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  1. Article ; Online: Infectious Diseases-Related Hospitalizations During Oral Polio Vaccine (OPV) and Non-OPV Immunization Periods: An Empirical Evaluation of all Hospital Discharges in California (1985-2010).

    Contopoulos-Ioannidis, Despina G / Altamirano, Jonathan / Maldonado, Yvonne

    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

    2022  Volume 75, Issue 7, Page(s) 1123–1130

    Abstract: Background: Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)- ... ...

    Abstract Background: Live attenuated vaccines such as oral polio vaccine (OPV) can stimulate innate immunity and may have off-target protective effects on other pathogens. We aimed to address this hypothesis by examining changes in infectious diseases (ID)-related hospitalizations in all hospital discharges in California during OPV (1985-1996) and non-OPV immunization periods (2000-2010).
    Methods: We searched the Office of Statewide Health Planning and Development database for all hospital discharges with any ID-related discharge diagnosis code during 1985-2010. We compared the proportion of ID-related hospitalizations (with at least 
1 ID-related discharge diagnosis) among total hospitalizations during OPV immunization (1985-1996) versus non-OPV immunization (2000-2010) periods.
    Results: There were 19 281 039 ID-related hospitalizations (8 464 037 with an ID-related discharge diagnosis as the principal discharge diagnosis for the hospitalization) among 98 117 475 hospitalizations in 1985-2010; 9 520 810 ID hospitalizations/43 456 484 total hospitalizations in 2000-2010 versus 7 526 957/43 472 796 in 1985-1996. The risk ratio for ID-related hospitalizations in 2000-2010 versus 1985-1996 was 1.27 (95% confidence interval [CI], 1.26-1.27) for all diagnoses and 1.15 (95% CI: 1.15-1.16) for principal diagnoses. Increases also existed in the proportion of lower respiratory and gastrointestinal infections.
    Discussion: The proportion of ID-related hospitalizations was lower in the OPV immunization period compared to the period after OPV was discontinued. When focused only on hospitalizations with ID as the principal discharge diagnosis, the signal remained significant but was smaller. These findings require replication in additional studies.
    MeSH term(s) Communicable Diseases ; Hospitalization ; Hospitals ; Humans ; Infant ; Patient Discharge ; Poliomyelitis/epidemiology ; Poliomyelitis/prevention & control ; Poliovirus Vaccine, Inactivated ; Poliovirus Vaccine, Oral ; Vaccination ; Vaccines, Attenuated
    Chemical Substances Poliovirus Vaccine, Inactivated ; Poliovirus Vaccine, Oral ; Vaccines, Attenuated
    Language English
    Publishing date 2022-02-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1099781-7
    ISSN 1537-6591 ; 1058-4838
    ISSN (online) 1537-6591
    ISSN 1058-4838
    DOI 10.1093/cid/ciac114
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  2. Article ; Online: Effects of surgeon sociodemographics on patient-reported satisfaction.

    Nuyen, Brian / Altamirano, Jonathan / Fassiotto, Magali / Alyono, Jennifer

    Surgery

    2021  Volume 169, Issue 6, Page(s) 1441–1445

    Abstract: Background: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.: Methods: ... ...

    Abstract Background: Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear.
    Methods: This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ
    Results: In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making.
    Conclusion: Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
    Language English
    Publishing date 2021-01-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 202467-6
    ISSN 1532-7361 ; 0039-6060
    ISSN (online) 1532-7361
    ISSN 0039-6060
    DOI 10.1016/j.surg.2020.12.006
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  3. Article ; Online: Disability Identity Among Diverse Learners and Employees at an Academic Medical Center.

    Jerome, Barbara / Fassiotto, Magali / Altamirano, Jonathan / Sutha, Ken / Maldonado, Yvonne / Poullos, Peter

    JAMA network open

    2022  Volume 5, Issue 11, Page(s) e2241948

    MeSH term(s) Humans ; Disabled Persons ; Surveys and Questionnaires ; Academic Medical Centers
    Language English
    Publishing date 2022-11-01
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.41948
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  4. Article ; Online: Reply to: "Parity at the Podium".

    Kothary, Nishita / Fassiotto, Magali / Altamirano, Jonathan

    Journal of vascular and interventional radiology : JVIR

    2019  Volume 30, Issue 7, Page(s) 1151

    MeSH term(s) Female ; Health Personnel ; Humans ; Male ; Radiology, Interventional ; Societies, Medical
    Language English
    Publishing date 2019-05-22
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 1137756-2
    ISSN 1535-7732 ; 1051-0443
    ISSN (online) 1535-7732
    ISSN 1051-0443
    DOI 10.1016/j.jvir.2019.04.008
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  5. Article: Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns.

    Walter, Katharine S / Altamirano, Jonathan / Huang, ChunHong / Carrington, Yuan J / Zhou, Frank / Andrews, Jason R / Maldonado, Yvonne

    medRxiv : the preprint server for health sciences

    2023  

    Abstract: There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying ... ...

    Abstract There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from vaccinated children and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Alarmingly, 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutation. Our results suggest that current definitions of cVDPVs may exclude circulating virulent viruses that pose a public health risk and underscore the need for intensive surveillance following OPV use.
    Language English
    Publishing date 2023-03-21
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2023.03.16.23287381
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  6. Article: Rebuilding child health in South Kivu, Democratic Republic of Congo (DRC): evaluating the Asili social enterprise program.

    Behl, Rasika / Ali, Sofia / Altamirano, Jonathan / Leno, Abraham / Maldonado, Yvonne / Sarnquist, Clea

    Conflict and health

    2022  Volume 16, Issue 1, Page(s) 21

    Abstract: Background: The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing local instability; the eastern provinces, including South Kivu, have been especially affected. Health systems and livelihoods have been undermined, ... ...

    Abstract Background: The Democratic Republic of Congo (DRC) has a long history of conflict and ongoing local instability; the eastern provinces, including South Kivu, have been especially affected. Health systems and livelihoods have been undermined, contributing to massive inequities in access to health services and high rates of internal displacement. Asili, an innovative social enterprise program, aimed to provide essential community services and improve the health of under-five children in two South Kivu communities, Mudaka and Panzi, via provision of small-format, franchisable health clinics and clean water services.
    Methods: We evaluated utilization and acceptance of Asili services in two study sites, Mudaka and Panzi. Data collected included questions on housing conditions, food security, and at follow up, Asili membership and use, satisfaction with services, and recommendations for improvement. Structured pre- and post-interviews with primary caregivers of families with under-five children were the primary source of data with additional community input collected through focus group discussions.
    Results: At baseline, we enrolled 843 households in Mudaka and 890 in Panzi. Market segmentation analysis illuminated service usage patterns, showing Asili services were well received overall in both Mudaka and Panzi. Families reporting higher levels of proxy measures of socioeconomic status (SES), such as electricity, land ownership, and education, were more likely to use Asili services, findings that were further supported by focus group discussions among community members.
    Conclusions: Rebuilding health infrastructure in post-conflict settings, especially those that continue to be conflict-affected and very low SES, is a challenging prospect. Focus group results for this study highlighted the positive community response to Asili, while also underscoring challenges related to cost of services. Programs may need, in particular, to have different levels of costs for different SES groups. Additionally, longer follow-up periods and increased stability may be needed to assess the potential of social enterprise interventions such as Asili to improve health outcomes, especially in children.
    Trial registration: Institutional Review Board approval for this study was obtained at Stanford University (IRB 35216) and the University of Kinshasa, DRC. Further, this study has been registered on Clinicaltrials.gov (record NCT03536286), retrospectively registered as of 4/23/2018.
    Language English
    Publishing date 2022-05-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 2273783-2
    ISSN 1752-1505
    ISSN 1752-1505
    DOI 10.1186/s13031-022-00454-0
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  7. Article ; Online: Rapid emergence and transmission of virulence-associated mutations in the oral poliovirus vaccine following vaccination campaigns.

    Walter, Katharine S / Altamirano, Jonathan / Huang, ChunHong / Carrington, Yuan J / Zhou, Frank / Andrews, Jason R / Maldonado, Yvonne

    NPJ vaccines

    2023  Volume 8, Issue 1, Page(s) 137

    Abstract: There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying ... ...

    Abstract There is an increasing burden of circulating vaccine-derived polioviruses (cVDPVs) due to the continued use of oral poliovirus vaccine (OPV). However, the informativeness of routine OPV VP1 sequencing for the early identification of viruses carrying virulence-associated reversion mutations has not been directly evaluated in a controlled setting. We prospectively collected 15,331 stool samples to track OPV shedding from children receiving OPV and their contacts for ten weeks following an immunization campaign in Veracruz State, Mexico and sequenced VP1 genes from 358 samples. We found that OPV was genetically unstable and evolves at an approximately clocklike rate that varies across serotypes and by vaccination status. Overall, 61% (11/18) of OPV-1, 71% (34/48) OPV-2, and 96% (54/56) OPV-3 samples with available data had evidence of a reversion at the key 5' UTR attenuating position and 28% (13/47) of OPV-1, 12% (14/117) OPV-2, and 91% (157/173) OPV-3 of Sabin-like viruses had ≥1 known reversion mutations in the VP1 gene. Our results are consistent with previous work documenting rapid reversion to virulence of OPV and underscores the need for intensive surveillance following OPV use.
    Language English
    Publishing date 2023-09-25
    Publishing country England
    Document type Journal Article
    ISSN 2059-0105
    ISSN (online) 2059-0105
    DOI 10.1038/s41541-023-00740-9
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  8. Article ; Online: Journal update monthly top five.

    Saxena, Monica / Altamirano, Jonathan / Rose, Christian / Bennett, Christopher / Govindarajan, Prasha / Lumba-Brown, Angela / Hirst, Robert

    Emergency medicine journal : EMJ

    2022  Volume 39, Issue 7, Page(s) 561–562

    MeSH term(s) Humans ; Pain Measurement ; Triage
    Language English
    Publishing date 2022-06-27
    Publishing country England
    Document type Journal Article
    ZDB-ID 2040124-3
    ISSN 1472-0213 ; 1472-0205
    ISSN (online) 1472-0213
    ISSN 1472-0205
    DOI 10.1136/emermed-2022-212603
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  9. Article ; Online: The effect of a relationship-centered communication program on patient experience and provider wellness.

    Altamirano, Jonathan / Kline, Merisa / Schwartz, Rachel / Fassiotto, Magali / Maldonado, Yvonne / Weimer-Elder, Barbette

    Patient education and counseling

    2021  Volume 105, Issue 7, Page(s) 1988–1995

    Abstract: Objectives: Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of ... ...

    Abstract Objectives: Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness.
    Methods: 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019.
    Results: 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion.
    Conclusions: The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience.
    Practice implications: Implementing a RCC course for providers may improve patient experience and provider wellness.
    MeSH term(s) Carcinoma, Renal Cell ; Communication ; Health Personnel ; Humans ; Kidney Neoplasms ; Patient Outcome Assessment ; Surveys and Questionnaires
    Language English
    Publishing date 2021-10-24
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 605590-4
    ISSN 1873-5134 ; 0738-3991
    ISSN (online) 1873-5134
    ISSN 0738-3991
    DOI 10.1016/j.pec.2021.10.025
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    Zs.A 1465: Show issues Location:
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  10. Article ; Online: Long-range inhibitory neurons mediate cortical neurovascular coupling.

    Ruff, Catherine F / Juarez Anaya, Fernanda / Dienel, Samuel J / Rakymzhan, Adiya / Altamirano-Espinoza, Alain / Couey, Jonathan J / Fukuda, Mitsuhiro / Watson, Alan M / Su, Aihua / Fish, Kenneth N / Rubio, Maria E / Hooks, Bryan M / Ross, Sarah E / Vazquez, Alberto L

    Cell reports

    2024  Volume 43, Issue 4, Page(s) 113970

    Abstract: To meet the high energy demands of brain function, cerebral blood flow (CBF) parallels changes in neuronal activity by a mechanism known as neurovascular coupling (NVC). However, which neurons play a role in mediating NVC is not well understood. Here, we ...

    Abstract To meet the high energy demands of brain function, cerebral blood flow (CBF) parallels changes in neuronal activity by a mechanism known as neurovascular coupling (NVC). However, which neurons play a role in mediating NVC is not well understood. Here, we identify in mice and humans a specific population of cortical GABAergic neurons that co-express neuronal nitric oxide synthase and tachykinin receptor 1 (Tacr1). Through whole-tissue clearing, we demonstrate that Tacr1 neurons extend local and long-range projections across functionally connected cortical areas. We show that whisker stimulation elicited Tacr1 neuron activity in the barrel cortex through feedforward excitatory pathways. Additionally, through optogenetic experiments, we demonstrate that Tacr1 neurons are instrumental in mediating CBF through the relaxation of mural cells in a similar fashion to whisker stimulation. Finally, by electron microscopy, we observe that Tacr1 processes contact astrocytic endfeet. These findings suggest that Tacr1 neurons integrate cortical activity to mediate NVC.
    MeSH term(s) Animals ; Mice ; Neurovascular Coupling/physiology ; Humans ; Neurons/metabolism ; Neurons/physiology ; Vibrissae/physiology ; Mice, Inbred C57BL ; GABAergic Neurons/metabolism ; GABAergic Neurons/physiology ; Male ; Cerebral Cortex/physiology ; Cerebral Cortex/blood supply ; Cerebrovascular Circulation/physiology ; Nitric Oxide Synthase Type I/metabolism
    Chemical Substances Nitric Oxide Synthase Type I (EC 1.14.13.39)
    Language English
    Publishing date 2024-03-19
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
    ZDB-ID 2649101-1
    ISSN 2211-1247 ; 2211-1247
    ISSN (online) 2211-1247
    ISSN 2211-1247
    DOI 10.1016/j.celrep.2024.113970
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