Michele Barry, MD, FACP

All Publications

• Making Pastoralists Count: Geospatial Methods for the Health Surveillance of Nomadic Populations. The American journal of tropical medicine and hygiene Wild, H., Glowacki, L., Maples, S., Mejia-Guevara, I., Krystosik, A., Bonds, M. H., Hiruy, A., LaBeaud, A. D., Barry, M. 2019

  Abstract

  Nomadic pastoralists are among the world's hardest-to-reach and least served populations. Pastoralist communities are difficult to capture in household surveys because of factors including their high degree of mobility over remote terrain, fluid domestic arrangements, and cultural barriers. Most surveys use census-based sampling frames which do not accurately capture the demographic and health parameters of nomadic populations. As a result, pastoralists are "invisible" in population data such as the Demographic and Health Surveys (DHS). By combining remote sensing and geospatial analysis, we developed a sampling strategy designed to capture the current distribution of nomadic populations. We then implemented this sampling frame to survey a population of mobile pastoralists in southwest Ethiopia, focusing on maternal and child health (MCH) indicators. Using standardized instruments from DHS questionnaires, we draw comparisons with regional and national data finding disparities with DHS data in core MCH indicators, including vaccination coverage, skilled birth attendance, and nutritional status. Our field validation demonstrates that this method is a logistically feasible alternative to conventional sampling frames and may be used at the population level. Geospatial sampling methods provide cost-affordable and logistically feasible strategies for sampling mobile populations, a crucial first step toward reaching these groups with health services.

  View details for DOI 10.4269/ajtmh.18-1009

  View details for PubMedID 31436151

• Prospective Biopsy-Based Study of Chronic Kidney Disease of Unknown Etiology in Sri Lanka. Clinical journal of the American Society of Nephrology : CJASN Anand, S., Montez-Rath, M. E., Adasooriya, D., Ratnatunga, N., Kambham, N., Wazil, A., Wijetunge, S., Badurdeen, Z., Ratnayake, C., Karunasena, N., Schensul, S. L., Valhos, P., Haider, L., Bhalla, V., Levin, A., Wise, P. H., Chertow, G. M., Barry, M., Fire, A. Z., Nanayakkara, N. 2019

  Abstract

  BACKGROUND AND OBJECTIVES: A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis.DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy.RESULTS: From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease.CONCLUSIONS: A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.PODCAST: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2019_01_18_CJASNPodcast_19_02_.mp3.

  View details for PubMedID 30659059

• Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emergency medicine journal : EMJ Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Ramana Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2019

  Abstract

  BACKGROUND: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.METHODS: We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Chi2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.RESULTS: We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).DISCUSSION: Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.

  View details for PubMedID 30635272

• Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool. Journal of global oncology Nwachukwu, C. R., Mudasiru, O., Million, L., Sheth, S., Qamoos, H., Onah, J. O., Okemini, A., Rhodes, M., Barry, M., Banjo, A. A., Habeebu, M., Olasinde, T. A., Bhatt, A. S. 2018: 1?9

  Abstract

  PURPOSE: Despite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation.METHODS: Using a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable.RESULTS: Data from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals.CONCLUSION: This study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.

  View details for PubMedID 30532992

• Institutionalizing healthcare hackathons to promote diversity in collaboration in medicine. BMC medical education Wang, J. K., Roy, S. K., Barry, M., Chang, R. T., Bhatt, A. S. 2018; 18 (1): 269

  Abstract

  BACKGROUND: Medical students and healthcare professionals can benefit from exposure to cross-disciplinary teamwork and core concepts of medical innovation. Indeed, to address complex challenges in patient care, diversity in collaboration across medicine, engineering, business, and design is critical. However, a limited number of academic institutions have established cross-disciplinary opportunities for students and young professionals within these domains to work collaboratively towards diverse healthcare needs.METHODS: Drawing upon best practices from computer science and engineering, healthcare hackathons bring together interdisciplinary teams of students and professionals to collaborate, brainstorm, and build solutions to unmet clinical needs. Over the course of six months, a committee of 20 undergraduates, medical students, and physician advisors organized Stanford University's first healthcare hackathon (November 2016). Demographic data from initial applications were supplemented with responses from a post-hackathon survey gauging themes of diversity in collaboration, professional development, interest in medical innovation, and educational value. In designing and evaluating the event, the committee focused on measurable outcomes of diversity across participants (skillset, age, gender, academic degree), ideas (clinical needs), and innovations (projects).RESULTS: Demographic data (n=587 applicants, n=257 participants) reveal participants across diverse academic backgrounds, age groups, and domains of expertise were in attendance. From 50 clinical needs presented representing 19 academic fields, 40 teams ultimately formed and submitted projects spanning web (n=13) and mobile applications (n=13), artificial intelligence-based tools (n=6), and medical devices (n=3), among others. In post-hackathon survey responses (n=111), medical students and healthcare professionals alike noted a positive impact on their ability to work in multidisciplinary teams, learn from individuals of different backgrounds, and address complex healthcare challenges.CONCLUSIONS: Healthcare hackathons can encourage diversity across individuals, ideas, and projects to address clinical challenges. By providing an outline of Stanford's inaugural event, we hope more universities can adopt the healthcare hackathon model to promote diversity in collaboration in medicine.

  View details for PubMedID 30458759

• Advancing Women Leaders in Global Health: Getting to Solutions. Annals of global health Moyer, C. A., Abedini, N. C., Youngblood, J., Talib, Z., Jayaraman, T., Manzoor, M., Larson, H. J., Garcia, P. J., Binagwaho, A., Burke, K. S., Barry, M. 2018; 84 (4): 743?52

  Abstract

  BACKGROUND: Women comprise 75% of the health workforce in many countries and the majority of students in academic global health tracks but are underrepresented in global health leadership. This study aimed to elucidate prevailing attitudes, perceptions, and beliefs of women and men regarding opportunities and barriers for women's career advancement, as well as what can be done to address barriers going forward.METHODS: This was a convergent mixed-methods, cross-sectional, anonymous, online study of participants, applicants, and those who expressed an interest in the Women Leaders in Global Health Conference at Stanford University October 11-12, 2017. Respondents completed a 26-question survey regarding beliefs about barriers and solutions to addressing advancement for women in global health.FINDINGS: 405 participants responded: 96.7% were female, 61.6% were aged 40 or under, 64.0% were originally from high-income countries. Regardless of age or country of origin, leading barriers were: lack of mentorship, challenges of balancing work and home, gender bias, and lack of assertiveness/confidence. Proposed solutions were categorized as individual or meta-level solutions and included senior women seeking junior women for mentorship and sponsorship, junior women pro-actively making their desire for leadership known, and institutions incentivizing mentorship and implementing targeted recruitment to improve diversity of leadership.INTERPRETATION: This study is the first of its kind to attempt to quantify both the barriers to advancement for women leaders in global health as well as the potential solutions. While there is no shortage of barriers, we believe there is room for optimism. A new leadership paradigm that values diversity of thought and diversity of experience will benefit not only the marginalized groups that need to gain representation at the table, but ultimately the broader population who may benefit from new ways of approaching long-standing, intractable problems.

  View details for PubMedID 30779525

• Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention GLOBAL HEALTH ACTION McCuskee, S., Garchitorena, A., Miller, A. C., Hall, L., Ouenzar, M., Rabeza, V. R., Ramananjato, R. H., Razanadrakato, H., Randriamanambintsoa, M., Barry, M., Bonds, M. H. 2018; 11 (1): 1452357

  Abstract

  Child malnutrition, a leading cause of death and disability worldwide, is particularly severe in Madagascar, where 47% of children under 5 years are stunted (low height-for-age) and 8% are wasted (low weight-for-height). Widespread poverty and a weak health system have hindered attempts to implement life-saving malnutrition interventions in Madagascar during critical periods for growth faltering.This study aimed to shed light on the most important factors associated with child malnutrition, both acute and chronic, and the timing of growth faltering, in Ifanadiana, a rural district of Madagascar.We analyzed data from a 2014 district-representative cluster household survey, which had information on 1175 children ages 6 months to 5 years. We studied the effect of child health, birth history, maternal and paternal health and education, and household wealth and sanitation on child nutritional status. Variables associated with stunting and wasting were modeled separately in multivariate logistic regressions. Growth faltering was modeled by age range. All analyses were survey-adjusted.Stunting was associated with increasing child age (OR = 1.03 (95%CI 1.02-1.04) for each additional month), very small birth size (OR = 2.32 (1.24-4.32)), low maternal weight (OR = 0.94 (0.91-0.97) for each kilogram, kg) and height (OR = 0.95 (0.92-0.99) for each centimeter), and low paternal height (OR = 0.95 (0.92-0.98)). Wasting was associated with younger child age (OR = 0.98 (0.97-0.99)), very small birth size (OR = 2.48 (1.23-4.99)), and low maternal BMI (OR = 0.84 (0.75-0.94) for each kg/m2). Height-for-age faltered rapidly before 24 months, then slowly until age 5 years, whereas weight-for-height faltered rapidly before 12 months, then recovered gradually until age 5 years but did not reach the median.Intergenerational transmission of growth faltering and early life exposures may be important determinants of malnutrition in Ifanadiana. Timing of growth faltering, in the first 1000 days, is similar to international populations; however, child growth does not recover to the median.

  View details for PubMedID 29595379

• Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges GLOBAL HEALTH-SCIENCE AND PRACTICE Hakim, J. G., Chidzonga, M. M., Borok, M. Z., Nathoo, K. J., Matenga, J., Havranek, E., Cowan, F., Abas, M., Aagaard, E., Connors, S., Nkomani, S., Ndhlovu, C. E., Matsika, A., Barry, M., Campbell, T. B. 2018; 6 (1): 82?92

  Abstract

  Sub-Saharan Africa has an inadequate number of health professionals, leading to a reduced capacity to respond to health challenges, including HIV/AIDS. From 2010 to 2015, the Medical Education Partnership Initiative (MEPI)-sponsored by the U.S. Presidents Emergency Plan for AIDS Relief (PEPFAR) and the National Institutes of Health (NIH)-was enthusiastically taken up by the University of Zimbabwe College of Health Sciences (UZCHS) and 12 other sub-Saharan African universities to develop models of training to improve medical education and research capacity. In this article, we describe the outcomes and challenges of MEPI in Zimbabwe.UZCHS in partnership with the University of Colorado, Denver; Stanford University; University of Cape Town; University College London; and King's College London designed the Novel Education Clinical Trainees and Researchers (NECTAR) program and 2 linked awards addressing cardiovascular disease and mental health to pursue MEPI objectives. A range of medical education and research capacity-focused programs were implemented, including faculty development, research support, mentored scholars, visiting professors, community-based education, information and technology support, cross-cutting curricula, and collaboration with partner universities and the ministries of health and education. We analyzed quantitative and qualitative data from several data sources, including annual surveys of faculty, students, and other stakeholders; workshop exit surveys; and key informant interviews with NECTAR administrators and leaders and the UZCHS dean.Improved Internet connectivity and electronic resource availability were early successes of NECTAR. Over the 5-year period, 69% (115 of 166) of faculty members attended at least 1 of 15 faculty development workshops. Forty-one faculty members underwent 1-year advanced faculty development training in medical education and leadership. Thirty-three mentored research scholars were trained under NECTAR, and 52 and 12 in cardiovascular and mental health programs, respectively. Twelve MEPI scholars had joined faculty by 2015. Full-time faculty grew by 36% (122 to 166), annual postgraduate and medical student enrollment increased by 61% (75 to 121) and 71% (123 to 210), respectively. To institutionalize and sustain MEPI innovations, the Research Support Center and the Department of Health Professions Education were established at UZCHS.MEPI has synergistically revitalized medical education, research capacity, and leadership at UZCHS. Investments in creating a new research center, health professions education department, and, programs have laid the foundation to help sustain faculty development and research capacity in the country.

  View details for PubMedID 29602867

• Health Education Advanced Leadership for Zimbabwe (Healz): Developing the Infrastructure to Support Curriculum Reform ANNALS OF GLOBAL HEALTH Aagaard, E. M., Connors, S. C., Challender, A., Gandari, J., Nathoo, K., Borok, M., Chidzonga, M., Barry, M., Campbell, T., Hakim, J. 2018; 84 (1): 176?82

  View details for DOI 10.29024/aogh.19

  View details for Web of Science ID 000441346800021

• MAKING PASTORALISTS COUNT: HEALTH SURVEILLANCE OF A NOMADIC POPULATION USING A GEOSPATIALLY DERIVED SAMPLING FRAME Wild, H., Glowacki, L., Maples, S., Mejia-Guevara, I., Hiruy, A., Krystosik, A., Bonds, M., LaBeaud, A., Barry, M. AMER SOC TROP MED & HYGIENE. 2018: 659?60

  View details for Web of Science ID 000461386605149

• Community outreach programs and major adherence lapses with antiretroviral therapy in rural Kakamega, Kenya. AIDS care Hodgkinson, L. M., Makori, J., Okwiri, J., Tsisiche, C., Arudo, J., Barry, M. 2018; 30 (6): 696?700

  Abstract

  We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20).

  View details for PubMedID 29058457

• Health Education Advanced Leadership for Zimbabwe (Healz): Developing the Infrastructure to Support Curriculum Reform. Annals of global health Aagaard, E. M., Connors, S. C., Challender, A., Gandari, J., Nathoo, K., Borok, M., Chidzonga, M., Barry, M., Campbell, T., Hakim, J. 2018; 84 (1): 176?82

  Abstract

  An economic crisis in Zimbabwe from 1999-2009 resulted in a shortage of faculty at the University of Zimbabwe College of Health Sciences (UZCHS) and declining enrollment and graduation rates. To improve proficiency and retention of graduates, the college sought to develop a competency-based curriculum using evidence-based educational methodologies. Achievement of this goal required a cadre of highly qualified educators to lead the curriculum review and innovation processes. The Health Education Advanced Leadership for Zimbabwe (HEALZ) program was established in 2012 to rapidly develop the needed faculty leadership. HEALZ is a one-year program of rigorous coursework delivered face-to-face in three intensive one-week sessions. Between sessions, scholars engage with mentors to conduct a needs assessment and to develop, implement, and evaluate a competency-based curriculum. Forty scholars completed training from 2012-15. All participants reported they were satisfied or extremely satisfied with the training after each week. Pre-post surveys identified significant knowledge gains in all key content domains. The program garnered significant organizational support. Scholars showed significant variation in progress toward implementing and evaluating their curricula as well as the quality of the work demonstrated by program end. Interviews of scholars and UZCHS leaders revealed important impacts of the program on the quality and culture of medical education at the college.

  View details for PubMedID 30873767

• A new vision for global health leadership LANCET Barry, M., Talib, Z., Jowell, A., Thompson, K., Moyer, C., Larson, H., Burke, K., Steering Comm Women Leaders 2017; 390 (10112): 2536?37

  View details for DOI 10.1016/S0140-6736(17)33101-X

  View details for Web of Science ID 000417493300009

• The impact of megacities on health: preparing for a resilient future. The Lancet. Planetary health Jowell, A., Zhou, B., Barry, M. 2017; 1 (5): e176?e178

  View details for PubMedID 29851637

• Making Online Outbreak Surveillance Work for all ANNALS OF GLOBAL HEALTH Wang, Y., Barry, M. 2017; 83 (3-4): 625?29

  View details for DOI 10.1016/j.aogh.2017.09.002

  View details for Web of Science ID 000417209100026

• The Perils of Trumping Science in Global Health - The Mexico City Policy and Beyond. New England journal of medicine Lo, N. C., Barry, M. 2017

  View details for DOI 10.1056/NEJMp1701294

  View details for PubMedID 28225666

• Gender myths in global health - Authors' reply. The Lancet. Global health Talib, Z., Burke, K. S., Barry, M. 2017; 5 (9): e872

  View details for PubMedID 28807186

• Medical Education Partnership Initiative in Zimbabwe: partnerships for transformation. The Lancet. Global health Hakim, J. G., Barry, M., Matenga, J., Cowan, F., Campbell, T. B. 2017; 5 (2): e143?e144

  View details for PubMedID 28104181

• PROTECTING, BALANCING, AND CONFRONTING: HEALTH-SEEKING AMONG HOMELESS YOUTH IN HO CHI MINH CITY, VIETNAM INTERNATIONAL JOURNAL OF CHILD YOUTH & FAMILY STUDIES Boggiano, V. L., Harris, L. M., Schmidt, V., Le Quang Nguyen, Ha An Nguyen, Barry, M. 2017; 8 (3-4): 1?25

  View details for DOI 10.18357/ijcyfs83/4201717998

  View details for Web of Science ID 000419834000001

• Community outreach programs and major adherence lapses with antiretroviral therapy in rural Kakamega, Kenya AIDS Care Hodgkinson, L. M., Makori, J., Okwiri, J., Tsisiche, C., Arudo, J., Barry, M. 2017: 696?700

  Abstract

  We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20).

  View details for DOI 10.1080/09540121.2017.1391987

• Women leaders in global health. The Lancet. Global health Talib, Z., Burke, K. S., Barry, M. 2017; 5 (6): e565?e566

  View details for PubMedID 28495255

• Minimally Symptomatic Infection in an Ebola 'Hotspot': A Cross-Sectional Serosurvey PLOS NEGLECTED TROPICAL DISEASES Richardson, E. T., Kelly, J. D., Barrie, M. B., Mesman, A. W., Karku, S., Quiwa, K., Marsh, R. H., Koedoyoma, S., Daboh, F., Barron, K. P., Grady, M., Tucker, E., Dierberg, K. L., Rutherford, G. W., Barry, M., Jones, J. H., Murray, M. B., Farmer, P. E. 2016; 10 (11)

  Abstract

  Evidence for minimally symptomatic Ebola virus (EBOV) infection is limited. During the 2013-16 outbreak in West Africa, it was not considered epidemiologically relevant to published models or projections of intervention effects. In order to improve our understanding of the transmission dynamics of EBOV in humans, we investigated the occurrence of minimally symptomatic EBOV infection in quarantined contacts of reported Ebola virus disease cases in a recognized 'hotspot.'We conducted a cross-sectional serosurvey in Sukudu, Kono District, Sierra Leone, from October 2015 to January 2016. A blood sample was collected from 187 study participants, 132 negative controls (individuals with a low likelihood of previous exposure to Ebola virus), and 30 positive controls (Ebola virus disease survivors). IgG responses to Ebola glycoprotein and nucleoprotein were measured using Alpha Diagnostic International ELISA kits with plasma diluted at 1:200. Optical density was read at 450 nm (subtracting OD at 630nm to normalize well background) on a ChroMate 4300 microplate reader. A cutoff of 4.7 U/mL for the anti-GP ELISA yielded 96.7% sensitivity and 97.7% specificity in distinguishing positive and negative controls. We identified 14 seropositive individuals not known to have had Ebola virus disease. Two of the 14 seropositive individuals reported only fever during quarantine while the remaining 12 denied any signs or symptoms during quarantine.By using ELISA to measure Zaire Ebola virus antibody concentrations, we identified a significant number of individuals with previously undetected EBOV infection in a 'hotspot' village in Sierra Leone, approximately one year after the village outbreak. The findings provide further evidence that Ebola, like many other viral infections, presents with a spectrum of clinical manifestations, including minimally symptomatic infection. These data also suggest that a significant portion of Ebola transmission events may have gone undetected during the outbreak. Further studies are needed to understand the potential risk of transmission and clinical sequelae in individuals with previously undetected EBOV infection.

  View details for DOI 10.1371/journal.pntd.0005087

  View details for Web of Science ID 000392154400022

  View details for PubMedID 27846221

• Mortality outcomes for Chinese and Japanese immigrants in the USA and countries of origin (Hong Kong, Japan): a comparative analysis using national mortality records from 2003 to 2011. BMJ open Hastings, K. G., Eggleston, K., Boothroyd, D., Kapphahn, K. I., Cullen, M. R., Barry, M., Palaniappan, L. P. 2016; 6 (10)

  Abstract

  With immigration and minority populations rapidly growing in the USA, it is critical to assess how these populations fare after immigration, and in subsequent generations. Our aim is to compare death rates and cause of death across foreign-born, US-born and country of origin Chinese and Japanese populations.We analysed all-cause and cause-specific age-standardised mortality rates and trends using 2003-2011 US death record data for Chinese and Japanese decedents aged 25 or older by nativity status and sex, and used the WHO Mortality Database for Hong Kong and Japan decedents in the same years. Characteristics such as age at death, absolute number of deaths by cause and educational attainment were also reported.We examined a total of 10?458?849 deaths. All-cause mortality was highest in Hong Kong and Japan, intermediate for foreign-born, and lowest for US-born decedents. Improved mortality outcomes and higher educational attainment among foreign-born were observed compared with developed Asia counterparts. Lower rates in US-born decedents were due to decreased cancer and communicable disease mortality rates in the US heart disease mortality was either similar or slightly higher among Chinese-Americans and Japanese-Americans compared with those in developed Asia counterparts.Mortality advantages in the USA were largely due to improvements in cancer and communicable disease mortality outcomes. Mortality advantages and higher educational attainments for foreign-born populations compared with developed Asia counterparts may suggest selective migration. Findings add to our limited understanding of the racial and environmental contributions to immigrant health disparities.

  View details for DOI 10.1136/bmjopen-2016-012201

  View details for PubMedID 27793837

  View details for PubMedCentralID PMC5093623

• Sex differences in obesity, dietary habits, and physical activity among urban middle-class Bangladeshis. International journal of health sciences Saquib, J., Saquib, N., Stefanick, M. L., Khanam, M. A., Anand, S., Rahman, M., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2016; 10 (3): 363-372

  Abstract

  The sustained economic growth in Bangladesh during the previous decade has created a substantial middle-class population, who have adequate income to spend on food, clothing, and lifestyle management. Along with the improvements in living standards, has also come negative impact on health for the middle class. The study objective was to assess sex differences in obesity prevalence, diet, and physical activity among urban middle-class Bangladeshi.In this cross-sectional study, conducted in 2012, we randomly selected 402 adults from Mohammedpur, Dhaka. The sampling technique was multi-stage random sampling. We used standardized questionnaires for data collection and measured height, weight, and waist circumference.Mean age (standard deviation) was 49.4 (12.7) years. The prevalence of both generalized (79% vs. 53%) and central obesity (85% vs. 42%) were significantly higher in women than men. Women reported spending more time watching TV and spending less time walking than men (p<.05); however, men reported a higher intake of unhealthy foods such as fast food and soft drinks.We conclude that the prevalence of obesity is significantly higher in urban middle-class Bangladeshis than previous urban estimates, and the burden of obesity disproportionately affects women. Future research and public health efforts are needed to address this severe obesity problem and to promote active lifestyles.

  View details for PubMedID 27610059

• Medical "Brain Drain" and Health Care Worker Shortages: How Should International Training Programs Respond? AMA journal of ethics Karan, A., DeUgarte, D., Barry, M. 2016; 18 (7): 665-675

  Abstract

  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

• The Global Health Implications of e-Cigarettes. JAMA Chang, A. Y., Barry, M. 2015; 314 (7): 663-664

  View details for DOI 10.1001/jama.2015.8676

  View details for PubMedID 26284714

• Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8)

  View details for DOI 10.1371/journal.pntd.0003961

  View details for PubMedID 26270343

• Is a Cholera Outbreak Preventable in Post-earthquake Nepal? PLoS neglected tropical diseases Nelson, E. J., Andrews, J. R., Maples, S., Barry, M., Clemens, J. D. 2015; 9 (8)

  View details for DOI 10.1371/journal.pntd.0003961

  View details for PubMedID 26270343

• Effects of Land Use on Plague (Yersinia pestis) Activity in Rodents in Tanzania AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE McCauley, D. J., Salkeld, D. J., Young, H. S., Makundi, R., Dirzo, R., Eckerlin, R. P., Lambin, E. F., Gaffikin, L., Barry, M., Helgen, K. M. 2015; 92 (4): 776-783

  Abstract

  Understanding the effects of land-use change on zoonotic disease risk is a pressing global health concern. Here, we compare prevalence of Yersinia pestis, the etiologic agent of plague, in rodents across two land-use types-agricultural and conserved-in northern Tanzania. Estimated abundance of seropositive rodents nearly doubled in agricultural sites compared with conserved sites. This relationship between land-use type and abundance of seropositive rodents is likely mediated by changes in rodent and flea community composition, particularly via an increase in the abundance of the commensal species, Mastomys natalensis, in agricultural habitats. There was mixed support for rodent species diversity negatively impacting Y. pestis seroprevalence. Together, these results suggest that land-use change could affect the risk of local transmission of plague, and raise critical questions about transmission dynamics at the interface of conserved and agricultural habitats. These findings emphasize the importance of understanding disease ecology in the context of rapidly proceeding landscape change.

  View details for DOI 10.4269/ajtmh.14-0504

  View details for Web of Science ID 000352828200018

  View details for PubMedID 25711606

  View details for PubMedCentralID PMC4385772

• International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in leogane, haiti. American journal of tropical medicine and hygiene Kligerman, M., Barry, M., Walmer, D., Bendavid, E. 2015; 92 (2): 448-453

  Abstract

  The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

  View details for DOI 10.4269/ajtmh.14-0379

  View details for PubMedID 25510716

  View details for PubMedCentralID PMC4347354

• Innovations to Enhance the Quality of Health Professions Education at the University of Zimbabwe College of Health Sciences-NECTAR Program ACADEMIC MEDICINE Ndhlovu, C. E., Nathoo, K., Borok, M., Chidzonga, M., Aagaard, E. M., Connors, S. C., Barry, M., Campbell, T., Hakim, J. 2014; 89 (8): S88-S92

  Abstract

  The University of Zimbabwe College of Health Sciences (UZCHS) is Zimbabwe's premier health professions training institution. However, several concerns were raised during the past decade over the quality of health education at UZCHS. The number of faculty and students declined markedly until 2010, when there was a medical student intake of 147 while the faculty comprised only 122 (39%) of a possible 314 positions. The economic and political crises that the country experienced from 1999 to 2009 compounded the difficulties faced by the institution by limiting the availability of resources. The Medical Education Partnership Initiative funding opportunity has given UZCHS the stimulus to embark on reforms to improve the quality of health education it offers. UZCHS, in partnership with the University of Colorado School of Medicine, the University of Colorado Denver Evaluation Center, and Stanford University, designed the Novel Education Clinical Trainees and Researchers (NECTAR) program to implement a series of health education innovations to meet this challenge. Between 2010 and 2013, innovations that have positively affected the quality of health professions education at UZCHS include the launch of comprehensive faculty development programs and mentored clinical and research programs for postgraduate students. A competency-based curriculum reform process has been initiated, a health professions department has been established, and the Research Support Center has been strengthened, providing critical resources to institutionalize health education and research implementation at the college. A core group of faculty trained in medical education has been assembled, helping to ensure the sustainability of these NECTAR activities.

  View details for DOI 10.1097/ACM.0000000000000336

  View details for Web of Science ID 000340290200023

  View details for PubMedID 25072588

• Treating hepatitis C in lower-income countries. New England journal of medicine Jayasekera, C. R., Barry, M., Roberts, L. R., Nguyen, M. H. 2014; 370 (20): 1869-1871

  View details for DOI 10.1056/NEJMp1400160

  View details for PubMedID 24720680

• High prevalence of chronic kidney disease in a community survey of urban Bangladeshis: a cross-sectional study. Globalization and health Anand, S., Khanam, M. A., Saquib, J., Saquib, N., Ahmed, T., Alam, D. S., Cullen, M. R., Barry, M., Chertow, G. M. 2014; 10 (1): 9-?

  Abstract

  The burden of chronic kidney disease (CKD) will rise in parallel with the growing prevalence of type two diabetes mellitus in South Asia but is understudied. Using a cross-sectional survey of adults living in a middle-income neighborhood of Dhaka, Bangladesh, we tested the hypothesis that the prevalence of CKD in this group would approach that of the U.S. and would be strongly associated with insulin resistance.We enrolled 402 eligible adults (>30 years old) after performing a multi-stage random selection procedure. We administered a questionnaire, and collected fasting serum samples and urine samples. We used the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation to estimate glomerular filtration rate, and sex-specific cut offs for albuminuria: > 1.9 mg/mmol (17 mg/g) for men, and >2.8 mg/mmol (25 mg/g) for women. We assessed health-related quality of life using the Medical Outcomes Study Short Form-12 (SF-12).A total of 357 (89%) participants with serum samples comprised the analytic cohort. Mean age of was 49.5 (± 12.7) years. Chronic kidney disease was evident in 94 (26%). Of the participants with CKD, 58 (62%) had albuminuria only. A participant with insulin resistance had a 3.6-fold increase in odds of CKD (95% confidence interval 2.1 to 6.4). Participants with stage three or more advanced CKD reported a decrement in the Physical Health Composite score of the SF-12, compared with participants without CKD.We found an alarmingly high prevalence of CKD-particularly CKD associated with insulin resistance-in middle-income, urban Bangladeshis.

  View details for DOI 10.1186/1744-8603-10-9

  View details for PubMedID 24555767

  View details for PubMedCentralID PMC3944963

• Meeting the Challenges of Global Health; pages 37-41 Stanford Social Innovation Review Denend, L., Lockwood, A., Barry, M., Zenios, S. 2014; 12 (Number 2)
• An ethics curriculum for short-term global health trainees GLOBALIZATION AND HEALTH Decamp, M., Rodriguez, J., Hecht, S., Barry, M., Sugarman, J. 2013; 9

  Abstract

  Interest in short-term global health training and service programs continues to grow, yet they can be associated with a variety of ethical issues for which trainees or others with limited global health experience may not be prepared to address. Therefore, there is a clear need for educational interventions concerning these ethical issues.We developed and evaluated an introductory curriculum, "Ethical Challenges in Short-term Global Health Training." The curriculum was developed through solicitation of actual ethical issues experienced by trainees and program leaders; content drafting; and external content review. It was then evaluated from November 1, 2011, through July 1, 2012, by analyzing web usage data and by conducting user surveys. The survey included basic demographic data; prior experience in global health and global health ethics; and assessment of cases within the curriculum.The ten case curriculum is freely available at http://ethicsandglobalhealth.org. An average of 238 unique visitors accessed the site each month (standard deviation, 19). Of users who had been abroad before for global health training or service, only 31% reported prior ethics training related to short-term work. Most users (62%) reported accessing the site via personal referral or their training program; however, a significant number (28%) reported finding the site via web search, and 8% discovered it via web links. Users represented different fields: medicine (46%), public health (15%), and nursing (11%) were most common. All cases in the curriculum were evaluated favorably.The curriculum is meeting a critical need for an introduction to the ethical issues in short-term global health training. Future work will integrate this curriculum within more comprehensive curricula for global health and evaluate specific knowledge and behavioral effects, including at training sites abroad.

  View details for DOI 10.1186/1744-8603-9-5

  View details for Web of Science ID 000315939700001

  View details for PubMedID 23410089

• Reflecting on Short-Term International Service-Learning Trips ACADEMIC MEDICINE Crump, J. A., Decamp, M., Barry, M., Sugarman, J. 2013; 88 (1): 10-11

  View details for DOI 10.1097/ACM.0b013e3182753f25

  View details for Web of Science ID 000312795900009

  View details for PubMedID 23267221

• High prevalence of type 2 diabetes among the urban middle class in Bangladesh. BMC public health Saquib, N., Khanam, M. A., Saquib, J., Anand, S., Chertow, G. M., Barry, M., Ahmed, T., Cullen, M. R. 2013; 13: 1032-?

  Abstract

  The prevalence of type-2 diabetes and metabolic syndrome are increasing in the developing world; we assessed their prevalence among the urban middle class in Bangladesh.In this cross-sectional survey (n = 402), we randomly selected consenting adults (? 30 years) from a middle-income neighborhood in Dhaka. We assessed demography, lifestyle, and health status, measured physical indices and blood pressure and obtained blood samples. We evaluated two primary outcomes: (1) type-2 diabetes (fasting blood glucose ? 7.0 mmol/L or hemoglobin A1C ? 6.5% (48 mmol/mol) or diabetes medication use) and (2) insulin resistance (type-2 diabetes or metabolic syndrome using International Diabetes Federation criteria).Mean age and Quételet's (body mass) index were 49.4 ± 12.6 years and 27.0 ± 5.1 kg/m²; 83% were married, 41% had ?12 years of education, 47% were employed, 47% had a family history of diabetes. Thirty-five percent had type-2 diabetes and 45% had metabolic syndrome. In multivariate models older age and family history of diabetes were significantly associated with type-2 diabetes. Older age, female sex, overweight or obese, high wealth index and positive family history of diabetes were significantly associated with insulin resistance. Participants with type-2 diabetes or insulin resistance had significantly poorer physical health only if they had associated cardiovascular disease.The prevalence of type-2 diabetes and metabolic syndrome among the middle class in Dhaka is alarmingly high. Screening services should be implemented while researchers focus on strategies to lessen the incidence and morbidity associated with these conditions.

  View details for DOI 10.1186/1471-2458-13-1032

  View details for PubMedID 24172217

• Reuters - Opinion, The Great Debate Internet access is a vital healthcare tool Barry, M. 2013
• Transient Facial Swellings in a Patient With a Remote African Travel History JOURNAL OF TRAVEL MEDICINE Richardson, E. T., Luo, R., Fink, D. L., Nutman, T. B., Geisse, J. K., Barry, M. 2012; 19 (3): 183-185

  Abstract

  We present a case of Loa loa infection in a patient, 21 years after visiting an endemic area for only 4 days. To our knowledge, this case represents the longest time for the diagnosis of loiasis to be made post-exposure in a traveler and emphasizes that even short exposures can place travelers at risk.

  View details for DOI 10.1111/j.1708-8305.2012.00612.x

  View details for Web of Science ID 000303197900009

  View details for PubMedID 22530826

  View details for PubMedCentralID PMC3437052

• Tb in a Global Health Exchange Program JOURNAL OF GENERAL INTERNAL MEDICINE Decamp, M., Crump, J. A., Rodriguez, J., Richardson, G., Barry, M., Sugarman, J. 2012; 27 (1): 7-7

  View details for DOI 10.1007/s11606-011-1908-1

  View details for Web of Science ID 000298883900004

  View details for PubMedID 22012345

• Health Technologies and Innovation in the Global Health Arena NEW ENGLAND JOURNAL OF MEDICINE Sinha, S. R., Barry, M. 2011; 365 (9): 779-782

  View details for Web of Science ID 000294405200002

  View details for PubMedID 21879894

• Short-Term Global Health Research Projects by US Medical Students: Ethical Challenges for Partnerships AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Provenzano, A. M., Graber, L. K., Elansary, M., Khoshnood, K., Rastegar, A., Barry, M. 2010; 83 (2): 211-214

  Abstract

  Recent interest in global health among medical students has grown drastically, and many students now spend time abroad conducting short-term research projects in low-resource settings. These short-term stints in developing countries present important ethical challenges to US-based students and their medical schools as well as the institutions that host such students abroad. This paper outlines some of these ethical issues and puts forth recommendations for ethically mindful short-term student research.

  View details for DOI 10.4269/ajtmh.2010.09-0692

  View details for Web of Science ID 000280694300003

  View details for PubMedID 20682858

• GLOBAL HEALTH Fifty Years of US Embargo: Cuba's Health Outcomes and Lessons SCIENCE Drain, P. K., Barry, M. 2010; 328 (5978): 572-573

  View details for DOI 10.1126/science.1189680

  View details for Web of Science ID 000277159800024

  View details for PubMedID 20430999

• Ethics and Best Practice Guidelines for Training Experiences in Global Health Am J Trop Med Hyg Crump JA, Sugarman J, Barry, M et al 2010; 83 (6): 1178-1182
• Talking Dirty-The Politics of Clean Water and Sanitation NEJM Barry M, Hughes J. 2008; 359 (8): 784-787
• The Tail End of Guinea Worm - Global Eradication without a Drug or Vaccine NEJM Barry M 2007; 356 (25): 2561-2564
• Suburban Leptospirosis: Atypical Lymphocytosis and Gamma-delta T cell response. Clinical Infectious Diseases Barry M, Wisnewski A, Matthias M, Inoye S, Vinetz J. 2006; 43 (Nov 15): 1306
• Presidential Address - Disease without borders: globalization's challenge to the American Society of Tropical Medicine and Hygiene: A call for public advocacy and activism. Am J Trop Med Hyg Barry M 2003; 69 (1): 3-7
• The International Health Program: The fifteen year experience with Yale University's Internal Medicine Residency Program. Am J Trop Med Hyg Gupta A, Wells C, Horwitz R, Bia F, Barry M. 1999; 61 (6): 1019-1023
• Treatment of a Laboratory Acquired Infection of Sabiá Virus. NEJM Barry M, Armstrong L, Russi M, Dembry L, Geller D, Tesh R, Gonzalez JP, Khan A, Peters CJ. 1995; 333: 294-296
• Zimbabwe: Health care changes after independence and transition to majority rule. JAMA Barry M, Cullen M, Thomas JEP, Loewenson R. 1990; 263 (5): 638-640
• Ethical considerations of human investigation in developing countries: The AIDS dilemma. NEJM Barry M. 1988; 319 (16): 1083-1086