Information for Public Health và Medical Professionals.
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CDC no longer provides miltefosine for treatment of free-living ameba infections. Miltefosine is now commercially available. Please visit impavido.comfor more information on obtaining miltefosine in the United States. If you have a patient with suspected free-living ameba infection, please contact the CDC Emergency Operations Center at 770-488-7100 to consult with a CDC expert.
Primary amebic meningoencephalitis (PAM) is treated with a combination of drugs, often including amphotericin B, azithromycin, fluconazole, rifampin, miltefosine, và dexamethasone. These drugs are used because they are thought lớn be effective against Naegleria fowleri & have been used to treat patients who survived. Miltefosine is the newest of these drugs and has been shown lớn kill free-living amebae, including Naegleria fowleri, in the laboratory1, 2, 3. Miltefosine has also been used to successfully treat patients infected with Balamuthia4 & disseminated Acanthamoeba infection5.
Although most cases of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri infection in the United States have been fatal (153/157 in the United States)6, 7, there have been five documented survivors in North America: one in the United States in 19788, 9, one in Mexico in 200310, two additional survivors from the United States in 2013 5, 6, and one from the United States in 2016. It has been suggested that the original U.S. Survivor’s strain of Naegleria fowleri was less virulent, which contributed to lớn the patient’s recovery. In laboratory experiments, the original U.S. Survivor’s strain did not cause damage to cells as rapidly as other strains, suggesting that it is less virulent than strains recovered from other fatal infections13.
After 35 years without a Naegleria survivor in the United States, during the summer of 2013, two children with Naegleria fowleri infection survived. The first, a 12-year-old girl, was diagnosed with PAM approximately 30 hours after becoming ill & was started on the recommended treatment of amphotericin B, fluconazole, rifampin, azithromycin, and dexamethasone within 36 hours. She also received the investigational drug miltefosine,7-9 and her brain swelling was aggressively managed with treatments that included cooling the toàn thân below normal body toàn thân temperature (therapeutic hypothermia). This patient made a full neurologic recovery và returned to lớn school. Her recovery has been attributed lớn early diagnosis và treatment and novel therapeutics including miltefosine và hypothermia11.
A second child, an 8-year-old male, is also considered a PAM survivor, although he has suffered what is likely lớn be permanent brain damage. He was also treated with amphotericin B, fluconazole, rifampin, azithromycin, miltefosine, and dexamethasone but was diagnosed và treated several days after his symptoms began. Cooling of the body toàn thân below normal toàn thân temperature was not used12.
In the summer of 2016, a 16-year-old boy was reported as the fourth U.S. PAM survivor. This patient was diagnosed within hours of presentation lớn the hospital and was treated with the same protocol used for the 12-year-old 2013 survivor. This patient also made a full neurologic recovery và returned to school.
The shortage of teachers is a global reality. According to UNESCO, there was a need to lớn create 1.6 million teaching posts lớn meet the goal of universal primary education by 2015, và this is expected lớn rise khổng lồ 3.3 million by 2030.
In India alone, there was a shortage of over 5 lakh teachers in schools in 2015. Besides, an additional 6.6 lakh teachers needed teacher-training.
Mudit Jain believes building a product because you can’t find it anywhere else may be the biggest cliché, but sometimes it is what is needed. You understand problems when you face them personally.
When Mudit was planning to vì a yoga course, he searched online to lớn find a capable yoga teacher. What the search gave him were dozens of phone numbers. Of these, some didn’t respond, some responses were not fruitful, many didn’t want khổng lồ come over to lớn his house và others wanted a hefty sum of money.
But an idea was born. He studied the problem & started building a platform.
In August 2015, Mudit và Co-founder Rishabh Jain, launched Qriyo, a learning platform that provides more than 400 courses in academics, co-curricular, extracurricular, & fitness activities.
“A learner can book a course on the platform via phone or the website. It asks users about their requirements & locations. As soon as there is a request, a matchmaking process begins based on several parameters & a menu of suitable teachers is generated. The best teacher from the list is then selected. The matchmaking is performed by an algorithm. The selected teacher is sent for a demo, and if the learner likes the demo, the course begins; else another teacher is sent from the list,” explains Mudit Jain, Founder và CEO of Qriyo.
After graduating from IIT-Bombay in 2011, Mudit worked with the consulting arm of Pricewaterhouse
Coopers US in the areas of strategy & analytics. Prior khổng lồ Qriyo, he was heading the India division of Finmechanics, the platform provides solutions & services khổng lồ the capital markets, treasury & risk departments of financial institutions and corporates.
Mudit says he keeps a danh mục of teachers in his database. Before putting the list on the platform, a thorough evaluation is carried out. “We cảnh báo their location, experience, and salary expectation once they pass the evaluation.”
The aim behind the launch of Qriyo is to lớn fill the gap between need & demand in the tuition segment.
Demand opens market
According lớn a survey by ASSOCHAM, the tuition sector was worth Rs 1.54 lakh crore in 2013 and was expected lớn grow to Rs 2.6 lakh crore in 2015.
The survey says that 87 percent of primary school and 95 percent of high school students take private tuitions.
Such tuitions have become an integral part of a school-going child"s life in India. While earlier mostly uneducated or less educated parents sent their children for tuitions, as per the report, private coaching has now edged out mainstream education, thanks to lớn poor standards of teaching in schools.
The survey points out that the proportion of primary schoolchildren relying on private tuitions increased 100 percent from 2006 to lớn 2013. Và simultaneously, the private tuition industry boomed, recording a growth of 35 percent from 2008 to 2013.
“This report presents a strong case for the tuition market in India. Besides academics, we are banking on rising demand in areas such as music, dance, art, và cooking,” says Mudit.
Growth graph
Bootstrapping the platform for at least six months, Qriyo raised the first round of funding from UAE-based early stage venture capital firm Idein Ventures in January this year.
It’s been almost a year since the launch of Qriyo, & it claims to have more than 450 clients. It says it has evaluated more than 2,000 teachers and has on-boarded about 400 of them.
The revenue model of the platform is commission-based. It takes a certain percentage from tutors based on the course fee.
In this segment, on-demand platforms lượt thích Urban
Pro, Urban
Clap, Housejoy, and many others provide this service among a danh mục of many other services.
Besides, competition in the sector includes online learning delivery players such as Vedantu, Merit
Nation, và Wiz
IQ. Then there are ‘smart classroom’ players like Educomp và i
Prof.
In May last year, Bengaluru-based edtech startup Vedantu raised $5 million from Accel Partners & Tiger Global Management.Last year, Meritnation.com, an online education company in K-12, also announced a fresh funding round of $ 6 million from
Info Edge (India) Limited.
What lies ahead?
Qriyo recently launched a new version of the website. It says it will continue building the website until it finds the right balance between the user interface and ease of use.
“We are building a customer ứng dụng for Android và i
OS. The customer can book courses from the trang web or app. The tutor will also have an app, called the provider app. The provider will help the tutor keep track of students and their schedules. The adoption of the apps will greatly reduce the manual efforts of our team, và everything from scheduling khổng lồ feedback will be automatic,” says Mudit.
He is also enthusiastic about the venture’s growth prospects. He says the service industry is bigger than ever and constantly growing. Research shows 93 percent of students show better results when given personalised attention.
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“This is motivating news for us. We are seeing constant growth. Our number of demos and customers is increasing day by day. There is a huge market that we are looking at and going forward khổng lồ acquire,” he adds.