Background: The Ebola virus disease (EVD) outbreak 2014 received extensive news media coverage, which faded out before the outbreak ended. News media coverage impacts risk perception; it is, however, unclear if the components of risk perception (affective and cognitive responses) change differently over time. Methods: In an online panel, we asked participants (n = 1376) about EVD risk perceptions at the epidemic's peak (November 2014) and after news media coverage faded out (August 2015). We investigated worry (affective response), perceived likelihood of infection, perceived personal impact, and coping efficacy (dimensions of cognitive response), and knowledge about transmission. Differences between the surveys with respect to manifestations of affective and cognitive dimensions were tested using the Wilcoxon signed-rank test. The association between individual change in knowledge and worries about EVD in the first survey was investigated using linear regression. Results: In November 2014, the survey was filled in by 974 participants. Ten months later, 662 of them were still members of the online panel and were invited to the follow-up survey. Among the 620 respondents, affective response decreased between the surveys. Knowledge about EVD also decreased; however, participants worried about EVD in 2014 had increased knowledge in 2015. Perceived likelihood of infection decreased over time, while perceived personal impact and coping efficacy did not. Conclusions: Risk communication appealing to cognitive reactions by informing clearly on the risk of infection in unaffected countries may decrease inappropriate behaviors.

The Ebola outbreak in West Africa in 2014 to 2016 had more than 28,000 suspected, probable, and confirmed cases. It was the largest Ebola outbreak in history. Of the 28,000 cases in the three Ebola-affected countries, Liberia had 10,000 cases with almost 5,000 deaths. The Ebola Virus Disease (EVD) entered Liberia along the border of Guinea and moved to the capital city of Monrovia where the virus spread. Ebola Treatment Units (ETUs) were constructed throughout the response in locations where there were available facilities versus distance to care challenges. This study examined the association of distance from villages to ETUs and mortality. Using Geographic Information System (GIS) and statistics framed within the Social Ecological Model and the GIS Framework, this study geolocated the Ebola cases by village, mapped the travel routes and calculated the distance to the ETU. A logistic regression was then used to determine if there was an association between distance and mortality, with and without controlling for age and gender, and, to calculate the odds ratio. A logistic regression model showed there is an association between distance and mortality and that Ebola patients living within 12 kilometers of the ETU were 1.8 times less at risk of mortality (OR = 1.778, 95% CI [1.171 - 2.7]) than those living more than 12 kilometers. In addition, males had a 1.4 times lower risk of death due to EVD. This understanding can inform future outbreak responses and placement of treatment units. In addition, this information can lead to social change with respect to individual understanding of access to care, community expectations, and national health care planning.

Ebola virus (EBOV) and other members of the Filoviridae family are enveloped RNA viruses that are the causative agents of sporadic outbreaks of highly lethal disease in humans and non-human primates. EBOV entry into host cells requires attachment, internalization, and subsequent trafficking to the late endosomal/lysosomal compartment in order to reach the filovirus entry receptor, Niemann-Pick C1 (NPC1) and other triggering factors required for EBOV glycoprotein (GP)-mediated fusion between the viral and host membranes. The highly regulated nature of endosomal trafficking coupled with the dependence of EBOV on accurate endolysosomal trafficking for entry led us to hypothesize that the virus depends on—and potentially actively regulates—a consortium of specific host trafficking factors. In this thesis, we investigated the role of two trafficking complexes involved in endosomal maturation and trafficking, the Homotypic Fusion and Vacuole Protein Sorting (HOPS) complex and the PIKfyve-ArPIKfyve-Sac3 (PAS) complex, in EBOV entry. Furthermore, in order to further dissect how the PAS complex is regulated and performs its effector functions, we performed a protein-protein interaction screen using BioID in order to define the PAS cellular interactome. Using an inducible CRISPR/Cas9 system, we found that depletion of each HOPS subunit, as well as depletion of a positive regulator of the HOPS complex, UVRAG, impaired EBOV entry. Furthermore, we mapped a region of UVRAG spanning residues 269-442 to be key for binding to the HOPS complex and mediating EBOV entry, indicating that expression of and coordination between the HOPS complex and UVRAG are required for EBOV entry. Similarly, knockout of each subunit of the PAS complex was found to impair EBOV entry. Further molecular dissection using small molecule inhibitors and enzymatic mutants of PIKfyve and Sac3 demonstrated that PIKfyve kinase activity is required for EBOV entry, while Sac3 phosphatase activity is dispensable. Using a fluorescent probe for phosphatidylinositol(3,5)bisphosphate, the lipid product generated by PIKfyve, we also found evidence that stimulation of cells by EBOV virus-like-particles enhances PIKfyve activity, suggesting that the virus can promote its entry by activating the PAS complex. Finally, using BioID to screen for interacting proteins of the PAS complex, we identified candidate interactors involved in endosomal trafficking as well as other cell processes including mitochondrial function and cell cycle regulation. Further characterization of one candidate interactor, the coatomer complex I (COPI), using proximity ligation assays validated the interaction between ArPIKfyve and COPI subunit COPB1, and provides further evidence for a role of COPI in endosomal trafficking. Taken together, these results highlight the importance of cellular trafficking factors involved in diverse facets of endosomal dynamics, from lipid metabolism to membrane tethering, for the entry of EBOV and other filoviruses, and further shed light on how EBOV can actively modulate host trafficking networks to promote successful viral entry and infection. Further molecular dissection of how the virus hijacks cell trafficking will facilitate the development of antiviral therapeutics as well as elucidate how these fundamental cellular processes are regulated.

Background. This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results. Methods. There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis of variance (ANOVA) were used to analyse pre- and post-psychological stress symptoms (PSS) for samples from both groups. Results. Separately, treatment group 1 (TG1) and treatment group 2's (TG2) paired t test yielded significant results (p < 0.001) for the decrease of PSS. The mixed-model ANOVA found that there were significant differences in total pre- and post-test PSS and a significant difference in PSS means over time. Conclusions. Results indicated that there was a statistically significant decrease in reported symptoms in both treatment groups pre- to post-intervention and a significant difference in total symptoms over time. However, the findings do not indicate that the longer programming was statistically different compared to the shorter programming. The study presented had gaps in data, largely due to limits in research during the crisis. However, this paper provides a unique case study for challenges that can be faced for project evaluation in emergency settings.

From 2014 to 2015, Liberia experienced the largest Ebola epidemic in world history. The impact of this disease was not only physical; it created fear, loss, and trauma throughout the country. This article will describe the process of three phases of a community-based psychosocial expressive arts program, which used theory from the fields of expressive arts therapy to build mental health capacity during and after the epidemic. This article will highlight the background of Ebola virus disease and the Ebola virus disease epidemic, provide an overview of current theory and research for expressive arts therapy and the impact of trauma, describe the process of how the program developed and was implemented, the process of partnering with the community, program components, the two pilot programs, and the large-scale community program. We performed a mixed-methods analysis of the large-scale program’s activity data to evaluate the impact. The results highlight a positive response from the participating children and facilitators. The authors discuss the findings from the results, best practices, and limitations. Additionally, the authors discuss implications and considerations for future programming.

Indiana University-Purdue University Indianapolis (IUPUI) / Policy and natural shocks are exogenous factors, which may disrupt patients’ ability to access recommended health care. My dissertation investigates the effect of recent natural and policy shocks in health care provision on different patient outcomes. The first chapter studies the effect of the 2014 Ebola virus epidemic in West Africa on maternal health care utilization and infant health in Sierra Leone. The Epidemic resulted in the diversion of the limited health care resource away from other services to care for Ebola patients. It also led to maternal stress from fear of infection and community breakdown. The results show the outbreak led to significant decline in maternal health care utilization and infant birth weight. The second chapter examines whether physician practices that are vertically integrated with hospitals provide healthcare at higher costs than non-integrated practices in a Medicare patient population. The degree of integration is exogenously assigned to a patient following a geographical move. The study finds that switching to integrated practice increases health care utilization and spending. Although integration may increase quality of care, the increase in spending suggests the need for a continuing attention to policies and incentives that are associated with integration. Finally, the third chapter documents the impact of the recent changes in state medical and recreational cannabis access laws in the United States on health care utilization. The liberalization of access to cannabis may enable patients to substitute cannabis for another prescription and non-prescription health care services. The results show a significant decline in the utilization of emergency and outpatient services among patients with chronic pain for the states that legalized cannabis. The effect is mainly due to medical cannabis laws, whereas the effect of recreational cannabis is ambiguous. The three chapters, taken together, show that exogenous shocks, such as natural shocks and government policy, affect health care utilization and the health of individuals. Health policies should, therefore, target developing a resilient health care system that withstands natural shocks and promote policies that provide better treatment alternatives.

Yes / Coronavirus is the most dangerous virus in the world wide and it can easy spread between people, animals and plants because it is existing on one strand of RNA (Ribonucleic Acid) and it can duplicate faster than any virus. The source of coronavirus is still unknown, but some sources said that it came from seafood market and other sources said that it came from bat and snakes. It starts in Wuhan; China and every day the fatality increases. The symptoms are like a SARS-CoV (acute respiratory syndrome coronavirus)) and MERS-CoV (Middle East Respiratory Syndrome Coronavirus). By using nucleotide sequence of coronavirus from NCBI (National Center for Biotechnology Information) and some programs that ran on Matlab, the results show that there are some differences and similarities between coronavirus and other viruses such as Ebola, Flu-b, Hepatitis B, HIV and Zika especially for DEBs (distinct excluded blocks) program that shows at 5bp (base pair) there is a common with slightly difference between coronavirus “cgggg” and Ebola virus “cgtgg”. The aim from this study is to find a way to help doctors and scientists to stop spreading the coronavirus or to destroy it.

This study critically explores the pervasive issue of corruption in humanitarian assistance, focusing on the Liberia Red Cross Society (LRCS) during the Ebola outbreak in Liberia from 2014-2016. For a country grappling with broken infrastructure and fragile healthcare systems due to a 14-year-long civil war, the Ebola crisis in Liberia was an unprecedented disaster as evidenced by 10,672 recorded cases and 4,808 reported fatalities between 2014 and 2016. The LRCS was a prominent local humanitarian actor in the Ebola response and recovery efforts, but its work was marred by corruption stemming from organizational, contextual, and motivational factors. This study sheds light on the nature and extent of corruption within humanitarian action from the perspective of the LRCS and the Ebola epidemic in Liberia, contributing to humanitarianism as a discipline and a profession. The study utilized the principal-agent theory and the organizational culture theory of corruption in humanitarian assistance, which had been employed in earlier studies of a similar nature. In terms of methodology, a qualitative approach with retrospective review was employed to address two research questions regarding the drivers and impact of corruption in the Ebola response and recovery operations conducted by the LRCS. Data for the study were collected from a mix of 14 pre-existing sources, including documents originating from the LRCS and its consortium of donors and partners, as well as published news content from notable local and global media outlets. The results were generated through document analysis facilitated by ATLAS.ti, a qualitative data analysis software, which considered patterns, trends, and insights within the sources gathered for the study. Multiple rounds of analyses on the data were conducted to validate the results of the study.  The findings of this study reveal a complex web of corruption within humanitarian aid delivery during crisis and disaster. Corrupt practices within the LRCS included fraud and misuse of Ebola relief funds and resources, driven by individual motivations coupled with a number of organizational and contextual factors. The corruption had adverse effects on the efficiency, effectiveness, and accountability of relief efforts, potentially leading to reduced donor confidence in the LRCS and funding reduction. The study also stresses the importance of leadership, decision-making processes as well as resource management in preventing or enabling corruption within humanitarian aid organizations. These findings underscore the need for robust internal oversight, accountability mechanisms, and ethical leadership in humanitarian organizations to prevent and address corruption effectively.

The purpose of this study was to explore the securitization of communicable disease in the case of the Ebola outbreak in West Africa 2014. Applying the Copenhagen School’s theory of securitization, this thesis conducted a discourse analysis of speech acts occurring at different levels of the global community in relation to the outbreak. The focus lay on two major events, namely the UN Security Council meeting on 18 September 2014 and the UN high-level meeting on Ebola a week later. Investigating to what extent the securitizing discourse apparent in Resolution 2177 which identified Ebola as a “threat to international peace and security” was upheld and justified by the speakers at these events, this study determined that Ebola virus disease has been “successfully” securitized on all levels of global governance. Despite the incredible amount of human suffering which the Ebola outbreak provoked in West Africa, the discourse employed by global governance identified the referent object nearly exclusively at the state-level. Further research is suggested in the concluding parts of this thesis that can build upon the findings of this study.

Over the past few decades researchers and industrial professionals alike have realized the vast potential of monoclonal antibodies to treat diseases ranging from arthritis, immune and infectious diseases to cancer. There are a number of antibodies on the market that constitute a large portion of the biopharmaceutical niche in the drug industry. Blockbuster drugs (selling greater than $1 billion/year), include antibodies such as Avastin (bevacizumab), Herceptin (trastuzumab), Rituxan (rituximab), Humira (adalimumab) and Remicade (infliximab), which are cornerstones in this type of sector. With the cost of development to market approval rising astronomically for a new drug, new ways to produce and process these molecules becomes a paramount objective to ultimately help both patients and drug developers. Plants, such as Nicotiana benthamiana, offer a unique production platform due to their recently found ability to produce large amounts of therapeutic proteins in a quick manner. While production would be simple and cheap, purification would not be due to the presence of toxic compounds in ground plant tissue. The current methods to purify these molecules from plant extract include expensive affinity column steps (Protein A/G) that are difficult to scale-up to bed volumes that would be necessary for this technology. In the following paper, a method to purify a monoclonal antibody by non-Protein A/G resins is accomplished and compared to purification by Protein A. The modified process involved an UF/DF step, a precipitation of native impurities step using a charged polymer, hydrophobic interaction chromatography and hydrophobic charge induction chromatography. The yield of this modified process was 19.0%. This process compared favorably with Protein A due to the fact that even with washing steps including NaCl and Tween-20, the Protein A elution fraction still contained a large portion of host cell impurities. A chromatography step would need to be included before Protein A to both protect the column resin and provide a more purified immunoglobulin. / Master of Science