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Eberhard M.L.,Centers for Disease Control and Prevention | Ruiz-Tiben E.,Carter Center
American Journal of Tropical Medicine and Hygiene | Year: 2014

Two large, living worms were collected as they emerged from the lower limb of each of two persons in South Sudan. The worms were observed by staff of the South Sudan Guinea Worm Eradication Program during surveillance activities in communities at-risk for cases of Guinea worm disease (dracunculiasis). The worms measured 7 and 8 cm in length and were identified as fourth-stage larvae of Eustrongylides. This is the first report of such worms emerging from the skin; all five previous reports of human infection involved surgical removal of worms from the peritoneal cavity. Copyright © 2014 by The American Society of Tropical Medicine and Hygiene.

Downes E.,Emory University | Downes E.,Carter Center
Nursing Outlook | Year: 2015

To effectively address the Ebola outbreak in West Africa, it must be viewed in terms of the connections between health, politics, security, the environment, and poverty. For the people in the countries involved and those responding, it is more than the viral illness. Although the medical management of the disease is far from simple, it is really only the proximal event of much greater social upheaval in the region, creating what is known as a complex humanitarian emergency (CHE). This article describes a course to introduce nursing students to CHEs and the role of nurses in the field of global response. CHEs are becoming more frequent with high death and disease rates. Nurses must become familiar with their complexity and multifaceted response. Although the planning for the course predated the current epidemic, the Ebola outbreak in West Africa served as an excellent exemplar for the health sector response in CHEs. © 2015 Elsevier Inc.

News Article
Site: www.nature.com

A decades-long push to make Guinea-worm disease the first parasitic infection to be wiped out is close to victory. But a mysterious epidemic of the parasite in dogs threatens to foil the eradication effort. “If we’re going to be aggressive and achieve this, we have to eliminate the infection in dogs,” says David Molyneux, a parasitologist at Liverpool School of Tropical Medicine, UK. The Carter Center in Atlanta, Georgia, is leading the global campaign to eradicate Guinea worm. Next week, it will announce that case numbers for the excruciatingly painful infection are at a record low, with approximately 25 cases reported in 2015 in just 4 countries: Chad, Ethiopia, Mali and South Sudan. But infections in dogs are soaring in Chad, where officials will meet at the end of January to grapple with the canine epidemic. The central African nation recorded more than 450 cases of Guinea worm in domestic dogs last year — an all-time high (see ‘Canine comeback’). Researchers and officials strongly suspect that dogs are spreading the infection to humans; now the race is on to understand how this might happen, as well as how dogs acquire the infection in the first place. The World Health Organization is unlikely to declare Guinea worm eradicated until the parasite has stopped spreading in dogs, says Molyneux, who is part of the commission that will make that decision. In 1986, when the Carter Centre joined the Guinea-worm eradication campaign, there were an estimated 3.5 million infections annually, mostly due to poor sanitation and lack of access to clean water. When people drink unfiltered water, they can swallow microscopic freshwater crustaceans called copepods, which Guinea-worm larvae infect. The copepods die, releasing the larvae, which mature and mate in the human intestine. Male worms die after mating, but adult females — approximately 80 centi­metres in length — survive and slowly migrate out of the gut. About a year after infection, they burrow through their host’s skin, usually around the legs and feet, sometimes taking weeks to fully escape. To cope with the searing pain, many people bathe in rivers and lakes, contaminating the water with the next generation of larvae. Although rarely fatal, Guinea worm can debilitate people for months and keep children out of school. There is no vaccine against the parasite and no effective treatment, so eradication efforts have focused on providing clean water and changing people’s behaviour, says Donald Hopkins, a special adviser at the Carter Center who is leading its Guinea-worm eradication efforts. People in areas in which the parasite was once rife have learnt to filter their water using cloths and to avoid re-contaminating water supplies. Even the most out-of-the-way villages now quickly contain cases and report them to health officials. Chad was on the cusp of being declared free of Guinea worm in the late 2000s: no case had been recorded in the previous decade. But starting in April 2010, increased surveillance turned up a handful of human infections, and around 60 cases have been recorded since then. The cases are unusually sporadic and isolated from one another, says Mark Eberhard, a parasitologist who consults on Guinea-worm eradication for the Carter Center. More typically, cases occur in clusters and recur in the same village year after year. “There was no increase or explosion of cases as one would expect,” he says. Shortly after these observations, officials began to hear rumours of Guinea-worm-infected dogs in Chad. Researchers have known for decades that dogs, leopards and other mammals occasionally acquire Guinea-worm-like infections, but they assumed that these cases stemmed from distinct species of Dracunculus, the nematode worm that causes the disease, or were rare examples of infections that had somehow spilt over from an outbreak in humans. But in Chad, researchers now think that dogs are spreading the worms to humans — not the other way around. Between January and October 2015, officials recorded 459 canine infections from 150 villages in the central African nation — an unprecedented volume. And genome sequencing has confirmed that dogs in Chad are infected by the same nematode worms (Dracunculus medinensis) that plague humans (M. L. Eberhard et al. Am. J. Trop. Med. Hyg. 90, 61–70; 2014). To better understand the situation, a team led by James Cotton and Caroline Durrant, genome scientists at the Wellcome Trust Sanger Institute in Hinxton, UK, is now sequencing the genomes of more Guinea worms collected from dogs and humans in Chad to confirm that dogs are indeed transmitting the disease to people. And Eberhard, who is convinced that this is the case, is trying to determine how dogs become infected in the first place. They are unlikely to contract the worms from drinking water, he says, because dogs tend to scare away copepods when they lap. Most of Chad’s cases have occurred among fishing communities along the Chari River, and Eberhard suspects that dogs are eating the entrails of gutted, copepod-eating fish. Dogs then pass the worms to humans by reintroducing the larvae into water. Researchers, including Eberhard, are testing aspects of this hypothesis in ferrets, a common animal model in disease research, but eradication officials in Chad are not waiting for the results before taking action. Since February 2015, they have offered the equivalent of US$20 to people who report Guinea-worm cases in dogs and tie up the animals to prevent them from contaminating water sources. They are also encouraging villagers to bury fish entrails to keep dogs from eating them. And a trial is ongoing to test whether a drug used to treat heartworm — a roundworm parasite common in dogs — has any effect on Guinea worm. Because of Guinea worm’s one-year incubation time, it should be clear before the end of 2016 whether these interventions have worked. Older residents from villages along the Chari River say that their fishing practices have not changed, according to Hopkins, and they cannot recall dogs becoming infected with Guinea worm in the past. But Molyneux says that the dearth of humans transmitting the disease could explain the parasite’s jump to dogs. “If you were Guinea worm and there were only 100 of you left in the world,” he says, “what would you do? You’d get the hell out of the host that’s being targeted and move to something else.”

Gebre T.,Carter Center | Ayele B.,Carter Center | Zerihun M.,Carter Center | Stoller N.E.,University of California at San Francisco | And 10 more authors.
The Lancet | Year: 2012

Background: In trachoma control programmes, azithromycin is distributed to treat the strains of chlamydia that cause ocular disease. We aimed to compare the effect of annual versus twice-yearly distribution of azithromycin on infection with these strains. Methods: We did a cluster-randomised trial in 24 subdistricts in northern Ethiopia, which we randomly assigned to receive annual or twice-yearly treatment for all residents of all ages. Random assignment was done with the RANDOM and SORT functions of Microsoft Excel. All individuals were offered their assigned treatment of a single, directly observed, oral dose of azithromycin. A 6 week course of topical 1 tetracycline ointment, applied twice daily to both eyes but not directly observed, was offered as an alternative to azithromycin in patients younger than 12 months, and in patients with self-reported pregnancy, with allergy, or who refused azithromycin. Our primary, prespecified outcome was the prevalence of ocular chlamydial infection in a random sample of children aged 0-9 years at baseline and every 6 months for a total of 42 months within sentinel villages. Our analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00322972. Findings: Antibiotic coverage of children aged 1-9 years was greater than 80 (range 80·9 to 93·0) at all study visits. In the groups treated annually, the prevalence of infection in children aged 0-9 years was reduced from a mean 41·9 (95 CI 31·5 to 52·2) at baseline to 1·9 (0·3 to 3·5) at 42 months. In the groups treated twice yearly, the prevalence of infection was reduced from a mean 38·3 (29·0 to 47·6) at baseline to 3·2 (0·0 to 6·5) at 42 months. The prevalence of ocular chlamydial infection in children aged 0-9 years in groups treated annually was not different from that of the groups treated twice yearly at 18, 30, and 42 months (pooled regression p>0·99, 95 CI -0·06 to 0·06). The mean elimination time in the twice-yearly treatment group was 7·5 months earlier (2·3 to 17·3) than that of the annual group (p=0·10, Cox proportional hazards model). Interpretation: After 42 months of treatment, the prevalence of ocular infection with chlamydia was similar in the groups treated annually and twice yearly. However, elimination of infection might have been more rapid in the groups of villages that received treatment twice yearly. Funding: National Institutes of Health (NEI U10 EY016214). © 2012 Elsevier Ltd.

News Article | August 6, 2015
Site: www.techinasia.com

In the fall of 2011, Shibuya Shuta was a recent college graduate looking for somewhere he could kick back with friends. During his short stint at Gree, the Japanese mobile gaming giant, Shibuya attended a workshop run by Lifenet Insurance co-founder Iwase Daisuke. Shibuya’s pitch went over well with Iwase. So well, in fact, that Iwase advised him to quit his job and start his own business immediately. In November of that year, Shibuya and three of his school pals founded Fuller. They haven’t stopped adding friends, and the team is about to reach 20 members. The company was established as a mobile data analytics service for enterprise in Japan, where companies have traditionally outsourced that research to foreign firms. In 2011, there was no way of procuring large data samples from mobile users about which apps they were using, how frequently, or for how long. Building a user base worthy of sampling would require creating consumer applications with broad appeal. That would mean success for many startups, but for Fuller, it’s only step one. Shibuya might be the ideal candidate to undertake such a challenge from zero. He and his friends hail from Japan’s kosen schools — competitive vocational academies that are renowned for taking in 15-year-olds and churning out the nation’s top engineers. Fuller’s head of PR and HR, Yoshida Miho, tells Tech in Asia that the kosen background still defines the company’s ethos. “The best thing about these guys is that they’re proper engineers,” says Yoshida. “They go in a room for a while, and when the door opens, there’s a finished product. The product that Fuller’s development team rolled out first is an Android app called BokuSumaho, or “Mr. Mobile” in English. Users can download the app for free, provided that they allow Fuller to record their total device activity to populate large data samples. Mr. Mobile functions primarily as a device management app, personifying each user’s phone as a digital ojisan, or middle-aged man, whose health and well-being reflect usage habits. For example, if a user has too many apps installed, the ojisan is overweight; if too many apps are left running in the background, he has users help him to close them. A healthier, happier ojisan should result in longer battery life. That’s a constant concern for Mr. Mobile’s target users, Japanese women. Research shows that the nation’s high school girls now use smartphones for an average of seven hours each day, a duration that threatens even the largest of batteries. Such a high level of use also makes the demographic group’s data a coveted commodity for web services. The ojisan character may not make sense to foreigners, but Yoshida says that it’s specifically designed to appeal to Japanese women, who have clearly responded – the app is nearing one million downloads since its launch in September 2012. No number for monthly active users was provided. “I understand he looks a little weird to you,” Yoshida explains. “But to Japanese women, this character is really cute, which is partly why we’re able to hold on to users.” Keeping users is exactly what Fuller needs to deliver the sort of long-term data analyses that set it apart from the competition. Part of that task is achieved by the simple relevance of Mr. Mobile’s functions; aging phones lose battery faster, which adds to the app’s utility over time. Users who meet Fuller’s criteria for inclusion in data samples – which includes length of use – currently number in the tens of thousands, though precise figures are closely guarded. That’s because step two of Fuller’s business plan is crunching the numbers that their app users generate for enterprise clients. Their service, App Ape, provides data analysis on a sample of nearly 100,000 users and 77,000 applications, with a two-year archive. That represents the largest direct sample of Japanese Android users available by far, since competitors use very different methods; Nielson maintains a direct sample of a few thousand users and App Annie extrapolates trends from a variety of sources, including app store downloads and direct user data. That volume of data allows Fuller to provide unique insights on app usage for App Ape clients. The free version includes monthly active user (MAU) data and a gender breakdown of users over the previous four months, but subscription versions boast a panoply of granular analyses. The Enterprise Plan, for JPY 198,000 (about US$1,590) per month, grants access to age breakdowns and daily active user (DAU) data. The Premium Plan, at JPY 498,000 (about US$3,990) per month, adds hourly active user (HAU) data and information about which other apps are used concurrently. Apple’s policies about harvesting data from iOS users have kept Fuller from reaching the iPhone market. That means more than half of Japan’s smartphone market is off limits, but demand for Android-only data analysis remains strong. Fuller counts tech heavyweights like SoftBank, Facebook, and DeNA among its App Ape subscribers. Those companies, and about fifty more, have made Fuller profitable as of this year. Fuller has had two funding rounds thus far, a JPY 100 million (US$1.2 million) round in 2012 and a JPY 230 million (US$1.9 million) round in February. Though rare in Japanese startup funding, both rounds included foreign investors, such as London’s M8 Capital and Silcon Valley’s Global Catalyst Partners. Yoshida says that was an indication that Fuller should be looking abroad to expand. “Each step of our business has been about relationships, from the day that Shuta met Iwase-san to our funding round this year,” she says. “We have relationships in Silicon Valley, so we want a future there.” Fuller is now beta testing its new offering for the American Android market, Mobile Bee. At a glance, Mobile Bee is decidedly more utilitarian than its counterparts in the Japanese market. There is no ojisan character and nothing you might call cute. The clean interface is solely devoted to device management, displaying data, battery, and memory usages by app. Upon its release, Mobile Bee will likely target a swath of demographics concerned with device management. Adapting to the US market will be a challenge, but Fuller is intent on maintaining its foothold in Japan. After a few years of user feedback, the team has released a second flagship application called Sumahospital, a portmanteau of “smartphone” and “hospital.” The popular ojisan character has helped Sumahospital hit the ground running with about 100,000 downloads since it launched in mid-May. The new app reflects shifting attitudes among Japanese smartphone users. Sumahospital features the ojisan character as a doctor who helps users manage their smartphone addiction. Statistics like how many times each app has been opened in a given day turns the same data Fuller is harvesting into a sobering reminder for users that they need to put down the phone now and again. Though encouraging users to unplug may seem counterintuitive for a company collecting their data, Fuller has other goals to consider. “We’re concerned with how people use their phones when they do, so more or less isn’t a huge issue,” Yoshida explains. “Understanding our users’ worries helps to maintain our long-term sample, and that’s what our clients need most.”

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