Kerri L Cavanaugh

Geisinger Medical Center, Danville, Pennsylvania, United States

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Publications (72)290.31 Total impact

  • Julie A. Wright Nunes · Kerri L. Cavanaugh · Angela Fagerlin

    No preview · Article · Jan 2016 · American Journal of Kidney Diseases
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    ABSTRACT: Reducing dietary sodium has potential to benefit patients with chronic kidney disease (CKD). Little research is available defining dietary sodium knowledge gaps in patients with pre-dialysis CKD. We designed a brief screening tool to rapidly identify patient knowledge gaps related to dietary sodium for patients with CKD not yet on dialysis. A Short Sodium Knowledge Survey (SSKS) was developed and administered to patients with pre-dialysis CKD. We also asked patients if they received counseling on dietary sodium reduction and about recommended intake limits. We performed logistic regression to examine the association between sodium knowledge and patient characteristics. Characteristics of patients who answered all SSKS questions correctly were compared to those who did not. One-hundred fifty-five patients were surveyed. The mean (SD) age was 56.6 (15.1) years, 84 (54%) were men, and 119 (77%) were white. Sixty-seven patients (43.2%) correctly identified their daily intake sodium limit. Fifty-eight (37.4%) were unable to answer all survey questions correctly. In analysis adjusted for age, sex, race, education, health literacy, CKD stage, self-reported hypertension and attendance in a kidney education class, women and patients of non-white race had lower odds of correctly answering survey questions (0.36 [0.16,0.81]; p = 0.01 women versus men and 0.33 [0.14,0.76]; p = 0.01 non-white versus white, respectively). Our survey provides a mechanism to quickly identify dietary sodium knowledge gaps in patients with CKD. Women and patients of non-white race may have knowledge barriers impeding adherence to sodium reduction advice.
    Full-text · Article · Dec 2015 · BMC Nephrology
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    Preview · Article · Dec 2015
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    ABSTRACT: Early preparation for renal replacement therapy (RRT) is recommended for patients with advanced chronic kidney disease (CKD), yet many patients initiate RRT urgently and/or are inadequately prepared. We conducted audio-recorded, qualitative, directed telephone interviews of nephrology health care providers (n = 10, nephrologists, physician assistants, and nurses) and primary care physicians (PCPs, n = 4) to identify modifiable challenges to optimal RRT preparation to inform future interventions. We recruited providers from public safety-net hospital-based and community-based nephrology and primary care practices. We asked providers open-ended questions to assess their perceived challenges and their views on the role of PCPs and nephrologist-PCP collaboration in patients’ RRT preparation. Two independent and trained abstractors coded transcribed audio-recorded interviews and identified major themes. Nephrology providers identified several factors contributing to patients’ suboptimal RRT preparation, including health system resources (e.g., limited time for preparation, referral process delays, and poorly integrated nephrology and primary care), provider skills (e.g., their difficulty explaining CKD to patients), and patient attitudes and cultural differences (e.g., their poor understanding and acceptance of their CKD and its treatment options, their low perceived urgency for RRT preparation; their negative perceptions about RRT, lack of trust, or language differences). PCPs desired more involvement in preparation to ensure RRT transitions could be as “smooth as possible”, including providing patients with emotional support, helping patients weigh RRT options, and affirming nephrologist recommendations. Both nephrology providers and PCPs desired improved collaboration, including better information exchange and delineation of roles during the RRT preparation process. Nephrology and primary care providers identified health system resources, provider skills, and patient attitudes and cultural differences as challenges to patients’ optimal RRT preparation. Interventions to improve these factors may improve patients’ preparation and initiation of optimal RRTs.
    Full-text · Article · Dec 2015 · BMC Nephrology
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    ABSTRACT: Background and objectives: Electronic health record (EHR) patient portals allow individuals to access their medical information with the intent of patient empowerment. However, little is known about portal use in nephrology patients. We addressed this gap by characterizing adoption of an EHR portal, assessing secular trends, and examining the association of portal adoption and BP control (<140/90 mmHg). Design, setting, participants, & measurements: Patients seen between January 1, 2010, and December 31, 2012, at any of four university-affiliated nephrology offices who had at least one additional nephrology follow-up visit before June 30, 2013, were included. Sociodemographic characteristics, comorbidities, clinical measurements, and office visits were abstracted from the EHR. Neighborhood median household income was obtained from the American Community Survey 2012. Results: Of 2803 patients, 1098 (39%) accessed the portal. Over 87% of users reviewed laboratory results, 85% reviewed their medical information (e.g., medical history), 85% reviewed or altered appointments, 77% reviewed medications, 65% requested medication refills, and 31% requested medical advice from their renal provider. In adjusted models, older age, African-American race (odds ratio [OR], 0.50; 95% confidence interval [95% CI], 0.39 to 0.64), Medicaid status (OR, 0.53; 95% CI, 0.36 to 0.77), and lower neighborhood median household income were associated with not accessing the portal. Portal adoption increased over time (2011 versus 2010: OR, 1.38 [95% CI, 1.09 to 1.75]; 2012 versus 2010: OR, 1.95 [95% CI, 1.44 to 2.64]). Portal adoption was correlated with BP control in patients with a diagnosis of hypertension; however, in the fully adjusted model this was somewhat attenuated and no longer statistically significant (OR, 1.11; 95% CI, 0.99 to 1.24). Conclusion: While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it. Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them, and their potential to improve outcomes.
    No preview · Article · Oct 2015 · Clinical Journal of the American Society of Nephrology
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    ABSTRACT: Most health literacy assessments are time consuming and administered verbally. Written self-administration of measures may facilitate more widespread assessment of health literacy. This study aimed to determine the intermethod reliability and concurrent validity of the written administration of the 3 subjective health literacy questions of the Short Literacy Survey (SLS). The Rapid Estimate of Adult Literacy in Medicine (REALM) and the shortened test of Functional Health Literacy in Adults (S-TOFHLA) were the reference measures of health literacy. Two hundred ninety-nine participants completed the written and verbal administrations of the SLS from June to December 2012. Intermethod reliability was demonstrated when (a) the written and verbal SLS score did not differ and (b) written and verbal scores were highly correlated. The written items were internally consistent (Cronbach's α = .733). The written total score successfully identified persons with sixth-grade equivalency or less for literacy on the REALM (AUROC = 0.753) and inadequate literacy on the S-TOFHLA (AUROC = 0. 869). The written administration of the SLS is reliable, valid, and is effective in identifying persons with limited health literacy.
    No preview · Article · Jun 2015 · Journal of Health Communication
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    ABSTRACT: Health literacy is associated with important outcomes among patients with kidney disease, but widely used measures of health literacy can be burdensome. In an effort to make a practical assessment available, we compared the performance of the three-item brief health literacy screen (BHLS) to other widely used measures of health literacy among patients with end-stage renal disease (ESRD). Adult hemodialysis patients (n = 150) from four urban dialysis facilities participated in a cross-sectional study from 2009 to 2012. Three health literacy measures were administered including (i) the rapid estimate of adult literacy in medicine (REALM), (ii) the short test of functional health literacy in adults (S-TOFHLA) and (iii) the three-item BHLS. The mini-mental state exam assessed cognitive status, and the chronic hemodialysis knowledge survey (CHeKS) and perceived kidney disease knowledge survey (PiKS) assessed kidney knowledge. Spearman's ρs and area under the receiver-operating curves examined relationships between the aforementioned variables. Participants had received dialysis for a mean of 4.6 years. They were 49% female, 73% African American and averaged 52 years of age. Less education and less cognitive capacity were each associated (P < 0.05) with lower health literacy for all three health literacy measures. Performance on the BHLS was significantly associated with the REALM [0.35 (95% confidence interval (95% CI): 0.20-0.49); P < 0.001] and S-TOFHLA [0.49 (95% CI: 0.35-0.69); P < 0.001], the CHeKS [0.43 (95% CI: 0.28-0.55); P < 0.001] and PiKS [0.41 (95% CI: 0.27-0.54); P < 0.001]. The BHLS demonstrates evidence of construct validity among ESRD patients. Furthermore, health literacy was associated with kidney knowledge, supporting it as a potential intervention target to improve outcomes among patients with lower health literacy.
    Full-text · Article · Jun 2015 · CKJ: Clinical Kidney Journal
  • Delphine S Tuot · Kerri L Cavanaugh

    No preview · Article · Jun 2015 · American Journal of Kidney Diseases
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    ABSTRACT: Hyperphosphatemia is common in end-stage renal disease and associates with mortality. Phosphate binders reduce serum phosphorus levels; however, adherence is often poor. This pilot study aims to assess patients' self-motivation to adhere to phosphate binders, its association with phosphorus control, and potential differences by race. Cross sectional design. Subjects were enrolled from one academic medical center dialysis practice from July to November 2012. Self-motivation to adhere to phosphate binders was assessed with the autonomous regulation (AR) scale (range: 1-7) and self-reported medication adherence with the Morisky Medication Adherence Scale. Linear regression models adjusting for age, sex, health literacy, and medication adherence were applied to determine associations with serum phosphorus level, including any evidence of interaction by race. Among 100 participants, mean age was 51 years (±15 years), 53% were male, 72% were non-white, 89% received hemodialysis, and mean serum phosphorus level was 5.7 ± 1.6 mg/dL. More than half (57%) reported the maximum AR score (7). Higher AR scores were noted in those reporting better health overall (P = .001) and those with higher health literacy (P = .01). AR score correlated with better medication adherence (r = 0.22; P = .02), and medication adherence was negatively associated with serum phosphorus (r = -0.40; P < .001). In subgroup analysis among non-whites, higher AR scores correlated with lower serum phosphorus (high vs lower AR score: 5.55 [1.5] vs 6.96 [2.2]; P = .01). Associations between AR score (β 95% confidence interval: -0.37 [-0.73 to -0.01]; P = .04), medication adherence (β 95% confidence interval: -0.25 [-0.42 to -0.07]; P = .01), and serum phosphorus persisted in adjusted analyses. Self-motivation was associated with phosphate binder adherence and phosphorus control, and this differed by race. Additional research is needed to determine if personalized, culturally sensitive strategies to understand and overcome motivational barriers may optimize mineral bone health in end-stage renal disease. Published by Elsevier Inc.
    Full-text · Article · Apr 2015 · Journal of Renal Nutrition
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    ABSTRACT: Efficiency in scale design reduces respondent burden. A brief but reliable measure of numeracy may provide a useful research tool eligible for integration into large epidemiological studies or clinical trials. Our goal was to validate a 3-item version of the Subjective Numeracy Scale (SNS-3). We examined 7 separate cross-sectional data sets: patients in the emergency department (n = 208), clinic (n = 205), and hospital (n = 460; n = 2053) and patients with chronic kidney disease (n = 147), with diabetes (n = 318), and on hemodialysis (n = 143). Internal reliability of the SNS-3 was assessed with Cronbach's α. Criterion validity was determined by nonparametric correlations of the SNS-3 with SNS-8 and other measures of numeracy; construct validity was determined by correlations with measures of health literacy and education. The SNS-3 had good internal reliability (median Cronbach's α = 0.78) and correlated highly with the full SNS (median ρ = 0.91). The SNS-3 was significantly correlated with other measures of numeracy (e.g., median ρ = 0.57 with the Wide Range Achievement Test 4), health literacy (e.g., median ρ = 0.35 with the Shortened Test of Functional Health Literacy in Adults), and education (median ρ = 0.41), providing good evidence of criterion and construct validity. The SNS-3 is sufficiently reliable and valid to be used as a measure of subjective numeracy. © The Author(s) 2015.
    No preview · Article · Apr 2015 · Medical Decision Making
  • Jamie A. Green · Kerri L. Cavanaugh
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    ABSTRACT: Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease. Copyright © 2015 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jan 2015 · Advances in Chronic Kidney Disease
  • Leigh Anne Dageforde · Amanda Box · Irene D Feurer · Kerri L Cavanaugh
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    ABSTRACT: Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychologic factors between evaluation visit attendees and absentees. A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic, and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with chi-square test, Fisher exact test, and t tests. Multivariable logistic regression was adjusted for relevant demographic characteristics. One hundred four adults participated (61% men, 46% white, 52±12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Previous evaluation at a different transplant center (P=0.029) and being on dialysis (P=0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (P=0.038) and higher perceived general knowledge about transplantation (P ≤0.001). No differences were appreciated in demographic, socioeconomic, or health literacy factors between groups. Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. Although concerns and perceived knowledge are important correlates of behavior, other considerations such as psychologic factors and prior medical experiences may influence patients' ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.
    No preview · Article · Jan 2015 · Transplantation
  • Kerri L Cavanaugh
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    ABSTRACT: Patient-centered care is upheld as one of the fundamental components of high quality health care. Although a deceptively easy concept, patient-centered care is an elusive goal in clinical practice. A core objective for patient-centered care is a collaboration between health care providers and patients that aligns therapy with patients' values and preferences through shared decision making. Advances in communication training that are tailored to the specific requirements of nephrology care are promising methods for enhancing the skill-set of our providers. However, patient-centered care extends beyond shared decision-making and also involves attention to patients' physical and emotional symptoms, care coordination, and the inclusion of family members. Research about patient-centered care processes, interventions and outcomes among patients with kidney disease is sparse. Recent discussions among nephrology experts name patient-centered care as a priority for research and quality improvement in care. Given recent advances in methods for quantifying patient-centered care as well as patient reported outcomes, now is the time to prioritize our resources to evolve our health system and meet the needs of all patients with kidney disease. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Dec 2014 · Seminars in Dialysis
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    ABSTRACT: Health numeracy is linked to important clinical outcomes. Kidney disease management relies heavily on patient numeracy skills across the continuum of kidney disease care. Little data are available eliciting stakeholder perspectives from patients receiving dialysis about the construct of health numeracy. Using focus groups, we asked patients receiving hemodialysis open-ended questions to identify facilitators and barriers to their understanding, interpretation, and application of numeric information in kidney care. Transcripts were analyzed using content analysis. Twelve patients participated with a mean (standard deviation) age of 56 (12) years. All were African American, 50% were women, and 83% had an annual income <$20,000/year. Although patients felt numbers were critical to every aspect in life, they noted several barriers to understanding, interpreting and applying quantitative information specifically to manage their health. Low patient self-efficacy related to health numeracy and limited patient–provider communication about quantitatively based feedback, were emphasized as key barriers. Through focus groups of key patient stakeholders we identified important modifiable barriers to effective kidney care. Additional research is needed to develop tools that support numeracy-sensitive education and communication interventions in dialysis.
    Full-text · Article · Nov 2014 · Hemodialysis International
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    ABSTRACT: Disclaimer: The authors are responsible for the content of this article, which does not necessarily represent the views of the Institute of Medicine. Disclosures: The authors report no significant conflicts or financial disclosures related to this work.
    Full-text · Article · Jul 2014
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    ABSTRACT: Health literacy (HL) may be a mediator for known socioeconomic and racial disparities in living kidney donation. We evaluated the associations of patient and demographic characteristics with HL in living kidney donors (LD), living donor kidney transplant recipients (LDR), and deceased donor recipients (DDR) in a single-center retrospective review of patients undergoing kidney donation or transplantation from September 2010 to July 2012. HL and demographic data were collected. HL was assessed via the Short Literacy Survey (SLS) comprising three self-reported screening questions scored using the five-point Likert scale (low [3-8], moderate [9-14], high [15]). Chi-square and logistic regression were used to test factors associated with lower HL. The sample included 360 adults (105 LD, 103 LDR, and 152 DDR; 46±14 years; 70% white; 56% male; 14±3 years of education). HL scores were skewed (49% high, 41% moderate, and 10% low). The distribution of HL categories differed significantly among groups (P=0.019). After controlling for age, race, sex, education, and a race-education interaction term, DDR was more likely to have moderate or low HL than LDR (OR, 1.911; 95%CI, 1.096-3.332; P=0.022). Overall, living donors had high HL. The distribution of low, moderate, and high HL differed significantly between LD, DDR, and LDR. DDR had a higher likelihood of having low HL than LDR. Screening kidney transplant candidates and donors for lower HL may identify barriers to living donation. Future interventions addressing HL may be important to increase living donation and reduce disparities.
    No preview · Article · Feb 2014 · Transplantation
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    ABSTRACT: The National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (KDOQI) developed guidelines to care for patients with chronic kidney disease (CKD). While these are disseminated through the NKF's website and publications, the guidelines' usage remains suboptimal. The KDOQI Educational Committee was formed to identify barriers to guideline implementation, determine provider and patient educational needs and develop tools to improve care of patients with CKD. An online survey was conducted from May to September 2010 to evaluate renal providers' familiarity, current use of and attitudes toward the guidelines and tools to implement the guidelines. Most responders reported using the guidelines often and felt that they could be easily implemented into clinical practice; however, approximately one-half identified at least one barrier. Physicians and physician extenders most commonly cited the lack of evidence supporting KDOQI guidelines while allied health professionals most commonly listed patient non-adherence, unrealistic guideline goals and provider time-constraints. Providers thought that the guidelines included too much detail and identified the lack of a quick resource as a barrier to clinical implementation. Most were unaware of the Clinical Action Plans. Perceived barriers differed between renal clinicians and allied health professionals; educational and implementation tools tailored for different providers are needed.
    Full-text · Article · Oct 2013 · BMC Nephrology
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    ABSTRACT: Preparation for end-stage renal disease (ESRD) is widely acknowledged to be suboptimal in the United States. We sought to determine whether participation in a kidney disease screening and education program resulted in improved ESRD preparation and survival in 595 adults who developed ESRD after participating in the National Kidney Foundation Kidney Early Evaluation Program (KEEP), a community-based screening and education program. Non-KEEP patients were selected from a national ESRD registry and matched to KEEP participants based on demographic and clinical characteristics. The main outcomes were pre-ESRD nephrologist care, placement of permanent vascular access, use of peritoneal dialysis, pre-emptive transplant wait listing, transplantation, and mortality after ESRD. Participation in KEEP was associated with significantly higher rates of pre-ESRD nephrologist care (76.0% vs. 69.3%), peritoneal dialysis (10.3% vs. 6.4%), pre-emptive transplant wait listing (24.2% vs. 17.1%), and transplantation (9.7% vs. 6.4%) but not with higher rates of permanent vascular access (23.4% vs. 20.1%). Participation in KEEP was associated with a lower risk for mortality (hazard ratio 0.80), but this was not statistically significant after adjusting for ESRD preparation. Thus, participation in a voluntary community kidney disease screening and education program was associated with higher rates of ESRD preparation and survival.Kidney International advance online publication, 25 September 2013; doi:10.1038/ki.2013.369.
    No preview · Article · Sep 2013 · Kidney International
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    ABSTRACT: The National Kidney Foundation and the US Food and Drug Administration (FDA) convened a symposium in September 2010, bringing together more than 70 experts, including representatives from the FDA, the National Institutes of Health, the Critical Path Institute, nephrologists, patients, and the pharmaceutical industry to discuss the feasibility and process of developing patient-reported outcome (PRO) measures to access how patients feel or function to be used in clinical trials for regulatory review of treatment benefit. Three disease areas were evaluated for development of end point models in which PRO measures may be useful: anemia secondary to chronic kidney disease, autosomal dominant polycystic kidney disease (ADPKD), and nephrotic syndrome. The participants thought it valuable to use observational data to generate hypotheses regarding patient baseline characteristics that are likely to predict clinically important changes in PROs in response to anemia treatment and to design adequately powered blinded randomized controlled trials of anemia treatment using PROs as primary rather than secondary end points. Validated PRO instruments that reflect the patient experience in ADPKD and nephrotic syndrome are essential to incorporate into clinical trials of new therapeutic interventions because glomerular filtration rate decline may occur late in the disease course, at which point therapeutic benefit is less likely. Conference attendees addressed how PRO measures could be used to evaluate, monitor, provide care, and facilitate the introduction of treatments for patients with these challenging conditions.
    No preview · Article · Aug 2013 · American Journal of Kidney Diseases
  • Leigh Anne Dageforde · Kerri L Cavanaugh
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    ABSTRACT: Health literacy represents the communication among patients, their social networks, providers, and health systems to promote patients' understanding and engagement in their care. This is particularly relevant in kidney disease, in which the complexity of the medical condition and the extent of the health-care team require strategies to overcome health-literacy-related barriers. Limited literacy is common in patients with all stages of kidney disease and is associated with important outcomes, including reduced knowledge, less adherence, hospitalization, and death. A growing understanding and characterization of the health system, or organizational health literacy, may further our understanding of this dynamic relationship. Although various valid methods exist, assessment of health literacy within individuals or systematically within care settings has not been routinely performed. This may be in part due to the limited research in kidney-specific strategies to address limited health literacy. Future research to understand the mechanisms of health literacy will permit targeted, efficient interventions to bridge gaps and improve outcomes even in patients with complex kidney disease.
    No preview · Article · Jul 2013 · Advances in chronic kidney disease

Publication Stats

1k Citations
290.31 Total Impact Points

Institutions

  • 2015
    • Geisinger Medical Center
      Danville, Pennsylvania, United States
  • 2007-2015
    • Vanderbilt University
      • Department of Medicine
      Нашвилл, Michigan, United States
    • Johns Hopkins Medicine
      • Department of Medicine
      Baltimore, Maryland, United States
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, Maryland, United States
  • 2013
    • University of Texas Southwestern Medical Center
      Dallas, Texas, United States
  • 2009
    • Fresenius Medical Care North America
      Волтам, Massachusetts, United States