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6,400 |
The Role of the Environment and Colonization in Healthcare-Associated Infections
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Healthcare-associated infections (HAIs) can be caused by endogenous host microbial flora or by exogenous microbes, including those found in the hospital environment. Efforts to decrease endogenous pathogens via decolonization and skin antisepsis may decrease the risk of infection in some settings. Controlling the spread of potential pathogens from the environment requires meticulous attention to cleaning and disinfection practices. In addition to selection of the appropriate cleaning agent, use of tools that assess the adequacy of cleaning and addition of no-touch cleaning technology may decrease environmental contamination. Hand hygiene is also a critical component of preventing transmission of pathogens from the environment to patients via healthcare worker hands.
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6,401 |
Kryptosporidien
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Cryptosporidium parvum, Cryptosporidium hominis
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6,402 |
Pulmonary Vascular Disease
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The pulmonary vasculature is an anatomic compartment that is frequently overlooked in the histologic review of lung biopsy samples, other than those obtained specifically to assess pulmonary vascular disease.1 Though often of a nonspecific nature, the histologic pattern of vascular remodeling may at times suggest its underlying pathogenesis and provide clues to the cause of pulmonary hypertension.2 Disproportionately severe vascular pathology may further indicate alternate disease processes, such as congestive heart failure or thromboemboli, contributing to the patient’s overall respiratory condition.
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6,403 |
Primates, Pathogens, and Evolution: A Context for Understanding Emerging Disease
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The world is rife with potential pathogens. Of those that infect humans, it is estimated that roughly 20 % are of nonhuman primate origin. The same ease characterizes pathogen transmission in the other direction, from humans to nonhuman primates. This latter problem has increasingly serious ramifications for conservation efforts, as growing numbers of ecotourists and researchers serve as potential vectors of disease. Here, we present an analysis of major cross-species transmission events between human and nonhuman primates. In particular, we consider HIV and malaria as case studies in which nonhuman primate pathogens emerged and became permanent fixtures in human populations. The human practices that facilitate such events are considered, as well as the evolutionary consequences of these events. In addition, we describe human-to-nonhuman primate transmission events and discuss the potential of human pathogens to adapt to nonhuman primate hosts. The topic of emerging infections is addressed, in both human and nonhuman species, in light of changing patterns of contact and novel adaptations on the part of pathogens and hosts.
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6,404 |
Bengalisches Fieber
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Ein 43-jähriger in Deutschland lebender Bengale wird am Wochenende im Februar 2004 mit dem Rettungstransportdienst in die Notaufnahme des Krankenhauses gebracht. Seit 3 Tagen leidet er unter zunehmendem Husten, Auswurf, Luftnot, Fieber und atemabhängigen Thoraxschmerzen. Der Hausarzt hatte bereits Roxithromycin verordnet, hierunter verschlechterte sich die Luftnot jedoch weiter. Nach Angaben der Ehefrau war der Patient 14 Tage zuvor von einem mehrwöchigen Aufenthalt in Dhaka/Bangladesh mit einem Zwischenstop in Dubai/Vereinigte Arabische Emirate zurückgekommen.
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6,405 |
Kretafieber
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6,406 |
Imports, Exports and Foreign Businesses in Japan
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This chapter discusses imports, exports, and foreign firms’ investments in Japan. Imports to Japan total to about US$ 812 billion and exports from Japan total to about US$ 697 billion in the year of 2013. Japan consists of two economically vivid areas, Kanto consisting of Tokyo, Saitama, Kawasaki and Yokohama; and the Kansai area consisting of Osaka, Kyoto and Kobe. Both areas are discussed separately. It will be shown that Chinese trade has a bigger impact on Kansai than on Kanto area. In the next part, information about foreign affiliated firms doing business in Japan will be demonstrated by expanding on Japanese External Trade Organization data. Kansai will also be discussed separately here. At the end of the chapter, some examples of success stories will be given of foreign affiliated firms located in the Kansai region.
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6,407 |
Agent-Based Simulation Tools in Computational Epidemiology
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An agent-based approach is evaluated for its applicability as a new modeling technology in the emerging area of Computational Epidemiology, a research domain that attempts to synergistically unite the fields of Computer Science and Epidemiology. A primary concern of epidemiologists is investigating the spread of infectious diseases. Computer Scientists can provide powerful tools for epidemiologists to study such diseases. The existing simulation approaches available to epidemiologists are fast becoming obsolete, with data being stored in newer formats like GIS formats. There is an urgent need for developing computationally powerful, user-friendly tools that can be used by epidemiologists to study the dynamics of disease spread. We present a survey of the state-of-the-art in agent-based modeling and discuss the unique features of our chosen technique. Our agent-based approach effectively models the dynamics of the spread of infectious diseases in spatially-delineated environments by using agents to model the interaction between people and pathogens. We present preliminary results of modeling an actual tuberculosis disease outbreak in a local shelter. This model is an important step in the development of user-friendly tools for epidemiologists.
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6,408 |
Thorax
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■ The respiratory system (Fig. 16.1) arises as an out-pouching from the primitive lung bud at the 3rd week of embryonic life. Between the 6th and 16th weeks of gestation, rapid bronchial division beyond the subsegmental level occurs ■ Alveoli begin to develop at the 24th week of gestation by out-pouching, so that by 8 years of age the adult number of approximately 300 million alveoli is attained ■ Each lung is divided into 10 segments (Fig. 16.2). For certain localized lesions segmental and subsegmental resections rather than lobectomy should be performed ■ The pulmonary lymph nodes are located at points of division of segmental bronchi or at the bifurcations of the pulmonary artery. The hilar nodes are allocated along the main bronchi. The interlobar nodes are situated in the angles of the main bronchi into the lobar bronchi ■ The child’s thorax is more flexible than that of adults
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6,409 |
A History of Zoonoses and Sapronoses and Research into Them
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The history of these diseases and of their study is given in a brief chronological review of the most important events (important epidemics) and milestones of their study (relevant microbiological discoveries). In some historical data it is difficult to differentiate between the year of discovery and the year of its publication.
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6,410 |
Introduction to Drugs and Drug Targets
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This chapter lays out some formal definitions of a drug or medicine and introduces the concept of a drug target. It then describes the wide range of drug types that are being produced by the biopharmaceutical industry. These include orally available drugs, proteins, nucleic acids, vaccines and stem cells. Some background on all of these different types of molecule is provided to create a foundation for the remainder of the book.
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6,411 |
Using Geographic Information for Disease Surveillance at Mass Gatherings
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Mass gatherings present the medical community with an excellent window of opportunity to study infectious diseases that can be transmitted over long distances. This is because the venue of a mass gathering usually does not change year-to-year. As a result, special attention can be given to the public health risks that are introduced by travelers from around the world into these mass gatherings. Travelers can also be infected with diseases that are endemic in the host country and transport the locally acquired infectious diseases to their home environments. Therefore, mass gatherings can be thought of as global-to-local-to-global events because of the initial convergence of global populations and the subsequent divergence of populations throughout the world. This chapter discusses three active areas of geographic research that have emerged from our understanding of disease surveillance at mass gatherings: the role of transportation and population geographies in disease surveillance; the spatial and temporal dimensions of environmental geography in the spread of disease; and the advances in GIScience that provide real-world surveillance and monitoring of disease and injuries at mass gatherings.
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6,412 |
Molecular Differential Diagnoses of Infectious Diseases: Is the Future Now?
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The clinical presentations for most infectious agents are often not specific enough to allow for a definitive diagnosis. Coughing and fever, for example, are symptoms that may be caused by many different bacterial or viral infections. Thus, for better treatment and disease control, a molecular differential diagnostic (MDD) assay that can identify, differentiate, and pinpoint the offending pathogen associated with a clinical syndrome (Fig. 27.1) is needed. MDDs are essential tools for effective infectious disease surveillance, biodefense, and personalized medicine.
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6,413 |
No Lasting Stability
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In as much as the main reason for the establishment of the 1986 Public Health Enquiry was the identification of problems concerned with the control of communicable disease, it was important to ensure that its recommendations were being implemented. By a curious set of coincidences, I found myself almost immediately deeply involved in many of the activities flowing from the Government’s acceptance of the recommendations. Having indicated my intention to take premature retirement from Coventry Health Authority in 1990 in order to develop my teaching activities at Warwick University, where I had been a visiting senior lecturer in community medicine for 10 years, I found that the fact that I was immediately available for part-time work led to a number of interesting invitations from a variety of organisations all of which were focused on one or other aspect of implementing the Acheson recommendations.
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6,414 |
An Evaluation of Gene Set Analysis for Biomarker Discovery with Applications to Myeloma Research
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In this paper, we evaluate 15 methods for gene set analysis in microarray classification problems. We employ four datasets from myeloma research and three types of biological gene sets, encompassing a total of 12 scenarios. Taking a two-step approach, we first identify important genes within gene sets to create summary gene set scores, we then construct predictive models using the gene set scores as predictors. We propose two powerful linear methods in addition to the well-known SuperPC method for calculating scores. By comparing the 15 gene set methods with methods used in individual-gene analysis, we conclude that, overall, the gene set analysis approach provided more accurate predictions than the individual-gene analysis.
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6,415 |
15 Vlekjesziekten
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Infecties die met exantheem gepaard gaan, behoren tot de meest voorkomende ziekten op de kinderleeftijd. Historisch gezien worden deze ziekten onderverdeeld in de eerste tot en met de zesde ziekte, in de volgorde waarin ze zijn ontdekt. Zo is mazelen (morbilli) de ‘eerste ziekte’, roodvonk de ‘tweede ziekte’ en rodehond (rubella) de ‘derde ziekte’.
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6,416 |
Transition Feasibility and Implications for Stakeholders
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6,417 |
Interesting case histories
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No crisis is ever exactly the same as any other. There are always variations and different factors to be taken into consideration, even in incidents which appear to be identical. But much can be learned from case histories. The details of those which follow have been culled from published information or personal experience. Some have been selected as interesting examples of how a problem has been tackled or even exploited. Others have been chosen because, in the view of the author, they have been watersheds in establishing guiding principles in the way in which crises should be handled. Some of the content may even be hearsay, but this is felt to be important to convey the atmosphere at the time.
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6,418 |
Radiofrequency Biology: In vivo
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6,419 |
Viral Infections in ICU Patients
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6,420 |
Nonneoplastic Pleural Disease
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This chapter discusses the etiology, epidemiology, and laboratory features of pleural effusions, and the pathologic features of selected pleural diseases.
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6,421 |
Nosokomiale Pneumonie – Antibiotikatherapie und hygienische Interventionsstrategien
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Die Pneumonie ist auch in unserer Zeit eine schwere Infektionskrankheit. Sie ist eine der häufigsten infektiösen Todesursachen der westlichen Industrieländer und steht an 3. Stelle unter den Infektionskrankheiten. Jede 4. ärztlich diagnostizierte Pneumonie ist nosokomial erworben. Nosokomiale Pneumonien führen neben einer verlängerten Morbidität und erhöhten Letalität zu einer Verlängerung der Krankenhausverweildauer und zu erheblichen Kosten.
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6,422 |
Protein-protein interactions: analysis and prediction
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Proteins represent the tools and appliances of the cell — they assemble into larger structural elements, catalyze the biochemical reactions of metabolism, transmit signals, move cargo across membrane boundaries and carry out many other tasks. For most of these functions proteins cannot act in isolation but require close cooperation with other proteins to accomplish their task. Often, this collaborative action implies physical interaction of the proteins involved. Accordingly, experimental detection, in silico prediction and computational analysis of protein-protein interactions (PPI) have attracted great attention in the quest for discovering functional links among proteins and deciphering the complex networks of the cell.
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6,423 |
Aandoeningen van ademhalingsstelsel, mediastinum en thoraxwand
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Aet. Holtevorming in een ontstekingsproces dat met verettering gepaard gaat en dat o.a. ontstaat na bacteriële infecties (stafylokokken) eventueel in aansluiting op infecties met influenzavirus (grieppneumonie), bij patiënten met een geringe weerstand tegen infecties (klebsiellapneumonie), bij slechte mondhygiëne, na verslikken met aspiratie, bij verdrinking, verminderd bewustzijn, longinfarct en septische embolen, maar ook in een obstructiepneumonie achter een bronchusobstructie (bijv. bronchuscarcinoom of corpus alienum) of zonder bekende oorzaak. Geen voorkeurlokalisatie, behalve bij verslikken: dan in de dorsobasale segmenten, voornamelijk rechts.
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6,424 |
Management of Severe Malaria
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Imported malaria is the principal, preventable, life-threatening infection among US travelers. Using a case scenario, we discuss the most recent information on the management and treatment of Severe Malaria.
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6,425 |
Influenza, Measles, SARS, MERS, and Smallpox
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Influenza, measles, SARS, MERS, and smallpox illnesses are caused by highly infectious viral pathogens that induce critical illness. These biologically diverse viruses enter and replicate within host cells triggering viral- and host-mediated damage that results in pneumonia and multiorgan failure in severe cases. Early case identification and strict infection control limit healthcare transmission. Vaccination allowed smallpox eradication and limits global measles and seasonal influenza mortality. While SARS-coronavirus (CoV) is no longer circulating, MERS-CoV and zoonotic influenza viruses, with pandemic potential, remain persistent threats. Supportive critical care is the mainstay of treatment for severe disease due to these viral infections.
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6,426 |
Gold salts, D-penicillamine and allopurinol
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Gold salts have been used in the treatment of patients with rheumatoid arthritis since 1927 [1]. After a controlled study, the Empire Rheumatism Council [2], confirmed the effectiveness of gold salts for the treatment of rheumatoid arthritis. Even today, chrysotherapy has remained one of the major therapeutic modalities in the second line treatment of progressive rheumatoid arthritis. Gold salts are also used in the treatment of pemphigus vulgaris [3] and bronchial asthma [4]. Before the introduction of an orally administered gold compound, auranofin (triethylphosphine gold tetra-acetyl glycopyranoside), to clinical use [5-7], parenterally administered gold salts, such as sodium aurothiomalate and gold thioglucose comprised chrysotherapy. The frequency and severity of the side effects for patients treated with parenteral gold versus those given oral gold preparations are significantly different [8-10]. With introduction of newer parental DMARDs, toxicity has been reduced using combination therapy [10a, 10b].
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6,427 |
Afwijkingen van het respiratoire systeem
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Respiratoire afwijkingen komen zeer frequent voor als primaire aandoening of secundair aan een maligniteit, infectie of systeemziekte. Zoals voor veel inwendige aandoeningen geldt, is een goede anamnese en lichamelijk onderzoek onontbeerlijk bij de analyse van pulmonale aandoeningen. De eerste paragrafen van dit hoofdstuk zullen hier dieper op ingaan. Helaas zijn de klachten vaak weinig specifiek en noodzaken dikwijls tot verder beeldvormend onderzoek. De X-thorax is vaak het beginpunt van een dergelijk diagnostisch traject. In de latere paragrafen zullen specifieke bevindingen op de X-thorax verder worden uitgediept. In veel gevallen is naast laboratoriumonderzoek ook functieonderzoek en computertomografie van de thorax noodzakelijk om de differentiële diagnose verder te versmallen. Het verkrijgen van weefsel is bij interstitiële longaandoeningen, tuberculose en maligniteit vaak het sluitstuk van de diagnostiek. Nieuwe endoscopische echogeleide technieken komen steeds meer in de plaats van invasief onderzoek zoals mediastinoscopie of thoracotomie. Ook kan met behulp van PCR-technieken sneller en meer specifiek een juiste diagnose worden verkregen.
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6,428 |
Interview Marc Faber
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Marc Faber ist meistens anderer Meinung als die Mehrheit der Börsenexperten. Da der Schweizer erst über Risiken spricht, bevor er die Chancen an der Börse würdigt, wird er auch “Dr. Doom” genannt. Sein Börsenbrief, mit dem er die Anleger immer wieder konfrontiert, heißt “Gloom, Boom & Doom Report”. Mit 24 Jahren promovierte Faber im Fach Wirtschaftswissenschaft. Früh zog es ihn nach Asien. Faber erläutert die Grenzen von Börsenprognosen und bezeichnet die wachsende Börsenspekulation als gefährlich. „Sie ist ein Indiz vergangener Prosperität.“
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6,429 |
Hoofdstuk 3 Afwijkingen van het respiratoire systeem
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Onder dyspnoe wordt gewoonlijk verstaan de subjectieve beleving van een bemoeilijkte ademhaling. Dit ontstaat als er sprake is van een excessieve stimulatie van de respiratoire motoneuronen, vooral als deze toegenomen activiteit niet leidt tot een adequate toename van de ventilatie. Men spreekt van orthopnoe indien de kortademigheid toeneemt in liggende houding en van platypnoe indien deze in staande houding toeneemt.
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6,430 |
Avian Astroviruses
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Avian astroviruses comprise a diverse group of viruses affecting many avian species and causing enteritis, hepatitis, and nephritis. To date, six different astroviruses have been identified in avian species based on the species of origin and viral genome characteristics: two turkey-origin astroviruses [Turkey Astrovirus type 1 (TAstV-1) and type 2 (TAstV-2)]; two chicken-origin astroviruses [Avian Nephritis Virus (ANV) and Chicken Astrovirus (CAstV)]; and two duck-origin astrovirus [Duck Astrovirus type 1 (DAstV-1) and type 2 (DAstV-2)]. ANV has also been detected in turkeys, ducklings, pigeons, and guinea fowl; and TAstrovirus-2-like viruses have also been found in guinea fowl. Astroviruses are commonly associated with enteric disease syndromes in poultry including runting-stunting syndrome of broilers (RSS), poult enteritis complex or syndrome (PEC or PES), poult enteritis mortality syndrome (PEMS), and enteritis in guinea fowl. The molecular characterization of the different avian astroviruses shows great genetic variability among each type, and this variability influences the ability to detect these viruses by molecular and serological techniques. In this chapter, we review the different aspects related to avian astroviruses, including molecular biology, pathogenesis, diagnosis, and control.
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6,431 |
A Young Lady with AVN after SARS
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Section I consists of a total of 39 clinical cases ranging from the very common case scenarios orthopedic surgeons and generalists see literally every day in their clinics (like issues regarding glucosamine, knee osteo-arthritis, bone health, foot problems associated with the wearing of high heels) to the introduction of new emerging rehabilitation techniques and concepts. Examples include concepts of home-based rehabilitation, the use of smart materials now popular in the field of engineering applied to orthopedics, the response of our skeleton to hyper-gravity stimulation and to micro-gravity environments as in space travel. Orthopedic conditions in which rehabilitation can be very challenging like hamstring injuries will also be touched upon.
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6,432 |
Acronimi e 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 in generale e i cardiologi in particolare adoperano perlomeno dieci abbreviazioni per minuto (questa è una statistica fatta in casa, non citatela).
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6,433 |
Parsing NCBI XML in Perl
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6,434 |
Colchicine
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Colchicine is an alkaloid which was originally extracted from bulbs of a plant called Colchicum autumnale (meadow saffron). Its active pharmacological component was isolated in 1820 and in 1833 the active ingredient was purified and named colchicine. It consists of three hexameric rings termed A, B, and C. It was first recommended for the treatment of gout by Alexander of Tralles in the sixth century AD. Later it has been employed for suggested and approved indications including primary biliary cirrhosis (PBC), alcohol induced hepatitis, psoriasis, Behçet disease, Sweet syndrome, scleroderma, sarcoidosis and amyloidosis. Perhaps the most effective results have been obtained in the prophylaxis of familial Mediterranean fever (FMF). Colchicine is absorbed in the jejunum and ileum and is trapped in the body tissues. It is metabolized in the liver and the intestine by cytochrome P (CYP) 450 3A4 and P-glycoprotein (PGY) 1. Colchicine is excreted mainly by the biliary system, intestines and the kidneys. It has a narrow therapeutic range, but with normal liver and kidney functions is relatively safe and can be used during pregnancy, nursing and in infants. The main mechanism of action of colchicine is probably through interaction with microtubules affecting leukocyte chemotaxis, thereby suppressing inflammation. The blood level of colchicine may be affected by concomitant drug administration and therefore, caution should be exercised when such medications are added.
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6,435 |
Sinusitis in Multiple Sclerosis and Acinetobacter
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Previous studies have shown that the onset of multiple sclerosis had been associated with the presence of upper respiratory tract infections involving both viral and bacterial agents. The relevance of these reports requires further consideration.
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6,436 |
Gezondheid van de Nederlandse bevolking
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Na 1970: hernieuwde sterftedaling in Europa en Noord-Amerika: vierde fase van de epidemiologische transitie. Het tijdperk van delayed degenerativediseases, d.w.z. geen uitschakeling ziekten maar uitstel naar hogere leeftijden (zie paragraaf 3.2.1). Daling sterfte hart- en vaatziekten door afname roken, daling serumcholesterol, betere opsporing hypertensie, betere medische zorg. Daling verkeersongevallen door verkeersveiligheid (zie paragraaf 3.2.1). Ischemische hartziekte werd van managersziekte een 'volksziekte' (zie paragraaf 3.2.1). Terugkeer infectieziekten na 1970 door resistentie micro-organismen tegen antibiotica en nieuwe infectieziekten zoals hiv/aids, SARS (zie paragraaf 3.2.1). Levensverwachting Nederlanders neemt toe, maar minder snel dan andere Europese landen (zie paragraaf 3.2.1). In de twintigste eeuw vijf tot acht jaar winst in levensverwachting door verbeteringen gezondheidszorg (o.a. antibiotica, vaccinaties, combinatiechemotherapie, verbeteringen chirurgie) (zie paragraaf 3.2.2). infecties bovenste luchtwegen; nek- en rugklachten; acute urineweginfecties; privéongevallen; contacteczeem. nek- en rugklachten; contacteczeem; artrose; diabetes mellitus; coronaire hartziekten. Kwaliteit van leven: 11% van Nederlanders van 12 jaar en ouder heeft een of meer ernstige functionele beperkingen (zie paragraaf 3.3.1). Top-5 aandoeningen met grootste verlies kwaliteit van leven is ander rijtje dan top-5 aandoeningen met hoogste prevalentie. Angststoornissen en depressie staan hoog in rangorde want beperkt sociaal functioneren (zie paragraaf 3.3.1). Sterfte belangrijkste indicator volksgezondheid. Sterftegegevens betrouwbaar en registratie over het algemeen volledig (zie paragraaf 3.3.1). Door toename levensverwachting is het relatieve belang van sterfte als indicator volksgezondheid verminderd (zie paragraaf 3.3.1). Belangrijkste doodsoorzaken Nederland. Mannen: kanker. Vrouwen: hart- en vaatziekten (zie paragraaf 3.3.1). Levensverwachting wordt berekend met behulp van overlevingstafel en geboortecohort (zie paragraaf 3.3.1). gezonde levensverwachting; health-adjusted life expectancy; disability-adjusted life years (DALY's). : Anticonceptie en vruchtbaarheidsproblemen. Geboorteregeling in Nederland nagenoeg perfect. Keerzijde: uitstellen zwangerschappen. Perinatale sterfte en zuigelingensterfte. Sinds jaren tachtig verloopt daling in Nederland minder snel dan bijvoorbeeld Zweden en Finland, door o.a. meerlingzwangerschappen (door ivf), roken, allochtone herkomst zwangeren, verschillen in zorg. Barkerhypothese: groeivertraging foetus heeft langetermijngevolgen voor gezondheid. Foetale programmering: aanpassingen van metabole en endocriene systeem van foetus onder invloed van tekort aan voedingsstoffen zijn schadelijk op latere leven. Ongevallen, suïcide(poging) en geweld: ongevallen in de privésfeer zorgen voor meeste aantal gewonden en overledenen. Moord en doodslag in Nederland vrij zeldzaam. Alcoholgebruik speelt bij verschillende categorieën een rol (zie paragraaf 3.3.3). : Depressie. Prevalentie 5%. Kwetsbaarheid en uitlokkende factoren spelen rol. Schizofrenie. Prevalentie 7 gevallen per 1.000 personen. Openbaart zich vaak op jonge leeftijd, tussen 16 en 24 jaar. Combinatie kwetsbaarheid en omgevingsfactoren. Komt meer voor bij Marokkanen en Surinamers, waarschijnlijk door migratie-ervaringen en/of discriminatie. . Thuisloosheid: vaak oorzaak ernstige psychische problemen. : Ischemische hartziekte. Hoge incidentie komt o.a. door toegenomen welvaart en roken, hoge bloeddruk en hoog serumcholesterol. Beroerte. Een derde toe te schrijven aan verhoogde bloeddruk. Ook verhoogd serumcholesterol, roken, overmatig alcoholgebruik en lichamelijke activiteit. Westerse ziekte en gevolg van modern voedingspatroon (met veel zout). Kanker. Strijd tegen kanker geen succesverhaal. Vroegere opsporing, dus overlevingsverbetering is deels artificieel. Longkanker heeft hoogste sterfte. Huidkanker komt het meest voor. Borstkanker komt na longkanker het meest voor bij vrouwen. Bevolkingsonderzoek leidt tot verbetering opsporing en daling sterfte. : Vergrijzing. Beperkingen: chronische ziekten, mobiliteit, slechthorendheid, dementie. Ontwikkelingen van (gezonde) levensverwachtingen: meningen zijn verdeeld. Evolutiebiologen denken dat bovengrens misschien bereikt is. Euthanasie: vormt uiterste puntje op heel scala aan medische beslissingen rond levenseinde, zoals intensivering pijnbestrijding en palliatieve sedatie. Relatief risico (RR): de verhouding van de incidentie van een ziekte bij personen met en zonder blootstelling aan een bepaalde determinant (zie paragraaf 3.4.1). Populatieattributieve fractie (PAF): de proportie van de totale incidentie van een ziekte binnen de bevolking die toe te schrijven is aan de blootstelling aan een bepaalde determinant (zie paragraaf 3.4.1). Voor de berekening van PAF hoeft de incidentie van de ziekte niet bekend te zijn. Kan met behulp van RR. Voor formules voor berekening RR en PAF, zie paragraaf 3.4.1. : Infectieziekten. Omgekeerde samenhang tussen ernst infectie en besmettelijkheid. Verspreidingswegen. Meldingsplicht bij ziekten als bacillaire dysenterie, kinkhoest, legionellose, malaria en tuberculose. Maag-darminfecties. Voedselvergiftiging komt op grote schaal voor. Hepatitis. A: verspreiding langs fecaal-orale weg. B: via bloed en andere lichaamsvloeistoffen, C: via bloed en veel gezien onder hemofiliepatiënten. Vectorgebonden infectieziekten: Malaria (importziekte). Ziekte van Lyme (via tekenbeten, wel in Nederland). Klimaatverandering verhoogt risico's op vectorgebonden infectieziekten. Zoönosen: infectieziekten van dier op mens. Creutzfeldt-Jakob, hondsdolheid, ornithose/psittacose, Q-koorts, SARS, vogelgriep. Risico is vermoedelijk toegenomen door verstoring ecosystemen en klimaatverandering. Soa's: ook in Nederland neemt frequentie toe, vermoedelijk door toename onveilig vrijen. Komt ook door besef dat behandeling hiv/aids is verbeterd. : Omgevingstemperatuur: verhoging sterfte met hittegolven en koude wintermaanden. Vooral bij kwetsbare groepen. Lawaai. Op werk of thuis. Stress en slaapverstoring kan tot hoge bloeddruk leiden. Veel jongvolwassenen gehoorschade door popconcerten. Ultraviolette straling. Veroorzaakt huidkanker. Neemt erg toe laatste jaren door verandering gedrag bevolking en dunner worden ozonlaag. Chemische stoffen. Asbest, metalen, oplosmiddelen. Geen grote bron gezondheidsschade in Nederland. Luchtverontreiniging. 'Fijn stof' zorgt vermoedelijk voor flink aantal extra sterfgevallen, maar nog niet duidelijk waarop dat effect berust. EU-norm wordt in grote delen van Nederland overschreden. Klimaatverandering. Gevolgen grotendeels onbekend. . : Psychosociale stress. Life events en arbeidssituatie kan invloed hebben. Sociale steun heeft gunstig effect op psychosociale stress. Roken. Verhoogd risico hart- en vaatziekten, kanker en COPD. Tabakswet van 2002 is mijlpaal in antirookbeleid. Rokers in Nederland onder 30%. Middenmoter in Europa. Alcohol en drugs. Veel lichamelijke en psychische problemen en oorzaak huiselijk geweld en zinloos geweld. Comazuipen onder jongeren in Nederland probleem. Ecstasygebruik ook hoog. Voeding. Nederlanders eten te vet en te weinig fruit en groenten, wat risico hart- en vaatziekten vergroot. Lichaamsbeweging. Helpt beschermen tegen hart- en vaatziekten, diabetes, depressie, borst- en dikkedarmkanker. Helft van de Nederlanders beweegt te weinig. . Energiebalans en overgewicht. Obesitas in Nederland 11% onder volwassenen en neemt toe. : Genen versus omgeving en gedrag. Genen belangrijk bij gezondheid individuen, niet zozeer bij volksgezondheid. Genen en ziekte. Rol genetische factoren bij ontstaan ziekte varieert sterk. . Belang van preventie. Belangrijk om meer inzicht te krijgen in genetische determinanten van multifactoriële aandoeningen. Gezondheidsverschillen naar geslacht (zie paragraaf 3.5.1): vrouwen worden ouder maar groter aantal jaren met minder goede gezondheid. Gezondheidsverschillen naar burgerlijke staat (zie paragraaf 3.5.1): gehuwden leven langer. : Arbeidsmarktpositie. Werkenden gezonder dan werklozen en arbeidsongeschikten. Sociaaleconomisch. Mensen met een lagere sociaaleconomische positie zijn vaker ziek. : Regionale verschillen. Verstedelijkte gebieden en aantal regio's in noordoosten hogere sterfte- en ziektecijfers. Brabant en Limburg hebben achterstand. Urbanisatiegraad. In grote steden sterfte hoger. Komt door veranderde bevolkingssamenstelling (gezonde bewoners vertrekken naar elders), niet door slechte levensomstandigheden.
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6,437 |
Introduction to Efficiency and Competitiveness of International Airlines
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This chapter provides the background on the significance of an efficiency analysis of airline industry in terms of its performance, motivation, and main objectives. This introductory chapter reviews the market size and economic contributions of the aviation industry to the global economy and briefly discusses the key issues in the industry in recent decades. It also provides an outline of the research questions, methodologies used, and the structure of the chapters in this volume.
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6,438 |
Health Inequalities, General Trends in Mortality and Morbidity, and Associated Factors
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All measures of health status are ultimately derived from observations of individuals. At the field level we have such measures as self-assessed health status, report of a specific disease, record of a particular death, or an individual’s test on a biomarker, such as blood pressure or serum cholesterol. The observations for individuals are combined and summarized to represent subnational geographic areas, demographic or socioeconomic groups within countries, or national populations. The summary measures, whether they are percentages, averages, or rates, apply to groups. A problem arises when the measures that are based on groups are assumed to represent individuals. The analysis becomes especially problematic when the units analyzed are geographic areas and inferences are being made about individuals from the analysis for these geographic areas.
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6,439 |
Webgestützter Organisationsaufbau
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Junge Firmen oder neue Unternehmensbereiche müssen von Beginn an kosteneffizient arbeiten und problemlos wachsen können. Dies kann durch neue Internet-Tools maß geblich unterstützt werden, wenn sie beherrschbar und wirklich effizienzstiftend sind. Junge Teams haben dabei die Chance, die neuen Internet-Tools und die damit einhergehende, offene Kommunikation und Projektarbeit auch gleich in ihrer Arbeitskultur zu verankern.
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6,440 |
Cysteine/Glutathione Deficiency: A Significant and Treatable Corollary of Disease
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Glutathione (GSH) deficiency may play a pivotal role in a variety of apparently unrelated clinical conditions and diseases. Orally administered N-acetylcysteine (NAC), which replenishes the cysteine required for GSH synthesis, has been tested in a large number of randomized placebo-controlled trials involving these diseases and conditions. This chapter focused on developing a base of evidence suggesting that NAC administration improves disease by increasing cysteine and/or GSH in a variety of diseases, thereby implying a significant role for GSH deficiency in the clinical basis of many diseases. To develop this base of evidence, we systematically selected studies which considered the hypothesis that the therapeutic efficacy for NAC is an indication that cysteine and/or GSH deficiency is a pathophysiological part of the diseases studied. In this manner we focus this chapter on explaining the biological mechanisms of NAC therapy in a wide variety of disorders and demonstrate its ubiquitous role in improving disease that involves disrupted GSH and/or cysteine metabolism. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/978-981-10-5311-5_20) contains supplementary material, which is available to authorized users.
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6,441 |
Mapping and Modeling Disease Risk Among Mobile Populations
| null |
6,442 |
Die Gesellschaft Deutscher Neurologen und Psychiater im Zweiten Weltkrieg
|
Mit Beginn des Zweiten Weltkriegs kam es – als Folge der Einberufung wichtiger Protagonisten – zu einer deutlichen Beeinträchtigung der Organisationsstrukturen der Gesellschaft Deutscher Neurologen und Psychiater. Im Verlauf des Krieges lösten sich die formalen Strukturen weiter auf, während das informelle Netzwerk, das die Fachgesellschaft zusammenhielt, weitgehend intakt blieb und es an der Schnittstelle von Wissenschaft und Politik zu neuen Konstellationen und Kooperationen kam.
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6,443 |
Bronchiolitis
|
Bronchiolitis produces significant morbidity and mortality worldwide every year. Approximately 3–10 % of all infants hospitalized with bronchiolitis develop acute respiratory failure and require admission to a pediatric intensive care unit. The vast majority of cases are caused by Respiratory Syncytial Virus (RSV), though other viruses (human metapneumovirus, parainfluenza, influenza, adenovirus, rhinovirus, coronavirus and bocavirus) may also cause bronchiolitis. Bronchiolitis is not merely a single organ disease (i.e. lung), but impacts on extrapulmonary organ systems. Basic supportive management remains the cornerstone. There is a paucity of established therapeutic options, with supplementary oxygen, continuous positive airway pressure (CPAP), humidified high-flow nasal oxygen, mechanical ventilation being the mainstay of respiratory support.
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6,444 |
RNA Pseudoknot Folding through Inference and Identification Using TAG(RNA)
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Studying the structure of RNA sequences is an important problem that helps in understanding the functional properties of RNA. After being ignored for a long time due to the high computational complexity it requires, pseudoknot is one type of RNA structures that has been given a lot of attention lately. Pseudoknot structures have functional importance since they appear, for example, in viral genome RNAs and ribozyme active sites. In this paper, we present a folding framework, TAG(RNA)Inf, for RNA structures that support pseudoknots. Our approach is based on learning TAG(RNA) grammars from training data with structural information. The inferred grammars are used to indentify sequences with structures analogous to those in the training set and generate a folding for these sequences. We present experimental results and comparisons with other known pseudoknot folding approaches.
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6,445 |
Taxonomy, Physiology, and Ecology of Aquatic Microorganisms
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The principles behind the taxonomy of the microorganisms, especially the molecular approach (using the sequence of the 16S RNA in the small subunit of the ribosome) in the identification of bacteria, are discussed. The detailed taxonomy of bacteria, fungi, algae, protozoa, and viruses (including bacteriophages) is discussed, and emphasis is laid on those microorganisms which are aquatic. The chapter includes information on some of the smaller macroorganisms found in water such as nematodes and rotifers. The activities of aquatic microorganisms in photosynthesis, and the global cycling of nitrogen and sulfur is discussed.
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6,446 |
Health Research Behind Bars: A Brief Guide to Research in Jails and Prisons
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While most people make staying out of jail and prison a priority, a growing number of researchers are eager to get into correctional facilities in order to study the criminal justice system, the causes and consequences of incarceration, and the role of corrections in our society. For health researchers and their collaborators, the audience for this chapter, correctional facilities offer several unique advantages: a population at high risk of many health problems including infectious and chronic diseases, substance abuse, and mental health problems; social and physical environments that can enhance or impede well-being; a setting that is a focal point for the class, racial/ethnic, and gender differences that divide the United States; a site where health and mental health services and prevention programs are offered and can be evaluated; a controlled environment for administration of treatments such as directly observed therapy for tuberculosis; and a stopping point in the cycle of incarceration and reentry that so profoundly affects community well-being.
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6,447 |
Acronyms and Abbreviations
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“The patient went from the ER to the OR and then to the ICU.” It is an irrefutable fact that doctor’s speech is full of abbreviations. Health-care professionals in general and cardiologists in particular use many abbreviations. This high prevalence has led us to consider medical abbreviations as a challenging pandemic.
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6,448 |
Sickle Cell Disease
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Sickle cell disease is characterized by vaso-occlusive and hemolysis events that may occur in a variable range of clinical presentations. Patients with this disease, particularly with acute chest syndrome, suffer acute episodes of chest pain caused by vaso-occlusive crisis, that tend to repeat, especially under the influence of lower respiratory infections, dehydration, and any cause of hypoxemia. Children and adolescents with sickle cell disease must be periodically evaluated through oximetry, lung function tests, sleep study, and echocardiograms to detect obstructive and restrictive diseases that frequently worsens the lung condition. Asthma and sleep disorders contribute to morbidity and must be controlled.
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6,449 |
Anti-viral approaches against influenza viruses
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6,450 |
Management of the Rheumatoid Arthritis Patient with Interstitial Lung Disease
|
The treatment of rheumatoid arthritis (RA) has undergone considerable changes over the last 15–20 years. With an expansion in the armamentarium of therapies available for RA comes a wider choice in selecting the best treatment in terms of comparative safety in the presence of comorbidities. Clinicians frequently encounter patients with RA-associated interstitial lung disease with uncontrolled joint disease and have to make decisions about the safest treatments in this context with the eventual goal of joint remission. In this chapter, available evidence is reviewed on the comparative pulmonary safety of non-biologic disease-modifying antirheumatic drugs (nbDMARDs), biologic DMARDs, biosimilars and targeted synthetic DMARDs in RA-ILD. In addition, the potential role for additional immunosuppression in RA-ILD is reviewed as well as overarching recommendations proposed for patient assessment to guide treatment decisions and management.
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6,451 |
Molecular farming for antigen (vaccine) production in plants
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Genomic and proteomic approaches to the study of fundamental cell mechanisms are rapidly contributing to broaden our knowledge on metabolic pathways for the optimal exploitation of the cell as a factory. In the last few years this knowledge has led to important advances in the large scale production of diagnostic and therapeutic proteins in heterologous hosts (bacteria, yeasts, mammalian and insect cells or transgenic animals and plants), allowing the comparison of the most efficient methods in terms of costs, product quality and safety.
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6,452 |
Cytopenias in Transplant Patients
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Anemia, leukopenia, thrombocytopenia, as well as pancytopenias can be seen following solid organ transplant. Varying patterns of cytopenia can be seen based on the drugs used in the posttransplant period, infections encountered by the individual, as well as the individual’s immune response and bone marrow function. The chapter discusses the main causes of anemia, leukopenia/neutropenia, and thrombocytopenia. The differential diagnosis for anemia after solid organ transplant includes hemolysis, drug toxicities, iron deficiency, infection, posttransplant lymphoproliferative disorder, graft-vs.-host disease, and hemophagocytic syndrome. Etiologies for leukopenia and neutropenia include drug toxicities and infection, and etiologies for thrombocytopenia include drug toxicities, infections, autoimmune events such as immune thrombocytopenic purpura, and underlying causes such as persistent portal hypertension and splenomegaly.
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6,453 |
Astrovirus Infections in Animal Mammalian Species
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The first reports of astroviruses in animals date back to the end of the 1970s, when infections in mammals such as lambs and calves suffering from diarrhea were reported for the first time. Since then, several mammalian species have been shown to be susceptible to astroviruses which appear to be genetically diverse and to have acquired host-specificity. To date, astroviruses have been detected in 16 different orders or species of mammals in addition to humans, and signs of infection range from unapparent infection or very mild disease to diarrhea, lethargy, and anorexia, mainly observed in young individuals. This chapter describes those astroviruses detected in nonhuman mammalian species worldwide, as well as their molecular and phenotypic characteristics and their role in diseases. The capacity of these viruses to cross-species barriers and their subsequent adaptation to novel hosts is also highlighted.
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6,454 |
Diabetes Mellitus: New Challenges and Innovative Therapies
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Diabetes is a common chronic disease affecting an estimated 285 million adults worldwide. The rising incidence of diabetes, metabolic syndrome, and subsequent vascular diseases is a major public health problem in industrialized countries. This chapter summarizes current pharmacological approaches to treat diabetes mellitus and focuses on novel therapies for diabetes mellitus that are under development. There is great potential for developing a new generation of therapeutics that offer better control of diabetes, its co-morbidities and its complications. Preclinical results are discussed for new approaches including AMPK activation, the FGF21 target, cell therapy approaches, adiponectin mimetics and novel insulin formulations. Gene-based therapies are among the most promising emerging alternatives to conventional treatments. Therapies based on gene silencing using vector systems to deliver interference RNA to cells (i.e. against VEGF in diabetic retinopathy) are also a promising therapeutic option for the treatment of several diabetic complications. In conclusion, treatment of diabetes faces now a new era that is characterized by a variety of innovative therapeutic approaches that will improve quality of life in the near future.
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6,455 |
Metalloproteases and Proteolytic Processing
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Proteolytic enzymes constitute around 2% of the human genome and are involved in all stages of cell and organism development from fertilization through to cell death. In the human genome the major classes of peptidases are represented by cysteine-, serine- and metalloenzymes, which possess a wide spectrum of substrate specificity and physiological functions. The identification of many novel peptidases from genome sequencing programmes has suggested potential new therapeutic targets. In addition, several well characterised peptidases were recently shown to possess new and unexpected biological roles in neuroinflammation, cancer and angiogenesis, cardiovascular diseases and neurodegeneration. This chapter will briefly characterize the main classes of metallopeptidases and their roles in health and disease. Particular attention will be paid to the angiotensin-converting enzyme (ACE), neprilysin (NEP) and adamalysin (ADAM) families of proteases and their pathophysiological roles with a particular emphasis on cancer and neurodegeneration. The roles and mechanisms of protein shedding which primarily involve the ADAMs family of metallopeptidases will be explained using amyloid protein precursor (APP) processing cascades as a well characterized example. The therapeutic significance of modulating (activating or inhibiting) metallopeptidase activity will be a particular focus of this chapter.
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6,456 |
Axons and Neurons in Corona Virus-Induced Demyelination
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Infection of mice with the coronavirus mouse hepatitis virus induces primary demyelination in susceptible strains of rodents. Although demyelination is the primary pathological process detected in the central nervous system of infected mice, axonal dysfunction and damage also occur concomitantly with demyelination. This process is T cell mediated, with either CD4 or CDS T cells sufficient for MHV-induced axonal damage. A striking feature is that axonal damage occurs early in the disease process, at nearly the same time as demyelination is first observed. Axonal damage in MHV-infected mice has many similarities with the parallel process in humans with multiple sclerosis.
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6,457 |
Xenotransplantation
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The above statement was made by Guido Persijn, former Medical Director of the Eurotransplant Foundation, an international organisation that coordinates organ donation and transplantation. Xenotransplantation is the transplantation of organs, tissues or cells from one species of animal to another. This chapter will look at transplantations between animal and humans. Xenotransplantation is one possible solution for the organ donor shortage in the area of transplant medicine(77). However, there is still a ban on this type of procedure because of the lack of clarity about the sort of risks entailed. The natural rejection responses to cross–species components still create insurmountable problems. The transfer of viral DNA with, as yet, unpredictable consequences is also another matter that requires due attention. The various facets of this topic will be discussed in this chapter, as will the question of whether or not xenotransplantation is ethically responsible. We’ll begin with the history of xenotransplantation, which has its origins in a dark past.
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6,458 |
Respiratoire aandoeningen
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De incidentie van community-acquired pneumonie (cap, pneumonie begonnen thuis of binnen 48 uur na ziekenhuisopname) bedraagt 0,5-i,5%. Zij is hoger bij jonge kinderen en ouderen en stijgt tijdens een influenza-epidemie. Slechts 10-20% van de patiënten moet worden opgenomen vanwege de ernst van de pneumonie of een belangrijke bijkomende aandoening. De mortaliteit van deze patiënten bedraagt 5-15%; pneumonie is dus de frequentste infectieuze doodsoorzaak.
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6,459 |
The Global Threats from Naturally Occurring Infectious Diseases
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Biological risk relates to a broad spectrum of possible scenarios, that can be classified in three categories: natural occurring, unintended and deliberate. The prevention and management of such events require dedicated measures at national and international level, in terms of biosafety and biosecurity: an optimized intervention can minimize the probability of occurrence, but also adverse short-term (i.e.: number of casualties, population reaction…) and long-term (i.e.: chronic illnesses, ecological changes, trades drop…) consequences. Natural scenarios include common, emerging/re-emerging and chronic infectious diseases: they are caused by biological agents, which can be normally present in the communities, as acute or chronic pathologies, or suddenly appear, causing new or uncommon syndromes. In particular, a lot of environmental and human factors can influence emerging and re-emerging diseases: for example, urbanization and people mobility facilitate microorganisms spread, while climate changes are likely to induce a relocation of pathogens vectors. Unintended events are usually due to research and diagnostic activities: laboratories are the places where biological agents are handled and a lack in Biosafety measures or negligence can result in accidental release; the so called Laboratory Acquired Infections represent the main consequence, since they cause pathologies in the laboratory workers, but could be also transmitted in the population. Deliberate use of biological agents is strictly related to terroristic activities: microorganisms are very suitable for this purpose, since they are hidden and can easily spread. The present chapter summarizes the main characteristics of biological agents related events, taking in account their origin and the principal consequences on the community.
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6,460 |
Health, Disease, and Illness as Conceptual Tools
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There is no absolute consensus on the definitions of health, disease, and illness, even though these concepts are central not only in medicine but also in the health social sciences. A definition of each of the concepts is imperative because they constitute part of the analytical tools in medical sociology. This chapter presents definitions of these concepts, noting that each of them is multidimensional, complex, and sometimes elusive. The WHO’s definition of health is critically examined with respects to its components, criticisms, and alternative definitions of health. This chapter proceeds to discuss the features of a disease and the specific realities of illness by showing the difference between the two concepts. Disease and illness categories (acute, chronic, accidents/injuries, and mental disease/illness) are discussed. The chapter concludes with a strong emphasis on the cultural beliefs regarding illness causation among lay populations, especially in the African context. The natural, supernatural, mystical, and hereditary/genetic causations are discussed based on cultural realities but are sometimes divergent from biomedical models of disease causation.
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6,461 |
4 Infectieziekten
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In het vorige hoofdstuk hebben we gezien dat de mens zich tegen velerlei soorten prikkels kan beschermen door middel van ontstekings- of immuunreacties. In dit hoofdstuk wordt besproken welke veranderingen in het lichaam plaatshebben indien de noxe bestaat uit micro-organismen.
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6,462 |
Infektionsimmunologie8
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Im Laufe der Entwicklung der Lebewesen traten die Organismen gegeneinander in Konkurrenz und entdeckten andere Spezies als eigene Lebensgrundlage oder Nahrung. Bei höheren Lebewesen sehen wir dies als selbstverständlich an und teilen Sie in Fleisch- und Pflanzenfresser ein. Bei niederen Lebewesen bezeichnen wir dies jedoch als pathogene Eigenschaft oder als parasitäre Lebensweise, wenn wir ihnen als Nahrungsgrundlage dienen. Zur Abwehr der Krankheitserreger entwickelten alle höheren Lebewesen ein Immunsystem, um das Fortbestehen der Spezies zu garantieren. Je weiter sich die Lebewesen entwickelt haben, desto höher hat sich auch das Immunsystem in einer Coevolution in Konkurrenz zu den Erregern entwickelt. Da das Immunsystem in der Evolution zur Infektionsabwehr entstanden ist, leiten sich seine übrigen physiologischen und pathophysiologischen Mechanismen von denen der Infektionsabwehr ab. Die Tumorabwehr entspricht der Abwehr von Viren und die Allergie der Abwehr von „nicht vorhandenen Parasiten“. Damit ist die Infektionsimmunologie der zentrale Punkt der Immunologie. Während wirbellose Tiere nur eine angeborene Immunität besitzen, hat sich bei den Wirbeltieren zusätzlich die spezifische (adaptive) Immunität entwickelt. Die Komplexität des Immunsystems steht dabei mit der Lebensdauer der Organismen und der Rate an Nachkommen im Einklang, d. h., je länger die Lebensdauer und je geringer die Anzahl der Nachkommen, desto komplexer muss das Immunsystem aufgebaut sein, um das Überleben der Art zu gewährleisten. Somit haben sich im Laufe der Evolution die in den vorherigen Kapiteln beschriebenen Abwehrsysteme entwickelt, die für die Abwehr von Infektionen koordiniert zusammenarbeiten müssen. Wichtig ist dabei, dass das Immunsystem den richtigen Reaktionsweg einschlägt, der den Erreger spezifisch bekämpfen kann, da sonst die Immunreaktion ins Leere läuft und der Erreger sich trotzdem weitervermehrt und den Körper schädigt.
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6,463 |
Contrast-Enhanced MRI and Micro-CT Adopted for Evaluation of a Lipid-Lowering and Anticoagulant Herbal Epimedium-Derived Phytoestrogenic Extract for Prevention of Steroid-Associated Osteonecrosis
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We developed an alternative steroid-associated osteonecrosis (ON) rabbit model using a combination of a single injection of low-dose lipopolysaccharide (LPS) and three subsequent injections of pulsed high-dose methylprednisolone (MPS).The usefulness of this experimental ON model was evaluated using both conventional and advanced bio-imaging techniques, including contrast-enhanced dynamic MRI and a high-resolution micro-CT. Details on establishment of methodology are described, which were adopted into an efficacy study on a herbal Epimedium-derived phytoestrogenic extract (HEPE) developed for prevention of steroid-associated ON using an established rabbit model. The underlying mechanisms of HEPE for prevention of steroid-associated ON were found to be associated with inhibition of both intravascular thrombosis and extravascular bone marrow lipid deposition, the two known mechanistic pathways in pathogenesis of ON. Our experimental results provide for potential clinical trials or applications of HEPE in the prevention of ON among hig-hrisk patients undergoing steroid treatment.
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6,464 |
Ambient Temperature and Major Infectious Diseases in China
|
Infectious diseases are a group of diseases which have complex transmission ways and various influencing factors. Clarifying the correlation between ambient temperature and major infectious diseases in China is a crucial step toward the successful control of infectious diseases including vector-borne diseases, water-borne diseases, food-borne diseases, respiratory infectious diseases, etc. and the implementations of climate change adaption strategy and measures in China. However, no study has systematically reviewed the available evidences on the impact of ambient temperature on the incidence of major infectious diseases, and such information is essential for policymakers and stakeholders to take specific actions to control infectious diseases and protect the vulnerable population in the future. In order to fill this gap, we systematically review the current evidence for the effect of ambient temperature on major infectious diseases in China. The findings could provide explicit information for the scientific prevention and control of infectious diseases in China.
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6,465 |
Nasal Cavity and Paranasal Sinuses
| null |
6,466 |
La terapia antimicrobica nella pratica clinica
|
In questa sezione vengono riportate le informazioni utili per un uso adeguato degli antimicrobici. Lo schema di presentazione ricalca il percorso clinico abituale: prima un approccio empirico, poi una terapia mirata nella quale è noto il patogeno e infine una classificazione che si concentra sul singolo principio attivo.
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6,467 |
The Impact and Control of Emerging and Re-Emerging Viral Diseases in the Environment: An African Perspective
|
Emerging viral infections (EVI), and re-emergent variants of existing ones, are a growing threat to public health worldwide with outbreaks occurring sporadically especially in Africa associated with significant adverse ecological, socioeconomic and public health implications. These pathogens have devised evolved environmental adaptations, including the possession of genomic resistance mutations. Haemorrhagic fever viruses like Ebola, Marburg and Lassa fever viruses and respiratory pathogens like the avian and human influenza severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) viruses, most from zoonotic reservoirs, may significantly increase morbidity and mortality in the human population in the nearest future. Likewise, vector-borne zoonotic viral diseases including Rift Valley fever, yellow fever, dengue, chikungunya and West Nile, transmitted by arthropods from animal reservoirs, occur frequently in the tropics, exhibiting previously unseen patterns of infection and spread. These patterns are facilitated by many intrinsic factors like mutated sites in the viral genome, and external factors including urbanization, displacement, human migration and climate change. Emerging viruses can easily cross boundaries and pose severe threats to the human populations in new geographical areas. Here, we outline the features of common emergent viruses and factors facilitating their emergence, effects, control and sustained management in the environment.
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6,468 |
Guangdong Province: Trade Liberalization and HIV
|
The Guangdong experience is interesting as a case study, given its role as an economic hub, having attracted both domestic migrant workers, as well as people from abroad ever since the economic reforms of the late 1970s. The first Special Economic Zones were set up in Guangdong, due to its proximity to Hong Kong, most famously in the city of Shenzhen. The region has a prospering manufacturing industry, where both labor-intensive manufacturing products, as well as high-end technology products, are produced and assembled. Trade liberalization and rapid economic growth have also created a booming commercial sex industry and a situation where many economically-marginalized workers are migrating to the region. Here, we document the development of Guangdong’s HIV epidemic, which has grown dramatically from 1997 to 2017, and we describe epidemic response efforts in Guangdong over the same period.
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6,469 |
Geschichtlicher Überblick
|
Für die Krankheiten, die wir heute als Viruserkrankungen kennen, sah man ursprünglich „Gifte“ als Ursache an. Mit den damals üblichen Methoden ließen sich keine (krankheitserzeugenden) pathogenen Organismen wie Bakterien oder Protozoen in den „giftigen Materialien“ nachweisen. Erst gegen Ende des 19. Jahrhunderts legten Tierversuche, die von Louis Pasteur durchgeführt wurden und bei denen sich auch nach mehreren Passagen keine Ausverdünnung der giftigen Eigenschaften einstellte, nahe, dass das krankheitsauslösende Agens in der Lage war, sich im Organismus zu vermehren. Man sprach deshalb von einem in lebenden Organismen, später auch von einem in Zellen vermehrungsfähigen „Virus“ (lateinisch für „Gift“ oder „Schleim“). Im Jahre 1892 konnte Dimitri I. Iwanowski in St. Petersburg zeigen, dass die Mosaikkrankheit der Tabakpflanzen durch ein „ultrafiltrierbares“ und damit deutlich unter Bakteriengröße liegendes Agens verursacht wird: das Tabakmosaikvirus.
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6,470 |
Erkrankungen der Trachea und der Bronchien
| null |
6,471 |
Lung
|
In the present chapter, we review and summarize current advances on the role of angiotensin-(1-7) [Ang-(1-7)] in the pathophysiology of main lung diseases: pulmonary hypertension (PH), acute respiratory distress syndrome (ARDS), asthma, and pulmonary fibrosis. Understanding the involvement of renin angiotensin system (RAS) in pulmonary inflammation may open new therapeutic possibilities for the treatment of respiratory diseases. Studies to date showed that Ang-(1-7) presents anti-inflammatory, antifibrotic activities and reduces pulmonary remodeling. These actions support the development of new pharmacological therapies based on the increase in Ang-(1-7) in the lungs to improve the treatment of inflammatory diseases.
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6,472 |
Issues in Community-Acquired Pneumonia
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Pneumonia is one of the most commonly diagnosed infectious diseases and is the third most frequent cause of death worldwide. Accurate statistics of community-acquired pneumonia incidence globally or in countries of various regions are lacking. Although the clinical diagnosis of pneumonia is not difficult, the etiology diagnosis to guide targeted specific antimicrobial therapy still poses a challenge even with novel molecular methods. This has led to different approaches and guidelines for the empiric treatment of community-acquired pneumonia, often with broad-spectrum antimicrobial agents which may play a role in fostering the worldwide development of antibiotic resistant bacteria. Severe community-acquired pneumonia, seen mainly at the extremes of age and in persons with chronic underlying diseases, is associated with high mortality of 20–40%. Pneumonia severity tools, such as CURB-65, have been developed over the past decade to assist emergency department physicians to recognize, admit, and implement rapid antimicrobial therapy in severely ill patients. The evidence for the beneficial effects of these tools will be reviewed in this chapter. Issues in the management of severe community-acquired pneumonia that are discussed include: combination with newer macrolides [irrespective of microbial etiology], value of adjunctive therapy such as corticosteroids and statins.
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6,473 |
Rhinoviruses
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Picornaviruses, which include the human rhinoviruses (HRVs) and enteroviruses (EVs), are the most frequent cause of acute human illness worldwide. HRVs are the most prevalent cause of acute respiratory tract illnesses (ARIs) which usually commence in the upper respiratory tract (URT). ARIs are the leading cause of morbidity in children under 5 years and occur in all seasons. ARIs linked to HRV infections are associated with excessive and perhaps inappropriate antibiotic prescribing and with significant direct and indirect healthcare expenditure. ARI incidence is highest in the first 2 years of life, with up to thirteen episodes per year including up to six positive for an HRV, and it is not uncommon to average one infection per child-month.
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6,474 |
The Baboon in Xenotransplant Research
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If cross-species transplantation is ever to become a reasonable therapeutic modality for human beings, it will be because the potential for success has been demonstrated in a nonhuman primate model. The imperative has always been to select a primate research subject from a species that is plentiful, is not endangered, readily procreates in a managed environment, and mimics the human response (immunologic homology) to both organ transplantation and potential transfer of infectious disease. Several Papio subspecies of baboons, including Papio hamadryas anubis (olive baboon), meet these important criteria. These animals remain ubiquitous throughout sub-Saharan Africa and have adapted well to the managed environments of major primate centers worldwide. A list of United States-based primate centers housing breeding colonies of baboons can be found in Table 19.1. The Surgical Research Laboratory at Loma Linda University, for instance, has maintained a salutary relationship with the Southwest National Primate Research Center in San Antonio, Texas, for the procurement of juvenile baboon research subjects.
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6,475 |
Medicinal Plant Active Compounds Produced by UV-B Exposure
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Ultraviolet (UV) radiation is a part of the sunlight reaching Earth surface. The UV spectrum of solar radiation is by convention divided into three parts: UV-A: 310–400 nm, UV-B: 280–310 nm and UV-C: less than 280 nm. UV-B is the most energetic component reaching Earth surface because the stratospheric ozone layer effectively absorbs completely wavelengths below 290 nm. UV-B is an increasing threat due to increasing UV-B levels on Earth surface as a consequence of depletion of stratospheric O(3). In general, the effects of atmospheric UV-B radiation are negative for biological life. Enhanced levels of UV-B radiation can indeed negatively change plant physiological processes, growth and productivity. However, while studying UV-B effects on medicinal plants, some interesting phenomena have been discovered. For example, basil plants respond positively to UV-B radiation by increasing oil yield (Chang et al. J Horticult For 1:27–31, 2009). In other studies medicinal plants show beneficial aspects in term of increase in volatile oil yield and secondary metabolite production (Kumari et al. Ecotoxicol Environ Safety 72:2013–2019, 2009c, 2010). Medicinal herbs have great market value in India and worldwide. The medicinal value of plants depends upon phenolics, antioxidants and volatile yield. Therefore further UV-B experiments increasing the levels of these compounds are needed. Here we review the effect of UV-B exposure on metabolites, volatiles, and antioxidants potential in medicinal plants. This chapter reports: (1) aspects of the global market for medicinal and aromatic plants in India in order to assist the medicinal plant industry to make informed decisions. (2) The biodiversity loss due to wild harvesting of plants, and as an alternative the cultivation strategy of medicinal plants. (3) Main medicinal plant species having rich antioxidant potential. (4) Main secondary metabolites of plant origin such as phenylpropanoids, terpenes, alkaloids, and volatile oil, and other important metabolites containing high antioxidant level used in human diet and health. (5) UV-B factors that enhance the quality of medicinal plant by increasing the content of secondary bioactive products. (6) Secondary metabolic pathways involving regulation of key enzymes, chalcone synthase, and phenylalanine ammonia lyase. Understanding of UV-B responses on secondary plant metabolites expand new opportunities for plant enriched in medicinal active compounds.
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6,476 |
Venous Thrombus
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Venous thromboembolism (VTE) includes pulmonary thromboembolism (PE) and deep venous thrombosis (DVT). Both belonging to thrombus, acute arterial thrombus is white thrombus, while acute venous thrombus is red thrombus. What does the pathological difference mean? Venous thrombosis can autolyze, while arterial thrombosis cannot. For VTE patients, oral anticoagulants are usually recommended for 3, 6, or 12 months and occasionally lifelong, but the course cannot be determined. Furthermore, even with standard anticoagulation therapy and INR, some patients still develop chronic thromboembolic pulmonary hypertension (CTEPH). Thus, the physicians are extremely puzzled about anticoagulant usage. Proposed risk factors for VTE include advanced age, infection, malignancy, autoimmune disease, surgery, trauma, pregnancy, long trip syndrome, family history, AMI, heart failure, and so on. Relevant risk factors are increasing over time. Risk factors are derived from the summary of evidence-based medicine. Although these factors are found to be associated with venous thrombosis, the intrinsic factors have not been well elucidated.
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6,477 |
Optimal Control of Multi-strain Epidemic Processes in Complex Networks
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The emergence of new diseases, such as HIV/AIDS, SARS, and Ebola, represent serious problems for the public health and medical science research to address. Despite the rapid development of vaccines and drugs, one challenge in disease control is the fact that one pathogen sometimes generates many strains with different spreading features. Hence it is of critical importance to investigate multi-strain epidemic dynamics and its associated epidemic control strategies. In this paper, we investigate two controlled multi-strain epidemic models for heterogeneous populations over a large complex network and obtain the structure of optimal control policies for both models. Numerical examples are used to corroborate the analytical results.
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6,478 |
Challenges in modelling complexity of fungal entomopathogens in semi-natural populations of insects
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The use of fungal entomopathogens as microbial control agents has driven studies into their ecology in crop ecosystems. Yet, there is still a lack of understanding of the ecology of these insect pathogens in semi-natural habitats and communities. We review the literature on prevalence of fungal entomopathogens in insect populations and highlight the difficulties in making such measurements. We then describe the theoretical host-pathogen models available to examine the role that fungal entomopathogens could play in regulating insect populations in semi-natural habitats, much of the inspiration for which has been drawn from managed systems, particularly forests. We further emphasise the need to consider the complexity, and particularly the heterogeneity, of semi-natural habitats within the context of theoretical models and as a framework for empirical studies. We acknowledge that fundamental gaps in understanding fungal entomopathogens from an ecological perspective coupled with a lack of empirical data to test theoretical predictions is impeding progress. There is an increasing need, especially under current rapid environmental change, to improve our understanding of the role of fungi in insect population dynamics beyond the context of forestry and agriculture.
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6,479 |
Damage Control Resuscitation
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Damage control resuscitation is a resuscitation modality that integrates permissive hypotension, hemostatic resuscitation, and damage control surgery, initially addressing all three components of the “lethal triad”: coagulopathy, acidosis, and hypothermia. Trauma patients predicted to require massive transfusion, administration of fresh frozen plasma, packed red blood cells, and platelets in a 1:1:1 ratio (of individual units) are associated with improved survival and less need for innumerous transfusions. In addition, the evidence so far indicates that the incorporation of these principles into a MTP will also contribute to less transfused units by minimizing variability of transfusion practices. Importantly, fewer units transfused will contribute to fewer complications associated with transfusions. These conclusions will need to be verified, especially with regard to the effect of MTPs incorporating higher ratios of FFP:PRBC:platelets effect on varying mechanism of injury, the timing of transfusions, and the number of units actually transfused. Also recombinant factor VIIa, cryoprecipitate, and tranexamic acid can be considered adjunctive treatments for coagulopathy. Lastly, damage control surgery is a surgical strategy aimed at restoring normal physiology rather than anatomical integrity; however, this component of damage control resuscitation should not be applied in isolation.
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6,480 |
Health Issues in Returned Travellers
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Travellers are more than ever choosing to visit adventurous destinations, sometimes in remote places. In addition, the ease of international travel makes it possible for travellers with underlying medical conditions, such as immunosuppression, the elderly, pregnant women and children to travel to destinations that may place them at risk of a range of exotic infections. It is therefore important for the travel medicine practitioner to have a firm understanding of the spectrum of infections that travellers may acquire according to their travel destination. This chapter provides an overview of the spectrum of infections travellers may encounter and provides an approach to the diagnosis and management of ill returned travellers.
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6,481 |
1.2 The Health System
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There are several factors (or determinants 1. Biology: the age and sex of the person; the genetic makeup including heritable diseases. At the current time, biological factors are the hardest to change, although many are hopeful that genetic engineering may change this at some point. For this reason, most public-sector investment in public health aims to affect the behavioral, social, environmental and medical access determinants. . 2. Behaviors: alcohol, tobacco, substance abuse; risk-prone lifestyles, such as working as a miner or prostitute. . 3. Social: discrimination, income disparities, socioeconomic status, education, occupation, class, social support. Poorer people often lack time and opportunity to exercise. Food for a healthier diet tends to be more expensive and takes longer to prepare. A strong and consistent finding of epidemiological research is that there are health differences among socioeconomic groups. Lower mortality, morbidity, and disability rates among socioeconomically advantaged people have been observed for hundreds of years. . 4. Environment (or total ecology): where a person lives, sanitary and crowding conditions, air and water quality, lead exposure, and the design of neighborhoods. Some of the most dramatic improvements in population health during the twentieth century include: improved water, food, and milk sanitation, reduced physical crowding, improved nutrition, and central heating with cleaner fuels. Most Americans live in urban areas, which are often associated with harmful health behaviors, such as exercise, diet, sexual behavior, alcohol and substance abuse. Cities also have higher levels of air pollution, which may cause cardiovascular and respiratory disease. Crowded buildings may increase the risk of lead exposure as well as asthma. Those that live in rural areas have other risks, such as exposure to pesticides. . 5. Medical care: access to quality health care; having insurance. For example, the availability of Medicaid (health insurance for the poor) was expanded greatly with the passage of the Affordable Care Act. This resulted in greater access to medical care for a previously underserved population. Similarly, the nationwide shift to high-deductible insurance plans has actually reduced accessibility to affordable healthcare for many. ;
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6,482 |
Vaccines: Biotechnology Market, Coverage, and Regulatory Challenges for Achieving Sustainable Development Goals
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This chapter provides an overview, from bioeconomic and global sustainability perspectives, of the main constraints to the current global vaccine innovation system for achieving Sustainable Development Goals – SDGs. Biotechnology market trends, gaps in vaccine coverage against emerging and neglected diseases, and patent protection and regulation are discussed. A structured long-term “public-return-driven” innovation model to overcome vaccine market failure is proposed.
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6,483 |
Towards Automated TEM for Virus Diagnostics: Segmentation of Grid Squares and Detection of Regions of Interest
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When searching for viruses in an electron microscope the sample grid constitutes an enormous search area. Here, we present methods for automating the image acquisition process for an automatic virus diagnostic application. The methods constitute a multi resolution approach where we first identify the grid squares and rate individual grid squares based on content in a grid overview image and then detect regions of interest in higher resolution images of good grid squares. Our methods are designed to mimic the actions of a virus TEM expert manually navigating the microscope and they are also compared to the expert’s performance. Integrating the proposed methods with the microscope would reduce the search area by more than 99.99 % and it would also remove the need for an expert to perform the virus search by the microscope.
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6,484 |
Understanding and Exploring HIV/AIDS and Discrimination
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This chapter outlines the main theories of discrimination and stigma and the methodology of the research. Both qualitative and quantitative techniques were used in collecting and analyzing the data. Research on refugees is a complex undertaking, and there is no tested method for studying both refugees and HIV/AIDS. This results in the enhanced challenge of conducting research in precarious conditions where refugees reside, owing to displacement of refugees caused by myriad of factors that we have to take into consideration. In this way, it addresses the vacuum in scholarship and prepares the ground for designing research based on geographical and political settings, and proposes new alternatives for addressing them. This will be an important contribution to the methodological underpinning in refugee research. Ethical issues pose a significant challenge as this research involves human subjects and deals with delicate and sensitive issues. This chapter also explains the process for handling confidential research material, developing intersectional analyses and answering specific questions related to multi-strategy research design that are crucial in researching refugees.
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6,485 |
Krim-Kongo-Virus
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6,486 |
Leberversagen
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Das Leberversagen ist eine schwere Leberfunktionseinschränkung mit Auftreten einer hepatischen Enzepha-lopathie infolge einer akuten oder chronischen Lebererkrankung. Ob es reversibel oder irreversibel ist, hängt von der Grunderkrankung, dem Lebensalter, einer Vorschädigung der Leber und dem Auftreten von Komplikationen ab.
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6,487 |
Disinfection Room: Cleaning Room
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The disinfection room is central to all operations and is a multifunctional room. Here, all contaminants and organic materials are taken care of and removed. Contaminated textiles are sorted and ordinary waste from infectious waste. Used syringes and other stabbing/cutting waste, glass, etc. are collected as hazardous waste. Used wheelchairs and other major patient aids are usually washed here. The bedpan, urine bottles, etc. are disinfected in the decontaminator. The room has a large load of dirt and microbial agents where the personnel may perform many space-demanding tasks. A large and efficient area with good separation between clean and unclean work tasks, good ventilation and negative pressure ventilation and good methods for cleaning and disinfection are necessary. The following chapter is focused on areal and outfit of the disinfection room to avoid transmittance of infections between patients, personal and environment.
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6,488 |
Interstitial Lung Diseases
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The term interstitial lung disease (ILD) comprises a diverse group of diseases that lead to inflammation and fibrosis of the alveoli, distal airways, and septal interstitium of the lungs. The ILDs consist of disorders of known cause (e.g., collagen vascular diseases, drug-related diseases) as well as disorders of unknown etiology. The latter include idiopathic interstitial pneumonias (IIPs), sarcoidosis and a group of miscellaneous, rare, but nonetheless interesting, diseases. In patients with ILD, MDCT enriches the diagnostic armamentarium by allowing volumetric high resolution scanning, i.e., continuous data acquisition with thin collimation and a high spatial frequency reconstruction algorithm. CT is a key method in the identification and management of patients with ILD. It not only improves the detection and characterization of parenchymal abnormalities, but also increases the accuracy of diagnosis. The spectrum of morphologic characteristics that are indicative of interstitial lung disease is relatively limited and includes a reticular pattern (with or without traction bronchiectasis), thickening of interlobular septa, honeycombing, nodules, and ground-glass opacities. In the correct clinical context, some patterns or combination of patterns, together with the anatomic distribution of the abnormality, i.e., from the lung apex to the base, or peripheral subpleural versus central bronchovascular, can lead the interpreter to a specific diagnosis. However, due to an overlap of the CT morphology between the various entities, complementary lung biopsy is recommended in virtually all cases of ILDs.
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6,489 |
Understanding the Impact of Face Mask Usage Through Epidemic Simulation of Large Social Networks
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Evidence from the 2003 SARS epidemic and 2009 H1N1 pandemic shows that face masks can be an effective non-pharmaceutical intervention in minimizing the spread of airborne viruses. Recent studies have shown that using face masks is correlated to an individual’s age and gender, where females and older adults are more likely to wear a mask than males or youths. There are only a few studies quantifying the impact of using face masks to slow the spread of an epidemic at the population level, and even fewer studies that model their impact in a population where the use of face masks depends upon the age and gender of the population. We use a state-of-the-art agent-based simulation to model the use of face masks and quantify their impact on three levels of an influenza epidemic and compare different mitigation scenarios. These scenarios involve changing the demographics of mask usage, the adoption of mask usage in relation to a perceived threat level, and the combination of masks with other non-pharmaceutical interventions such as hand washing and social distancing. Our results shows that face masks alone have limited impact on the spread of influenza. However, when face masks are combined with other interventions such as hand sanitizer, they can be more effective. We also observe that monitoring social internet systems can be a useful technique to measure compliance. We conclude that educating the public on the effectiveness of masks to increase compliance can reduce morbidity and mortality.
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6,490 |
The Mighty World of Microbes: An Overview
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The world of microbes on our planet is vast and diverse. This includes the normal bacterial flora present on the skin and mucous membranes of humans. The human microbiome project (HMP) was launched by NIH in 2007 as a part of a road map for medical research. The HMP serves as a template for researchers who are studying more than 1,000 microbial genomes with a focus on their role in health and disease. The study samples have been derived from five human body regions that are known to be inhabited by microbial flora. These include the gastrointestinal tract, female urogenital tract, mouth, nose, and skin. The techniques being used include finger printing, sequencing, dynamic range, and comparison of multiple samples. It is now well accepted that there are more microbial cells than human cells in the human body. Just the gastrointestinal tract harbors more than tenfold microbial cells than the number of human cells in the entire body. The understanding of the relationship between microbes and humans is at best rudimentary at this point in time. Similarly, the relationship between humans and microbes in the environment and environmental surfaces is poorly understood except for a few pathogenic microbes.
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6,491 |
Financial Services Industry
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Critical infrastructure and services in financial industry are important for our society and the financial industry starts to understand the topic beyond the normal and well maintained Business Continuity Management and Disaster Recovery Plans (BCM & DRP). Today, the international backbone financial infrastructures operate pretty well, but in the infrastructure towards clients, two issues are utmost critical for the banks: Drive By Download and Phishing; both are related to steeling identity and money via e-banking. This is one of the results achieved by the EU project Parsifal (Protection and Trust in Financial Infrastructure (Parsifal-Team, 2010), for compositing a research agenda for the cyber security of the financial industry.
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6,492 |
Infections in Transplantation: Introduction and Overview
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Over the last 70 years, a steady growth in population of patients with severe and mostly iatrogenically induced immune suppression while undergoing myeloablative antineoplastic therapy and blood- and marrow-derived stem cell or solid organ transplantation has resulted in a near-explosive growth of opportunistic infections. Furthermore, the advent and now common use of biologic immunosuppressive drugs are given to an increasing number of patients prior to transplantation or for treatment of complications arising during the posttransplant period such as graft-versus-host disease, lymphoproliferative disorders, opportunistic malignancies, cancer recurrences, and rejection of solid organ allograft. These and other recent therapeutic advances in transplantation procedures continue to be fraught with prolonged and often unpredictable period of drug-induced immune dysregulation. The emergence and spread of difficult-to-treat opportunistic bacterial, viral, fungal, and parasitic diseases in transplant population have evolved under the influence of environmental-, host-, disease-, and treatment-specific variance. A diligent diagnostic adjudication is of utmost importance in a population with known proclivity for atypical disease presentation. Inaccurate diagnosis may result in inappropriate and ineffective empiric therapy that may worsen patients’ morbidity and heighten the risk for further complications and death. Advancement in understanding the immunopathogenesis of infectious diseases, hosts’ immunologic vulnerability for infections, emerging molecular diagnostic paradigms, deciphering potential therapeutic impact of immune modulation by existing and new antimicrobial drugs, and active research and development in mitigation strategies to promote immune recovery and immune preservation are encouraging developments in optimizing care for patients in need for lifesaving transplantation procedures.
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6,493 |
How Governmental Regulation Can Help or Hinder the Integration of Bt Crops within IPM Programs
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Regulatory risk assessments are an important part of the introduction of insect-resistant genetically modified (GM) crops (e.g., Bacillus thuringiensis [Bt] crops) into the environment to ensure the safe use of such products. In doing so, the regulatory assessment process can be clearly beneficial to integrated pest management (IPM) programs. In general, the regulatory framework for insect-resistant GM crops includes an assessment of the following: effects of the insecticidal trait on non-target organisms, other potential adverse environmental impacts, evolution of resistance to target pests, and environmental and agronomic benefits of the insecticidal trait. Each country’s regulatory system is dependent on the overall environmental risk management goals, relevant and available risk information, scientific capacity, and the available financial resources. A number of regulatory activities can help to ensure that new products such as Bt crops fit well within IPM programs: (1) evaluation of the environmental safety of new products, and their ability to enhance IPM; (2) encouragement of the adoption of new technologies with improved environmental safety profiles; (3) adoption of an expedited regulatory review system; and (4) encouragement and appropriate oversight of sustainable use of such products. Governmental regulation of insect-resistant GM crops can also hinder IPM programs by creating significant barriers to the adoption of such technologies. Such barriers include: (1) absence of functioning regulatory systems in many developing countries; (2) meeting the obligations and understanding the various interpretations of international treaties, e.g., Cartagena Protocol on Biosafety; (3) lack of public sector research to generate data supporting the safety of these crops; and (4) regulatory costs involved in the development and commercialization of novel products for small market sectors. Ways in which regulatory data requirements can be globally harmonized need to be considered to decrease the regulatory barriers for insect-resistant GM crops and comparable technologies. International organizations can play a key role in rationalizing regulatory systems; however, public sector research will also be needed to make sure that the risk assessment process is scientifically sound and transparent.
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6,494 |
Aircraft Environmental Control Systems
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The external environment at 41000 ft (12500 m), a typical cruise altitude for modern civil aircraft, is hostile to human life. Aircraft environmental control systems are designed to ensure the survival of the aircraft occupants as well as providing them with a comfortable atmosphere. Major design drivers for the environmental control system are thermal comfort, pressurisation and cabin air quality. However, these parameters cannot be considered independently. They interact between themselves and with other parameters, which may or may not be controllable by the system designer. These interactions occur in a highly complex manner. Research has led to a good understanding of the basic functions to allow safe and comfortable aircraft environmental conditions. Future research efforts will be increasingly focussed on identifying and elaborating the interdependency of factors in order to further enhance the aircraft cabin environment.
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6,495 |
Ventilator-Associated Pneumonia and Other Complications
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Ventilator-associated pneumonia occurs in patients who have been intubated for two to three days with significant exposure to hospital-acquired organisms. Treatment should be initiated rapidly and cover P. aeruginosa, Escheriochia coli, Klebsiella pneumonia, and Acinetobacter species as well as methicillin-resistant S. aureus. 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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6,496 |
Diagnosis of Viral Infections
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Accurate diagnosis of viral infections enhances the ability of the clinician to make decisions on appropriate treatment of patients, evaluate disease progression and prevent misuse of antibiotics. Knowledge of the pathogen involved also allow implementation of infection control and monitoring of success of antiviral treatments that may affect the prognosis of patients. Epidemiological data collected through accurate diagnostics play an important role in public health through identification and control of outbreaks, implementation of appropriate diagnostic tests, vaccination programs and treatment but also to recognize common and emerging pathogens in a community. It is key that the clinician have an understanding of appropriate specimens to send to the laboratory and the value of specific nucleic acid and serological testing for different viral pathogens. Molecular techniques have revolutionized viral diagnoses over the past decade and enhanced both the sensitivity and specificity of tests and the speed by which a diagnosis can be made and new tests be developed. The continued use of serology for viruses with a short viremia, or for chronic infections should however complement these tests. This chapter aims to provide an overview of the available tests, the principles of testing and appropriate tests to select for different viruses and syndromes. Also provided is a glimpse of new developments in diagnostics that may further enhance the capacity to make a conclusive diagnosis in the near future.
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6,497 |
The CD95/CD95L Signaling Pathway: A Role in Carcinogenesis
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Apoptosis is a fundamental process contributing to tissue homeostasis, immune response, and development. CD95, also called Fas, is a member of the tumor necrosis factor receptor (TNF-R) superfamily. Its ligand, CD95L, was initially detected at the plasma membrane of activated T lymphocytes and natural killer (NK) cells where it contributes to the elimination of transformed and infected cells. Given its implication in immune homeostasis and immune surveillance combined with the fact that various lineages of malignant cells exhibit loss-of-function mutations, CD95 was initially classified as a tumor suppressor gene. Nonetheless, in different pathophysiological contexts, this receptor is able to transmit non-apoptotic signals and promote inflammation and carcinogenesis. Although the different non-apoptotic signaling pathways (NF-κB, MAPK, and PI3K) triggered by CD95 are known, the initial molecular events leading to these signals, the mechanisms by which the receptor switches from an apoptotic function to an inflammatory role, and, more importantly, the biological functions of these signals remain elusive.
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6,498 |
Wie katz und Maus
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Die Patientin M.S. ist eine 20-jährige Frau, bei der vor etwa 2 Jahren eine akute lymphoblastische Leukämie festgestellt wurde. Die Erstmanifestation war ein lymphozytäres Chlorom an der rechten Seite des Kopfes. Nach der operativen Entfernung des Chloromes erhielt Frau S. eine kurative Radio- und Chemotherapie. Rund 18 Monate später kam es zu einem Rezidiv, das nach Konditionierung mit Cyclophosphamid, Anti-Thymozyten-Globulin und Ganzkörperbestrahlung mit einer allogenen Stammzelltransplantation behandelt wurde. Die Patientin war seit einem halben Jahr in einer kompletten Remission. Vor einigen Tagen bekam sie plötzlich Fieber bis zu 40°C. Bis zur Aufnahme im Krankenhaus entwickelte sie Dyspnoe, Tachypnoe und etwas unproduktiven Husten.
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6,499 |
Krätzmilben (Sarcoptes scabiei und ähnliche)
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Acarus scabiei, Sarcoptes scabiei scabiei, itch mite
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