The International Health Fellowship was established by the Feinberg School of Medicine to provide support to medical students who wish to conduct international research projects. Each year one to two Feinberg medical students will be awarded stipends to support their investigation of medical issues, public health systems and health policy, and/or health care delivery methods at an international site. The goal of the program is to gain a deeper understanding of how cultural and economic factors influence health care systems and promote scholarship among medical students in the field of global health. While the Global Health Initiative supports medical student research especially via the Area of Scholarly Concentration program, these funds are generally limited to research in low and middle-income settings. The International Health Fellowship is a unique funding opportunity for FSM students in that it has no geographical or institutional restrictions once a research proposal is accepted.
How to Apply
Review the How to Apply page if you are interested in applying for the International Health Fellowship for the next academic year.
Research and IRB Resources for International Health Fellows
Applicants must ensure they are following all IRB guidelines by working directly with the Northwestern IRB office.
2014/2015 Fellows and Projects
More information on these projects to come soon.
Previous Fellows and Projects
Investigators: Joseph Simonett
Mentor: Amani Fawzi, MD
Research Site: Rome, Italy
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and is the leading cause of blindness in industrialized countries.1 The prevalence of diabetes mellitus (DM) is increasing in both developed and developing nations, reaching 37.5% in the most severely stricken locations, and places a large burden of morbidity and mortality and financial cost on these populations.
Early pathologic changes, capillary nonperfusion and retinal ischemia, often go undetected as vision is typically preserved. Development of vision threatening complications, including diabetic macular edema and proliferative diabetic retinopathy, follow these early microvascular changes. Although the relationship between these early and late complications is not clear, inadequate blood flow to the photoreceptor cells, and the resulting production of reactive oxygen species and vascular endothelial growth factor, has been hypothesized as a major contributor to the progression of diabetic retinopathy.
Dr. Fabio Scarinci, who recently completed a visiting international research fellowship at Northwestern University, along with his Northwestern collaborators demonstrated that an enlarged area of foveal capillary nonperfusion was associated with outer retinal and photoreceptor disruption on optical coherence tomography imaging (OCT) in patients with early diabetic retinopathy. In this study, fluorescein angiography, which uses intravascular dye, was used to produce a 2-‐dimensional image of retinal blood flow. The correlated photoreceptor disruption seen was hypothesized to be due to capillary nonperfusion at the level of the deep capillary plexus, which has recently been recognized as an important blood vessel group in retinal pathogenesis, however the 2-‐dimensional nature of fluorescein angiographymade this impossible to confirm.
Two emerging imaging techniques, adaptive optics (AO) and 3-‐dimensional optical coherence tomography angiography (OCT-‐angiography), facilitate noninvasive, high-‐resolution and functional imaging of the retina (figure 1). With these new tools, further investigation into early DR pathophysiology is possible. Specifically, we will extend Dr. Scarinci’s current study to test the hypothesis that photoreceptor cell density is decreased (determined by AO) and retinal ischemia is due to deep capillary plexus nonperfusion (determined by OCT-‐angiography).
2014/2015 Fellows and Projects
Investigators: Ashley Ceniceros & Adina Goldberg
Mentor: Dana R. Gossett MD MSCI & Gelila Goba, MD
Research Site: Ethopia
Beginning in the year 2000, world leaders have prioritized targeted population health improvements in the developing world via the agenda of the Millennium Development Goals (MDGs). MDGs 4 and 5 are devoted to child and maternal health: 67% reduction in under-five mortality and 75% reduction in maternal mortality by the year 2015. Unfortunately, far fewer than half of the high-risk countries currently targeted with interventions to meet these goals will achieve them by the 2015 deadline (1). Although significant progress has been made even in countries that will not fully meet their goals, including Ethiopia, which has managed to reduce child and maternal mortality by 28% and 22%, respectively, many millions of reproductive age women and their children will continue to face health challenges. Pregnant women, especially in low and middle-income countries, are uniquely vulnerable to medical, psychosocial and economic stressors, including complications of pregnancy, cultural pressure to reproduce, and the cost of peripartum care. They are thus an important population to target with improved health infrastructure. Furthermore, maternal health during pregnancy is an important precursor to child health after delivery, and an important predictor of the child’s future health (2). The parameters of maternal health are wide, and include features broader than simply surviving pregnancy and delivery. Medical and psychological complications of pregnancy may result in long-term physical and mental health problems, and can impact women’s ability to care for themselves and their children, thus compromising both MDGs 4 and 5 (3). An important, though often underestimated, challenge to maternal and child health in the postnatal period is postpartum depression. Though the perinatal mental health of women in the developing world has only recently come to global attention, studies have demonstrated similar or even higher rates of postpartum depression (4).
Alexandra Goodwin & Sarah Chuzi, Jack Dougherty
2012/2013 Fellows and Projects
Investigators: Alexandra Goodwin & Sarah Chuzi
Mentor: Dana R. Gossett MD MSCI
Research Site: Kumi, Uganda
The World Health Organization (WHO) states that improving the quality of basic healthcare services for women in the setting of intrapartum complications is essential to achieving Millenium Development Goal 5 of reducing maternal deaths. Known as Emergency Obstetric Care (EmOC) services, 7 medical interventions have been described by the WHO as requisite for the provision of quality obstetric care in district hospitals internationally. The identified EmOC services are used to treat the major obstetric complications that cause the most maternal deaths; thus, ensuring that healthcare providers have the knowledge, training, and confidence to successfully perform these interventions is vital. The primary purpose of this research study is to estimate the level of knowledge of the 7 EmOC services among the labor and delivery medical staff at 2 district hospitals in Uganda: Kumi and Kayunga. These institutions are district hospitals that serve as major access points to the Ugandan national healthcare system in their respective provinces. As such, they are ideal settings in which to study the provision of EmOC services and the role of obstetric nursing staff. In this study, obstetrics nurses, midwives, birthing attendants, and physicians at each hospital will complete surveys designed to estimate their level of knowledge of the 7 EmOC services as well as their perceived areas of strength, weakness, and comfort in delivering these services. Secondary aims are to estimate the level of knowledge of intrapartum management of HIV patients and intrapartum analgesia among the labor and delivery medical staff at the hospitals as well as to conduct a direct observation of the staff in the wards and operating room in order to evaluate the volume and quality of EmOC services employed during obstetric emergencies.
Problem Statement: What is the level of knowledge of the 7 emergency obstetric care services among labor and delivery medical staff at 2 district hospitals in Uganda (Kumi and Kayunga)?
Investigators: Jack Dougherty
Mentor: Pierre Ferrier, MD, PhD
Research Site: Centre d'Immunologie Marseille-Luminy (C.I.M.L.), France
In order to defend against invading pathogens, your immune system must first be able to recognize them. This task is daunting given the huge diversity of bacteria, viruses, parasites and fungi that can infect the human body. In this ever-evolving world, a genetic code that could pass along the ability to fight merely the organisms that it had previously encountered would leave each successive generation constantly vulnerable to new threats. Instead, T and B cells use a process called V(D)J recombination to create receptors and antibodies that are capable of detecting not only patterns that are known, but rather as many different patterns as possible. V, D and J are abbreviations for variable, diversity and joining, which are genomic regions, each containing a number of similar segments that can be rearranged in a huge number of different ways.
A great deal of research has contributed to our understanding of the control mechanisms to which V(D)J recombination is subjected. These include epigenetic-dependent chromatin accessibility (via histone hyperacetylation and allele demethylation), locus decontraction, centromeric recruitment, recombination signal sequence (RSS) diversity and enhancer-promoter interactions, among others. This research project aims to improve our understanding of allelic exclusion, the process by which only a single V(D)J recombination event produces a functional receptor on a given T cell. Limiting each cell to a single receptor type is important to maintaining specificity in immune targeting. Loss of specificity is purported to contribute to autoimmunity as well as immunodeficiency, especially in the elderly. Using transgenic mice, we seek to find evidence in support of a mathematical model that describes an appropriate balance between stochasticity and regulation within the system.
Tyler Maiers, Ariella Pratzer, Margaret Yu
Mentor: Dr. Arthur Elster, Department of Preventative Medicine
Research Site: Office of the Chief Scientist; Tel Aviv, Israel
Various investment models (direct foreign aid, loans, micro-finance, etc.) currently exist for the funding and delivery of foreign aid, and specifically aid dedicated to improving global health. As new, multi-billion dollar initiatives are launched, and as countries look to increase the impact of their global health investments, ongoing analysis and evaluation of the successes and failures of these models, upon which funding decisions can be based, is called for.
The Government of Israel (henceforth referred to as “the GOI”) is looking to expand its commitment to global health by investing in research and development initiatives by Israeli companies and start-ups targeted at improving global health. Its investment strategy is based on the philosophy of “integrated innovation”, which involves the coordinated application of technological, social, and business innovation to develop scalable and sustainable solutions to complex challenges. This model has been developed, refined, and endorsed by multiple major players in global health investment, including The Gates Foundation, US AID, and Grand Challenges Canada (GCC) – the Canadian government’s global health initiative.
The Israeli investment strategy, which will effectively operate as a government-backed venture capital fund, will be developed and operated by the Office of the Chief Scientist, in the Ministry of Industry, Trade, and Labor (henceforth referred to as “The Office”). I will be working under the chief economist in The Office. In collaboration with The Office, my project will involve the development of concrete global health goals that the GOI hopes to achieve, the identification of practical metrics that can be used to track progress towards these goals, and the building of an analytic evaluation model that will use both quantitative and qualitative data to measure success and allow for refinement of the GOI initiative.
Research Question: To determine how the GOI can most effectively allocate its financial resources through an "integrated innovation" model to achieve its global health goals.
Investigator: Margaret Yu
Mentor Name: Dr. Lei Liu PhD, Associate Professor of Preventative Medicine
Research Site: Jiangxi, China
Preceptor in Jiangxi, China: Dr. Yu-Zhi Ge MD, PhD
Project Title: Tailoring the use of BMI as a risk factor for Peripheral Arterial Disease in the Chinese population
Abstract: Rapidly developing countries like China are facing dramatic changes in terms of the diseases that affect their populations. The rapid economic growth that China experienced over the past few decades, coupled with the fact that the population is aging, has contributed to the increase of cardiovascular disease in the country. Cardiovascular diseases, which include stroke and coronary heart disease, cause one-third of all deaths in China and that number is expected to double by 2020.
Ankle-brachial index (ABI) is used clinically in order to detect the presence of peripheral arterial disease (PAD), which is due to atherosclerotic occlusions in lower extremity arteries. Research has found that low ABI values (<0.9) are associated not only with other cardiovascular risk factors like hypertension along with coronary artery disease itself, but it is also independently associated with increased mortality from cardiovascular events. Therefore, it is an extremely important clinical tool to help determine outcomes.
Prior research demonstrates that when compared to Caucasians, the Chinese population tends to have a higher proportion of body fat for the same BMI. Body fat is a stronger risk factor for cardiovascular events than BMI. Thus, lower levels of BMI may have different implications for the Chinese population in terms of cardiovascular health.
The purpose of my project is to further understand how BMI can be used as an independent risk factor for low ABI values from a cohort of patients in Jiangxi, China. The goal is to determine, for this population, when BMI becomes significant in correlating with PAD and also, potentially increased mortality from cardiovascular events.
Investigator: Tyler Maiers
Title: Fingerstick Blood Collection for HIV Viral Load Testing
Nucleic acid testing (NAT) is recommended for monitoring HIV viral load (VL) levels in conjunction with antiretroviral therapy. Systems are under development to perform VL point of care tests (POCT) that can be used in resource-limited settings.
Testing in resource-limited settings may require sampling by fingerstick due to shortages in skilled phlebotomists and the expense of venipuncture supplies. Currently, fingerstick specimens are used for point of care hematocrit and CD4 determinations where blood is drawn into the test cartridge as well as for infant HIV testing where blood is collected onto filter paper, dried, and shipped to a central laboratory for testing. Recently, the Kelso Lab at Northwestern University investigated the feasibility and accuracy of performing multiple POCT on fingersticks. They found that capillary blood for four POCT, which required a total of 95 μl, could be obtained from 92% of the subjects with a single fingerstick.
With funding from the Bill and Melinda Gates Foundation and Quidel Corporation, Northwestern University and the Northwestern Global Health Foundation are developing a POC instrument and VL NAT. For a limit of quantification of 1,000 copies/ml of plasma, it will require approximately 150 μl of blood. If this volume can be obtained by fingerstick instead of venipuncture, it could possibly make the test available in a wider range of clinics.
The volume of blood obtained from fingersticks can vary from person to person depending upon the thickness of the subject’s skin, the blood’s hematocrit, the amount and potency of clotting factors in the subject’s blood, and numerous other factors. In this study, we want to determine if sufficient quantities of plasma to perform viral load quantification could be collected from fingersticks of patients undergoing antiretroviral therapy (ART) and if it is preferred to venipuncture. Our subjects will be patients receiving antiretroviral therapy at the Hillbrow and Themba Lethu clinics in Johannesburg, South Africa. They will be recruited by healthcare workers and consented by a study nurse. We will collect 100 capillary blood specimens to achieve a 95% confidence interval of 10% on the overall proportion of samples yielding a sufficient volume of plasma.
Research question: From what proportion of HIV+ patients can 150 uL capillary blood be collected via fingerstick for use in an HIV viral load quantification device?
Kathryn Fay, Stanley Ilya Gutiontov, Karina Nieto, Cristina Thomas
2011/2012 Fellows and Projects
This year four Feinberg medical students were awarded an International Health Fellowship.
Health Care Providers' Response to Sexual Violence Survivors: Exploring Local Strategy Compared to International Guidelines
Investigator: Kathryn Fay
Research Site: Uganda
No one denies the universal, devastating impact of sexual violence. And yet accurate estimates of its prevalence and even consensus on its definition remain elusive. Sexual violence research not only increases visibility of the issue and understanding of its dynamics, but also opens to door to the possibility of more coordinated, compassionate responses.
Information has been collected on the prevalence of sexual violence in Uganda and the experiences of sexual violence survivors. Therefore, particularly given the growing responsibilities of health care providers in sexual violence response (eg, they are part of the select few qualified to submit evidence to police), data on their behaviors and attitudes regarding sexual assault is of most utility. While international guidelines exist for sexual violence response in health care settings, there is ample evidence that actual practices vary greatly. For example, a small number of police surgeons perform forensic exams at select locations. This may limit access to exams but perhaps function as a discrete group for uniform response and training. International guidelines suggest that forensic exams and necessary medical care be offered in the same location and be easily accessible. A study of such differences may yield valuable information for a national policy that incorporates both international guidelines and existing strengths.
This project aims to explore sexual violence and the response of health care providers in Uganda.. The intention of this research is to investigate Ugandan health providers’ awareness of and attitudes towards recommended World Health Organization (WHO) and the Inter-Agency Standing Committee (IASC) Task Force on Gender and Humanitarian Assistance guidelines. Collecting information on hospital-specific protocol will elucidate the strengths of existing guidelines and strategies of Ugandan providers in response to sexual violence.
Alcoholism and Smoking in St. Petersburg, Russia: A Qualitative Study of Behavior, Views, and Possibilities for the Future
Investigator: Stanley Ilya Gutiontov
Research Site: Saint Petersburg, Russia
In the Russian Federation (RF), the life expectancy of men is a dismal 59.8 years: even when averaged with the 73.2 year life expectancy of Russian women, the RF average life expectancy is worse than that of Iraq and North Korea. This statistic is due in large part to alcohol and tobacco use, which together account for nearly 50% of disability-adjusted life years (DALYs) in the country. In spite of this and the fact that the death rate in the RF is 5th in the world, the RF’s sparse legislative (beer is now officially an alcoholic beverage), medical (much treatment is based on narcology, an outdated Soviet methodology), and economic (the RF’s tax on cigarettes is the lowest in Europe) responses targeting alcohol and tobacco have been largely ineffective. Though much work has been done accumulating quantitative data regarding alcohol and tobacco use, qualitative studies regarding the Russian people’s views and ideas for moving forward are difficult to find. Through a series of interviews to be conducted at Pavlov State Medical University in St. Petersburg, this study will seek to begin to answer the following primary question: how do the Russian people view the tobacco and alcohol epidemics in their country and do they have ideas for improving the situation? The information thus collected should be of use generating novel paths forward in what appears, by all measures, to be a bleak public health situation in the RF.
Comparison of Beliefs and Stigma Associated with Chagas Disease amongst Bolivian Highlander Yapacanis and Lowlanders
Investigator: Karina Nieto
Research Site: Palacios, Bolivia
Chagas is a Neglected Tropical Disease (NTD) that afflicts nearly 10 million people worldwide. The Centro Medico Humberto Parra Clinic, located in the rural rain forest on the Eastern part of Bolivia, estimates that over 50% of the patients are affected by the disease. The patient population is for the most part rural and has limited access to healthcare. Since there is no effective cure for Chagas, the remedy lies in continued preventative measures. In order to obtain patient compliance, it is crucial that we understand the social context and belief system present. In Bolivia there are dramatic cultural differences between the Highlanders and the Lowlanders given that Highlanders remained an autonomous population much longer. The Highlanders’ long autonomy resulted in limited Westernization. Many Highlanders continue to resort to Jampiris and other traditional healers who often times diagnose Chagas patients as having contaminated inner fluids. The primary objective of this research project is to gain a better understanding of Highlanders’ and Lowlanders’ cultural attitudes, stigmas and beliefs towards Chagas, in order to modify as necessary the way preventative measures are taught and the way the chronic disease is managed.
Disability and Quality of Life in Patients with Lyphatic Filariasis in Rural Southern India
Investigator: Cristina Thomas
Research Site: India
According to the World Health Organization, lymphatic filariasis, a mosquito-borne parasitic disease, is the second leading cause of disability worldwide. Across 81 countries, approximately 120 million people are infected with the disease, and of those infected, an estimated 40% reside in India alone. The most disfiguring symptoms of lymphatic filariasis, elephantiasis and lymphedema, cause long-term suffering in patients who are then often embarrassed or even rejected from their communities. Because of the disease’s debilitating physical and social effects on patients, this study will explore the intersection of disability and health-related quality of life (HRQoL) in lymphatic filariasis patients in India. Specifically, HRQoL and disability in lymphatic filariasis subjects and age- and gender- matched control subjects will be compared. Two HRQoL tools , the general Dermatology Life Quality Index (DLQI) and a disease-specific instrument developed by a dermatology group in India will be used to gauge HRQol. In addition, the demographic and disease-specific factors associated with HRQoL and disability in filarial lymphedema subjects will be identified
Mitra Afshari, Lindsay Fox, David W. Grant, Maya Ragavan, Selma Siddiqui, Ashima Singal, Andrew Su & Brandon Yim, Erika Wallender
Multi-Pathogen Point-of-Care Diagnostics in Uganda
Investigator: Mitra Afshari
Research Site: Kampala, Uganda
Multi-pathogen point-of-care diagnostic tests for infectious diseases have the potential to confer great benefits in the developing world, improving the efficiency of the diagnostic process, reducing improper treatment and costs, and ultimately improving patient outcomes. Two such diseases with high burden are tuberculosis and community-acquired pneumonia. Cost-effectiveness analysis of these prospective tests is yet to be performed. Herein, I propose to contribute to the development of a cost-effective analysis of said tests for TB, MDR-TB, and CAP through a university-based initiative in Uganda, in hopes of taking new steps at the interface of Global Health and biotechnology. Equally important, this project empowers future Ugandan leaders with the skills they need to take these steps themselves.
Barriers to Accessing Sexual Assault Services for Rural Bolivian Women
Investigator: Lindsay Fox
Research Site: Palacios and Santa Cruz, Bolivia
Sexual violence is a significant problem in Latin America, with high prevalence reported in many areas. Victims of sexual violence are at risk for a host of mental and physical health problems, however utilization of services to help prevent or treat the problems associated with sexual violence is low. Previous research has identified a variety of barriers to accessing services for sexual assault survivors, including availability, affordability, accessibility (e.g. transportation), and acceptability (perception of harm or benefit of a given service). In general, the stigma and self-blame associated with rape have been found to be extremely important barriers to getting help following sexual assault. This study will examine barriers to utilizing services related to sexual assault in a population of adult women in rural Bolivia served by the Centro Medico Humberto Parra. It will begin by identifying availability and cost of services for survivors of sexual assault. It will then use structured interviews with adult women to learn more about their opinions of sexual violence and their knowledge and perceptions of services for victims of sexual assault.
Assessing the Plastic and Reconstructive Surgery Needs Along the Continuum of Care in An East African Setting
Investigator: David W. Grant
Research Site: Nairobi, Kenya
It has been estimated that surgery can address 7% of Disability Adjusted Life Years in Africa1. The WHO has launched the “Safe Surgery Saves Lives” program, recognizing that surgery is a public health issue. Disfigurements as a result of injury (e.g. burns, severed limbs), disease (e.g. leprosy), or congenital deformities (e.g. cleft lip and palate) all lead to debilitating and long-lasting effects on the livelihood of individuals caused by negative health outcomes, stigma and considerable economic burden due to potential loss of income. The proposal herein descries a two phase project aimed to improve plastic and reconstructive surgical capacity in East Africa. My role during the proposed IHF-sponsored internship will be in the first phase, which is to conduct a needs assessment for reconstructive surgery in Kenya. The aim of the project is to determine the current practices in reconstructive surgery as they pertain to congenital and traumatic deformities such as limb reconstruction and burn-related injuries, and to determine the need to establish appropriate surgical programs along the continuum of care which are necessary for successful recovery. The needs assessment will combine focused group interviews with health care professionals, ministries of health and surgical training teams in both urban and rural areas of Kenya; and standardized questionnaires to reach a wider number of health care professionals and to differentiate greater needs based on geographic locations. The second phase and long-term outcome of this project is the establishment of a new surgical training program and surgical centers of excellence in Kenya that will serve to train local surgeons, nurses and post-operation care staff to serve the greater area of East Africa. The project is being undertaken by the University of Toronto’s Division of Plastic and Reconstructive Surgery, in collaboration with the African and Medical Research Foundation and The Feinberg School of Medicine of Northwestern University.
The Conceptualization of Intimate Partner Violence in Women in Northern India
Investigator: Maya Ragavan
Research Site: New Delhi, India
Intimate Partner Violence (IPV) is a significant health concern amongst women in India. Through this project, I will examine the way that women define and apply the concept of abuse both theoretically and in their personal lives. The project will occur in Udaipur, India and will consist of narrative based interviews of 30 women. The results will help form the basis for further larger studies and hopefully in the longer run will greatly enhance knowledge about IPV in India.
Motorized Two Wheeled Vehicle Riders in New Delhi: Patterns of Injury and Attitudes on Helmet Use
Investigator: Selma Siddiqui
Research Site: New Delhi, India
Data from sites worldwide demonstrate efficacy of helmet use in preventing mortality and morbidity from traumatic brain injury in two wheeled vehicle road traffic accidents. However, there nevertheless exists a long history of debate between those in favor of mandatory helmet use and those opposing such mandates as an infringement on the rights of the individual. India, a country of 1.2 billion with 70% of registered vehicles representing motorized two wheelers, is a prime example. In 1997, the Indian municipality and capital New Delhi attempted to mandate helmet use for all motorists on two wheeled vehicles, but public opposition based on religious and cultural beliefs forced an exemption in the law for all women and all Sikh riders. Objectives: First, due to locoregional differences, we must identify the attitudes toward helmet use among women of the distinct socioethnic and religious groups within New Delhi. Second, to assess adherence to current law and impact of attitudes on actual use, we must accurately identify rates of MTW rider helmet usage. Third, we must demonstrate if there is a lower rate of intracranial injury and pre-hospital death in helmeted versus non helmeted drivers and pillion riders, especially women and Sikhs. If the chart review demonstrates significant differences in mortality and morbidity, length of stay, etc, then these data can be used to advocate review of current legislation and ultimately mandate helmet use for all MTW drivers and pillion riders without exception. This data will also be used in conjunction with the survey data and actual helmet usage data to develop a city wide campaign to improve actual helmet usage rates.
Update: Dr. Siddiqui will present on her International Health Fellowship research at the 2012 Annual Academic Surgical Conference.
The Significance of Tumor Associated Antigen Specific Tregs in Colorectal Patients Peripheral Blood in Expanding Treg Response in those Patient’s Tumors
Investigator: Ashima Singal
Rsearch Site: Heidelberg, Germany
Colorectal cancer is the third leading cancer killer in the United States with a incidence of more than 140,000 in 2010. Patients with stage IV disease who are given the current standard of care, have a 5-year survival rate of only 6 percent. It is therefore necessary to continue to search for more effective therapies, and cancer vaccines are one promising area of development. With the discovery of Tumor associated antigens (TAAs) researchers have found a potential target for future vaccine development. Furthermore, it is known that there is some natural degree of anti-tumor immunity in colorectal carcinomas. However, this response is downregulated by regulatory T cells (Treg), and increased Treg response is associated with decreased survival. To evaluate this downregulation, the frequency and activation status of Treg and effector Tcells on paraffin sections from approximately 30 colorectal carcinoma patients who have had surgical removal of their tumor will be quantified by utilizing six staining combinations on serial sections: CD4+CD69, CD4+CD107a, CD8+CD69, CD8+CD107a, Foxp3+CD4, Foxp3+CD8.
An Investigation of Singapore's Integrative Healthcare Model
Investigators: Andrew Su & Brandon Yim (Recipients of 2009-2010 IHF awards)
Research Site: Republic of Singapore
Singapore's healthcare system is uniquely positioned to integrate both Eastern and Western medicine practices. While it possesses modern hospitals, cutting-edge technology and trains its physicians using the British model, there is still widespread use of TCM such as acupuncture and herbal medicine. These practices coexist synergistically in a system that remains able to offer universal healthcare coverage, keep healthcare spending below 3% of their annual GDP, and is regarded as "one of the most successful healthcare systems in the world" by the World's Health Organization. Through Westernized basic science research addressing the efficacy of TCM herbal compounds as cancer therapeutics and interviewing healthcare experts throughout the country, we investigated the integration of Eastern and Western medical practices in Singapore.
Assessing Liver Disease in HIV/HBV Co-infected patients using Fibroscan®, in Jos, Nigera
Investigator: Erika Wallender
Research Site: Jos, Nigeria
Although HIV/HBV co-infected individuals are at higher risk for liver disease progression than those with chronic Hepatitis B (HBV) alone (Puoti et al. 2006), little is known about the prevalence of liver disease in resource limited settings (RLS), and better diagnostic and prognostic tools are needed. The proposed study aims to 1) determine the prevalence of liver fibrosis and cirrhosis using the Fibroscan®, among HIV-infected patients, both with and without HBV co-infection who are enrolled at a AIDS Prevention Initiative Nigeria’s (APIN) U.S. President’s Emergency Plan For AIDS Relief (PEPFAR) funded HIV Care and Treatment Center in Jos, Nigeria and 2) among HIV/HBV co-infected patients, assess the correlation between severity of liver disease and HBV viral, serologic and genotypic markers. This study will have multiple potential benefits for HIV/HBV infected patients in RLS, providing more accurate data on the burden of liver disease among these individuals, as well as the prognostic and diagnostic utility of serum HBV markers in liver disease. The findings of the study will inform the standard of care for monitoring and treating patients with HIV and HBV in RLS such as Nigeria, and improve our ability to effectively prevent and manage liver related morbidity and mortality.
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