222 results on '"T. Montague"'
Search Results
2. Mycobacterium abscessus Meningitis Associated with Stem Cell Treatment During Medical Tourism
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Andrew B. Wolf, Kelli M. Money, Arun Chandnani, Charles L. Daley, David E. Griffith, Lakshmi Chauhan, Nathan Coffman, Amanda L. Piquet, Kenneth L. Tyler, Shanta M. Zimmer, Brian T. Montague, Sarah Mann, and Daniel M. Pastula more...
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Mycobacterium abscessus ,meningitis/encephalitis ,medical tourism ,stem cells ,nontuberculous mycobacterium infections ,multiple sclerosis ,Medicine ,Infectious and parasitic diseases ,RC109-216 - Abstract
Mycobacterium abscessus infections have been reported as adverse events related to medical tourism. We report M. abscessus meningitis in a patient who traveled from Colorado, USA, to Mexico to receive intrathecal stem cell injections as treatment for multiple sclerosis. We also review the management of this challenging central nervous system infection. more...
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- 2023
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Catalog
3. Substance use disorder-associated infections’ treatment with dalbavancin enabling outpatient transition (SUDDEN OUT) – an investigator-initiated single-arm unblinded prospective cohort study
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Martin Krsak, Sias Scherger, Matthew A. Miller, Vincent Cobb, Brian T. Montague, Andrés F. Henao-Martínez, and Kyle C. Molina
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Infectious and parasitic diseases ,RC109-216 - Abstract
Background: Severe gram-positive infections are frequent in people who inject drugs, and successful completion of treatment presents unique challenges in this population. Objectives: We aimed to evaluate the feasibility of a long-acting antibiotic, dalbavancin, as an alternative to standard-of-care antibiotics for severe infections due to vancomycin-susceptible pathogens requiring ⩾2 weeks of therapy. Design: We designed an investigator-initiated single-arm unblinded prospective cohort study to evaluate the safety and efficacy of an early switch to dalbavancin in two doses administered 1 week apart. Methods: We screened patients admitted with bloodstream infection, osteomyelitis, septic arthritis, infective endocarditis or deep abscesses, and comorbid substance use disorder (SUD) for eligibility. Consenting patients were switched to dalbavancin within 7 days from their index culture. They were monitored in the hospital for efficacy and safety of the treatment until the second dose of dalbavancin 7 days later and then discharged if stable. Study participants were evaluated with a decision support engine for a hypothetical appropriate level of care regarding their SUD after discharge. Their follow-up was planned for 12 months from the index culture, either in-person or via telehealth/telephone. Results: The enrollment was terminated early due to significant loss-to-follow-up. In all, 11 patients were enrolled, 4 completed 12 months of follow-up, 2 completed 8 months of follow-up, and 1 was seen once after discharge. The remaining five patients were lost to follow-up immediately after discharge. All 11 patients continued to improve after switching to dalbavancin between the first and second doses. There were two per-protocol failures of treatment. Dalbavancin was well tolerated, though some adverse events were reported. Conclusion: Dalbavancin may be a safe and effective alternative for an early switch in treating severe gram-positive infections. Trial registration: The trial was registered as NCT04847921 with clinicaltrials.gov. more...
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- 2024
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4. Elevated serum IgA following vaccination against SARS-CoV-2 in a cohort of high-risk first responders
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Brian T. Montague, Matthew F. Wipperman, Erica Chio, Rowena Crow, Andrea T. Hooper, Meagan P. O’Brien, and Eric A. F. Simões
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Medicine ,Science - Abstract
Abstract IgA plays an important early neutralizing role after SARS-CoV-2 infection. Systemically administered vaccines typically produce an IgM/IgG predominant response. We evaluated the serum anti-spike (anti-S) IgG, anti-nucleocapsid (anti-N) IgG and anti-S IgA response following vaccination against SARS-CoV-2 in a cohort of first-responders. Among the 378 completely vaccinated participants, 98% were positive for anti-S IgG and 96% were positive for anti-S IgA. Nine percent were positive for anti-N IgG suggesting prior exposure to SARS-CoV-2. No statistically significant difference was seen in IgA response based on prior evidence infection (p = 0.18). Ninety-eight of those receiving the Moderna vaccine (98%) were positive for anti-S IgA as compared to 91% of those who received the Pfizer vaccine (p = 0.0009). The high proportion of participants observed to have a positive anti-S IgA response after vaccination suggests that the vaccines elicit a systemic response characterized by elevated levels of both IgG and IgA. more...
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- 2022
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5. Investigating transmission of SARS-CoV-2 using novel face mask sampling: a protocol for an observational prospective study of index cases and their contacts in a congregate setting
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Daniel Olson, Stephanie James, Thomas Jaenisch, Stephen Berman, Molly M Lamb, Emily N Gallichotte, Brian Adams, Charles Henry, Jeannine Riess, Joni Triantis van Sickle, Kellie L Hawkins, Brian T Montague, Cody Coburn, Leisha Conners Bauer, Jennifer Kovarik, Mark T Hernandez, Amy Bronson, Lucy Graham, Stephanie Hanenberg, James Kovacs, John S Spencer, Mark Zabel, Philip D Fox, Olivia Pluss, William Windsor, Geoffrey Winstanley, Michael Barer, Gregory Ebel, and May Chu more...
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Medicine - Abstract
Introduction This study aims to measure how transmission of SARS-CoV-2 occurs in communities and to identify conditions that lend to increased transmission focusing on congregate situations. We will measure SARS-CoV-2 in exhaled breath of asymptomatic and symptomatic persons using face mask sampling—a non-invasive method for SARS-CoV-2 detection in exhaled air. We aim to detect transmission clusters and identify risk factors for SARS-CoV-2 transmission in presymptomatic, asymptomatic and symptomatic individuals.Methods and analysis In this observational prospective study with daily follow-up, index cases and their respective contacts are identified at each participating institution. Contact definitions are based on Centers for Disease Control and Prevention and local health department guidelines. Participants will wear masks with polyvinyl alcohol test strips adhered to the inside for 2 hours daily. The strips are applied to all masks used over at least 7 days. In addition, self-administered nasal swabs and (optional) finger prick blood samples are performed by participants. Samples are tested by standard PCR protocols and by novel antigen tests.Ethics and dissemination This study was approved by the Colorado Multiple Institutional Review Board and the WHO Ethics Review Committee. From the data generated, we will analyse transmission clusters and risk factors for transmission of SARS-CoV-2 in congregate settings. The kinetics of asymptomatic transmission and the evaluation of non-invasive tools for detection of transmissibility are of crucial importance for the development of more targeted control interventions—and ultimately to assist with keeping congregate settings open that are essential for our social fabric.Trial registration number ClinicalTrials.gov (#NCT05145803). more...
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- 2022
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6. Use of viral load surveillance data to assess linkage to care for persons with HIV released from corrections.
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Brian T Montague, Betsey John, Cara Sammartino, Michael Costa, Dawn Fukuda, Liza Solomon, and Josiah D Rich
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Medicine ,Science - Abstract
Incarcerated people remain a priority group in efforts to control and reverse the HIV epidemic. Following release, social instability and reengagement in key transmission risk behaviors increase the risk of secondary transmission of HIV. Targeted programs have been developed to facilitate reengagement in care on reentry. Evaluation of the impact of these initiatives requires a systematic, confidential, framework for assessment of linkage to care for persons released from corrections. By linking HIV viral load surveillance data to corrections release data, the time to the first laboratory monitoring service in the community as well as the virologic status can be assessed. Using this method, we linked release data for sentenced individuals released from Massachusetts state correctional facilities in 2012 to HIV surveillance data from the Massachusetts HIV/AIDS Surveillance Program (MHASP) for the years 2012-2013. We identified 41 individuals with HIV released in 2012. Ninety-one percent had identified virologic assessments post release, 41% within 30 days. Thirty-three percent did not have a viral load assessed for more than 90 days and 31% had detectable virus at the time of their initial assessment. Persons with longer incarcerations (> 180 days) were more likely to have suppressed viral load at the time of follow-up (p = 0.05). This work demonstrates the important value of HIV laboratory surveillance data and correctional release data as a tool to assess linkage to care following release from corrections. We encourage jurisdictions to explore utilizing similar methodology to evaluate the effectiveness of the linkage to HIV care after release from incarceration. more...
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- 2018
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7. Anti-SARS-CoV-2 IgA Identifies Asymptomatic Infection in First Responders
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Eric A. F. Simões, Femi Elemo, Andrea T. Hooper, Rowena Crow, Brian T. Montague, Jennifer D. Hamilton, Matthew F. Wipperman, Shaun Langdon, Lisa Hersh, Sara Hamon, and Meagan P. O'Brien
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medicine.medical_specialty ,serosurvey ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population ,Antibodies, Viral ,Asymptomatic ,first responders ,Serology ,Immune system ,Internal medicine ,Epidemiology ,Major Article ,medicine ,Humans ,Immunology and Allergy ,Cumulative incidence ,education ,Asymptomatic Infections ,cumulative incidence ,Retrospective Studies ,education.field_of_study ,SARS-CoV-2 ,business.industry ,Risk of infection ,Emergency Responders ,COVID-19 ,Immunoglobulin A ,AcademicSubjects/MED00290 ,Infectious Diseases ,Immunoglobulin G ,epidemiology ,medicine.symptom ,business ,IgA - Abstract
Background Immunoglobulin A (IgA) is an important component of the early immune response to SARS-CoV-2. Prior serosurveys in high-risk groups employing IgG testing alone have provided discordant estimates. The potential added benefit of IgA in serosurveys has not been established. Methods Longitudinal serosurvey of first responders (police, emergency medical service providers, fire fighters, and other staff) employing 3 serologic tests (anti-spike IgA, anti-spike IgG, and anti-nucleocapsid IgG) correlated with surveys assessing occupational and nonoccupational risk, exposure to COVID-19, and illnesses consistent with COVID-19. Results Twelve percent of first responders in Colorado at baseline and 22% at follow-up were assessed as having SARS-CoV-2 infection. Five percent at baseline and 6% at follow-up were seropositive only for IgA. Among those IgA positive only at baseline, the majority (69%) had a positive antibody at follow-up; 45% of those infected at baseline and 33% at follow-up were asymptomatic. At all time points, the estimated cumulative incidence in our study was higher than that in the general population. Conclusions First responders are at high risk of infection with SARS-CoV-2. IgA testing identified a significant portion of cases missed by IgG testing and its use as part of serologic surveys may improve retrospective identification of asymptomatic infection. more...
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- 2021
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8. Opioid Use and Chronic Infections: The Value of Addressing the Syndemic in Correctional Settings Via Telemedicine Guidance and Broader Use of Long-Acting Medications
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Steven C. Johnson, Brian T. Montague, Ingrid A. Binswanger, Paul Trowbridge, and Martin Krsak
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medicine.medical_specialty ,Telemedicine ,Time Factors ,Specialty ,030508 substance abuse ,HIV Infections ,Telehealth ,Antiviral Agents ,Health Services Accessibility ,Drug Users ,03 medical and health sciences ,Risk-Taking ,0302 clinical medicine ,Syndemic ,Unsafe Sex ,Health care ,Prevalence ,medicine ,Humans ,Mass Screening ,Immunology and Allergy ,030212 general & internal medicine ,Opioid Epidemic ,health care economics and organizations ,business.industry ,Public health ,Opioid-Related Disorders ,United States ,Analgesics, Opioid ,Infectious Diseases ,Prisons ,Family medicine ,Expanded access ,Chronic Disease ,0305 other medical science ,business - Abstract
In the United States, we are experiencing linked epidemics (a syndemic) of substance use disorders (SUDs) and infections associated with drug use, including unsafe injecting and unsafe sex in exchange for drugs or money. Current drug laws, together with risk-taking behavior among persons with SUDs, contribute to disproportionately high prevalences of these conditions in correctional settings. Detection and treatment of diseases with a high impact on public health are best addressed in the settings where such conditions are most prevalent (ie, jails and prisons for SUDs and chronic infections). The effectiveness, safety, cost of care. and public health impact of these conditions can be improved by means of broader screening and expanded access to specialty consultations through telemedicine/telehealth, along with broader use of long-acting medications for the treatment of human immunodeficiency virus and SUDs. Expanding telemedicine/telehealth, first for specialties which do not require advanced technology (eg, infectious diseases, addictions), can eventually lead to further advancements in correctional healthcare. more...
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- 2020
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9. Physiological Response to Water Deficit Stress with Restricted Rooting in Tall Fescue and Zoysiagrass
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Benjamin Wherley, David T. Montague, Manish Sapkota, Joseph Young, Eduardo Escamilla, and Travis Culpepper
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0106 biological sciences ,Greenhouse ,04 agricultural and veterinary sciences ,Horticulture ,Environmental Science (miscellaneous) ,01 natural sciences ,Water deficit ,Stress (mechanics) ,Water conservation ,Agronomy ,Soil water ,040103 agronomy & agriculture ,0401 agriculture, forestry, and fisheries ,Soil horizon ,Environmental science ,010606 plant biology & botany - Abstract
Urban soils may restrict turfgrass rooting depth with shallow soil layers in high sand content soils, which may influence water conservation. A greenhouse study sought to quantify water usage and determine the physiological response of turfgrasses at four irrigation levels. ‘ATF-1434′ tall fescue (Schedonorus arundinaceus (Schreb.) Dumort. nom. cons.; syn. Festuca arundinacea Schreb.), ‘Jamur' Japanese lawngrass (Zoysia japonica Steud.), and ‘Zeon' Manilagrass [Zoysia matrella (L.) Merr.] were established in 10 cm (4 in) diameter by 17.8 cm (7 in) tall containers. Each species was irrigated with 16.5, 21.9, 27.3, or 32.7 mm.wk−1 (0.65, 0.86, 1.1, or 1.3 in.wk−1). Gravimetric water loss was determined by pre- and post-irrigation pot weights. Turf quality, leaf discoloration, percent green cover, and gross photosynthesis were evaluated weekly and root parameters were measured at the conclusion of each trial. Although root mass was similar among species, water deficit stress and leaf discoloration occurred sooner in tall fescue than the two Zoysia species, reducing turf quality and green cover. Japanese lawngrass and Manilagrass had greater stomatal conductance, resulting in 109 and 89% higher gross photosynthesis relative to tall fescue. Both zoysiagrasses maintained acceptable turf quality with 27.3 mm water.wk−1. However, tall fescue quality was not acceptable at any irrigation level.Index words: Photosynthesis, gravimetric water loss, tall fescue, Japanese lawngrass, Manilagrass.Species used in this study: Tall fescue (Schedonorus arundinaceus (Schreb.) Dumort. nom. cons.; syn. Festuca arundinacea Schreb.); Japanese lawngrass (Zoysia japonica Steud.); Manilagrass [Zoysia matrella (L.) Merr.]. more...
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- 2020
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10. Investigating transmission of SARS-CoV-2 using novel face mask sampling: a protocol for an observational prospective study of index cases and their contacts in a congregate setting
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Thomas Jaenisch, Molly M Lamb, Emily N Gallichotte, Brian Adams, Charles Henry, Jeannine Riess, Joni Triantis van Sickle, Kellie L Hawkins, Brian T Montague, Cody Coburn, Leisha Conners Bauer, Jennifer Kovarik, Mark T Hernandez, Amy Bronson, Lucy Graham, Stephanie James, Stephanie Hanenberg, James Kovacs, John S Spencer, Mark Zabel, Philip D Fox, Olivia Pluss, William Windsor, Geoffrey Winstanley, Daniel Olson, Michael Barer, Stephen Berman, Gregory Ebel, and May Chu more...
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Observational Studies as Topic ,SARS-CoV-2 ,Masks ,Humans ,COVID-19 ,Prospective Studies ,General Medicine ,Personal Protective Equipment - Abstract
IntroductionThis study aims to measure how transmission of SARS-CoV-2 occurs in communities and to identify conditions that lend to increased transmission focusing on congregate situations. We will measure SARS-CoV-2 in exhaled breath of asymptomatic and symptomatic persons using face mask sampling—a non-invasive method for SARS-CoV-2 detection in exhaled air. We aim to detect transmission clusters and identify risk factors for SARS-CoV-2 transmission in presymptomatic, asymptomatic and symptomatic individuals.Methods and analysisIn this observational prospective study with daily follow-up, index cases and their respective contacts are identified at each participating institution. Contact definitions are based on Centers for Disease Control and Prevention and local health department guidelines. Participants will wear masks with polyvinyl alcohol test strips adhered to the inside for 2 hours daily. The strips are applied to all masks used over at least 7 days. In addition, self-administered nasal swabs and (optional) finger prick blood samples are performed by participants. Samples are tested by standard PCR protocols and by novel antigen tests.Ethics and disseminationThis study was approved by the Colorado Multiple Institutional Review Board and the WHO Ethics Review Committee. From the data generated, we will analyse transmission clusters and risk factors for transmission of SARS-CoV-2 in congregate settings. The kinetics of asymptomatic transmission and the evaluation of non-invasive tools for detection of transmissibility are of crucial importance for the development of more targeted control interventions—and ultimately to assist with keeping congregate settings open that are essential for our social fabric.Trial registration numberClinicalTrials.gov (#NCT05145803). more...
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- 2022
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11. Physiological Responses in C3 and C4 Turfgrasses under Soil Water Deficit
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Joseph Young, Travis Culpepper, David T. Montague, Dana Sullivan, and Benjamin Wherley
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Agronomy ,Soil water deficit ,Environmental science ,Lawn ,Horticulture ,Physiological responses - Abstract
Lawns must be managed increasingly under less frequent or deficit irrigation. Deficit irrigation can reduce gas exchange, carbon assimilation, and physiological function in both warm- (C4) and cool- (C3) season turfgrasses, yet limited research has compared the physiological response to increasing levels of soil water deficit. The objectives of this greenhouse study were to compare three commonly used transition-zone turfgrasses—bermudagrass [Cynodon dactylon (L.) Pers.] (C4), buffalograss [Buchloe dactyloides (Nutt.) Engelm.] (C4), and tall fescue (Festuca arundinacea Schreb.) (C3)—and their ability to maintain quality and physiological function under water deficit stress. Visual turf quality, normalized difference vegetation index (NDVI), reflective canopy temperature, and gross photosynthesis were evaluated initially near field capacity (FC), and subsequent soil water deficit [48% (moderate) and 33% (severe) of plant-available water] conditions. Bermudagrass and tall fescue had similar quality ratings near FC, although the photosynthetic rate was greater for bermudagrass. Compared with other turfgrasses, bermudagrass maintained greater turf quality, NDVI, and photosynthetic rates further into water deficit stress. Tall fescue quality and photosynthetic rates declined most rapidly in both experiments as a result of the combined heat and drought stress. Buffalograss used less water compared with other species, and maintained consistent turf quality, NDVI, and photosynthetic rates under moderate and severe water deficit. These results support the notion that buffalograss and bermudagrass are better adapted than tall fescue at maintaining functional and ecosystem services with shallow soil depths in landscape situations under imposed summertime water restrictions. more...
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- 2019
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12. Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees
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Susanna E. Winston MD, Brian T. Montague DO, MS, MPH, Michael J. Lopez MS, Allison Delong PhD, Chloe LeMarchand MS, Armando Bedoya MD, Fizza S. Gillani PhD, and Curt G. Beckwith MD
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Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Background: HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. Methods: We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. Results: The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P < .05). Discussion: Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success. more...
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- 2013
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13. Credible learning of hydroxychloroquine and dexamethasone effects on COVID-19 mortality outside of randomized trials
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Brian T. Montague, Bogdan Pasaniuc, Chad Hazlett, Kristine M. Erlandson, Onyebuchi A. Arah, and David Ami Wulf
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Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Mortality rate ,Clinical Trials and Supportive Activities ,Hydroxychloroquine ,Percentage point ,Disease ,Neurodegenerative ,Cardiovascular ,law.invention ,Good Health and Well Being ,Randomized controlled trial ,law ,Clinical Research ,Cohort ,medicine ,business ,Dexamethasone ,medicine.drug - Abstract
ObjectivesTo investigate the effectiveness of hydroxychloroquine and dexamethasone on coronavirus disease (COVID-19) mortality using patient data outside of randomized trials.DesignPhenotypes derived from electronic health records were analyzed using the stability-controlled quasi-experiment (SCQE) to provide a range of possible causal effects of hydroxy-chloroquine and dexamethasone on COVID-19 mortality.Setting and participantsData from 2,007 COVID-19 positive patients hospitalized at a large university hospital system over the course of 200 days and not enrolled in randomized trials were analyzed using SCQE. For hyrdoxychloroquine, we examine a high-use cohort (n=766, days 1 to 43) and a later, low-use cohort (n=548, days 44 to 82). For dexamethasone, we examine a low-use cohort (n=614, days 44 to 101) and high-use cohort (n=622, days 102 to 200).Outcome measure14-day mortality, with a secondary outcome of 28-day mortality.ResultsHydroxycholoroquine could only have been significantly (pConclusionsThe assumptions required for a beneficial effect of hydroxychloroquine on 14 day mortality are difficult to sustain, while the assumptions required for hydroxychloroquine to be harmful are difficult to reject with confidence. Dexamethasone, by contrast, was beneficial under a wide range of plausible assumptions, and was only harmful if a nearly impossible assumption is met. More broadly, the SCQE reveals what inferences can be credibly supported by evidence from non-randomized uses of experimental therapies, making it a useful tool when randomized trials have not yet produced clear evidence or to provide corroborative evidence from different populations. more...
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- 2020
14. Falling Through the Cracks: Risk Factors for Becoming Lost to HIV Care After Incarceration in a Southern Jail
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Brian T. Montague, Xilong Li, Yordanos M. Tiruneh, Benjamin Bovell-Ammon, Ank E. Nijhawan, Josiah D. Rich, Timothy P. Flanigan, and Princess A. Iroh
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Male ,medicine.medical_specialty ,Social Psychology ,HIV Infections ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Risk Factors ,Medicine ,Humans ,030212 general & internal medicine ,Lost to follow-up ,Retrospective Studies ,030505 public health ,business.industry ,Public health ,Prisoners ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,medicine.disease ,Mental illness ,Texas ,Health psychology ,Infectious Diseases ,Falling (accident) ,Prisons ,Residence ,Female ,medicine.symptom ,0305 other medical science ,business ,Demography - Abstract
Using a retrospective cohort analysis of inmates released from Dallas County Jail between January 2011 and November 2013, this study characterizes people living with HIV/AIDS (PLWHA) who are lost to care after release from jail. We used Kaplan-Meier analysis to estimate the risk of becoming lost to post-release HIV care and a Cox proportional hazards regression model to identify associated factors. The majority of individuals (78.2%) were men and 65.5% were black. Of the incarcerations that ended with release to the community, approximately 43% failed to link to community HIV care. Non-Hispanic Whites were more likely than Hispanics or Blacks to drop out of care after release. Individuals with histories of substance use or severe mental illness were more likely to become lost, while those under HIV care prior to incarceration and/or who had adhered to antiretroviral therapy (ART) were more likely to resume care upon release. Targeted efforts such as rapid linkage to care and re-entry residence programs could encourage formerly incarcerated individuals to re-engage in care. more...
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- 2020
15. A Correctness Proof for Binary Search.
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Patricia T. Montague
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- 1991
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16. Feedforward Control of Gear Mesh Vibration Using Piezoelectric Actuators
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Gerald T. Montague, Albert F. Kascak, Alan Palazzolo, Daniel Manchala, and Erwin Thomas
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Physics ,QC1-999 - Abstract
This article presents a novel means for suppressing gear mesh related vibrations. The key components in this approach are piezoelectric actuators and a high-frequency, analog feed forward controller. Test results are presented and show up to a 70% reduction in gear mesh acceleration and vibration control up to 4500 Hz. The principle of the approach is explained by an analysis of a harmonically excited, general linear vibratory system. more...
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- 1994
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17. Assessing the Effect of Recent Incarceration in Prison on HIV Care Retention and Viral Suppression in Two States
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Brian T. Montague, David L. Rosen, Chava Zibman, Liza Solomon, Cara J. Sammartino, Josiah D. Rich, Michael A. Costa, and Roee Gutman
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,media_common.quotation_subject ,Population ,HIV Infections ,Prison ,Article ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Epidemiology ,North Carolina ,Retention in Care ,Humans ,Medicine ,030212 general & internal medicine ,education ,Psychiatry ,Aged ,Retrospective Studies ,media_common ,Aged, 80 and over ,education.field_of_study ,030505 public health ,business.industry ,Prisoners ,Public health ,Public Health, Environmental and Occupational Health ,Rhode Island ,virus diseases ,Continuity of Patient Care ,Middle Aged ,Viral Load ,medicine.disease ,Health equity ,Urban Studies ,Female ,0305 other medical science ,business ,Viral load ,Cohort study - Abstract
The prevalence of HIV among people in correctional facilities remains much higher than that of the general population. Numerous studies have demonstrated the effectiveness and acceptability of HIV treatment for individuals incarcerated in US prisons and jails. However, the period following incarceration is characterized by significant disruptions in HIV care. These disruptions include failure to link in a timely manner (or at all) to community care post-release, as well as not being retained in care after linking. We used a retrospective, propensity-matched cohort design to compare retention in care between HIV-positive individuals recently released from prison (releasees) who linked to care in Ryan White HIV/AIDS Program (RWHAP) clinics and RWHAP patients without a recent incarceration history (community controls). We also performed analyses comparing viral load suppression of those retained in both groups. This study shows that even for those who do successfully link to care after prison, they are 24 to 29 percentage points less likely to be retained in care than those already in community care. However, we found that for those who did retain in care, there was no disparity in rates of viral suppression. These findings provide valuable insight regarding how best to address challenges associated with ensuring that HIV-positive individuals leaving prison successfully move through the HIV care continuum to become virally suppressed. more...
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- 2018
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18. Gas exchange and growth of landscape tree species in response to drought and post establishment applied organic mulch
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C. McKenney and T. Montague
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0106 biological sciences ,Tree canopy ,Stomatal conductance ,Irrigation ,010504 meteorology & atmospheric sciences ,biology ,Growing season ,Horticulture ,biology.organism_classification ,010603 evolutionary biology ,01 natural sciences ,Quercus robur ,Annual growth cycle of grapevines ,Agronomy ,Environmental science ,Quercus muehlenbergii ,Mulch ,0105 earth and related environmental sciences - Abstract
Landscape industry employees often advises homeowners to place organic mulches on soils surrounding trees in new and existing landscapes. However, limited research has been conducted to determine if organic mulch placed below established landscape trees enhances tree growth. Under non-irrigated conditions, our research objective was to compare gas exchange and growth of established landscape trees that either had, or did not have organic mulch placed on the soil surface surrounding each tree. English oak (Quercus robur), Chinquapin oak (Q. muehlenbergii), and Shantung maple (Acer truncatum) trees were planted 2002. In Fall 2008, six trees of each species were randomly assigned a mulch treatment: organic mulch or no organic mulch placed on the soil below the tree canopy. From Fall of 2008 through Fall of 2011 trees received weekly irrigation. Beginning 2012, trees were not irrigated. Daily weather data were collected by an onsite weather station. Throughout the 2012, 2013, and 2014 growing seasons bud break data was collected from each tree. In addition, throughout each growing season mid-day gas exchange data (stomatal conductance, photosynthetic rate, etc.) were collected. At the end of each growing season, growth data were assessed. Data indicate soil under mulch was cooler, had greater soil moisture, and less extreme temperature fluctuations extremes when compared to soil without mulch. Throughout the experiment, species and treatment differences were found in gas exchange data. Shoot growth tended to be greater for non-mulch trees. However, leaf area varied between species and mulch treatments. Results suggest benefits (greater gas exchange, growth, etc.) of organic mulch placed under non-irrigated established trees is species specific, and should be carefully considered prior to making recommendations. more...
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- 2018
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19. HIV Suppression among Patients on Treatment in Vietnam: A Review of HIV Viral Load Testing in a Public Urban Clinic in Ho Chi Minh City
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T. Tony Trinh, Brian T. Montague, Timothy P. Flanigan, and Hoang My Gerard
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Immunologic diseases. Allergy ,RC581-607 - Abstract
Background. There are few reports of HIV viral load (VL) testing among patients on ART in Vietnam. Methods. From a public clinic in Ho Chi Minh City (HCMC), we reviewed cases of VL measurements from adults on ART. Results. We identified 228 cases. Median age was 30 years (27–34), 85% were male, and 77% had a history of IDU. The mean ART duration was 26 months (95% CI 25–27); d4T/3TC/NVP was the most common regimen. Viral suppression was seen in 160/228 (70%). Viremia (>1000 copies/mL) was associated with prior ART exposure (OR 5.68, ) and immunologic failure (OR 4.69, ). Targeted testing accounted for 13% of cases, only half of which yielded viremia. Conclusion. We demonstrate a high HIV suppression rate among patients on ART in HCMC, Vietnam. In this setting, routine testing detects viremia missed by targeted testing. more...
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- 2011
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20. Mystery of God's Mercy, The: Stories and Meditations
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George T. Montague, SM and George T. Montague, SM
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- God (Christianity)--Mercy--Miscellanea, Word of God (Christian theology)--Miscellanea, Christian life--Anecdotes
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The author recounts stories of God's mercy in her life and the lives of others. Some of the stories are meditations on the mercy stories of the Bible, seen through the eyes of those who spoke them or those who wrote them. more...
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- 2022
21. Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities
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Myron S, Cohen, Ajay, Nirula, Mark J, Mulligan, Richard M, Novak, Mary, Marovich, Catherine, Yen, Alexander, Stemer, Stockton M, Mayer, David, Wohl, Blair, Brengle, Brian T, Montague, Ian, Frank, Russell J, McCulloh, Carl J, Fichtenbaum, Brad, Lipson, Nashwa, Gabra, Julio A, Ramirez, Christine, Thai, Wairimu, Chege, Margarita M, Gomez Lorenzo, Nirupama, Sista, Jennifer, Farrior, Meredith E, Clement, Elizabeth R, Brown, Kenneth L, Custer, Jacob, Van Naarden, Andrew C, Adams, Andrew E, Schade, Matan C, Dabora, Jack, Knorr, Karen L, Price, Janelle, Sabo, Jay L, Tuttle, Paul, Klekotka, Lei, Shen, Daniel M, Skovronsky, and George, Taffet more...
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Adult ,Male ,medicine.medical_specialty ,Randomization ,Adolescent ,Health Personnel ,Population ,Antibodies, Monoclonal, Humanized ,Placebo ,Antiviral Agents ,Severity of Illness Index ,01 natural sciences ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,Assisted Living Facilities ,law ,Severity of illness ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Young adult ,Infusions, Intravenous ,education ,Drug Approval ,Aged ,Skilled Nursing Facilities ,Aged, 80 and over ,education.field_of_study ,SARS-CoV-2 ,business.industry ,Incidence ,Incidence (epidemiology) ,010102 general mathematics ,Immunization, Passive ,COVID-19 ,General Medicine ,Odds ratio ,Middle Aged ,Antibodies, Neutralizing ,Emergency medicine ,Female ,business - Abstract
IMPORTANCE Preventive interventions are needed to protect residents and staff of skilled nursing and assisted living facilities from COVID-19 during outbreaks in their facilities. Bamlanivimab, a neutralizing monoclonal antibody against SARS-CoV-2, may confer rapid protection from SARS-CoV-2 infection and COVID-19. OBJECTIVE To determine the effect of bamlanivimab on the incidence of COVID-19 among residents and staff of skilled nursing and assisted living facilities. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, single-dose, phase 3 trial that enrolled residents and staff of 74 skilled nursing and assisted living facilities in the United States with at least 1 confirmed SARS-CoV-2 index case. A total of 1175 participants enrolled in the study from August 2 to November 20, 2020. Database lock was triggered on January 13, 2021, when all participants reached study day 57. INTERVENTIONS Participants were randomized to receive a single intravenous infusion of bamlanivimab, 4200mg (n = 588), or placebo (n = 587). MAIN OUTCOMES AND MEASURES The primary outcomewas incidence of COVID-19, defined as the detection of SARS-CoV-2 by reverse transcriptase���polymerase chain reaction and mild or worse disease severity within 21 days of detection, within 8 weeks of randomization. Key secondary outcomes included incidence of moderate or worse COVID-19 severity and incidence of SARS-CoV-2 infection. RESULTS The prevention population comprised a total of 966 participants (666 staff and 300 residents) who were negative at baseline for SARS-CoV-2 infection and serology (mean age, 53.0 [range, 18-104] years; 722 [74.7%] women). Bamlanivimab significantly reduced the incidence of COVID-19 in the prevention population compared with placebo (8.5%vs 15.2%; odds ratio, 0.43 [95%CI, 0.28-0.68]; P < .001; absolute risk difference, ���6.6 [95%CI, ���10.7 to ���2.6] percentage points). Five deaths attributed to COVID-19 were reported by day 57; all occurred in the placebo group. Among 1175 participants who received study product (safety population), the rate of participants with adverse events was 20.1% in the bamlanivimab group and 18.9% in the placebo group. The most common adverse events were urinary tract infection (reported by 12 participants [2%] who received bamlanivimab and 14 [2.4%] who received placebo) and hypertension (reported by 7 participants [1.2%] who received bamlanivimab and 10 [1.7%] who received placebo). CONCLUSIONS AND RELEVANCE Among residents and staff in skilled nursing and assisted living facilities, treatment during August-November 2020 with bamlanivimab monotherapy reduced the incidence of COVID-19 infection. Further research is needed to assess preventive efficacy with current patterns of viral strains with combination monoclonal antibody therapy. more...
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- 2021
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22. Risk Compensation Following Medical Male Circumcision: Results from a 1-Year Prospective Cohort Study of Young School-Going Men in KwaZulu-Natal, South Africa
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Janet A. Frohlich, C. T. Montague, Kaymarlin Govender, Gavin George, and Sean Beckett
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Psychological intervention ,Human immunodeficiency virus (HIV) ,HIV Infections ,Human sexuality ,medicine.disease_cause ,law.invention ,Condoms ,South Africa ,Young Adult ,03 medical and health sciences ,Risk-Taking ,0302 clinical medicine ,Condom ,law ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Applied Psychology ,Gynecology ,030505 public health ,business.industry ,Risk compensation ,Health psychology ,Sexual Partners ,Circumcision, Male ,Male circumcision ,0305 other medical science ,business ,Demography - Abstract
This study sought to assess risk compensation following voluntary medical male circumcision of young school-going men. Risk compensation is defined as an inadvertent increase in sexual risk behaviors and a corresponding decrease in self-perceived risk for contracting HIV following the application of a risk reduction technology. This study documented the sexual practices of circumcised (n = 485) and uncircumcised (n = 496) young men in 42 secondary schools at three time points (baseline and 6 and 12 months) in a sub-district of KwaZulu-Natal, South Africa. Study participants were aged from 16 to 24 years old. At the end of the study period, there was no significant difference between the two cohorts concerning learners’ perceptions of being at risk of contracting HIV (interaction effect: b = −0.12, p = 0.40). There was also no significant difference in the number of sexual partners in the previous month (interaction effect: b = −0.23, p = 0.15). The proportion of learners who have never used a condom decreased significantly over time (time effect: b = −0.27, p = 0.01), and there was no difference between the circumcised and uncircumcised learners (interaction effect: b = −0.09, p = 0.91). Risk compensation, as evidenced in this study over a 1-year period, was not associated with undergoing voluntary medical male circumcision (VMMC) in our sample of young school-going men. However, it is of concern that at the end of this study, less than half of the sexually active sample in a high-HIV-prevalence community used condoms consistently in the previous month (39% for both study cohorts). The latter underscores the need to view VMMC as a potential entry point for planned HIV and sexuality education interventions targeting young men in this community. more...
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- 2017
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23. A systematic review of curricula on relationships between residents and the pharmaceutical industry
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T Montague, Brian, Fortin VI, Auguste H, and Rosenbaum, Julie
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- 2008
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24. Long-Acting Lipoglycopeptides: 'Lineless Antibiotics' for Serious Infections in Persons Who Use Drugs
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Taylor Morrisette, Gerard R. Barber, R. Brett McQueen, Matthew A Miller, Brian T. Montague, and Martin Krsak
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medicine.medical_specialty ,medicine.drug_class ,Cost effectiveness ,business.industry ,Staphylococcus ,Antibiotics ,Oritavancin ,Dalbavancin ,medicine.disease ,Comorbidity ,Infectious Diseases ,injection drug use ,Oncology ,Interquartile range ,Emergency medicine ,Major Article ,medicine ,intravenous drug use ,Lost to follow-up ,business ,Medicaid ,dalbavancin ,oritavancin - Abstract
Background Injection drug use is associated with serious infections. Due to challenges with medical management of addiction, relapses and additional infections are common. Persons who use drugs (PWUD) are more likely to leave against medical advice before completing treatment, which could result in treatment failure. Prolonged intravenous (IV) antimicrobial therapy in PWUD may be complicated by concern for IV catheter misuse, sometimes requiring prolonged hospitalization. Ideal alternatives would provide the following: (1) high success rate; (2) reduced rate of medical complications; (3) improved safety profiles; and (4) improved cost-effectiveness. Long-acting lipoglycopeptides present such opportunity for treatment of serious Gram-positive infections. Methods We performed a system-wide, retrospective analysis of adults admitted to University of Colorado Health from September 2015 to June 2018 and treated with dalbavancin or oritavancin based on clinical judgment of their treating physicians. Results Fifty-six patients met inclusion criteria (17 PWUD vs 39 non-PWUD). The PWUD group were younger, healthier by Charlson comorbidity index, more likely insured by Medicaid, and admitted for conditions requiring longer treatment. Ten patients were lost to follow-up. Of the patients with follow-up, clinical failure was met in 1 PWUD patient (6%) and 6 non-PWUD patients (15%) (P = .413). The median hospital length-of-stay reduction was 20 days (interquartile range [IQR], 10–30 days) in PWUD vs 11 days (IQR, 9–14 days) in non-PWUD; P = .133. Estimated median savings were $40 455.08 (IQR, $20 900.00–$62 700.00) in PWUD vs $19 555.08 (IQR, $15 375.08–$23 735.08) in non-PWUD; P = .065. Conclusions Long-acting lipoglycopeptides may be equally effective as standard-of-care, present a safety advantage, and secure earlier discharge and significant cost-savings. more...
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- 2019
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25. Risk factors and epidemiologic predictors of blood stream infections with New Delhi Metallo-b-lactamase (NDM-1) producing Enterobacteriaceae
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Brian T. Montague, Valsan Philip Verghese, A. G. Madabhushi, B. M. Snyder, Agila Kumari Pragasam, Shalini Anandan, Veeraraghavan Balaji, and Eric A. F. Simões
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0301 basic medicine ,Male ,Carbapenem ,Klebsiella ,Epidemiology ,Klebsiella pneumoniae ,medicine.medical_treatment ,Bacteremia ,Carbapenem-resistant enterobacteriaceae ,0302 clinical medicine ,Risk Factors ,030212 general & internal medicine ,Child ,Aged, 80 and over ,biology ,Middle Aged ,Infectious Diseases ,Child, Preschool ,Female ,Central venous catheter ,medicine.drug ,Adult ,medicine.medical_specialty ,Adolescent ,030106 microbiology ,India ,NDM-1 ,beta-Lactamases ,03 medical and health sciences ,Young Adult ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Aged ,Retrospective Studies ,Mechanical ventilation ,Original Paper ,business.industry ,Infant, Newborn ,Infant ,biology.organism_classification ,medicine.disease ,bacterial infections and mycoses ,Survival Analysis ,Klebsiella Infections ,Multiple drug resistance ,Carbapenem-Resistant Enterobacteriaceae ,Case-Control Studies ,Bloodstream infections ,business - Abstract
Carbapenem-resistantEnterobacteriaceaeconferred by New Delhi metallo-b-lactamase (NDM-1) resistance mechanism are endemic in India and Southeast Asia. An understanding of risk factors for NDM-1 infections is necessary to guide prevention strategies. We performed a retrospective case-control study of patients admitted at Christian Medical College Hospital, Vellore, India between May 2010 and August 2014 withKlebsiella pneumoniaeblood stream infection (BSI). We compared patients with BSI caused by NDM-1 producing strains to two control groups: BSI with other multidrug resistant (MDR) strains and BSI with pan-susceptible strains. The study groups were assessed for risk factors for the outcomes: (1) infection with any MDR strain compared to pan-susceptible; and, (2) infection with NDM-1 strain as compared with other MDR and (3) Mortality. A total of 101 patients with BSI with NDM-1 producingKlebsiella pneumoniaewere matched to two groups of controls: 112 with non-NDM-1 MDR strains and 101 with pan-susceptible strains. Medical (OR 10.4) and neonatal (OR 0.7) ICU admission, central venous catheter placement (CVC, OR 7.4) predicted MDR BSI. Prior carbapenem use (OR 8.4) and CVC (OR 4.8) predicted acquisition of an NDM-1 strain. Significant predictors for mortality included ICU stay (OR 3.0), mechanical ventilation (OR 3.2), female gender (OR 2.2), diabetes (OR 0.4). CVC placement, prior carbapenem use and ICU admission were significantly associated with BSI with NDM-1 producing and other MDR strains. more...
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- 2019
26. On- and off-label utilization of dalbavancin and oritavancin for Gram-positive infections
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Brian T. Montague, Taylor Morrisette, Martin Krsak, Gerard R. Barber, R. Brett McQueen, and Matthew A Miller
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0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Colorado ,Adolescent ,medicine.drug_class ,030106 microbiology ,Antibiotics ,medicine.disease_cause ,Enterococcus faecalis ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Endocarditis ,Humans ,Pharmacology (medical) ,030212 general & internal medicine ,Adverse effect ,Gram-Positive Bacterial Infections ,Aged ,Retrospective Studies ,Pharmacology ,Aged, 80 and over ,biology ,business.industry ,Oritavancin ,Dalbavancin ,Lipoglycopeptides ,Retrospective cohort study ,Off-Label Use ,Length of Stay ,Middle Aged ,biology.organism_classification ,medicine.disease ,Methicillin-resistant Staphylococcus aureus ,Hospitals ,Anti-Bacterial Agents ,Infectious Diseases ,Treatment Outcome ,Female ,Teicoplanin ,business - Abstract
BackgroundLong-acting lipoglycopeptides (laLGPs) are FDA approved only for acute bacterial skin and skin structure infections (ABSSSIs). However, these antibiotics show promise for off-label use, reductions in hospital length of stay (LOS) and healthcare cost savings.ObjectivesTo assess the effectiveness, safety, impact on LOS and estimated cost savings from laLGP treatment for Gram-positive infections.MethodsRetrospective cohort of adult patients who received at least one dose of laLGPs at the University of Colorado Health system. Descriptive statistics were utilized for analysis.ResultsOf 59 patients screened, 56 were included: mean age 47 years, 59% male and 30% injection drug users/polysubstance abusers (dalbavancin, 71%; oritavancin, 25%; both, 4%). Most common indications for laLGP: ABSSSIs (36%), osteomyelitis (27%) and endocarditis (9%). Most common isolated pathogens: MSSA and MRSA (25% and 19%, respectively), Enterococcus faecalis (11%) and CoNS (11%). Previous antibiotics were administered for a median of 13 days (IQR = 7.0–24.5 days) and laLGPs for a median of one dose (IQR = 1–2 doses). Ten (18%) patients were lost to follow-up. Clinical failure was found in 7/47 (15%) cases with adequate follow-up. Mild adverse effects occurred in six (11%) patients. Projected reduction in hospital LOS and health-system costs were 514 days (9.18 days/person average) and $963456.72 ($17204.58/person average), respectively.ConclusionsProspective trials are needed to validate the use of these antibiotics for Gram-positive infections in practice, with the hope that they will reduce hospital LOS and the need for daily antibiotic infusions to provide alternative options for patients not qualifying for outpatient parenteral antimicrobial therapy. more...
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- 2018
27. Marijuana use in transplantation: A call for clarity
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Christian Thurstone, Marilyn E. Levi, Brian T. Montague, Camille N. Kotton, Deepali Kumar, and Shirish Huprikar
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medicine.medical_specialty ,030230 surgery ,Executive committee ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Marijuana use ,law ,Surveys and Questionnaires ,Medicine ,Humans ,Recreation ,Transplantation ,biology ,business.industry ,Brain ,Organ Transplantation ,biology.organism_classification ,Family medicine ,Practice Guidelines as Topic ,CLARITY ,030211 gastroenterology & hepatology ,Marijuana Use ,Cannabis ,business - Abstract
Transplant centers have varying policies for marijuana (MJ) use in donors, transplant candidates, and recipients. Rationales for these differences range from concerns for fungal complications, impaired adherence, and drug interactions. This paper reviews the current status of MJ policies and practices in transplant centers and results of a survey sent to the American Society of Transplantation (AST) membership by the Executive Committee of the AST Infectious Diseases Community of Practice.The purpose of the survey was to compare policies and concerns of MJ use to actual observed complications. Of the 3321 surveys sent, 225 members (8%) responded. Transplant centers varied in their approval processes, differing even in organ types within the same institutions. Furthermore, there was discordance among transplant centers in their perceived risks of marijuana use as opposed to complications actually observed. An increasing number of states continue to legalize medical and recreational MJ resulting in widespread availability. Further research is needed to assess the validity of concerns for complications of MJ use in potential donors and recipients. Ultimately, standardized guidelines should be established based on studies and evidence-based criteria to assist transplant programs in their policies around the use of cannabis in their donors and recipients. more...
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- 2018
28. HIV Care After Jail: Low Rates of Engagement in a Vulnerable Population
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Brian T. Montague, Xilong Li, Princess A. Iroh, Josiah D. Rich, Ank E. Nijhawan, Yordanos M. Tiruneh, and Benjamin Ammon
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Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Patient Dropouts ,Black People ,HIV Infections ,Vulnerable Populations ,White People ,Article ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Socioeconomic status ,030505 public health ,business.industry ,Public health ,Prisoners ,Public Health, Environmental and Occupational Health ,Hispanic or Latino ,Middle Aged ,Patient Acceptance of Health Care ,Mental illness ,medicine.disease ,Texas ,Health equity ,Urban Studies ,Socioeconomic Factors ,Population study ,Female ,0305 other medical science ,business ,Criminal justice ,Demography - Abstract
The criminal justice system is a critical area of focus to improve HIV outcomes and reduce health disparities. We analyzed demographic, incarceration, socioeconomic, and clinical data for HIV-positive persons released to the community from the Dallas County Jail (1450 incarcerations, 1111 unique individuals) between January 2011 and November 2013. The study population was 68% black and 14% Hispanic; overall linkage to care within 90 days of release was 34%. In adjusted analyses, Hispanics were more likely to link than whites (aOR 2.33 [95% CI: 1.55–3.50]), and blacks were as likely to link as whites (aOR 1.14 [95% CI: 0.84–1.56]). The majority of HIV-positive jail releases did not re-engage in HIV care after release, though Hispanics were twice as likely as other groups to link to care. Further efforts are needed to improve the transition from jail to community HIV care with particular attention to issues of housing, mental illness, and substance use. more...
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- 2018
29. Use of viral load surveillance data to assess linkage to care for persons with HIV released from corrections
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Cara J. Sammartino, Betsey John, Liza Solomon, Michael A. Costa, Josiah D. Rich, Dawn Fukuda, and Brian T. Montague
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RNA viruses ,Male ,Research Facilities ,Epidemiology ,Human immunodeficiency virus (HIV) ,lcsh:Medicine ,HIV Infections ,medicine.disease_cause ,Pathology and Laboratory Medicine ,White Blood Cells ,0302 clinical medicine ,Immunodeficiency Viruses ,Animal Cells ,Medicine and Health Sciences ,030212 general & internal medicine ,lcsh:Science ,Post release ,Multidisciplinary ,Transmission (medicine) ,T Cells ,Applied Mathematics ,Simulation and Modeling ,HIV diagnosis and management ,Viral Load ,Clinical Laboratory Sciences ,3. Good health ,Clinical Laboratories ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Population Surveillance ,Viruses ,Physical Sciences ,Female ,Pathogens ,Cellular Types ,0305 other medical science ,Research Laboratories ,Viral load ,Algorithms ,Research Article ,Adult ,Surveillance data ,Laboratory monitoring ,Immune Cells ,Immunology ,Research and Analysis Methods ,Microbiology ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,Environmental health ,Virology ,Retroviruses ,medicine ,Humans ,Microbial Pathogens ,Linkage (software) ,030505 public health ,Blood Cells ,business.industry ,lcsh:R ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Cell Biology ,medicine.disease ,Diagnostic medicine ,Prisons ,lcsh:Q ,business ,Viral Transmission and Infection ,Mathematics ,Government Laboratories - Abstract
Incarcerated people remain a priority group in efforts to control and reverse the HIV epidemic. Following release, social instability and reengagement in key transmission risk behaviors increase the risk of secondary transmission of HIV. Targeted programs have been developed to facilitate reengagement in care on reentry. Evaluation of the impact of these initiatives requires a systematic, confidential, framework for assessment of linkage to care for persons released from corrections. By linking HIV viral load surveillance data to corrections release data, the time to the first laboratory monitoring service in the community as well as the virologic status can be assessed. Using this method, we linked release data for sentenced individuals released from Massachusetts state correctional facilities in 2012 to HIV surveillance data from the Massachusetts HIV/AIDS Surveillance Program (MHASP) for the years 2012-2013. We identified 41 individuals with HIV released in 2012. Ninety-one percent had identified virologic assessments post release, 41% within 30 days. Thirty-three percent did not have a viral load assessed for more than 90 days and 31% had detectable virus at the time of their initial assessment. Persons with longer incarcerations (> 180 days) were more likely to have suppressed viral load at the time of follow-up (p = 0.05). This work demonstrates the important value of HIV laboratory surveillance data and correctional release data as a tool to assess linkage to care following release from corrections. We encourage jurisdictions to explore utilizing similar methodology to evaluate the effectiveness of the linkage to HIV care after release from incarceration. more...
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- 2018
30. 'Better Out Than in': Outcomes for an Early Review Clinic for Heart Failure Patients
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T. Montague, A. Sindone, A. Rao, and S. Hales
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Heart failure ,medicine ,Cardiology and Cardiovascular Medicine ,medicine.disease ,business ,Intensive care medicine - Published
- 2019
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31. Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States
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Josiah D. Rich, Brian T. Montague, Lisa LeRoy, Theodore M. Hammett, Sara Donahue, Michael A. Costa, Liza Solomon, David L. Rosen, and David A. Wohl
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Gerontology ,medicine.medical_specialty ,Health (social science) ,media_common.quotation_subject ,Psychological intervention ,HIV Infections ,Prison ,Qualitative property ,Context (language use) ,Health informatics ,Article ,Nursing ,North Carolina ,Humans ,Medicine ,Qualitative Research ,media_common ,business.industry ,Prisoners ,Public health ,Public Health, Environmental and Occupational Health ,Rhode Island ,Continuity of Patient Care ,Urban Studies ,Care in the Community ,Prisons ,business ,Qualitative research - Abstract
One in seven people living with HIV in the USA passes through a prison or jail each year, and almost all will return to the community. Discharge planning and transitional programs are critical but challenging elements in ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission. This paper describes facilitators and challenges of in-prison care, transitional interventions, and access to and continuity of care in the community in Rhode Island and North Carolina based on qualitative data gathered as part of the mixed-methods Link Into Care Study of prisoners and releasees with HIV. We conducted 65 interviews with correctional and community-based providers and administrators and analyzed the transcripts using NVivo 10 to identify major themes. Facilitators of effective transitional systems in both states included the following: health providers affiliated with academic institutions or other entities independent of the corrections department; organizational philosophy emphasizing a patient-centered, personal, and holistic approach; strong leadership with effective "champions"; a team approach with coordination, collaboration and integration throughout the system, mutual respect and learning between corrections and health providers, staff dedicated to transitional services, and effective communication and information sharing among providers; comprehensive transitional activities and services including HIV, mental health and substance use services in prisons, timely and comprehensive discharge planning with specific linkages/appointments, supplies of medications on release, access to benefits and entitlements, case management and proactive follow-up on missed appointments; and releasees' commitment to transitional plans. These elements were generally present in both study states but their absence, which also sometimes occurred, represent ongoing challenges to success. The qualitative findings on the facilitators and challenges of the transitional systems were similar in the two states despite differences in context, demographics of target population, and system organization. Recommendations for improved transitional systems follow from the analysis of the facilitators and challenges. more...
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- 2015
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32. Factors associated with the take-up of voluntary medical male circumcision amongst learners in rural KwaZulu-Natal
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C. T. Montague, Janet A. Frohlich, Kaymarlin Govender, Gavin George, and Sean Beckett
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Voluntary Programs ,media_common.quotation_subject ,Sexual Behavior ,HIV Infections ,Negative association ,Health benefits ,Social Environment ,law.invention ,Condoms ,03 medical and health sciences ,South Africa ,Young Adult ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Condom ,law ,Hygiene ,Virology ,medicine ,Humans ,030212 general & internal medicine ,Students ,media_common ,Gynecology ,030505 public health ,business.industry ,Public Health, Environmental and Occupational Health ,General Medicine ,Patient Acceptance of Health Care ,medicine.disease ,Infectious Diseases ,Circumcision, Male ,adolescent friendly health services, circumcision for HIV prevention, demand for circumcision, HIV/AIDS, HIV prevention, South Africa ,Turnover ,Male circumcision ,Adolescent Behavior ,Family medicine ,0305 other medical science ,business ,Kwazulu natal - Abstract
Voluntary medical male circumcision (VMMC) is an integral part of South Africa’s HIV prevention programme. School-going males, in particular, are considered a cost-effective target population. However, ambitious policy targets have not been achieved due to the plateau in demand for VMMC. This study documents the factors influencing demand for VMMC amongst school-going males. Data were collected from 750 learners (251 circumcised and 499 uncircumcised) from 42 secondary schools in KwaZulu-Natal, South Africa. There was a positive association between the perceived benefit of VMMC and the likelihood of undergoing circumcision (AOR: 1.41, p = 0.01). There was a negative association between self-efficacy to use condoms and likelihood of undergoing VMMC (AOR: 0.75, p < 0.01). Learners who perceived VMMC as having a number of health benefits, including reducting of the chances of contracting HIV and sexually transmitted infections (STIs), increasing penile hygiene and the belief that VMMC allows them to use condoms less frequently, were more likely to undergo VMMC. Of concern, learners who were confident in their ability to access condoms and t use a condom with their partner were less likely to undergo VMMC. Keywords: adolescent friendly health services, circumcision for HIV prevention, demand for circumcision, HIV/AIDS, HIV prevention, South Africa more...
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- 2017
33. The immunosuppressed patient
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Brian T. Montague, Christopher M. Salas, Terri L. Montague, and Maria D. Mileno
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- 2017
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34. Brief Intervention to Increase Emergency Department Uptake of Combined Rapid Human Immunodeficiency Virus and Hepatitis C Screening Among a Drug Misusing Population
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Lynn E. Taylor, Roland C. Merchant, Ted D. Nirenberg, Brian T. Montague, Tao Liu, and Janette R. Baird
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Gynecology ,medicine.medical_specialty ,education.field_of_study ,Screening test ,business.industry ,Drug misuse ,Population ,Human immunodeficiency virus (HIV) ,General Medicine ,medicine.disease_cause ,HCV Antibody ,Hepatitis C screening ,Emergency Medicine ,Medicine ,Brief intervention ,business ,education ,Mass screening - Abstract
Objectives In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening. Methods InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening. Results Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = –0.7%; 95% confidence interval [CI] = –10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post– vs. pre–risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening. Conclusions Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening. Resumen Objetivos El estudio Increasing Viral Testing in the Emergency Department (InVITED) investiga si una intervencion breve sobre los comportamientos de riesgo en relacion con el virus de inmunodeficiencia humana (VIH) y la hepatitis C (VHC), consumo y abuso de drogas, junto con una evaluacion autoadministrada del riesgo, en comparacion con solo la evaluacion autoadministrada del riesgo, incrementaba la aceptacion de despistaje combinado de VIH y VHC, el riesgo autopercibido de VIH/VHC, y las creencias y opiniones del despistaje de VIH/VHC. Metodologia InVITED fue un ensayo clinico controlado y aleatorizado llevado a cabo en dos SU urbanos de febrero de 2011 a marzo de 2012. Se invito a participar a los pacientes del SU que autorefirieron consumo de drogas en los tres ultimos meses. La gravedad del abuso de drogas y la necesidad de una intervencion breve o mas intensa se valoro usando el Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Los pacientes fueron asignados aleatoriamente a uno de los dos brazos del estudio: solamente evaluacion autoadministrada del riesgo de VIH/VHC (grupo control) o la evaluacion mas una intervencion breve sobre sus abusos de drogas y el despistaje de VIH/VHC (grupo de intervencion). Se midieron las creencias acerca del valor del despistaje combinado VIH/VHC, la autopercepcion del riesgo de VIH/VHC, y las opiniones acerca del despistaje de VIH/VHC en el SU en ambos brazos del estudio antes de la evaluacion del riesgo de VIH/VHC (pre), despues de la evaluacion en el grupo control, y despues de la intervencion breve (post). Se ofrecio gratuitamente un test de despistaje rapido VIH/VHC a los participantes de ambos brazos del estudio. La aceptacion del despistaje se comparo segun el brazo del estudio. Se usaron modelos de regresion logistica multivariable para evaluar los factores relacionados con la aceptacion del despistaje. Resultados De los 395 participantes del estudio, la mediana de edad fue de 28 anos (RIC de 23 a 38), un 44,8% fueron mujeres, un 82,3% nunca habia recibido un test de VIH, y un 67,3% nunca de VHC. La aceptacion del despistaje rapido combinado de VIH/VHC fue practicamente igual en ambos brazos del estudio (64,5% contra 65,2%; Δ = -0,7%; IC 95% = -10,1% a 8,7%). De los 256 a los que se les realizo el despistaje, ninguno tuvo un test de anticuerpos de VIH positivo, pero siete (2,7%) presentaron un test de anticuerpos de VHC positivo. Los resultados del analisis de regresion logistica multivariable indicaron que la aceptacion del despistaje no se relaciono con el brazo de asignacion del estudio, el total de las puntuaciones del test ASSIST, la necesidad de una intervencion sobre el abuso de drogas, o las puntuaciones de evaluacion del riesgo sexual de VIH/VHC. Sin embargo, la aceptacion del despistaje fue mayor entre los participantes que indicaron otorgar un mayor valor al despistaje rapido combinado de VIH/VHC para si mismos y para todos los pacientes del SU, y aquellos con mayores niveles de riesgo percibido de VIH/VHC. La aceptacion del despistaje rapido combinado de VIH/VHC no se relaciono con cambios en las creencias sobre el valor del despistaje combinado VIH/VHC o la autopercepcion del riesgo de VIH/VHC (valoracion del riesgo pre, con o sin intervencion breve, frente a post). Las opiniones acerca del SU como un lugar para el despistaje rapido combinado de VIH/VHC no se relacionaron con la aceptacion del despistaje. Conclusiones La aceptacion del despistaje rapido combinado de VIH/VHC es elevada y se considero valiosa entre los pacientes del SU con consumo o abuso de drogas sin mucha preocupacion sobre el SU como lugar de despistaje. La intervencion breve investigada en este estudio no parece cambiar las creencias acerca del despistaje, el riesgo autopercibido, o la aceptacion del despistaje de VIH/VHC en esta poblacion. Las creencias iniciales respecto al valor del despistaje y al riesgo autopercibido para estas infecciones predijeron la aceptacion del despistaje. more...
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- 2014
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35. iMAX: A Multiprocessor Operating System for an Object-Based Computer.
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Kevin C. Kahn, William M. Corwin, T. Don Dennis, Herman D'Hooge, David E. Hubka, Linda A. Hutchins, John T. Montague, and Fred J. Pollack
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- 1981
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36. Task Communication in DEMOS.
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Forest Baskett, John H. Howard, and John T. Montague
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- 1977
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37. Early Resumption of Sex following Voluntary Medical Male Circumcision amongst School-Going Males
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C. T. Montague, Sean Beckett, Kaymarlin Govender, Gavin George, and Janet A. Frohlich
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0301 basic medicine ,Male ,RNA viruses ,Time Factors ,Physiology ,Epidemiology ,Human immunodeficiency virus (HIV) ,Social Sciences ,lcsh:Medicine ,HIV Infections ,medicine.disease_cause ,Pathology and Laboratory Medicine ,South Africa ,0302 clinical medicine ,Learning and Memory ,Immunodeficiency Viruses ,Sociology ,Safer sex ,Risk Factors ,Circumcision ,Reproductive Physiology ,Copulation ,Medicine and Health Sciences ,Medicine ,Psychology ,030212 general & internal medicine ,Reproductive System Procedures ,Hiv transmission ,lcsh:Science ,Young male ,Multidisciplinary ,Schools ,Male circumcision ,Medical Microbiology ,HIV epidemiology ,Viral Pathogens ,Cohort ,Viruses ,Infectious diseases ,Pathogens ,Research Article ,medicine.medical_specialty ,Adolescent ,Sexual Behavior ,Surgical and Invasive Medical Procedures ,Viral diseases ,Microbiology ,Education ,03 medical and health sciences ,Acquired immunodeficiency syndrome (AIDS) ,Retroviruses ,Tissue Repair ,Humans ,Learning ,Microbial Pathogens ,Gynecology ,Wound Healing ,business.industry ,Lentivirus ,lcsh:R ,Organisms ,Cognitive Psychology ,Biology and Life Sciences ,HIV ,medicine.disease ,030112 virology ,Circumcision, Male ,Turnover ,Cognitive Science ,lcsh:Q ,business ,Physiological Processes ,Demography ,Neuroscience - Abstract
Voluntary medical male circumcision is an integral part of the South African government’s response to the HIV and AIDS epidemic. Following circumcision, it is recommended that patients abstain from sexual activity for six weeks, as sex may increase the risk of female-to-male HIV transmission and prolong the healing period. This paper investigates the resumption of sexual activity during the healing period among a cohort of school-going males in the KwaZulu-Natal province of South Africa. The analysis for this paper compares two groups of sexually active school-going males: the first group reported having sex during the healing period (n = 40) and the second group (n = 98) reported no sex during the healing period (mean age: 17.7, SD: 1.7).The results show that 29% (n = 40) of young males (mean age: 17.9, SD: 1.8) who were previously sexually active, resumed sexual activity during the healing period, had on average two partners and used condoms inconsistently. In addition, those males that engage in sexual activity during the healing period were less inclined to practice safe sex in the future (AOR = 0.055, p = 0.002) than the group of males who reported no sex during the healing period. These findings suggest that a significant proportion of young males may currently and in the future, subject themselves to high levels of risk for contracting HIV post circumcision. Education, as part of a VMMC campaign, must emphasize the high risk of HIV transmission for both the males their partners during the healing period. more...
- Published
- 2016
38. Systematic Assessment of Linkage to Care for Persons with HIV Released from Corrections Facilities Using Existing Datasets
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Roee Gutman, Josiah D. Rich, Michael A. Costa, Liza Solomon, Cara J. Sammartino, David L. Rosen, and Brian T. Montague
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Gerontology ,Adult ,medicine.medical_specialty ,Time Factors ,Human immunodeficiency virus (HIV) ,Patient characteristics ,HIV Infections ,medicine.disease_cause ,Multivariate survival ,Health Services Accessibility ,03 medical and health sciences ,0302 clinical medicine ,medicine ,North Carolina ,Prevalence ,Humans ,030212 general & internal medicine ,Community Health Services ,Referral and Consultation ,Aged ,Retrospective Studies ,Linkage (software) ,030505 public health ,High prevalence ,business.industry ,Prisoners ,Clinical and Epidemiologic Research ,Public Health, Environmental and Occupational Health ,Rhode Island ,Retrospective cohort study ,Continuity of Patient Care ,Patient Acceptance of Health Care ,Viral Load ,Infectious Diseases ,Anti-Retroviral Agents ,Socioeconomic Factors ,Family medicine ,0305 other medical science ,business ,Viral load - Abstract
Populations in corrections continue to have high prevalence of HIV. Expanded testing and treatment programs allow persons to be identified and stabilized on treatment while incarcerated. However, these gains and frequently lost on reentry. Systemic frameworks are needed to monitor linkage to care to guide programs supporting linkage to care. To assess the adequacy of linkage to care on reentry, incarceration data from the National Corrections Reporting Program and data from the Ryan White Services Report from 2010 to 2012 were linked using an encrypted client identification (eUCI). Time from release to the first visit and presence of detectable HIV RNA at linkage were assessed. Multivariate survival analyses were performed to identify associations between patient characteristics and time to linkage. Among those linking, only 43% in Rhode Island and 49% in North Carolina linked within 90 days, and 33% in both states had detectable viremia at the first visit. Those not previously in care and with shorter incarceration experiences longer linkage times. Persons identified as black, had median times greater than 1 year. Using existing datasets, significant gaps in linkage to care for persons with HIV on release from corrections were demonstrated in Rhode Island and North Carolina. Systemically implementing this monitoring to evaluate changes over time would provide important information to support interventions to improve linkage in high-risk populations. Using national datasets for both corrections and clinical data, this framework equally could be used to evaluate experiences of persons with HIV linking to care on release from corrections facilities nationwide. more...
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- 2016
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39. Evaluation of Longitudinal Clinical Outcomes and Adherence to Care among HIV-Infected Refugees
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Brian T. Montague, Allison DeLong, Curt G. Beckwith, Armando Bedoya, Chloe LeMarchand, Michael J. Lopez, Susanna E. Winston, and Fizza S. Gillani
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Adult ,Male ,Health Knowledge, Attitudes, Practice ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Anti-HIV Agents ,Longitudinal data ,Art initiation ,Refugee ,Immunology ,Population ,HIV Infections ,Viremia ,Dermatology ,lcsh:RC870-923 ,Article ,Appointments and Schedules ,Young Adult ,Hiv infected ,medicine ,Antiretroviral treatment ,Humans ,Longitudinal Studies ,education ,Africa South of the Sahara ,Aged ,Refugees ,education.field_of_study ,business.industry ,fungi ,food and beverages ,Middle Aged ,lcsh:Diseases of the genitourinary system. Urology ,medicine.disease ,United States ,Treatment Outcome ,Infectious Diseases ,Socioeconomic Factors ,Patient Compliance ,Female ,business ,Viral load ,Demography - Abstract
Background: HIV-infected refugees resettled in the United States face many challenges. Longitudinal data regarding HIV-specific outcomes in this population are limited. Methods: We reviewed charts of 51 HIV-infected sub-Saharan African refugees matched to 102 nonrefugees. Outcomes analyzed included CD4 counts, viral loads (VLs), antiretroviral treatment (ART) use, appointment adherence, opportunistic infections, and resistance mutations. Results: The ART initiation was similar. Appointment adherence was similar in year 1, but refugees were significantly less adherent beyond year 3. Refugees and nonrefugees spent similar amounts of time in care suppressed (83% vs 80%, P = .93). Refugees had higher odds of viremia following undetectable VL (OR 2.3, P < .05). Discussion: Initially, sub-Saharan African HIV-infected refugees have comparable appointment adherence, ART use, and VL suppression to nonrefugees. Overtime refugees were less adherent to appointments and more likely to have postsuppression viremia. The support services provided to refugees early in care may be important for retention in care and treatment success. more...
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- 2012
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40. Tracking linkage to HIV care for former prisoners
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Brian T. Montague, David L. Rosen, Liza Solomon, Amy Nunn, Traci Green, Michael Costa, Jacques Baillargeon, David A. Wohl, David P. Paar, Josiah D. Rich, and on behalf of the LINCS Study Group
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Microbiology (medical) ,Linkage (software) ,Service (business) ,medicine.medical_specialty ,business.industry ,Prisoners ,Public health ,Immunology ,Internet privacy ,Human immunodeficiency virus (HIV) ,HIV Infections ,Patient Acceptance of Health Care ,medicine.disease_cause ,Microbiology ,Test (assessment) ,Identifier ,Infectious Diseases ,Perspective ,medicine ,Humans ,Parasitology ,Confidentiality ,Tracking (education) ,business ,Public Health Administration - Abstract
Improving testing and uptake to care among highly impacted populations is a critical element of Seek, Test, Treat and Retain strategies for reducing HIV incidence in the community. HIV disproportionately impacts prisoners. Though, incarceration provides an opportunity to diagnose and initiate therapy, treatment is frequently disrupted after release. Though model programs exist to support linkage to care on release, there is a lack of scalable metrics with which to assess adequacy of linkage to care after release. The linking data from Ryan White program Client Level Data (CLD) files reported to HRSA with corrections release data offers an attractive means of generating these metrics. Identified only by use of a confidential encrypted Unique Client Identifier (eUCI) these CLD files allow collection of key clinical indicators across the system of Ryan White funded providers. Using eUCIs generated from corrections release data sets as a linkage tool, the time to the first service at community providers along with key clinical indicators of patient status at entry into care can be determined as measures of linkage adequacy. Using this strategy, high and low performing sites can be identified and best practices can be identified to reproduce these successes in other settings. more...
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- 2012
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41. Hepatitis B in the United States: ongoing missed opportunities for hepatitis B vaccination, evidence from the Behavioral Risk Factor Surveillance Survey, 2007
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F, Ladak, A, Gjelsvik, E, Feller, S R, Rosenthal, S, Rosenthal, and B T, Montague
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Adult ,Male ,Microbiology (medical) ,Pediatrics ,medicine.medical_specialty ,Adolescent ,medicine.disease_cause ,Risk Factors ,Health care ,medicine ,Humans ,Hepatitis B Vaccines ,Aged ,Hepatitis B virus ,Insurance, Health ,business.industry ,Transmission (medicine) ,Vaccination ,General Medicine ,Odds ratio ,Middle Aged ,Hepatitis B ,medicine.disease ,United States ,Pneumonia ,Infectious Diseases ,Hepatitis b vaccination ,Immunology ,Regression Analysis ,Female ,business - Abstract
In the USA, the burden of hepatitis B disproportionately affects high-risk adults who alone account for more than 75% of newly reported hepatitis B virus infections each year. Despite the localization of new infections in identifiable high-risk groups, vaccination rates in this subgroup, with the exception of health care workers, remain consistently low. The purpose of this study was to characterize those at risk for hepatitis B transmission and quantify the association between missed opportunities and hepatitis B vaccination. Data from the 2007 Behavioral Risk Factor Surveillance Survey (BRFSS) of adults aged 18 years and older who were at high risk for hepatitis B infection (n = 15,432) were analyzed. Multivariate regression analysis was conducted to determine factors independently associated with vaccination. In a nationally representative sample, 51.4% of high-risk adults remained unvaccinated against hepatitis B and more than 50% had a missed opportunity for vaccination. High-risk adults who were vaccinated against pneumonia and influenza had a higher odds ratio of being vaccinated against hepatitis B than those not vaccinated against pneumonia and influenza (OR 2.27 and 1.67, respectively). Also, high-risk adults tested for human immunodeficiency virus (HIV) at a counseling and testing site or a drug treatment facility had a higher OR of being vaccinated than those who had not been tested for HIV (OR 1.78 and 1.73, respectively). The opposite relationship was true among individuals tested for HIV at a correctional facility (OR 0.60). The findings of this study underscore the inadequacy of vaccination coverage in high-risk adults and highlight advantageous opportunities to bridge gaps in vaccination coverage. more...
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- 2012
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42. The Immunosuppressed Patient
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Mph Brian T. Montague Do, Terri L. Montague Md and, and Maria D. Mileno
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- 2011
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43. 1766. Sustained Viral Suppression with Dolutegravir and Boosted Darunavir Dual Therapy Among Highly Treatment-Experienced Individuals
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Edward M. Gardner, Steven C. Johnson, Margaret P. McLees, Brian T. Montague, Kellie L Hawkins, Robert Beum, and Sarah E Rowan
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Oncology ,medicine.medical_specialty ,business.industry ,Treatment experienced ,Abstracts ,chemistry.chemical_compound ,Infectious Diseases ,chemistry ,A. Oral Abstracts ,Internal medicine ,Dolutegravir ,medicine ,Viral suppression ,Dual therapy ,business ,Darunavir ,medicine.drug - Abstract
Background The use of antiretroviral (ARV) dual therapy for treatment of HIV is increasing; raltegravir with boosted darunavir (bDRV) is recommended in certain clinical situations in DHHS guidelines. Dolutegravir (DTG) with bDRV has not been widely studied. We sought to determine the effectiveness of DTG/bDRV in treatment experienced patients. Methods This retrospective cohort study evaluated viral suppression in patients prescribed DTG/bDRV dual therapy within a large urban health system. Data collected included demographics, cumulative ARV exposure, reasons for use, regimen start/stop dates, and viral suppression (HIV-RNA ≤200). Follow-up was defined as the number of days from start of regimen until last HIV-RNA determination on the study regimen. Results From January 1, 2013 to December 31, 2017, 60 patients received DTG/bDRV dual therapy: 15% were female, median age was 56, 83% were ≥3 class ARV-experienced, and median time since starting ARVs was 20 years. Median follow-up on DTG/bDRV was 444 days (IQR 273–808). Viral suppression was achieved by 59 of 60 (98%) patients at some point on DTG/bDRV. When stratified by baseline viral suppression, 46 of 46 (100%) who had baseline viral suppression maintained viral suppression in comparison to 11 of 14 (79%) without baseline viral suppression (table). The most common reasons for DTG/bDRV were simplification in setting of prior resistance (47%), toxicity reduction (39%), and virologic failure (15%). At study end, 53 of 60 (88%) were still on DTG/bDRV and the most common reason for stopping was drug interactions. Conclusion In a highly treatment-experienced cohort of patients, DTG/bDRV dual therapy demonstrated sustained rates of viral suppression, even in those who were failing therapy prior to initiating the regimen. Further study of this potent, simple, high-barrier dual class regimen is warranted. Disclosures S. Rowan, Gilead Sciences: Investigator, Research grant. S. C. Johnson, Viiv Healthcare: Scientific Advisor, Consulting fee. more...
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- 2018
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44. A systematic review of curricula on relationships between residents and the pharmaceutical industry
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Auguste H. Fortin Vi, Julie R. Rosenbaum, and Brian T. Montague
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Medical education ,Drug Industry ,business.industry ,Interprofessional Relations ,education ,Graduate medical education ,Internship and Residency ,Context (language use) ,General Medicine ,Scientific literature ,Education ,Analytical skill ,Curriculum development ,Curriculum ,Social science ,business ,Psychology ,Educational program ,Pharmaceutical industry - Abstract
CONTEXT Research has demonstrated the potential adverse impact of pharmaceutical company marketing techniques on doctor knowledge and prescribing practices. Lack of experience may make resident doctors particularly vulnerable to pharmaceutical industry influence. Curricula addressing resident-pharmaceutical industry relations have been reported, but there is no consensus regarding the best approach to take. OBJECTIVE This study aimed to review published curricula that address resident-pharmaceutical industry relations and to assess them for content, validity and outcomes measures. METHODS Curricula were identified via searches of electronic databases and bibliographies of collected articles. Inclusion criteria required articles to describe an educational curriculum, applied in graduate medical education, on relations between doctors and the pharmaceutical industry. RESULTS The search identified 9 curricula. Most addressed detailing of residents by pharmaceutical representatives. Two articles described curriculum development. Eight articles included an evaluation component; only 1 included a control group for comparison. Modest improvements were noted in resident confidence, knowledge of guidelines, belief in the potential influence of marketing on behaviour, and self-reported acceptance of gifts. Only 2 evaluations used a validated outcome instrument, and no studies included longterm follow-up. CONCLUSIONS A limited number of curricula have addressed resident-pharmaceutical industry interactions. Inconsistency in content, application and evaluation methodology prevents any meaningful synthesis of data. Resident attitudes and behaviours may be affected, but the outcome measures used lacked sufficient validity to assess improvements in knowledge and analytic skills. A clearer delineation of the curriculum development process and the use of standardised outcome measures would facilitate the reproduction of positive results at other institutions. more...
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- 2008
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45. Fabrication of Biomolecular Nanostructures by Scanning Near-Field Photolithography of Oligo(ethylene glycol)-Terminated Self-Assembled Monolayers
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Karen S. L. Chong, Robert E. Ducker, Matthew T. Montague, Robert J. Manning, Frank J. M. Rutten, Martyn C. Davies, and Graham J. Leggett
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Static secondary-ion mass spectrometry ,Photochemistry ,Ultraviolet Rays ,Chemistry ,Analytical chemistry ,Self-assembled monolayer ,Surfaces and Interfaces ,Condensed Matter Physics ,Nanostructures ,Polyethylene Glycols ,Contact angle ,Secondary ion mass spectrometry ,chemistry.chemical_compound ,X-ray photoelectron spectroscopy ,Chemical engineering ,Monolayer ,Microscopy ,Electrochemistry ,General Materials Science ,Gold ,Sulfhydryl Compounds ,Oxidation-Reduction ,Ethylene glycol ,Spectroscopy - Abstract
The UV photo-oxidation of oligo(ethylene glycol) (OEG)-terminated self-assembled monolayers (SAMs) has been studied using static secondary ion mass spectrometry, X-ray photoelectron spectroscopy, contact angle measurement, and friction force microscopy. OEG-terminated SAMs are oxidized to yield sulfonates, but photodegradation of the OEG chain also occurs on a more rapid time scale, yielding degradation products that remain bound to the surface via gold-sulfur bonds. The oxidation of these degradation products is the rate-limiting step in the process. Photopatterning of OEG-terminated SAMs may be accomplished by using a mask and suitable light source or by using scanning near-field photolithography (SNP) in which the mask is replaced by a scanning near-field optical microscope coupled to a UV laser. Using SNP, it is possible to fabricate patterns in SAMs with a full width at half-maximum height (fwhm) as small as 9 nm, which is approximately 15 times smaller than the conventional diffraction limit. SNP-patterned OEG-terminated SAMs may be used to fabricate protein nanopatterns. By adsorbing carboxylic acid-terminated thiols into oxidized regions and converting these to active ester intermediates, it has been possible to fabricate lines of protein molecules with widths of only a few tens of nanometers. more...
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- 2007
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46. Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers: Opportunities for Better Integration of HIV and Alcohol Treatment Services
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Brian T. Montague, Donna Gallagher, R. Kathryn McHugh, Christopher W. Kahler, Suzanne M. Colby, Daniel D. Squires, Peter M. Monti, Brieanne Fitzgerald, Don Operario, and Kenneth H. Mayer
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medicine.medical_specialty ,business.industry ,Human immunodeficiency virus (HIV) ,Alternative medicine ,Medicine (miscellaneous) ,Medication adherence ,Alcohol treatment ,medicine.disease_cause ,Article ,Psychiatry and Mental health ,New england ,medicine ,Training needs ,Cognitive decline ,business ,Psychiatry ,Addiction treatment - Abstract
Unhealthy alcohol use is common among HIV-infected patients and contributes to co-morbidities, cognitive decline, unprotected sex, and poor medication adherence. Studies consistently show missed opportunities to address unhealthy alcohol use as part of care. Although treatment of other drug use has been integrated into HIV care in some settings, more information is needed regarding provider attitudes regarding the need for integration of alcohol treatment and HIV care.We surveyed 119 HIV and 159 addiction providers regarding the following domains: existing knowledge, desire for new knowledge (with subdomains relative advantage, compatibility, and complexity of integrating knowledge), and individual and program development needs. Scale scores for each domain were correlated with demographics to identify factors associated with training need.Both HIV and addiction providers reported agreement with statements of existing knowledge and the need for additional skills. The priority attributed to training, however, was low for both groups. Knowledge and perceived prevalence of HIV and unhealthy alcohol use increased with years of experience. Perceived prevalence correlated with compatibility but not the relative advantage of training.Though addressing alcohol use and HIV was acknowledged to be important, the priority of this was low, particularly early career providers. These providers may be important targets for training focusing on motivating coordination of care and skills related to assessment and counseling. more...
- Published
- 2015
47. Tuberculous meningitis in child born in the US to immigrants from a tuberculosis-endemic country
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Eric J, Chow, Elizabeth, Toll, Brian T, Montague, Nicole, Alexander-Scott, and Erin, Van Scoyoc
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Endemic Diseases ,Child, Preschool ,Tuberculosis, Meningeal ,Emigrants and Immigrants ,Humans ,Female ,Liberia ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,United States - Abstract
This is a case of a child born in the US to immigrant parents from a tuberculosis (TB)-endemic area of Liberia who was diagnosed with TB meningitis after a greater than 1-month history of unremitting fever. This report aims to highlight the importance of early identification of TB in the pediatric population with risk factors for TB and considering TB as a diagnosis among US born children to immigrants from TB-endemic countries. more...
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- 2015
48. Tuberculosis control in RI: maintaining control efforts in the context of declining incidence and funding for tuberculosis programs
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Brian T, Montague, Jaime, Comella, Nicole E, Alexander-Scott, Utpala, Bandy, and Awewura, Kwara
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Tuberculin Test ,Incidence ,Communicable Disease Control ,Antitubercular Agents ,Healthcare Financing ,Humans ,Mass Screening ,Rhode Island ,Tuberculosis ,Sensitivity and Specificity ,Interferon-gamma Release Tests - Published
- 2015
49. Public-private partnerships, programs target infectious diseases in RI
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Brian T, Montague
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Communicable Disease Control ,Humans ,Rhode Island ,Epidemics ,Public-Private Sector Partnerships - Published
- 2015
50. Sequence variants in the melatonin-related receptor gene (GPR50) associate with circulating triglyceride and HDL levels
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Julia M. Keogh, Jian'an Luan, I. Sadaf Farooqi, Sarah Lowenbeim, John Edward Norris Morten, Stephen O'Rahilly, Sumit Bhattacharyya, Benjamin G. Challis, John Brennand, C. T. Montague, Nicholas J. Wareham, and Suzanne Jenkins more...
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Male ,Molecular Sequence Data ,Nerve Tissue Proteins ,QD415-436 ,Biology ,Biochemistry ,neuronal ,Receptors, G-Protein-Coupled ,chemistry.chemical_compound ,Endocrinology ,metabolic ,Polymorphism (computer science) ,medicine ,Humans ,Amino Acid Sequence ,Obesity ,Receptor ,Gene ,Triglycerides ,Genetics ,Polymorphism, Genetic ,Triglyceride ,Cell Biology ,Middle Aged ,medicine.disease ,Phenotype ,bipolar ,Haplotypes ,chemistry ,GPR50 ,Female ,Lipoproteins, HDL ,Body mass index - Abstract
The gene encoding the melatonin-related receptor (GPR50) is highly expressed within hypothalamic nuclei concerned with the control of body weight and metabolism. We screened GPR50 for mutations in an obese cohort and identified an insertion of four amino acid residues (TTGH) at position 501, two common coding polymorphisms (T528A and V602I), and one noncoding polymorphism (C-16X2GPR50T). Single-nucleotide polymorphisms were then typed in 500 English Caucasian subjects, and associations were sought to intermediate obesity phenotypes. Although no association was seen with body mass index, carriers of two copies of the mutant allele at C-16X2GPR50T, Ins501Del, and A1582G had significantly higher fasting circulating triglyceride levels (P < 0.05). In a separate set of 585 subjects, the associations were replicated, with statistically significant effects of similar magnitude and direction. The association of C-16X2GPR50T with fasting triglycerides was highly significant (P < 0.001). In addition, a significant association between C-16X2GPR50T and circulating HDL levels was observed in the combined population, with C-16X2GPR50T carriers having significantly lower circulating HDL-cholesterol levels (1.39 mM) than wild-type subjects (1.47 mM) (P < 0.01). These findings suggest a previously unexpected role for this orphan receptor in the regulation of lipid metabolism that warrants further investigation. more...
- Published
- 2006
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