Cross-border connections

UC San Diego chancellor visits Tijuana to learn about industry, health care and education.

Health Frontiers in Tijuana Clinic

From touring the production floor of one of Mexico’s best places to work to witnessing a student-run free health clinic in action, UC San Diego Chancellor Pradeep K. Khosla’s visit to Tijuana, Mexico, Friday offered him an introduction to the bustling metropolis just across the border from San Diego. The one-day tour included visits to Hospital Angeles Tijuana, the Health Frontiers in Tijuana Clinic, the Business Innovation and Technology Center, El Florido Parque Industrial, and the Culinary Art School.

“I’m pleased to have the opportunity to meet with our community partners in Tijuana and learn more about this region and cross-border issues,” said Khosla. “My goal is to strengthen the existing partnerships between UC San Diego and our neighboring country, and pursue other opportunities for collaboration. Our teamwork is vital for the economic and social growth and prosperity of our regions, and we look forward to the ongoing exchange of ideas.”

Accompanying Khosla in Tijuana were Mary Walshok, associate vice chancellor for Public Programs at UC San Diego; Juan Lasheras, interim dean of the Jacobs School of Engineering; Alberto Díaz-Cayeros, director of the university’s Center for U.S.-Mexican Studies; and James Clark, director general of the Mexico Business Center at the San Diego Regional Chamber of Commerce, who helped arrange the trip.

The day began with a visit to Hospital Angeles Tijuana, Mexico’s largest private hospital network and a top-tier facility for medical care. In a series of brief presentations, Khosla was introduced to the hospital’s breadth of services, novel technology and leading-edge research. Representatives from UC San Diego and Hospital Tijuana discussed where there may be opportunities for future collaboration, from research and clinical trials to training students.

Next on the tour was a visit to a different side of healthcare in Tijuana: a student-run free clinic in one of the city’s poorest districts. About a dozen patients, many homeless, gathered in the alley in front of the Health Frontiers in Tijuana (HFiT) Clinic, waiting to be seen.

The HFiT Clinic is a collaborative project of UC San Diego and the Universidad Autónomo de Baja California. Students from both sides of the border are mentored by faculty at the clinic to provide free care for underserved populations in Tijuana. Faculty and students also collaborate on a number of research projects focusing on HIV and STD prevention, substance abuse, policing practices and sex trafficking.

“There is an intense need for health services here,” said Steffanie Strathdee, associate dean of global health sciences at UC San Diego, as she gave an overview of the project. “We align research, training and service. And we, the professors, learn as much from the students as they learn from us.”

Before leaving the site, Khosla thanked the graduating medical students for their work. “What you’re doing here is truly amazing,” he said. “I had heard about some of this work, but it is not the same as being here today and seeing the impact.”

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UC Health ranks among best in nation

U.S. News gives high marks to UC medical schools.

University of California Health ranked among the nation’s best graduate schools in a survey released today (March 12) by U.S. News & World Report.

Five UC medical schools placed in the top 50 nationally for research rankings and four placed in the top 40 nationally for primary care rankings.

In research, UC San Francisco was the top-ranked public school and tied for fourth among all U.S. schools, with UCLA 13th overall, UC San Diego 15th, and UC Davis and UC Irvine tied for 42nd. In primary care, UCSF ranked fourth, UCLA ranked 11th, UC Davis tied for 19th and UC San Diego tied for 39th, with UC Irvine tied for 66th. UCSF has the only medical school ranked in the top five of both categories.

UC medical schools also received high marks in a number of specialty programs. UCSF ranked first for its medical program in AIDS, second in both internal medicine and women’s health, tied for second in drug/alcohol abuse education, fourth in family medicine, sixth in geriatrics, and seventh in pediatrics. UCLA ranked third in geriatrics, seventh in drug/alcohol abuse education, tied for ninth in AIDS and 10th in women’s health. UC San Diego ranked ninth in drug/alcohol abuse education and 11th in AIDS.

U.S. News’ 2014 America’s Best Graduate Schools rankings were released online today (March 12) and can be viewed at www.usnews.com/grad.

The new rankings include previous assessments of a number of other health fields, which U.S. News also surveys but not each year. UCLA ranked first in clinical psychology, UCSF ranked first in pharmacy, UC Davis ranked second in veterinary medicine, UCSF ranked fourth for both its master’s of nursing program (tied) and its nursing-midwifery program, while in public health UC Berkeley tied for eighth and UCLA was 10th. The surveys do not rank dental or optometry schools.

UC Health runs five academic health centers and the nation’s largest health sciences education system with more than 14,000 students and 18 health professional schools and programs in medicine, dentistry, nursing, optometry, pharmacy, public health and veterinary medicine. UC’s sixth medical school, UC Riverside, will enroll its first class this fall.

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HIV testing up, infection reduced in Africa with community intervention

Trial shows effectiveness in increasing HIV testing among men.

A mobile HIV testing station for Project Accept says “Plan for Tomorrow – Get HIV Tested Today.”

Community intervention with free mobile HIV testing and counseling, same-day results and post-test support led to a 14 percent reduction in new HIV infections in targeted communities in Sub-Saharan Africa, according to results of a large randomized, controlled trial.

In women between the ages of 25 and 32, the intervention showed an even greater effect, with rates of new infections lowered by almost one-third.

The trial, National Institute of Mental Health “Project Accept” (HIV Prevention Trial Network 043), was conducted in 48 communities at five sites in Zimbabwe, Tanzania, South Africa and Thailand. The study was undertaken by UC San Francisco at the Zimbabwe site in collaboration with the University of Zimbabwe. The trial sought to demonstrate a community-level impact on HIV when proven prevention interventions were taken to scale. A primary goal was to increase awareness of HIV status by decreasing barriers to testing.

“HIV testing increased by a quarter overall and we saw a four-fold increase in the detection of new HIV cases at the Sub-Saharan sites.” said Stephen F. Morin, Ph.D., co-principal investigator of the multi-institution trial and professor of medicine at the UCSF Center for AIDS Prevention Studies.

“The trial was particularly effective in increasing HIV testing among men. At baseline, women were far more likely to have been tested than men and the intervention increased their testing by 15 percent. However, the study’s success in substantially increasing HIV testing in men, by 45 percent, erased the gender gap.”

In addition, Morin said, the trial found that men who learned they were infected reduced their overall number of sexual partners by one-fifth and reduced their concurrent partnerships by almost one-third. Many epidemiological studies have identified concurrent partnerships as a major impetus for high rates of HIV infections in Sub-Saharan Africa.

“The trial demonstrated that a well-designed and -implemented intervention can change behavior that leads to an effect at a community level. We were particularly successful in changing behavior in men after they learned they were infected, and we saw the impact in the sharp reduction in the rate of new infections in women in the intervention communities,” said Morin.

The results of the trial were presented at the Conference on Retroviruses and Opportunistic Infections in Atlanta.

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UCLA students dance for 26 hours, raise record amound for pediatric AIDS

Dance Marathon raises nearly $500,000.

Last weekend’s 12th annual Dance Marathon in Ackerman Grand Ballroom raised $475,422 to benefit pediatric AIDS.

More than 900 dancers — even one in crutches — received pledges if they could stay on their feet for 26 hours, taking only meal and bathroom breaks. The student-produced event includes choreographed theme songs and costume changes to break up the 26 hours – one for every mile in a marathon.

This was the largest event in the marathon’s history, with over 3,000 participants – dancers, morale-boosters and volunteers. A staff of EMTs stood by, but only one case of fainting was reported.

Since its inception, the UCLA Dance Marathon has raised roughly $3.5 million. It is the largest student fundraising event at UCLA and the largest Dance Marathon benefiting pediatric HIV/AIDS in the country.

Organizers said that 100 percent of the funds raised will be split between three organizations: the Elizabeth Glaser Pediatric AIDS Foundation; Project Kindle, a Santa Clarita camp for children infected or affected by HIV; and the UCLA AIDS Institute. The student-run Pediatric AIDS Coalition at UCLA, which organizes the event, finds sponsors and grants to cover event costs.

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Virus-blocking protein identified

Discovery could help fight HIV, Ebola and other deadly pathogens.

Genhong Cheng, UCLA

Genhong Cheng, UCLA

A team of UCLA-led researchers has identified a protein with broad virus-fighting properties that potentially could be used as a weapon against deadly human pathogenic viruses such as HIV, Ebola, Rift Valley Fever, Nipah and others designated “priority pathogens” for national biosecurity purposes by the National Institute of Allergy and Infectious Disease.

In a study published in the January issue of the journal Immunity, the researchers describe the novel antiviral property of the protein, cholesterol-25-hydroxylase (CH25H), an enzyme that converts cholesterol to an oxysterol called 25-hydroxycholesterol (25HC), which can permeate a cell’s wall and block a virus from getting in.

Interestingly, the CH25H enzyme is activated by interferon, an essential antiviral cell-signaling protein produced in the body, said lead author Su-Yang Liu, a student in the department of microbiology, immunology and molecular genetics at the David Geffen School of Medicine at UCLA.

“Antiviral genes have been hard to apply for therapeutic purposes because it is difficult to express genes in cells,” said Liu, who performed the study with principal investigator Genhong Cheng, a professor of microbiology, immunology and molecular genetics. “CH25H, however, produces a natural, soluble oxysterol that can be synthesized and administered.

“Also, our initial studies showing that 25HC can inhibit HIV growth in vivo should prompt further study into membrane-modifying cholesterols that inhibit viruses,” he added.

The discovery is particularly relevant to efforts to develop broad-spectrum antivirals against an increasing number of emerging viral pathogens, Liu said.

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Social media may prove useful in prevention of HIV, STDs, study shows

Social networking also can be useful tool for collecting and analyzing data.

Sean Young, UCLA

Facebook and other social networking technologies could serve as effective tools for preventing HIV infection among at-risk groups, new UCLA research suggests.

In a study published in the February issue of the peer-reviewed journal Sexually Transmitted Diseases, researchers found that African American and Latino men who have sex with men voluntarily used health-related Facebook groups, which were created by the study’s investigators, to discuss such things as HIV knowledge, stigma and prevention and ultimately to request at-home HIV testing kits.

“Researchers, policymakers and public health professionals are hoping that social media can be used as a tool for improving health research and solving health and HIV prevention–related issues,” said principal investigator Sean Young, an assistant professor of family medicine at the David Geffen School of Medicine at UCLA. “This study helps direct us toward that goal by suggesting that participants will use social media to learn about HIV prevention and that those who talk about HIV prevention over social networking groups are not just talking about it — they are acting on their words by getting an HIV test.”

The study also demonstrates that social networking can be a useful tool for collecting and analyzing data, added Young, who is a member of the Center for HIV Identification, Prevention and Treatment Services (CHIPTS) at UCLA.

“Having one platform that allows multiple types of data collection and analysis can save money and improve the accuracy of research findings,” he said.

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NIMH awards funding to study successful aging in adults with HIV

UC San Diego receives $3.4M grant.

Dilip Jeste, UC San Diego

The National Institute of Mental Health has awarded a $3.4 million grant to a team of researchers at the UC San Diego School of Medicine to study successful aging in HIV-infected adults. HIV is a serious, chronic, medical disease that affects the lives of more than 1 million Americans.

Since the advent of antiretroviral therapy (ART) to treat HIV, life expectancy of HIV+ adults has been increasing progressively. By 2015, nearly half of HIV+ individuals in the United States will be over age 50, and this number is expected to continue to rise. The newly funded study will be the first large-scale investigation of successful aging in HIV-infected individuals between the ages of 36 and 65 years.

The goals of the UC San Diego study are to examine the positive psychosocial factors such as resilience, hardiness, optimism, and social engagement that determine self-perceived successful aging, according to principal investigator Dilip Jeste, M.D., Distinguished Professor of Psychiatry and Neurosciences, and director of UC San Diego’s Stein Institute for Research on Aging. The study will also look at biomarkers of both physical and cognitive aging, comparing these factors in individuals who are HIV-infected with non-infected adults.

“Our hope is that understanding factors that promote successful aging at an individual level may lead to the development of new preventive and therapeutic interventions aimed at improving quality of life and well-being in adults living with HIV,” said co-principal investigator David J. Moore, Ph.D., associate professor of psychiatry at UC San Diego School of Medicine.

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Mistrust of government deters older adults from HIV testing

Later detection poses greater health risks.

Older woman talks with doctorOne out of every four people living with HIV/AIDS is 50 or older, yet these older individuals are far more likely to be diagnosed when they are already in the later stages of infection. Such late diagnoses put their health, and the health of others, at greater risk than would have been the case with earlier detection.

According to the Centers for Disease Control and Prevention, 43 percent of HIV-positive people between the ages of 50 and 55, and 51 percent of those 65 or older, develop full-blown AIDS within a year of their diagnosis, and these older adults account for 35 percent of all AIDS-related deaths. And since many of them are not aware that they have HIV, they could be unknowingly infecting others.

Various psychological barriers may be keeping this older at-risk population from getting tested. Among them are a general mistrust of the government — for example, the belief that the government is run by a few big interests looking out for themselves — and AIDS-related conspiracy theories, including, for example, the belief that the virus is man-made and was created to kill certain groups of people.

Now, a team of UCLA-led researchers has demonstrated that government mistrust and conspiracy fears are deeply ingrained in this vulnerable group and that these concerns often — but in one surprising twist, not always — deter these individuals from getting tested for HIV. The findings are published today (Jan. 29) in the peer-reviewed journal The Gerontologist.

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Taking technology to Malawi to improve HIV/AIDS research

Audio “interview” preferred to face-to-face interview.

Pamina Gorbach, UCLA

With nearly 23 million people across the African continent living with HIV/AIDS, public health experts across the globe are working feverishly to stem the epidemic. Among them is UCLA’s Pamina M. Gorbach, a behavioral epidemiologist whose research recently took her to Malawi, where 10 percent of the population lives with HIV/AIDS, the leading cause of death in that country.

As part of a study of the effectiveness of new HIV-prevention medications, called microbicides, Gorbach, a professor in the Department of Epidemiology at the UCLA Fielding School of Public Health as well as the Division of Infectious Diseases at the David Geffen School of Medicine, explored the use of a new high-tech approach to interviewing the study’s 585 women research subjects. The study, which was reported in the journal AIDS and Behavior, used Audio Computer-Assisted Self-Interviewing (ACASI), a technology developed by epidemiologists in the U.S. Population Council, which conducts biomedical, social science and public health research, to obtain information on sensitive subjects like sexual behavior and drug use.

Gorbach and her research team found that the women in the Malawi study reported that they preferred to do an audio “interview” with a handheld ACASI device compared to a face-to-face interview. Particularly significant to researchers, the participants were likely to give more honest and accurate responses in a computer-assisted interview than when asked the same questions face-to-face by a human interviewer.

Perhaps these results aren’t so surprising, given such deeply personal interview questions as “In the past three months, how many sex partners have you had?,” “Have you had anal sex?” and “The last time you had vaginal sex, did you use study gel [the experimental microbicide] or a condom?” While questions like these must be asked to enable a better understanding of HIV/AIDS transmission and prevention, Gorbach said that “sensitive or “socially undesirable” sexual behaviors are known to be underreported, while socially desirable behaviors such as adherence to taking medication or using condoms tend to be overreported. The ACASI interviews in Malawi, conversely, produced higher reports of sexual behaviors and lower reports of adherence — results that, Gorbach noted, “support the assumption that [computer-assisted interviews] can improve the accuracy of the data.”

Enhancing the user-friendliness of this approach, the audio devices were programmed to ask the interview questions in the local Chichewa language — one of 21 languages and dialects in which the software can be programmed. The devices also incorporated images to improve comprehension for women with low literacy levels.

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World AIDS Day symposium to feature emerging investigators

Art for AIDS raises $200K to benefit San Francisco’s HIV/AIDS population.

Paul Volberding (left) and Warner Greene, UC San Francisco

Emerging investigators working in different areas to combat HIV/AIDS will share the latest on their research at a sympsosium marking World AIDS Day on Monday, Dec. 3.

As one of the pre-eminent health sciences research and education institutions in the world, UC San Francisco emerged early as a pioneer in the fight against AIDS. Three decades later, UCSF and its affiliate,  the J. David Gladstone Institutes, are working on multiple fronts to prevent, treat and stop the spread of the disease.

The World AIDS Day symposium will be held in the auditorium at the J. David Gladstone Institutes, 1650 Owens St., in Mission Bay. Here is the schedule:

1:30 p.m. Welcome and Introduction – Paul Volberding, M.D., and Warner Greene, M.D., Ph.D.

1:45 p.m. “Heme Oxygenase-1 Modulates Immune Activation and Immunopathogenesis During SIV Infection via the Type-I Interferon Response,” Trevor Burt, M.D.

2 p.m. “Effects of Interferon-α Treatment on Anti-HIV-1 Intrinsic Immunity in Vivo,” Satish Pillai, Ph.D.

2:15 p.m. “New Insights into How CD4 T Cells Die During HIV Infection: A Surprising Role for Innate Immunity,” Gilad Doitsh, Ph.D., M.Sc.

2:30 p.m. “Cytokine Responses in HIV Elite Controllers,” Evan Jacobs, Ph.D.

2:45 p.m. “Addressing Loss to Follow-Up in Clinic-Based Cohorts of HIV Patients in Africa: A Measurement Strategy for Implementation Science Research,” Elvin Geng, M.D., M.P.H.

3 p.m. “A Pilot Study to Engage HIV-Positive African American Youth via Telehealth Technology,” Parya Saberi, Pharm.D., M.A.S.

Art For AIDS supports UCSF health project

In related news, the annual Art For AIDS auction, which has become one of San Francisco’s premier events supporting health services for the local LGBTQ population and people living with HIV and AIDS, raised more than $200,000 for the UCSF Alliance Health Project, one of the nation’s leading AIDS prevention and care organizations.

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Pioneer in HIV/AIDS research works on a global scale

UCLA’s Roger Detels reflects on distinguished career.

Roger Detels, UCLA

When he was an undergraduate student at Harvard University in 1958, Roger Detels spent three months as an exchange student in Kanazawa, Japan. As one of the first few Americans in Kanazawa after the war, Detels — today a UCLA distinguished professor of epidemiology and infectious diseases — still recalls with amusement many of his experiences with his Japanese host family.

“I arrive in Kanazawa and my family takes me around the house, and they’re talking to me in Japanese, of course,” said Detels, who had studied as much Japanese as he could on the boat trip from Hawaii to Kanazawa. “And I could tell that they were apologizing for how small the rooms were.”

Wanting to say something nice, Detels said, “Ah, kirai desu.” He got no reaction. The same thing happened with each room. Finally, Detels discovered that he and the older daughter both spoke a little bit of German. “And what had happened was, I meant to say, ‘Ah, kirei desu,’ which means, ‘It’s beautiful.’ But I said, ‘kirai,’ which means, ‘I don’t like it.’ ”

He laughed heartily at the memory. “We managed to survive that one,” he said.

That first experience in Japan actually turned out to be the first of many Asian adventures for Detels, who received his B.A. from Harvard later that same year. He went on to New York University where, while working toward an M.D. that he earned in 1962, he served his elective period at the U.S. Naval Medical Research Unit (NAMRU-2) in Taipei, Taiwan.

“That experience made me realize that one-on-one medicine was not very efficient; that if I really wanted to have an impact, I should get into the area of epidemiology and public health,” Detels said. “I realized that was going to have a much greater impact than seeing patients one at a time.”

While in Taipei, Detels worked with professor Thomas Grayston, who had organized a department of preventive medicine and started a residency program in epidemiology at the University of Washington. Detels completed the residency program and also earned an M.S. from the University of Washington in 1966.

After graduation, Detels was drafted into the U.S. Navy and requested to be sent back to NAMRU-2 in Taipei, where he lived for three years with his wife, Mimi, and their two sons, Martin and Edward. During his tour of duty he did research in the Philippines, Bangkok and Taiwan, field-testing the rubella vaccine and studying tropical diseases. Once his Navy service was fulfilled, Detels took a position as a medical officer for the National Institutes of Health in Bethesda, Md.

Two years later, in 1970, Detels joined the UCLA faculty as an associate professor in what is now UCLA’s Fielding School of Public Health. “When I got here, there was only one faculty member in epidemiology, and he promptly retired upon my arrival,” Detels said, laughing. As a young professor, Detels quickly learned how to teach courses and set about recruiting new colleagues and expanding the department, which today has approximately 40 faculty, including in-residence and adjunct appointments.

In 1981, Detels started a study of AIDS in young homosexual men in Los Angeles and, in 1983, he formed a collaborative study with centers at three other institutions: Pittsburgh, Northwestern and Johns Hopkins. This study, known as the Multicenter AIDS Cohort Study (MACS), is still going strong some 30 years later.

Detels also runs the UCLA/Fogarty AIDS International Training and Research Program for health professionals from China, Southeast Asia and India, who come here to earn advanced degrees in epidemiology. “But I insist that they go back to their home countries to do the field work for their dissertations,” Detels said. “I feel that doing their dissertations in the United States is irrelevant for them. One of the requirements is that they can’t get into the program unless they agree to go back to their home countries.”

Besides currently serving as adviser to 15-20 doctoral students, teaching two graduate courses and an introductory public health course for 280 undergraduates, and delivering guest lectures, Detels is also senior editor of the recently published book, “Public Health in East and Southeast Asia: Challenges and Opportunities in the 21st Century” (UC Press, 2012).

On Nov. 15, Detels will deliver UCLA’s 113th Faculty Research Lecture at the invitation of the Academic Senate.

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Global health pioneer touts community-based health care model

Partners in Health co-founder addresses standing-room-only crowd at UCSF.

Paul Farmer gave a special lecture, titled "Global Health Delivery," to a packed Cole Hall at UCSF on Oct. 17.

To illustrate his model for bringing quality medical care to the world’s poorest patients, global health pioneer Paul Farmer, M.D., Ph.D., presented a diagram that’s proven effective throughout his career.

“Be careful because this is really complex. You’ll want to take notes,” Farmer joked, as he showed a slide to the hundreds packed into Cole Hall on Oct. 17 to hear about his experiences as founding director of Partners in Health (PIH), a nonprofit organization dedicated to providing health care to underserved communities around the world. The slide simply had three boxes describing the platform of care to keep any individual healthy: Community-Based, Health Center-Enriched and Hospital-Linked.

“The quality of care that we can deliver with this system that goes from community to clinic to hospital, when necessary, can provide better rates of retention, better outcomes than any other model in the world,” said Farmer, a medical anthropologist and physician. “And it’s not because of some secret PIH sauce. It’s because we have community health workers. That’s the cornerstone of this.”

Farmer is a Kolokotrones University Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School as well as chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston. His message resonated with the UC San Francisco audience – which filled seats, aisle floors and standing room in the back – inspired by Farmer’s stories from Haiti and Rwanda, where PIH has dramatically improved survival rates for people with HIV and AIDS.

UCSF has a long history of tackling critical global health issues, including serving at the forefront of research and care in the HIV/AIDS epidemic. Roughly 1,200 faculty, staff and students at UCSF currently are engaged in global health activities, which reach almost every country in the world.

In response to that engagement and student interest, UCSF created the nation’s first master’s program in global health sciences. Now entering its fifth year, the program currently has 40 students, with the program expected to double its student body in the coming years, adding Ph.D., certificate and online programs.

“We wanted Paul to share with the UCSF community the incredible possibilities when academic medical centers partner with NGOs and governments for global health delivery,” said Phuoc Le, M.D., M.P.H., an assistant clinical professor of Internal Medicine and Pediatrics, who invited Farmer, one of his mentors, to speak at UCSF. Mandhavi Dandu, M.D., M.P.H., assistant clinical professor of medicine and associate director of the Pathways to Discovery Program in Global Health, also helped organize Farmer’s visit, which included smaller discussions with global health students.

“We believe that the right ingredients are also here for UCSF to become a significant change agent to address service delivery in the most vulnerable communities,” Le said. “We hope that Paul’s visit will galvanize the critical mass of talent that is already here at UCSF.”

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