Featured articleBuruli ulcer is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.
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July 7, 2020Good article nomineeListed
December 30, 2020Featured article candidatePromoted
Current status: Featured article

Some notes[edit]

Preliminary notes from SG

Complete citations
This is linking to a 2 April 2019 press release ... fix date, check for updates, use cite press release rather than cite web ... ??
Listed separately, but linking to the same page ?checkY Out with the old. In with the new!

Ajpolino, that is all for now;[1] have not read article, pls ping me as you get closer to FAC and I will do a prose review. Not a fan of the word “just” as it is a value judgment ... unless sources use it. SandyGeorgia (Talk) 18:31, 6 July 2020 (UTC)[reply]

Lead says:

Body says:

SandyGeorgia (Talk) 11:44, 8 July 2020 (UTC)[reply]

 Done Resolved (for any interested, the discrepancy is because there is apparently one reported case of human-to-human transmission, thereby complicating our prose for all time). Ajpolino (talk) 15:16, 21 October 2020 (UTC)[reply]

Lead says 2,000 cases, but infobox and body mention 2 to 5. SandyGeorgia (Talk) 11:46, 8 July 2020 (UTC)[reply]

 Done I think I've brought all the estimates to 3,000 to 5,000 (the true case count is probably much higher, but I haven't seen anyone dare estimate how much higher). Ajpolino (talk) 15:16, 21 October 2020 (UTC)[reply]

See top of User:SandyGeorgia for links on however, subsequently, consequently and other prose redundancies. SandyGeorgia (Talk) 11:59, 8 July 2020 (UTC)[reply]

Society and culture section needed

Etcetera SandyGeorgia (Talk) 01:19, 9 July 2020 (UTC)[reply]

WhatamIdoing will inquire about In pregnancy ... several journal articles describe treatment issues.SandyGeorgia (Talk) 01:22, 9 July 2020 (UTC)[reply]

Just a quick note to say thank you for the comments so far! I hope to have some time to start working on them this weekend or next week. Much appreciated. Ajpolino (talk) 17:48, 9 July 2020 (UTC)[reply]
You might be able to tell that I can barely contain my excitement at seeing two medical articles prepping for FAC! SandyGeorgia (Talk) 18:21, 9 July 2020 (UTC)[reply]

I don't speak HarvRef, but my gadget is reporting an error here:

SandyGeorgia (Talk) 18:23, 5 September 2020 (UTC)[reply]

Fixed! Now that Spicy's FAC is wrapping up, I'm coming back around to this. Taking a look back through each section to see if I can add anything and improve my wording. Once I finish this pass I'll be knocking on your door looking for help with the prose. Lucid writing is not my specialty (yet, anyway). Thanks in advance! Ajpolino (talk) 22:22, 5 September 2020 (UTC)[reply]
I have to write up a FAC oppose that I am dreading because it will take days ... then I can turn my attention back to here. If I forget, bug me on my talk when you are ready ... SandyGeorgia (Talk) 13:57, 21 September 2020 (UTC)[reply]

I noticed there is not much info on social and psychological effects of the disease - [5] looks like it could be a good source for this. [6] this may be useful as well. Spicy (talk) 13:40, 21 September 2020 (UTC)[reply]

Ajpolino, are you back at it ? Don't forget to follow the Spicy trail! SandyGeorgia (Talk) 22:11, 13 October 2020 (UTC)[reply]

After a (too) long break, I'm back! Forgive the chaos above, I may start striking through the items I've completed. Still on my to-do list: add info on treating pregnant women as well as society & culture (including stigma). I suspect I'll need lots of help cleaning up my prose and pointing out spots where info is missing. It is, after all, my first rodeo. Ajpolino (talk) 23:02, 13 October 2020 (UTC)[reply]
Let me know when you're done with the list. Then I'll check stylistic stuff. Then we call in more WPMED types for a med review. And finally I will bring in some non-med people for a jargon/accessibility check. Don't worry too much about prose at this stage; others can fix it (although I doubt many fixes will be needed; Spicy has remarkable clarity of prose. Here we go! (The final coup de grace is that you must bring in Tim V for a check :) SandyGeorgia (Talk) 23:20, 13 October 2020 (UTC)[reply]
Ok, finally got a chance to look for treatment during pregnancy and came up mostly empty-handed. I found a case report where folks decided to wait until the baby was delivered, then start treatment. Now that the treatment has changed to rifampicin and clarithromycin, I can't find any mention of pregnancy. Not being a physician, I'm not 100% certain of this. But from a quick Google it looks like pregnant women can safely take both drugs? If anyone watching this page knows different, please let me know. As we go through article improvements, I'll keep an eye out for any other info.
Also with that, I think my ability to see the problems with the article have reached a block. Whenever you've got the time to read it over, I'd be happy to hear your thoughts. Ajpolino (talk) 01:30, 31 October 2020 (UTC)[reply]
I will look in tomorrow, and then call in Colin, Graham, Spicy, Cas, WAID ... then Ceoil when med editors are done... unless they are watching already. SandyGeorgia (Talk) 01:36, 31 October 2020 (UTC)[reply]
I'm watching... I'll try to take a look either later tonight or tomorrow. Spicy (talk) 01:40, 31 October 2020 (UTC)[reply]

Random thoughts from Spicy

Some thoughts while skimming, feel free to disagree with my nitpicking... Thank you! Leaving comments inline so I can keep track a bit better. I hope red doesn't come off as hostile. Just wanted a color that stood out...

More to come... Spicy (talk) 02:44, 31 October 2020 (UTC)[reply]

Forgive my nitpicking. This is a very clearly written and informative article. Spicy (talk) 04:57, 31 October 2020 (UTC)[reply]

Nitpickery is exactly what I'm looking for (though if you see large glaring issues, I'm happy to hear that too)! Thank you very much for the quick response! Will get to these ASAP. Halloween seems like a great day to think about mysterious gaping wounds that will not heal. Ajpolino (talk) 18:11, 31 October 2020 (UTC)[reply]

Pre-FAC notes from SandyGeorgia

That's it ... a whole lot of this is trivial. I won't ping in anyone else until you've had time to deal with comments from Spicy and me. Or would you prefer to put a call at WT:MED yourself? If so, remember to ping Casliber, Graham Beards, Colin, Jfdwolff, WhatamIdoing ... anyone else familiar with FA standards? Once all the med people are through, there are several non-med editors I can ping in for a non-med jargon review before you head to FAC. Bst, SandyGeorgia (Talk) 17:39, 31 October 2020 (UTC)[reply]

Images

I hadn't thought much about the images as I was working on the text. Now that I do, I'm not sure I've picked a batch that represent the disease well. Today I added images of early signs (lumps and bumps) and images of ulcers. My question for both of you (and anyone else watching)... have I overdone it? Since the pre-ulcer and ulcer can have many different forms, I'd like to illustrate that. But I get that it's not Wikipicturebooks. Thoughts? Ajpolino (talk) 21:55, 1 November 2020 (UTC)[reply]

Oh wait, I have an idea. Please hold. Ajpolino (talk) 21:56, 1 November 2020 (UTC)[reply]
Ok, how about that instead? I swapped the composite ulcer image into the lead, kicking out the ankle image. Is that better? Ajpolino (talk) 21:59, 1 November 2020 (UTC)[reply]
Yikes. Yep, that does the job. hard to believe it is not painful! SandyGeorgia (Talk) 22:20, 1 November 2020 (UTC)[reply]
Does it continue to be painless, once it reaches the open-ulcer stage?
@Ajpolino, another option for the images is to use a proper gallery. Compare-and-contrast uses are uncommon but officially allowed, and it would let you use larger images. WhatamIdoing (talk) 03:11, 11 November 2020 (UTC)[reply]
I'm not convinced this use would meet WP:GALLERY. But you can try to get it through FAC if you want ... but GALLERY is a policy page, not just a guideline. SandyGeorgia (Talk) 03:23, 11 November 2020 (UTC)[reply]
I think this fits under "A gallery section may be appropriate in some Wikipedia articles if a collection of images can illustrate aspects of a subject that cannot be easily or adequately described by text or individual images....avoiding similar or repetitive images, unless a point of contrast or comparison is being made." If this doesn't pass the 'letter of the law', then having a single collage image doesn't, either. WhatamIdoing (talk) 03:30, 11 November 2020 (UTC)[reply]
Good point ;) SandyGeorgia (Talk) 03:31, 11 November 2020 (UTC)[reply]
@WAID, unsettlingly enough, even the large open ulcers are painless. As an example, the leg ulcer in the lead collage is from this paper. The image caption notes On the picture, the lesion of a Nigerian 10 years old child on the right thigh and with the typical characteristic of a late stage of the disease: large painless ulceration with presence of necrosis and undermined edges.. As far as adding images, if the collages are ok, then I think I'm happy. If not, perhaps a gallery to show the different categories of ulcer and different early disease presentations would be appropriate. Ajpolino (talk) 04:02, 11 November 2020 (UTC)[reply]

Molecular biology, huh, what is it good for

Per the suggestions above, I tried several times to reword and clarify the part of the causes section with the molecular biology explanation for mycolactone's effect. After several unsuccessful attempts, I decided the problem may be that I'm writing for two totally different audiences there. I cut the molecular detail, since I suppose (agh! Pains me to say!) most people don't care. That said I care how mycolactone works. As an act of protest, I left the molecular explanation in a footnote. Eventually I plan to clean up the article mycolactone which would obviously hold a more detailed explanation. But... what do you think of this compromise? Better? Or am I just moving bad text around... Ajpolino (talk) 04:09, 9 November 2020 (UTC)[reply]

I don't think taking it out of the prose entirely is the right way to go. Some information on molecular biology seems warranted. People who are better writers than I might be able to give you some ideas on how to rephrase it... Spicy (talk) 17:28, 9 November 2020 (UTC)[reply]

Digging in (ps, I am useless on images and alt text):

What you had: [9]

How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin, mycolactone. As the bacteria grow, they release mycolactone, which diffuses into host cells and blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis. This results in tissue death at the site of infection, causing the open ulcer characteristic of the disease. At the same time, Sec61 inhibition prevents cells from signaling to activate the immune system, resulting in ulcers that lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils.

What is left: [10]

How M. ulcerans is transmitted to humans remains unclear, but somehow bacteria enter the skin and begin to grow. Ulceration is primarily caused by a bacterial toxin called mycolactone. As the bacteria grow, they release mycolactone into the tissue around them. Mycolactone enters host cells and prevents them from secreting proteins, eventually resulting in cell death.A Dead cells slough off, leaving the open wound characteristic of the disease. At the same time, mycolactone prevents dying cells from signaling to activate the immune system. As a result, Buruli ulcers tend to lack infiltrating immune cells. Immune cells that do make it to the ulcer are killed by mycolactone, and tissue examinations of the ulcer show a core of growing bacteria surrounded by debris from dead and dying neutrophils (the most common immune cell).
Note A Specifically, mycolactone blocks the action of Sec61, the core translocation protein that serves as the gateway to the endoplasmic reticulum. When Sec61 is blocked, proteins that would normally enter the endoplasmic reticulum are instead translated into the cytosol, causing a pathological stress response that results in cell death by apoptosis.

Several points:

In either case, I think we have to accept that sometimes not every one can get every section. Bst, SandyGeorgia (Talk) 17:49, 9 November 2020 (UTC)[reply]

Hmmm ok it seems I've over-corrected. Sorry for that; thanks both for the suggestions. I gave it another tweak, swapping out a few jargon words but mostly keeping it as it was before. Is it any easier to understand now? Ajpolino (talk) 01:26, 10 November 2020 (UTC)[reply]
I get the gist of it even though I have no idea what it is saying. This may be a sticking point at FAC, and you may just have to say that’s the best we can do. SandyGeorgia (Talk) 01:41, 10 November 2020 (UTC)[reply]
I'm not convinced it's an unfixably complex idea. I may just be too close to it to see clearer ways of expressing it. If you'll permit me a somewhat long and rambly explanation, perhaps we'll be on the same page and you (or someone) will think of a better way to phrase things?
Basically, cells communicate by secreting proteins into the area around them. Different proteins need to be secreted at different times and to different destinations, so it's all a logistics/sorting problem for the cell. To deal with this sorting problem our cells have developed a charming group of organelles that we collectively call the "secretory system". The first stop on the secretory system is the endoplasmic reticulum (affectionately, "the ER"). Proteins destined for secretion are produced (translated) directly into the ER. They then begin their merry journey through the secretory system, visiting the Golgi, various vesicles, and arriving at some destinations some time later. Sec61 is the doorway to the ER, and the target of mycolactone. Blocked Sec61 means no secreting proteins, which means no communicating with other cells (hence, no immune cells in the ulcers). Stuff that ought to go into the ER instead gets piled up outside it (in the cytosol). The accumulated junk makes the cell freak out and push the self-destruct button (apoptosis)... Put another way, if cells used the US Postal Service, the ER would be the blue box on the street corner (the Golgi would be the distribution center on the edge of town) and Sec61 would be the flap on the box that you push your mail through.
Either way, I'll keep thinking about it. All suggestions welcome. But if this is the best we can do, I suppose that's alright too. Thanks again for your time and suggestions Sandy and Spicy! Sorry I've been a bit slow to get to them! Ajpolino (talk) 02:04, 10 November 2020 (UTC)[reply]
All of that is what I get ... but I still don’t know what the endoplasmic reticulum is, in six words or less. SandyGeorgia (Talk) 02:08, 10 November 2020 (UTC)[reply]
PS, I see how fascinating the study of this stuff must be, but I don’t know how you sleep at night !! SandyGeorgia (Talk) 02:16, 10 November 2020 (UTC)[reply]
The endoplasmic reticulum is basically a tube that the protein/mail goes through on its way to its destination. A mid-century Pneumatic tube system might be a clearer analogy than a postal box on the street corner. You create the protein/mail and put what you made straight in the tubes. The system makes sure that your protein/mail gets routed to the correct destination. WhatamIdoing (talk) 03:26, 11 November 2020 (UTC)[reply]
We need a short parenthetical ... like six or eight words. SandyGeorgia (Talk) 03:28, 11 November 2020 (UTC)[reply]
Maybe something like "pathway for moving proteins out of the cell" would work. WhatamIdoing (talk) 03:32, 11 November 2020 (UTC)[reply]

Images 2

Nikkimaria this article is getting very close to FAC ready; when you have time, could I interest you in reviewing the images? Regards, SandyGeorgia (Talk) 18:14, 10 November 2020 (UTC)[reply]

The images are all appropriately licensed. However, I am concerned about the accessibility of File:Buruli_ulcer_cases_2018.svg - it's difficult to distinguish which country is meant to be what shade. Nikkimaria (talk) 22:28, 10 November 2020 (UTC)[reply]
Ajpolino, I think this can be addressed by simply adding the country names for each color grouping to the caption ... that allows visually impaired to get the information without seeing the colors. SandyGeorgia (Talk) 22:20, 11 November 2020 (UTC)[reply]
@Nikkimaria: Forgive me, I don't have a good eye for this kind of thing. Is this color scheme any better? Either way, I can add the country names to the caption as well (or to the alt-text? That would be unusually long alt-text; so, perhaps the caption is best after all?). Ajpolino (talk) 01:21, 15 November 2020 (UTC)[reply]
that's definitely better than it was, but I would suggest adding the data in the caption as well. Nikkimaria (talk) 01:23, 15 November 2020 (UTC)[reply]
Done. Thanks for taking the time to look through the images! Ajpolino (talk) 02:21, 15 November 2020 (UTC)[reply]

Semi-arbitrary break for reading ease

Hi all, thank you for the comments. I think I've addressed everything above? If there's something you're still waiting for me to respond to, or you wanted to follow-up on something, please let me know. Otherwise, I can try reaching out to a few others to get their opinions? I'm in no big rush here. Thanks again! Ajpolino (talk) 20:28, 16 November 2020 (UTC)[reply]

Ajpolino what would you think of me now calling in a non-medical FA regular and asking only for a brief, is it lay-reader-friendly-only review? Once that is done, I think you're ready ... we have overthought this one to death :) SandyGeorgia (Talk) 21:59, 16 November 2020 (UTC)[reply]
That would be great! Thank you. Ajpolino (talk) 22:00, 16 November 2020 (UTC)[reply]
Done ... and a reminder to you of all of the notes I gave Spicy for when you approach FAC. No "done" checkmarks. I know there's no chance of you being combative with reviewers :0 And remember that it is very hard to entice reviewers, so keep responses as brief as possible to avoid overwhelming the FAC, and be sure to put up a catchy introductory blurb that will entice others to read ... mention that you've had medical and non-medical review, as well as image review. As soon as you post the FAC, I will mention that I've checked that the sources are MEDRS-compliant, but have not done a copyvio check (and will make a joke that it's not needed since you work at CCI :) SandyGeorgia (Talk) 22:11, 16 November 2020 (UTC)[reply]

A layman's look

Okay, so these are liable to be a bit rough on the medical side, so please bear with me. I don't believe I've ever collaborated on a review with you before, so I'll go ahead and give a disclaimer that I tend to throw a lot of stuff out with an eye for discussion about smaller points, not that I'm trying to nitpick something to death.

Okay, so I think that's all I see. Hog Farm Bacon 03:05, 17 November 2020 (UTC)[reply]

@Hog Farm: Thank you very much for taking the time to read through. If you don't mind, I'll reply inline to your points above. If that seems messy for you, let me know and I'll happily refactor things back out. Ajpolino (talk) 04:22, 17 November 2020 (UTC)[reply]
Gave a first response to each. Happy to hear your further thoughts on any. Thank you again for taking the time. As an aside, I was thrilled to see your recent updates to Battle of Pilot Knob and Fort Davidson. My +1 and I were finally going to see Taum Sauk a few weeks ago and had to pull over in Pilot Knob when the dog lost his breakfast in the back seat. The park is quite nice. A lovely walk, a sobering monument, and a public trash can for disposing of dog vomit. Next trip I'll reach out to see if we can take any useful pictures for you. Ajpolino (talk) 05:47, 17 November 2020 (UTC)[reply]
Okay, so I really like the changes made. Personally, I'd support this at an FAC, but I also know little about the subject matter, and my vote probably wouldn't be weighted too heavily at FAC. As to Fort Davidson, I rewrote a good chunk of that late at night while quarantined, so the GAN has flagged an embarrassing number of issues. Hog Farm Bacon 17:05, 17 November 2020 (UTC)[reply]
Hog Farm , part of my devious plot to haul you in here where I usually call on Ceoil is to show more editors that they need not be scared off of reviewing medical FACs ... it wasn’t that bad after all ;) Thank you ever so much! SandyGeorgia (Talk) 17:09, 17 November 2020 (UTC)[reply]
Thank you Hog Farm. Your comments are much appreciated, and an outsider's view is always immensely valuable. Ajpolino (talk) 17:47, 17 November 2020 (UTC)[reply]

Editnotice[edit]

As this article has been promoted to FA (congratulations Ajpolino!) I've created the editnotice at Template:Editnotices/Page/Buruli ulcer. Spicy (talk) 07:48, 30 December 2020 (UTC)[reply]

You mean I woke up in the middle of the night for nothing? [11]. Thanks, Spicy, and congratulations to Ajpolino and all who helped! SandyGeorgia (Talk) 07:55, 30 December 2020 (UTC)[reply]
Well, I didn't know that page existed until now, so rest assured your work is not in vain... :p Spicy (talk) 08:00, 30 December 2020 (UTC)[reply]
Thank you both for your commentary and guidance. The article wouldn't have made it across the FAC line without you both. Here's to many more overhauled articles and trips to FAC. Cheers! Ajpolino (talk) 08:08, 30 December 2020 (UTC)[reply]

Rethink the caption or image about Albert R. Cook[edit]

So that image is so, so problematic -- in that it includes a white man, who (assuming) forced a bunch of youth to stand around him. It definitely profiles his very colonial, missionary relationship to the local community -- however the caption doesn't critically engage with those issues -- and its rather unexpected as you read the article, and reinforces a "white non-African saviour to the rescue" kindof narrative in the history section. Could there be some other way to illustrate or engage with that section? Is there really not any description of African or Australian indigenous medicine or story telling about the topic? That whole section feels off with the way the image is contextualizing. Sadads (talk) 12:33, 24 March 2021 (UTC)[reply]

Yes I'm not crazy about the image either. Besides looking like it should be a hit on Google Images for "Colonialism", I don't think it's particularly informative to a reader. As far as replacements, Commons has this similar and just slightly less problematic image. But after a brief search, I haven't come up with anything too clever to take its place. Cook's original notes are digitized, but none of his sketches is particularly clear. I'd prefer an image that relates to the WHO Global Buruli Ulcer Initiative, but haven't found anything visually interesting. We could just chop this image, and instead add an image to "Research" (though then we might have two images of small mammals with ulcers). I had wanted to add this image which is appropriately licensed and shows a community health worker discussing BU in Benin, but couldn't decide where to slot it.
To your second question, there's almost certainly loads of indigenous medicine and story-telling on the topic, but sadly little of it has been catalogued. The first paragraph in the "Society and culture" section is basically all I could find. I tried to avoid having the text lionize white colonialists or disparage local understandings. If there's particular text that concerns you, I'm more than happy to address it. Ajpolino (talk) 15:07, 24 March 2021 (UTC)[reply]
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