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1.  Continuity in a VA Patient-Centered Medical Home Reduces Emergency Department Visits 
PLoS ONE  2014;9(5):e96356.
Background
One major goal of the Patient-Centered Medical Home (PCMH) is to improve continuity of care between patients and providers and reduce the utilization of non-primary care services like the emergency department (ED).
Objective
To characterize continuity under the Veterans Health Administration’s PCMH model – the Patient Aligned Care Team (PACT), at one large Veterans Affair’s (VA’s) primary care clinic, determine the characteristics associated with high levels of continuity, and assess the association between continuity and ED visits.
Design
Retrospective, observational cohort study of patients at the West Haven VA (WHVA) Primary Care Clinic from March 2011 to February 2012.
Patients
The 13,495 patients with established care at the Clinic, having at least one visit, one year before March 2011.
Main Measures
Our exposure variable was continuity of care –a patient seeing their assigned primary care provider (PCP) at each clinic visit. The outcome of interest was having an ED visit.
Results
The patients encompassed 42,969 total clinic visits, and 3185 (24%) of them had 15,458 ED visits. In a multivariable logistic regression analysis, patients with continuity of care – at least one visit with their assigned PCP – had lower ED utilization compared to individuals without continuity (adjusted odds ratio [AOR] 0.54; 95% CI: 0.41, 0.71), controlling for frequency of primary care visits, comorbidities, insurance, distance from the ED, and having a trainee PCP assigned. Likewise, the adjusted rate of ED visits was 544/1000 person-year (PY) for patients with continuity vs. 784/1000 PY for patients without continuity (p = 0.001). Compared to patients with low continuity (<33% of visits), individuals with medium (33–50%) and high (>50%) continuity were less likely to utilize the ED.
Conclusions
Strong continuity of care is associated with decreased ED utilization in a PCMH model and improving continuity may help reduce the utilization of non-primary care services.
doi:10.1371/journal.pone.0096356
PMCID: PMC4035271  PMID: 24867300
2.  Regional Changes in the Sequence of Cotton Leaf Curl Multan Betasatellite 
Viruses  2014;6(5):2186-2203.
Cotton leaf curl disease (CLCuD) in Pakistan and northwestern India is caused by monopartite begomoviruses in association with an essential, disease-specific satellite, Cotton leaf curl Multan betasatellite (CLCuMB). Following a recent upsurge in CLCuD problems in Sindh province (southern Pakistan), sequences of clones of CLCuMB were obtained from Sindh and Punjab province (central Pakistan), where CLCuD has been a problem since the mid-1980s. The sequences were compared to all sequences of CLCuMB available in the databases. Analysis of the sequences shows extensive sequence variation in CLCuMB, most likely resulting from recombination. The range of sequence variants differ between Sindh, the Punjab and northwestern India. The possible significance of the findings with respect to movement of the CLCuD between the three regions is discussed. Additionally, the lack of sequence variation within the only coding sequence of CLCuMB suggests that the betasatellite is not involved in resistance breaking which became a problem after 2001 in the Punjab and subsequently also in northwestern India.
doi:10.3390/v6052186
PMCID: PMC4036549  PMID: 24859342
begomovirus; betasatellite; genetic diversity; recombination
3.  Atypical radiological manifestations of thoracic sarcoidosis: A review and pictorial essay 
Annals of Thoracic Medicine  2013;8(4):186-196.
Thoracic sarcoidosis is a common disease, with well-described and recognizable radiographic features. Nevertheless, most physicians are not familiar with the rare atypical often-confusing manifestations of thoracic sarcoid. Although these findings have been previously reviewed, but more recent advances in imaging and laboratory science, need to be incorporated. We present a review of literature and illustrate the review with unpublished data, intended to provide a more recent single comprehensive reference to assist with the diagnosis when atypical radiographic findings of thoracic sarcoidosis are encountered. Thoracic involvement accounts for most of morbidity and mortality associated with sarcoidosis. An accurate timely identification is required to minimize morbidity and mortality. It is essential to recognize atypical imaging findings and relate these to clinical manifestations and histology.
doi:10.4103/1817-1737.118490
PMCID: PMC3821277  PMID: 24250731
Atypical; cardiology; chest; radiology; sarcoidosis
4.  Origin of chains of Au-PbS Nano-Dumbbells in space 
Scientific Reports  2013;3:2612.
Self-assembled, one-dimensional (1D) nanomaterials are amenable building blocks for bottom-up nanofabrication processes. A current shortcoming in the self-assembly of 1D nanomaterials in solution phase is the need for specific linkers or templates under very precise conditions to achieve a handful of systems. Here we report on the origin of a novel self-assembly of 1D dumbbells consisting of Au tipped PbS nanorods into stable chains in solution without any linkers or templates. A realistic multi-particle model suggests that the mesophase comprises 1D dumbbells arrayed in chains formed by anisotropic van der Waals type interactions. We demonstrate an alternative recognition mechanism for directing the assembly of the 1D dumbbells, based on effective interaction between the neighboring dumbbells consisting of Au tips with complementary crystallographic facets that guides the entire assembly in space.
doi:10.1038/srep02612
PMCID: PMC3767952  PMID: 24018991
5.  Value of delayed 18F-FDG PET in the diagnosis of solitary pulmonary nodule 
Journal of Thoracic Disease  2013;5(3):373-374.
Performing dual point 18F-FDG PET scans of solitary pulmonary nodules at an initial SUV (max) <2.5 is a useful technique. However, prolonging second image acquisition from 120 to 180 min does not appear to improve accuracy. Dual time 18F-FDG PET is not useful in differentiating benign and malignant pulmonary nodules with an initial mean SUV ≤2.5 in parts of the world where granulomatous disease is prevalent. Prolonged imaging on PET scanners is expensive particularly where availability if these scanners is limited. Further prospective research is required to define the potential benefits of dual time point 18F-FDG PET imaging, before recommending routine use of the technique.
doi:10.3978/j.issn.2072-1439.2013.06.05
PMCID: PMC3698279  PMID: 23825780
Solitary pulmonary nodules; dual-point scan18F-FDG PET scans
6.  Molecular origin of EPR lineshapes on β–barrel membrane proteins: local solvation environment modulates spin label configuration† 
Biochemistry  2011;50(41):8792-8803.
In the present work, EPR spectroscopy and X-ray crystallography were used to examine the origins of EPR lineshapes from spin labels at the protein-lipid interface on the β-barrel membrane protein BtuB. Two atomic-resolution structures were obtained for the methanethiosulfonate spin label derivatized to cysteines on the membrane-facing surface of BtuB. At one of these sites, position 156, the label side-chain resides in a pocket formed by neighboring side chains; however, it extends from the protein surface and yields a single-component EPR spectrum in the crystal that results primarily from fast rotation about the fourth and fifth bonds linking the spin label to the protein backbone. In lipid bilayers, site 156 yields a multicomponent spectrum resulting from different rotameric states of the labeled side chain. Moreover, changes in the lipid environment, such as variations in bilayer thickness, modulate the EPR spectrum by modulating label rotamer populations. At a second site, position 371, the labeled side chain interacts with a pocket on the protein surface leading to a highly immobilized single component EPR spectrum that is not sensitive to hydrocarbon thickness. This spectrum is similar to that seen at other sites that are deep in the hydrocarbon, such as position 170. This work indicates that the rotameric states of spin labels on exposed hydrocarbon sites are sensitive to the environment at the protein-hydrocarbon interface, and that this environment may modulate weak interactions between the labeled side chain and the protein surface. In the case of BtuB, lipid acyl chain packing is not symmetric around the β-barrel, and EPR spectra from labeled hydrocarbon facing sites in BtuB may reflect this asymmetry. In addition to facilitating the interpretation of EPR spectra from membrane proteins, these results have important implications for the use of long-range distance restraints in protein structure refinement that are obtained from spin labels.
doi:10.1021/bi200971x
PMCID: PMC3199607  PMID: 21894979
8.  Imaging Review of Procedural and Periprocedural Complications of Central Venous Lines, Percutaneous Intrathoracic Drains, and Nasogastric Tubes 
Pulmonary Medicine  2012;2012:842138.
Placements of central venous lines (CVC), percutaneous intrathoracic drains (ITDs), and nasogastric tubes (NGTs) are some of the most common interventional procedures performed on patients that are unconscious and in almost all intensive care/high dependency patients in one form or the other. These are standard procedures within the remit of physicians, and other trained health professionals. Procedural complications may occur in 7%–15% of patients depending upon the intervention and experience of the operator. Most complications are minor, but other serious complications may add significantly to morbidity and even mortality of already compromised patients. Imaging findings are the key to the detection of misplaced lines, and tubes and their prompt recognition are vital to avoid harm to the patient. It is, therefore, pertinent that healthcare professionals who perform these procedures are familiar with imaging complications of these procedures. Here, we present the imaging characteristics of procedural complications.
doi:10.1155/2012/842138
PMCID: PMC3437305  PMID: 22970363
9.  Combined use of EUS-guided FNA and immunocytochemical stains discloses metastatic and unusual diseases in the evaluation of mediastinal lymphadenopathy of unknown etiology 
Annals of Thoracic Medicine  2012;7(2):84-91.
PURPOSE:
Mediastinal lymphadenopathy (ML) is a cause for concern, especially in patients with previous malignancy. We report our experience with the use of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with immunocytochemical stains in patients being evaluated for ML.
METHODS:
Retrospective analysis of patients with ML of unknown origin who underwent EUS-FNA. On-site evaluation was performed by experienced cytologist, and special immunocytochemical stains were requested as indicated.
RESULTS:
A total of 116 patients were included, and a total of 136 mediastinal LN were sampled. Prior malignancy was present in 45%. The most common site of examined lymph node (LN) were subcarinal (76%, 103 LN). The median long and short axis diameters were 28 mm and 13 mm, respectively. FNA was read on-site as malignant, 21 (16%); benign, 100 (76.9%); suspicious, six (4%); atypical, 3 (2%); and inadequate sample, six (4%). Sixty-four LN were deferred for additional studies; 22 for immunocytochemical and 26 for Gimesa (GMS) stain and 21 for flow cytometry. Final FNA read was malignant in 28 (21%), benign in 103 (76%), suspicious in three (2%), and atypical in two (1%). Metastatic malignancies disclosed included Hodgkin's and Non-Hodgkin's lymphoma, melanoma, hepatoma, breast, lung, colon, renal, endometrial, Fallopian tube, and unknown carcinoma. The sensitivity, specificity, and accuracy of the final FNA read to predict malignancy were 100%.
CONCLUSION:
EUS-guided FNA with additional ancillary studies is useful in disclosing metastatic ML from a variety of neoplasms. Due to its safety and accuracy profile, it should be considered the test of choice in evaluating abnormal ML in appropriately selected patients.
doi:10.4103/1817-1737.94527
PMCID: PMC3339209  PMID: 22558013
Endoscopic ultrasound; fine needle aspiration; immunostains; lung cancer; metastatic disease
10.  Solitary pulmonary nodule: A diagnostic algorithm in the light of current imaging technique 
Avicenna Journal of Medicine  2011;1(2):39-51.
The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT). The finding of a SPN usually provokes a flurry of clinical and imaging activity as an SPN in at-risk population is an alert signal of possible lung cancer. The frequency of malignant nodules in a given population is variable and depends on the endemicity of granulomatous disease. The percentage of malignant nodules also rises when dealing with at-risk population. The problem is compounded by the fact that with the present generation of CT scanners, 1–2 mm nodules are discovered in approximately half of the smokers aged 50 years or older scanned. A variety of management approaches are applied in the work-up of SPN often requiring evaluation over a long period of time to establish a benign or malignant diagnosis. Comparison with previous imaging studies and morphologic evaluation of the size, margins, and internal characteristics are usually the first step in the evaluation of these nodules. It is often necessary to use additional imaging techniques and occasionally invasive procedures such a percutaneous needle lung or a surgical biopsy. Until recently, the guidelines for follow-up of indeterminate noncalcified nodules detected on nonscreening CT was a minimum of 2 years. However, during the past few years due to further refinements in CT technology and better understanding of tumor behavior, it has prompted a revision of the guidelines of the follow-up of small indeterminate nodules. These guidelines have been endorsed by the Fleischner Society.
doi:10.4103/2231-0770.90915
PMCID: PMC3507065  PMID: 23210008
Benign lung nodules; CT; lung cancer; PET/CT; pulmonary nodules
11.  Pulmonary vascular complications of chronic liver disease: Pathophysiology, imaging, and treatment 
Annals of Thoracic Medicine  2011;6(2):57-65.
To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease.
doi:10.4103/1817-1737.78412
PMCID: PMC3081557  PMID: 21572693
Hepatopulmonary syndrome; portopulmonary hypertension; pulmonary arteriovenous shunts; Yttrium-90 microsphere embolization hepatocellular carcinoma
12.  Potential Influence of Climate Change on Vector-Borne and Zoonotic Diseases: A Review and Proposed Research Plan 
Environmental Health Perspectives  2010;118(11):1507-1514.
Background
Because of complex interactions of climate variables at the levels of the pathogen, vector, and host, the potential influence of climate change on vector-borne and zoonotic diseases (VBZDs) is poorly understood and difficult to predict. Climate effects on the nonvector-borne zoonotic diseases are especially obscure and have received scant treatment.
Objective
We described known and potential effects of climate change on VBZDs and proposed specific studies to increase our understanding of these effects. The nonvector-borne zoonotic diseases have received scant treatment and are emphasized in this paper.
Data sources and synthesis
We used a review of the existing literature and extrapolations from observations of short-term climate variation to suggest potential impacts of climate change on VBZDs. Using public health priorities on climate change, published by the Centers for Disease Control and Prevention, we developed six specific goals for increasing understanding of the interaction between climate and VBZDs and for improving capacity for predicting climate change effects on incidence and distribution of VBZDs.
Conclusions
Climate change may affect the incidence of VBZDs through its effect on four principal characteristics of host and vector populations that relate to pathogen transmission to humans: geographic distribution, population density, prevalence of infection by zoonotic pathogens, and the pathogen load in individual hosts and vectors. These mechanisms may interact with each other and with other factors such as anthropogenic disturbance to produce varying effects on pathogen transmission within host and vector populations and to humans. Because climate change effects on most VBZDs act through wildlife hosts and vectors, understanding these effects will require multidisciplinary teams to conduct and interpret ecosystem-based studies of VBZD pathogens in host and vector populations and to identify the hosts, vectors, and pathogens with the greatest potential to affect human populations under climate change scenarios.
doi:10.1289/ehp.0901389
PMCID: PMC2974686  PMID: 20576580
anthropogenic disturbance; climate change; infectious diseases; reservoir; vector; vector-borne disease; wildlife; zoonotic disease
13.  Image perception and interpretation of abnormalities; can we believe our eyes? Can we do something about it? 
Insights into Imaging  2010;2(1):47-55.
The radiologist’s visual impression of images is transmitted, via non-visual means (the report), to the clinician. There are several complex steps from the perception of the images by the radiologist to the understanding of the impression by the clinician. With a process as complex as this, it is no wonder that errors in perception, cognition, interpretation, transmission and understanding are very common. This paper reviews the processes of perception and error generation and possible strategies for minimising them.
doi:10.1007/s13244-010-0048-1
PMCID: PMC3259345  PMID: 22347933
Image perception; Interpretation; Errors
14.  Image perception and interpretation of abnormalities; can we believe our eyes? Can we do something about it? 
Insights into Imaging  2010;2(1):47-55.
The radiologist’s visual impression of images is transmitted, via non-visual means (the report), to the clinician. There are several complex steps from the perception of the images by the radiologist to the understanding of the impression by the clinician. With a process as complex as this, it is no wonder that errors in perception, cognition, interpretation, transmission and understanding are very common. This paper reviews the processes of perception and error generation and possible strategies for minimising them.
doi:10.1007/s13244-010-0048-1
PMCID: PMC3259345  PMID: 22347933
Image perception; Interpretation; Errors
15.  Imaging lung manifestations of HIV/AIDS 
Annals of Thoracic Medicine  2010;5(4):201-216.
Advances in our understanding of human immunodeficiency virus (HIV) infection have led to improved care and incremental increases in survival. However, the pulmonary manifestations of HIV/acquired immunodeficiency syndrome (AIDS) remain a major cause of morbidity and mortality. Respiratory complaints are not infrequent in patients who are HIV positive. The great majority of lung complications of HIV/AIDS are of infectious etiology but neoplasm, interstitial pneumonias, Kaposi sarcoma and lymphomas add significantly to patient morbidity and mortality. Imaging plays a vital role in the diagnosis and management of lung of complications associated with HIV. Accurate diagnosis is based on an understanding of the pathogenesis of the processes involved and their imaging findings. Imaging also plays an important role in selection of the most appropriate site for tissue sampling, staging of disease and follow-ups. We present images of lung manifestations of HIV/AIDS, describing the salient features and the differential diagnosis.
doi:10.4103/1817-1737.69106
PMCID: PMC2954374  PMID: 20981180
HIV/AIDS; imaging lung; mediastinal manifestations
16.  FreeSurfer-Initiated Fully-Automated Subcortical Brain Segmentation in MRI Using Large Deformation Diffeomorphic Metric Mapping 
NeuroImage  2008;41(3):735-746.
Fully-automated brain segmentation methods have not been widely adopted for clinical use because of issues related to reliability, accuracy, and limitations of delineation protocol. By combining the probabilistic-based FreeSurfer (FS) method with the Large Deformation Diffeomorphic Metric Mapping (LDDMM) based label propagation method, we are able to increase reliability and accuracy, and allow for flexibility in template choice. Our method uses the automated FreeSurfer subcortical labeling to provide a coarse to fine introduction of information in the LDDMM template-based segmentation resulting in a fully-automated subcortical brain segmentation method (FS+LDDMM).
One major advantage of the FS+LDDMM-based approach is that the automatically generated segmentations generated are inherently smooth, thus subsequent steps in shape analysis can directly follow without manual post-processing or loss of detail.
We have evaluated our new FS+LDDMM method on several databases containing a total of 50 subjects with different pathologies, scan sequences and manual delineation protocols for labeling the basal ganglia, thalamus, and hippocampus. In healthy controls we report Dice overlap measures of 0.81, 0.83, 0.74, 0.86 and 0.75 for the right caudate nucleus, putamen, pallidum, thalamus and hippocampus respectively. We also find statistically significant improvement of accuracy in FS+LDDMM over FreeSurfer for the caudate nucleus and putamen of Huntington’s disease and Tourette’s syndrome subjects, and the right hippocampus of Schizophrenia subjects.
doi:10.1016/j.neuroimage.2008.03.024
PMCID: PMC2905149  PMID: 18455931
Computational Anatomy; Automated Segmentation; MR Imaging; FreeSurfer; Hippocampus; Basal Ganglia; Thalamus
17.  Fully-Automated, Multi-Stage Hippocampus Mapping in Very Mild Alzheimer Disease 
Hippocampus  2009;19(6):541-548.
Landmark-based high-dimensional diffeomorphic maps of the hippocampus (although accurate) is highly-dependent on rater’s anatomic knowledge of the hippocampus in the magnetic resonance images. It is therefore vulnerable to rater drift and errors if substantial amount of effort is not spent on quality assurance, training, and re-training. A fully-automated, FreeSurfer-initialized large-deformation diffeomorphic metric mapping procedure of small brain substructures, including the hippocampus, has been previously developed and validated in small samples. In this report, we demonstrate that this fully-automated pipeline can be used in place of the landmark-based procedure in a large-sample clinical study to produce similar statistical outcomes. Some direct comparisons of the two procedures are also presented.
doi:10.1002/hipo.20616
PMCID: PMC2841395  PMID: 19405129
Computational anatomy; Automated segmentation; MR imaging; FreeSurfer
18.  The calcified lung nodule: What does it mean? 
Annals of Thoracic Medicine  2010;5(2):67-79.
The aim of this review is to present a pictorial essay emphasizing the various patterns of calcification in pulmonary nodules (PN) to aid diagnosis and to discuss the differential diagnosis and the pathogenesis where it is known. The imaging evaluation of PN is based on clinical history, size, distribution and the gross appearance of the nodule as well as feasibility of obtaining a tissue diagnosis. Imaging is instrumental in the management of PN and one should strive not only to identify small malignant tumors with high survival rates but to spare patients with benign PN from undergoing unnecessary surgery. The review emphasizes how to achieve these goals. One of the most reliable imaging features of a benign lesion is a benign pattern of calcification and periodic follow-up with computed tomography showing no growth for 2 years. Calcification in PN is generally considered as a pointer toward a possible benign disease. However, as we show here, calcification in PN as a criterion to determine benign nature is fallacious and can be misleading. The differential considerations of a calcified lesion include calcified granuloma, hamartoma, carcinoid, osteosarcoma, chondrosarcoma and lung metastases or a primary bronchogenic carcinoma among others. We describe and illustrate different patterns of calcification as seen in PN on imaging.
doi:10.4103/1817-1737.62469
PMCID: PMC2883201  PMID: 20582171
Benign pulmonary nodules; malignant pulmonary nodules; calcification
19.  Reading chest radiographs in the critically ill (Part II): Radiography of lung pathologies common in the ICU patient 
Annals of Thoracic Medicine  2009;4(3):149-157.
This is part II of two series review of reading chest radiographs in the critically ill. Conventional chest radiography remains the cornerstone of day to day management of the critically ill occasionally supplemented by computed tomography or ultrasound for specific indications. In this second review we discuss radiographic findings of cardiopulmonary disorders common in the intensive care patient and suggest guidelines for interpretation based not only on imaging but also on the pathophysiology and clinical grounds.
doi:10.4103/1817-1737.53349
PMCID: PMC2714572  PMID: 19641649
Chest x-ray; intensive care unit; cardiopulmonary disorders
21.  Micronutrients and Anaemia 
Micronutrient deficiencies and anaemia remain as major health concerns for children in Bangladesh. Among the micronutrient interventions, supplementation with vitamin A to children aged less than five years has been the most successful, especially after distribution of vitamin A was combined with National Immunization Days. Although salt sold in Bangladesh is intended to contain iodine, much of the salt does not contain iodine, and iodine deficiency continues to be common. Anaemia similarly is common among all population groups and has shown no sign of improvement even when iron-supplementation programmes have been attempted. It appears that many other causes contribute to anaemia in addition to iron deficiency. Zinc deficiency is a key micronutrient deficiency and is covered in a separate paper because of its importance among new child-health interventions.
PMCID: PMC2740705  PMID: 18831229
Anaemia; Anaemia, Iron-deficiency; Iodine deficiency; Iron deficiency; Interventions; Micronutrients; Vitamin A deficiency; Bangladesh
22.  Bronchiolitis obliterans organizing pneumonia: Pathogenesis, clinical features, imaging and therapy review 
Annals of Thoracic Medicine  2008;3(2):67-75.
Bronchiolitis obliterans organizing pneumonia (BOOP) was first described in the early 1980s as a clinicopathologic syndrome characterized symptomatically by subacute or chronic respiratory illness and histopathologically by the presence of granulation tissue in the bronchiolar lumen, alveolar ducts and some alveoli, associated with a variable degree of interstitial and airspace infiltration by mononuclear cells and foamy macrophages. Persons of all ages can be affected. Dry cough and shortness of breath of 2 weeks to 2 months in duration usually characterizes BOOP. Symptoms persist despite antibiotic therapy. On imaging, air space consolidation can be indistinguishable from chronic eosinophilic pneumonia (CEP), interstitial pneumonitis (acute, nonspecific and usual interstitial pneumonitis, neoplasm, inflammation and infection). The definitive diagnosis is achieved by tissue biopsy. Patients with BOOP respond favorably to treatment with steroids.
doi:10.4103/1817-1737.39641
PMCID: PMC2700454  PMID: 19561910
Bronchiolitis; cryptogenic organizing pneumonia; organizing pneumonia
23.  Virus-specific RNA and Antibody from Convalescent-phase SARS Patients Discharged from Hospital 
Emerging Infectious Diseases  2004;10(10):1745-1750.
The prevalence of SARS-CoV in bodily excretions was determined.
Severe acute respiratory syndrome (SARS) is caused by a novel coronavirus (SARS-CoV). In a longitudinal cross-sectional study, we determined the prevalence of virus in bodily excretions and time of seroconversion in discharged patients with SARS. Conjunctival, throat, stool, and urine specimens were collected weekly from 64 patients and tested for SARS-CoV RNA by real-time polymerase chain reaction; serum samples were collected weekly and tested for SARS-CoV antibody with indirect enzyme immunoassay and immunofluorescence assay. In total, 126 conjunctival, 124 throat swab, 116 stool, and 124 urine specimens were analyzed. Five patients had positive stool samples, collected in weeks 5–9. Two patients seroconverted in weeks 7 and 8; the others were seropositive at the first serum sample collection. In this study, 5 (7.8%) of 64 patients continued to shed viral RNA in stool samples only, for up to week 8 of illness. Most seroconversions occurred by week 6 of illness.
doi:10.3201/eid1010.040026
PMCID: PMC3323266  PMID: 15504259
SARS; convalescence; polymerase chain reaction; serology; ELISA; Indirect Immunofluorescence Assay; research
24.  Outbreak of Hantavirus Pulmonary Syndrome, Los Santos, Panama, 1999–2000 
Emerging Infectious Diseases  2004;10(9):1635-1642.
The first identified outbreak of hantavirus pulmonary syndrome in Central America is described.
An outbreak of hantavirus pulmonary syndrome occurred in the province of Los Santos, Panama, in late 1999 and early 2000. Eleven cases were identified; 9 were confirmed by serology. Three cases were fatal; however, no confirmed case-patient died. Case-neighborhood serologic surveys resulted in an overall hantavirus antibody prevalence of 13% among household and neighborhood members from the outbreak foci. Epidemiologic investigations did not suggest person-to-person transmission of hantavirus infection. By use of Sin Nombre virus antigen, hantavirus antibodies were detected in Oligoryzomys fulvescens and Zygodontomys brevicauda cherriei. This outbreak resulted in the first documented cases of human hantavirus infections in Central America.
doi:10.3201/eid1009.040143
PMCID: PMC3320309  PMID: 15498167
Hantavirus pulmonary syndrome; hantavirus; kidney diseases; biliary disease; hemorrhage; Zygodontomys; Oligoryzomys fulvescens; Panama; research
25.  SARS Transmission and Hospital Containment 
Emerging Infectious Diseases  2004;10(3):395-400.
An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute care hospitals in Singapore. The critical factor in containing this outbreak was early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.
doi:10.3201/eid1003.030650
PMCID: PMC3322797  PMID: 15109403
coronavirus; cross infections; hospital; infection control; nosocomial infections; severe acute respiratory syndrome; Singapore

Results 1-25 (34)