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6,200 |
12 Intersectionality, Structural Vulnerability, and Access to Sexual and Reproductive Health Services: Filipina Domestic Workers in Hong Kong, Singapore, and Qatar
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In this chapter the experiences of Filipina domestic workers in Hong Kong, Singapore, and Qatar are examined in the framework of their structural vulnerability to health problems. The chapter shows how their poor state of Sexual and Reproductive Health (SRH) can be the outcome of a combination of forms of institutional discrimination that are interconnected and should be investigated in respect of: (a) the worth of their ‘identity’ (migrant, female, the work they do); (b) the distinct aspects of discourse on sexuality and normativity which specifically relate to their presence in the destination countries; and (c) ideational and material realities constraining their own agency in finding adequate care. The chapter shows how variations in the potential for access may be explained by the types and degree of their structural vulnerability regarding labour rights, their relationship with employers and migrants’ associations, and their personal SRH awareness–together with what emerges from cooperation between those government officials and civil society organizations who work with migrant domestic workers. Attentiveness to the particular combination of forms of institutional discrimination in a given cultural and institutional context, especially the ways in which the Sexual and Reproductive Health of Filipina domestic workers are linked to the ways in which labour migration are organized, should be helpful for effective SRH advocacy.
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6,201 |
Design and Study of Novel Peptide Inhibitors against the SARS-Coronavirus Spike Protein
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6,202 |
Lung Transplantation and Precision Medicine
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Lung transplantation is an accepted therapeutic option for end-stage lung diseases. Its history starts in the 1940s, initially hampered by early deaths due to perioperative problems and acute rejection. Improvement of surgical techniques and the introduction of immunosuppressive drugs resulted in longer survival. Chronic lung allograft dysfunction (CLAD), a new complication appeared and remains the most serious complication today. CLAD, the main reason why survival after lung transplantation is impaired compared to other solid-organ transplantations is characterized by a gradually increasing shortness of breath, reflected in a deterioration of pulmonary function status, respiratory insufficiency and possibly death.
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6,203 |
New Human Astroviruses
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The first human astrovirus was discovered in 1975 by Madeley and Cosgrove through visualization of viral particles in stool using electron microscopy. Over the course of the next ∼20 years, an additional seven serotypes of human astroviruses were discovered. In the last decade, new technological advances in microarrays and sequencing strategies enabled more sophisticated methods for detecting viruses in clinical and environmental specimens. These methods led to the discovery of many novel viruses from a variety of virus families. They also brought about a dramatic realization that more astroviruses can be found in humans than previously recognized. In fact, the number of astroviruses associated with humans has nearly doubled within the last few years. Furthermore, the discovery of novel astroviruses in human specimens revealed that there is more diversity amongst them than was assumed based on the high level of similarity between human astroviruses 1 and 8. This chapter will describe the discovery and early characterization of the five novel astroviruses initially identified in human stool samples in 2008 and 2009.
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6,204 |
Surface Disinfection
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The patient-care areas in a dental setting become contaminated with bacterial and viral pathogens during patient treatment. Incorporating standard precautions set forth by CDC and OSHA guidelines will reduce the risk of disease transmission. Contaminated environmental surfaces, including clinical contact and housekeeping surfaces, become a reservoir of infectious material with the potential to spread an infection to health-care personnel and patients. Transmission of pathogens can occur by direct or indirect contact of clinical contact surfaces and the hands of health-care personnel. Proper infection control protocol of these surfaces includes cleaning, disinfecting, and the use of barriers to prevent the spread of infectious pathogens. This chapter will provide an overview of the disinfection protocol of environmental surfaces in the dental setting. The topics include the various chemical formulations of hospital disinfectants and their proper use, as well as physical barriers that aim to reduce the degree of contamination in the dental treatment area thus decreasing the probability of cross-infection and disease transmission.
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6,205 |
Global Health Security: The WHO Response to Outbreaks Past and Future
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During the first years of the 21(st) century, concern about the threat of infectious diseases has rapidly escalated after three dramatic events: a bioterrorist attack, the emergence and international spread of a severe new disease, and the looming threat of an influenza pandemic.
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6,206 |
High-Risk Infections: Influence of Down-Regulation and Up-Regulation of Cough Using Airway Reflexes and Breathing Maneuvers
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Coughing is a watchdog of the lungs. It represents the most important airway defensive reflex and one of the main symptoms of respiratory disease. During coughing and sneezing, particles of mucus can be expelled for a distance of up to 9 m [1]. Various pathogens, if present, may therefore, infect nearby people and animals, contributing to massive dissemination of airborne infections. In addition to using various protective measures, down-regulation of coughing plays a substantial role in preventing dissemination of respiratory infections. For example, about 80 % of passengers on a 3-h airplane trip may be infected by the cough of an individual carrying the flu virus. These newly infected passengers then disseminate the viral infection at their destinations worldwide.
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6,207 |
Staff Uniforms and Uniform Policy
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Personnel in contact with patients or equipment and textiles should always use the hospital’s work attire. It includes anyone handling food, medicines, textile, waste or cleaning tools. By caring, treating, examining and transporting patients, there will be direct contact between own work clothes and the patient’s cloths/bedding or skin. The same is true when working with used patient equipment such as bedpans, toilet chairs, beds and other aids and working in patient rooms, toilets and bathrooms or when handling bedding and bandages, giving physiotherapy, etc. The work uniform is particularly exposed to organic matter and microbes, for example, in ambulances, in emergency services, in restless and anxious patients and children, during sampling and examination/treatment, etc. In acute wards, the staff is often exposed to splashes from patients, especially blood but also vomit, sputum, pus, faeces and urine. This chapter is focused on practical measures to prevent transmission of infections via contaminated staff uniforms.
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6,208 |
Was ist denn „Molekularbiologie“, bitteschön?
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In diesen Zeiten Molekularbiologie zu betreiben ist aufregend. Es bedeutet „Gentechnik“ und „Klonieren“ und hat etwas Göttliches. Beim einen Teil der Bevölkerung wird man, wenn man verrät, womit man seinen lieben langen Arbeitstag verbringt, grenzenlose Bewunderung hervorrufen, beim anderen grenzenlose Ablehnung — man sollte sich daher genauestens überlegen, mit wem man es gerade zu tun hat, bevor man den Mund aufmacht. Am besten, man erwähnt keiner der Gruppen gegenüber, mit wieviel Problemen und Frust man in Wahrheit täglich kämpft, weil der erste Teil dann desillusioniert wäre und der zweite, vielleicht zurecht, unweigerlich die Frage stellen würde: “Wozu machst du das dann überhaupt?”
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6,209 |
Lung
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Experiments with animals in the 1940 and 1950s demonstrated that lung transplantation was technically possible [33]. In 1963, Dr. James Hardy performed the first human lung transplantation. The recipient survived 18 days, ultimately succumbing to renal failure and malnutrition [58]. From 1963 through 1978, multiple attempts at lung transplantation failed because of rejection and complications at the bronchial anastomosis. In the 1980s, improvements in immunosuppression, especially the introduction of cyclosporin A, and enhanced surgical techniques led to renewed interest in organ transplantation. In 1981, a 45-year-old-woman received the first successful heart–lung transplantation for idiopathic pulmonary arterial hypertension (IPAH) [106]. She survived 5 years after the procedure. Two years later the first successful single lung transplantation for idiopathic pulmonary fibrosis (IPF) [128] was reported, and in 1986 the first double lung transplantation for emphysema [25] was performed.
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6,210 |
Fungal Infections
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The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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6,211 |
Infectious Diseases
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Pulmonary infections are caused by a wide range of pathogenic microorganisms, including bacteria, viruses, fungi, and parasites. The most common lung infections in immunocompetent hosts are caused by pyogenic bacteria (e.g., Streptococcus pneumoniae), common respiratory viruses, and mycoplasma. These infections are usually diagnosed by clinical and microbiologic studies, including cultures and serology tests. Lung biopsy is rarely used in these diagnoses. Patients with life-threatening pneumonia, especially those who are immunocompromised, are more likely to undergo lung biopsy to rule out unusual infections not easily diagnosed using conventional microbiologic methods and for which treatment strategies may be different. Pathogens more likely to be diagnosed using lung biopsy for which there are characteristic pathologic changes are highlighted in this chapter and listed in Table 4.1.
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6,212 |
An Infectious Disease Outbreak Simulator Based on the Cellular Automata Paradigm
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In this paper, we propose the use of Cellular Automata paradigm to simulate an infectious disease outbreak. The simulator facilitates the study of dynamics of epidemics of different infectious diseases, and has been applied to study the effects of spread vaccination and ring vaccination strategies. Fundamentally the simulator loosely simulates SIR (Susceptible Infected Removed) and SEIR (Susceptible Exposed Infected Removed). The Geo-spatial model with global interaction and our approach of global stochastic cellular automata are also discussed. The global stochastic cellular automata takes into account the demography, culture of a region. The simulator can be used to study the dynamics of disease epidemics over large geographic regions. We analyze the effects of distances and interaction on the spread of various diseases.
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6,213 |
Emerging Infectious Diseases
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Emerging infectious diseases (EIDs) including novel avian influenza viruses or even recently reported Zika virus (ZIKV) have drawn great attentions globally. The application of modern diagnostic technologies is expected to increase. Imaging plays a key role on diagnosis and prognosis assessment in patients with EID.
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6,214 |
Working Towards A Healthier Brunei
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Brunei Darussalam is a small equatorial country of 5,765 square kilometers that lies on the north-west coast of the island of Borneo. An affluent nation, its economy is based mostly on oil and gas. Brunei’s GDP per capita of US$50,117 places the country fifth highest on this index internationally (International Monetary Fund, 2010). The population of Brunei is about 398,000, with Malays, who are Muslims, forming the majority (just under 67% of the country’s people) (Prime Minister’s Office, 2008). The annual population growth rate is just over 2.0%; life expectancy is 75 years (Central Intelligence Agency, 2010).
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6,215 |
Post-Newborn: A New Concept of Period in Early Life
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Post-newborn infants refer to infants from >28 days to <100 days after birth. During this period, infants are still completely dependent on breast milk or/and formula milk for feeding. Up to now, the concept of post-newborn has not been mentioned in classic textbooks. With the development of perinatal medicine, mortality rate of diseases in neonates such as premature infants, asphyxia, infectious diseases have decreased significantly, and consequently, issues of the quality of life for these survivors have aroused widespread concerns. The post-newborn infants have some important characteristics differing from both newborn infants and infants after the period: (1) different fatal diseases and mortality rate; (2) the diseases inherited from newborn period requiring early and prompt treatments; (3) some peculiar diseases during this period requiring much attention; (4) either similar or different immune function; (5) rapid growth and uneven development of organ systems. Establishment of the new concept of post-newborn will further reveal the nature of life, reduce the mortality rate of infants, and improve the quality of life.
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6,216 |
Pneumonia
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Most patients suffering from community acquired pneumonia do not appear at a radiology department since diagnosis is made on a clinical basis. In severe or unclear situations, a chest X-ray is done and analysis is frequently done by interns. Radiologists frequently see those patients that suffer from recurrent, nosocomial pneumonia, or an additional predisposing disease. The appropriate investigational technique, frequently targeted differential diagnosis, and the special needs of these patients need to be understood by radiologists. Early detection of a focus of infection is the major goal in immunocompromised patients. As pneumonia is the most common focus, chest imaging is to be done at the beginning. The sensitivity of chest X-rays, especially in the supine position, is known to be low. Therefore the very sensitive high-resolution CT (HRCT) became the gold standard in neutropenic hosts and is widely replaced by thin-section multi-detector-row-CT (MDCT). Underlying diseases such as pulmonary embolism or bronchial carcinoma might also be depicted. Furthermore, the costs of CT are low in comparison to antibiotics. The infiltrate needs to be localised, so that a physician can utilise this information as a guidance for invasive procedures for further microbiological work-up. The radiological characterisation of infiltrates gives a first and rapid hint to differentiate between different sorts of infectious (typical bacterial, atypical bacterial, fungal) and non-infectious aetiologies. Follow-up investigations need careful interpretation according to disease and concomitant treatment. Temporary exclusion of infectious involvement of the lung with high accuracy is, besides of pneumonia management, a hot topic for clinicians.
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6,217 |
Precision Medicine in Critical Illness: Sepsis and Acute Respiratory Distress Syndrome
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Sepsis and the acute respiratory distress syndrome (ARDS) each cause substantial morbidity and mortality. In contrast to other lung diseases, the entire course of disease in these syndromes is measured in days to weeks rather than months to years, which raises unique challenges in achieving precision medicine. We review advances in sepsis and ARDS resulting from omics studies, including those involving genome-wide association, gene expression, targeted proteomics, and metabolomics approaches. We focus on promising evidence of biological subtypes in both sepsis and ARDS that consistently display high risk for death. In sepsis, a gene expression signature with dysregulated adaptive immune signaling has evidence for a differential response to systemic steroid therapy, whereas in ARDS, a hyperinflammatory pattern identified in plasma using targeted proteomics responded more favorably to randomized interventions including high positive end-expiratory pressure, volume conservative fluid therapy, and simvastatin therapy. These early examples suggest heterogeneous biology that may be challenging to detect by clinical factors alone and speak to the promise of a precision approach that targets the right treatment at the right time to the right patient.
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6,218 |
Viral Infection and Multiple Sclerosis
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6,219 |
Gastrointestinal Disorders
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A.Classification 1.Upper gastrointestinal (GI) bleeding is above the ligament of Treitz.2.Lower GI bleeding is below the ligament of Treitz.
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6,220 |
History of the Thermometer
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The temperature of the human body has been used as a diagnostic sign since the earliest days of clinical medicine. The earliest thermal instruments were developed during the sixteenth and seventeenth centuries. In 1665, it was suggested that the melting point of ice and the boiling point of water should be the standard. The most common scales today are the Fahrenheit, Centigrade, and the Kelvin scales. Since the earliest days of medicine, physicians have recognized that the human body can exhibit an abnormal rise in temperature, usually defined as fever, as an obvious symptom of illnesses. In 1868, Wunderlich established that the temperature in a healthy person is constant and that variation of temperature occurs in disease. The Allbutt thermometer was the first practical device to become commercially available. The technology has then improved to provide highly accurate devices, for example, thermal imaging; its use is still growing in medicine.
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6,221 |
Epidemiology and Etiology of Mesothelioma
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Unequivocally the history of mesothelioma parallels that of asbestos exposure. The estimation that the asbestos cancer epidemic will cause 10 million deaths past and present renders the need to reach urgently a global ban on asbestos an issue of highest priority, so that the asbestos cancer epidemic will not become more devastating and will not continue indefinitely.
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6,222 |
Extracorporeal Membrane Oxygenation
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Extracorporeal Membrane Oxygenation (ECMO) is a life-saving technology that uses partial heart and lung bypass for extended periods. It is not a therapeutic modality, but rather a supportive tool that provides suf-fi cient gas exchange and perfusion for patients with acute, reversible cardiac or respiratory failure. This affords the patient's cardiopulmonary system time to rest, sparing them from the deleterious effects of traumatic mechanical ventilation and perfusion impairment. The Extracorporeal Life Support Organization (ELSO) was formed in 1989 by a collaboration of physicians, nurses, perfusionists, and scientists with an interest in ECMO. The group provides an international registry that collects data from almost all ECMO centers in the United States and throughout the world. At the end of 2005, ELSO registered nearly 30,000 neonatal and pediatric patients treated with ECMO for a variety of cardiopulmonary disorders with an overall survival rate of 66%.
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6,223 |
Predicting Palmitoylation Sites Using a Regularised Bio-basis Function Neural Network
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Palmitoylation is one of the most important post-translational modifications involving molecular signalling activities. Two simple methods have been developed very recently for predicting palmitoylation sites, but the sensitivity (the prediction accuracy of palmitoylation sites) of both methods is low (< 65%). A regularised bio-basis function neural network is implemented in this paper aiming to improve the sensitivity. A set of protein sequences with experimentally determined palmitoylation sites are downloaded from NCBI for the study. The protein-oriented cross-validation strategy is used for proper model construction. The experiments show that the regularised bio-basis function neural network significantly outperforms the two existing methods as well as the support vector machine and the radial basis function neural network. Specifically the sensitivity has been significantly improved with a slightly improved specificity (the prediction accuracy of non-palmitoylation sites).
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6,224 |
Surveillance for Hepatitis C
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Hepatitis C is a global public health problem. Globally, an estimated 170 million persons (3 % of the world’s population) have been infected with the hepatitis C virus, and an estimated 350,000 persons die annually from complications of chronic hepatitis C. Furthermore, an increasing trend in hepatitis C mortality in the USA was observed over the last decade; in 2007, mortality associated with hepatitis C surpassed mortality associated with HIV. As the hepatitis C epidemic continues, it is increasingly important to accurately measure hepatitis C-related morbidity and mortality in order to inform public health programs and policies and prioritize and evaluate prevention efforts. This chapter provides an overview of hepatitis C surveillance and methods used in the USA with some examples from other countries.
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6,225 |
Epidemic Alert & Response Framework and Technology Based on Spreading Dynamics Simulation
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There have been many research works on epidemic spreading by mathematical or simulation methods. However, to make it practical as a decision support tool for policy maker, it should be combined with business operation of epidemic control. Thus, an alert and response framework covering outbreak detection, policy analysis and policy execution is proposed in this paper. Key technologies for such a framework at modeling, analysis and data collection aspects are discussed. Sensitivity analysis is proposed for model verification and confidence analysis. Critical point identification is another important topic for control policy making by network topology analysis. The importance and feasibility of these technologies are illustrated by the experiment on Beijing SARS (Severe Acute Respiratory Syndrome) data in 2003.
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6,226 |
Teilgebiete der Biomathematik und ihre Bezüge zur Menschheitsgeschichte
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Die Demographie befasst sich ganz allgemein mit der menschlichen Bevölkerung, ihrer Struktur und ihren Bewegungen. Kenngrößen, die in der Demographie häufig verwendet werden, sind z. B. die Geburten- und die Sterberate. Dabei ist natürlich darauf zu achten, dass diese Größen in unterschiedlichen Altersgruppen auch unterschiedlicheWerte annehmen. Ebenso wie die Fertilität, also die mittlere Anzahl an Nachkommen pro Zeiteinheit und Frau. Und nicht nur vom Alter, auch von der geographischen Lage hängen diese Größen und damit auch die durchschnittliche Lebenserwartung bzw. die Gesamtzahl an Nachkommen pro Jahrgang ab. So genannte Alterspyramiden, also Darstellungen der Bevölkerungsstruktur nach Altersklassen, sehen demnach in unterschiedlichen Teilen der Welt auch qualitativ sehr verschieden aus.
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6,227 |
Mathematical Models of Infectious Diseases in Livestock: Concepts and Application to the Spread of Highly Pathogenic Avian Influenza Virus Strain Type H5N1
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Animal health governance faces new challenges as the ecology of infectious livestock diseases is changing (Tomley and Shirley 2009). Environmental and climate changes, intensification of livestock production, modification in land-use and agricultural practices, globalization of human travel, the development of the trade of livestock and livestock products have created conditions for an increase in the emergence and re-emergence of infectious agents in the last decades (Weiss and McMichael 2004; Randolph and Rogers 2010; Jones et al. 2008; Gibbs 2005). The frequency of emergence of new highly pathogenic avian influenza viruses (HPAIV) has increased over the past 20 years, as well as the economic impact of associated outbreaks (Alexander and Brown 2009). Bluetongue virus serotypes have continuously increased their spatial distribution, specifically in a northern direction. Treatment-resistant strains, such as methicillin-resistant Staphylococcus aureus (MRSA), have appeared. Numerous infectious diseases such as foot-and-mouth disease (FMD) are endemic in many parts of the world, and may have a high impact on animal health and farmer livelihood. Moreover, they constrain the ability of affected countries to trade livestock and livestock-derived products. Production systems in developed countries are also vulnerable. For example, outbreaks of FMD in United Kingdom in 2001, classical swine fever in Holland in 1997/1998, and highly pathogenic avian influenza H7N7 in Holland in 2003 resulted in the loss of millions of animals, mainly as a result of culling of affected and exposed animals. Finally, infectious livestock diseases are a threat for public health: about 75% of human infectious agents that emerged in the last 25 years had an animal origin (King et al. 2006).
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6,228 |
Alignment-Free Z-Curve Genomic Cepstral Coefficients and Machine Learning for Classification of Viruses
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Accurate detection of pathogenic viruses has become highly imperative. This is because viral diseases constitute a huge threat to human health and wellbeing on a global scale. However, both traditional and recent techniques for viral detection suffer from various setbacks. In codicil, some of the existing alignment-free methods are also limited with respect to viral detection accuracy. In this paper, we present the development of an alignment-free, digital signal processing based method for pathogenic viral detection named Z-Curve Genomic Cesptral Coefficients (ZCGCC). To evaluate the method, ZCGCC were computed from twenty six pathogenic viral strains extracted from the ViPR corpus. Naïve Bayesian classifier, which is a popular machine learning method was experimentally trained and validated using the extracted ZCGCC and other alignment-free methods in the literature. Comparative results show that the proposed ZCGCC gives good accuracy (93.0385%) and improved performance to existing alignment-free methods.
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6,229 |
14 Intravasale infecties en sepsis
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Infecties in het hart en de bloedbaan worden intravasale of endovasculaire infecties genoemd. De circulatie van bloed door het hart is essentieel voor de aanvoer van zuurstof en voedingstoffen naar weefsel en organen en voor de afvoer van afvalstoffen.
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6,230 |
The Migrant Monsters of Multiculturalism in Andrew Currie’s Fido
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On June 9, 2008, the Canadian House of Commons passed an amendment to the Immigrant and Refugee Protection Act. Titled Bill C-50, the amendment shifts discretionary powers from Parliament to current and future immigration and citizenship ministers. Touted by the Conservative Party as an expedient remedy to the 900,000-applicant backlog and an estimated labour shortage of 300,000, Bill C- 50 raised immediate concerns within immigrant and activist communities (CBC News, 2008). Critics contend that the bill caters to the interests of Canadian employers and business lobbyists in its provision of “disposable” and inexpensive labour, while “family” and “refugee” applications may be deferred indefinitely and without recourse. In some ways, the changes under Bill C-50 are redolent of the Live-in Caregiver Program in Canada as well as the Bracero Program (1942-1964), Guest Worker legislation and H-2A initiatives in the US, all of which offered temporary visas to migrant workers but resembled what Gilbert Gonzalez calls “an imperialist schema of colonial labour” (2006, p. 2). Whereas government policies in North America continue to reduce migrants to economic figures, other conservative discourses depict migrants as self-identical foreigners who flood the economy with cheap labour, deplete welfare resources reserved for “native”citizens and present a possible threat of terror in the “post-9/11” era. If “the socalled invasion of immigrants is the exaggerated rhetoric” of political pundits, however, “the increase in global migration within and from Third World countries is real” (Bakan and Stasiulis, 1997b, p. 30).
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6,231 |
Surfattante polmonare
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La respirazione normale include circa 12 atti respiratori al minuto, ognuno dei quali di circa 0,500 l. Pertanto il volume di aria che transita nei polmoni al minuto (ventilazione minuto) è di circa: 12 × 0,500 = 6 l min. A sua volta, il volume inspirato è uguale all’incirca a quello espirato (volume corrente). Poiché, in tal caso, il flusso inspiratorio è uguale a − 0,5 l sec(−1) e quello espiratorio a + 0.5 l sec(−1), il flusso definitivo di un ciclo completo è pari a zero.
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6,232 |
Acronimi ed abbreviazioni
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“The patient went from the ER to the OR and then to the ICU”. Indubbiamente il lessico dei medici è ricco di abbreviazioni, tanto che gli operatori della sanità di lingua italiana e inglese adoperano perlomeno dieci abbreviazioni per minuto (questa è una statistica fatta in casa, per favore non citatela). Questa alta prevalenza ci ha spinto a considerare le abbreviazioni in medicina come una dilagante epidemia.
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6,233 |
Besmettingsbronnen
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Aan de GGD worden twee gevallen van hepatitis A (besmettelijke geelzucht) op een kinderdagverblijf gemeld. Al een maand eerder was via melding door het laboratorium een geval van hepatitis A bekend geworden in dezelfde woonwijk. In de dagen daarna kwamen nog meer meldingen binnen. Uiteindelijk raken binnen vier maanden 41 personen (23 kinderen en 18 adolescenten en volwassenen) besmet met het hepatitis A-virus. Het primaire geval betrof een driejarige peuter van Marokkaanse ouders die vóór zijn ziekte ongevaccineerd op vakantie naar Marokko was geweest en daar waarschijnlijk besmet was geraakt. Via het gezin werd hepatitis A op een kinderdagverblijf en een basisschool geïntroduceerd. Het voortduren van de epidemie wordt gestopt door gezinnen en kinderen op het kinderdagverblijf en de basisschool uit voorzorg te immuniseren tegen hepatitis A. Daarmee werd het optreden van nieuwe gevallen en het verder verspreiden van de infectieziekte voorkomen.
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6,234 |
Bakterielle Infektionen
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Vor der Einführung von Antibiotika führten schwere bakterielle Infektionen wie Sepsis, Diphtherie und Meningitis fast zwangsläufig zum Tod. Heute meist folgenlose Erkrankungen wie Typhus, Scharlach oder bakterielle Gelenksinfektionen führten zu Tod oder schweren Behinderungen. Gefahren gehen heute v.a. durch Resistenzentwicklungen gegen Antibiotika (z.B. bei der Tuberkulose) und durch mangelnde Impffreudigkeit (z. B. bei Diphtherie) aus. So sind bakterielle Infektionen weiterhin nicht zu verharmlosen.
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6,235 |
Profiling and Searching for RNA Pseudoknot Structures in Genomes
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We developed a new method that can profile and efficiently search for pseudoknot structures in noncoding RNA genes. It profiles interleaving stems in pseudoknot structures with independent Covariance Model (CM) components. The statistical alignment score for searching is obtained by combining the alignment scores from all CM components. Our experiments show that the model can achieve excellent accuracy on both random and biological data. The efficiency achieved by the method makes it possible to search for structures that contain pseudoknot in genomes of a variety of organisms.
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6,236 |
Longziekten
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In het eerste deel van dit hoofdstuk worden de ziektebeelden op het gebied van de longziekten op een beknopte, heldere wijze behandeld door een vakexpert, huisarts en apotheker; de beste combinatie om de klinische relevantie voor de huisartsenpraktijk te waarborgen. De volgorde van de paragrafen is alfabetisch. In het tweede deel volgt een bespreking van de belangrijkste verschijnselen/ klachten in de pulmonologie, die bij verschillende ziekten kunnen horen, zoals hemoptoë, hoesten, hyperventilatie, piepen, snurken.
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6,237 |
Viren mit einzelsträngigem RNA-Genom in Plusstrangorientierung
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Heute sind acht Virusfamilien bekannt, deren Vertreter eine einzelsträngige RNA in Plusstrangorientierung besitzen: Die Picornaviridae, Caliciviridae, Astroviridae und Hepeviren verfügen über Capside, die keine Hüllmembran aufweisen, wohingegen die Flaviviridae, Togaviridae, Arteriviridae und Coronaviridae durch membranumhüllte Partikel gekennzeichnet sind. Allen gemeinsam ist, dass sie ihre Genome als mRNA verwenden und davon ein oder mehrere Polyproteine synthetisieren, die im weiteren Verlauf durch virale oder auch zelluläre Proteasen in Einzelkomponenten gespalten werden. Die Viren verfügen über eine RNA-abhängige RNA-Polymerase, welche die Plusstrang-RNA sowie die als Zwischenprodukte der Replikation auftretenden Negativstränge übersetzt; dabei gehen die neuen genomischen RNA-Moleküle aus dem zweiten Transkriptionsschritt hervor. Die Einteilung in die unterschiedlichen Familien richtet sich nach Zahl, Größe, Lage und Orientierung der Virusgene auf der RNA, nach der Anzahl der unterschiedlichen Polyproteine, die während der Infektion synthetisiert werden, und nach dem Vorhandensein einer Hüllmembran als Teil der Virionen.
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6,238 |
Systemic consequences of intestinal inflammation
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6,239 |
Article 13 Entry and Clearance Regulations
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The laws and regulations of a contracting State as to the admission to or departure from its territory of passengers, crew or cargo of aircraft, such as regulations relating to entry, clearance, immigration, passports, customs, and quarantine shall be complied with by or on behalf of such passengers, crew or cargo upon entrance into or departure from, or while within the territory of that State.
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6,240 |
Pneumonia in the Pregnant Patient
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Community acquired pneumonia is a common illness, and pneumonia and influenza serve as the seventh leading cause of death in the United States. In the pregnant patient, pneumonia is the most common cause of fatal non-obstetric infection (1–3). Pneumonia can have adverse consequences for both the mother and her fetus, with certain infections (particularly viral and fungal) assuming greater virulence and mortality than in non-pregnant women of similar age (2, 3). Pneumonia is a relatively common cause of respiratory failure in pregnant patients, but in contrast to older studies, newer data suggest that not all pneumonias are more common or more serious in pregnant women than in other populations. However, because pneumonia can impact both the mother and fetus, it may lead to an increased likelihood of complicated preterm delivery, compared to pregnancies in which infection is absent. The pathogens responsible for community-acquired pneumonia (CAP) are similar in pregnant and non-pregnant patients, with Streptococcus pneumoniae, Hemophilus influenzae, Mycoplasma pneumoniae, Legionella spp., Chlamydophila pneumoniae, and influenza A accounting for the majority of cases (2–4). However, reduction in cell-mediated immunity associated with pregnancy (especially during the third trimester) places women at an increased risk of more severe forms of pneumonia and disseminated diseases from pathogens normally contained by this type of immune response, including herpes virus, influenza, varicella, and coccidioidomycosis (3, 5–7).
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Viral Infections in Hematopoietic Stem Cell Transplant Recipients
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Viral infections are important as causes of morbidity and mortality after allogeneic stem cell transplantation (SCT). Severe viral infections are more common after unrelated and mismatched donor SCT and in particular after haploidentical SCT. B-cell function and specific antibodies are the main defense mechanisms against infection with exogenous viruses, thus reducing the risk for reinfection in already seropositive individuals. On the other hand, T-cell function in particular cytotoxic T-cell function is the main mechanism for preventing severe viral disease and also for the control of viruses such as herpesviruses that can cause latency and thus reactivate in an immunocompromised individual. The immune defects in SCT-patients are frequently complex with defects in cytotoxic T-lymphocyte, helper T-lymphocyte, NK-cell, and B-lymphocyte functions. T-cell dysfunction is usually most important early after SCT while deficient B-cell reconstitution can remain for many years after SCT. Furthermore, since loss of specific antibodies occurs frequently over time after allogeneic SCT, this will also increase the risk for reinfections with previously encountered viruses such as measles or varicella-zoster virus (VZV) and allow reactivation of viruses controlled by antibodies such as hepatitis B virus (HBV) [1, 2].
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Plant Edible Vaccines: A Revolution in Vaccination
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Plants have been used as a source for many pharmaceutical since long. However, utilization of plant systems for production of edible vaccines has been a comparatively recent phenomenon. There are several potential advantages of plant derived vaccines over other conventional systems of vaccine production such as mammalian or avian cell culture. The cost of vaccines is one factor preventing further use of vaccination, leaving hundreds of thousands of children susceptible to preventable diseases. Especially for developing world this novel technique proved to be a boon for its low cost of production, convenient administration, easy storage and negligible chances of infection whereas the conventional system of vaccine production limits the applicability of vaccines in many parts of the world. These vaccines are prepared by introducing selected desired genes into plants and inducing these genetically modified plants to manufacture the encoded proteins. Transgenic plants may provide an ideal expression system, in which transgenic plant material can be fed directly as oral dose of recombinant vaccines. Expression of vaccines in plant tissue eliminates the risk of contamination with animal pathogen, provides a heat stable environment and enables oral delivery thus eliminating infection related hazards. Identification of transgenic material, containment of the transgenes and control of recombinant protein may be potential problems for large scale production of vaccines in plants. Factors like scaling up production as well as distribution and handling of transgenic plant material must comprise the future consideration in this field.
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Mechanisms of Hypersensitivity
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Allergic reactions to drugs are not always the result of the drug’s protein-binding capacity, biotransformation, or degradation. Mediator release may occur via cross-linking of cell-bound IgE by di-(multi-) valent free drug. Physiological and pharmacological effects of histamine are mediated through four receptors, H(1), H(2), H(3), and H(4.) The H(3) receptor has a regulatory role in the release of neurotransmitters such as serotonin and dopamine; the H(4) receptor exerts a chemotactic effect on several cell types associated with allergy and asthma. Cysteinyl leukotrienes and PAF are powerful mediators of anaphylaxis, asthma, and shock. Sphingosine-1-phosphate, elevated in the lungs of asthmatics, regulates pulmonary epithelium permeability and contributes to the pathogenesis of anaphylaxis. Urticaria is a heterogeneous disease with many subtypes. Both ACE inhibitors and angiotensin II receptor blockers may cause angioedema. Abacavir changes the shape of the HLA antigen-binding cleft producing an alteration in the repertoire of self-peptides that bind HLA-B*57:01 and a T cell response to self-proteins. Drug-induced delayed-type cutaneous hypersensitivity reactions are mediated by CD4+ and CD8+ CD3+ T cells in the dermis and epidermis. Granulysin appears to be a key molecule for keratinocyte killing in TEN/SJS. Drugs provide good examples of types II (immune hemolytic anemia, drug-induced thrombocytopenia) and III (serum sickness-like) hypersensitivities.
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A Comparative Analysis of Models for West Nile Virus
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This chapter describes the steps needed to formulate, analyze and apply epidemiological models to vector-borne diseases. Our models focus on West Nile (WN) virus, an emerging infectious disease in North America, first identified in Africa. We begin by introducing a minimalist model for WN dynamics to illustrate the processes of model formulation, analysis, and application. We then revisit the question of model formulation to examine how two major biological assumptions affect the model structure and therefore its predictions. Next, we briefly compare these different model structures in an introductory exercise of model parameterization, validation, and comparison. Finally, we address model applications in more detail with two examples of how the model output can usefully be connected to public health applications.
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6,245 |
Modernities, Sciences, and Democracy
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The “modern” in “modern science” is a relatively uninterrogated and untheorized concept within the sciences and in the philosophy, sociology, and history of science. This is so today at a time when other aspects of Western sciences have been fruitfully explored in critical and illuminating ways (see Christensen and Hansen, Chap. 13; and Skovsmose, Chap. 15). In particular, the exceptionalism and triumphalism characteristic of Western attitudes toward our sciences have been explicitly criticized and purportedly abandoned by many of the scholars working in science studies fields. By exceptionalism is meant the belief that Western sciences alone among all human knowledge systems are capable of grasping reality in its own terms—that these alone have the resources to escape the human tendency to project onto nature cultural assumptions, fears, and desires. By triumphalism is meant the assumption that the history of science consists of a history of achievements — that this history has no significant downsides. According to this view, Hiroshima, environmental destruction, the alienation of labour, escalating global militarism, the increasing gap between the “haves” and the ”have nots,” gender, race, and class inequalities — these and other undesirable social situations are all entirely consequences of social and political projects, to which the history of Western sciences makes no contribution. Such conventional Euro centric assumptions can no longer gather the support either in the West or elsewhere that they could once claim In recent decades a huge amount of literature on modernity has emerged from the social sciences and humanities. Stimulated by the massive shifts in local and global social formations during the last half of the Twentieth Century, and by the post-modern response to such changes, social theorists, literary and other cultural critics, and, especially, historians have debated the uneven and complex origins, nature, and desirable futures of modernity, modernization, and modernism. Such controversies about modernity are first and foremost about a culture's relation to its past and its possible futures. They arise as ways of asking what went wrong, and what needs to be corrected. The last half a century has witnessed the global decline and fall of belief in the unquestionably legitimate authority of the white, bourgeois, male. Contributing to the epistemological, economic, political, and cultural rubble left by his demise — or, at least, deflation — have been compelling and influential counter-histories of social relations between the races, classes, genders, and within colonial and imperial eras
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Development of Highly Active Titanium Oxide Photocatalysts Anchored on Silica Sheets and their Applications for Air Purification Systems
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The purpose of this study is to develop highly active titanium oxide photocatalysts that can be anchored onto a substrate. We have, thus, prepared a titanium oxide photocatalyst using a wet or dry process and the results of this study have led to the successful development of highly active rectangular column-structured titanium oxide photocatalysts, which can be anchored onto silica sheets. These highly active photocatalysts were then applied to develop an effective air purification system.
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6,247 |
Pregnancy-Associated Kidney Injury
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A 23-year-old G1P0000 without prior past medical history is 31 weeks pregnant with prenatal care presents with complaints of worsening leg and face swelling for the past 2 days now seeks care because of headache, diarrhea, nausea, and vomiting. On exam she is found to have a blood pressure of 120/86, edema, and brisk deep tendon reflexes. Laboratory testing revealed hemoglobin 11.3 g/dl, platelet count 141,000/μl white blood count 18,000/μl, creatinine 1.1 mg/dl, aspartate aminotransferases (AST) 65 U/l, lactate dehydrogenase (LDH) 400 U/l, total bilirubin 1.1 mg/dl, prothrombin time (PT) 14.7 s, ammonia of 90 mcg/dl, blood glucose 139 mg/dl, calcium 7.3 mg/dl, and uric acid of 6.0 mg/dl. The urinalysis demonstrated WBC’s 3–5/hpf, RBC’s 3–5/hpf—non-dysmorphic, renal tubular epithelial cells were seen and a urine protein to creatinine ratio of 2. One day after hospitalization the patient’s blood pressure was 145/87 with a similar blood pressure 6 h later.
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6,248 |
Pneumonien
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Pneumonien sind wichtige Verursacher kindlicher Morbidität und in den Entwicklungsländern eine führende Todesursache. Die ätiologische Diagnostik bakterieller Infektionen ist unbefriedigend, die therapeutischen Möglichkeiten bei viralen Pneumonien sehr beschränkt. Klare Möglichkeiten zur Differenzierung der einzelnen Pneumonien fehlen. Für die Behandlung ambulant erworbener Pneumonien orientiert man sich am besten an den zu erwartenden Erregern, die ein gewisse Altersabhängigkeit aufweisen. Amoxicillin und Makrolide stellen die besten, weil zielorientiertesten, Antibiotika für ambulante Pneumonien dar. Angesichts noch relativ günstiger Empfindlichkeitsverhältnisse in mitteleuropäischen Ländern ist nicht primär mit Therapieversagern zu rechnen. Besondere Probleme ergeben sich bei neonatalen Pneumonien sowie bei Pneumonien als Folge von Immunsuppression. Allergisch bedingte Pneumonien müssen gesondert untersucht werden.
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Alphabetisches Verzeichnis der Professoren
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Alphabetisches Verzeichnis der Professoren
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Ventilator-Associated Pneumonia
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Ventilator-associated pneumonia occurs in patients who have been intubated for at least 2–3 days with significant exposure to hospital-acquired organisms. Treatment should be initiated rapidly and cover Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumonia, and methicillin-resistant Staphylococcus aureus(MRSA). Within 72 h or with the availability of culture results, antibiotics should be narrowed. Active research is on-going to identify patients at risk for ventilator-associated complications and to minimize the likelihood of infection in these patients.
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6,251 |
Bioterrorismus, infektiologische Aspekte
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Infektionskrankheiten sind ständige Begleiter und gefürchtete Geißeln der Menschheit. Pest und Pocken versetzen als todbringende Seuchen die Menschen nicht erst seit dem Altertum in Schrecken (lat.: terror). Archaische Ängste und eine hohe Medienaufmerksamkeit sorgen mitunter bis in die Gegenwart noch für Panik und irrationale Reaktionen, wie die Massenflucht während eines ungewöhnlichen Lungenpestausbruchs in Surat im Herbst 1994 und daraus resultierende drastische Flug- und Handelsbeschränkungen mit Indien beweisen.
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6,252 |
Hong Kong Paradox: Appearance and Disappearance in Western Cinema
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This chapter investigates what I call “the paradox of appearance and disappearance of Hong Kong” in Western cinema over the past two decades. The city has in recent years appeared in a number of big-budget Hollywood productions (e.g. The Dark Knight, Transformers, Doctor Strange, Pacific Rim), attesting to its continuing visual and “exotic” appeal to Western audiences, reminding one of the role pre-handover Hong Kong played in the conception and design of Blade Runner. However, the real Hong Kong is often displaced in these films and supplanted by a recycled and stereotyped impression of the city’s skyline and urban landscape. The chapter looks at instances of Hong Kong being otherworlded and the implications for the Hong Kong identity in the global cinematic gaze.
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6,253 |
Pharmacogenomics of Viral Diseases
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Viral diseases are leading cause of deaths worldwide as WHO report suggests that hepatitis A virus (HAV) infects more than 80 % of the population of many developing countries. Viral hepatitis B (HBV) affects an estimated 360 million people, whereas hepatitis C affects 123 million people worldwide, and last but not least, at current, India has an HIV/AIDS population of approximately 2.4 million people and more than 30 million in whole world and now it has become a reason for 1.8 million death globally; thus, millions of people still struggle for their lives. The progress in medical science has made it possible in overcoming the various fatal diseases such as small pox, chicken pox, dengue, etc., but human immunodeficiency viruses, influenza, and hepatitis virus have renewed challenge surprisingly. The obstacles and challenges in therapy include existence of antibiotic resistance strains of common organisms due to overuse of antibiotics, lack of vaccines, adverse drug reaction, and last but not least the susceptibility concerns. Emergence of pharmacogenomics and pharmacogenetics has shown some promises to take challenges. The discovery of human genome project has opened new vistas to understand the behaviors of genetic makeup in development and progression of diseases and treatment in various viral diseases. Current and previous decade have been engaged in making repositories of polymorphisms (SNPs) of various genes including drug-metabolizing enzymes, receptors, inflammatory cells related with immunity, and antigen-presenting cells, along with the prediction of risks. The genetic makeup alone is most likely an adequate way to handle the therapeutic decision-making process for previous regimen failure. With the introduction of new antiviral therapeutic agents, a significant improvement in progression and overall survival has been achieved, but these drugs have shown several adverse responses in some individuals, so the success is not up to the expectations. Research and acquisition of new knowledge of pharmacogenomics may help in overcoming the prevailing burden of viral diseases. So it will definitely help in selecting the most effective therapeutic agents, effective doses, and drug response for the individuals. Thus, it will be able to transform the laboratory research into the clinical bench side and will also help in understanding the pathogenesis of viral diseases with drug action, so the patients will be managed more properly and finally become able to fulfill the promise of the future.
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6,254 |
Pleura: Anatomy, Physiology, and Disorders
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Disorders of the pleura and pleural space reflect some of the oldest diseases encountered in surgical history. Hippocrates described the symptoms of empyema 2400 years ago: “Empyema may be recognized by the following symptoms: In the first place the fever is constant, less during the day and greater at night, and copious sweats supervene. There is a desire to cough and the patient expectorates nothing worth mentioning.” He also described an open drainage procedure: “When the fifteenth day after rupture has appeared, prepare a warm bath, set him upon a stool, which is not wobbly, someone should hold his hands, then shake him by the shoulders and listen to see on which side a noise is heard. And right at this place, preferably on the left, make an incision, then it produces death more rarely.”1,2 Beyond providing less-wobbly stools, few advances were made for more than 2000 years that allowed surgeons to routinely enter the pleural cavity, the fear being a potentially fatal pneumothorax. With the advent of positive pressure ventilation in the early 1900s, pneumothorax was no longer a prohibitive risk, and the era of surgical intervention in the pleural cavity had begun.3
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6,255 |
Human Immunodeficiency Virus Infection: Spectrum of Rheumatic Manifestations
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Emerging and reemerging viral infections have been a characteristic feature of the past several decades, with HIV infection being the most important example of an emergent viral infection. To date, the status of a considerable proportion of HIV/AIDS patients has changed from a near-fatal disorder secondary to opportunistic infections to a chronic disease in which a variety of co-morbid conditions have become prevalent and relevant. Arthralgia and myalgias are the most common symptoms. The rate of spondyloarthritis varies according to the geographic area, genetic and mode of transmission. Most RA and SLE patients might go into remission after the development of AIDS, but also there are patients that continue with active disease. Prevalence of DILS is highest among African Americans in less advanced stages. PAN is clinically less aggressive and peripheral neuropathy is the most common clinical manifestation. Anti-phospholipid syndrome (APS), systemic sclerosis and poly-dermatomyositis are uncommon. After the introduction of combination antiretroviral therapy (cART), a decline of spondyloarthritis disorders and of DILS and development of new syndromes such as IRIS, osteoporosis and avascular bone necrosis have occurred. The treatment of patients with rheumatic diseases and HIV infection remains a challenge.
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6,256 |
The Impact of ASEAN FTA: Regional Level Analysis
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, ASEAN India FTA and ASEAN Australia New Zealand FTA. These three considerations have significantly changed the major factors that affect FDI inflows in ASEAN region other than ASEAN FTA as such. Given its time-series framework, this chapter takes the founding members of ASEAN and in particular Indonesia, Malaysia, Thailand, and Philippines as the observation countries.
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6,257 |
Clinical Aspects and Principles of Management of Tuberculosis
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Tuberculosis over the ages, has killed more people than any other infection has. Notwithstanding the advances in modern science, clinical diagnosis sometimes remains elusive, owing principally to the frequent paucibacillary occurrence of the disease and the slow doubling time of the organism; empiric treatment is often fraught with risks in the era of increasing drug resistance. This chapter attempts to provide an overview of the disease, beginning with the pathogenesis and its protean clinical presentations. It also discusses the recent evolution of molecular methods that have lately provided an impetus to early diagnosis with a clear opportunity to unmask drug resistance before initiating “blind”, potentially ineffective, and sometimes harmful treatment with standard therapy. The chapter also provides insight into tuberculosis in special situations, and discusses briefly the treatments in uncomplicated cases as well as in special situations, and in instances of drug resistance. Preventive methods including current and upcoming vaccines are mentioned. Finally, a short discussion of the sequelae of tuberculosis—which have the potential to be confused with active disease—is presented.
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6,258 |
Chemokine Receptors in Allergic Lung Disease
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This chapter is an attempt to integrate recent studies concerning the role of chemokine receptors in the initiation, development, and maintenance of allergic lung diseases collectively referred to as asthma. The pathogenesis of asthma involves the coordinated trafficking of inflammatory cells to the lungs and draining lymph nodes, as well as the activation of these inflammatory cells. Chemokine receptors and their ligands play a prominent role in directing the inflammation associated with allergic lung disease. T lymphocyte-mediated immune responses can be broadly categorized as being type 1 or type 2, based on the cell types present and the associated cytokines produced. Allergic lung disease is a predominately type 2-mediated disease. The chemokine receptors CCR4, CCR6, and CCR8 serve to promote the recruitment of type 2 T (T helper 2; Th2) cells, whereas CXCR3 antagonizes type 2 and promotes type 1 T (T helper 1; Th1) cells. The pathophysiologic manifestations of asthma, including excessive mucus production, eosinophilia, and airway hyperreactivity, are dependent upon the trafficking and activation of eosinophils, mast cells, and goblet cells. Roles for chemokine receptors, including CCR4, CCR2, and CXCR4, in the trafficking and activation of these cell types during allergic lung disease are discussed. Finally, the incidence of allergic lung disease is increasing, and the costs associated with it are substantial. Chemokine receptor expression and use by inflammatory cells during allergic lung disease makes chemokine receptors an attractive therapeutic target. Implications for drug development are discussed in the context of experimental results.
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6,259 |
Challenges to the European Exception: What Can S&T Do?
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6,260 |
Geschichte der nosokomialen Pneumonie
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Nosokomiale Pneumonien sind ein Problem, das sich erst in der Folge des zivilisatorischen und medizinischen Fortschritts ergeben hat. Ihre Geschichte hängt eng zusammen mit der regelhaften Etablierung von Krankenhäusern und Intensivstationen sowie mit der Entwicklung der Beatmungsmedizin. In der Nachkriegszeit bis zum Ende der achtziger Jahre bildet sich die nosokomiale Pneumonie als Entität aus. Johanson Jr und seine Arbeitsgruppe legten den Grundstein in der Forschung der Pneumonie unter invasiver Beatmung (VAP). Jean-Yves Fagon und Jean Chastre sowie Antoni Torres gebührt das Verdienst, bis Anfang der neunziger Jahre auf der Basis der Arbeiten der Johanson-Gruppe neue und wichtige Impulse im Verständnis dieser Pneumonie-Entität sowie speziell hinsichtlich der Diagnostik gesetzt zu haben. Die Konsensus-Konferenz 1992 war ein Meilenstein der weiteren Entwicklung, indem sie zudem eine Reihe anderer Arbeitsgruppen zu methodisch komplexen Untersuchungen stimulieren konnte, deren Ertrag das Verständnis der nosokomialen Pneumonie heute noch prägt. Die Einführung der nichtinvasiven Beatmung auf der einen sowie der lungenprotektiven invasiven Beatmung auf der anderen Seite hat die Charakteristik der beatmeten Patienten grundlegend verändert. Eine hohe Aufmerksamkeit auf die Prävention der nosokomialen Pneumonie, bis hin zum Ziel der „Zero VAP“, sowie die Herausforderungen durch steigende Prävalenzen von multiresistenten Erregern prägen die Praxis und Forschungslandschaft der Gegenwart.
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Longziekten
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Deze aandoeningen, die soms met ‘verkoudheid’ of ‘griep’ betiteld worden, doen zich regelmatig – en vaak epidemisch – voor; bij kinderen (drie- tot viermaal per jaar) vaker dan bij volwassenen (een- tot tweemaal per jaar). Bij verkoudheid of griep is er vrijwel uitsluitend sprake van een virusinfectie. Slechts een deel van de verwekkers is bekend: influenzavirussen, para-influenzavirussen, adenovirussen en rinovirussen. Zo veroorzaken rinovirusinfecties vooral ontstekingsverschijnselen van het neusslijmvlies. Zij geven meestal weinig algemene ziekteverschijnselen. Adenovirusinfecties beginnen met keelpijn en neusirritatie en worden vaak vergezeld van bronchitis, terwijl koorts en algemene malaise als regel vanaf het begin aanwezig zijn. Infecties door influenzavirus uiten zich meestal door ernstige algemene symptomen (koorts, spierpijn, ‘doodziek’), terwijl lokale ziekteverschijnselen (keelpijn, hoest) op de achtergrond staan of zelfs achterwege kunnen blijven. Virale luchtweginfecties doen zich vooral voor in het najaar (vanaf september) en in het voorjaar (tot april). Zowel meteorologische (temperatuurwisselingen) als sociale (schoolgaan) omstandigheden lijken een rol te spelen.
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6,262 |
Influenza: Biology, Infection, and Control
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The growth of the human population has profoundly affected the global ecosystem, influencing the animal population balance, the availability of fresh water, arable land, biotic production, and atmospheric gases. The human ecological impact has significantly accelerated the evolutionary change of numerous organisms. For example, the production of human medicine and food has resulted in the rapid evolution of drug-resistant pathogenic organisms as well as plants and insects resistant to pesticides (Palumbi, 2001). Recently, the nutritional support of the human population has relied on the vast monoculture of domestic mammals and birds, which has facilitated the emergence of pathogenic enzootic organisms that infect both animals and humans. This chapter will focus on the global threat to human health represented by the highly contagious enzootic virus influenza. It will also discuss current efforts and future improvements to protect humans from global influenza epidemics and pandemics.
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6,263 |
Antimicrobials
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This chapter introduces the reader to the treatment of infections with antimicrobial drugs. In doing so, an ecological and evolutionary approach is taken that sees humans as just one part of the biosphere, which is the totality of life on earth. Our interaction with microorganisms is constant and ever changing, and it is this dynamic relationship between evolving organisms that makes the treatment of infectious diseases so challenging. Early in the chapter, this ecological approach is introduced, followed by the key to treating infectious diseases, which is the concept of selective toxicity. After that the key groups of organisms and their treatment are discussed, most notably bacteria, viruses and fungi, but also protozoa and helminths. More general topics of identification, testing and resistance are then discussed and before the chapter ends with consideration of opportunistic infections and pharmacological approaches to prevention.
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Hematology and Hemostasis
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6,265 |
Propinquity
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One defining attributes of the city is propinquity. Propinquity, defined as the state of physical proximity to another individual, can also develop into relational propinquity by design. Through environmental design, individuals who are brought close together in propinquity can be regarded as neighbors, while those outside this circle are usually marked as strangers. In turn, and at least by the ethics of proximity, how neighbors and strangers are treated is likely to be different. This difference is morally significant and impinges on any city with cosmopolitan aspirations. What then is an ethic of proximity that can commensurate with the cosmopolitan aspirations in cities today? This chapter then relies on the story of the Good Samaritan as an intuition pump to initiate thinking on this question.
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6,266 |
Drivers of Emerging Zoonotic Infectious Diseases
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This chapter discusses drivers of emerging infectious diseases (EID) of humans that have an origin in other vertebrate animals (zoonoses). This is a broad topic, worthy of a book in its own right. This chapter will therefore provide only an overview of key concepts of drivers of the emergence of zoonotic diseases, and particularly infectious diseases with a major disease burden in humans. As the authors mainly work in Asia, the focus of this chapter is Asia, but many of the lessons learned in this region are likely to apply elsewhere. More than 60 % of the world population live in Asia, a region with some of the fastest developing economies in the world. Yet, despite tremendous advances, infectious diseases still remain a major burden for the human population in Asia. Of the estimated 2.1 million deaths in children aged less than 5 years in Southeast Asia in 2010, 47 % are attributable to infectious causes (Liu et al., Lancet 379:2151–2161, 2012). As such, Asia is both vulnerable to imported EIDs and a global focus of major social and environmental change that may facilitate the emergence and dissemination of new pathogens. However, it would be too simplistic to present the extensive changes in Asia as inevitably increasing the risk of EIDs. Some aspects of socio-economic change might serve to reduce the overall risk of infectious disease emergence, but all ecosystem changes have the potential to provide new opportunities for microorganisms to spill-over into human populations.
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6,267 |
The flowering of the age of Biotechnology 1990–2000
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6,268 |
Surveillance and Epidemiology of Infectious Diseases using Spatial and Temporal Lustering Methods
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In the control of infectious diseases, epidemiologic information and useful clustering algorithms can be integrated to garner key indicators from huge amounts of daily surveillance information for the need of early intervention. This chapter first introduces the temporal, spatial and spatio-temporal clustering algorithms commonly used in surveillance systems–the key concepts behind the algorithms and the criteria for appropriate use. This description is followed by an introduction to different statistical methods that can be used to analyze the clustering patterns which occur in different epidemics and epidemic stages. Research methods such as flexible analysis of irregular spatial and temporal clusters, adjustment of personal risk factors, and Bayesian approaches to disease mapping and better prediction all will be needed to understand the epidemiologic characteristics of infectious diseases in the future.
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Arctic health problems and environmental challenges in Greenland
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6,270 |
Ethics and Terror Medicine
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The field of medicine has long been defined not only by diagnostic and treatment techniques but also by standards of behavior. The Hippocratic Oath was introduced about the same time as the concept of case histories and prognosis, in ancient Greece, fifth century BCE. Despite vast changes in medicine through the ages, the oath’s core message continues to resonate: that a physician has a special responsibility to perform honorably. Forms of the Hippocratic Oath are still recited during graduation ceremonies at medical schools, many in the United States, though the classical version has been altered to suit contemporary values.(1) For example, passages in the early oath that prohibited the practice of abortion or euthanasia now are commonly omitted. The shifting text is a reflection of attempts to accommodate medical ethics to new findings, experiences, and values.
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6,271 |
Oncologic Emergencies
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It has been estimated that genitourinary malignancies will account for 25% of new cancer diagnoses in the United States in 2005 (Jemal et al. 2005). While the incidence of many of these malignancies has increased over the past two decades, the mortality rates appear to be decreasing. Early cancer detection combined with improvements in surgical and nonsurgical oncologic therapy account for these trends. Although not common, newly diagnosed cancer patients occasionally present in an emergent, life-threatening manner that warrants immediate medical or surgical intervention. As the prevalence of genitourinary malignancies continues to expand, additional patients can be expected to develop disease or treatment-related complications. This chapter will serve to review the diagnosis and management of oncologic emergencies as they pertain to the urologist.
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6,272 |
Intergenerational Cities Embracing Diversity and Social Justice
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Concentration and diversity of people and activities are invaluable assets for cities, colorful beehives and schools for respecting difference and learning how to live in society. This chapter sheds light on the evolving social capital of cities and their capacity for intergenerational and intracity equity, social justice, and solidarity. Urban social capital is of increasing importance in cities that face new forms of poverty and exclusion, where more than three generations coexist, and immigrants come looking for better living and working conditions. Citizens can play a major role in shaping vital urban spaces and forging bonds out of degraded spaces and estranged relationships. Distressed urban areas, the backstage of urban dramas where underprivileged and excluded citizens come together, can be transformed into innovative neighborhoods and vibrant inclusive communities acting as extended families for the disadvantaged. The participation of youth and women in projects can further extend opportunities, and education is always the most decisive productive investment towards a skill-intensive economy.
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6,273 |
Pulmonary Complications of Malignancies and Blood and Marrow Transplantation
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Advances in childhood cancer therapies and blood and marrow transplantation (BMT) have dramatically improved survival in the past decade, with 5-year survival now approaching 85% (Australian Institute of Health and Welfare, Cancer in Australia: an overview 2014. Cancer series no 90 Cat no CAN 88 Canberra, AIHW2014). Pulmonary complications however remain an important cause of short- and long-term morbidity and mortality in childhood malignancies (Meyer et al., Pediatr Hematol Oncol 21(2):175–195, 2004; Jenney, Paediatr Respir Rev 1(3):279–286, 2000). The development of acute respiratory complications should prompt consideration of a wide range of differentials as appropriate management can be a major predictor of survival, especially in children undergoing BMT (Meyer et al., Pediatr Hematol Oncol 21(2):175–195, 2004; McCahon, Paediatr Respir Rev 7(3):191–196, 2006; Krowka et al., Chest 87(2):237–246, 1985). In childhood cancer survivors, permanent and late-onset respiratory dysfunction have been found in up to 45% of patients and continue to have important impacts on quality of life and premature mortality (Mertens et al., Cancer 95(11):2431–2441, 2002; Versluys and Bresters, Paediatr Respir Rev 17:63–70, 2015; Huang et al., Chest 140(4):881–901, 2011; Mulder et al., Thorax 66(12):1065–1071, 2011). This chapter provides an overview of respiratory complications of childhood cancer and BMT, with a focus on mechanisms of injury.
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6,274 |
Biomarkers of Pulmonary Diseases
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Lungs and airways are affected by several pathologies, the most important of which are inflammation, infection and cancer. Some of the biomarkers of these pathologies are similar to those found in involvement of other organs. This chapter will briefly discuss general issues of biomarkers of pulmonary disorders listed in Table 16.1. Biomarkers of lung cancer are described in Chapter 13.
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Elderly Transplant Recipients
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While the total number of organs transplanted in this country has increased over the years, there is still an ever-widening gap between the need for organs and our capacity to meet that need as the overall waiting list continues to grow. This is due in part to significant advances in transplant techniques and outcomes such that Americans with organ failure now seek transplants in greater numbers. Additionally, life-expectancy gains in the United States are creating an aging population who are more likely to suffer organ failure than younger Americans. The national transplant waiting list has continued to shift toward older candidates. The Scientific Registry of Transplant Recipients (SRTR) reported that at the end of 2007, 59.7% of all 97,248 candidates on the waiting list for all organs were 50 years old or older, and 14.9% were 65 years or older. These percentages are substantially higher than they were in 1998 (41.5 and 8.1%, respectively) [1].
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6,276 |
Tracheobronchitis in the Intensive Care Unit
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Tracheobronchitis can be broadly defined as inflammation of the airways between the larynx and the bronchioles. Clinically, this syndrome is recognized by an increase in the volume and purulence of the lower respiratory tract secretions and is frequently associated with signs of variable airflow obstruction. In the intensive care unit (ICU), tracheobronchitis is a relatively common problem with an incidence as high as 10.6% [1]. Although tracheobronchitis is associated with a significantly longer length of ICU stay and a prolonged need for mechanical ventilation, it has not been shown to increase mortality. These outcomes can be improved through the use of antimicrobial agents [1].
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6,277 |
Supply Chain Risk Management
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Recognizing various natural and man-made disasters have caused major supply chain disruptions over the last two decades, this chapter illustrates the vulnerability of many global supply chains and provides justifications for companies to develop a systemic approach to managing supply chain risks. Viewing supply chain risk management as comprising four steps—identifying risks, accessing risks, mitigating risks, and responding to risks—this chapter highlights the overall structure and key objectives of the book.
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6,278 |
Microarrays as Research Tools and Diagnostic Devices
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Molecular diagnostics comprises a main analytical division in clinical laboratory diagnostics. The analysis of RNA or DNA helps to diagnose infectious diseases and identify genetic determined disorders or even cancer. Starting from mono-parametric tests within the last years, technologies have evolved that allow for the detection of many parameters in parallel, e.g., by using multiplex nucleic acid amplification techniques, microarrays, or next-generation sequencing technologies. The introduction of closed-tube systems as well as lab-on-a-chip devices further resulted in a higher automation degree with a reduced contamination risk. These applications complement or even stepwise replace classical methods in clinical microbiology like virus cultures, resistance determination, microscopic and metabolic analyses, as well as biochemical or immunohistochemical assays. In addition, novel diagnostic markers appear, like noncoding RNAs and miRNAs providing additional room for novel biomarkers. This article provides an overview of microarrays as diagnostics devices and research tools. Introduced in 1995 for transcription analysis, microarrays are used today to detect several different biomolecules like DNA, RNA, miRNA, and proteins among others. Mainly used in research, some microarrays also found their way to clinical diagnostics. Further, closed lab-on-a-chip devices that use DNA microarrays as detection tools are discussed, and additionally, an outlook toward applications of next-generation sequencing tools in diagnostics will be given.
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6,279 |
New Emerging Risks
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In earlier chapters, mention has been made to some new emerging risks in the changing world of work. Here we give a short list of new risks (Section 5.1), combined with a description of strategies and methods on how to deal with those risks within the Risk Management and Risk Governance process, focussing on the “precautionary principle” (Section 5.2).
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6,280 |
Nodular Diseases
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6,281 |
Alveolar Diseases
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6,282 |
Neonatal Emergencies
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Newborns may present with vague signs and symptoms that result from a large variety of aetiologies.
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6,283 |
Antivirals: Past, Present and Future
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The uses of antiviral agents are increasing in the new era along with the development of vaccines for the effective control of viral diseases. The main aims of antiviral agents are to minimize harm to the host system and eradicate deadly viral diseases. However, the replications of viruses in host system represent a massive therapeutic challenge than bacteria and fungi. Antiviral drugs not just penetrate to disrupt the virus’ cellular divisions but also have a negative impact on normal physiological pathways in the host. Due to these issues, antiviral agents have a narrow therapeutic index than antibacterial drugs. Nephrotoxicity is the main adverse reaction of antiviral drugs in human and animals. In this chapter, we summarize the antiviral agents’ past, present and future perspectives with the main focus on the brief history of antiviral in animals, miscellaneous drugs, natural products, herbal and repurposing drugs.
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6,284 |
Explaining the Neolithic Demographic Transition
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Three main questions are raised in this chapter. 1. The part of the signal of the NDT which is demographically identifiable, based on the proportion of the immature skeletons in cemeteries, shows that a baby-boom occurred and, beyond that, with the onset of the change in the economic system, a fertility transition towards high values also occurred. What was the biodemographic cause of this fertility explosion, beyond the proxy variable represented by sedentarism? The cause is a major shift in the maternal energetics of farming communities relative to mobile foragers. In the energy balance there was (i) on the intake side, an underlying trend towards a reduction in low-calorie food from hunting and fishing, and a correlative increase in high-calorie food from agriculture, (ii) on the expenditure side, a reduction in the physical energy devoted to mobility and the maternal stress of child transportation. 2. The NDT is detectable from a signal representing a fertility transition, but the transition relating to mortality is missing and must be inferred. If, during the fertility transition, mortality had remained the same as in the preceding forager period, then the population would have grown infinitely. The assumption of unchanged mortality during the entire fertility transition is therefore not realistic. Mortality, in its turn, must have begun to rise well before the end of the fertility transition. But when? Why? One of the answers consists of a model where, except at the start of the process, birth and mortality rates rise more or less simultaneously, bringing about a typical rate of increase for pre-industrial populations of slightly above zero. 3. According to the level and speed of the population growth, what should we expect in terms of population structure? What are the expected effects of this growth, not only on the population in numbers but also on age distribution, the distribution and structure of families, the distribution of households and on family systems?
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6,285 |
Epidemic Dynamics Modeling and Analysis
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Disastrous epidemic such as SARS, H1N1, or smallpox released by some terrorists can significantly affect people’s life. The outbreak of infections in Europe in 2011 is another example. The infection, from a strain of Escherichia coli, can lead to kidney failure and death and is difficult to treat with antibiotics. A recent example of epidemic outbreak was the 2014–2015 Ebola pandemic in West Africa, which infected approximately 28,610 individuals and approximately 11,300 lives were lost in Guinea, Liberia, and Sierra Leone. It is now widely recognized that a large-scale epidemic diffusion can conceivably cause many deaths and more people of permanent sequela, which presents a severe challenge to the local or regional health-care systems.
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6,286 |
Introduction of Emerging Infectious Diseases
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Emerging infectious diseases (EIDs) refer to contagious diseases newly appeared, or with drug resistance, whose incidences have been rapidly increasing and are likely to further rise in the future. EIDs are usually discovered in three ways. Firstly, some existing diseases are ascertained as EIDs due to the recent discovery of pathogens. Secondly, previously considered noninfectious diseases are identified contagious as a result of new etiological findings. Thirdly, new infectious diseases are incurred by various complicated reasons such as evolution of pathogens. Due to their uncertainty and unpredictability, EIDs could result in high mortality and great impacts on social stability and economic development as people are unable to react immediately and take specific preventive or control measures. Therefore, EIDs have become a major public health problem worldwide. Cases in point are the epidemics of SARS in 2003 and H7N9 avian influenza around 2006, which have eloquently demonstrated their great threats to human health, society, and economy. In the coming twenty-first century, contagious diseases are expected to remain as a crucial public health concern for countries around the world.
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6,287 |
Advances in Lentiviral Vector-based Cell Therapy with Mesenchymal Stem Cells
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The field of possible application of mesenchymal stem cells in medicine and research expanded tremendously with the advent of improved Lentiviral-vectors capable of inserting stable copies of genes of interest and expressing proteins or biologically active RNA species ad libitum, performing delicate gene editing or active gene silencing or serving as advanced drug delivery systems utilized in ex vivo cell therapy. The combination of these two fields has created a number of new areas of research in the landscape of modern medicine which are now extensively studied and discussed here. These areas include tissue engineering, tissue repair, wound healing and tissue implants, anticancer therapies, angiogenesis, myocardial infarction and repair as well as understanding and treating acute lung damage and injury. In addition, genetically modified, tagged MSCs are being intensively deployed in research and therapeutic attempts of the various ailments of the central nervous system including Parkinson’s disease, Alzheimer’s disease, various phases of acute ischemia and trauma. The emergence of new and important data for type II diabetes research is being followed with treatment suggestions and studies of senescence to find novel applications for genetically engineered MSCs. We find in general that genetically modified MSCs are at the cusp of breaking through from basic research into the next phase of clinical trials.
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6,288 |
Disinfection Agents and Antiseptics
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Germicidal agents are nonspecific antimicrobial agents that are too toxic to be administered internally but are safe and effective when used topically. When applied to living tissue (e.g., the skin), they are termed antiseptics. When applied to inanimate objects (e.g., environmental surfaces or instruments used to perform medical procedures), they are termed disinfectants. All of these agents work at least by damaging microbial surfaces, often by alkylation, oxidation, or reaction with proteins. Products capable of destroying all forms of microbial life, including bacterial spores, are termed sterilizing agents.
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6,289 |
Pulmonary Infections – Pneumonia
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The different appearances of pneumonia such as ill-defined nodules, ground-glass opacities, and consolidations can be easily detected and differentiated with MRI. Since very small nodules and calcifications are extremely challenging due to rather thick slices and loss of signal, MRI is highly recommended as a follow-up tool, to avoid repetitive investigations using ionizing radiation. With the sensitivity of T2-weighted sequences and the potential of contrast-enhanced T1-weighted sequences important differential diagnostic considerations can be provided. Additionally, developing complications, such as pericardial or pleural effusions, empyema or lung abscess, are easily recognized. Current and future studies are to demonstrate that MRI is well suited as a monitoring and follow-up tool during and after therapy and compares favorably with CT or other imaging methods regarding sensitivity and specificity.
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6,290 |
'Hallo, ik ben June' maar niet aanraken
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6,291 |
Respiratory Infections
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Pneumonia is defined as the presence of a new pulmonary infiltrate on radiologic imaging in the patient with appropriate clinical symptoms such as fever, cough, production of purulent sputum, shortness of breath and/or hypoxia, in the absence of pulmonary edema [1, 2].
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6,292 |
Estimating Phylogenies from Molecular Data
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Phylogenetic estimation from aligned DNA, RNA or amino acid sequences has attracted more and more attention in recent years due to its importance in analysis of many fine-scale genetic data. Nowadays, its application fields range from medical research to drug discovery, to epidemiology, to systematics and population dynamics. Estimating phylogenies involves solving an optimization problem, called the phylogenetic estimation problem (PEP), whose versions depend on the criterion used to select a phylogeny among plausible alternatives. This chapter offers an overview of PEP and discuss the most important versions that occur in the literature.
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6,293 |
SARS (Schweres Akutes Respiratorisches Syndrom)
| null |
6,294 |
Protein Microarray Technologies for Detection and Identification of Bacterial and Protein Analytes
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Protein-based microarrays is a novel, rapidly evolving proteomic technology with great potential for analysis of complex biological samples. The technology will provide miniaturized set-ups enabling us to perform multiplexed profiling of minute amounts of biological samples in a highly specific, selective, and sensitive manner. In this review, we describe the potential and specific use of protein microarray technology, including both functional protein microarrays and affinity protein microarrays, for the detection and identification of bacteria, bacterial proteins as well as bacterial diseases. To date, the first generations of a variety of set-ups, ranging from small-scale focused biosensors to large-scale semi-dense array layouts for multiplex profiling have been designed. This work has clearly outlined the potential of the technology for a broad range of applications, such as serotyping of bacteria, detection of bacteria and/or toxins, and detection of tentative diagnostic biomarkers. The use of the protein microarray technology for detection and identification of bacterial and protein analytes is likely to increase significantly in the coming years.
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6,295 |
Infectieziekten
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In dit hoofdstuk wordt beoogd de belangrijkste nieuwe ontwikkelingen waarvan de huisarts moet kennisnemen, te bespreken. Voor specifieke therapie wordt verwezen naar hoofdstuk 25 Antimicrobiële therapie waaraan wij ook hebben bijgedragen.
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6,296 |
Foreign Aid and Humanitarian Assistance
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Together the US and EU provide two-thirds of global humanitarian assistance for the alleviation of emergencies arising from natural and man-made disasters and 80% of global foreign aid for longer-term development assistance programs. It is therefore vital that they continue their close partnership to ensure their dollars and euros are spent as effectively as possible in an era of increasingly tight budgetary constraints. The outbreak of Ebola in West Africa in 2014 is a good example of how the US and the EU successfully addressed (albeit belatedly) a major health crisis that could have turned into a global pandemic. In many areas in Africa, they are collaborating closely on the foundation of shared priorities, including on food security, resilience, and electrification. They are also among the largest donors to the Global Fund to fight HIV/AIDS, tuberculosis, and malaria and to the Global Alliance for Vaccines and Immunisation.
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6,297 |
Wireless Network Security Fundamentals
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6,298 |
General Infectious Disease Question and Answer Items
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An overview of the general pediatric infectious disease topics necessary for ward knowledge, clinical acumen in practice, and board examination preparation is presented in an easy-to-study question & answer format.
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6,299 |
3 Medische microbiologie
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De microbiologie is de wetenschap die zich bezighoudt met de bestudering van micro-organismen. Dit zijn kleine organismen die niet met het blote oog waarneembaar zijn. Micro-organismen zijn essentieel voor alle levensprocessen, ze zijn dan ook alom vertegenwoordigd op aarde. Zo spelen ze onder meer een belangrijke rol bij het vruchtbaar houden van de aardbodem, de recirculatie van afvalstoffen en de vorming van voedingsbronnen.
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