TAG: "Global health"

The path to eradicating Ebola


New technology helps UCSF volunteers continue to fight Ebola.

By Kathleen Masterson, UC San Francisco

The worst Ebola outbreak in history is not yet over.

While Ebola no longer dominating headlines and nightly newscasts, global health care workers remain in West Africa fighting the deadly virus and helping communities still reeling from the outbreak. More than 9,700 people have died of the disease since the epidemic emerged in December 2013, according to the World Health Organization.

For many on the frontlines, there’s also a bigger opportunity: leveraging the global outcry to improve health system infrastructure and disease surveillance in countries still trying to recover from decades of civil war.

Ebola response volunteers joined leading researchers at a Feb. 26 UC San Francisco town hall meeting to discuss the current state of the outbreak – and the path forward. The UCSF community also took the time to recognize the courageous work by volunteers who worked on the ground in West Africa, as well as those who ensured we were prepared for potential cases at UCSF Medical Center.

“It’s certainly fitting that Time magazine named Ebola responders as the persons of the year,” said Chancellor Sam Hawgood, M.B.B.S. “They certainly should be hailed as heroes, no question about that. So today I’d like to take a moment to recognize and show appreciation for more than 100 local and global UCSF responders to Ebola.”

Testing new Ebola diagnostic tools

Despite the containment of Ebola in some countries, volunteer responders are still needed in West Africa.

Sierra Leone and Guinea continue to face new Ebola cases and ongoing struggles with the virus, while the Ebola outbreak in Liberia appears to be contained, said George Rutherford, M.D., who serves as the director of the Global Health Sciences Prevention and Public Health Group and co-chair of the Chancellor’s Ebola Task Force.

“As of Feb. 18, 23,350 cases had been reported worldwide,” said Rutherford. “Currently Sierra Leone has substantially more cases than other countries.”

To that end, researchers and clinicians are testing and implementing a new rapid Ebola diagnostic field tool in Sierra Leone.

It’s a simple dipstick that tests a tiny prick of blood from a patient’s finger, giving results within minutes. The tool can be transported to remote clinics across the country, and requires no complex machinery other than refrigeration.

“It’s a game-changer,” said Dan Kelly, M.D. ”It will change the way we approach screening and triage with patients, and not just at Ebola treatment units but through all clinics, as well as potentially at schools and other facilities.”

Initial data suggest this dipstick tool is effective in screening for Ebola.

Kelly and responders investigated the point-of-care diagnostic tool in the field and plan to release this final level of validation testing before clinical use. Then, he will begin to evaluate the clinical outcomes, looking to answer such questions as: Does the result from the rapid diagnostic predict survival? Can its clinical use improve mortality rates?

Kelly has been working with Sierra Leonean medical staff to improve health infrastructure since he co-founded the Wellbody Alliance in 2006 with Mohamed Bailor Barrie, M.B.Ch.B., a Sierra Leonean doctor who is now a global health fellow at Harvard University.

Kelly, who is curently on leave to boost response efforts in Sierra Leone, is one of a dozen UCSF trainees and faculty members to respond to the outbreak in West Africa.

“Given the altruism of our faculty and staff, we have made a conscious decision to facilitate their involvement in providing care to patients in West Africa.” said Rutherford. “UCSF, in contrast to other North American academic medical centers, has been remarkably foresighted about the Ebola outbreak.”

Better diagnostics beyond Ebola

UCSF researchers are also working on diagnostic tools that could detect not only Ebola, but other causes of acute hemorrhagic fever that up until recently were more common than Ebola.

“We need tools in the field to not only diagnose Ebola, but also distinguish it from Lassa, malaria, typhoid and dengue,” said Charles Chiu, M.D., Ph.D., an infectious disease specialist who is working on validating the data from early prototypes of a comprehensive diagnostic test for hemorrhagic fever. Malaria is endemic in West Africa, and Lassa fever causes more than 300,000 cases in West Africa each year.

“These infections can all cause a similar clinical illness, and Ebola hemorrhagic fever actually presents more like flu in the early stages, so it’s critical to have a test that could be rapidly implemented once a person rolls into the clinic.”

Accurately identifying a person’s illness could curb the spread of an epidemic like Ebola, and help get the patient more quickly get the treatment he or she needs.

Beyond individual diagnosis, a test that can simultaneously test for eight different hemorrhagic fever diseases will be an invaluable tool for local, regional and global health surveillance, said Chiu.

“Once these surveillance measures are in place, they will help prevent this outbreak from spreading, because if we can curtail it early on, we can limit the disease to very few people,” said Chiu.

Creating lasting change in global response

Better disease surveillance is indeed a key part of building a stronger health care infrastructure – not just in West Africa, but for our a global community.

The flurry of international attention and the horror of the disease did serve to highlight how woefully unprepared some African countries and global health organizations are to manage an outbreak like this, said Eric Goosby, M.D., the director for Global Health Delivery and Diplomacy in UCSF Global Health Sciences.

“Up until now, strengthening the health system hasn’t been a high priority because it’s not sexy, but now I think it’s at the front of the discussion, and I hope we can keep it there.”

Goosby – former global AIDS coordinator for the Obama administration who recently was appointed the United Nations Special Envoy on Tuberculosis – has been closely involved in ongoing reforms at the World Health Organization, which he said has involved unusually frank discussions of its current efforts and how they can be realistically enhanced. Local and international officials are trying to understand what happened, what didn’t happen, who was in charge and how to put disease reporting mechanisms in place. It’s all led to difficult conversations among the highest levels at WHO and the UN, he said.

“I believe [these discussions] have generated a substantive move to understand the specifics, and to use our findings as opportunity to pivot into real solutions that will be laid in place over next few years,” said Goosby.

“I don’t believe it’s there by any means yet, but I’ve never seen the movement that has occurred before,” he said. “I’m quite optimistic.”

Helping on the homefront

Here are some ways the UCSF community rallied to help in the Ebola response, even without leaving the country.

  • As Ebola cases started being reported in the U.S., more than 100 UCSF Medical Center staff volunteered and went through training to serve in an Ebola Isolation Unit constructed at Mount Zion to handle potential cases. “It was heartwarming, how quick and easy it was to recruit for this position,” said Adrienne Green, M.D., associate chief medical officer at UCSF Medical Center.
  • UCSF created a “vacation bank” where employees could donate vacation time, so Ebola volunteers traveling to West Africa needn’t take unpaid leave. More than 2,000 hours have been donated. In one infectious diseases division, within an hour after an e-mail went out asking people to pitch in, two months’ worth of shifts had been filled.

To learn more about UCSF efforts, watch a replay of the Ebola town hall meeting here.

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Registration opens for UC Global Health Day


Feb. 27 is submission deadline for student video and student plenary contests.

Early-bird registration is now open for UC Global Health Day, April 18 at UCLA.

Presented by the UC Global Health Institute, UC Global Health Day is an annual conference that showcases the research, training and outreach in global health being undertaken across the University of California.

This event is an opportunity for UC students, fellows, faculty, staff and visiting scholars to share their current work in global health. The day will feature plenary sessions, posters and concurrent breakout sessions covering a broad range of global health topics.

For those who register before March 20, registration costs $50 for general admission and $25 for students. For those who register between March 21 and April 14, registration costs $75 for general admission and $50 for students. To register, visit: https://www.eventbrite.com/e/uc-global-health-day-2015-tickets-15838746116.

UC Global Health Day also will feature a student video contest and student plenary contest. The submission deadline for those contests is at 11:59 p.m. today (Feb. 27).

Read more at the UC Global Health Institute website

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Recommendations for improving farmworker health to be unveiled

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Recommendations for improving farmworker health to be unveiled


Briefing will be held March 17 at UC Center Sacramento.

>>Register for briefing

By Pat Bailey, UC Davis

An update on the status of health among agricultural workers and their families, as well as policy recommendations for making related health care advances, will be presented from noon to 1 p.m. Tuesday, March 17, at UC Center Sacramento.

“A variety of social, economic and political factors have converged to create a uniquely opportune moment to take action and improve the health of farmworkers and their families,” said Marc Schenker, distinguished professor of public health sciences and medicine at UC Davis and co-director of the Center of Expertise on Migration and Health of the UC Global Health Institute (UCGHI).

Policy recommendations will involve health care funding and insurance, occupational safety, labor law enforcement, and improving farmworker living conditions.

In addition to Schenker, speakers at the briefing will include Gil Ojeda, director of the California Program on Access to Care at the UC Berkeley School of Public Health, and Tom Coates, director of UCLA’s Center for World Health and co-director of the UC Global Health Institute. A panel including representatives from a nonprofit social services organization, a farmworker advisory group and a major California berry grower will provide responses to the presentation.

The presentation is free and open to the public, however attendees are asked to register at http://tinyurl.com/pjlgge7. The UC Center Sacramento is located at 1130 K St., Sacramento.

The event is sponsored by the UC Global Health Institute, with support from the California Program on Access to Care, Western Center for Agricultural Health and Safety, Migration and Health Research Center, and Health Initiative of the Americas.

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Airport screening for viruses can be improved, says UCLA-led study


Current airport screening misses at least half of infected travelers, researchers find.

By Jennifer Mitchell, UCLA

In the past decade, the H1N1 virus and Ebola are just two of the diseases whose spread was spurred by international airline travel. Screening passengers at airports, therefore, could be one key method for slowing the global spread of infectious diseases.

And although a team lead by UCLA researchers has found that airport screening misses at least half of infected travelers, the scientists say that rate could be improved. Their research was published in eLife, a highly regarded open-access online science journal.

The life scientists used a mathematical model to analyze screening for six viruses: the SARS coronavirus, the Ebola virus, the Middle East respiratory syndrome coronavirus, the Marburg virus, Influenza H1N1 and Influenza H7N9.

“We found that for diseases with a long incubation period, such as Marburg and Ebola, taking passengers’ temperature to test for fever is particularly ineffective at the start of an epidemic but does pick up more cases as the epidemic stabilizes,” said Katelyn Gostic, a lead author of the study and a UCLA doctoral student in the laboratory of Professor James Lloyd-Smith. “With diseases such as swine flu, which take a shorter time to incubate, fever screening is the most effective method throughout an epidemic.”

Depending on the circumstances, airport workers conduct screenings before passengers board their flights, when they land at their destinations, or both. The researchers write that although fever screening on arrival has been criticized for being ineffective, it can catch cases that are missed before passengers’ flights depart. Screeners often use infrared non-contact thermometers to help identify sick passengers, but previous studies have shown that the devices identify fevers no more than 70 percent of the time, so the “double-check” of arriving passengers can help catch people who were missed before their departures.

Currently, traveler questionnaires are one of the tools screeners use — asking passengers, for example, whether they have been in contact with an infected individual (in the case of Ebola) or have handled live poultry (for viruses like avian influenza). The researchers write that screeners could more effectively identify sick passengers if those who create those questionnaires understand the risk factors for each disease, which would help them to better tailor the surveys.

The researchers found that no more than 25 percent of passengers answered honestly about whether they had been exposed to influenza during the 2009 pandemic, and that some may have hidden their symptoms by taking medication.

“Anyone who reports honestly puts himself or herself at risk of delay or detainment; this is a terrible incentive for truthful reporting,” Gostic said. “A high number of people use over-the-counter drugs like acetaminophen that conceal fevers and can make their symptoms undetectable, which is likely an overlooked problem.”

Lloyd-Smith, a UCLA associate professor of ecology and evolutionary biology and senior author of the research, said current screening programs can reduce the rate of importing infections, but nowhere close to zero.

“Even under the best-case scenarios we considered, arrival screening missed at least half of infected travelers for all pathogens,” he said. “Traveler screening by these methods is inherently leaky.”

The researchers identified ways to make current screening as effective as possible and highlighted how it can be improved.

“An important gap is that we have little direct data on the efficacy of departure screening,” Lloyd-Smith said. “This is needed to weigh the benefits of different screening policies and areas for investment. For example, in the current Ebola outbreak, how many potential travelers were turned away before boarding airplanes to depart West Africa? Of these, how many were actually Ebola cases? There is broad agreement that departure screening is probably more efficient than arrival screening, but we don’t actually have any examples where we know how well it worked in practice.”

In the paper, the researchers recommend cost-effectiveness studies that allow policy makers to assess the social and economic impact of screening policies at departure and arrival, but note that these studies will require more extensive data on the efficacy of current screening practices. They also recommend studies to quantify how many travelers are using fever-suppressing drugs, and evaluating the possible use of incentives to encourage honest reporting.

Adam Kucharski from the London School of Tropical Hygiene and Medicine was the study’s other co-author. The research was supported by the National Institutes of Health, the National Science Foundation and the Medical Research Council in the U.K.

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Doctorate program will study substance abuse, its consequences


Collaboration between UC San Diego, SDSU among first in nation.

By Scott LaFee, UC San Diego

A new Joint Doctoral Program (JDP) in Interdisciplinary Research on Substance Use has been launched by the Division of Global Public Health in the UC San Diego School of Medicine and San Diego State University’s School of Social Work. The program will emphasize research devoted to studying the use and misuse of alcohol and drugs – and related social and health consequences.

“This program is the first of its kind,” said JDP co-director Steffanie Strathdee, Ph.D., professor and head of the UC San Diego Global Health Initiative. “Given that substance use has a growing health and societal impact in the U.S. and globally, this program could not come at a better time.”

The JDP will focus on research designed to identify and assess substance use risk and create intervention programs for preventing or ameliorating high‐risk behaviors related to substance use. It will include training to craft and evaluate disease prevention and health promotion recommendations and help guide public health policies.

María Luisa Zúñiga, Ph.D., JDP co-director and associate professor in SDSU’s School of Social Work, said “SDSU and UC San Diego have a long history of jointly offering cutting edge, high-demand programs. This new doctoral program is designed to train the next generation of researchers to lead interdisciplinary research efforts that will meaningfully address substance use issues of national and global impact. Our graduates will be highly sought after in fields including medicine, social work and public health, as well as research firms and governmental health departments.”

The new JDP is the 14th such program offered by UC San Diego and SDSU. Others include highly acclaimed programs in public health and clinical psychology.

Funding from SDSU Division of Academic Affairs and College of Health and Human Services will cover tuition fees and a teaching associate stipend for four students per year for up to four years. Students will spend the first year of study at SDSU, the second at UC San Diego and subsequent years working with faculty from both campuses.

For more information on the joint doctoral program in Interdisciplinary Substance Use Studies, visit socialwork.sdsu.edu/degrees-programs/graduate-programs/phd-substance-use-studies/phd-overview.

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Genomics initiative launch draws enthusiastic industry, academic partners


UC Berkeley-UCSF partnership will apply new gene-editing techniques to improve health.

By Robert Sanders, UC Berkeley

Several hundred guests crowded the lobby of the Li Ka Shing Center for Biomedical and Health Sciences Wednesday night (Feb. 4) as the campus celebrated the launch of the Innovative Genomics Initiative (IGI), a partnership between UC Berkeley and UC San Francisco researchers and the biopharmaceutical industry to perfect new gene-editing techniques and apply them to drug development and global health in general.

Among the attendees were a representative from the Li Ka Shing Foundation, which was an early lead supporter of IGI, as well as representatives from two pharmaceutical companies – AstraZeneca and Agilent – that have signed agreements to partner with IGI to use the CRISPR/Cas9 technology to better understand diseases and speed the development of new drugs to treat them.

“The science is cool, but the kind of collaborative structure we have is cool as well,” said Lorenz Mayr, vice president for reagents and assay development at AstraZeneca.

IGI, located in the Li Ka Shing Center for Genomic Engineering, was formed after Berkeley biochemist Jennifer Doudna and her colleagues discovered precision “DNA scissors,” a complex of RNA and protein called CRISPR/Cas9, that can snip DNA at very specific targets in a the genome, allowing scientists to cut out or edit defective genes, or add new genes. Doudna, a professor of molecular and cellular biology and a Howard Hughes Medical Institute investigator, hopes that IGI will make the Bay Area, with its wealth of scientific and clinical research and its business, technology and investment innovation, a global hub for development and application of the groundbreaking technology.

“The Bay Area offers a unique combination of world-leading academic research facilities and clinical institutions with a vibrant and innovative biotech sector,” said Doudna, who cofounded IGI with Jonathan Weissman, a UCSF professor of cellular and molecular pharmacology and HHMI investigator. “There is no better place in the world to spark innovation and discovery in the field of genomics.”

The technology is already being explored by IGI collaborator Jennifer Puck, medical director of the UCSF Clinical and Translational Science Institute’s Pediatric Clinical Research Center, as a possible way to treat severe combined immunodeficiency (SCID), often called the “Bubble Boy” disease. Puck’s work has focused on the genetic cause of SCID and the development of gene-targeted therapies for SCID.

Other scientists around the globe are applying CRISPR/Cas9 to understand and explore new treatments for diabetes, HIV/AIDS, blood cancers and rare genetic diseases like Huntington’s.

“Professor Jennifer Doudna’s groundbreaking scientific work and her launch of the Innovative Genomics Initiative are emblematic of all that we strive for in our research endeavors at Berkeley,” UC Berkeley Chancellor Nicholas Dirks said in a statement. “With its enormous potential to dramatically improve the health and well-being of people around the world, the IGI is another wonderful example of how this university’s research enterprise contributes to the greater good.”

AstraZeneca, IGI’s first partner, plans to use CRISPR/Cas9 to identify and validate gene targets relevant to cancer; cardiovascular, metabolic, respiratory, autoimmune and inflammatory diseases; and regenerative medicine to understand their precise roles in these conditions.

“We are excited to pair the IGI’s premier expertise in CRISPR/Cas9 gene editing and regulation with AstraZeneca’s deep experience in therapeutics,” said Jacob Corn, IGI’s scientific director. “I’m confident that, in working side-by-side with scientists at AstraZeneca, our collaboration will positively impact drug discovery and development to hasten treatments to patients.”

For more on IGI’s new partnerships, link to IGI’s website and AstraZeneca’s press release.

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1,000th solar suitcase is beacon in developing world


This innovation out of UC Berkeley has saved lives in places where light, power unreliable.

In 2008, an idea for bringing solar-powered light and electricity to energy-starved sub-Saharan Africa was burning brightly in Laura Stachel’s mind.

Stachel, an obstetrician turned public health graduate student at UC Berkeley, was appalled at conditions she saw at a maternity ward in a hospital in northern Nigeria. Frequent power outages meant emergency patient care was delayed, disrupted, or just impossible.

Stachel and her husband, solar energy educator Hal Aronson, devised the solar suitcase — delivering power and light from a most reliable source, the sun. The Blum Center for Developing Economies, at UC Berkeley, helped bring We Care Solar to life. Now, the nonprofit has shipped its 1,000th solar suitcase to provide electricity to health clinics trying to recover from the Ebola outbreak in Sierra Leone.

Read more on the Blum Center’s site

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UC San Diego, Perdana partner to advance medical education, research


Collaboration with Malaysian university will bring opportunities for both institutions.

UC San Diego and Perdana University in Malaysia have announced a medical education partnership.

By Jackie Carr, UC San Diego

Officials of UC San Diego and Perdana University in Malaysia have announced a plan to collaborate on further development of the Perdana University Graduate School of Medicine (PUGSOM). UC San Diego was chosen from among the top schools of medicine in the United States to lead this initiative.

“UC San Diego has a long history of excellence in education, research and medicine,” said Chancellor Pradeep K. Khosla. “Our School of Medicine is ranked among the nation’s top graduate programs, and UC San Diego Health System has been ranked number one in San Diego for four consecutive years by U.S. News & World Report. We are excited to share our expertise and knowledge in the power of academic medicine, and collaborate with Perdana University in joint research efforts.”

“Perdana University is delighted to work together with UC San Diego. This collaboration will bring tremendous opportunities to both institutions. This venture will drive Perdana University towards its goal of achieving international distinction as well as bring it recognition as an elite and successful academic institution,” said YABhg Tun Dr. Mahathir Mohamad, chancellor of Perdana University.

The collaboration is designed to help Perdana University (PU) capitalize on the breadth and depth of UC San Diego’s experience in stimulating and helping to sustain San Diego’s status as a major research, health care and biotechnology hub.

“The 10-year joint collaboration will focus on enhancing and implementing a forward-thinking medical curriculum, a model for comprehensive patient care and a platform for innovative world-class research in Malaysia and Southeast Asia,” said David A. Brenner, M.D., vice chancellor for health sciences and dean of the UC San Diego School of Medicine. “Opportunities for clinical research from a global health perspective will exist in many areas, including cardiovascular, neuroscience, tropical diseases, diabetes, cancer and trauma care.”

“This collaboration will help PU to achieve its vision of becoming a top-tier academic medical center serving the 21st century health care needs of Malaysia and the broader region,” said Tan Sri Datuk Dr. Mohan Swami, chairman of the Board of Governors of Perdana University. “It will also accelerate the growth of a vibrant biomedical research, biotechnology and pharmaceutical infrastructure, helping to elevate Malaysia as a global center for translational medicine.”

“This is an exciting and important collaboration that will benefit both universities through shared knowledge and expertise, and especially through joint research,” said Mounir Soliman, M.D., M.B.A., assistant vice chancellor and executive director of UC San Diego Health Sciences International. “Joint research will help improve health in Malaysia and empower Perdana University Graduate School of Medicine to train the future health care workforce. Perdana University is the first medical school in Malaysia to offer graduate entry medical education similar to the United States model.”

Professor Dato’ Sothi Rachagan, vice chancellor, and Ph.D. barrister of law of Perdana University also stated that UC San Diego Health Sciences will assist in creating and refining the organizational infrastructure and facilities necessary for the continued growth of the graduate medical school program, including faculty recruitment, academic program development, student enrollment and the advancement of research and clinical needs.

“We envision a collaboration that will facilitate two-way transfer of knowledge, operational expertise and accrued health care experience to the benefit of both institutions. We are committed to working closely with PU to listen, learn, then plan, and finally bring these plans to fruition,” said Soliman who will lead the planning and implementation of this venture.

The collaboration between UC San Diego and PUGSOM will include exchange of faculty, students and staff. Faculty members from UC San Diego will travel to PUGSOM as visiting faculty to facilitate collaborative educational and research programs. PUGSOM faculty members may travel to UC San Diego to gain valuable skills and knowledge.

“In addition to Perdana University Graduate School of Medicine’s strong education focus, there will be future opportunities for collaboration in biomedical research, including bioengineering and technology, as well as for planned new academic teaching facilities, which include a 600-bed hospital,” said Tan Sri Datuk Dr. Mohan Swami.

Perdana University Graduate School of Medicine was established in 2011 with the vision of contributing to the global community through the pursuit of excellence in education, research and service. PUGSOM is intended to promote intellectual discovery, generate and spread state-of-the art knowledge and be a center of excellence in medical education based on a graduate entry level approach. Perdana University was established as a Public Private Partnership (PPP) initiative with the support of the Economic Planning Unit in the Prime Minister’s Department.

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UCSF expert appointed UN Special Envoy on Tuberculosis


Drug-resistant TB poses threat to global health security.

Eric Goosby, UC San Francisco

By Laura Kurtzman, UC San Francisco

UC San Francisco’s Eric Goosby, M.D., who led the Obama administration’s efforts on HIV/AIDS, has been appointed to a new position as United Nations Special Envoy on Tuberculosis. He will remain at UCSF while he takes on his new duties with the UN.

Goosby’s appointment comes amid an epidemic of drug-resistant forms of TB that is posing a significant threat to global health security. Every year, nearly 9 million people become ill with TB, which has long been among the world’s top killers, and about 1.5 million die. A third of those with TB also have HIV, and TB is a leading cause of death for HIV-positive people.

New technology can rapidly diagnose drug-resistant strains of TB, even in remote and poorly equipped clinics, so patients do not waste time taking ineffective drugs. But curing these patients requires a long and arduous therapeutic regimen, which is difficult to sustain, especially in the low-income countries where the vast majority of infections are occurring.

“We know how to prevent, diagnose, treat and cure TB, but many programs have not yet been able to implement the effective measures that identify, enter and retain people in care for the time that is needed to give them a cure,” Goosby said.

Goosby, who attended medical school and did his residency and fellowship at UCSF, was ambassador-at-large and global AIDS coordinator from 2009 to 2013 in the Obama administration. He returned to UCSF in 2013 as a professor in the Department of Medicine and in Global Health Sciences, where he is the director for Global Health Delivery and Diplomacy.

“I will engage in international dialogue around direction and resource allocation for TB and HIV/AIDS, two of the largest killers on the planet, which is a core mission of UCSF Global Health Sciences,” he said. “UCSF affords a wonderful platform that combines the basic sciences with clinical and public health knowledge. Faculty members here have been leaders globally for years. I hope to amplify and catalyze more involvement from UCSF faculty.”

As UN envoy, Goosby will encourage countries to adopt and implement the World Health Organization’s global End TB Strategy after 2015, and its international targets for tuberculosis prevention, care and control, while also pursuing the tuberculosis targets outlined in the Millennium Development Goals.

“Eric will be fundamental to our efforts to promote the new WHO global strategy with member states, donors and all stakeholders,” said Dr Hiroki Nakatani, assistant director-general at the WHO. “His profound knowledge of global health challenges, the AIDS epidemic and the fight against TB will be a tremendous asset for our work and will make the difference. WHO is enthusiastic about this appointment.”

He will work closely with the World Health Organization to carry out the ambitious new targets agreed to at last year’s World Health Assembly: to reduce TB deaths by 95 percent and cut new cases by 90 percent by 2035.

In his new role, Goosby expects to focus on both TB and HIV/AIDS, an important driver of the tuberculosis epidemic, especially in Africa, which has 80 percent of the HIV-associated TB patients around the world.

He will focus on identifying and expanding the best TB programs, while improving those already in place. Although the science of how to treat TB is well established, little is known about what interventions work best in the real world.

Michel Sidibé, executive director of UNAIDS, worked with Goosby when he was head of the President’s Emergency Plan for AIDS Relief (PEPFAR) to cut the number of HIV infections among children by almost half in 21 countries. He said Goosby brings a wealth of practical experience to his new role.

“Dr. Goosby’s knowledge and experience working on HIV and TB, together with his dynamic and committed leadership, will further strengthen our collaboration and bring us closer to ending the dual epidemics of HIV and TB,” Sidibé said.

Through interdisciplinary education, service and research programs, Global Health Sciences harnesses UCSF’s scientific strengths to train global health leaders and develop solutions to today’s toughest health challenges. GHS faculty, staff and students are on the cutting edge of research, treatment, public health practice and policy development for HIV/AIDS, malaria, tuberculosis, neglected tropical diseases, immunizations, women’s reproductive and children’s health, and other conditions that have a devastating impact both globally and locally. They work in more than 50 countries and partner with academic centers, international organizations, ministries of health and private industries to improve the health of vulnerable populations.

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Cuba opens doors to its health care system for visiting nursing students


Cubans embrace UCLA visitors after news of closer ties between two countries.

Students and faculty from the UCLA School of Nursing visit Casa de Maternidad, a maternity home for women with high-risk pregnancies.

By Laura Perry, UCLA

The timing couldn’t have been better for 18 UCLA School of Nursing graduate students and two faculty members headed for Cuba on an educational mission. As they were boarding a flight to Havana from Miami on Dec. 17, big news was breaking: The U.S. was re-establishing diplomatic relations with Cuba, mending a break that has lasted more than 50 years.

One hour later, the UCLA group arrived in Havana, where they were greeted with exuberant hugs, kisses and tears of joy by an excited group of Cuban health leaders over the historic turn of events.

That was the auspicious beginning of a five-day, action-packed visit for the UCLA group. To learn about Cuba’s health care system, they met with physician-nurse teams, engaged in Pan American Health Organization-based discussions on major causes of illness and death, among other topics; and visited community-based consultorios, polyclinics and sex education centers as well as nursing and medical schools.

Eager to see different health care settings, they spent time at a home for seniors and a residence where women with high-risk pregnancies went to live to receive special care.

Ties between Westwood and Havana

This was not the first time that UCLA nurses have connected with their counterparts in Cuba. In 2011, Maria Elena Ruiz, assistant adjunct professor at the school, attended an International Health Conference in Cuba as a member of the American Public Health Association. Through those meetings, she saw firsthand how a first-world, prevention-focused primary health care system functions with third-world economics.

When she returned to UCLA, Ruiz, together with Adey Nyamathi, associate dean for international research and scholarly activities, developed a program that would provide similar experiences for nursing students, who would receive partial credit for a public health course, complete required readings, participate in pre- and post- conferences, and write daily reflective papers.

How do they do it?

Cuba, the UCLA nurses learned during their visit last December, is a third-world country with some impressive health outcomes, including an overall life expectancy that rivals that in the U.S. (78.4 years for Cubans versus 78.6 years for Americans), immunization rates that are nearly 100 percent and low infant mortality. Yet their health care costs per capita are nearly 15 times lower than that of the United States.

Primary care and an emphasis on prevention are key to the success of the Cuban health care system.

“Their system shows how primary care really does work,” said student Vladimir Camarce.  “And when implemented correctly, you can see great outcomes. Historically, the U.S. system has been focused on acute and tertiary care, but we are now starting to see a shift with the Affordable Care Act.”

In Cuba, public service announcements about health are shown daily on television. “They don’t have traditional television commercials like we do here, so the government uses the opportunity to deliver messages about hygiene or reminders on vaccines,” observed student Stephanie Phan.

Another reason for Cuba’s success is its focus on personalized, community-based care. Doctors and nurses work as a team and live in the communities they serve.  They might see patients in a clinic in the morning, said graduate student John Scholtz, and then visit patients who can’t get to the clinic at home “to ensure that they are receiving their checkups and following through with the recommendations.”

The students also noted the personal nature of health care in Cuba. “Patients are referred to by name,” said Phan, “not by ‘the patient in room 11′ …  They told us, ‘They’re not patients, they’re people.”

There is also a strong integration of traditional, herbal and western medicine. It’s all considered good health care. “I believe we should find a way to incorporate that integration into our practices because we do get a lot of patients who use complementary therapies,” said Camarce.

What amazed the students was that the Cubans achieve all this with a scarcity of equipment and health resources. “They don’t have the equipment we have, the technology we have or the pharmaceutical industry,” noted student Jacqueline Marroquin. “They make do with so little, but they are able to accomplish so much.”

“What medical equipment is available resembles a scene from the old MASH television series,” said Ruiz. “And yet we were overwhelmed with the kindness and eagerness of our hosts to share their health experiences with us.”

Also surprising: On average, nurses and doctors make only $20-$30 a month.  But their education and housing are free or subsidized, and they don’t have student loans to pay off.

“In the U.S., you wouldn’t have a lot of people pursuing these professions for that kind of pay,” said Scholtz. “But in Cuba, you have a lot of people interested in being doctors or nurses. They go into it because they want to make a difference in their community.”

Part of the reason why the Cuban system works is the collectivist-based culture and the population perspective, the students said. Many things that have been adapted in Cuba, however, wouldn’t work in the U.S.  “We might be able to integrate some of the ideas in a micro-community,” suggested Marroquin.

Leaving behind impressions — and hand sanitizers

While the students were there to learn, they also taught Cubans something about Americans.  “Our interactions showed them that we were open to ideas and willing to learn from them,” said Scholtz. On a more tangible note, the group left behind hand sanitizers.  And pens. Lots of them.  “There is a real need for basic hygienic supplies, everything we take for granted,” added Ruiz.

But more importantly, the UCLA visitors came away with a new resolve. “As nursing students, as nurses, we really need to understand what is going on across our borders,” said Marroquin.

Nyamathi added:  “These students are now motivated to make a difference, to learn more about other countries and to question our health system, health care costs, disparities, and what we can learn from others to improve health and health care in the U.S.”

It’s also a hope that, with the dawning of warmer relationships with Cuba, the U. S. health care community may be able to learn a lot more from their neighbor, they said.

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UC Global Health Day deadline nears for abstracts, proposals


Submissions due Jan. 30.

The deadline is 11:59 p.m. Friday (Jan. 30) to submit abstracts for posters and proposals for breakout sessions at UC Global Health Day.

Presented by the UC Global Health Institute, UC Global Health Day — which will be April 18 at UCLA –  is an annual conference that showcases the research, training and outreach in global health being undertaken across the University of California.

This event is an opportunity for UC students, fellows, faculty, staff and visiting scholars to share their current work in global health. The day will feature plenary sessions, posters and concurrent breakout sessions covering a broad range of global health topics.

Interdisciplinary and cross-campus collaborations are strongly encouraged. All presenters will receive complimentary registration to UC Global Health Day. Students selected to present at UC Global Health Day will receive funding to offset travel and poster expenses. Read the calls for posters and breakout sessions for more information.

Submit your abstract or proposal today.

UC Global Health Day also will feature a student video contest and student plenary contest, which have Feb. 27 deadlines for submission.

Visit the UC Global Health Institute website for more information.

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Common human protein linked to adverse parasitic worm infections


UC Riverside-led research could lead to new therapies for parasitic worm infections.

Hookworms infect the lung and cause severe inflammation. This image shows immunofluorescent staining of infected mouse lung tissue for worm antigen (green), worm and macrophage bound lectin (red) and cell nuclei (blue). (Credit: Nair Lab, UC Riverside)

By Kathy Barton, UC Riverside

Worm infections represent a major global public health problem, leading to a variety of debilitating diseases and conditions, such as anemia, elephantiasis, growth retardation and dysentery. Several drugs are available to treat worm infections, but reinfection is high especially in developing countries.

Now, scientists at UC Riverside and colleagues around the world have made a discovery, reported in this month’s issue of PLOS Pathogens, that could lead to more effective diagnostic and treatment strategies for worm infections and their symptoms. The researchers found that resistin, an immune protein commonly found in human serum, instigates an inappropriate inflammatory response to worm infections, impairing the clearance of the worm.

“Targeting this inflammatory pathway with drugs or antibodies could be a new therapeutic strategy to treat worm infections and the associated pathology,” said Meera Nair, an assistant professor of biomedical sciences in the UC Riverside School of Medicine, whose laboratory made the discovery.  “Additionally, our data point to the diagnostic potential for resistin as a new biomarker for impaired immune responses to worms.”

Jessica Jang, the lead author of the research paper and a third-year UCR graduate student in microbiology, explained that resistin regulates the recruitment of innate immune cells called monocytes to the site of infection to produce inflammatory cytokines (small proteins that are important in cell signaling).

“Future work in my Ph.D. research will focus on further investigating the activation of monocytes so we can clinically exploit this immune pathway,” she said.

Parasitic worms, known scientifically as helminths, include filarial worms and hookworms. They cause diseases such as elephantiasis, which produces extreme swelling of extremities, and necatoriasis, which causes abdominal pain, diarrhea and weight loss. The infections are often associated with life-long morbidity, including malnutrition, growth retardation and organ failure.

In many developing countries where parasitic worms are prevalent due to substandard sanitation facilities, infections in humans are common, as are reinfections. Some infected patients develop immunity, but others remain susceptible to infections when they are re-exposed or develop chronic infections. Currently, no vaccine is available against human worm pathogens.

The research directed by Nair’s lab combined mouse studies with human data to demonstrate that resistin is actually detrimental, causing excessive inflammation that impedes the body’s ability to clear parasitic worms.

In the animal studies, mice containing the gene expressing human resistin and infected with a parasitic worm similar to the human hookworm experienced excessive inflammation, leading to increased weight loss and other symptoms. Clinical samples from two groups of individuals from the south Pacific island of Mauke and from Ecuador – one group infected with filarial worms causing lymphatic filariasis and a second group infected with intestinal roundworms Ascaris – revealed increased levels of resistin in the infected individuals compared to those who were uninfected or immune.

A better understanding of human resistin may also reveal new knowledge about obesity and diabetes. Resistin has been mapped to the pathway of immune-mediated inflammation that promotes diabetes and other obesity-related disorders and Nair hopes to combine her lab’s basic science expertise with the developing clinical research enterprise in the UCR medical school as a future avenue to research new diagnostic or treatment strategies.

Collaborating in the study were scientists from: the Malaghan Institute of Medical Research in New Zealand; Pontificia Universidad Católica del Ecuador in Quito, Ecuador; St. George’s University of London; the Laboratory of Parasitic Diseases at the National Institutes of Health; and the Perelman School of Medicine at the University of Pennsylvania.

Funding for the research at UCR was provided by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the Division of Biomedical Sciences (UCR School of Medicine) and a UCR Academic Senate Regents Faculty Fellowship.

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