subunit VII (Uqcrq) gene showed an experiment-wise significant increase in adolescents that self-administered oxycodone compared with controls. This effect was not found in adult mice. We also found that mRNA levels of the oxidase assembly 1-like (Oxa1l) gene showed a point-wise significant decrease in adult mice that had self-administered oxycodone. Additionally, twentyseven genes had increased expression in adolescents that self-administered oxycodone. Conversely, adults that self-administered oxycodone had eight genes with lower expression; none showed higher expression. Conclusion: These findings demonstrate that prescription opioid use caused significant changes of gene expression related to mitochondrial metabolism. The differences between adolescents and adults demonstrate the importance of studying adolescents in order to develop effective treatments.
- Published
- 2014
32. Handling and vehicle injections impact corticosterone but not adrenocorticotropic hormone levels in Sprague-Dawley but not Lewis rats
- Author
-
A.J. Brownstein, Roberto Picetti, K. Seip-Cammack, Molly Deutsch-Feldman, Mary Jeanne Kreek, and Michele Buonora
- Subjects
Pharmacology ,medicine.medical_specialty ,business.industry ,Adrenocorticotropic hormone ,Toxicology ,Sprague dawley ,Psychiatry and Mental health ,chemistry.chemical_compound ,Endocrinology ,chemistry ,Corticosterone ,Internal medicine ,medicine ,Lewis rats ,Pharmacology (medical) ,business - Published
- 2014
33. Self-administration of oxycodone by adolescent and adult mice differentially affects hypothalamic mitochondrial metabolism gene expression
- Author
-
Molly Deutsch-Feldman, Keiichi Niikura, A.J. Brownstein, Ann Ho, Mary Jeanne Kreek, Michele Buonora, Jurg Ott, and Yong Zhang
- Subjects
Pharmacology ,medicine.medical_specialty ,Metabolism ,Biology ,Toxicology ,Psychiatry and Mental health ,Endocrinology ,Internal medicine ,Gene expression ,medicine ,Pharmacology (medical) ,Self-administration ,Oxycodone ,medicine.drug - Published
- 2015
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