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1.  Changes in Immunization Program Managers' Perceptions of Programs' Functional Capabilities During and After Vaccine Shortages and pH1N1 
Public Health Reports  2014;129(Suppl 4):42-48.
We surveyed U.S. immunization program managers (IPMs) as part of a project to improve public health preparedness against future emergencies by leveraging the immunization system. We examined immunization program policy and Immunization Information System (IIS) functionality changes as a result of the Haemophilus influenzae type B (Hib) vaccine shortage and pandemic influenza A(H1N1) (pH1N1). Evaluating changes in immunization program functionalities and policies following emergency response situations will assist in planning for future vaccine-related emergencies.
We administered three consecutive surveys to IPMs from 64 state, city, and territorial jurisdictions in 2009, 2010, and 2012. We compared IPMs' responses across either two or three years (e.g., changes in response or consistent responses across years) using McNemar's test.
Immunization programs maintained increases in functionality related to communication systems with health-care providers during this period. Immunization programs often did not maintain changes to IIS functionalities made from 2009 to 2010 (e.g., identifying high-risk and priority populations, tracking adverse events, and mapping disease risk) in the post-pandemic period (2010–2012). About half of IPMs reporting additional IIS functionality in identifying high-risk populations from 2009 to 2010 reported no longer having this function in 2012. There was an 18% decline in respondents reporting geographic information systems risk-mapping capability in IIS from 2010 to 2012.
Because of the Hib vaccine shortage and pH1N1, immunization program needs and efforts changed to address evolving situations. The lack of sustained increases in resources or system functions after the pandemic highlights the need for comprehensive, sustainable public health emergency preparedness systems and related resources.
PMCID: PMC4187306  PMID: 25355974
2.  Attitudes and knowledge of Georgian physicians regarding cervical cancer prevention, 2010 
To document Georgian physician’s knowledge, attitudes, and practices concerning HPV, Pap smear testing, and HPV vaccination, and to assess whether physician practice might change with additional education and training.
A cross-sectional study was conducted using a self-administered written survey of 288 physicians practicing in 7 healthcare institutions in Tbilisi, Rustavi, and Batumi, Georgia. Data were collected on demographics, conduct of and perceived barriers to Pap smear testing, knowledge about HPV and HPV vaccination, and willingness to receive education and training about HPV and cervical cancer. Univariate counts and proportions were calculated. Pap smear testing and barriers were compared across demographics using bivariate and Poisson regression with robust error variance methods.
Overall, 54% of physicians never performed Pap smears; most reported testing was not their responsibility. Most (88%) obstetricians/gynecologists performed Pap smears. Younger physicians were more likely to perform Pap smears. Approximately 48% of physicians actively offered the HPV vaccine. Most physicians were receptive to increased education and training about HPV and cervical cancer.
Age-related differences in the conduct of and attitudes toward Pap smear testing exist among Georgian physicians. There is an opportunity to increase Pap smear testing and provide evidence-based HPV vaccine counseling in Georgia.
PMCID: PMC3642210  PMID: 23497751
Cervical cytology; Human papillomavirus; Vaccine
3.  Evaluation of the frequency of immunization information system use for public health research 
Human Vaccines & Immunotherapeutics  2013;9(6):1346-1350.
Immunization information systems (IIS) have been useful for consolidating immunization data and increasing coverage, and have the potential to be a valuable resource for immunization research, but the extent which IIS data are used for research purposes has not been evaluated. We reviewed studies conducted using data from federally supported state and city immunization program IIS, and categorized research type based on study objectives to evaluate patterns in the types of research conducted. Research papers using IIS data published between 1999 and July 3, 2012 were identified by searching the CDC IIS publication database and PubMed. These searches produced 304 and 884 papers, respectively, 44 of which were eligible to be included in this evaluation. The most common research category was evaluation of factors associated with vaccine coverage and vaccine coverage estimates (n = 20). This study shows that IIS may not be used to their full potential with regards to research. Further research is needed to determine barriers to using IIS data for research purposes.
PMCID: PMC3901828  PMID: 23422024
immunization information systems; research; review; registry; functionality
4.  Disruption of mutated BRAF signaling modulates thyroid cancer phenotype 
BMC Research Notes  2014;7:187.
Thyroid cancer is the most common endocrine-related cancer in the United States and its incidence is rising rapidly. Since among various genetic lesions identified in thyroid cancer, the BRAFV600E mutation is found in 50% of papillary thyroid cancers and 25% of anaplastic thyroid cancers, this mutation provides an opportunity for targeted drug therapy. Our laboratory evaluated cellular phenotypic effects in response to treatment with PLX4032, a BRAFV600E-specific inhibitor, in normal BRAF-wild-type thyroid cells and in BRAFV600E-positive papillary thyroid cancer cells.
Normal BRAF-wild-type thyroid cells and BRAFV600E-mutated papillary thyroid cancer cells were subjected to proliferation assays and analyzed for cell death by immunofluorescence. Cell cycle status was determined using an EdU uptake assay followed by laser scanning cytometry. In addition, expression of proteins within the MAPK signal transduction pathway was analyzed by Western blot.
PLX4032 has potent anti-proliferative effects selectively in BRAF-mutated thyroid cancer cells. These effects appear to be mediated by the drug’s activity of inhibiting phosphorylation of signaling molecules downstream of BRAF within the pro-survival MAPK pathway. Interestingly, PLX4032 promotes the phosphorylation of these signaling molecules in BRAF-wild-type thyroid cells.
These findings support further evaluation of combinational therapy that includes BRAFV600E inhibitors in thyroid cancer patients harboring the BRAFV600E mutation.
PMCID: PMC3976539  PMID: 24673746
Thyroid cancer; BRAFV600E mutation; PLX4032; MAPK signal transduction pathway; Targeted therapy; Kinase inhibitors
5.  Discovery of a novel T. gondii conoid-associated protein important for parasite resistance to reactive nitrogen intermediates1 
T. gondii modifies its host cell to suppress its ability to become activated in response to IFN-γ and TNF-α and to develop intracellular antimicrobial effectors including nitric oxide. Mechanisms used by of T. gondii to modulate activation of its infected host cell likely underlies its ability to hijack monocytes and dendritic cells (DC) during infection to disseminate to the brain and CNS where it converts to bradyzoites contained in tissue cysts to establish persistent infection. To identify T. gondii genes important for resistance to the effects of host cell activation we developed an in vitro murine macrophage infection and activation model to identify parasite insertional mutants that have a fitness defect in infected macrophages following activation but normal invasion and replication in naïve macrophages. We identified fourteen independent T. gondii insertional mutants out of over 8000 screened that share a defect in their ability to survive macrophage activation due to macrophage production of reactive nitrogen intermediates (RNIs). These mutants have been designated counter-immune (CIM) mutants. We successfully used one of these mutants to identify a T. gondii cytoplasmic and conoid-associated protein important for parasite resistance to macrophage RNIs. Deletion of the entire gene or just the region encoding the protein in wild type parasites recapitulated the RNI-resistance defect in the CIM mutant confirming the role of the protein in resistance to macrophage RNI.
PMCID: PMC3320748  PMID: 22387554
6.  Parents' Source of Vaccine Information and Impact on Vaccine Attitudes, Beliefs, and Nonmedical Exemptions 
In recent years, use of the Internet to obtain vaccine information has increased. Historical data are necessary to evaluate current vaccine information seeking trends in context. Between 2002 and 2003, surveys were mailed to 1,630 parents of fully vaccinated children and 815 parents of children with at least one vaccine exemption; 56.1% responded. Respondents were asked about their vaccine information sources, perceptions of these sources accuracy, and their beliefs about vaccination. Parents who did not view their child's healthcare provider as a reliable vaccine information source were more likely to obtain vaccine information using the Internet. Parents who were younger, more highly educated, and opposed to school immunization requirements were more likely than their counterparts to use the Internet for vaccine information. Compared to parents who did not use the Internet for vaccine information, those who sought vaccine information on the Internet were more likely to have lower perceptions of vaccine safety (adjusted odds ratio (aOR), 1.66; 95% CI, 1.18–2.35), vaccine effectiveness (aOR, 1.83; 95% CI, 1.32–2.53), and disease susceptibility (aOR, 2.08; 95% CI, 1.49–2.90) and were more likely to have a child with a nonmedical exemption (aOR 3.53, 95% CI, 2.61–4.76). These findings provide context to interpret recent vaccine information seeking research.
PMCID: PMC3469070  PMID: 23082253
7.  Descriptive epidemiology of Pap test results from women with gynecologic symptoms in Georgia 
With abnormal cervical cytology found in approximately 20% of Georgian women presenting with gynecologic complaints, widespread education is needed about Pap testing when symptoms are present.
PMCID: PMC3039132  PMID: 21272882
Cervical cytology; High risk; Pap test

Results 1-7 (7)