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  1. AU="Zunt, Joseph R"
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  1. Article ; Online: Building Equitable Neuroscience Research Collaborations in Resource-limited Settings.

    Asukile, Melody T / Zunt, Joseph R / Thakur, Kiran T

    Seminars in neurology

    2024  Volume 44, Issue 2, Page(s) 159–167

    Abstract: The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience ... ...

    Abstract The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience research aimed at defining the burden of neurological diseases across the lifespan, as well as optimizing diagnosis and treatment strategies, is fundamental to improving neurological health in resource-limited settings. One of the key factors to advancing neuroscience research in LMICs is the establishment of effective collaborations based on responsible and trustworthy partnerships between local scientists in LMICs and international collaborators. LMIC researchers face many logistical, institutional, and individual level challenges as they embark on their neuroscience research journey. Despite these challenges, there are opportunities for improving LMIC investigator-led research that should focus on human and institutional infrastructure development. With regard to human capacity building, potential areas for offering support include enhancing research methodology training, offering instruction in manuscript and grant-writing, institutionalizing mentorship programs, and providing opportunities to conduct funded, mentored research to disseminate in high-impact journals. The foundational elements required for implementing and optimizing neuroscience research within an institution include an institutional review board, mentorship programs, data management, research administration, and laboratory facilities. This institutional capacity varies significantly across and within countries, and many rely on collaborations with better-resourced institutions to initiate research. Successful equitable collaborations ensure the engagement of all local and international stakeholders, as well as implementation of a self-sustaining long-term program. Building research capacity in LMICs is an essential endeavor that requires ongoing commitment to training independent scientists. As research capacity increases, LMIC institutions and governments should consider developing competitive research grant programs to support innovative studies led by local researchers, foster regional collaborations, and hence create a sustainable and independent neuroscience research environment.
    MeSH term(s) Humans ; Resource-Limited Settings ; Developing Countries ; Capacity Building
    Language English
    Publishing date 2024-03-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0043-1778640
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Building Equitable Neuroscience Research Collaborations in Resource-limited Settings

    Asukile, Melody T. / Zunt, Joseph R. / Thakur, Kiran T.

    Seminars in Neurology

    (Neurology in Underserved and Marginalized Populations)

    2024  Volume 44, Issue 02, Page(s) 159–167

    Abstract: The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience ... ...

    Series title Neurology in Underserved and Marginalized Populations
    Abstract The burden of noncommunicable neurological disorders, such as stroke, dementia, and headache disorders, are on the rise in low- to middle-income countries (LMICs), while neuroinfectious diseases remain a major concern. The development of neuroscience research aimed at defining the burden of neurological diseases across the lifespan, as well as optimizing diagnosis and treatment strategies, is fundamental to improving neurological health in resource-limited settings. One of the key factors to advancing neuroscience research in LMICs is the establishment of effective collaborations based on responsible and trustworthy partnerships between local scientists in LMICs and international collaborators. LMIC researchers face many logistical, institutional, and individual level challenges as they embark on their neuroscience research journey. Despite these challenges, there are opportunities for improving LMIC investigator-led research that should focus on human and institutional infrastructure development. With regard to human capacity building, potential areas for offering support include enhancing research methodology training, offering instruction in manuscript and grant-writing, institutionalizing mentorship programs, and providing opportunities to conduct funded, mentored research to disseminate in high-impact journals. The foundational elements required for implementing and optimizing neuroscience research within an institution include an institutional review board, mentorship programs, data management, research administration, and laboratory facilities. This institutional capacity varies significantly across and within countries, and many rely on collaborations with better-resourced institutions to initiate research. Successful equitable collaborations ensure the engagement of all local and international stakeholders, as well as implementation of a self-sustaining long-term program. Building research capacity in LMICs is an essential endeavor that requires ongoing commitment to training independent scientists. As research capacity increases, LMIC institutions and governments should consider developing competitive research grant programs to support innovative studies led by local researchers, foster regional collaborations, and hence create a sustainable and independent neuroscience research environment.
    Keywords research infrastructure ; capacity building ; international collaboration ; neurosciences
    Language English
    Publishing date 2024-03-14
    Publisher Thieme Medical Publishers, Inc.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0043-1778640
    Database Thieme publisher's database

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  3. Article ; Online: Tuberculosis of the Central Nervous System.

    Zunt, Joseph R

    Continuum (Minneapolis, Minn.)

    2018  Volume 24, Issue 5, Neuroinfectious Disease, Page(s) 1422–1438

    Abstract: Purpose of review: This article details the epidemiology and clinical manifestations of central nervous system (CNS) tuberculosis (TB), provides guidance for diagnostic imaging and CSF testing, and recommends treatment strategies for tuberculous ... ...

    Abstract Purpose of review: This article details the epidemiology and clinical manifestations of central nervous system (CNS) tuberculosis (TB), provides guidance for diagnostic imaging and CSF testing, and recommends treatment strategies for tuberculous meningitis and other forms of CNS TB, illustrating key aspects of diagnosis and management with case presentations.
    Recent findings: Although improvements in our understanding of the pathogenesis and management of CNS TB have occurred over the past 50 years, the emergence of multidrug-resistant and extensively drug-resistant TB, the advent of acquired immunodeficiency syndrome (AIDS), and the subsequent availability of highly active antiretroviral therapy that can produce the immune reconstitution inflammatory syndrome have complicated the diagnosis and treatment of CNS TB. Advances in diagnostic assays promise to increase the speed of diagnosis as well as the percentage of people with a confirmed rather than a presumptive diagnosis. Advances in precision medicine have identified polymorphisms in the LTA4H gene that influence the risk for inflammation in patients with tuberculous meningitis.
    Summary: CNS TB continues to be a major cause of morbidity and mortality, with the majority of people affected living in low-income and middle-income countries. Newer diagnostic assays promise to increase the speed of diagnosis and improve appropriate selection of antituberculous therapy and anti-inflammatory medications. Despite these advances, CNS TB remains difficult to diagnose, and clinicians should have a low threshold for initiating empiric therapy in patients with presumptive infection.
    MeSH term(s) Adolescent ; Central Nervous System/microbiology ; Central Nervous System/pathology ; Disease Management ; Humans ; Magnetic Resonance Imaging ; Male ; Tuberculosis/epidemiology ; Tuberculosis/pathology ; Tuberculosis/therapy
    Language English
    Publishing date 2018-09-29
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Review
    ISSN 1538-6899
    ISSN (online) 1538-6899
    DOI 10.1212/CON.0000000000000648
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Neurologic Infections in Travelers.

    Sharma, Malveeka / Zunt, Joseph R

    Seminars in neurology

    2019  Volume 39, Issue 3, Page(s) 399–414

    Abstract: This review will provide an outline of the neurological complications of specific parasitic, bacterial, and viral infectious diseases that can affect the international traveler. We will discuss the epidemiology, life cycle, ecology, clinical ... ...

    Abstract This review will provide an outline of the neurological complications of specific parasitic, bacterial, and viral infectious diseases that can affect the international traveler. We will discuss the epidemiology, life cycle, ecology, clinical manifestation, diagnosis, treatment, and prevention.
    MeSH term(s) Central Nervous System Infections/diagnosis ; Central Nervous System Infections/drug therapy ; Humans ; Travel-Related Illness
    Language English
    Publishing date 2019-08-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0039-1688914
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Neurologic Infections in Travelers

    Sharma, Malveeka / Zunt, Joseph R.

    Seminars in Neurology

    (Neuroinfectious Disease, Part 1)

    2019  Volume 39, Issue 03, Page(s) 399–414

    Abstract: This review will provide an outline of the neurological complications of specific parasitic, bacterial, and viral infectious diseases that can affect the international traveler. We will discuss the epidemiology, life cycle, ecology, clinical ... ...

    Series title Neuroinfectious Disease, Part 1
    Abstract This review will provide an outline of the neurological complications of specific parasitic, bacterial, and viral infectious diseases that can affect the international traveler. We will discuss the epidemiology, life cycle, ecology, clinical manifestation, diagnosis, treatment, and prevention.
    Keywords neurological disease ; infectious diseases ; travel
    Language English
    Publishing date 2019-06-01
    Publisher Thieme Medical Publishers
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 603165-1
    ISSN 1098-9021 ; 0271-8235
    ISSN (online) 1098-9021
    ISSN 0271-8235
    DOI 10.1055/s-0039-1688914
    Database Thieme publisher's database

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  6. Article ; Online: Outcomes and Experiences of Patients and Their Caregivers After Severe Stroke Requiring Tube Feeding in Peru.

    Abedini, Nauzley C / Shulein, Orli M / Berrú-Villalobos, Sandra / Ramírez-Quiñones, Jorge / Creutzfeldt, Claire J / Portocarrero, Jill / Zunt, Joseph R / Abanto-Argomedo, Carlos

    Journal of pain and symptom management

    2024  Volume 67, Issue 4, Page(s) 296–305

    Abstract: Objectives: Evaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers.: Methods: Retrospective chart review to ... ...

    Abstract Objectives: Evaluate clinical outcomes of stroke survivors in Peru discharged with artificial nutrition via a feeding tube (FT), and explore perspectives and experiences of these patients and their caregivers.
    Methods: Retrospective chart review to describe the prevalence of FT placement and characteristics of patients admitted with stroke to the Instituto Nacional de Ciencias Neurológicas in Lima, Peru between January 2019 and 2021. Follow-up calls to stroke survivors discharged home with FTs or their caregivers included quantitative and qualitative questions to assess long-term outcome and explore perspectives around poststroke care and FT management. We analyzed quantitative data descriptively and applied thematic analysis to qualitative data using a consensus-driven codebook.
    Results: Of 812 hospitalized patients with stroke, 146 (18%) were discharged home with FT, all with nasogastric tubes (NGTs). Follow-up calls were performed a median of 18 months after stroke with 96 caregivers and three patients. Twenty-five patients (25%) had died, and 82% of survivors (n = 61) remained dependent for some care. Four themes emerged from interviews: (1) perceived suffering (physical, emotional, existential) associated with the NGT and stroke-related disability, often exacerbated by lack of preparedness or prognostic awareness; (2) concerns around compromised personhood and value-discordant care; (3) coping with their loved-one's illness and the caregiving role; and (4) barriers to NGT care and skill acquisition.
    Conclusion: We identified a high burden of palliative and supportive needs among severe stroke survivors with NGTs and their caregivers suggesting opportunities to improve poststroke care through education, communication, and support.
    MeSH term(s) Humans ; Caregivers/psychology ; Enteral Nutrition ; Retrospective Studies ; Peru ; Stroke/therapy
    Language English
    Publishing date 2024-01-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639142-4
    ISSN 1873-6513 ; 0885-3924
    ISSN (online) 1873-6513
    ISSN 0885-3924
    DOI 10.1016/j.jpainsymman.2024.01.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article: Tuberculous Meningitis: Impact of Timing of Treatment Initiation on Mortality.

    Soria, Jaime / Chiappe, Alfredo / Gallardo, Jorge / Zunt, Joseph R / Lescano, Andres G

    Open forum infectious diseases

    2021  Volume 8, Issue 7, Page(s) ofab345

    Abstract: We conducted a retrospective cross-sectional study of adult hospitalized patients with confirmed tuberculous meningitis to determine the impact of the timing of treatment initiation on mortality. The mortality of tuberculous meningitis patients was high ... ...

    Abstract We conducted a retrospective cross-sectional study of adult hospitalized patients with confirmed tuberculous meningitis to determine the impact of the timing of treatment initiation on mortality. The mortality of tuberculous meningitis patients was high and was associated with delay in initiation of treatment, older age, HIV infection, and higher disease severity at admission.
    Language English
    Publishing date 2021-06-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2757767-3
    ISSN 2328-8957
    ISSN 2328-8957
    DOI 10.1093/ofid/ofab345
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru.

    Zafra-Tanaka, Jessica Hanae / Portocarrero, Jill / Abanto, Carlos / Zunt, Joseph R / Miranda, J Jaime

    Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

    2021  Volume 31, Issue 4, Page(s) 106275

    Abstract: Objectives: To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences ... ...

    Abstract Objectives: To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru.
    Methods: A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients' journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis.
    Results: We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services.
    Conclusion: The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients' experiences and feelings by developing solutions in a participatory manner.
    MeSH term(s) Aftercare ; COVID-19 ; Caregivers ; Humans ; Pandemics ; Patient Discharge ; Peru/epidemiology ; Tertiary Care Centers ; Tertiary Healthcare
    Language English
    Publishing date 2021-12-24
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1131675-5
    ISSN 1532-8511 ; 1052-3057
    ISSN (online) 1532-8511
    ISSN 1052-3057
    DOI 10.1016/j.jstrokecerebrovasdis.2021.106275
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Infections of the central nervous system in the neurosurgical patient.

    Zunt, Joseph R

    Handbook of clinical neurology

    2010  Volume 96, Page(s) 125–141

    MeSH term(s) Central Nervous System Infections/diagnosis ; Central Nervous System Infections/epidemiology ; Central Nervous System Infections/etiology ; Central Nervous System Infections/therapy ; Humans ; Neurosurgical Procedures/adverse effects ; Postoperative Complications
    Language English
    Publishing date 2010-01-19
    Publishing country Netherlands
    Document type Journal Article ; Review
    ISSN 0072-9752
    ISSN 0072-9752
    DOI 10.1016/S0072-9752(09)96009-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Mentorship and Ethics in Global Health: Fostering Scientific Integrity and Responsible Conduct of Research.

    Bukusi, Elizabeth A / Manabe, Yukari C / Zunt, Joseph R

    The American journal of tropical medicine and hygiene

    2018  Volume 100, Issue 1_Suppl, Page(s) 42–47

    Abstract: Addressing ethical issues through mentorship is key to encouraging scientific integrity and increasing research capacity. Across the global health arena, mentorship requires helping mentees understand and negotiate the regulatory aspects of research- ... ...

    Abstract Addressing ethical issues through mentorship is key to encouraging scientific integrity and increasing research capacity. Across the global health arena, mentorship requires helping mentees understand and negotiate the regulatory aspects of research-which can substantially differ even between countries with similar resources. Mentorship support spans across the research framework from obtaining ethical approval and ensuring scientific integrity, to determining authorship and disseminating study results-providing multiple opportunities to model ethical behavior for mentees. The power imbalances between the global north and south in accessing funding resources produce further challenges in setting the research agenda and for ensuring equity in the dissemination of research findings. Gender further complicates the aspiration for equity; the proportion of women in high administrative or research positions remains low. This study explores four specific mentoring case scenarios commonly encountered in the global health research field in low- and middle-income institutions.
    MeSH term(s) Authorship ; Biomedical Research/education ; Biomedical Research/ethics ; Cross-Cultural Comparison ; Developing Countries/economics ; Ethics Committees, Research/ethics ; Global Health/education ; Global Health/ethics ; Guidelines as Topic ; Humans ; Mentoring/economics ; Mentoring/ethics ; Mentoring/methods ; Mentors/education ; Plagiarism ; Professional Competence ; Teaching/ethics ; Teaching/organization & administration
    Language English
    Publishing date 2018-12-28
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2942-7
    ISSN 1476-1645 ; 0002-9637
    ISSN (online) 1476-1645
    ISSN 0002-9637
    DOI 10.4269/ajtmh.18-0562
    Database MEDical Literature Analysis and Retrieval System OnLINE

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