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Sankhala RS, Dussupt V, Chen WH, Bai H, Martinez EJ, Jensen JL, Rees PA, Hajduczki A, Chang WC, Choe M, Yan L, Sterling SL, Swafford I, Kuklis C, Soman S, King J, Corbitt C, Zemil M, Peterson CE, Mendez-Rivera L, Townsley SM, Donofrio GC, Lal KG, Tran U, Green EC, Smith C, de Val N, Laing ED, Broder CC, Currier JR, Gromowski GD, Wieczorek L, Rolland M, Paquin-Proulx D, van Dyk D, Britton Z, Rajan S, Loo YM, McTamney PM, Esser MT, Polonis VR, Michael NL, Krebs SJ, Modjarrad K, Joyce MG. Antibody targeting of conserved sites of vulnerability on the SARS-CoV-2 spike receptor-binding domain. Structure 2024; 32:131-147.e7. [PMID: 38157856 DOI: 10.1016/j.str.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/14/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
Given the continuous emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VoCs), immunotherapeutics that target conserved epitopes on the spike (S) glycoprotein have therapeutic advantages. Here, we report the crystal structure of the SARS-CoV-2 S receptor-binding domain (RBD) at 1.95 Å and describe flexibility and distinct conformations of the angiotensin-converting enzyme 2 (ACE2)-binding site. We identify a set of SARS-CoV-2-reactive monoclonal antibodies (mAbs) with broad RBD cross-reactivity including SARS-CoV-2 Omicron subvariants, SARS-CoV-1, and other sarbecoviruses and determine the crystal structures of mAb-RBD complexes with Ab246 and CR3022 mAbs targeting the class IV site, WRAIR-2134, which binds the recently designated class V epitope, and WRAIR-2123, the class I ACE2-binding site. The broad reactivity of class IV and V mAbs to conserved regions of SARS-CoV-2 VoCs and other sarbecovirus provides a framework for long-term immunotherapeutic development strategies.
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Affiliation(s)
- Rajeshwer S Sankhala
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Vincent Dussupt
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Wei-Hung Chen
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Hongjun Bai
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Elizabeth J Martinez
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jaime L Jensen
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Phyllis A Rees
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Agnes Hajduczki
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - William C Chang
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Misook Choe
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Lianying Yan
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Spencer L Sterling
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Isabella Swafford
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Caitlin Kuklis
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sandrine Soman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jocelyn King
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Courtney Corbitt
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michelle Zemil
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Caroline E Peterson
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Letzibeth Mendez-Rivera
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Samantha M Townsley
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Gina C Donofrio
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kerri G Lal
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ursula Tran
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Ethan C Green
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Clayton Smith
- Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA; Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Natalia de Val
- Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA; Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Eric D Laing
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Christopher C Broder
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA
| | - Jeffrey R Currier
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lindsay Wieczorek
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Morgane Rolland
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Dominic Paquin-Proulx
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Dewald van Dyk
- Antibody Discovery and Protein Engineering (ADPE), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Zachary Britton
- Antibody Discovery and Protein Engineering (ADPE), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Saravanan Rajan
- Antibody Discovery and Protein Engineering (ADPE), BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Yueh Ming Loo
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Patrick M McTamney
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Mark T Esser
- Vaccines and Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Victoria R Polonis
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nelson L Michael
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Shelly J Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - M Gordon Joyce
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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Joyce MG, Sankhala RS, Chen WH, Choe M, Bai H, Hajduczki A, Yan L, Sterling SL, Peterson CE, Green EC, Smith C, de Val N, Amare M, Scott P, Laing ED, Broder CC, Rolland M, Michael NL, Modjarrad K. A Cryptic Site of Vulnerability on the Receptor Binding Domain of the SARS-CoV-2 Spike Glycoprotein. bioRxiv 2020:2020.03.15.992883. [PMID: 32511298 PMCID: PMC7217142 DOI: 10.1101/2020.03.15.992883] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
SARS-CoV-2 is a zoonotic virus that has caused a pandemic of severe respiratory disease-COVID-19-within several months of its initial identification. Comparable to the first SARS-CoV, this novel coronavirus's surface Spike (S) glycoprotein mediates cell entry via the human ACE-2 receptor, and, thus, is the principal target for the development of vaccines and immunotherapeutics. Molecular information on the SARS-CoV-2 S glycoprotein remains limited. Here we report the crystal structure of the SARS-CoV-2 S receptor-binding-domain (RBD) at a the highest resolution to date, of 1.95 Å. We identified a set of SARS-reactive monoclonal antibodies with cross-reactivity to SARS-CoV-2 RBD and other betacoronavirus S glycoproteins. One of these antibodies, CR3022, was previously shown to synergize with antibodies that target the ACE-2 binding site on the SARS-CoV RBD and reduce viral escape capacity. We determined the structure of CR3022, in complex with the SARS-CoV-2 RBD, and defined a broadly reactive epitope that is highly conserved across betacoronaviruses. This epitope is inaccessible in the "closed" prefusion S structure, but is accessible in "open" conformations. This first-ever resolution of a human antibody in complex with SARS-CoV-2 and the broad reactivity of this set of antibodies to a conserved betacoronavirus epitope will allow antigenic assessment of vaccine candidates, and provide a framework for accelerated vaccine, immunotherapeutic and diagnostic strategies against SARS-CoV-2 and related betacoronaviruses.
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Affiliation(s)
- M. Gordon Joyce
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rajeshwer S. Sankhala
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Wei-Hung Chen
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Misook Choe
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Hongjun Bai
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Agnes Hajduczki
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Lianying Yan
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA, Bethesda, MD, USA
| | - Spencer L. Sterling
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA, Bethesda, MD, USA
| | - Caroline E. Peterson
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Ethan C. Green
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Clayton Smith
- Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
- Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Natalia de Val
- Center for Molecular Microscopy, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
- Cancer Research Technology Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD, USA
| | - Mihret Amare
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Paul Scott
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Eric D. Laing
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA, Bethesda, MD, USA
| | - Christopher C. Broder
- Department of Microbiology and Immunology, Uniformed Services University, Bethesda, MD, USA, Bethesda, MD, USA
| | - Morgane Rolland
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nelson L. Michael
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Outwater A, Nkya L, Lwihula G, O'Connor P, Leshabari M, Nguma J, Mwizarubi B, Laukamm-Josten U, Green EC, Hassig SE. Patterns of partnership and condom use in two communities of female sex workers in Tanzania. J Assoc Nurses AIDS Care 2000; 11:46-54. [PMID: 10911593 DOI: 10.1016/s1055-3290(06)60395-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Two rapid ethnographic studies have found that commercial sex workers (CSWs) and other high-risk women in Tanzania have different categories of partners, ranging from single-time contacts to long and enduring relationships. Since the advent of HIV/AIDS prevention programs in Tanzania in the late 1980s, CSWs and their clients have been aware of the multiple benefits of condom use for the prevention of pregnancy and STDs including HIV. These women often use condoms for the single-time contact. However, since the HIV/AIDS epidemic, casual partners have decreased in number. These days, most of their sexual contacts occur within long-term partnerships, and within these relationships, condom use is rare. Although the message that condoms should be used during high-risk behavior has been largely accepted, the definition of a high-risk relationship needs to be extended from casual partnerships to include multiple long-term partnerships. In addition, men and women's empowerment through education, business, and equal rights needs to be addressed at all levels of society.
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Green EC. Involving healers. AIDS Action 1999:3. [PMID: 12296172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
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Abstract
The Civil War and Reconstruction and the South's postbellum industrialization produced economic dislocation on a tremendous scale. One product of that economic upheaval was an increasing problem of infanticides and infant abandonments. This case study of Richmond, Virginia, examines patterns of abandonment and neonaticide as documented in records of the city almshouse and the city coroner. It demonstrates that race shaped the options available to women with problem pregnancies in that African American women had access to fewer social welfare unstitutions such as maternity homes. As a result, unmarried black women kept their out-of-wedlock babies more often than did whites, but they also committed infanticide at higher rates than did whites. Moreover, racial trends in infanticides and infant abandonment suggest that Ricomond's white working class experienced economic advancements at the turn of the twentieth century, while the city's black working class continued to live in depression-like conditions throughout the period.
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Masauso Nzima M, Romano K, Anyangwe S, Wiseman J, Macwan'gi M, Kendall C, Green EC. A targetted intervention research on traditional healer perspectives of sexually transmitted illnesses in urban Zambia. Current research. Soc Afr SIDA 1996:7. [PMID: 12179374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
There exists in parts of southern and eastern Africa an apparently widespread belief in the existence of an invisible, internal "snake," often described as a power or force of some kind that dwells in the stomach but that can move throughout the upper body. Although some anthropologists have described this snake as related to witchcraft, findings from diverse parts of Mozambique, South Africa and elsewhere suggest that it may (also) be thought of as a symbolic expression of the need to respect the human body, specifically to protect it against the introduction of impurity. Belief in nyoka, as Tsonga- and Shona-speakers call the invisible snake, suggests the importance of purity and pollution beliefs as they relate to health in a particular society; the presence of nyoka belief may even be taken as an empirical measure of their importance. Going beyond nyoka, it is argued that pollution beliefs are more central in southern African ethnomedicine than the literature suggests, perhaps more so than witchcraft and sorcery beliefs. It is hypothesized that pollution-related illnesses tend to be roughly coterminous with diseases biomedically classified as contagious. Apart from ethnographic and theoretical significance, establishing the nature and centrality of pollution beliefs, aided by analysis of cultural metaphors such as the invisible snake, can point to culturally appropriate ways of presenting health education messages in societies where pollution beliefs are important. Pollution beliefs may be characterized as quasi-naturalistic and they in fact represent an area of potential interface between indigenous and cosmopolitan medicine-far more than witchcraft beliefs.
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Abstract
The quality of life of patients relying on electrically powered artificial organs is currently restricted by the limited energy availability provided by portable batteries. As these patients become increasingly ambulatory, and are developing more active lifestyles, this limitation grows more apparent. Coincidentally, these patients may themselves be capable of generating electrical power as a consequence of their physical activity. Extraction of this latent autologous energy could, in turn, be used to augment charging of internal batteries--thus untethering the patient from external power for extended periods of time. In this study, the viability of deriving energy associated with natural human ambulation has been evaluated. The kinematic components of gait were evaluated to identify the largest useful forces and moments that may be harnessed as an energy source, while presenting minimal "perceived" work for the patient. It was found that the ground reaction forces associated with the heel strike and toe-off phases of the gait represent the greatest potential for usable energy. This study uses a piezoelectric array within the midsole of the shoe for the conversion of mechanical to electric energy. This power could then be easily coupled in tandem with existing transcutaneous transformers for augmenting or temporarily replacing external power sources.
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Affiliation(s)
- J F Antaki
- Artificial Heart and Lung Program, University of Pittsburgh, PA 15219, USA
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Abstract
A national HIV/STD prevention program focused on traditional healers was started in South Africa in late 1992. An initial group of 28 healers (the 'first generation') was trained in HIV/AIDS and STD prevention. These 28 in turn trained a total of 630 additional healers (the 'second generation') in formal, week-long workshops within seven months of the first workshop (this figure grew to 1510 healers by the end of the tenth month). This paper reports results of an assessment of the impact of training during the first seven months of the program. The second generation appeared to be as well trained as the first, if we can rely on measures such as reporting correctly how HIV is transmitted and how HIV transmission can be prevented. Healers also reported advising their patients to use condoms, and demonstrating methods of correct condom use. Healers were initially recruited through national, formal associations of traditional healers, of which there are several in South Africa. Yet several months into the program, healers were critical of donor groups working with and through such associations. Most preferred that membership in such associations not be a prerequisite for participation in donor group-supported collaborative programs. The present program accordingly began to explore the possibility of recruiting healers through existing, indigenous associations of diviner-mediums known as impandes.
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Affiliation(s)
- E C Green
- Department of Traditional Medicine, GEMT, Maputo, Mozambique
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Abstract
Qualitative research was conducted with traditional healers in Manica Province, Mozambique to develop an empirical, culturally-appropriate strategy for communication between government and traditional healers related to the prevention of STDs including AIDS. Most Manica healers regard AIDS as a new disease for which they lack medicines. However, when questioned on other sexually transmitted diseases, as defined by healers themselves, relatively complex disease taxonomies based on fine distinctions between symptoms emerged. Manica healers recognize two broad categories of STDs: siki and nyoka-related. The former seems to correspond with the more serious common STDs of Western biomedicine--syphilis, gonorrhea, chlamydia and chancroid--and is believed to be caused by a common invisible, microscopic agent, khoma. Nyoka-related illnesses are understood in terms of traditional ideas of pollution, and denote less serious, self-limiting genito-urinary conditions. Healers express great faith in the efficacy of traditional medicines. Based on the ethnomedical research findings, a culturally-sensitive and -specific AIDS/STD health education strategy for Manica indigenous healers was developed and began operating in a week-long workshop held in Chimoio, Mozambique in November 1991.
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Affiliation(s)
- E C Green
- Department of Traditional Medicine, Ministry of Health, Maputo, Mozambique
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Abstract
In sub-Saharan African countries where AIDS is established, HIV transmission is primarily by means of heterosexual intercourse. A major co-factor in such transmission is the presence of other, sexually transmitted diseases (STDs). Efforts to limit the heterosexual transmission of HIV in Africa must therefore address the high prevalence of other, standard STDs. The present study attempts to establish a preliminary information base for interventions to prevent the spread of HIV in Liberia where there is relatively high incidence of standard STDs but low incidence of HIV seropositivity. Employing in-depth, key-informant interviews with traditional healers, prostitutes and others, as well as focus group discussions with groups selected on the basis of several criteria, knowledge, beliefs, attitudes and behavior related to AIDS and STDs were elicited. Although evidence of exposure to scientific concepts was found, traditional, ethnomedical views predominated. Notions of sorcery, taboo violation and contamination were often expressed when describing the etiologies of locally-recognized sexually transmitted diseases. More 'naturalistic' explanations were often based on simplified notions of human anatomy and biochemistry. Three basic messages about AIDS that were broadcast in a recent radio campaign were retained, namely 'AIDS kills;' 'there is no cure for it;' and 'it is transmitted through sex.' There was also evidence of Liberians beginning to view AIDS in frameworks of interpretation compatible with traditional ethnomedical beliefs, such as sorcery. Most traditional healers reported they knew little or nothing about AIDS, including those who had a lot to say about other STDs that are well-established in Liberia. Many cases of STDs seem to be handled by traditional healers. Treatment typically consists of decoctions from the leaves and roots of various medicinal plants, administered as teas--less often as enemas or vaginal implants--to be taken over a 2-4 day period. It is recommended that efforts to lower incidence of standard STDs be given priority comparable to promotion of condom use and 'safer sex' in efforts to slow the transmission of HIV in Liberia. Strategies for combating STDs will have to take into account popular beliefs and attitudes regarding STDs as well as the role and influence of traditional healers. Strategies of this sort are recommended.
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Abstract
Compared with both industrialized countries and other less developed parts of the world, most of sub-Saharan Africa suffers inordinately from sexually transmitted diseases (STDs). It has high prevalence rates of traditional STDs, such as gonorrhea and syphilis, and if accurate seroprevalence surveys were to be done, it would probably prove to have the highest HIV seropositive incidence in the world. Unlike the pattern in the West, AIDS is primarily a heterosexually transmitted disease in Africa. This appears to be largely because of the prevalence of other untreated or improperly treated STDs. Therefore to lower the incidence of STDs would be to curtail the spread of HIV infection. The problem becomes how exactly to accomplish this. Most STD cases are never even presented at biomedical health facilities; they are presented to traditional healers. Both healers and their patients seem to believe that traditional STD cures are more effective than 'modern' cures, although the former are probably biomedically ineffective. While there is scant ethnomedical literature on STDs in Africa, the present paper presents Swaziland findings and related evidence from other African societies that the ultimate cause of several common STDs is believed to be the violation of norms governing sexual behavior, requiring traditional rather than biomedical treatment. Traditional healers therefore need to be a central part of any scheme to lower the incidence of STDs.
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Abstract
Ground beef patties were processed from boneless beef which was subjected to two different inspection systems for bone and cartilage defects. One system permitted a higher ("high") level of defects (USDA Food Safety and Inspection Service, Meat and Poultry Inspection Requirements), while the other system (USDA PP-B-2120 Federal Purchasing Specification) permitted only a lower ("low") level of defects. Before formation into patties, the ground beef was subjected to three processing systems for defect removal (none, Weiler Bone Collector System, Speco Spiral Groove Plate System). A sensory approach (teeth and tongue) for detecting defects with cooked patty samples revealed more bone and cartilage defects in the "high" than the "low" formulation regardless of defect removal system. While the defect removal systems reduced the levels of detected defects in the "high" formulation, neither system produced patties with defect levels achieved through inspection procedures required to produce "low" levels of these defects. However, it appears that much of the bone remaining as a defect in boneless beef is reduced in size during grinding so as to be undetectable by sensory approaches.
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Affiliation(s)
- B W Berry
- Meat Science Research Laboratory, Agricultural Research Service, USDA, Beltsville, Maryland 20705 and Food Quality Assurance Branch, MRDD, AMS, USDA, Washington, D C
| | - E C Green
- Meat Science Research Laboratory, Agricultural Research Service, USDA, Beltsville, Maryland 20705 and Food Quality Assurance Branch, MRDD, AMS, USDA, Washington, D C
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21
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Green EC. A consumer intercept study of oral contraceptive users in the Dominican Republic. Stud Fam Plann 1988; 19:109-17. [PMID: 3381225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purchasers of a low-cost oral contraceptive were intercepted and interviewed in a sample of Santo Domingo pharmacies that represented the highest sales of the product, yet also reflected the socioeconomic profile of the city's entire population. Users of the contraceptive were later interviewed in greater depth in their homes. The survey of users showed that the Dominican Republic's social marketing program, implemented by PROFAMILIA, was reaching an appropriate target market--that is, younger, lower-middle-class women of low parity. The program was, in addition, successful in attracting first-time adopters, and it was also expanding the overall commercial market for all contraceptives. The marketing campaign was successful in part because a mass audience was reached, through brief television spots. Program impact on contraceptive prevalence can be assessed from sales data.
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Affiliation(s)
- E C Green
- John Short and Associates, Columbia, MD 21044
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22
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Abstract
The paper explores the various factors that appear to constrain the implementation in sub-Saharan Africa of the WHO/UNICEF Alma Ata resolutions that member states support the use of indigenous health practitioners in government health programs. It also presents arguments and evidence that suggest ways to overcome the constraining factors. Discussion focuses on traditional healers as distinct from traditional birth attendants. The question posed in the title is not fully answered, but a considerable amount of fact, programmatic experience, and observation related to the issue is assembled and discussed in order to approach an answer, and to inform those who hold a variety of positions with regard to the Alma Ata resolutions.
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23
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Abstract
An anthropological study of knowledge, attitudes and practices relating to child diarrhea and specifically to ORS was carried out in Bangladesh. The purpose of the study was to help design a culturally-sensitive social marketing program. Information was gathered on indigenous classification of diarrheas, patterns of therapy recourse and diarrhea management, and understanding of dehydration symptoms as well as use and attitudes regarding ORS. Among the findings were that 58% of households sampled had tried ORS at least once; ORS was perceived as a medicine with several positive attributes; literacy was positively related to ORS use; and there were no significant cultural barriers to ORS adoption.
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24
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Green EC, Hunter A. Toxicity of carbon disulfide in developing rats: LD50 values and effects on the hepatic mixed-function oxidase enzyme system. Toxicol Appl Pharmacol 1985; 78:130-8. [PMID: 4035665 DOI: 10.1016/0041-008x(85)90312-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The 24-hr LD50 values of carbon disulfide (CS2) were estimated in 1-, 5-, 10-, 20-, 30-, and 40-day-old rats. CS2 was least toxic to 20-day-old rats (LD50 1545 mg/kg, ip) and most toxic to 1-day-old rats (LD50 583 mg/kg, ip). Twenty-four hours after administration of CS2 (375 mg/kg, ip) to 1-, 5-, 10-, 20-, 30-, and 40-day-old rats, significant inhibition of cytochrome P-450 and aniline hydroxylation was observed in rats of all ages studied except the 1-day-old rats. Following incubation of hepatic microsomes isolated from 1-, 5-, 10-, 20-, 30-, and 40-day-old rats with CS2, decreases in activity of the hepatic mixed-function oxidase enzyme system and/or concentration of cytochrome P-450 were observed when an NADPH-generating system was present during incubation. When hepatic microsomes isolated from rats of all ages studied were incubated with C35S2, 35S was covalently bound to microsomal protein in the presence of an NADPH-generating system. Also, more 35S than 14C was covalently bound to microsomal membranes after incubation of microsomes isolated from rats of all ages studied with C35S2 or 14CS2 in the presence of an NADPH-generating system. The results of this research demonstrated the LD50 of CS2, the effects of CS2 on the hepatic mixed-function oxidase enzyme system, and that the conversion of CS2 to a covalently binding sulfur-containing biotransformation product varied with age in developing rats.
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25
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Green EC. Factors relating to the presence and use of sanitary facilities in rural Swaziland. Trop Geogr Med 1985; 37:81-5. [PMID: 4012856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Findings related to latrine construction and use in a sample of rural homesteads in Swaziland are summarized from a larger, unpublished sample survey. Anthropological research techniques were also used to gain information on attitudes and beliefs. Pit latrines were found in 21% of the sampled homesteads. The most significant variables in predicting the presence of a latrine were respondent's education and the highest level of education achieved by anyone in the residential unit. Older people and small children were least likely to use a latrine; people with less education were least likely to even have a latrine.
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26
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Abstract
A study of beliefs and practices relating to childhood diarrhea, relying primarily on traditional healers as informants and survey respondents, revealed an indigenous classification of childhood diarrhea into three main types. Enemas are used as a treatment in two types of more serious diarrhea regarded as due to unnatural causes. Most children with diarrhea are taken to clinics only after home treatments and those of traditional healers have failed, by which time a child may be severely dehydrated. The role of oral rehydration and strategies for health education are discussed in the context of Swazi culture.
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28
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Abstract
The paper describes applied research efforts, requested by the Swaziland Ministry of Health and funded by U.S. AID, aimed at providing an information base for new government policies regarding traditional healers in Swaziland. Information reported relates to: health care manpower in the traditional sector; treatment seeking behavior in a pluralistic medical setting; traditional health beliefs and practices; payment practices; patterns of patient referral; attempts to establish an association of healers; attitudes of healers toward paraprofessional training; and possibilities for specific types of cooperation between modern and traditional health sectors.
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