CNH: Collaborative Research: Climatic Extremes, Mining, and Mycobacterium Ulcerans: A Coupled Systems Approach

布鲁里溃疡（BU）是热带国家最容易被忽视但可治疗的疾病之一。它被认为是穷人的疾病，因为它使人衰弱和毁容的皮肤变化往往造成社会耻辱。布鲁里溃疡通常发生在水体附近，特别是在死水附近，如缓慢流动的河流、池塘、沼泽和湖泊。在加纳，自1993年以来已有超过1.1万例病例，是非洲发病率第二高的国家。绝大多数布鲁里溃疡病例报告为儿童和妇女。虽然人类皮肤溃疡发展的临床特征已经被很好地理解，但细菌的自然宿主、激活和传播仍然未知，这使得世界卫生组织（WHO）将布鲁里溃疡标记为一种“有趣的疾病”。几项研究证实了布鲁里溃疡与受干扰的环境之间的联系，特别是与洪水有关的环境。环境干扰和景观改变可能在死水的产生和疾病的发生中发挥重要作用，但很少有研究关注与人类有关的土地干扰或破碎化与布鲁里溃疡暴发之间的联系。这个跨学科的研究项目将集中在加纳作为一个案例研究，并将探讨环境变化的作用和BU在多个时空尺度上的出现。研究人员假设，布鲁里溃疡暴发是由外部干扰（更极端和频繁的降雨事件）和森林砍伐、农业和采矿活动导致的景观变化缓慢驱动因素导致的系统脆弱性增加引发的。项目目标是加强对土地干扰在布鲁里溃疡暴发中的作用和类型的基本了解；识别被忽视但可能至关重要的非线性和意外情况，这些非线性和意外情况是由于人类和自然因素对景观的相互作用以及随后的疾病出现造成的；增加正在进行的关于布鲁里溃疡宿主、宿主和传播的辩论；并为越来越多的关于新出现的传染病和生态变化的文献和科学论述做出贡献，重点是极端气候。研究人员将使用环境采样、访谈和调查、参与式测绘活动和复杂系统建模的创新组合来解开BU的复杂性。该项目将对理解人-环境耦合系统中的恢复力具有重要意义。它将讨论在不断变化的环境中有关复杂的新出现疾病的新的重要问题，特别强调相互作用的类型和规模、正反馈、阈值和非线性动力学。这项研究将为加纳的研究人群提供健康益处，并为美国和加纳提供教育和培训机会。美国调查人员将与加纳伙伴机构（矿业与技术大学、夸梅赫·恩克鲁玛科技大学、加纳大学、矿产委员会和加纳卫生服务机构）的研究人员和从业人员密切合作。通过涉及跨文化的国际“K-12姐妹学校”的教育部分，该项目将展示人类改造的景观和疾病模式如何在美国和非洲相互关联。本项目由美国国家科学基金会自然与人类系统耦合动力学（CNH）项目资助。

Buruli ulcer (BU) is one of the most neglected but treatable diseases in tropical countries. It is considered to be a disease of the poor because of its debilitating and disfiguring skin alterations that often create social stigmas. BU typically occurs near water bodies, especially near stagnant water, such as slow-flowing rivers, ponds, swamps, and lakes. In Ghana, more than 11,000 cases have been counted since 1993, the second highest rate in Africa. The large majority of BU cases are reported for children and women. While the clinical dimensions of the development of the ulcer on the human skin are well understood, the natural reservoir, activation, and transmission of the bacterium remain unknown, leading the World Health Organization (WHO) to label BU as an "intriguing disease." Several studies have confirmed the linkage between BU and disturbed environments, especially in association with flooding. Environmental disturbances and landscape modifications may play a major role in the creation of stagnant water and the occurrence of the disease, but little research has focused on the linkages between human-related land disturbance or fragmentation and BU outbreaks. This interdisciplinary research project will focus on Ghana as a case study and will explore role of environmental change and the emergence of BU at multiple temporal and spatial scales. The investigators hypothesize that BU outbreaks are triggered by increased systems vulnerability resulting from exogenous disturbance in the form of more extreme and frequent rainfall events and slow drivers of landscape change due to deforestation, agriculture, and mining activities. Project objectives are to enhance basic understanding of the role and types of land disturbance on BU outbreak; identify overlooked yet potentially critical nonlinearities and surprises resulting from the interaction of human and natural factors on the landscape and subsequent disease emergence; add to the ongoing debate on BU reservoirs, host(s), and transmission; and contribute to the growing body of literature and scientific discourse regarding emerging infectious disease and ecological change, with emphasis on climatic extremes. The investigators will use an innovative combination of environmental sampling, interviews and surveys, participatory mapping activities, and complex systems modeling to unravel the complexities of BU.This project will have significant implications for the understanding of resilience in coupled human-environmental systems. It will address new and important questions regarding complex, emerging diseases in changing landscapes, with particular emphasis on types and scales of interactions, positive feedbacks, thresholds, and non-linear dynamics. The research will provide health benefits for the study populations in Ghana and education and training opportunities in the U.S. and Ghana. The U.S. investigators will work closely with researchers and practitioners at Ghanaian partner institutions (University of Mines and Technology, Kwameh Nkrumah University of Science and Technology, University of Ghana, Minerals Commission, and Ghana Health Services). Through its educational component involving cross-cultural, international "K-12 sister-schools," the project will demonstrate how human-modified landscapes and disease patterns are interconnected in both the United States and Africa. This project is supported by the NSF Dynamics of Coupled Natural and Human Systems (CNH) Program.