Harold C Wiesenfeld

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (66)310.86 Total impact

  • Harold C Wiesenfeld
    Obstetrics and Gynecology 07/2013; 122(1):156. · 4.80 Impact Factor
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    ABSTRACT: PURPOSE: To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED). METHODS: A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter. RESULTS: Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%-48%) to 53% (95% CI 27%-79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%-22%) to 33% (95% CI 12%-62%). These changes were not statistically different from control participants. CONCLUSIONS: SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample.
    Journal of Adolescent Health 05/2013; · 2.97 Impact Factor
  • Harold C Wiesenfeld
    Sexually transmitted diseases 05/2013; 40(5):386-7. · 2.58 Impact Factor
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    Kimberly A Paccione, Harold C Wiesenfeld
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    ABSTRACT: . To investigate adherence to the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococci (GBS) prevention in penicillin-allergic obstetric patients. . This is a retrospective cohort study of penicillin-allergic obstetric patients who tested positive for GBS and delivered at our institution in 2010. Electronic medical records were reviewed for the nature of the penicillin allergy, documentation of having previously tolerated cephalosporins, gestational age at delivery, type of delivery, antimicrobial sensitivity testing, and antibiotics administered. Antimicrobial sensitivity testing and "appropriate" antibiotic choice, which was determined using 2002 CDC guidelines, were analyzed. . Intrapartum antibiotic prophylaxis was administered in 97.8% (95% confidence interval [CI] 93.5-99.5%) of patients, but it was considered appropriate in only 62.2% (95% CI 53.8-70.0%) of patients. Clindamycin was the most commonly used antibiotic, but 26.4% (95% CI 16.3-39.7%) of patients who received clindamycin did not have confirmation of susceptibility via antimicrobial sensitivity testing. Overall, the sensitivity testing was performed in only 65.5% (95% CI 56.2-73.7%) of patients in whom it was indicated. . Compliance with CDC guidelines for performing antimicrobial sensitivity testing and choosing an appropriate antibiotic in GBS-positive penicillin-allergic women continues to be suboptimal. Institution of measures to increase adherence is necessary.
    Infectious Diseases in Obstetrics and Gynecology 01/2013; 2013:917304.
  • Catherine A Chappell, Harold C Wiesenfeld
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    ABSTRACT: Severe pelvic inflammatory disease and tuboovarian abscesses (TOAs) are common pelvic infections requiring inpatient admission. There are few large randomized trials guiding appropriate clinical management of TOA, including antibiotic selection and timing of surgical management and drainage. The pathogenesis, diagnosis, and management of severe pelvic inflammatory disease and TOA are summarized and reviewed from the most current literature.
    Clinical obstetrics and gynecology 12/2012; 55(4):893-903. · 2.06 Impact Factor
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    ABSTRACT: PROBLEM: Development of safe and effective Chlamydia trachomatis vaccines requires better understanding of the host immune responses elicited by natural infection. METHOD OF STUDY: Peripheral blood mononuclear cells isolated from women with or without history of genital tract chlamydial infection were stimulated with inactivated C. trachomatis elementary bodies (EB) in ELISPOT assays that enumerated frequencies of cells producing interferon (IFN)-γ or interleukin (IL)-17. RESULTS: IFN-γ-positive cells were highest among women sampled 30-60 days after diagnosis of C. trachomatis infection and treatment initiation, while the numbers of IFN-γ-positive cells were equally low among uninfected women and women sampled <30 or >60 days after diagnosis of infection. Conversely, IL-17-positive cell numbers were uniformly low among all participants. CONCLUSION: Dramatically reduced numbers of Chlamydia-specific Th1 memory cells in the peripheral circulation of study participants sampled more than 2 months after diagnosis, and initiation of treatment provides new insight into the results from C. trachomatis vaccine trials, in which immunization with EB provided only short-lived protection. Our results also suggest that an effective vaccine against this weakly antigenic intracellular pathogen will need to generate immunological memory more durable than that elicited by natural infection.
    American Journal Of Reproductive Immunology 08/2012; · 3.32 Impact Factor
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    ABSTRACT: The reported incidence of acute pelvic inflammatory disease (PID) has decreased but rates of tubal infertility have not, suggesting that a large proportion of PID leading to infertility may be undetected. Subclinical PID is common in women with uncomplicated chlamydial or gonococcal cervicitis or with bacterial vaginosis. We assessed whether women with subclinical PID are at an increased risk for infertility. A prospective observational cohort of 418 women with or at risk for gonorrhea or chlamydia or with bacterial vaginosis was recruited. Women with acute PID were excluded. An endometrial biopsy was performed to identify endometritis (subclinical PID). After provision of therapy for gonorrhea, chlamydia and bacterial vaginosis participants were followed-up for fertility outcomes. There were 146 incident pregnancies during follow-up, 50 pregnancies in 120 (42%) women with subclinical PID and 96 in 187 (51%) women without subclinical PID. Women with subclinical PID diagnosed at enrollment had a 40% reduced incidence of pregnancy compared with women without subclinical PID (hazard ratio 0.6, 95% confidence interval 0.4-0.8). Women with Neisseria gonorrhoeae or Chlamydia trachomatis, in the absence of subclinical PID, were not at increased risk for infertility. Subclinical PID decreases subsequent fertility despite provision of treatment for sexually transmitted diseases. These findings suggest that a proportion of female infertility is attributable to subclinical PID and indicate that current therapies for sexually transmitted diseases are inadequate for prevention of infertility.
    Obstetrics and Gynecology 06/2012; 120(1):37-43. · 4.80 Impact Factor
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    ABSTRACT: While endometrial neutrophils and plasma cells are criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease (PID) research, plasma cell misidentification and nonspecificity may limit the accuracy of these criteria. Herein, we examined: (1) the identification of endometrial plasma cells with conventional methyl green pyronin-based methodology versus plasma cell-specific (CD138) immunostaining, (2) the prevalence of endometrial plasma cells among women at low risk for PID, and (3) endometrial leukocyte subpopulations among women diagnosed with acute or chronic histologic endometritis by conventional criteria. We observed an absence of CD138+ cells in 25% of endometrial biopsies in which plasma cells had been identified by conventional methodology, while additional immunohistochemical analyses revealed indistinguishable inflammatory infiltrates among women diagnosed with acute or chronic endometritis by conventional criteria. Among women considered at lower risk for PID development, flow cytometric analyses detected plasma cells in 30% of endometrial biopsy specimens, suggesting that these cells, even when accurately identified, only nonspecifically identify upper genital tract inflammatory processes. Combined, our findings underscore the limitations of the criteria used to diagnose histologic endometritis in PID-related research and suggest that satisfactory understanding of PID pathogenesis, treatment, and prevention is hindered by continued use of these criteria.
    Pathology - Research and Practice 11/2011; 207(11):680-5. · 1.21 Impact Factor
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    ABSTRACT: Timely notification and treatment of sex partners exposed to a sexually transmitted disease (STD) is essential to reduce reinfection and transmission. Our objectives were to determine factors associated with patient-initiated notification of sex partners and preferences regarding standard partner referral versus expedited partner therapy (EPT). Participants diagnosed with gonorrhea, chlamydia, trichomoniasis, or nongonococcal urethritis within the previous year were administered a baseline survey asking about demographics, sexual history, and partner treatment preferences (standard partner referral vs. EPT). They identified up to 4 sex partners within the past 2 months, and answered questions on relationship characteristics, quality, and notification self-efficacy. At follow-up, participants with a current STD were asked whether they notified their partners. Generalized estimating equations were used to evaluate the associations between predictor variables and partner notification. Of the 201 subjects enrolled, 157 had a current STD diagnosis, and 289 sex partners were identified. The rate of successful partner notification was 77.3% (157/203 sex partners). Partner notification was increased if the subject had a long-term relationship with a sex partner (odds ratio: 3.07; 95% confidence interval: 1.43, 6.58), considered the partner to be a main partner (odds ratio: 2.53; 95% confidence interval: 1.43, 6.58), or had increased notification self-efficacy. Overall, participants did not prefer EPT over standard referral; however, females, those with higher education levels, and those with a prior STD preferred EPT. Patient-initiated partner referral is more successful in patients with increased self-efficacy who have stronger interpersonal relationships with their sex partners.
    Sexually transmitted diseases 09/2011; 38(9):821-7. · 2.58 Impact Factor
  • M R Kennedy, L A Meyn, M F Reeves, H C Wiesenfeld
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    ABSTRACT: The objectives of this study were to determine the prevalence of and factors associated with prenatal HIV screening and the availability of HIV test results in medical records in Pittsburgh, PA, USA. Three hundred postpartum women were surveyed about demographics and prenatal care provider(s) and practice setting and were asked to recall prenatal HIV screening and reasons for accepting or declining a HIV test. Medical records were reviewed for documentation of HIV results. Overall, 65% of women reported screening. White race, higher annual household income and fewer lifetime sexual partners were independently associated with decreased likelihood of prenatal HIV screening. Provider presentation of screening as standard practice and provider encouragement were associated with prenatal HIV screening. Only 38% of medical records contained HIV results at the time of labour. Universal and routine offering of prenatal HIV screening as standard practice, in conjunction with encouragement from health-care providers, may increase patient acceptability and the uptake of prenatal HIV screening.
    International Journal of STD & AIDS 04/2011; 22(4):194-8. · 1.00 Impact Factor
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    ABSTRACT: The role of hormonal contraception on acquisition of gonorrhea has not been well-characterized, as the transmission dynamics of Neisseria gonorrhoeae are poorly understood. The purpose of this study is to determine the influence of hormonal contraception on gonococcal infection in women exposed to males with gonococcal urethritis. Females aged 15 to 35 years reporting sexual contact to a male partner diagnosed with N. gonorrhoeae were enrolled. Demographic and sexual histories, physical findings, and laboratory tests were collected. Women testing positive and negative for cervical N. gonorrhoeae were compared using chi and Fisher exact tests, with multivariable logistic regression performed on those factors independently associated with gonococcal infection on univariate analysis. N. gonorrhoeae infection occurred in 68 of 107 (64%) women. Women using combined hormonal contraception were significantly less likely than nonusers to test positive for N. gonorrhoeae (32% vs. 76%; prevalence ratio: 0.42; 95% confidence interval: 0.22, 0.78; P = 0.006). Gonorrhea was also less common in depomedroxyprogesterone acetate users. A new sexual partner was also associated with testing positive for gonorrhea (35% vs. 13%; prevalence ratio: 1.47; 95% confidence interval: 1.13, 1.90; P = 0.004). Women using combined hormonal contraceptives or depomedroxyprogesterone acetate were less likely to test positive for N. gonorrhoeae after sexual exposure compared with nonusers. Our data suggest that, in addition to contraceptive benefits, modern hormonal contraception may have a protective effect on the acquisition of N. gonorrhoeae.
    Sexually transmitted diseases 06/2010; 37(6):356-60. · 2.58 Impact Factor
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    ABSTRACT: The purpose of our study was to estimate the frequency and risk factors for symptomatic urinary tract infection (UTI) after surgery for stress urinary incontinence (SUI) and/or pelvic organ prolapse (POP). Case-control study of 389 consecutive women who underwent surgery for POP and/or SUI. Cases were defined as a symptomatic, culture-confirmed UTI within 6 weeks of surgery. Multivariable logistic regression was used to determine independent risk factors. Thirty five (9%) women developed a UTI. The risk of UTI was significantly increased by previous history of multiple UTIs (adjusted OR: 3.7, CI 1.4-10.1), increased distance between the urethra and the anus (adjusted OR: 1.4, CI 1.1-1.9), and prolonged duration of catheterization (adjusted odds ratio (OR) for >or=10 days: 4.2, 95% CI 1.5-11.6); 94.6% of catheterizing women were prescribed daily nitrofurantoin. UTI is an important postoperative morbidity after urogynecologic surgery and is common in catheterizing women despite antibiotic prophylaxis.
    International Urogynecology Journal 03/2010; 21(8):955-61. · 2.17 Impact Factor
  • Obstetrics and Gynecology 01/2010; 115(1):188. · 4.80 Impact Factor
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    ABSTRACT: The relationship between weight and sexual behavior among adolescents is poorly understood. We examined this relationship in a nationally representative sample of high school girls. We performed a cross-sectional analysis of self-reported data from 7193 high school girls who completed the 2005 Youth Risk Behavior Surveillance survey. We used multivariate logistic regression to examine associations among 3 weight indices (BMI calculated from self-reported weight and height, perceived weight, and weight misperception) and 6 sexual behaviors (ever had vaginal sex; sex before age 13; >or=4 sexual partners; and alcohol, condom, and oral contraceptive use at last sex) adjusting for age, race/ethnicity, and a history of intimate partner violence. There were no differences in the likelihood of ever having sex on the basis of BMI or weight perception accuracy; however, girls who perceived themselves as overweight were less likely to have ever had sex. Among sexually active girls, those who had low BMI and perceived themselves as overweight or had overweight misperceptions were less likely to report condom use at last sex. Sexually active girls who perceived themselves as overweight were also more likely to have had sex before age 13. Associations between the 3 weight indices and sexual risk behaviors varied across racial/ethnic groups. Sexual risk behaviors may be more common among girls who are underweight or perceive themselves (accurately or not) to be overweight and vary by racial/ethnic group. This suggests that girls at weight extremes and those from different racial backgrounds may have unique sexual health education and prevention needs.
    PEDIATRICS 10/2009; 124(5):e913-20. · 4.47 Impact Factor
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    ABSTRACT: To estimate the effect of a hospital-wide change in the timing of antimicrobial prophylaxis in cesarean deliveries on maternal and neonatal infections. In November 2004, our institution instituted guidelines recommending that the administration of antimicrobial prophylaxis for cesarean delivery be administered before skin incision rather than after umbilical-cord clamping. We reviewed all cesarean deliveries from two time periods. Group 1 received antibiotics after umbilical-cord clamping (July 2002 to November 2004). Group 2 received antibiotics before skin incision (June 2005 to August 2007). Rates of maternal and neonatal infectious complications were compared between groups. There were 4,229 cesarean deliveries in group 1 and 4,781 cesarean deliveries in group 2. Compared with women receiving antimicrobial prophylaxis after umbilical-cord clamping, those administered antimicrobial prophylaxis before skin incision had lower rates of postpartum endometritis (2.2% compared with 3.9%) and wound infection (2.5% compared with 3.6%). After multivariable logistic regression, antimicrobial prophylaxis before skin incision remained associated with lower rates of endometritis (odds ratio [OR] 0.61, 95% confidence interval [CI] 0.47-0.79) and wound infection (OR 0.70, 95% CI 0.55-0.90). Antimicrobial prophylaxis before skin incision had no adverse effect on neonatal infection rates or on the evaluation of the neonate. Antimicrobial prophylaxis before skin incision, compared with after cord clamping, resulted in lower rates of maternal infections and had no effect on neonatal infections. Antimicrobial prophylaxis for cesarean delivery should occur before skin incision, consistent with basic tenets of surgical antimicrobial prophylaxis. II.
    Obstetrics and Gynecology 10/2009; 114(3):573-9. · 4.80 Impact Factor
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    ABSTRACT: Vaginal microbicides have the potential to reduce HIV/STD acquisition when used consistently. Our objectives were to determine product attributes associated with willingness to use a vaginal microbicide and whether product preferences varied according to participant characteristics. Women (n = 408) with bacterial vaginosis (BV) were recruited as part of a randomized trial to prevent BV. Participants completed a survey interview that assessed demographic information, sexual history, and douching behavior. To assess microbicide preferences, women rated whether specific product attributes would make them more or less likely to use a vaginal microbicide. Principal components analyses revealed two major groupings for the product attribute items. We determined the relative importance of each group of product attributes and whether the importance of the different groupings varied among subgroups of women. The participants' mean age was 24 years (range 14-45), 64% were black, and 74% were unmarried. Overall, participants reported being most likely to use a vaginal product with protection properties (2.54), whereas they were nearly neutral regarding side effects (0.56). The individual product attributes, could prevent BV, could prevent vaginal odor (2.72), and could prevent vaginal itching and burning (2.61), were rated similarly or slightly higher than could reduce the risk of getting an STD (2.58) or could reduce the risk of getting HIV (2.44). In multivariate analyses, protection attributes were rated significantly higher among older women and marginally higher in women with a greater number of lifetime sexual partners. Younger women were most likely to report that side effects would affect their likelihood of using the product. Women with BV rated potential protection features of a vaginal microbicide higher than side effects. A product's personal hygiene aspects were rated equally or more important than the product's ability to prevent HIV/STD infections. Younger women may respond to different factors that influence product acceptability and adherence.
    Journal of Women s Health 08/2009; 18(8):1163-7. · 1.42 Impact Factor
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    ABSTRACT: To determine the risk of preterm birth related to use of additional antibiotics. Women with Group B streptococcal (GBS) bacteriuria and women with negative urine cultures in a hospital-wide research registry were included. The impact of prenatal antibiotics in addition to those used to treat GBS bacteriuria was assessed. Logistic regression was used to determine the risk of preterm birth among bacteriuric women who received "other antibiotics". A total of 203 women with GBS bacteriuria and 220 women with negative cultures were included. The frequency of preterm birth was 16% (35/220) for women in the control group, 16% (19/120) for women with bacteriuria not receiving additional antibiotics, and 28% (23/83) for women with bacteriuria who received antibiotics for "other indications". Among women with GBS bacteriuria, the risk of preterm birth was increased with the use of "other antibiotics" (adjusted odds ratio, 2.7; 95% confidence interval, 1.2-6.1). Among women with GBS bacteriuria, exposure to additional antibiotics is associated with an increased risk of preterm birth.
    International Journal of Gynecology & Obstetrics 09/2008; 102(2):141-5. · 1.84 Impact Factor
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    ABSTRACT: Quality of life utilities for health states associated with pelvic inflammatory disease (PID) have been estimated but not directly measured. Utilities for PID could have important implications on the cost-effectiveness of interventions to prevent and manage this disease. We obtained, in women with versus without a history of PID, visual analogue scale (VAS) and time-tradeoff (TTO) valuations for 5 PID-associated health states: ambulatory PID treatment, hospital PID treatment, ectopic pregnancy, chronic pelvic pain, and infertility. Subjects read brief scenarios describing the medical, functional, and social activity effects typically associated with each state, then gave valuations in the order above. Health state valuations were obtained from 56 women with and 150 women without a PID history. Subjects with a PID history had significantly lower mean valuations (P <0.05) on the VAS for ectopic pregnancy (0.55 vs. 0.63), pelvic pain (0.45 vs. 0.53), and infertility (0.53 vs. 0.66) but not on the TTO; VAS differences remained significant when controlling for demographic and childbearing characteristics. VAS and TTO valuations were similar in women with versus without a history of PID for the ambulatory and hospital PID treatment health states. PID has substantial impact on utility. In addition, some PID-related health states are valued less by women who have experienced PID, which could affect cost-effectiveness analyses of PID treatments when examined from the societal versus patient perspective.
    Sex Transm Dis 03/2008; 35(3):307-11. · 2.59 Impact Factor
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    ABSTRACT: To augment the understanding of parvovirus B19 infection in pregnancy with respect to maternal characteristics and their corresponding fetal outcomes. Retrospective case-series of all women referred to Magee-Women_s Hospital with serologically-documented parvovirus B19 infection during pregnancy from 1998-2001. All 25 cases that are available for analysis occurred from January through June. The frequency of cases varied substantially from year to year, with 14 cases in 1998, 0 cases in 1999 and 2000, and 11 cases in 2001. In contrast to previous reports, the minority of women [4/25(16%)] experienced symptoms attributable to parvovirus B-19 infection although 3 of 25 (12%) fetuses developed hydrops fetalis and 4/25 (16%) suffered an intrauterine of fetal death. These findings suggest that parvovirus B19 infection in pregnancy follows seasonal and annual trend variation, may produce a lower frequency of maternal symptoms and a higher fetal loss rate than previously reported. Synopsis. Maternal parvovirus B19 infection follows seasonal and annual variation is often asymptomatic and may have higher fetal loss rates than previously reported. Continued surveillance is warranted.
    Infectious Diseases in Obstetrics and Gynecology 02/2008; 2008:524601.
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    ABSTRACT: Effectiveness differences between outpatient pelvic inflammatory disease (PID) treatment regimens are uncertain, but significant differences in cost exist. To examine the influence of antibiotic costs on PID therapy cost-effectiveness. The authors used a Markov decision model to estimate the cost-effectiveness of recommended antibiotic regimens for PID and performed a value of information analysis to guide future research. Antibiotic costs vary between USD 43 and USD188. Pairwise comparisons, assuming a hypothetical 1% relative risk reduction in PID complications with the more expensive regimen, showed economically reasonable cost-effectiveness ratios. Value of information and sample size considerations support further investigation to detect 10% PID complication rate differences between regimens with >or=USD 50 cost differences. Within the cost range of recommended regimens, use of more expensive antibiotics would be economically reasonable if relatively small decreases in PID complication rates exist. Further investigation of effectiveness differences between regimens is needed.
    Sex Transm Dis 01/2008; 34(12):960-6. · 2.59 Impact Factor

Publication Stats

1k Citations
310.86 Total Impact Points

Institutions

  • 1996–2013
    • University of Pittsburgh
      • Department of Obstetrics, Gynecology and Reproductive Sciences
      Pittsburgh, Pennsylvania, United States
  • 1993–2013
    • Magee-Womens Hospital
      • • Department of Pathology
      • • Department of Obstetrics
      Pittsburgh, Pennsylvania, United States
  • 2009
    • University of Florida
      Gainesville, Florida, United States
  • 2008
    • Brown University
      • Department of Obstetrics and Gynecology
      Providence, RI, United States
  • 2007
    • University of California, Davis
      • Department of Obstetrics and Gynecology
      Davis, CA, United States
  • 2006
    • Wayne State University
      • School of Medicine
      Detroit, MI, United States
    • University of Washington Seattle
      • Department of Medicine
      Seattle, WA, United States
  • 2004
    • University of Minnesota Twin Cities
      • Department of Medicine
      Minneapolis, MN, United States