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Open Access Publications from the University of California

Scholarly Works (6 results)

  • Multimedia
Symposium 2023 (2023)

Background:

The transition period between pediatric and adult care is a challenging time marked with high risk and vulnerability. This is especially true in adolescent patients with a transplanted kidney, which is described as the period with the highest rate of graft loss. Studies demonstrate that 83% of young adult with special health care needs (SHCN) and 86% of young adults without SHCN do not meet the national health care transition (HCT) measures published in a clinical report authored by the AAP in collaboration with the AAFP and ACP. Studies demonstrate that there are adverse effects associated with a lack of structured HCT interventions including medical complications, limitations in health and well-being, problems with treatment and medication adherence, discontinuity of care, patient dissatisfaction, higher emergency department use, and higher costs of care. Data are limited regarding HCT outcomes, but studies in the US and internationally demonstrate improvements in quality of care, terms of service use, and patient and family experience with a structured transition protocol.

Description of the Project:

Our project aims to assess how well patients are transitioned from pediatric kidney transplant clinic at Rady Children’s Hospital in San Diego (RCHSD) to adult kidney transplant clinic at UC San Diego Health (UCSD). A retrospective chart review of patients who transitioned from RCHSD to UCSD transplant clinic from the years 2020-2023 is currently being performed to examine metrics such as change in creatinine, blood pressure, rates of infection, and episodes of rejection during this period of transition. Additionally, we will look at the time elapsed between patients’ last visit at RCHSD and first visit at UCSD and time between labs to assess for possible areas of improvement. We will also conduct a telephone survey with patients who have completed this transition to understand their perspective of the transition process. We will look at outcomes prior to and following the implementation of our current transitions program which includes strutted transition-specific visits to assess and address individual areas of need before they transition.

Lessons Learned/Expected Outcomes:

We expect to have more data at the time of the presentation as a chart review is currently underway. We anticipate that the outcome of this project will reveal a few areas of improvement. One area of anticipated improvement would be in decreasing the time between the last visit and last labs performed at RCHSD and the first visit and first set of labs performed at UCSD.

Recommendations/Next Steps:

The next steps for this project are to further analyze the data collected from chart review and assess for patterns and areas of possible intervention in the current kidney transplant clinic transition process. Following this study which focuses specifically on transitions of care in patients with kidney transplant, the goal will be to perform similar studies assessing how effective our transitions are for patients with various forms of kidney pathology who are seen in other nephrology clinics.

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  • Article
  • Peer Reviewed
UCLA Previously Published Works (2011)
Abstract Background Influenza super-strains can emerge through recombination of strains from birds, pigs, and humans. However, once a new recombinant strain emerges, it is not clear whether the strain is capable of sustaining an outbreak. In certain cases, such strains have caused major influenza pandemics. Methods Here we develop a multi-host (i.e., birds, pigs, and humans) and multi-strain model of influenza to analyze the outcome of emergent strains. In the model, pigs act as “mixing vessels” for avian and human strains and can produce super-strains from genetic recombination. Results We find that epidemiological outcomes are predicted by three factors: (i) contact between pigs and humans, (ii) transmissibility of the super-strain in humans, and (iii) transmissibility from pigs to humans. Specifically, outbreaks will reoccur when the super-strain intections are less frequent between humans (e.g., R0=1.4) but grequent from pigs to humans, and a large-scale outbreak followed by successively damping outbreaks will occur when human transmissibility is high (e.g., R0=2.3). The average time between the initial outbreak and the first resurgence varies from 41 to 82 years. We determine the largest outbreak will occur when 2.3
    Cover page: Emergence and dynamics of influenza super-strains
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2017)
    Detailed geospatial mapping of a generalized HIV epidemic in sub-Saharan Africa shows that implementing the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 strategy could potentially exacerbate urban-rural health care disparities.
      Cover page: Response to comment on “Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa”
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2013)
      Abstract Background The most severe HIV epidemics worldwide occur in Lesotho, Botswana and Swaziland. Here we focus on the Lesotho epidemic, which has received little attention. We determined the within-country heterogeneity in the severity of the epidemic, and identified the risk factors for HIV infection. We also determined whether circumcised men in Lesotho have had a decreased risk of HIV infection in comparison with uncircumcised men. We discuss the implications of our results for expanding treatment (current coverage is only 60%) and reducing transmission. Methods We used data from the 2009 Lesotho Demographic and Health Survey, a nationally representative survey of 3,849 women and 3,075 men in 9,391 households. We performed multivariate analysis to identify factors associated with HIV infection in the sexually active population and calculated age-adjusted odds ratios (aORs). We constructed cartographic country-level prevalence maps using geo-referenced data. Results HIV is hyperendemic in the general population. The average prevalence is 27% in women and 18% in men, but shows substantial geographic variation. Throughout the country prevalence is higher in urban centers (31% in women; 21% in men) than in rural areas (25% in women; 17% in men), but the vast majority of HIV-infected individuals live in rural areas. Notably, prevalence is extremely high in women (18%) and men (12%) with only one lifetime sex partner. Women with more partners have a greater risk of infection: aOR 2.3 (2 to 4 partners), aOR 4.4 (≥5 partners). A less substantial effect was found for men: aOR 1.4 (3 to 6 partners), aOR 1.8 (≥7 partner). Medical circumcision protected against infection (aOR 0.5), traditional circumcision did not (aOR 0.9). Less than 5% of men in Lesotho have been medically circumcised; approximately 50% have been circumcised using traditional methods. Conclusions There is a substantial need for treatment throughout Lesotho, particularly in rural areas where there is the greatest burden of disease. Interventions aimed at reducing the number of sex partners may only have a limited effect on reducing transmission. Substantially increasing levels of medical circumcision could be very effective in reducing transmission, but will be very difficult to achieve given the current high prevalence of traditional circumcision.
        Cover page: Current drivers and geographic patterns of HIV in Lesotho: implications for treatment and prevention in Sub-Saharan Africa
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2009)
        Abstract Background Clearly air travel, by transporting infectious individuals from one geographic location to another, significantly affects the rate of spread of influenza A (H1N1). However, the possibility of within-flight transmission of H1N1 has not been evaluated; although it is known that smallpox, measles, tuberculosis, SARS and seasonal influenza can be transmitted during commercial flights. Here we present the first quantitative risk assessment to assess the potential for within-flight transmission of H1N1. Methods We model airborne transmission of infectious viral particles of H1N1 within a Boeing 747 using methodology from the field of quantitative microbial risk assessment. Results The risk of catching H1N1 will essentially be confined to passengers travelling in the same cabin as the source case. Not surprisingly, we find that the longer the flight the greater the number of infections that can be expected. We calculate that H1N1, even during long flights, poses a low to moderate within-flight transmission risk if the source case travels First Class. Specifically, 0-1 infections could occur during a 5 hour flight, 1-3 during an 11 hour flight and 2-5 during a 17 hour flight. However, within-flight transmission could be significant, particularly during long flights, if the source case travels in Economy Class. Specifically, two to five infections could occur during a 5 hour flight, 5-10 during an 11 hour flight and 7-17 during a 17 hour flight. If the aircraft is only partially loaded, under certain conditions more infections could occur in First Class than in Economy Class. During a 17 hour flight, a greater number of infections would occur in First Class than in Economy if the First Class Cabin is fully occupied, but Economy class is less than 30% full. Conclusions Our results provide insights into the potential utility of air travel restrictions on controlling influenza pandemics in the winter of 2009/2010. They show travel by one infectious individual, rather than causing a single outbreak of H1N1, could cause several simultaneous outbreaks. These results imply that, during a pandemic, quarantining passengers who travel in Economy on long-haul flights could potentially be an important control strategy. Notably, our results show that quarantining passengers who travel First Class would be unlikely to be an effective control strategy.
          Cover page: Calculating the potential for within-flight transmission of influenza A (H1N1)
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2017)
          Treatment as prevention (TasP) has been proposed by the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) as a global strategy for eliminating HIV. The rationale is that treating individuals reduces their infectivity. We present a geostatistical framework for designing TasP-based HIV elimination strategies in sub-Saharan Africa. We focused on Lesotho, where ~25% of the population is infected. We constructed a density of infection map by gridding high-resolution demographic data and spatially smoothing georeferenced HIV testing data. The map revealed the countrywide geographic dispersion pattern of HIV-infected individuals. We found that ~20% of the HIV-infected population lives in urban areas and that almost all rural communities have at least one HIV-infected individual. We used the map to design an optimal elimination strategy and identified which communities should use TasP. This strategy minimized the area that needed to be covered to find and treat HIV-infected individuals. We show that UNAIDS's elimination strategy would not be feasible in Lesotho because it would require deploying treatment in areas where there are ~4 infected individuals/km2 Our results show that the spatial dispersion of Lesotho's population hinders, and may even prevent, the elimination of HIV.
            Cover page: Using geospatial mapping to design HIV elimination strategies for sub-Saharan Africa
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