I am an infectious disease fellow and post-doctoral researcher in the Division of Infectious Diseases and Geographic Medicine, the Luby Lab, the Center for Innovation in Global Health, and the Woods Institute for the Environment. I worked on the covid19 outbreak for the Massachusetts Department of Public Health in 2020, and the monkeypox outbreak for the Los Angeles County Department of Public Health in 2022-23. I also served on the WHO-commissioned Independent Panel on Pandemic Preparedness and Response's research team investigating early global spread of covid19, and helped with policy-writing for the Biden-Harris campaign on reducing Covid19 in schools. I am currently the Principal Investigator of a cluster-randomized controlled trial investigating whether air filtration and ventilation can reduce spread of Covid19 in homes (https://clinicaltrials.gov/ct2/show/NCT05777720).
I completed my internal medicine residency at the Brigham and Women's Hospital/Harvard Medical School in the Global Health Equity program, and have been working in global health since 2008. I co-edited the book, "Protecting the Health of the Poor" (December 2015, Bloomsbury Publishing, https://www.bloomsbury.com/us/protecting-the-health-of-the-poor-9781783605521/); and co-founded Longsleeve insect repellent, winner of the 2018 Harvard Business School New Venture Competition and finalist in the 2019 Harvard President's Challenge. Media/press coverage has included NBC, ABC, BBC, PBS, CBS, CNN, MSNBC, Fox News, Washington Post, New York Times, SF Chronicle, Bloomberg, Boston Globe, ProPublica, WSJ, TIME, Politico, CBC News, Democracy Now, NPR, ESPN, The Atlantic, The Hill, Business Insider, Vice, Mother Jones, Vox, Forbes, Slate, STAT News, MTV News, Mother Jones, Science Friday, TMZ.
For a full list of publications, please see "Publications" tab. For full list of press/media interviews, please see "Media" link.
- Infectious Diseases
- Emerging Pathogens
- Zoonotic Infections
- One Health
- Global Health
Honors & Awards
Global Infectious Disease Epidemiology Training Grant 2T32AI52073-16A1, Stanford University (2023-2024)
Top Reviewer, Annals of Internal Medicine (2023)
Applied Genomics in Infectious Diseases Training Grant 2T32AI7502-26, Stanford University (2022-2023)
Global Health Seed Grant Winner, Stanford Center for Innovation in Global Health (2022)
ID Week Travel Award, Infectious Diseases Society of America (2022)
K. Frank Austen Resident Research Award for Disruption of Scientific Thinking, Brigham and Women's Hospital (2021)
40 Under 40, National Minority Quality Forum (2020)
50 Experts to Trust in a Pandemic, Medium (2020)
40 Under 40, Medtech Boston Healthcare Innovators (2018)
Global Health Equity Residency, Brigham and Women's Hospital (2018)
New Venture Competition Winner (Longsleeve Insect Repellent), Harvard Business School (2018)
STAT Wunderkind, STAT News (2018)
Inaugural Global Health Alumni Leadership Award, Unite for Sight (2017)
AMA Journal of Ethics Fellowship, American Medical Association (2016, 2019)
Aesculapius Student Service Award, UCLA David Geffen School of Medicine (2016)
FASPE Fellow, Fellowship at Auschwitz for the Study of Professional Ethics (2016)
Student Body President; Commencement Speaker, UCLA David Geffen School of Medicine (2016)
Journalism Scholar; Distinction in the Major, Yale University (2011)
MS Candidate, Epidemiology, Stanford University
Fellowship, Infectious Diseases, Stanford University
Residency, Brigham and Women's Hospital, Harvard Medical School
Internship, Brigham and Women's Hospital, Harvard Medical School
DTM&H, London School of Hygiene and Tropical Medicine
MPH, Health Policy, Harvard School of Public Health
MD, University of California, Los Angeles
BA, Political Science, Yale University
Prevalence of Mpox (Monkeypox) in patients undergoing STI screening in northern California, April-September 2022.
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
2023; 164: 105493
Despite the sharp increase in mpox (formerly monkeypox) incidence and the wide geographic spread of mpox during the 2022 outbreak, the community prevalence of infection remains poorly characterized. This study is a retrospective epidemiologic survey to estimate mpox prevalence.Samples obtained for sexually transmitted infection (STI) testing from April to September 2022 in the public hospital and clinic system of San Mateo County, California were screened for mpox virus (MPXV) using polymerase chain reaction.16/1,848 samples from 11/1,645 individuals were positive for MPXV by qPCR. 4/11 individuals with positive MPXV testing were cisgender women, 2 of whom were pregnant at the time of sample collection. Both deliveries were complicated by chorioamnionitis. Anorectal and oropharyngeal samples were the most likely to be positive for MPXV (4/60 anorectal samples and 4/66 oropharyngeal samples compared with 5/1,264 urine samples and 3/445 vaginal samples).Our study is one of the first epidemiologic surveys for MPXV infection outside of sexual health/STI clinic settings. Relatively high rates of MPXV from oropharyngeal and anorectal samples reinforces the importance of MPXV testing at various anatomic sites, particularly if patients are presenting with non-lesional symptoms (pharyngitis, proctitis). However, the United States Food and Drug Administration (FDA) has not yet authorized non-lesional MPXV testing. The identification of MPXV in women in our cohort suggests that the rates of mpox in women may have previously been underestimated and highlights the risk of pregnancy complications associated with mpox.
View details for DOI 10.1016/j.jcv.2023.105493
View details for PubMedID 37220710
View details for PubMedCentralID PMC10184869
Retrospective Screening of Clinical Samples for Monkeypox Virus DNA, California, USA, 2022.
Emerging infectious diseases
2023; 29 (4): 848-850
We retrospectively screened oropharyngeal and rectal swab samples originally collected in California, USA, for Chlamydia trachomatis and Neisseria gonorrhoeae testing for the presence of monkeypox virus DNA. Among 206 patients screened, 17 (8%) had samples with detectable viral DNA. Monkeypox virus testing from mucosal sites should be considered for at-risk patients.
View details for DOI 10.3201/eid2904.221576
View details for PubMedID 36918374
View details for PubMedCentralID PMC10045697
Lack of preparedness for the next pandemic is an emergency.
BMJ (Clinical research ed.)
2023; 380: p489
View details for DOI 10.1136/bmj.p489
View details for PubMedID 36858452
Case Report: Monkeypox - Not Just a Rash.
The American journal of tropical medicine and hygiene
Mpox (formally monkeypox) is an Orthopoxvirus associated with both zoonotic and person-to-person spread. Human mpox classically presents with rash and systemic symptoms. Although sporadic outbreaks of mpox have occurred worldwide, the 2022 outbreak is the first of pandemic significance. Thousands of geographically dispersed cases were reported beginning in May 2022. The clinical presentations and outcomes of mpox infection have varied greatly based on viral clade. Further guidance is needed for clinicians to diagnose and treat this emerging infection. We present five clinical vignettes of confirmed cases diagnosed in June and July 2022 in northern California to demonstrate the range of mpox disease, including myocarditis, pharyngitis, epididymitis, and proctitis. We note a significant overlap with HIV infection and a high rate of concurrent sexually transmitted infection. Given the heterogenous presentations of mpox disease, clinicians should maintain a high degree of suspicion in patients with oropharyngeal or genital lesions, proctitis, or new rash.
View details for DOI 10.4269/ajtmh.22-0626
View details for PubMedID 36716741
SARS-CoV-2 Reduction in Shared Indoor Air.
2022; 328 (21): 2162-2163
View details for DOI 10.1001/jama.2022.18028
View details for PubMedID 36472600
Occupational Monkeypox Virus Transmission to Healthcare Worker, California, USA, 2022.
Emerging infectious diseases
2022; 29 (2)
Risk for transmission of monkeypox virus (MPXV) (clade IIb) to healthcare workers (HCWs) is low. Although many cases have been reported among HCW, only a few have been occupationally acquired. We report a case of non-needle stick MPXV transmission to an HCW in the United States.
View details for DOI 10.3201/eid2902.221750
View details for PubMedID 36469326
Overcoming "failures of imagination"-rethinking the US covid-19 pandemic response.
BMJ (Clinical research ed.)
2022; 379: o2397
View details for DOI 10.1136/bmj.o2397
View details for PubMedID 36198405
Human Monkeypox without Viral Prodrome or Sexual Exposure, California, USA, 2022.
Emerging infectious diseases
2022; 28 (10)
We report human monkeypox in a man who returned to the United States from the United Kingdom and reported no sexual contact. He had vesicular and pustular skin lesions but no anogenital involvement. The potential modes of transmission may have implications for the risk of spread and for epidemic control.
View details for DOI 10.3201/eid2810.221191
View details for PubMedID 35971952
Lack of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission from a healthcare worker to a cohort of immunosuppressed patients during the SARS-CoV-2 omicron variant surge, California, 2022.
Infection control and hospital epidemiology
View details for DOI 10.1017/ice.2022.175
View details for PubMedID 35794737
The covid-19 pandemic will end with public health tools, not clinical ones.
BMJ (Clinical research ed.)
2022; 377: o1561
View details for DOI 10.1136/bmj.o1561
View details for PubMedID 35750340
We need more support and less normalcy to stop airborne viruses.
BMJ (Clinical research ed.)
2022; 377: o976
View details for DOI 10.1136/bmj.o976
View details for PubMedID 35418446
We cannot afford to repeat these four pandemic mistakes.
BMJ (Clinical research ed.)
2022; 376: o631
View details for DOI 10.1136/bmj.o631
View details for PubMedID 35587391
What the face mask debacle can teach us about pandemic response.
BMJ (Clinical research ed.)
1800; 376: o85
View details for DOI 10.1136/bmj.o85
View details for PubMedID 35022183
Covid-19: An urgent call for global "vaccines-plus" action
BMJ-BRITISH MEDICAL JOURNAL
2022; 376: o1
View details for DOI 10.1136/bmj.o1
View details for Web of Science ID 000740515600001
View details for PubMedID 34980603
- The Biden Administration is wrong. Many N95 masks are comfortable- and they work. Washington Post. 2022
- Why Masks Still Matter TIME. 2022
- It’s time to redouble and refocus our efforts to fight covid, not retreat BMJ. 2022
- Polio is back-- aided by global health failures that spread COVID and monkeypox LA Times. 2022
- Don't pretend we are back to normal. Fight for cleaner air to prevent COVID. LA Times. 2022
- The Omicron Wave Is Receding But the Pandemic Is Far From Over TIME Magazine. 2022
Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant.
View details for DOI 10.1001/jama.2022.0262
How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic.
Lancet (London, England)
Understanding the spread of SARS-CoV-2, how and when evidence emerged, and the timing of local, national, regional, and global responses is essential to establish how an outbreak became a pandemic and to prepare for future health threats. With that aim, the Independent Panel for Pandemic Preparedness and Response has developed a chronology of events, actions, and recommendations, from December, 2019, when the first cases of COVID-19 were identified in China, to the end of March, 2020, by which time the outbreak had spread extensively worldwide and had been characterised as a pandemic. Datapoints are based on two literature reviews, WHO documents and correspondence, submissions to the Panel, and an expert verification process. The retrospective analysis of the chronology shows a dedicated initial response by WHO and some national governments, but also aspects of the response that could have been quicker, including outbreak notifications under the International Health Regulations (IHR), presumption and confirmation of human-to-human transmission of SARS-CoV-2, declaration of a Public Health Emergency of International Concern, and, most importantly, the public health response of many national governments. The chronology also shows that some countries, largely those with previous experience with similar outbreaks, reacted quickly, even ahead of WHO alerts, and were more successful in initially containing the virus. Mapping actions against IHR obligations, the chronology shows where efficiency and accountability could be improved at local, national, and international levels to more quickly alert and contain health threats in the future. In particular, these improvements include necessary reforms to international law and governance for pandemic preparedness and response, including the IHR and a potential framework convention on pandemic preparedness and response.
View details for DOI 10.1016/S0140-6736(21)01897-3
View details for PubMedID 34762857
The Risk of SARS-CoV-2 Transmission from Patients with Undiagnosed Covid-19 to Roommates in a Large Academic Medical Center.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
We assessed SARS-CoV-2 transmission between patients in shared rooms in an academic hospital between September 2020-April 2021. 11,290 patients were admitted to shared rooms, of whom 25 tested positive. Among 31 exposed roommates, 12 (39%) tested positive within 14 days. Transmission was associated with PCR cycle thresholds ≤21.
View details for DOI 10.1093/cid/ciab564
View details for PubMedID 34145449
Rethinking vaccine hesitancy among minority groups.
Lancet (London, England)
View details for DOI 10.1016/S0140-6736(21)00938-7
View details for PubMedID 33894143
Healthcare System Stress Due to Covid-19: Evading an Evolving Crisis.
Journal of hospital medicine
2021; 16 (2): 127
View details for DOI 10.12788/jhm.3583
View details for PubMedID 33523798
- Why should healthy front-line workers get vaccine boosters? Not to protect themselves. Washington Post. 2021
- A natural pandemic has been terrible. A synthetic one would be even worse STAT News. 2021
- What a recent Covid-19 flight outbreak tells us about spread on planes Vox. 2021
- America needs better masks to fight Covid-19 CNN. 2021
- Along with vaccine rollouts, the U.S. needs a National Hi-Fi Mask Initiative STAT News. 2021
- The government can — and should — send high-quality masks to every American Washington Post. 2021
- Give people better tools to stop viral transmission, and trust that they will use them British Medical Journal. 2021
- Vaccines are great, but testing and tracing will stamp out transmission Washington Post. 2021
- How to Protect Yourself Against Coronavirus Variants New York Times. 2021
- Why We're Terrible At Weighing The Risks Of The J&J Vaccine NPR (Boston)/ WBUR. 2021
- Solving global vaccine inequity requires new incentives for pharmaceutical companies British Medical Journal. 2021
- How Covid reveals the hypocrisy of the global health experience. NPR. 2021
- The pandemic is out of control in India. These quick interventions would help. Washington Post. 2021
- Herd immunity is not a helpful concept for Covid19. It's time to retire it. Washington Post. 2021
- The CDC's latest blunder is really about trust, not masks STAT News. 2021
- I'm a doctor in the US, fighting to save my family in India from covid Washington Post. 2021
- Mitigating trafficking of migrants and children through disaster risk reduction: Insights from the Thailand flood International Journal of Disaster Risk Reduction 2021; 60
There is no stopping covid-19 without stopping racism.
BMJ (Clinical research ed.)
2020; 369: m2244
View details for DOI 10.1136/bmj.m2244
View details for PubMedID 32518097
To control the covid-19 outbreak, young, healthy patients should avoid the emergency department
BMJ-BRITISH MEDICAL JOURNAL
2020; 368: m1040
View details for DOI 10.1136/bmj.m1040
View details for Web of Science ID 000523762400004
View details for PubMedID 32184232
The responsibility and potential of public health.
Lancet (London, England)
2020; 395 (10217): 29
View details for DOI 10.1016/S0140-6736(19)31911-7
View details for PubMedID 31908278
How Should Global Health Security Priorities Be Set in the Global North and West?
AMA journal of ethics
2020; 22 (1): E50-54
Epidemics threaten all countries, yet epidemic responses are not implemented in all countries. One reason why is that transnational disease containment efforts (to keep diseases from spreading across borders) differ in important ways from efforts to protect those in countries where an epidemic is active. This article explores these 2 approaches to global health security and suggests reasons to reconsider prioritizing the former first.
View details for DOI 10.1001/amajethics.2020.50
View details for PubMedID 31958391
- Culture, Context, and Epidemic Containment AMA Journal of Ethics. 2020
- Coronavirus—containing the parallel epidemics of xenophobia and misinformation British Medical Journal. 2020
- Responding to Global Public Health Crises AMA Journal of Ethics. 2020
- If You Get Critically Ill With COVID-19, How Far Should Doctors Go To Keep You Alive? NPR (Boston)/ WBUR. 2020
- Covid-19—on trust, experts, and the brilliance of everyday people British Medical Journal. 2020
- The thankless task of social distancing Vox. 2020
- If you get covid-19, leaving your house may be the best way to protect your family Washington Post. 2020
- A Plan to Safely Reopen the U.S. Despite Inadequate Testing Harvard Business Review. 2020
- Alone with our patients in a pandemic British Medical Journal. 2020
- A doctor on how to make Covid-19 decisions when so much is unknown Vox. 2020
- We Need Better Masks Harvard Business Review. 2020
- Sports can’t restart safely right now Washington Post. 2020
- We could control the coronavirus by winter if we start using rapid tests Washington Post. 2020
- The U.S. Needs Smarter Lockdowns. Now. Harvard Business Review. 2020
- We can’t stop covid-19 if we don’t know where and why it’s spreading Washington Post. 2020
- Trump’s case should not change how we think about covid-19 Washington Post. 2020
- It's Easy To Say, 'Wear A Mask'. But People Need More Advice On Managing The Risk Of COVID-19 NPR (Boston)/ WBUR. 2020
- Essential Workers Need Better Masks Harvard Business Review. 2020
- To Solve The Pandemic, Biden Must Focus On Equity NPR. 2020
- Stigma is making the COVID-19 pandemic more invisible Boston Globe. 2020
- Pandemics are stopped by people—here’s what we, as individuals, can still do British Medical Journal. 2020
A perpendicular framing for global health
2019; 394 (10210): 1708
View details for DOI 10.1016/S0140-6736(19)32464-X
View details for Web of Science ID 000496920300018
View details for PubMedID 31630792
- It's Time To End The Colonial Mindset In Global Health NPR. 2019
- Should you be worried about Ebola? It depends on where you live Los Angeles Times. 2019
The Blind Men and the Elephant - Aligning Efforts in Global Health
NEW ENGLAND JOURNAL OF MEDICINE
2018; 378 (15): 1374–75
View details for DOI 10.1056/NEJMp1800883
View details for Web of Science ID 000429718500003
View details for PubMedID 29641955
Does the Stockholm Syndrome affect female sex workers? The case for a "Sonagachi Syndrome"
BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS
2018; 18: 10
Female sex workers are subjected to intense physical, sexual, and mental abuses that are well documented in the medical and public health literature. However, less well-studied are the mental coping mechanisms that are employed by women in this population to survive. The Stockholm Syndrome has been discussed in the news media as a potential phenomenon in this vulnerable population, but has not been formally studied. From a previous retrospective qualitative analysis reviewing interviews with women in sex work throughout India, we found that the four main criteria for Stockholm Syndrome (perceived threat to survival; showing of kindness from a captor; isolation from other perspectives; perceived inability to escape) are present in narrative accounts from this population. Thus, we propose that Stockholm Syndrome should be considered as a contributing phenomenon with regard to the psychological challenges faced by female sex workers, and can likely help guide interventions accordingly.
View details for DOI 10.1186/s12914-018-0148-4
View details for Web of Science ID 000424676700001
View details for PubMedID 29409491
View details for PubMedCentralID PMC5802051
- Caring about the Congo shouldn't require an Ebola epidemic Boston Globe. 2018
- We Need to Stop Ebola for the Right Reasons PLoS Global Health Blog (discontinued). 2018
- The Most Important Tool For Doctors Fighting DRC’s Ebola Crisis Isn’t Medicine Huffington Post. 2018
- Ebola In The DRC Is More About The DRC Than It Is About Ebola Health Affairs. 2018
Global general pediatric surgery partnership: The UCLA-Mozambique experience
JOURNAL OF PEDIATRIC SURGERY
2017; 52 (9): 1528–33
There has been increasing recognition of the disparities in surgical care throughout the world. Increasingly, efforts are being made to improve local infrastructure and training of surgeons in low-income settings. The purpose of this study was to review the first 5-years of a global academic pediatric general surgery partnership between UCLA and the Eduardo Mondlane University in Maputo, Mozambique.A mixed-methods approach was utilized to perform an ongoing needs assessment. A retrospective review of admission and operative logbooks was performed. Partnership activities were summarized.The needs assessment identified several challenges including limited operative time, personnel, equipment, and resources. Review of logbooks identified a high frequency of burn admissions and colorectal procedures. Partnership activities focused on providing educational resources, on-site proctoring, training opportunities, and research collaboration.This study highlights the spectrum of disease and operative case volume of a referral center for general pediatric surgery in sub-Saharan Africa, and it provides a context for academic partnership activities to facilitate training and improve the quality of pediatric general surgical care in limited-resource settings.Level IV.
View details for DOI 10.1016/j.jpedsurg.2016.12.026
View details for Web of Science ID 000410651900029
View details for PubMedID 28087136
View details for PubMedCentralID PMC5498270
The potential for political leadership in HIV/AIDS communication campaigns in Sub-Saharan Africa
GLOBAL HEALTH ACTION
2017; 10: 1–7
The HIV/AIDS epidemic has become a point of important political concern for governments especially in Sub-Saharan Africa. Clinical and public health interventions to curb the epidemic can be greatly enhanced with the strategic support of political leaders.We analyzed the role of national political leadership in large-scale HIV/AIDS communications campaigns in 14 countries in Sub-Saharan Africa.We primarily reviewed grey and white literature published from 2005-2014. We further triangulated data from in-person and phone interviews with key public health figures.A number of themes emerged supporting political leaders' efforts toward HIV/AIDS program improvement, including direct involvement of public officials in campaign spearheading, the acknowledgment of personal relationship to the HIV epidemic, and public testing and disclosure of HIV status. Areas for future improvement were also identified, including the need for more directed messaging, increased transparency both nationally and internationally and the reduction of stigmatizing messaging from leaders.The political system has a large role to play within the healthcare system, particularly for HIV/AIDS. This partnership between politics and the health must continue to strengthen and be leveraged to effect major change in behaviors and attitudes across Sub-Saharan Africa.
View details for DOI 10.1080/16549716.2017.1270525
View details for Web of Science ID 000397602000001
View details for PubMedID 28156196
View details for PubMedCentralID PMC5328337
Medical "Brain Drain" and Health Care Worker Shortages: How Should International Training Programs Respond?
AMA journal of ethics
2016; 18 (7): 665-675
The movement of health care workers from countries with resource scarcity and immense need ("source" countries) to areas of resource abundance and greater personal opportunity ("destination" countries) presents a complex set of decisions and relationships that affect the development of international health care systems. We explore the extent to which ethical quandaries arising from this movement are the responsibility of the said actors and the implications of these ethical quandaries for patients, governments, and physicians through the case of Dr. R, a surgeon from Nigeria who is considering working in the United States, where he is being trained to help develop surgical capacity in his country. We suggest how Dr. R, the United States, and Nigeria all contribute to "brain drain" in different but complementary ways.
View details for DOI 10.1001/journalofethics.2016.18.7.ecas1-1607
View details for PubMedID 27437816
Evaluating the socioeconomic and cultural factors associated with pediatric burn injuries in Maputo, Mozambique
PEDIATRIC SURGERY INTERNATIONAL
2015; 31 (11): 1035–40
Pediatric burn injuries are one of the leading causes of preventable morbidity and mortality in Sub-Saharan Africa. Research on the complex system of social, economic and cultural factors contributing to burn injuries in this setting is much needed.We conducted a prospective questionnaire-based analysis of pediatric burn patients presenting to the Hospital Central de Maputo. A total of 39 patients were included in the study. Interviews were conducted with the children's caretakers by two trained medical students at the Eduardo Mondlane Medical School in Maputo with the aid of local nursing staff.Most burns occurred from scald wounds (26/39) particularly from bathwater, followed by fire burns (11/39). Burns occurred more frequently in the afternoon (16/39) and evening (16/39). Over one quarter of burns (9/33) occurred in the absence of a caretaker. One-third (12/36) of participants attempted to treat the burn at home prior to bringing the child into the hospital, and roughly two-thirds (24/37) reported using traditional remedies for burn care. The average household had just 2 rooms for an average of 5 family members. Most burns were second degree (25/37).Prevention efforts in this setting are much needed and can be implemented taking complex cultural and social factors into account. Education regarding regulation of water temperature for baths is important, given the prevalence of scald burns. Moreover, the introduction of low-cost, safer cooking technology can help mitigate inhalation injury and reduce fire burns. Additionally, burn care systems must be integrated with local traditional medical interventions to respect local cultural medicinal practices.
View details for DOI 10.1007/s00383-015-3761-5
View details for Web of Science ID 000363040200005
View details for PubMedID 26280740
View details for PubMedCentralID PMC4609601
Ebola and the need for restructuring pharmaceutical incentives
JOURNAL OF GLOBAL HEALTH
2015; 5 (1): 44–47
View details for DOI 10.7189/jogh.05.010303
View details for Web of Science ID 000370619100004
View details for PubMedID 25734003
View details for PubMedCentralID PMC4337146
The effect of multimedia interventions on the informed consent process for cataract surgery in rural South India
INDIAN JOURNAL OF OPHTHALMOLOGY
2014; 62 (2): 171–75
The provision of ocular surgical interventions for poorer, less educated populations is increasing as a result of increased globalization and outreach. However, these populations still have trouble understanding surgical concepts and are not always fully informed decision makers.We aimed to test the effect that a multimedia addition to a traditional verbal informed consent would have on patient comprehension of relatively difficult cataract surgical concepts.We conducted a randomized controlled trial with relatively uneducated patients reporting to a private surgical hospital in Chennai, India. 47 patients were placed into the intervention group and 50 patients were placed into the control group.The intervention group was presented with a scripted verbal informed consent as well as a 3-fold pamphlet and a presentation with a 3-dimensional model of the eye. The control group was only presented with a scripted verbal informed consent. The two groups were tested using an 11 item "True/False/I don't know" quiz directly before the informed consent, directly after the informed consent, and one-day postoperatively.Scores on the quiz were compared across groups and time-points using paired t-tests.Patients in the both groups showed a significant improvement in scores between pre- and post-informed consent quizzes (P value on the order of 10(-6)) and the improvement in scores was significantly greater in the intervention group than the control group (P value on the order of 10(-16)). There was no significant difference observed in either group with regards to the change in scores between post-informed consent and post-operative quizzes.Multimedia aids in addition to a standard informed consent process are effective in improving patient comprehension even for patients with low literacy and limited knowledge of surgical interventions.
View details for DOI 10.4103/0301-4738.116488
View details for Web of Science ID 000348927800014
View details for PubMedID 24008787
View details for PubMedCentralID PMC4005233
The influence of poverty and culture on the transmission of parasitic infections in rural nicaraguan villages.
Journal of parasitology research
2012; 2012: 478292
Intestinal parasitic infections cause one of the largest global burdens of disease. To identify possible areas for interventions, a structured questionnaire addressing knowledge, attitude, and practice regarding parasitic infections as well as the less studied role of culture and resource availability was presented to mothers of school-age children in rural communities around San Juan del Sur, Nicaragua. We determined that access to resources influenced knowledge, attitude, and behaviors that may be relevant to transmission of parasitic infections. For example, having access to a clinic and prior knowledge about parasites was positively correlated with the practice of having fencing for animals, having fewer barefoot children, and treating children for parasites. We also found that cultural beliefs may contribute to parasitic transmission. Manifestations of machismo culture and faith in traditional medicines conflicted with healthy practices. We identified significant cultural myths that prevented healthy behaviors, including the beliefs that cutting a child's nails can cause tetanus and that showering after a hot day caused sickness. The use of traditional medicine was positively correlated with the belief in these cultural myths. Our study demonstrates that the traditional knowledge, attitude, and practice model could benefit from including components that examine resource availability and culture.
View details for DOI 10.1155/2012/478292
View details for PubMedID 22934154
- To Have an Almost-Normal Summer, Do This Now: Guidance from a global health doctor Medium. 2021
- We must stop blaming- and start protecting- unvaccinated people British Medical Journal. 2021
- Incremental Policy Can’t Keep Up With Exponential Spread Medium. 2021
- Messaging About Covid-19 Needs to Account for Privilege Medium. 2021
- We Are All Tired Of The Pandemic — But Our Actions Can Still Make A Big Difference NPR (Boston)/ WBUR. 2020
- Why I Said Nothing When My Med School Professor Made Racist Remarks NPR (Boston)/ WBUR. 2020
- How do we deal with “old guard” bigotry in healthcare? British Medical Journal. 2020
- Second-guessing may do more harm than good — especially among doctors Los Angeles Times. 2020
- Hollywood and Gun Violence Scientific American. 2020
- The Unsung Coronavirus Heroes Medium. 2020
- What We Can Learn from Past Covid19 Outbreaks Medium. 2020
- Here Comes the Pandemic Winter NPR (Boston)/ WBUR. 2020
The dehumanisation of the patient
BMJ-BRITISH MEDICAL JOURNAL
2019; 367: l6336
View details for DOI 10.1136/bmj.l6336
View details for Web of Science ID 000498179100009
View details for PubMedID 31690568
Doing things for no reason in the hospital
BMJ-BRITISH MEDICAL JOURNAL
2019; 364: l841
View details for DOI 10.1136/bmj.l841
View details for Web of Science ID 000460389900008
View details for PubMedID 30808632
Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.
Circulation. Heart failure
2019; 12 (11): e006214
Racial inequities for patients with heart failure (HF) have been widely documented. HF patients who receive cardiology care during a hospital admission have better outcomes. It is unknown whether there are differences in admission to a cardiology or general medicine service by race. This study examined the relationship between race and admission service, and its effect on 30-day readmission and mortality Methods: We performed a retrospective cohort study from September 2008 to November 2017 at a single large urban academic referral center of all patients self-referred to the emergency department and admitted to either the cardiology or general medicine service with a principal diagnosis of HF, who self-identified as white, black, or Latinx. We used multivariable generalized estimating equation models to assess the relationship between race and admission to the cardiology service. We used Cox regression to assess the association between race, admission service, and 30-day readmission and mortality.Among 1967 unique patients (66.7% white, 23.6% black, and 9.7% Latinx), black and Latinx patients had lower rates of admission to the cardiology service than white patients (adjusted rate ratio, 0.91; 95% CI, 0.84-0.98, for black; adjusted rate ratio, 0.83; 95% CI, 0.72-0.97 for Latinx). Female sex and age >75 years were also independently associated with lower rates of admission to the cardiology service. Admission to the cardiology service was independently associated with decreased readmission within 30 days, independent of race.Black and Latinx patients were less likely to be admitted to cardiology for HF care. This inequity may, in part, drive racial inequities in HF outcomes.
View details for DOI 10.1161/CIRCHEARTFAILURE.119.006214
View details for PubMedID 31658831
View details for PubMedCentralID PMC7183732
- Doing things for no reason in the hospital British Medical Journal. 2019
- Should family members be present during end of life medical emergencies? British Medical Journal. 2019
- Making sure patients understand and that doctors do too British Medical Journal. 2019
- Doctors and their Unhealthy Dependency on Tech Boston Globe. 2019
- Don't Let Your Institution Define You British Medical Journal. 2019
- Advice to New Doctors British Medical Journal. 2019
- The clinical value in listening Boston Globe. 2019
- Why Every Doctor Should Write British Medical Journal. 2019
- Medicine's Power Problem Scientific American. 2019
- Has the physical exam had its day? British Medical Journal. 2018
- Why Doctors Need To Remember That Sick Patients Were Once Healthy People NPR Boston/ WBUR. 2018
- When the Prescription is Not a Medicine but a Home Huffington Post. 2018
- The Forgotten Needs Of Refugees From Hurricane Irma NPR. 2018
- How to Prevent the Next Oxfam Scandal- a Yelp for International Aid? PLoS Global Health Blog (discontinued). 2018
- Why can't we accept that residents are being overworked? British Medical Journal. 2018
- The ethical implications of culture: challenges in the care of female sex workers in India Journal of Global Health Reports. 2018
- Changing the way we communicate about patients British Medical Journal. 2018
- Why we need more diversity in our doctors British Medical Journal. 2018
- Code Blue Confusion: He'd Checked 'Do Not Resuscitate' But Wanted To Live NPR Boston/ WBUR. 2017
- Women In India’s Cultural Sex Trade Need Healthcare Huffington Post. 2017
- The success trap of academic medicine and the need for change The British Medical Journal. 2017
- Publication should not be the endgame of medical research The British Medical Journal. 2017
- Please Keep Religious Intolerance Out of Medicine Huffington Post. 2017
- Medical students need to be quizzed, but ‘pimping’ isn’t effective STAT News. 2017
- Revisiting health as a human right—does everyone have the right to be healthy? The British Medical Journal. 2017
- A Doctor’s Dilemma: How We Confront Two “Right” Choices in Medicine & Public Health Huffington Post. 2017
- Do doctors’ other motivations, like the need for sleep, affect patient care? STAT News. 2017
- Understanding Leadership: What a Surgeon, a Senator, and the Former President of Mexico Have in Common. Huffington Post. 2017
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- The Surprising Wishes Of India's Sex Workers NPR. 2017
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- Incarceration is a dead end in the opioid epidemic AL dot com. 2017
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A Dance With Mrs Chan
ANNALS OF FAMILY MEDICINE
2016; 14 (4): 380–81
As a third-year medical student on an internal medical clerkship, I learned the most important lesson about how to care for patients. I saw my attending physician give attention first to the person he was treating, and then to the patient and her clinical picture. They are not the same, and our training in medical school does not always teach us this distinction. Months later I found myself with an opportunity to truly help another individual who had been clinically and emotionally overcome by his disease. My attending physician's lesson guided me in a very meaningful way: it allowed me to remind a man that he was more than the disease he was fighting. Many times, it may be something very little that we need to do or say but to our patients, these little things end up being the biggest of them all.
View details for DOI 10.1370/afm.1922
View details for Web of Science ID 000380145600016
View details for PubMedID 27401429
View details for PubMedCentralID PMC4940471
- Finding Who We Are in Those for Whom We Care Journal of General Internal Medicine. 2016
- To My Patients: An Apology, A Thank You The Gold Humanism Foundation. 2016
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- Good Afternoon, Mrs. Gates UCLA Health Magazine. 2016
- Hashtag Ebola The Medicine Maker. 2016
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- Building Ethical Global Health Care Systems AMA Journal of Ethics. 2016
- Writing in medical school: how students can be a voice for their patients UCLA David Geffen School of Medicine. 2016
- Students can prevent global health groups from fabricating success stories STAT News. 2016
- The ACA: We Got Quantity but What About Quality? The Health Care Blog. 2016
- Students are the key to addressing the gap between academia and action in global health The British Medical Journal. 2016
- A Call for Courage in Uncertain Times: Curbing HIV/AIDS in Sub-Saharan Africa through Political Leadership PLoS Translational Global Health blog (discontinued). 2016
- Understanding cultural female sex work in India and why tradition must be challenged Lancet Global Health Blog (discontinued). 2016
- Supervising physicians’ bad behavior adds to depression in medical students STAT News. 2016
- To Dance Even When There is No Music The Lancet. 2015
- Are medical school rankings threatening the future of health care? Kevin MD. 2015
- The Case for Taking a Pill a Day to Prevent HIV The World (formerly Global Post). 2015
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Teaching and Learning Moments It's Not Always About Health Care
2014; 89 (7): 1023
View details for DOI 10.1097/ACM.0000000000000282
View details for Web of Science ID 000338210000022
View details for PubMedID 24979170
Evaluation of Adverse Events in Self-Reported Sulfa-Allergic Patients Using Topical Carbonic Anhydrase Inhibitors
JOURNAL OF OCULAR PHARMACOLOGY AND THERAPEUTICS
2013; 29 (5): 456–61
To investigate whether a self-reported history of allergy to sulfa-based drugs is a predictor for subsequent adverse reactions to topical carbonic anhydrase inhibitors (CAIs).A retrospective case-controlled cohort study via chart review was performed on 1,287 patients with a diagnosis of glaucoma. The outcome measure was the development of an adverse reaction (either ocular, systemic, or both) within at least 30 days after receipt of 1 of 4 classes of topical glaucoma medications: CAIs (dorzolamide and brinzolamide), prostaglandin analogues, beta-adrenergic blockers, and alpha2-adrenergic agonists.Patients with a self-reported history of sulfa allergy had significantly more ocular adverse reactions after the initiation of any of the topical antiglaucoma medications when compared to those patients with no reported allergies. Patients with a self-reported sulfa allergy and patients who self-reported other, nonsulfa-related allergies had similar rates of adverse reactions to most of the topical medications. The patients reporting a sulfa allergy who used topical CAIs did not have more adverse reactions compared with patients who reported having other, nonsulfa-related allergies who used topical CAIs. Self-reported sulfa-allergic patients had similar rates of adverse reactions to topical CAIs compared with topical prostaglandin analogues.It may be safe to use a topical CAI in patients who report a history of a sulfa allergy. Patients with medication allergies of any kind may be more likely to develop allergic reactions to other, unrelated drug classes.
View details for DOI 10.1089/jop.2012.0123
View details for Web of Science ID 000319760600003
View details for PubMedID 23445203
- The reality of medicine’s inherently unequal power dynamic Kevin MD. 2013
- Globalizing the Internet for Health Prevention PSI Impact (discontinued). 2013
- When Your Doctor Dies The Health Care Blog. 2013
- Campaigns and Public Messaging: Important Aspects of HIV Prevention and Treatment, but Fraught with Complex Challenges. PLoS Translational Global Health (discontinued). 2013
- The Other White Coat Phenomenon Centre for Medical Humanities . 2013
Seasonal variations in dermatology manuscript submission
JOURNAL OF DERMATOLOGICAL TREATMENT
2011; 22 (1): 60
View details for DOI 10.3109/09546630903544428
View details for Web of Science ID 000286812200012
View details for PubMedID 20113215
The effect of a visual aid on the comprehension of cataract surgery in a rural, indigent South Indian population.
Digital journal of ophthalmology : DJO
2011; 17 (3): 16–22
PURPOSE: To determine whether a visual aid improves the understanding and retention of information presented during informed consent for rural, indigent patients presenting for cataract surgery.MATERIALS AND METHODS: This was a randomized, unmasked, interventional study. We recruited patients who presented to the Hande Surgical Hospital in Chennai, India, for cataract surgery. Patients were randomized into two groups: verbal consent alone (group A) and verbal consent plus a poster (group B). Both groups completed an 11-question true/false quiz immediately before and after informed consent and one day after surgery.RESULTS: A total of 60 patients were recruited for the study, with 30 randomly assigned to each group; 23 patients from group A and 17 from group B completed the study. Informed consent improved patient scores in both groups; however, group B had significantly higher mean scores on postoperative day 1 (7.4 vs 8.7, P = 0.005) and significantly greater improvement in mean scores from pre-informed consent to postoperative day 1 (1.3 vs 3.6, P = 0.002).CONCLUSIONS: Informed consent improves patient understanding of cataract surgery. Using a visual aid during informed consent for cataract surgery improves understanding and retention of information more than verbal consent alone in a rural South Indian population.
View details for DOI 10.5693/djo.01.2011.05.001
View details for PubMedID 23362389
- The lesson of persistence Yale Alumni Magazine. 2011
Microscopically differentiating dermatophytes from sock fibers
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
2009; 61 (6): 1024–27
Dermatophytes are responsible for a number of superficial fungal infections that affect millions worldwide. During microscopic observation a potassium hydroxide (KOH) fungal smear, various filamentous materials such as common textile fibers from socks can obfuscate proper discernment of dermatophytes.To differentiate dermatophytes from 9 common sock fibers.Nine different textile fiber samples were microscopically analyzed by using a KOH direct smear test; their defining structural features were compared and contrasted with those of dermatophytes.Although there are several similarities, sock fibers tend to have a non-septate, uniform structure which differentiates them from dermatophytes. Sock fibers are also significantly larger than dermatophytes and can be viewed better at lower magnifications.There is a lack of sock samples with 100% textile fiber composition. Also, fibers were examined in a clean setting, without the detritus that normally accompanies dermatophytes in a clinical setting.While textile fibers may be present in KOH preparations, their general appearance typically differs from that of dermatophytes; an observer who is familiar with these distinctions will be able to differentiate between the two.
View details for DOI 10.1016/j.jaad.2008.11.010
View details for Web of Science ID 000272346800010
View details for PubMedID 19925927
Toxicologic implications of cutaneous barriers: a molecular, cellular, and anatomical overview
JOURNAL OF APPLIED TOXICOLOGY
2009; 29 (7): 551–59
The skin barrier is a complex system of chemical, biological and physical processes that together regulate the admission and expulsion of foreign agents in contact with the skin. The eggresive movement of the stratum corneum (SC) is often a measure of its integrity, and transepidermal water loss has typically been a gold standard. However, the skin barrier has several barrier systems, such as ion flux, O(2), CO(2) and pH, which can give an informative and sometimes more sensitive measure of the SC condition. Furthermore, the penetrative interactions with the barrier have focused around occlusive methods to promote drug delivery, the interactions of topically applied drugs with the barrier and the presence of environmental agents that can harm the barrier. However, the nature of penetrative barrier interactions must also be elucidated on a microscopic level. The variable nature of barrier function is demonstrated when comparing the skin properties of neonates and adults. In addition, new biochemical methods have used keratin metrics to improve diagnostic efficacy and barrier integrity analysis. This review addresses the aforementioned aspects of the skin barriers that require further study to help discern the complexity of this essential organ as it relates to dermatotoxicology and dermatopharmacology.
View details for DOI 10.1002/jat.1461
View details for Web of Science ID 000271407100001
View details for PubMedID 19629956