Ellen A Spotts Whitney

Emory University, Atlanta, Georgia, United States

Are you Ellen A Spotts Whitney?

Claim your profile

Publications (35)122.78 Total impact

  • Ellen A Whitney, Ruth L Berkelman
    Infection Control and Hospital Epidemiology 11/2014; 35(11):1441-2. DOI:10.1086/678430 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract In mid-2012 we conducted survey of immunization program managers (IPMs) for the purpose of describing relationships between immunization programs and emergency preparedness programs, IPM's perceptions of challenges encountered and changes made or planned in programmatic budgeting, vaccine allocation and pandemic plans as a result of the H1N1 vaccination campaign. Over 95% of IPMs responded (61/64) to the survey. IPMs reported that a primary budget-related challenge faced during H1N1 included staff-related restrictions that limited the ability to hire extra help or pay regular staff overtime resulting in overworked regular staff. Other budget-related challenges related to operational budget shortfalls and vaccine procurement delays. IPMs described overcoming these challenges by increasing staff where possible, using executive order or other high-level support by officials to access emergency funds and make policy changes, as well as expedite hiring and spending processes according to their pandemic influenza plan or by direction from leadership. Changes planned for response to future pandemic vaccine allocation strategies were to "tailor the strategy to the event" taking into account disease virulence, vaccine production rates and public demand, having flexible vaccine allocation strategies, clarifying priority groups for vaccine receipt to providers and the public, and having targeted clinics such as through pharmacies or schools. Changes already made to pandemic plans were improving strategies for internal and external communication, improving vaccine allocation efficiency, and planning for specific scenarios. To prepare for future pandemics, programs should ensure well-defined roles, collaborating during non-emergency situations, sustaining continuity in preparedness funding, and improved technologies.
    Human Vaccines and Therapeutics 10/2014; DOI:10.4161/21645515.2014.972798 · 3.64 Impact Factor
  • Alyssa Parr, Ellen A Whitney, Ruth L Berkelman
    [Show abstract] [Hide abstract]
    ABSTRACT: Reported cases of legionellosis more than tripled between 2001 and 2012 in the United States. The disease results primarily from exposure to aerosolized water contaminated with Legionella.
    Journal of public health management and practice: JPHMP 09/2014; DOI:10.1097/PHH.0000000000000123 · 1.47 Impact Factor
  • Clinical Infectious Diseases 06/2014; 59(6). DOI:10.1093/cid/ciu479 · 9.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To identify factors associated with vaccine receipt among correctional facilities during the A(H1N1)pdm09 influenza pandemic, this study surveyed one third of U.S. correctional facilities. Analysis of the association of average daily population (ADP) on A(H1N1)pdm09 influenza vaccine receipt found that an ADP increase of 100 inmates resulted in a 32% increased likelihood of receiving influenza vaccine among smaller jails. Zero percent of large jails, 14% of federal prisons, 11% of nonfederal prisons, and 57% of small jails reported never receiving pandemic influenza vaccine. A qualitative assessment identified barriers to vaccine delivery, lessons learned from pandemic response, and recommendations for public health partners. Building stronger relationships between public health entities and correctional facilities to collaborate in influenza pandemic preparedness efforts may help protect correctional and community populations.
    Journal of Correctional Health Care 06/2014; 20(3):228-239. DOI:10.1177/1078345814532223
  • [Show abstract] [Hide abstract]
    ABSTRACT: We surveyed U.S. immunization program managers (IPMs) as part of a project to improve public health preparedness against future emergencies by leveraging the immunization system. We examined immunization program policy and Immunization Information System (IIS) functionality changes as a result of the Haemophilus influenzae type B (Hib) vaccine shortage and pandemic influenza A(H1N1) (pH1N1). Evaluating changes in immunization program functionalities and policies following emergency response situations will assist in planning for future vaccine-related emergencies.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Emergency response involving mass vaccination requires the involvement of traditional vaccine providers as well as other health-care providers, including pharmacists, obstetricians, and health-care providers at correctional facilities. We explored differences in provider experiences administering pandemic vaccine during a public health emergency. We conducted a cross-sectional survey of H1N1 vaccine providers in Washington State, examining topics regarding pandemic vaccine administration, participation in preparedness activities, and communication with public health agencies. We also examined differences among provider types in responses received (n=619, 80.9% response rate). Compared with other types of vaccine providers (e.g., family practitioners, obstetricians, and specialists), pharmacists reported higher patient volumes as well as higher patient-to-practitioner ratios, indicating a broad capacity for community reach. Pharmacists and correctional health-care providers reported lower staff coverage with seasonal and H1N1 vaccines. Compared with other vaccine providers, pharmacists were also more likely to report relying on public health information from federal sources. They were less likely to report relying on local health departments (LHDs) for pandemic-related information, but indicated a desire to be included in LHD communications and plans. While all provider types indicated a high willingness to respond to a public health emergency, pharmacists were less likely to have participated in training, actual emergency response, or surge capacity initiatives. No obstetricians reported participating in surge capacity initiatives. Results from this survey suggest that efforts to increase communication and interaction between public health agencies and pharmacy, obstetric, and correctional health-care vaccine providers may improve future preparedness and emergency response capability and reach.
    Public Health Reports 05/2013; 128(3):198-211. · 1.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the prevalence of zoonotic infections among laboratory animal care technicians (LAT). Q fever, a disease caused by Coxiella burnetii, is a known occupational hazard for persons caring for livestock. We sought to determine the seroprevalence of C. burnetii antibodies among LAT and to identify risk factors associated with C. burnetii seropositivity. A survey was administered and serum samples collected from a convenience sample of 97 LAT. Samples were screened by using a Q fever IgG ELISA. Immunofluorescent antibody assays for phase I and phase II IgG were used to confirm the status of samples that were positive or equivocal by ELISA; positive samples were titered to endpoint. Antibodies against C. burnetii were detected in 6 (6%) of the 97 respondents. In our sample of LAT, seropositivity to C. burnetii was therefore twice as high in LAT as compared with the general population. Age, sex, and working with sheep regularly were not associated with seropositivity. Risk factors associated with seropositivity included breeding cattle within respondent's research facility, any current job contact with waste from beef cattle or goats, and exposure to animal waste during previous jobs or outside of current job duties. Only 15% of responding LAT reported being aware that sheep, goats, and cattle can transmit Q fever. Research facilities that use cattle or goats should evaluate their waste-management practices and educational programs in light of these findings. Additional efforts are needed to increase awareness among LAT regarding Q fever and heightened risk of exposure to infectious materials. Physicians should consider the risk of infection with C. burnetii when treating LAT with potential occupational exposures.
    Journal of the American Association for Laboratory Animal Science: JAALAS 01/2013; 52(6):725-31. · 0.73 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To understand immunization programs' experience managing the 2007 to 2009 Haemophilus influenzae type B (Hib) vaccine shortage and identify ways in which the US immunization system can be improved to assist in responses to future shortages of routine vaccines and large-scale public health emergencies. An Internet-based survey was conducted from July 2009 to October 2009 among the 64 city, state, and territorial immunization program managers (IPMs). Fifty-eight percent (37 of the 64) of IPMs responded. Forty percent of responding IPMs indicated not having enough Hib vaccine within their Vaccines for Children program to fulfill the temporary 3-dose recommendation issued in December 2007 in response to the Hib vaccine shortage. While 73% of IPMs indicated success in monitoring provider inventory and 68% indicated success in monitoring doses administered during the shortage, fewer than half indicated success in monitoring providers' compliance with shortage-specific recommendations regarding Hib vaccine. Forty-six percent of IPMs used their immunization information system (IIS) to monitor provider compliance with recommendations regarding Hib vaccine use, and of these, nearly 60% reported success in monitoring provider compliance with recommendations compared with 35% of IPMs who did not use their IIS in this way. Forty-two percent of IPMs felt that the Centers for Disease Control and Prevention (CDC) was successful in determining stockpiled vaccine allocations to their program, and 56% felt that the CDC was successful in communicating its rationale for their immunization program's Hib allocation during the shortage. Experiences from the 2007 to 2009 Hib vaccine shortage offer insights on how the US immunization system and system-wide response to vaccine shortages can be improved. Results from this survey suggest that improving vaccine transfer between jurisdictions and using IIS to track provider compliance with shortage recommendations are 2 ways that can help the US immunization system respond to future vaccine shortages and large-scale public health emergencies like influenza pandemics.
    Journal of public health management and practice: JPHMP 05/2012; 18(3):E9-E16. DOI:10.1097/PHH.0b013e31821dce27 · 1.47 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In June and July 2010, we conducted a national internet-based survey of 64 city, state, and territorial immunization program managers (IPMs) to assess their experiences in managing the 2009-10 H1N1 influenza vaccination campaign. Fifty-four (84%) of the managers or individuals responsible for an immunization program responded to the survey. To manage the campaign, 76% indicated their health department activated an incident command system (ICS) and 49% used an emergency operations center (EOC). Forty percent indicated they shared the leadership of the campaign with their state-level emergency preparedness program. The managers' perceptions of the helpfulness of the emergency preparedness staff was higher when they had collaborated with the emergency preparedness program on actual or simulated mass vaccination events within the previous 2 years. Fifty-seven percent found their pandemic influenza plan helpful, and those programs that mandated that vaccine providers enter data into their jurisdiction's immunization information system (IIS) were more likely than those who did not mandate data entry to rate their IIS as valuable for facilitating registration of nontraditional providers (42% vs. 25%, p<0.05) and tracking recalled influenza vaccine (50% vs. 38%, p<0.05). Results suggest that ICS and EOC structures, pandemic influenza plans, collaborations with emergency preparedness partners during nonemergencies, and expanded use of IIS can enhance immunization programs' ability to successfully manage a large-scale vaccination campaign. Maintaining the close working relationships developed between state-level immunization and emergency preparedness programs during the H1N1 influenza vaccination campaign will be especially important as states prepare for budget cuts in the coming years.
    Biosecurity and bioterrorism: biodefense strategy, practice, and science 02/2012; 10(1):142-50. DOI:10.1089/bsp.2011.0077 · 1.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The recent reoccurrence of several vaccine-preventable diseases demonstrates the need for new techniques to promote childhood vaccination. Many mothers make decisions regarding vaccination of their children during pregnancy. As a result, obstetricians have a unique opportunity to influence maternal decisions on this crucial component of child health. Our objective was to understand OB/GYNs' attitudes, beliefs, and current practices toward providing vaccinations to pregnant patients and providing information about routine childhood immunizations during standard prenatal care. We surveyed OB/GYNs in the United States about their vaccination practices and perceptions during the 2009 H1N1 outbreak. Most (84%) respondents indicated their practice would be administering H1N1 vaccines to pregnant patients. While a majority (98%) of responding providers felt childhood vaccination is important, relatively few (47%) felt that they could influence mothers' vaccination choices for their children. Discussion of routine childhood immunization between obstetricians and their patients is an area for future improvements in childhood vaccination.
    Maternal and Child Health Journal 12/2011; 16(9). DOI:10.1007/s10995-011-0936-0 · 2.24 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: We conducted a survey of Immunization Program Managers (IPMs) aimed at learning how state, city, and territorial immunization programs (IP) and emergency preparedness programs (EPP) collaborated to implement the H1N1 influenza vaccination initiative. The survey is part of a larger project aimed at improving public health preparedness against future emergencies in which leveraging the vaccine system may be useful. Objectives: Examine collaborations between IPs and EPPs during the H1N1 vaccination response focusing on successes, challenges, and lessons learned. Methods: The survey was administered via email to 64 state/city/territorial IPMs in June 2010. Data were analyzed using SAS, version 9.2 (Cary, NC). Results: Eighty-four percent (54/64) of IPMs responded to the survey. Thirty percent (19/64) of IPMs indicated sharing the lead role with EPP for their public health agencies’ HN1N vaccination campaign. Equivalent numbers of IPs and EPPs led the response (23% each). There was no association between who IPMs reported doing the bulk of the work with who they reported leading the response. On average 47% of IPMs indicated EPP were effective in supporting H1N1 management tasks (i.e. allocating vaccine, facilitating allocation decisions, developing risk communications for providers and the public, supplementing IP staff, facilitating overall response and educating new providers). IPMs qualitatively reported successes in collaborations with EPP in communication, coordination, and resource management. Communication was also cited the number one challenge, along with differences in work cultures between the two groups. Conclusions: During the H1N1 influenza vaccination campaign, there were national variations in how health agencies structured who was the lead for response activities. Overall, about half of IPs indicated EPP were effective in supporting response activities. To improve collaborative efforts in future pandemics, it may be useful to further investigate ways to continue enhancing “peace-time” relationships between IPs and EPPs .
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Per the Federal Emergency Management Agency’s National Incident Management System guidelines, the use of incident command systems (ICSs) and emergency operation centers (EOCs) to manage public health emergencies has become more common. In an effort to understand how ICSs and EOCs are used to respond to a vaccine-related emergency, we conducted a survey of Immunization Program Managers (IPMs) regarding their use of ICSs and EOCs during the 2009 H1N1 influenza vaccination response. Objectives: Examine how immunization programs used ICSs and EOCs and other preparedness activities during the H1N1 vaccination response, focusing on improving the response to future vaccine-related emergencies. Methods: The survey was administered via email to 64 state/city/territorial IPMs in June 2010. Data were analyzed using SAS, version 9.2 (Cary, NC). Results: Eighty-four percent (54/64) of IPMs responded to the survey. Thirty four percent of IPMs indicated participation in or coordination of preparedness events within two years before the pandemic. Fifty-six percent found their existing pandemic plan helpful as it provided both an established framework and forged collaborations among entities involved in the response. Of the 44% that found the plan unhelpful to implementing H1N1 vaccines, the primary reasons cited were the inappropriateness of the plan for the specifics of this pandemic and being outdated or inadequate. Seventy-six percent indicated their health department used ICS and 49% opened an EOC to manage the vaccine campaign. Forty-three percent used both. ICS commanders were Public Health Preparedness Coordinators (33%), State Public Health Officers (40%) and 23% by various others (i.e. IPMs, State Medical Officers, etc.). ICS was activated for an average of 28 weeks (range: 12-50) during the response. Conclusions: ICS and EOCs were widely used by health departments during the H1N1 influenza vaccine response. Flexibility and collaborations were key elements in making use of pre-existing pandemic response plans.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Researchers from Emory University and the Association of Immunization Managers conducted a survey of U.S. immunization program managers (IPMs) regarding management of the 2009 - 2010 H1N1 vaccination campaign. The survey is part of a larger project aimed at improving public health preparedness against future emergencies in which leveraging the vaccine system may be useful. Objectives: Explore the use of immunization information systems (IIS) by immunization programs during the H1N1 vaccination campaign, focusing on provider participation in IIS, provider use of IIS, and IIS functionalities of greatest benefit to immunization programs during the campaign. Methods: The survey was administered via email to 64 state/city/territorial IPMs in June 2010. Data were analyzed using SAS, version 9.2 (Cary, NC). Results: Eighty-four percent (54/64) of IPMs responded to the survey. Fifty-seven percent (31/54) of IPMs indicated provider registration in their IIS was a precondition for receiving H1N1 vaccine. Forty-nine percent (25/51) indicated data entry into their IIS was mandatory for providers, and 44% (20/45) indicated providers were generally compliant with entering data into their IIS. Program managers who indicated IIS data entry was mandatory for providers were more likely to report provider compliance with entering data into IIS than IPMs who indicated data entry was not mandatory (p=0.06). Activities in which IPMs believed IIS to be most valuable included tracking vaccine coverage rates, tracking vaccine inventory, supporting mass immunization clinics, and reminder/recall for follow-up doses. Conclusions: During the H1N1 vaccination campaign, many immunization programs urged vaccine providers to register with their IIS before receiving vaccine; with half making data entry mandatory. Improving provider participation in IIS during an emergency like an influenza pandemic can enhance immunization programs’ ability to respond to and manage vaccine shortages and other vaccine-related public health emergencies in the future.
    45rd National Immunization Conference 2011 Centers for Disease Control and Prevention; 03/2011
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Since 2001, many state and local health departments have implemented automated systems to monitor healthcare use and to promptly identify and track epidemics and other public health threats. In 2007-08, we conducted case studies of selected events with actual or potential public health impacts to determine whether and how health departments and hospitals used these new systems. We interviewed public health and hospital representatives and applied qualitative analysis methods to identify response themes. So-called "syndromic" surveillance methods were most useful in situations with widespread health effects, such as respiratory illness associated with seasonal influenza or exposures to smoke from wildfires. In other instances, such as a tornado or hazardous material exposures, these systems were useful for detecting or monitoring health impacts that affected relatively few people, or they were used to affirm the absence of outbreaks following natural disasters or the detection of a potential pathogen in air samples. Typically, these data supplemented information from traditional sources to provide a timelier or fuller mosaic of community health status, and use was shaped by long-standing contacts between health department and hospital staffs. State or local epidemiologists generally preferred syndromic systems they had developed over the CDC BioSense system, citing lesser familiarity with BioSense and less engagement in its development. Instances when BioSense data were most useful to state officials occurred when analyses and reports were provided by CDC staff. Understanding the uses of surveillance information during such events can inform further investments in surveillance capacity in public health emergency preparedness programs.
    Biosecurity and bioterrorism: biodefense strategy, practice, and science 07/2009; 7(2):165-77. DOI:10.1089/bsp.2009.0013 · 1.64 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: As pandemic influenza becomes an increasing threat, partnerships between public health and correctional facilities are necessary to prepare criminal justice systems adequately. In September 2007, the Planning for Pandemic Influenza in Prison Settings Conference took place in Georgia. This article describes the collaboration and ongoing goals established between administrative leaders and medical staff in Georgia prison facilities and public health officials. Sessions covered topics such as nonpharmaceutical interventions, health care surge capacity, and prison-community interfaces. Interactive activities and tabletop scenarios were used to promote dynamic learning, and pretests and posttests were administered to evaluate the short-term impact of conference participation. The conference has been followed by subsequent meetings and an ongoing process to guide prisons' preparation for pandemic influenza.
    Journal of Correctional Health Care 05/2009; 15(2):118-28; quiz 159. DOI:10.1177/1078345808330056
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the seroprevalence of antibodies against Leptospira serovars among veterinarians and identify risk factors for seropositivity in veterinary care settings. Seroepidemiologic survey. Veterinarians attending the 2006 AVMA Annual Convention. Blood samples were collected from 511 veterinarians, and serum was harvested for a microcapsule agglutination test (MAT) to detect antibodies against 6 serovars of Leptospira. Aggregate data analysis was performed to determine the ratio of the odds of a given exposure (eg, types of animals treated or biosafety practices) in seropositive individuals to the odds in seronegative individuals. Evidence of previous leptospiral infection was detected in 2.5% of veterinarians. Most veterinarians reported multiple potential exposures to Leptospira spp and other pathogens in the previous 12 months, including unintentional needlestick injuries (379/511 [74.2%]), animal bites (345/511 [67.5%]), and animal scratches (451/511 [88.3%]). Treatment of a dog with an influenza-like illness within the past year was associated with seropositivity for antibodies against Leptospira spp. Veterinarians are at risk for leptospirosis and should take measures to decrease potential exposure to infectious agents in general. Diagnostic tests for leptospirosis should be considered when veterinarians have febrile illnesses of unknown origin.
    Journal of the American Veterinary Medical Association 05/2009; 234(7):938-44. DOI:10.2460/javma.234.7.938 · 1.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Little is known about the occurrence of Q fever among veterinarians in the United States. In this study, we sought to estimate the prevalence of Coxiella burnetii antibodies among veterinarians and to identify risk factors for exposure. We tested serum samples from 508 veterinarians who attended the 143rd American Veterinary Medical Association Annual Convention in 2006. Samples were screened using a Q fever IgG enzyme-linked immunosorbent assay (ELISA). Samples with positive or equivocal results of ELISA were confirmed using phase I and phase II IgG immunofluorescence antibody assays, and end point IgG titers were determined for samples with positive results. Antibodies against C. burnetii were detected in 113 (22.2%) of 508 veterinarians. Risk factors associated with seropositivity included age 46 years, routine contact with ponds, and treatment of cattle, swine, or wildlife. Veterinarians have a high level of exposure to C. burnetii, the causative organism of Q fever, especially those veterinarians who treat livestock. In this study, risk of C. burnetii seropositivity was also independently associated with contact with ponds. The role of exposure to standing bodies of water in infection is not usually considered and should be investigated in future studies. Additionally, the evidence of past infection with C. burnetii in >20% of veterinarians also highlights the need for use of appropriate personal protective equipment when treating animals that are potentially infected with C. burnetii. Physicians should consider the risk of infection with C. burnetii when treating ill veterinarians and others with potential occupational exposures.
    Clinical Infectious Diseases 03/2009; 48(5):550-7. DOI:10.1086/596705 · 9.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Concern over the adequacy of biosafety training and incident-reporting practices within biological laboratories in the United States has risen in recent years due to the increase in research on infectious diseases and the concomitant rise in the number of biocontainment laboratories. Reports of laboratory-acquired infections and delays in reporting such incidents have also contributed to the concern. Consequently, biosafety training and incident-reporting practices are being given considerable attention by both the executive branch and Congress. We conducted a 51-question survey of biosafety professionals in June 2008 to capture information on methods used to train new laboratory workers within biosafety level 2 (BSL-2) laboratories, animal biosafety level 2 (ABSL-2) laboratories, biosafety level 3 (BSL-3) laboratories, and animal biosafety level 3 (ABSL-3) laboratories. The survey results suggest nearly all senior scientists, faculty, staff, and students working in these biocontainment laboratories are required to have biosafety training, and three-quarters of respondents indicated a biosafety or environmental health and safety professional provides explicit instructions on reporting incidents to each new lab worker. Only half of the respondents with BSL-2/ABSL-2 laboratories at their institution and 59% of respondents from institutions with BSL-3/ABSL-3 laboratories indicated custodial or maintenance workers are required to receive biosafety training at the BSL-2/ABSL-2 and BSL-3/ABSL-3 levels, respectively. Opportunities for targeted improvement such as providing training to non-traditional laboratory workers (e.g., custodians, maintenance workers) and posting laboratory incident-reporting protocols on institutional environmental health and safety websites may exist. Variations in biosafety training requirements, incident-reporting practices, and attitudes towards laboratory safety revealed through this survey of biosafety professionals also support the development of core competencies in biosafety practice that could lead to more uniform practices and robust safety cultures.
    01/2009; 14(3):135-143.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Similar to other mycobacterial diseases, susceptibility to Buruli ulcer (Mycobacterium ulcerans infection) may be determined by host genetic factors. We investigated the role of SLC11A1 (NRAMP1) in Buruli ulcer because of its associations with both tuberculosis and leprosy. We enrolled 182 Buruli ulcer patients (102 with positive laboratory confirmation) and 191 healthy neighbourhood-matched controls in Ghana, and studied three polymorphisms in the SLC11A1 gene: 3' UTR TGTG ins/del, D543N G/A, and INT4 G/C. Finger prick blood samples from study subjects were dried on filter papers (FTA) and processed. D543N was significantly associated with Buruli ulcer: the odds ratio (adjusted for gender, age, and region of the participant) of the GA genotype versus the GG genotype was 2.89 (95% confidence intervals (CI): 1.41-5.91). We conclude that a genetic polymorphism in the SLC11A1 gene plays a role in susceptibility to develop Buruli ulcer, with an estimated 13% population attributable risk.
    Genes and Immunity 05/2006; 7(3):185-9. DOI:10.1038/sj.gene.6364281 · 3.79 Impact Factor