Publications by authors named "Sarah Cox"

101 Publications

Should countries switch to using five- or ten-dose rotavirus vaccines now that they are available?

Vaccine 2021 07 19;39(31):4335-4342. Epub 2021 Jun 19.

Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA. Electronic address:

Introduction: Single-dose rotavirus vaccines, which are used by a majority of countries, are some of the largest-sized vaccines in immunization programs, and have been shown to constrain supply chains and cause bottlenecks. Efforts have been made to reduce the size of the single-dose vaccines; however, with two-dose, five-dose and ten-dose options available, the question then is whether using multi-dose instead of single-dose rotavirus vaccines will improve vaccine availability.

Methods: We used HERMES-generated simulation models of the vaccine supply chains of the Republic of Benin, Mozambique, and Bihar, a state in India, to evaluate the operational and economic impact of implementing each of the nine different rotavirus vaccine presentations.

Results: Among single-dose rotavirus vaccines, using Rotarix RV1 MMP (multi-monodose presentation) led to the highest rotavirus vaccine availability (49-80%) and total vaccine availability (56-79%), and decreased total costs per dose administered ($0.02-$0.10) compared to using any other single-dose rotavirus vaccine. Using two-dose ROTASIIL decreased rotavirus vaccine availability by 3-6% across each supply chain compared to Rotarix RV1 MMP, the smallest single-dose vaccine. Using a five-dose rotavirus vaccine improved rotavirus vaccine availability (52-92%) and total vaccine availability (60-85%) compared to single-dose and two-dose vaccines. Further, using the ten-dose vaccine led to the highest rotavirus vaccine availability compared to all other rotavirus vaccines in both Benin and Bihar.

Conclusion: Our results show that countries that implement five-dose or ten-dose rotavirus vaccines consistently reduce cold chain constraints and achieve higher rotavirus and total vaccine availability compared to using either single-dose or two-dose rotavirus vaccines.
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http://dx.doi.org/10.1016/j.vaccine.2021.06.021DOI Listing
July 2021

A systems map of the economic considerations for vaccination: Application to hard-to-reach populations.

Vaccine 2021 May 24. Epub 2021 May 24.

Public Health Informatics, Computational, and Operations Research (PHICOR), City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, United States. Electronic address:

Background: Understanding the economics of vaccination is essential to developing immunization strategies that can be employed successfully with limited resources, especially when vaccinating populations that are hard-to-reach.

Methods: Based on the input from interviews with 24 global experts on immunization economics, we developed a systems map of the mechanisms (i.e., necessary steps or components) involved in vaccination, and associated costs and benefits, focused at the service delivery level. We used this to identify the mechanisms that may be different for hard-to-reach populations.

Results: The systems map shows different mechanisms that determine whether a person may or may not get vaccinated and the potential health and economic impacts of doing so. The map is divided into two parts: 1) the costs of vaccination, representing each of the mechanisms involved in getting vaccinated (n = 23 vaccination mechanisms), their associated direct vaccination costs (n = 18 vaccination costs), and opportunity costs (n = 5 opportunity costs), 2) the impact of vaccination, representing mechanisms after vaccine delivery (n = 13 impact mechanisms), their associated health effects (n = 10 health effects for beneficiary and others), and economic benefits (n = 13 immediate and secondary economic benefits and costs). Mechanisms that, when interrupted or delayed, can result in populations becoming hard-to-reach include getting vaccines and key stakeholders (e.g., beneficiaries/caregivers, vaccinators) to a vaccination site, as well as vaccine administration at the site.

Conclusion: Decision-makers can use this systems map to understand where steps in the vaccination process may be interrupted or weak and identify where gaps exist in the understanding of the economics of vaccination. With improved understanding of system-wide effects, this map can help decision-makers inform targeted interventions and policies to increase vaccination coverage in hard-to-reach populations.
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http://dx.doi.org/10.1016/j.vaccine.2021.05.033DOI Listing
May 2021

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study.

BMC Med 2021 05 7;19(1):116. Epub 2021 May 7.

Department of Medicine, University of California, San Francisco, San Francisco, CA, 94110, USA.

Background: COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.

Methods: We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.

Results: The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R) estimates of 2.9-6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R = 1.5), moderate-risk (R = 2.9), and high-risk (R = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R) within the simulated shelter and increasing incidence in the local community.

Conclusions: In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.
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http://dx.doi.org/10.1186/s12916-021-01965-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103431PMC
May 2021

Lives and Costs Saved by Expanding and Expediting Coronavirus Disease 2019 Vaccination.

J Infect Dis 2021 09;224(6):938-948

Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA.

Background: With multiple coronavirus disease 2019 (COVID-19) vaccines available, understanding the epidemiologic, clinical, and economic value of increasing coverage levels and expediting vaccination is important.

Methods: We developed a computational model (transmission and age-stratified clinical and economics outcome model) representing the United States population, COVID-19 coronavirus spread (February 2020-December 2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage.

Results: When achieving a given vaccination coverage in 270 days (70% vaccine efficacy), every 1% increase in coverage can avert an average of 876 800 (217 000-2 398 000) cases, varying with the number of people already vaccinated. For example, each 1% increase between 40% and 50% coverage can prevent 1.5 million cases, 56 240 hospitalizations, and 6660 deaths; gain 77 590 quality-adjusted life-years (QALYs); and save $602.8 million in direct medical costs and $1.3 billion in productivity losses. Expediting to 180 days could save an additional 5.8 million cases, 215 790 hospitalizations, 26 370 deaths, 206 520 QALYs, $3.5 billion in direct medical costs, and $4.3 billion in productivity losses.

Conclusions: Our study quantifies the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with the time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the fall/winter.
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http://dx.doi.org/10.1093/infdis/jiab233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136017PMC
September 2021

The Benefits of Vaccinating With the First Available COVID-19 Coronavirus Vaccine.

Am J Prev Med 2021 05 19;60(5):605-613. Epub 2021 Jan 19.

Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health & Health Policy, New York City, New York. Electronic address:

Introduction: During a pandemic, there are many situations in which the first available vaccines may not have as high effectiveness as vaccines that are still under development or vaccines that are not yet ready for distribution, raising the question of whether it is better to go with what is available now or wait.

Methods: In 2020, the team developed a computational model that represents the U.S. population, COVID-19 coronavirus spread, and vaccines with different possible efficacies (to prevent infection or to reduce severe disease) and vaccination timings to estimate the clinical and economic value of vaccination.

Results: Except for a limited number of situations, mainly early on in a pandemic and for a vaccine that prevents infection, when an initial vaccine is available, waiting for a vaccine with a higher efficacy results in additional hospitalizations and costs over the course of the pandemic. For example, if a vaccine with a 50% efficacy in preventing infection becomes available when 10% of the population has already been infected, waiting until 40% of the population are infected for a vaccine with 80% efficacy in preventing infection results in 15.6 million additional cases and 1.5 million additional hospitalizations, costing $20.6 billion more in direct medical costs and $12.4 billion more in productivity losses.

Conclusions: This study shows that there are relatively few situations in which it is worth foregoing the first COVID-19 vaccine available in favor of a vaccine that becomes available later on in the pandemic even if the latter vaccine has a substantially higher efficacy.
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http://dx.doi.org/10.1016/j.amepre.2021.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817395PMC
May 2021

Pressure injury and risk in the inpatient paediatric and neonatal populations: A single centre point-prevalence study.

J Tissue Viability 2021 May 9;30(2):231-236. Epub 2021 Feb 9.

Nottingham Childrens Hospital and Neonatal Services, Family Health Division, Nottingham University Hospitals NHS Trust, Nottingham, UK; Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, UK.

Introduction: Prevention and management of pressure injury is a key nurse-sensitive quality indicator. From clinical insights, pressure injury effects hospitalised neonates and children, however it is unclear how prevalent this is. The aim of this study was to quantify prevalence of pressure injury, assess skin integrity risk level, and quantify preventive interventions in both neonatal and child inpatient populations at a large children's hospital in the UK.

Methods: A cross-sectional study was undertaken, assessing the skin integrity of all children allocated to a paediatric or neonatal bed in June/July 2020. A data collection tool was adapted from two established pressure ulcer point prevalence surveys (EUPAP and Medstrom pre-prevalence survey). Risk assessment was performed using the Braden QD scale.

Results: Eighty-eight participants were included, with median age of 0.85 years [range 0-17.5 years), with 32 (36%) of participants being preterm. Median length of hospital stay was 11 days [range 0-174 days]. Pressure ulcer prevalence was 3.4%. The majority of participants had at least two medical devices, with 16 (18.2%) having more than four. Having a medical device was associated with increased risk score of developing pressure injury (odds ratio [OR] 0.03, 95% Confidence Interval [CI] 0.01-0.05, p = 0.02). Most children (39 (44%)) were reported not having proposed preventive measures in place aligned to their risk assessment. However, for those that did, 2 to 4 hourly repositioning was associated with a risk reduction on pressure damage (OR 0.13, 95% CI 0.03-0.23, p = 0.01).

Conclusion: Overall, we found a low prevalence of pressure injury across preterm infants, children and young people at a tertiary children's hospital. Accurate risk assessment as well as availability and implementation of preventive interventions are a priority for healthcare institutes to avoid pressure injury.
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http://dx.doi.org/10.1016/j.jtv.2021.02.004DOI Listing
May 2021

Estimated number of N95 respirators needed for healthcare workers in acute-care hospitals during the coronavirus disease 2019 (COVID-19) pandemic.

Infect Control Hosp Epidemiol 2021 Jan 11:1-9. Epub 2021 Jan 11.

Public Health Informatics, Computational, and Operations Research, CUNY Graduate School of Public Health and Health Policy, New York City, New York.

Objective: Due to shortages of N95 respirators during the coronavirus disease 2019 (COVID-19) pandemic, it is necessary to estimate the number of N95s required for healthcare workers (HCWs) to inform manufacturing targets and resource allocation.

Methods: We developed a model to determine the number of N95 respirators needed for HCWs both in a single acute-care hospital and the United States.

Results: For an acute-care hospital with 400 all-cause monthly admissions, the number of N95 respirators needed to manage COVID-19 patients admitted during a month ranges from 113 (95% interpercentile range [IPR], 50-229) if 0.5% of admissions are COVID-19 patients to 22,101 (95% IPR, 5,904-25,881) if 100% of admissions are COVID-19 patients (assuming single use per respirator, and 10 encounters between HCWs and each COVID-19 patient per day). The number of N95s needed decreases to a range of 22 (95% IPR, 10-43) to 4,445 (95% IPR, 1,975-8,684) if each N95 is used for 5 patient encounters. Varying monthly all-cause admissions to 2,000 requires 6,645-13,404 respirators with a 60% COVID-19 admission prevalence, 10 HCW-patient encounters, and reusing N95s 5-10 times. Nationally, the number of N95 respirators needed over the course of the pandemic ranges from 86 million (95% IPR, 37.1-200.6 million) to 1.6 billion (95% IPR, 0.7-3.6 billion) as 5%-90% of the population is exposed (single-use). This number ranges from 17.4 million (95% IPR, 7.3-41 million) to 312.3 million (95% IPR, 131.5-737.3 million) using each respirator for 5 encounters.

Conclusions: We quantified the number of N95 respirators needed for a given acute-care hospital and nationally during the COVID-19 pandemic under varying conditions.
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http://dx.doi.org/10.1017/ice.2020.1418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884668PMC
January 2021

Big Data and Systems Methods: The Next Frontier to Tackling the Global Obesity Epidemic.

Obesity (Silver Spring) 2021 02 9;29(2):263-264. Epub 2021 Jan 9.

Johns Hopkins Carey Business School, Baltimore, Maryland, USA.

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http://dx.doi.org/10.1002/oby.23062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409058PMC
February 2021

The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

PLoS Comput Biol 2021 01 7;17(1):e1008470. Epub 2021 Jan 7.

Infectious Disease Clinical Outcomes Research Unit (ID-CORE), Lundquist Institute, Harbor-UCLA Medical Center, Torrance, California, United States of America.

Finding medications or vaccines that may decrease the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially reduce transmission in the broader population. We developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. Simulation experiments found that reducing the average infectious period duration could avert a median of 442,852 [treating 25% of symptomatic cases, reducing by 0.5 days, reproductive number (R0) 3.5, and starting treatment when 15% of the population has been exposed] to 44.4 million SARS-CoV-2 cases (treating 75% of all infected cases, reducing by 3.5 days, R0 2.0). With R0 2.5, reducing the average infectious period duration by 0.5 days for 25% of symptomatic cases averted 1.4 million cases and 99,398 hospitalizations; increasing to 75% of symptomatic cases averted 2.8 million cases. At $500/person, treating 25% of symptomatic cases saved $209.5 billion (societal perspective). Further reducing the average infectious period duration by 3.5 days averted 7.4 million cases (treating 25% of symptomatic cases). Expanding treatment to 75% of all infected cases, including asymptomatic infections (R0 2.5), averted 35.9 million cases and 4 million hospitalizations, saving $48.8 billion (societal perspective and starting treatment after 5% of the population has been exposed). Our study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.
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http://dx.doi.org/10.1371/journal.pcbi.1008470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790237PMC
January 2021

A Comparative Study on Phenolic Content, Antioxidant Activity and Anti-Inflammatory Capacity of Aqueous and Ethanolic Extracts of Sorghum in Lipopolysaccharide-Induced RAW 264.7 Macrophages.

Antioxidants (Basel) 2020 Dec 18;9(12). Epub 2020 Dec 18.

Center for Grain and Animal Health Research, USDA-ARS, Manhattan, KS 66502, USA.

Sorghum is an important cereal with diverse phenolic compounds that have potential health promoting benefits. The current study comparatively characterized the phenolic contents of two novel black-seeded sorghum lines (SC84 and PI570481) using different extraction systems (water, ethanol and their acidified counterparts) and evaluated their antioxidant and anti-inflammatory activities. Phenolic compositions were determined by spectrophotometric assays and HPLC analysis. Antioxidant activities were assessed by radical scavenging effects on nitric oxide (NO) and 2,2-diphenyl-1-picrylhydrazyl (DPPH) free radicals, and the oxygen radical absorbance capacity (ORAC). Anti-inflammatory capacity was estimated by measuring levels of pro-inflammatory markers produced by lipopolysaccharide (LPS)-induced RAW 264.7 macrophages. Results showed that effects of solvent types and HCl on extraction efficiency differed among phenolic compounds and sorghum samples. Tannins were the most dominant polyphenols in the studied extracts (11.11-136.11 mg epicatechin equivalent/g sorghum). Sorghum extracts exerted more potent scavenging activity on DPPH than NO radicals. In LPS-activated RAW264.7 cells, sorghum extracts dose-dependently inhibited the production of NO, interleukin-6 (IL-6), and intracellular reactive oxygen species (ROS), with ethanolic extracts showing greater anti-inflammatory activity. Positive correlations were noted between tannin content and DPPH radical scavenging activity, and anti-inflammatory capacity. These results suggest the potential role of tannin-rich sorghum extracts against inflammation and associated diseases.
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http://dx.doi.org/10.3390/antiox9121297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767246PMC
December 2020

The Potential Clinical and Economic Value of a Human Papillomavirus Primary Screening Test That Additionally Identifies Genotypes 31, 45, 51, and 52 Individually.

Sex Transm Dis 2021 05;48(5):370-380

From the Public Health Computational and Operations Research (PHICOR), City University of New York (CUNY) School of Public Health and Health Policy, New York City, NY.

Background: Although current human papillomavirus (HPV) genotype screening tests identify genotypes 16 and 18 and do not specifically identify other high-risk types, a new extended genotyping test identifies additional individual (31, 45, 51, and 52) and groups (33/58, 35/39/68, and 56/59/66) of high-risk genotypes.

Methods: We developed a Markov model of the HPV disease course and evaluated the clinical and economic value of HPV primary screening with Onclarity (BD Diagnostics, Franklin Lakes, NJ) capable of extended genotyping in a cohort of women 30 years or older. Women with certain genotypes were later rescreened instead of undergoing immediate colposcopy and varied which genotypes were rescreened, disease progression rate, and test cost.

Results: Assuming 100% compliance with screening, HPV primary screening using current tests resulted in 25,194 invasive procedures and 48 invasive cervical cancer (ICC) cases per 100,000 women. Screening with extended genotyping (100% compliance) and later rescreening women with certain genotypes averted 903 to 3163 invasive procedures and resulted in 0 to 3 more ICC cases compared with current HPV primary screening tests. Extended genotyping was cost-effective ($2298-$7236/quality-adjusted life year) when costing $75 and cost saving (median, $0.3-$1.0 million) when costing $43. When the probabilities of disease progression increased (2-4 times), extended genotyping was not cost-effective because it resulted in more ICC cases and accrued fewer quality-adjusted life years.

Conclusions: Our study identified the conditions under which extended genotyping was cost-effective and even cost saving compared with current tests. A key driver of cost-effectiveness is the risk of disease progression, which emphasizes the need to better understand such risks in different populations.
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http://dx.doi.org/10.1097/OLQ.0000000000001327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8281325PMC
May 2021

Anticancer Activity of a Novel High Phenolic Sorghum Bran in Human Colon Cancer Cells.

Oxid Med Cell Longev 2020 2;2020:2890536. Epub 2020 Oct 2.

Agricultural Research Service, U.S. Department of Agriculture, Center for Grain and Animal Health Research, Manhattan, KS 66502, USA.

Human colon cancer is the third leading cause of mortality in the United States and worldwide. Chemoprevention using diet is widely accepted as a promising approach for cancer management. Numerous population studies indicate a negative correlation between the incidence of colon cancer and consumption of whole grains with a high content of bioactive phenolic compounds. In the current study, we evaluated the anticancer properties of a high phenolic sorghum bran extract prepared using 70% ethanol with 5% citric acid solvent at room temperature. A significant dose-dependent suppression of cell proliferation was observed in human colon cancer cells treated with the high phenolic sorghum bran extract. Apoptosis and S phase growth arrest were induced, while cell migration and invasion were inhibited by this treatment; these effects were accompanied by altered expression of apoptosis, cell cycle, and metastasis-regulating genes. We also found that the high phenolic sorghum bran extract stimulated DNA damage in association with induction of extracellular signal-regulated kinase (ERK) and c-Jun-NH-terminal kinase (JNK) and subsequent expression of activating transcription factor 3 (ATF3). The present study expands our understanding of the potential use of high phenolic sorghum bran to prevent human colon cancer.
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http://dx.doi.org/10.1155/2020/2890536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556115PMC
May 2021

Advancing provitamin A biofortification in sorghum: Genome-wide association studies of grain carotenoids in global germplasm.

Plant Genome 2020 03 26;13(1):e20013. Epub 2020 Mar 26.

Department of Agronomy, Kansas State University, Manhattan, KS, 66506, USA.

Vitamin A deficiency is one of the most prevalent nutritional deficiencies worldwide. Sorghum [Sorghum bicolor L. (Moench)] is a major cereal crop consumed by millions of people in regions with high vitamin A deficiency. We quantified carotenoid concentrations in a diverse sorghum panel using high-performance liquid chromatography and conducted a genome-wide association study (GWAS) of grain carotenoids to identify genes underlying carotenoid variation. There was moderate variation for β-carotene (00.8 μg g ), lutein (0.3-9.4 μg g ), and zeaxanthin (0.2-9.1 μg g ), but β-cryptoxanthin and α-carotene were nearly undetectable. Genotype had the largest effect size, at 81% for zeaxanthin, 62% for β-carotene, and 53% for lutein. Using multiple models, GWAS identified several significant associations between carotenoids and single nucleotide polymorphisms (SNPs), some of which colocalized with known carotenoid genes that have not been previously implicated in carotenoid variation. Several of the candidate genes identified have also been identified in maize (Zea mays L.) and Arabidopsis (Arabidopsis thaliana) carotenoid GWAS studies. Notably, an SNP inside the putative ortholog of maize zeaxanthin epoxidase (ZEP) had the most significant association with zeaxanthin and with the ratio between lutein and zeaxanthin, suggesting that ZEP is a major gene controlling sorghum carotenoid variation. Overall findings suggest there is oligogenic inheritance for sorghum carotenoids and suitable variation for marker-assisted selection. The high carotenoid germplasm and significant associations identified in this study can be used in biofortification efforts to improve the nutritional quality of sorghum.
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http://dx.doi.org/10.1002/tpg2.20013DOI Listing
March 2020

Small molecule induced toxic human-IAPP species characterized by NMR.

Chem Commun (Camb) 2020 Nov 2;56(86):13129-13132. Epub 2020 Oct 2.

Department of Chemistry, University of Michigan, Ann Arbor, MI, USA.

In this study, the effect of CurDAc, a water-soluble curcumin derivative, on the formation and stability of amyloid fibers is revealed. CurDAc interaction with amyloid is structurally selective, which is reflected in a strong interference with hIAPP aggregation while showing weaker interactions with human-calcitonin and amyloid-β in comparison. Remarkably, CurDAc also exhibited potent fiber disaggregation for hIAPP generating a toxic oligomeric species.
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http://dx.doi.org/10.1039/d0cc04803hDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641245PMC
November 2020

Using a Virtual-Representational-Abstract Integrated Framework to Teach Multiplicative Problem Solving to Middle School Students with Developmental Disabilities.

J Autism Dev Disord 2021 Jul;51(7):2284-2296

School of Teacher Education, Florida State University, 1114 W. Call St, Tallahassee, FL, 32306, USA.

Effective instructional strategies to improve mathematical problem solving skills are critically important to student success in both school-based and real-world mathematics tasks. This study reports effects of a Virtual-Representational-Abstract Integrated framework on the mathematical problem solving skills of three middle school students with developmental disabilities (autism spectrum disorder and intellectual disability). All participants improved in their problem solving accuracy when solving multiplicative comparison word problems using realistic double and triple multipliers. Additionally, all participants maintained their mathematical problem solving accuracy after visual supports (graphic organizer) were removed. Detailed findings and implications for future research and practitioners are discussed.
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http://dx.doi.org/10.1007/s10803-020-04674-2DOI Listing
July 2021

Implementing a high-risk medication education introductory pharmacy practice experience.

Curr Pharm Teach Learn 2020 Nov 31;12(11):1354-1359. Epub 2020 Jul 31.

University of Missouri - Kansas City School of Pharmacy at MU, 701 South Fifth Street, Columbia, MO 65211, United States. Electronic address:

Background And Purpose: The purpose of this project was to implement a sustainable high-risk medication education (HRME) experience for student pharmacists, assess the impact on institutional metrics, and evaluate student competence.

Educational Activity And Setting: Students completed a longitudinal introductory pharmacy practice experience (IPPE) to provide patient education on anticoagulant and antiplatelet medications. Data collected included student feedback on the experience, the achievement of applicable pre-advanced pharmacy practice experience (APPE) core domains, student effect on number of patients counseled, and number of patient interactions per student.

Findings: Student feedback of the HRME experience indicated that 98% either strongly agreed or agreed to meeting defined parameters. Ninety-seven percent of students completing the experience demonstrated achievement of all applicable domain abilities. Over a three-year period, students educated 1055 patients.

Summary: The creation of a sustainable HRME experience for student pharmacists allowed for the achievement of applicable pre-APPE core domains. It also enhanced institutional metrics by greatly increasing the number of patient touches and providing students with direct patient care opportunities on a consistent basis.
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http://dx.doi.org/10.1016/j.cptl.2020.06.001DOI Listing
November 2020

A Human IgSF Cell-Surface Interactome Reveals a Complex Network of Protein-Protein Interactions.

Cell 2020 08;182(4):1027-1043.e17

Department of Molecular and Cellular Physiology, Stanford University School of Medicine, Stanford, CA 94305, USA; Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Structural Biology, Stanford University School of Medicine, Stanford, CA 94305, USA. Electronic address:

Cell-surface protein-protein interactions (PPIs) mediate cell-cell communication, recognition, and responses. We executed an interactome screen of 564 human cell-surface and secreted proteins, most of which are immunoglobulin superfamily (IgSF) proteins, using a high-throughput, automated ELISA-based screening platform employing a pooled-protein strategy to test all 318,096 PPI combinations. Screen results, augmented by phylogenetic homology analysis, revealed ∼380 previously unreported PPIs. We validated a subset using surface plasmon resonance and cell binding assays. Observed PPIs reveal a large and complex network of interactions both within and across biological systems. We identified new PPIs for receptors with well-characterized ligands and binding partners for "orphan" receptors. New PPIs include proteins expressed on multiple cell types and involved in diverse processes including immune and nervous system development and function, differentiation/proliferation, metabolism, vascularization, and reproduction. These PPIs provide a resource for further biological investigation into their functional relevance and may offer new therapeutic drug targets.
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http://dx.doi.org/10.1016/j.cell.2020.07.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7440162PMC
August 2020

Vaccine Efficacy Needed for a COVID-19 Coronavirus Vaccine to Prevent or Stop an Epidemic as the Sole Intervention.

Am J Prev Med 2020 10 15;59(4):493-503. Epub 2020 Jul 15.

Public Health Informatics, Computational, and Operations Research, CUNY Graduate School of Public Health and Health Policy, New York City, New York. Electronic address:

Introduction: Given the continuing COVID-19 pandemic and much of the U.S. implementing social distancing owing to the lack of alternatives, there has been a push to develop a vaccine to eliminate the need for social distancing.

Methods: In 2020, the team developed a computational model of the U.S. simulating the spread of COVID-19 coronavirus and vaccination.

Results: Simulation experiments revealed that to prevent an epidemic (reduce the peak by >99%), the vaccine efficacy has to be at least 60% when vaccination coverage is 100% (reproduction number=2.5-3.5). This vaccine efficacy threshold rises to 70% when coverage drops to 75% and up to 80% when coverage drops to 60% when reproduction number is 2.5, rising to 80% when coverage drops to 75% when the reproduction number is 3.5. To extinguish an ongoing epidemic, the vaccine efficacy has to be at least 60% when coverage is 100% and at least 80% when coverage drops to 75% to reduce the peak by 85%-86%, 61%-62%, and 32% when vaccination occurs after 5%, 15%, and 30% of the population, respectively, have already been exposed to COVID-19 coronavirus. A vaccine with an efficacy between 60% and 80% could still obviate the need for other measures under certain circumstances such as much higher, and in some cases, potentially unachievable, vaccination coverages.

Conclusions: This study found that the vaccine has to have an efficacy of at least 70% to prevent an epidemic and of at least 80% to largely extinguish an epidemic without any other measures (e.g., social distancing).
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http://dx.doi.org/10.1016/j.amepre.2020.06.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361120PMC
October 2020

Coronavirus Disease 2019 Outbreak in a San Francisco Homeless Shelter.

Clin Infect Dis 2021 07;73(2):324-327

San Francisco Department of Public Health, San Francisco, California, USA.

We report the public health response to a coronavirus disease 2019 (COVID-19) outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.
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http://dx.doi.org/10.1093/cid/ciaa1071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454344PMC
July 2021

Mathematical interventions for students with autism spectrum disorder: Recommendations for practitioners.

Res Dev Disabil 2020 Oct 25;105:103744. Epub 2020 Jul 25.

University of Texas Arlington, 701 S. Nedderman Drive, Arlington, TX 76019, USA. Electronic address:

Students with extensive support needs (ESN; i.e., autism spectrum disorder, intellectual disability, or both), have the ability to learn a variety of mathematical skills when taught using scientifically validated strategies (e.g., Bouck, Satsangi, Taber-Doughty, & Courtney, 2014; Creech-Galloway, Collins, Knight, & Bausch, 2013; Root, Browder, Saunders, & Lo, 2017). The urgency of teaching grade-aligned, mathematical standards to this population has significantly increased in the past two decades. Yet, in order to teach grade-aligned mathematics to individuals with disabilities, teachers need access to scientifically validated strategies that can be effective with this heterogeneous population. This article extends work by Fleury and colleagues (2014) by expanding their findings of interventions to teach academic content to students with ASD. We hope practitioners can use this article as a starting point when selecting scientifically validated interventions to teach mathematics to students with ESN. We highlight mathematics interventions from a variety of recent literature reviews of mathematics interventions for students with ASD, ID, or both to provide guidance for practitioners of what we know works for which students under what conditions. This article also seeks to bridge research to practice by offering recommendations for math educators serving students with disabilities in heterogeneous classrooms.
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http://dx.doi.org/10.1016/j.ridd.2020.103744DOI Listing
October 2020

How Efficacious Must a COVID-19 Coronavirus Vaccine be to Prevent or Stop an Epidemic by Itself.

medRxiv 2020 May 30. Epub 2020 May 30.

Background: Given the continuing coronavirus disease 2019 (COVID-19) pandemic and much of the U.S. implementing social distancing due to the lack of alternatives, there has been a push to develop a vaccine to eliminate the need for social distancing.

Methods: In 2020, we developed a computational model of the U.S. simulating the spread of COVID-19 coronavirus and vaccination.

Results: Simulation experiments revealed that when vaccine efficacy exceeded 70%, coverage exceeded 60%, and vaccination occurred on day 1, the attack rate dropped to 22% with daily cases not exceeding 3.2 million (reproductive rate, R0, 2.5). When R0 was 3.5, the attack rate dropped to 41% with daily cases not exceeding 14.4 million. Increasing coverage to 75% when vaccination occurred by day 90 resulted in 5% attack rate and daily cases not exceeding 258,029when R0 was 2.5 and a 26% attack rate and maximum daily cases of 22.6 million when R0 was 3.5. When vaccination did not occur until day 180, coverage (i.e., those vaccinated plus those otherwise immune) had to reach 100%. A vaccine with an efficacy between 40% and 70% could still obviate the need for other measures under certain circumstances such as much higher, and in some cases, potentially unachievable, vaccination coverages.

Conclusion: Our study found that to either prevent or largely extinguish an epidemic without any other measures (e.g., social distancing), the vaccine has to have an efficacy of at least 70%.
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http://dx.doi.org/10.1101/2020.05.29.20117184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274250PMC
May 2020

High-Throughput Screening at the Membrane Interface Reveals Inhibitors of Amyloid-β.

Biochemistry 2020 06 5;59(24):2249-2258. Epub 2020 Jun 5.

Department of Chemistry, University of Michigan, Ann Arbor, Michigan 48109, United States.

Aggregation and the formation of oligomeric intermediates of amyloid-β (Aβ) at the membrane interface of neuronal cells are implicated in the cellular toxicity and pathology of Alzheimer's disease. Small molecule compounds have been shown to suppress amyloid aggregation and cellular toxicity, but often the presence of a lipid membrane negates their activity. A high-throughput screen of 1800 small molecules was performed to search for membrane active inhibitors, and 21 primary hits were discovered. Through the use of fluorescence-based assays, transmission electron microscopy, and dot blot assays, the initial 21 primary hits were narrowed down to five lead compounds. Nuclear magnetic resonance and circular dichroism experiments were used for further confirmation of amyloid inhibition at the membrane interface and to obtain insights into the secondary structure of amyloid-β, while size exclusion chromatography was used to characterize the size of Aβ species. Lastly, dye-leakage assays allowed us to understand how the addition of the five lead compounds affected amyloid-β's ability to permeate the lipid bilayer. These results provide insights into small molecules that stabilize small amyloid species in the presence of membranes for the development of tool compounds for deeper investigations of these transient species.
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http://dx.doi.org/10.1021/acs.biochem.0c00328DOI Listing
June 2020

Secure Delivery of HIV-Related and Tuberculosis Laboratory Results to Patient Cell Phones: A Pilot Comparative Study.

AIDS Behav 2020 Dec;24(12):3511-3521

Perinatal HIV Research Unit (PHRU), SA MRC Soweto Matlosana Collaborating Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa.

South Africa processes 5.1 million HIV CD4, viral load (VL), and tuberculosis (TB) tests annually. This pilot non-randomized trial in South Africa explored an intervention ("MatlaMobile") to deliver laboratory results via mobile phone. Adults completing CD4, VL, and/or TB laboratory tests were enrolled-either receiving results by returning to clinic (control, n = 174) or mobile phone (intervention, n = 226). Study staff instructed control participants to return within 6 days (standard-of-care). MatlaMobile instructed intervention participants with clinically actionable results requiring intervention or treatment change (i.e., < 200 CD4 cells per milliliter, ≥ 400 viral copies per milliliter, or TB positive) to return immediately. A greater proportion of intervention participants than controls saw their results within 7 days of enrollment (73% vs. 8.6%, p < 0.001). Among participants instructed to return, more intervention participants (20%, n = 14/70) returned than controls (8.6%, n = 15/174, p = 0.02). MatlaMobile demonstrated that patients can quickly receive and respond appropriately to digital delivery of health information.
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http://dx.doi.org/10.1007/s10461-020-02912-3DOI Listing
December 2020

What If the Influenza Vaccine Did Not Offer Such Variable Protection?

J Infect Dis 2020 09;222(7):1138-1144

Public Health Informatics, Computational, and Operations Research, CUNY Graduate School of Public Health & Health Policy, New York City, New York, USA.

Background: The protection that an influenza vaccine offers can vary significantly from person to person due to differences in immune systems, body types, and other factors. The question, then, is what is the value of efforts to reduce this variability such as making vaccines more personalized and tailored to individuals.

Methods: We developed a compartment model of the United States to simulate different influenza seasons and the impact of reducing the variability in responses to the influenza vaccine across the population.

Results: Going from a vaccine that varied in efficacy (0-30%) to one that had a uniform 30% efficacy for everyone averted 16.0-31.2 million cases, $1.9-$3.6 billion in direct medical costs, and $16.1-$42.7 billion in productivity losses. Going from 0-50% in efficacy to just 50% for everyone averted 27.7-38.6 million cases, $3.3-$4.6 billion in direct medical costs, and $28.8-$57.4 billion in productivity losses. Going from 0-70% to 70% averted 33.6-54.1 million cases, $4.0-$6.5 billion in direct medical costs, and $44.8-$64.7 billion in productivity losses.

Conclusions: This study quantifies for policy makers, funders, and vaccine developers and manufacturers the potential impact of efforts to reduce variability in the protection that influenza vaccines offer (eg, developing vaccines that are more personalized to different individual factors).
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http://dx.doi.org/10.1093/infdis/jiaa240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459138PMC
September 2020

High-resolution probing of early events in amyloid-β aggregation related to Alzheimer's disease.

Chem Commun (Camb) 2020 Apr 17;56(34):4627-4639. Epub 2020 Apr 17.

Biophysics Program, Department of Chemistry, University of Michigan, Ann Arbor, MI 48109-1055, USA.

In Alzheimer's disease (AD), soluble oligomers of amyloid-β (Aβ) are emerging as a crucial entity in driving disease progression as compared to insoluble amyloid deposits. The lacuna in establishing the structure to function relationship for Aβ oligomers prevents the development of an effective treatment for AD. While the transient and heterogeneous properties of Aβ oligomers impose many challenges for structural investigation, an effective use of a combination of NMR techniques has successfully identified and characterized them at atomic-resolution. Here, we review the successful utilization of solution and solid-state NMR techniques to probe the aggregation and structures of small and large oligomers of Aβ. Biophysical studies utilizing the commonly used solution and F based NMR experiments to identify the formation of small size early intermediates and to obtain their structures, and dock-lock mechanism of fiber growth at atomic-resolution are discussed. In addition, the use of proton-detected magic angle spinning (MAS) solid-state NMR experiments to obtain high-resolution insights into the aggregation pathways and structures of large oligomers and other aggregates is also presented. We expect these NMR based studies to be valuable for real-time monitoring of the depletion of monomers and the formation of toxic oligomers and high-order aggregates under a variety of conditions, and to solve the high-resolution structures of small and large size oligomers for most amyloid proteins, and therefore to develop inhibitors and drugs.
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http://dx.doi.org/10.1039/d0cc01551bDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7254607PMC
April 2020

High-polyphenol extracts from Sorghum bicolor attenuate replication of Legionella pneumophila within RAW 264.7 macrophages.

FEMS Microbiol Lett 2020 04;367(7)

Division of Biology, Kansas State University, 1717 Claflin Road, Manhattan, Kansas, 66506 USA.

Polyphenols derived from a variety of plants have demonstrated antimicrobial activity against diverse microbial pathogens. Legionella pneumophila is an intracellular bacterial pathogen that opportunistically causes a severe inflammatory pneumonia in humans, called Legionnaires' Disease, via replication within macrophages. Previous studies demonstrated that tea polyphenols attenuate L. pneumophila intracellular replication within mouse macrophages via increased tumor necrosis factor (TNF) production. Sorghum bicolor is a sustainable cereal crop that thrives in arid environments and is well-suited to continued production in warming climates. Sorghum polyphenols have anticancer and antioxidant properties, but their antimicrobial activity has not been evaluated. Here, we investigated the impact of sorghum polyphenols on L. pneumophila intracellular replication within RAW 264.7 mouse macrophages. Sorghum high-polyphenol extract (HPE) attenuated L. pneumophila intracellular replication in a dose-dependent manner but did not impair either bacterial replication in rich media or macrophage viability. Moreover, HPE treatment enhanced both TNF and IL-6 secretion from L. pneumophila infected macrophages. Thus, polyphenols derived from sorghum enhance macrophage restriction of L. pneumophila, likely via increased pro-inflammatory cytokine production. This work reveals commonalities between plant polyphenol-mediated antimicrobial activity and provides a foundation for future evaluation of sorghum as an antimicrobial agent.
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http://dx.doi.org/10.1093/femsle/fnaa053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023677PMC
April 2020

Why WIBA?

Behav Anal Pract 2019 Dec 11;12(4):810-815. Epub 2019 Jun 11.

Behavior Analysis Center for Autism, 9929 E. 126th St., Fishers, IN 46038 USA.

Historically, men have dominated the field of behavior analysis; however, recent trends have indicated increased participation by women. As a result of these recent changes to the field of behavior analysis, the inaugural Women in Behavior Analysis Conference (WIBA) was hosted in 2017. WIBA was initially established to highlight the accomplishments of women in the field of behavior analysis, to provide opportunities for early career behavior analysts to obtain mentorship, and to encourage meaningful discourse about gender issues in the field. Since the inaugural conference, WIBA has attempted to establish a platform for promoting gender equality but most recently has incorporated efforts related to the needs surrounding social justice and inclusiveness in the field of behavior analysis. The goal of this paper is to provide an overview of the WIBA conference. The history of WIBA is discussed, including the impetus for establishing the conference. This paper highlights existing issues on gender equality in the field of behavior analysis and the larger community, serves to demonstrate how WIBA is part of the solution, and shares accomplishments to date. Furthermore, future directions and goals are presented.
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http://dx.doi.org/10.1007/s40617-019-00369-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6834794PMC
December 2019

Control of Bacillus subtilis Replication Initiation during Physiological Transitions and Perturbations.

mBio 2019 12 17;10(6). Epub 2019 Dec 17.

Department of Physics, University of California, San Diego, La Jolla, California, USA

and are evolutionarily divergent model organisms whose analysis has enabled elucidation of fundamental differences between Gram-positive and Gram-negative bacteria, respectively. Despite their differences in cell cycle control at the molecular level, the two organisms follow the same phenomenological principle, known as the adder principle, for cell size homeostasis. We thus asked to what extent and share common physiological principles in coordinating growth and the cell cycle. We measured physiological parameters of under various steady-state growth conditions with and without translation inhibition at both the population and single-cell levels. These experiments revealed core physiological principles shared between and Specifically, both organisms maintain an invariant cell size per replication origin at initiation, under all steady-state conditions, and even during nutrient shifts at the single-cell level. Furthermore, the two organisms also inherit the same "hierarchy" of physiological parameters. On the basis of these findings, we suggest that the basic principles of coordination between growth and the cell cycle in bacteria may have been established early in evolutionary history. High-throughput, quantitative approaches have enabled the discovery of fundamental principles describing bacterial physiology. These principles provide a foundation for predicting the behavior of biological systems, a widely held aspiration. However, these approaches are often exclusively applied to the best-known model organism, In this report, we investigate to what extent quantitative principles discovered in Gram-negative are applicable to Gram-positive We found that these two extremely divergent bacterial species employ deeply similar strategies in order to coordinate growth, cell size, and the cell cycle. These similarities mean that the quantitative physiological principles described here can likely provide a beachhead for others who wish to understand additional, less-studied prokaryotes.
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http://dx.doi.org/10.1128/mBio.02205-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918070PMC
December 2019
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