Papers by Guy Nicolette MD
BMJ Open, Apr 1, 2023
Objectives To identify incident SARS-CoV-2 infections and inform effective mitigation strategies ... more Objectives To identify incident SARS-CoV-2 infections and inform effective mitigation strategies in university settings, we piloted an integrated symptom and exposure monitoring and testing system among a cohort of university students and employees. Design Prospective cohort study. Setting A public university in California from June to August 2020. Participants 2180 university students and 738 university employees. Primary outcome measures At baseline and endline, we tested participants for active SARS-CoV-2 infection via quantitative PCR (qPCR) test and collected blood samples for antibody testing. Participants received notifications to complete additional qPCR tests throughout the study if they reported symptoms or exposures in daily surveys or were selected for surveillance testing. Viral whole genome sequencing was performed on positive qPCR samples, and phylogenetic trees were constructed with these genomes and external genomes. Results Over the study period, 57 students (2.6%) and 3 employees (0.4%) were diagnosed with SARS-CoV-2 infection via qPCR test. Phylogenetic analyses revealed that a super-spreader event among undergraduates in congregate housing accounted for at least 48% of cases among study participants but did not spread beyond campus. Test positivity was higher among participants who self-reported symptoms (incidence rate ratio (IRR) 12.7; 95% CI 7.4 to 21.8) or had household exposures (IRR 10.3; 95% CI 4.8 to 22.0) that triggered notifications to test. Most (91%) participants with newly identified antibodies at endline had been diagnosed with incident infection via qPCR test during the study. Conclusions Our findings suggest that integrated monitoring systems can successfully identify and link at-risk students to SARS-CoV-2 testing. As the study took place before the evolution of highly transmissible variants and widespread availability of vaccines and rapid antigen tests, further research is necessary to adapt and evaluate similar systems in the present context.
BMJ Open
ObjectivesTo identify incident SARS-CoV-2 infections and inform effective mitigation strategies i... more ObjectivesTo identify incident SARS-CoV-2 infections and inform effective mitigation strategies in university settings, we piloted an integrated symptom and exposure monitoring and testing system among a cohort of university students and employees.DesignProspective cohort study.SettingA public university in California from June to August 2020.Participants2180 university students and 738 university employees.Primary outcome measuresAt baseline and endline, we tested participants for active SARS-CoV-2 infection via quantitative PCR (qPCR) test and collected blood samples for antibody testing. Participants received notifications to complete additional qPCR tests throughout the study if they reported symptoms or exposures in daily surveys or were selected for surveillance testing. Viral whole genome sequencing was performed on positive qPCR samples, and phylogenetic trees were constructed with these genomes and external genomes.ResultsOver the study period, 57 students (2.6%) and 3 empl...
Open access journal of sports medicine, Sep 1, 2018
Introduction: Elbow ulnar collateral ligament (UCL) injuries in gymnastics have not been well doc... more Introduction: Elbow ulnar collateral ligament (UCL) injuries in gymnastics have not been well documented in the literature, in comparison to UCL injuries in baseball. Few studies have examined the mechanism and nonoperative management of this injury, and no studies to date have been published on incidence of injury and return to play recommendations in gymnastics. Patient case review: A literature search was performed using PubMed to review articles from 1980 to 2016 that addressed the biomechanics of UCL injury in baseball and gymnastics, the anatomy of the elbow, injury rates, surgical vs non-surgical management, rehabilitation, and return to play recommendations for the sport of gymnastics. Five female collegiate gymnasts sustained UCL injury over a 3-year period. Electronic medical records for each case were thoroughly reviewed including imaging, surgical and non-surgical management, rehabilitation, and the progressive return to gymnastics. Discussion: Four UCL injuries were confirmed by MRI to be avulsions at the distal insertion of the UCL and one was an avulsion at the proximal origin. While less than half of baseball players can return to competition with conservative management of these types of injuries, four out of five gymnasts were able to return to competition with nonoperative management. One gymnast opted to have reconstruction after a successful competition season. Time to return to play varied seemingly dependent on the severity of UCL injury and event. Conclusion: In our case series, collegiate female gymnasts were able to return to participation with nonoperative treatment of the UCL. Their success in returning to competitive gymnastics may also depend on the event(s) in which they are trying to participate. Strength of Recommendation Taxonomy: C.
Additional file 1: Supplemental Table 1. List of Symptoms Asked on Participant Daily Surveys. Sup... more Additional file 1: Supplemental Table 1. List of Symptoms Asked on Participant Daily Surveys. Supplemental Table 2. Answers to the Endline survey question "What was the most difficult or frustrating component of the study for you?". Supplemental Figure 1. Number of surveys completed per day, all participants. Supplemental Figure 2. Number of surveys completed per day, students only (A) and faculty, staff, or essential workers only (B).
PLOS ONE, 2021
Background Colleges and universities across the country are struggling to develop strategies for ... more Background Colleges and universities across the country are struggling to develop strategies for effective control of COVID-19 transmission as students return to campus. Methods and findings We conducted a prospective cohort study with students living on or near the UC Berkeley campus from June 1st through August 18th, 2020 with the goal of providing guidance for campus reopening in the safest possible manner. In this cohort, we piloted an alternative testing model to provide access to low-barrier, high-touch testing and augment student-driven testing with data-driven adaptive surveillance that targets higher-risk students and triggers testing notifications based on reported symptoms, exposures, or other relevant information. A total of 2,180 students enrolled in the study, 51% of them undergraduates. Overall, 6,247 PCR tests were administered to 2,178 students over the two-month period. Overall test positivity rate was 0.9%; 2.6% of students tested positive. Uptake and acceptabilit...
SummaryRegular surveillance testing of asymptomatic individuals for SARS-CoV-2 has played a vital... more SummaryRegular surveillance testing of asymptomatic individuals for SARS-CoV-2 has played a vital role in SARS-CoV-2 outbreak prevention on college and university campuses. Here we describe the voluntary saliva testing program instituted at the University of California, Berkeley during an early period of the SARS-CoV-2 pandemic in 2020. The program was administered as a research study ahead of clinical implementation, enabling us to launch surveillance testing while continuing to optimize the assay. Results of both the testing protocol itself and the study participants’ experience show how the program succeeded in providing routine, robust testing capable of contributing to outbreak prevention within a campus community and offer strategies for encouraging participation and a sense of civic responsibility.
Poster was presented at the 2018 American College Health Association meeting in Washington D.C.
FP essentials, 2018
Plantar fasciitis is the most common cause of heel pain in adults. It involves painful symptoms o... more Plantar fasciitis is the most common cause of heel pain in adults. It involves painful symptoms occurring along the plantar fascia with or without the presence of a bony heel spur. Heel pain that occurs on standing after a prolonged non-weight-bearing period is a prominent symptom of plantar fasciitis. On physical examination, palpation along the medial plantar calcaneal region reproduces the painful symptoms. Routine imaging studies usually are not necessary but can be used to rule out pathologies or confirm chronic or recalcitrant plantar fasciitis. The presence of a heel spur on x-ray is not thought to be an underlying cause of symptoms and indicates the condition has been present for at least 6 to 12 months. Conservative therapies such as rest, ice massage, nonsteroidal anti-inflammatory drugs, specific plantar fascia stretching exercises, and orthoses are the preferred initial treatments. Injection therapies using a corticosteroid or platelet-rich plasma typically provide short...
FP essentials, 2018
Pes planus or pes planovalgus (ie, flatfoot) is a common condition among young children and also ... more Pes planus or pes planovalgus (ie, flatfoot) is a common condition among young children and also is encountered in adults. In children, congenital pes planus typically resolves with age as the foot musculature strengthens. Flexible pes planus is defined as a normal arch during non-weight-bearing activity or tiptoeing, with a flattening arch on standing. In rigid pes planus, the arch remains stiff and collapsed with or without weight bearing. Patients with rigid pes planus should be referred for subspecialist treatment. Patients with flexible pes planus, in the absence of signs of rheumatologic, neuromuscular, genetic, or collagen conditions, should be treated conservatively. Asymptomatic children should be monitored and maintenance of a healthy weight should be encouraged. Surgical intervention for refractory symptomatic pediatric pes planus may be considered but there is little evidence to support it. Several etiologies of acquired pes planus in adults have been identified. The mos...
FP essentials, 2018
Chronic ankle pain is relatively common in family medicine. Sequelae from lateral ankle sprains a... more Chronic ankle pain is relatively common in family medicine. Sequelae from lateral ankle sprains are the most common cause. Other etiologies include peroneal tendinopathy or subluxation, osteochondral injury, lateral ankle impingement, sinus tarsi syndrome, cuboid syndrome, bony stress injury, and other unusual factors. A thorough history focusing on the mechanism of injury (if traumatic) and the nature of the pain along with a targeted physical examination typically will provide the information needed to make the diagnosis. Imaging might be necessary for diagnosis or confirmation of the diagnosis. Early functional bracing, physical therapy for strengthening, and proprioceptive exercises are the preferred treatments for most patients. Daily pain drugs or full immobilization devices rarely are necessary.
FP essentials, 2018
The midfoot and forefoot are the regions of the foot distal to the talus and calcaneus and are cr... more The midfoot and forefoot are the regions of the foot distal to the talus and calcaneus and are critical to weight bearing and movement. They help support the arch of the foot, provide shock absorption, and convert vertically oriented forces into horizontal forward and propulsive movement. A spectrum of acute, subacute, and chronic conditions in these regions can cause pain and decreased function. A thorough history and physical examination should include foot and leg biomechanics, alignment, and posture in addition to palpation of painful areas. All patients with traumatic or overuse midfoot and forefoot injuries should be evaluated with x-rays, with the need for advanced imaging determined based on initial findings. Appropriate diagnosis and management of Lisfranc joint injuries and navicular and base of the fifth metatarsal stress fractures can prevent adverse outcomes. Management of these injuries commonly includes a period of non-weight-bearing immobilization and referral to an ...
Journal of Nursing Measurement, 2021
BackgroundCollege students are a priority population for health insurance literacy interventions.... more BackgroundCollege students are a priority population for health insurance literacy interventions. Yet, there are few psychometric studies on measuring health insurance knowledge – a core construct of health insurance literacy.MethodsWe administered a health insurance survey to 2,250 college students. We applied Classical Test Theory and Item Response Theory methods to estimate psychometric properties of the Kaiser Family Foundation's 10-item health insurance knowledge quiz.ResultsThe scale is unidimensional, and a two-parameter logistic model best fit the data. IRT estimates indicated varying item discriminations (a range: 0.717–2.578) and difficulties (b range: −0.913–1.790). Precision of measurement was maximized for students half a standard deviation below the mean (θ = −0.686) health insurance knowledge ability.ConclusionsThis scale can be used to identify gaps in health insurance knowledge among college students and be applied in clinical and community health education prac...
ABSTRACTBackgroundMany persons with active SARS-CoV-2 infection experience mild or no symptoms, p... more ABSTRACTBackgroundMany persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. Regular temperature screening is nonetheless used in some settings, including University campuses, to reduce transmission potential. We evaluated the potential impact of this strategy using a prospective University-affiliated cohort.MethodsBetween June and August 2020, 2,912 participants were enrolled and tested for SARS-CoV-2 by PCR at least once (median: 3, range: 1-9). Participants reported temperature and symptoms daily via electronic survey using a previously owned or study-provided thermometer. We assessed feasibility and acceptability of daily temperature monitoring, calculated sensitivity and specificity of various fever-based strategies for restricting campus access to reduce transmission, and estimated the association between measured temperature and SARS-CoV-2 test positivity using a longitudinal binomial mixed model.ResultsMost parti...
Medicine & Science in Sports & Exercise, 2018
Annals of Case Reports, Jan 15, 2018
This case report describes a collegiate football player diagnosed with a high-grade partial pecto... more This case report describes a collegiate football player diagnosed with a high-grade partial pectoralis major tear, patient outcome after non-operative management using platelet-rich plasma injections, and a detailed description of the rehabilitation program used in this case. The purpose of this article is to describe a newer option for the management of this injury and give context to clinical decision-making in this setting.
Medicine & Science in Sports & Exercise, 2018
Journal of American College Health, 2019
Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among co... more Objective: Cocaine use is increasing. Comorbidities and diagnostic sequencing are needed among college students to inform treatment of cocaine use disorder (CUD). Method: Using electronic medical records from the psychiatric clinic at the student health care center of a large, public university from 2005 to 2015, patients diagnosed with CUD were identified. Their top mental health conditions were identified and assessed to see whether the first diagnosis of these conditions was made (1) before, (2) at the same time as, or (3) after the first diagnosis of CUD. Results: Among the 50 CUD patients, their most common mental health comorbidities were alcohol use disorder, anxiety, depression, and cannabis use disorder. Anxiety and depression were likely to be diagnosed before CUD; alcohol and cannabis use disorders were likely to be diagnosed concurrently with CUD. Conclusion: Diagnostic sequencing can be used to inform screening, workup, and treatment for patients with CUD.
Epidemiology and Infection, 2019
Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibio... more Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes – where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal c...
Journal of American College Health, 2019
Objective: The objective of this study was to examine clinical and epidemiological information co... more Objective: The objective of this study was to examine clinical and epidemiological information collected by Student Health Center (SHC) providers on HIV-positive students, and benchmark this information against Infectious Disease Society of America guidelines. Participants: Students who utilized the SHC and had an ICD-9 code indicating positive HIV status between 2005 and 2015 (3 ¼ 7). Methods: In June 2016, we accessed the free-form provider notes of the SHC's electronic medical records to identify specific, recorded epidemiological and clinical information. Results: Seven unique students sought care at the SHC during the study period. Current sexual risk taking and other known behavioral risk factors were absent from all records, along with CD4 count and viral load. ART status was only available for one patient, and he was not on ART. The information collected failed to meet IDSA benchmarks. Conclusion: Clinically-and epidemiologically-relevant information is not systematically collected from HIV-positive students at SHCs.
International Journal of Case Reports, 2018
In the late 1800's, Morel-Lavallèe described a pattern of injury to the proximal thigh involving ... more In the late 1800's, Morel-Lavallèe described a pattern of injury to the proximal thigh involving a fluid collection associated with a de-gloving type of injury. These injuries typically result from blunt trauma and falls. There is existing literature that suggests surgical management as primary treatment, although no rigorous controlled trials are found in English language medical literature. Non-surgical aspiration with sclerodesis is an option, however individual case reports suggest that using multiple aspirations without sclerodesis could be effective. This series illustrates that nonsurgical management (i.e. aspiration without sclerodesis) is a viable option for these injuries.
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Papers by Guy Nicolette MD