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7,400 |
Sociology and Health
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Many people (including students of sociology) often wonder about the relevance of social sciences (especially sociology) to health issues. In general, it is often a challenge to discuss the nexus between social science and health. Why medical sociology? What does sociology have to do with medicine or health? This chapter aims to answer these questions. It starts with the meaning of sociology and its links to health studies—a definition and brief history of medical sociology and topic description of the discipline. All health problems are conceived as social problems, which are the core focus of sociological studies. This chapter explains the characteristics of social problems with regard to health issues. Health problems are viewed as parts of social pathologies by advancing the sociological dimensions of health problems. The chapter then attempts to re-explain the topical description of medical sociology (first advanced by David Mechanic in 1968) and includes some current issues. The topical descriptions specifically include social aetiology of disease, cultural beliefs and social response to illness, sociology of medical care and hospitals, sociology of psychiatry, social transition and health care, traditional medicine (alternative medicine), sociology of bioethics, health policy and politics, social epidemiology, sociology of dying and death, and medical education.
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7,401 |
Hightech im Dienste der Infektiologie
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Jeden Tag sterben weltweit etwa 13 Millionen Menschen an den Folgen viraler, bakterieller oder parasitärer Erkrankungen.
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7,402 |
Vitamin D and Chronic Obstructive Pulmonary Disease
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Vitamin D is an important regulator of calcium and bone homeostasis. It is also involved in the regulation of different genes and cellular functions, particularly in the context of inflammation, regeneration and immune control. Conversely, vitamin D deficiency which is often found in chronic, infectious and inflammatory diseases is thought to drive or enhance uncontrolled inflammation. Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the airways most often because of cigarette smoking. It has been recognized that repetitive airway infections and systemic consequences or co-morbidities also contribute to the progressive nature of COPD. Vitamin D deficiency is known to sneak in from the early stages of COPD, to become highly prevalent at the more severe stages, and may thereby catalyse airway infection, inflammation and systemic consequences. Undoubtedly, vitamin D deficiency enhances bone resorption and osteoporosis in COPD for which appropriate vitamin D supplementation is recommended. However, conflicting evidence has emerged on the extra-calcemic effects of vitamin D in COPD. A recent intervention trial with high-dose supplementation in COPD was only able to reduce exacerbation frequency in the subgroup of patients with lowest baseline vitamin D levels. It confirms that severe vitamin D deficiency is a health hazard but that more clinical and experimental studies are needed to explore how vitamin D deficiency may affect airway biology and systemic effects in the context of smoke-induced lung diseases.
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7,403 |
Vertebrates as Hosts and Reservoirs of Zoonotic Microbial Agents
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This chapter presents a survey of zoonotic microorganisms that have been isolated from vertebrates (Vertebrata), and are potentially transmissible to humans. It is intended as an aid for microbiologists, zoologists and epidemiologists, making possible better orientation among hosts (and reservoirs) of zoonoses. A great number of sources have been used in this compilation, e.g. Davis et al. (1970), Kucheruk (1979, 1989), Karabatsos (1985–1995), Hubálek (1994), etc.
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7,404 |
Antioxidant Properties of Surfactant
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Surfactant treatment is one of the milestones of respiratory distress syndrome (RDS) treatment in preterm infants, but it has been also demonstrated to exert consistent antioxidant and anti-inflammatory activities. Exogenous natural surfactant contains antioxidant enzymes, such as catalase (CAT) and superoxide dismutase (SOD), and nonenzymatic antioxidant molecules, such as plasmalogens and polyunsaturated phospholipids (PUPLs). Moreover, surfactant can contribute to the modulation of intra-alveolar inflammatory processes through the regulation effect of the surfactant A (SP-A) and B (SP-B) proteins. Although less extensively investigated, these functions may contribute to the efficacy of exogenous surfactant administration in preterm neonates with RDS.
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7,405 |
Molecular Diagnostics in Pulmonary Infections
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Infection of the lung parenchyma, or pneumonia, accounts for over four million deaths per year worldwide (Ferkol and Schraufnagel, Ann Am Thorac Soc 11:404–406, 2014). The condition is common, but also over-diagnosed, in part due to relatively poor laboratory and radiographic diagnostics. Indeed, we continue to rely on antiquated tools such as sputum culture and chest X-ray – the former of which lacks speed and sensitivity, and the latter specificity (Albaum et al. Chest 110:343–50, 1996). The resulting presumptive diagnoses of pneumonia lead to excessive use of empiric broad spectrum antibiotics; indeed, by some estimates, 30–70% of antibiotic prescriptions for lower respiratory tract infection are inappropriate (Kraus, PLoS One 12(3): e0174584, 2017). This approach begets microbial resistance, exposes patients to medication side effects, and puts patients at risk of potentially life-threatening complications including Clostridium difficile colitis. To improve diagnostic certainty in patients with suspected pneumonia, we must begin to consider and implement emerging technologies for efficient and accurate characterization of host responses to infection and identification of pathogens. In this chapter, we will discuss precision diagnostics already in common practice and those poised to be, and how these tools may ultimately enable personalization in the diagnosis of pneumonia.
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7,406 |
TMEV and Neuroantigens: Myelin Genes and Proteins, Molecular Mimicry, Epitope Spreading, and Autoantibody-Mediated Remyelination
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The Theiler’s murine encephalomyelitis (TMEV) model has been used to study the interactions of virus, myelin and anti-neuroantigen autoimmunity, TMEV and myelin can interrelate during virus entry and persistence. On virus entry, TMEV might use peripheral myelin P0 protein as a virus receptor. For persistence, TMEV seems to require myelin functional proteins or structural myelin itself. Here, myelin and oligodendrocyte loss and downregulation of myelin genes would lead to demyelination, but might limit virus spread in the central nervous system. Unlike experimental allergic encephalomyelitis (EAE), a pathogenic role of anti-myelin autoimmunity is unclear in TMEV infection. Anti-myelin autoantibodies have been detected in TMEV infection. Among them, only anti-galactocerebroside (GC) antibody is shown to be myelinotoxic, and has molecular mimicry with TMEV. Myelin-specific T cells play no role in initiation or progression of demyelination in the first two to three months after TMEV infection. However, cellular autoimmunity against several myelin antigens (epitope spreading) can be detected during the late chronic stage. Using the TMEV model, epitope spreading and autoantibody-mediated remyelination have been investigated by recombinant TMEV and anti-neuroantigen (natural) antibodies, respectively
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7,407 |
Networks in Agent-Based Social Simulation
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Computational social science and in particular agent-based social simulation continue to gain momentum in the academic community. Social network analysis enjoys even more popularity. They both have much in common. In agent-based models, individual interactions are simulated to generate social patterns of all kinds, including relationships that can then be analyzed by social network analysis. This chapter describes and discusses the role of agent-based modeling in the generative-analytical part of this symbiosis. More precisely, we look at what concepts are used, how they are used (implemented), and what kind of validation procedures can be applied.
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7,408 |
Short Peptide Vaccine Design and Development: Promises and Challenges
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Vaccine development for viral diseases is a challenge where subunit vaccines are often ineffective. Therefore, the need for alternative solutions is crucial. Thus, short peptide vaccine candidates promise effective answers under such circumstances. Short peptide vaccine candidates are linear T-cell epitopes (antigenic determinants that are recognized by the immune system) that specifically function by binding human leukocyte antigen (HLA) alleles of different ethnicities (including Black, Caucasian, Oriental, Hispanic, Pacific Islander, American Indian, Australian aboriginal, and mixed ethnicities). The population-specific allele-level HLA sequence data in the public IMGT/HLA database contains approximately 12542 nomenclature defined class I (9437) and class II (3105) HLA alleles as of March 2015 present in several ethnic populations. The bottleneck in short peptide vaccine design and development is HLA polymorphism on the one hand and viral diversity on the other hand. Hence, a crucial step in its design and development is HLA allele-specific binding of short antigen peptides. This is usually combinatorial and computationally labor intensive. Mathematical models utilizing structure-defined pockets are currently available for class I and class II HLA-peptide-binding peptides. Frameworks have been developed to design protocols to identify the most feasible short peptide cocktails as vaccine candidates with superantigen properties among known HLA supertypes. This approach is a promising solution to develop new viral vaccines given the current advancement in T-cell immuno-informatics, yet challenging in terms of prediction efficiency and protocol development.
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7,409 |
25 Speeksel als diagnostische vloeistof
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Speekselonderzoek kan worden toegepast als hulpmiddel voor de diagnose van een aantal speekselklieraandoeningen, waaronder auto-immuunziekten zoals het syndroom van Sjögren. Verschillende ziektebeelden hebben ook invloed op speeksel en met geschikte parameters kunnen deze in de loop der tijd worden vervolgd, zoals cystische fibrose en enkele tumoren, onder andere borsttumoren. Screening van antimicrobiële afweersystemen in speeksel geeft een indicatie voor de ontvankelijkheid voor infectieziekten. Steroïdhormonen, zoals cortisol en de geslachtshormonen, kunnen nauwkeurig in speeksel worden bepaald. Van een groot aantal geneesmiddelen kunnen de kinetiek en het serumniveau doelmatig worden bestudeerd in speeksel. Drugsgebruik, het gebruik van doping en het rookgedrag kunnen betrouwbaar in speekselmonsters worden geanalyseerd. Voor forensische diagnostiek is speeksel een eenvoudig en gemakkelijk verkrijgbaar diagnosticum.
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7,410 |
Detection of Enteroviruses
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Enteroviruses are members of the Picornaviridae family and represent one of the most important water-transmitted pathogens. Detection of enteroviruses in water sources, or water-contaminated food, is a very valuable tool not only to prevent waterborne diseases but also to track down animal or human environmental viral pollution. Nowadays, molecular biology techniques allow the use of very sensitive and specific reverse-transcription polymerase chain reaction (RT-PCR) procedures to detect enteroviruses. In this chapter, using bovine enterovirus as a model, we describe procedures for enterovirus detection. Detailed descriptions of proper sample collection, storage, and processing, including methods for water concentration and solid sample extraction to obtain viral RNA, are outlined. Next, we describe methods for enterovirus detection based on virus isolation in appropriate cell culture. Finally, protocols for molecular detection of enterovirus are described, including procedures for conventional, nested, and real-time RT-PCR.
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7,411 |
Requirements for Empirical Immunogenicity Trials, Rather than Structure-Based Design, for Developing an Effective HIV Vaccine
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The claim that it is possible to rationally design a structure-based HIV-1 vaccine is based on misconceptions regarding the nature of protein epitopes and of immunological specificity. Attempts to use reverse vaccinology to generate an HIV-1 vaccine on the basis of the structure of viral epitopes bound to monoclonal neutralizing antibodies have failed so far because it was not possible to extrapolate from an observed antigenic structure to the immunogenic structure required in a vaccine. Vaccine immunogenicity depends on numerous extrinsic factors such as the host immunoglobulin gene repertoire, the presence of various cellular and regulatory mechanisms in the immunized host and the process of antibody affinity maturation. All these factors played a role in the appearance of the neutralizing antibody used to select the epitope to be investigated as potential vaccine immunogen, but they cannot be expected to be present in identical form in the host to be vaccinated. It is possible to rationally design and optimize an epitope to fit one particular antibody molecule or to improve the paratope binding efficacy of a monoclonal antibody intended for passive immunotherapy. What is not possible is to rationally design an HIV-1 vaccine immunogen that will elicit a protective polyclonal antibody response of predetermined efficacy. An effective vaccine immunogen can only be discovered by investigating experimentally the immunogenicity of a candidate molecule and demonstrating its ability to induce a protective immune response. It cannot be discovered by determining which epitopes of an engineered antigen molecule are recognized by a neutralizing monoclonal antibody. This means that empirical immunogenicity trials rather than structural analyses of antigens offer the best hope of discovering an HIV-1 vaccine.
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7,412 |
MBL Deficiency as Risk of Infection and Autoimmunity
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In pathogen recognition by C-type lectins, several levels of complexity can be distinguished; these might modulate the immune response in different ways. Firstly, the pathogen-associated molecular pattern repertoire expressed at the microbial surface determines the interactions with specific receptors (Fig. 42.1). Secondly, each immune cell type possesses a specific set of pathogen-recognition receptors. Thirdly, changes in the cell-surface distribution of C-type lectins regulate carbohydrate binding by modulating receptor affinity for different ligands. Crosstalk between these receptors results in a network of multimolecular complexes, adding a further level of complexity in pathogen recognition (Cambi and Figdor 2005; Thiel et al. 2006) (see 10.1007/978-3-7091-1065-2_23). MBL deficiency is genetically determined and predisposes to recurrent infections and chronic inflammatory diseases. MBL deficiency has been implicated in susceptibility and course of viral, bacterial, fungal, and protozoan infection. More than 10% of the general population may, depending on definition, be classified as MBL deficient, underlining the redundancy of the immune system. MBL-disease association studies have been a fruitful area of research, which implicates a role for MBL in infective, inflammatory and autoimmune disease processes. MBL deficiency predisposes both to infection by extra-cellular pathogens and to autoimmune disease.
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7,413 |
Pooling Experiments for Blood Screening and Drug Discovery
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Pooling experiments date as far back as 1915 and were initially used in dilution studies for estimating the density of organisms in some medium. These early uses of pooling were necessitated by scientific and technical limitations. Today, pooling experiments are driven by the potential cost savings and precision gains that can result, and they are making a substantial impact on blood screening and drug discovery. A general review of pooling experiments is given here, with additional details and discussion of issues and methods for two important application areas, namely, blood testing and drug discovery. The blood testing application is very old, from 1943, yet is still used today, especially for HIV antibody screening. In contrast, the drug discovery application is relatively new, with early uses occurring in the period from the late 1980s to early 1990s. Statistical methods for this latter application are still actively being investigated and developed through both the pharmaceutical industries and academic research. The ability of pooling to investigate synergism offers exciting prospects for the discovery of combination therapies.
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7,414 |
Bronchiolite e asma
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La letteratura internazionale ha recentemente riconosciuto la mancanza di confini netti fra bronchiolite (BR), wheezing (WH), o respiro sibilante, e asma.
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7,415 |
Journalismus und PR als Seismographen und Frühwarnsysteme?
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Wie so oft, klaffen normative Erwartungen und empirische Befunde im Journalismus und in der PR auch in Bezug auf deren Seismographen- und Frühwarnfunktion weit auseinander. Sowohl Journalisten selbst als auch Kommunikationsforscher haben immer wieder die aufklärende Rolle des Journalismus herausgearbeitet und allen Ernstes gehofft, der Journalismus könnte halbwegs verlässlich — oder zumindest verlässlicher als andere gesellschaftliche Subsysteme — vor Gefahren, vor sich anbahnenden Krisen und Katastrophen warnen.
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7,416 |
Toxoplasmose
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7,417 |
7 Ademhaling
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Om ziekteprocessen die zich afspelen in de longen, luchtwegen en longvliezen (pleurae) te kunnen begrijpen en de gevolgen ervan voor het functioneren van het lichaam te kunnen inschatten, is kennis nodig van de normale anatomie van de thoraxinhoud en de fysiologie van het functioneren van de long. Deze is te vinden in het boek Fysiologie en Anatomie uit de serie Basiswerken, waarnaar wordt verwezen. Alleen waar nodig zal er in het kort even op worden ingegaan.
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7,418 |
Nonrestorative Sleep, Musculoskeletal Pain, Fatigue in Rheumatic Disorders, and Allied Syndromes: A Historical Perspective
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This chapter provides a historical perspective of the notion that the sleeping–waking brain is intimately related to complaints of unrefreshing sleep, widespread musculoskeletal pain, fatigue, and suffering. Such a constellation of symptoms extend from the remote biblical past, and involve various religious and cultural belief systems up to the recent evolution in Western medicine application of scientific methods for classification of illness. The contemporary application of scientific principles is directed to the etiology of diseases and to derive procedures for the management of such ill-understood illnesses. Historically, this constellation of rheumatic pain and fatigue symptoms have been given ever-changing medical and psychiatric labels that have been devoid of satisfactory medical understanding. In this chapter, the hypothesis that the sleeping/waking brain is integral to the somatic and behavioral symptoms of these disabling rheumatic chronic illness, termed fibromyalgia and various allied disorders, that are being examined and treated by a variety of health care professionals. Contemporary advances in mechanisms of how the sleeping–waking brain connects to these somatic and behavioral symptoms are reviewed. Potential avenues for further scientific understanding are described. Advances in such understanding are influencing current pharmacological and behavioral management of these suffering patients.
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7,419 |
Surfactant metabolism: factors affecting lipid uptake in vivo and in vitro
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7,420 |
Patterns and Trends in Semantic Predications
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We demonstrate a series of studies of semantic predications from Semantic MEDLINE, including the detection of semantic predications with burstness and in association with conflict, contradictory, or other sources of uncertainties of scientific knowledge. Semantic networks of predications are analyzed within the framework of structural variations. Examples in this chapter represent scientific knowledge at a level of granularity that differs from those studies of scientific knowledge at the level of articles or journals of scholarly communication.
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7,421 |
Bio-kernel Self-organizing Map for HIV Drug Resistance Classification
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Kernel self-organizing map has been recently studied by Fyfe and his colleagues [1]. This paper investigates the use of a novel bio-kernel function for the kernel self-organizing map. For verification, the application of the proposed new kernel self-organizing map to HIV drug resistance classification using mutation patterns in protease sequences is presented. The original self-organizing map together with the distributed encoding method was compared. It has been found that the use of the kernel self-organizing map with the novel bio-kernel function leads to better classification and faster convergence rate ...
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7,422 |
Food Virology: Past, Present, and Future
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7,423 |
Vaccines and Vaccination
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Livestock vaccines aim to increase livestock product and improve the health and welfare of livestock animals in a cost-efficient manner and prevent disease transmission. Successful livestock vaccines have been generated for pathogens including bacterial, viral, protozoan, and multicellular pathogens. These livestock vaccines have a significant effect on animal health and products and on human health through growing safe food procurement and preventing zoonotic diseases. There are successful production of biotechnological-based animal vaccines licensed for use that include virus-like particle vaccines, gene-deleted marker vaccines, subunit vaccines, DIVA vaccines, and DNA vaccines.
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7,424 |
Vasculitides: F. Kawasaki’s Disease
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Kawasaki’s disease (KD), once known as mucocutaneous lymph node syndrome, is a systemic inflammatory disorder occurring in children that is accompanied by vasculitis and a risk of coronary artery aneurysms. Other typical features of KD include spiking fevers, cervical lymphadenopathy, conjunctivitis, erythematous changes on the lips and in the oral cavity, dryness and cracking of the lips, a strawberry appearance to the tongue, and a polymorphous rash. Eighty percent of KD cases occur in children less than 5 years of age. Attempts to link KD definitively to some types of infection, particularly ones associated with superantigens, have thus far been unsuccessful. High dose aspirin and intravenous immune globulin (IVIG) are the cornerstones of therapy in KD. IVIG is essential to the prevention of coronary aneurysms. ■ Years after KD has occurred during childhood years, some cases of myocardial infarction caused by thrombosis of coronary aneurysms have been reported.
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7,425 |
Livestock husbandry as a tool for carnivore conservation in Africa’s community rangelands: a case–control study
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Conflict between people and wildlife is a major issue in both wildlife conservation and rural development. In African rangelands, species such as African wild dogs (Lycaon pictus), cheetahs (Acinonyx jubatus), lions (Panthera leo), leopards (Panthera pardus), and spotted hyaenas (Crocuta crocuta) may kill livestock and are therefore themselves killed by local pastoralists. Such conflict has led to the extirpation of these species from many areas, and also impacts the livelihoods of local livestock farmers. To investigate the possibilities for coexistence of people, livestock, and large predators in community rangelands, we measured the effectiveness of traditional livestock husbandry in reducing depredation by wild carnivores, using a case–control approach. Different measures were effective against different predator species but, overall, the risk of predator attack by day was lowest for small herds, accompanied by herd dogs as well as human herders, grazing in open habitat. By night, the risk of attack was lowest for herds held in enclosures (‘bomas’) with dense walls, pierced by few gates, where both men and domestic dogs were present. Unexpectedly, the presence of scarecrows increased the risks of attack on bomas. Our findings suggest that improvements to livestock husbandry can contribute to the conservation and recovery of large carnivores in community rangelands, although other measures such as prey conservation and control of domestic dog diseases are also likely to be necessary for some species.
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7,426 |
Biological systems: Applications and perspectives
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Viable biological systems occur on a wide scale of dimensions ranging from sizes of 30 meters for mammals (blue whale), and 120 meters for plants (sequoia tree), down to 10(−6) meters for single cellular organisms.
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7,427 |
3 Ziektebeelden
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Patiënten kunnen zich melden met de zorg dat ze een besmettelijke aandoening opgelopen hebben na een ‘prikaccident’ of onveilig seksueel contact. Denk echter ook aan de mogelijkheid tot overdracht van een infectieziekte na bijvoorbeeld trauma of een bijtwond.
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7,428 |
Dermatologic Emergencies
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Prompt diagnosis and treatment of dermatologic emergencies in cancer patients decrease both morbidity and mortality. However the overlapping clinical presentations, complex medical and surgical comorbidities, and numerous medications often complicate diagnosis. Some dermatologic emergencies are primarily reactive and require immunosuppression such as pyoderma gangrenosum (PG) while others are a sign of systemic infection and require antimicrobials, such as staphylococcal scalded skin syndrome. Many primary inflammatory disorders, such as Steven–Johnson syndrome (SJS), can develop secondary infections and further complicate diagnosis and management. This chapter reviews the most common dermatologic emergencies seen in cancer patients, diagnostic dilemmas, and treatment options. Typical cases with photographs are also presented.
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7,429 |
Five Years of Increasing Structural Biology Throughput - A Retrospective Analysis
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7,430 |
Respiratory Infection in Immunocompromised Neutropenic Patients
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Neutropenia is increasingly common in the hospital. The rise in incidence is due to proliferation of indications for and centers performing hematopoietic stem cell transplantation, hematologic effects of AIDS, and myelosuppressive side-effects of anti-viral and cancer chemotherapies (Table 39.1). As a result, these neutropenic patients are increasingly common in the intensive care units. These patients are often lymphopenic, anemic, and thrombocytopenic. They are at risk for multiple organ failures and various infections. This chapter will focus on respiratory infections in the neutropenic patient.
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7,431 |
Depressive und Angststörungen bei somatischen Krankheiten
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Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.
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7,432 |
Safety and Security Regulations Against Biological Threats
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Biological threat agents include bacteria, viruses, fungi, parasites and their associated toxins. They have the ability to harmfully affect human health ranging from an allergic reactions to serious illnesses, even death. Water, soil, air, plants or animals can be a suitable habitat for their live and proliferation. Because biological agents may reproduce rapidly and initially unnoticed, need minimal resources to survive and can infect at very small doses they can be used as biological warfare agent or bioweapon. Genetic modification may enhance their hazardous and lethal properties, or develop resistance to conventional treatments. In effect, to protect people from dangerous biological agents as well as protect biological agents from intentional malicious acts both, biological safety and biological security measures should be implemented and respected. Because of wide scale of risks caused by biological agents, biosafety and biosecurity issues should be interpreted on many fields taking as priority protection of human beings and their surrounding environment. The reader will familiarize with different point of views on biosafety and biosecurity issues in relation to occupational health and safety, public health and disease surveillance, biodiversity protection, genetic modification of microorganisms, transportation of dangerous goods, storage control of biological agents, dual-use technology, education and awareness raising, weapon of mass destruction threats and bioterrorism acts. The main international agreements, the European Union regulations and principles supporting implementation of national legislation concerning biosafety and biosecurity areas are presented. The role of legally and not-legally binding instruments is highlighted, as well.
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7,433 |
Inhibitoren für Hydrolasen mit Acylenzym-Zwischenstufe
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Peptidasen und Esterasen sind hydrolysierende Enzyme. Alleine 2–3 % aller Genprodukte werden dieser Gruppe zugeordnet. Daher sind sie eine wichtige Gruppe von Zielproteinen für den Entwurf neuer Arzneistoffe und haben besondere Bedeutung für das strukturbasierte Wirkstoffdesign. Dies zeigt sich nicht alleine dadurch, dass zurzeit etwa 14 % aller bekannten humanen Peptidasen als mögliche Zielstrukturen für eine Arzneimitteltherapie geprüft werden.
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7,434 |
Methods for Gene Delivery
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The success of any gene transfer procedure, either through in vivo inoculation of the genetic material or after gene transfer into the patient’s cells ex vivo, strictly depends upon the efficiency of nucleic acid internalization by the target cells. As a matter of fact, making gene transfer more efficient continues to represent the most relevant challenge to the clinical success of gene therapy.
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7,435 |
Fungal Infections
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Older adults are at increased risk of developing opportunistic fungal infections because organ transplantation, intensive cancer chemotherapy regimens, and anti-tumor necrosis factor agents are now used more commonly, and because admission to an intensive care unit, which carries many risk factors for fungal infection, has become commonplace in this group. Candida species are the most common cause of opportunistic fungal infections, and bloodstream infections are usually treated with fluconazole or an echinocandin antifungal agent. Invasive mold infections are mostly caused by Aspergillus species; in older adults, they cause primarily pulmonary and sinus infections, and they are associated with a high mortality rate. The endemic fungi, Histoplasma capsulatum, Coccidioides species, and Blastomyces dermatitidis, cause infection when the mold form is dispersed and inhaled from the environment in those specific areas of the country in which these organisms flourish. Amphotericin B is used for initial treatment of severe histoplasmosis, coccidioidomycosis, and blastomycosis; itraconazole is the therapy of choice for most mild to moderate infections due to these endemic mycoses.
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7,436 |
Bildgebende Verfahren: Röntgen, Ultraschall, CT, Nuklearmedizin
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In der Intensivmedizin findet die radiologische Diagnostik überwiegend am Krankenbett statt (»bedside radiology«). Etwa 90% der radiologischen Untersuchungen in der Intensiv- und Notfallmedizin stellen projektionsradiographische Röntgenaufnahmen des Thorax, des Abdomens und des Skelettsystems dar. In zunehmendem Maße werden neben den klassischen Aufnahmen auch die Schnittbildverfahren eingesetzt. Hier kommt der Ultraschalldiagnostik eine führende Rolle zu, gefolgt von der Computertomographie (CT).
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7,437 |
Public Health Surveillance: A Vital Alert and Response Function
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Ungchusak, Heymann and Pollack address the critical global issue of public health surveillance. They describe how epidemiologists collect and use surveillance data to detect unusual events or outbreaks and to guide control programmes. Drawing on their combined international experience, the authors explain the vital role that data play in alerting authorities to respond to outbreaks such as Severe Acute Respiratory Syndrome, Ebola, Zika virus and Avian influenza. They point to the importance of sharing information globally while ensuring equal benefits to providers of data, coordinating surveillance activities across sectors, building capacity for surveillance and coordinating national surveillance activities. The authors emphasise the need for enhanced global cooperation to prepare for future public health emergencies of international concern.
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7,438 |
Hematologic Emergencies in the PICU
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The pediatric critical care physician is frequently challenged by hematologic abnormalities in critically ill children admitted to the pediatric intensive care unit (PICU). The challenge is to differentiate between primary hematologic emergencies that require critical care interventions and abnormalities secondary to other disease conditions. It is therefore necessary for the pediatric critical care physician to collaborate with the pediatric hematologist when managing such patients. This chapter summarizes some of the most common hematologic emergencies of red blood cell (RBC), white blood cell (WBC), or platelet disorders observed in critically ill children that may require attention of the pediatric critical care physician.
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7,439 |
Preventieve gezondheidszorg
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Voorkomen is beter dan genezen, is een veelgehoorde uitspraak. Preventie heeft als doel ervoor te zorgen dat mensen gezond blijven door enerzijds de gezondheid te bevorderen en anderzijds de gezondheid te beschermen. Dit kan bereikt worden door ziekten en aandoeningen te voorkomen of in een vroeg stadium op te sporen en door complicaties van ziekten te voorkomen. Maar het bevorderen van gezondheid moet ook in de bredere context van de definitie van de World Health Organisation van gezondheid gezien worden: preventie heeft als doel om te bevorderen dat mensen optimaal functioneren, zowel fysiek als mentaal als sociaal. De algehele kwaliteit van leven staat daarbij centraal.
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7,440 |
Infectious Lung Diseases and Endogenous Oxidative Stress
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Lower respiratory tract infections, according to the World Health Organization, account for nearly one third of all deaths from infectious diseases. They account for approximately 4 million deaths annually including children and adults and provide a greater disease burden than HIV and malaria. Among the common respiratory diseases, tuberculosis, influenza, and pneumonia are very common and can be life threatening if not treated properly. The causative agent of tuberculosis is the slow-growing bacilli Mycobacterium tuberculosis, while the causative agent of influenza is a segmented genome RNA virus. Pneumonia can be caused by a number of different microorganisms like bacteria, virus, and mycoplasma. In case of the entry of a pathogen in our body, the immune system gets activated, and the phagocytic cells try to eliminate it by generating reactive oxygen and nitrogen species (ROS and RNS) inside the phagosome. These reactive species or respiratory bursts are sufficient to eliminate most of the pathogens, except a few. M. tuberculosis is one such microorganism that has evolved mechanisms to escape this respiratory burst-mediated killing and thus survive and grow inside the macrophages. Infection with M. tuberculosis leads to the destruction of macrophages and release of cytokines, which lead to prolonged immune activation and oxidative stress. In some cases, the bacilli remain dormant inside macrophages for a long time. Flu viruses infect the epithelial cells present in respiratory tract, and the infection site is dependent on the hemagglutinin protein present on their capsid. Destruction of epithelial cells promotes secretion of mucus and activation of immune system leading to the oxidative damage. Community-acquired pneumonia is more serious and difficult to treat. In all these infections, ROS/RNS are developed as a defense mechanism against the pathogen. Persistence of the pathogen for a long time would lead to the uncontrolled production of ROS/RNS which will lead to oxidative stress and tissue damage to the host. Administration of antioxidants along with conventional treatments can be useful in the elimination of the reactive oxygen and nitrogen species.
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7,441 |
Molecular Virology
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This chapter describes common viral pathogens in humans with emphasis on the molecular diagnosis. Each section includes molecular characteristics, clinical presentation, and commonly used diagnostic methods (both conventional and molecular). Commercially available molecular diagnostic kits are preferentially described. Recommendations and guidelines (if available) for result interpretation and clinical approach are also included. For detailed methods, please refer to the chapter “Methodology and Instrumentation” in this book.
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7,442 |
War, Refugees, Migration, and Public Health: Do Infectious Diseases Matter?
| null |
7,443 |
Tick-Borne Bacterial, Rickettsial, Spirochetal, and Protozoal Diseases
|
Approximately 900 tick species exist worldwide, parasitizing a broad array of mammals, including humans, and thereby playing a significant role in the transmission of infectious diseases (1). In the United States, tick-borne diseases are generally seasonal and geographically distributed. They occur mostly during the spring and summer but can occur throughout the year.
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7,444 |
Pathophysiology of Acute Illness and Injury
|
The pathophysiology of acute illness and injury recognizes three main effectors: infection, trauma, and ischemia-reperfusion injury. Each of them can act by itself or in combination with the other two in developing a systemic inflammatory reaction syndrome (SIRS) that is a generalized reaction to the morbid event. The time course of SIRS is variable and influenced by the number and severity of subsequent insults (e.g., reparative surgery, acquired hospital infections). It occurs simultaneously with a complex of counter-regulatory mechanisms (compensatory anti-inflammatory response syndrome, CARS) that limit the aggressive effects of SIRS. In adjunct, a progressive dysfunction of the acquired (lymphocytes) immune system develops with increased risk for immunoparalysis and associated infectious complications. Both humoral and cellular effectors participate to the development of SIRS and CARS. The most important humoral mediators are pro-inflammatory (IL-1β, IL-6, IL-8, IL-12) and anti-inflammatory (IL-4, IL-10) cytokines and chemokines, complement, leukotrienes, and PAF. Effector cells include neutrophils, monocytes, macrophages, lymphocytes, and endothelial cells. The endothelium is a key factor for production of remote organ damage as it exerts potent chemo-attracting effects on inflammatory cells, allows for leukocyte trafficking into tissues and organs, and promotes further inflammation by cytokines release. Moreover, the loss of vasoregulatory properties and the increased permeability contribute to the development of hypotension and tissue edema. Finally, the disseminated activation of the coagulation cascade causes the widespread deposition of microthrombi with resulting maldistribution of capillary blood flow and ultimately hypoxic cellular damage. This mechanism together with increased vascular permeability and vasodilation is responsible for the development of the multiple organ dysfunction syndrome (MODS).
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7,445 |
Tracheobronchitis
| null |
7,446 |
Demographic and Epidemiological Perspectives of Human Movement
| null |
7,447 |
Specificity And Affinity
|
The hallmark of lectins is the ability to bind carbohydrates specifically and reversibly. Understanding the properties and functions of lectins, as well as using them for diverse purposes, requires knowledge of this specificity, which is the major topic of the present chapter. Several lectins combine also with non-carbohydrate ligands, either at their carbohydrate binding sites or at sites distinct from the latter. A few others possess enzymatic activity unrelated to their carbohydrate specificity. These will be discussed briefly at the end of the chapter.
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7,448 |
Cell Regeneration in Lung Injury
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The acute respiratory distress syndrome (ARDS) is a lethal inflammatory disorder of the lung. Its incidence is estimated at 75 cases per 100,000 population and appears to be increasing [1]. Even with optimal treatment, mortality is about 30% [1–3]. As such, ARDS represents a major public health problem. The effects of two recent crises created by unusual viral infections of the respiratory tract — the severe acute respiratory syndrome (SARS) epidemic caused by the novel SARS coronavirus [4, 5] and the bird flu [6] highlight the importance of research into ARDS. Both viruses cause an ARDS-like picture. Because lung repair and regeneration contribute substantially to the pathophysiology of ARDS, understanding these processes is essential [7]. This chapter focuses on specific cell populations and markers involved in cell division and regeneration. In addition, a brief review of two pathways intimately associated with cell division is provided because of their potential for pharmacologic manipulation.
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7,449 |
Exploring the Linkages Between Ecosystems and Human Health
|
The linkages between human health and ecosystems are complex, dynamic, and political. For millennia ecosystems have provided humans with essential services such as food, water, shelter and medicine. At the same time, they have mediated the transmission of many diseases and posed a number of health risks. The vitality of ecosystem services for human health and well-being is well captured by Bernard Abraham, President of Weskit-Chi Aboriginal Trappers Association, when he commented on the importance of forest ecosystems to Aboriginal people. He observed that many Aboriginal people consider the forest as: “their food bank, drugstore, meat market, bakery, fruit and vegetable stand, building material centre, beverage supply, and the habitat for all of the creator’s creatures.”(1)
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7,450 |
The Role of Influenza Vaccination in Asthmatic Children
|
Asthma is the most occurring chronic disease in children. Asthma related genes and environmental factors play a role in the etiology. Nowadays, asthma is regarded as a chronic inflammatory disease of the airways instead of solely a reversible airway obstruction. Asthma is often diagnosed on specific symptoms such as chest tightness, wheezing, dyspnea, and coughing. It is likely that, rather than a single disease entity, asthma consists of related, partially overlapping syndromes. The first symptoms often are experienced before the age of 5. Children with the highest risk have a family history of atopy and/or asthma. Viral infections with symptoms of wheezing acquired in the first year of life may be associated with the risk of developing asthma later on [1]. However, making the diagnosis with a reasonable certainty that is supported by spirometry is only possible from the age of 6 onward. More than 50% of children with a period of wheezing earlier on in life are not diagnosed as having asthma at the age of 6 [2]. The use of rescue and anti-inflammatory medication has largely altered the prospects of asthma patients and has improved their quality of life. Thus, nowadays, most asthma patients lead a normal life without restrictions. Disease control achieved by the asthmatics is an important predictor of the likelihood of complications of the disease [3]. However, asthma exacerbations neither respond to inhaled steroids nor can they substantially be prevented in this way [4, 5]. Only the use of oral corticos-teroids seems to be unmistakably effective in case of exacerbations [6, 7].
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7,451 |
Sudden Death from Pulmonary Causes
|
This chapter seeks to survey many of the common pathological entities identified in the lungs at autopsy and the potential role of pulmonary disease in formulating an opinion regarding the cause of death. Appreciation of pulmonary pathology in the medicolegal context is important as it frequently contributes to the immediate or underlying mechanisms of death. The primacy of the lungs in breathing and their coordinated function with the cardiovascular system means that pulmonary failure can rapidly compromise tissue oxygenation and body chemistry, leading to an alteration in blood pH, hypoxic damage to downstream tissues and ultimately multiorgan failure and death. Moreover, given that the lungs have direct contact with the environment through inhalation and receive approximately 50% of the cardiac output with each beat of the heart, they may be adversely affected by hazardous agents from the outside world or other pathologic processes not primarily located in the lungs. The range of topics discussed herein is limited by design to deaths due to disease and largely foregoes discussion of more forensically relevant issues relating to toxicology or trauma. Furthermore, the content and format of this chapter is not intended to be encyclopedic, but rather attempts to highlight selected issues regarding pulmonary disease of potential relevance to surgical or forensic pathologists who perform medicolegal postmortem examinations.
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7,452 |
Mining Good Sliding Window for Positive Pathogens Prediction in Pathogenic Spectrum Analysis
|
Positive pathogens prediction is the basis of pathogenic spectrum analysis, which is a meaningful work in public health. Gene Expression Programming (GEP) can develop the model without predetermined assumptions, so applying GEP to positive pathogens prediction is desirable. However, traditional time-adjacent sliding window may not be suitable for GEP evolving accurate prediction model. The main contributions of this work include: (1) applying GEP-based prediction method to diarrhea syndrome related pathogens prediction, (2) analyzing the disadvantages of traditional time-adjacent sliding window in GEP prediction, (3) proposing a heuristic method to mine good sliding window for generating training set that is used for GEP evolution, (4) proving the problem of training set selection is NP-hard, (5) giving an experimental study on both real-world and simulated data to demonstrate the effectiveness of the proposed method, and discussing some future studies.
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7,453 |
Spectators and Victims: Between Denial and Projection
|
This chapter goes into the unproductive metamorphosis of fear, and analyses the defence mechanisms that it generates: namely denial and projection. In the case of global risks, fear provokes self-defensive strategies based on denial (in the face of the nuclear challenge) and self-deception (in the face of global warming); and, in the case of the threat of the other, projective and persecutory strategies based on reactivating the dynamic of the ‘scapegoat’. They are two contrasting but specular responses which, at the emotional level, reflect the divarication between (unlimited) individualism and (endogamous) communitarianism. The first, implosive response converts into an absence of fear, attested to above all by the figure of the global spectator, while the second, explosive response converts into an excess of fear (fear of the other, fear of contamination), fuelled by forms of reinventing community. These responses are defined as irrational since in the first case they inhibit the spectator’s capacity to recognize himself as also a potential victim of the threats, thus preventing his mobilization, and in the second case they give rise to dynamics of demonization-dehumanization of the other, which result in a spiral of violence and impede forms of solidarity.
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7,454 |
Basics of Molecular Biology
|
Molecular biology is the study of biology on molecular level. The field overlaps with areas of biology and chemistry, particularly genetics and biochemistry. Molecular biology chiefly concerns itself with understanding the interactions between the various systems of a cell, including the interactions between DNA (deoxyribonucleic acid), RNA (Ribonucleic acid) and protein biosynthesis as well as learning how these interactions are regulated([1]).
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7,455 |
Effectiveness of Vaccination Strategies for Infectious Diseases According to Human Contact Networks
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A ‘contact network’ modeling infection transmission comprises of nodes (or individuals) that are linked when they are in contact that possibly transmits an infection. We here studied infection transmission on contact networks of various degree distributions—scale-free, exponential and constant—under SIRV model assuming susceptible, infected, removed and vaccinated statuses of nodes. Aiming for infectious disease containment within the very early stage of spreading, we computed the minimum transmissibility at which an infectious disease epidemic begins to emerge, and its change according to mass preventive and ring post-outbreak vaccination. In the most degree-heterogeneous scale-free network, the ‘super-spreading’ by the hubs, or high-degree nodes, allowed epidemics even for low transmissibility. In compensation, vaccination was much more efficient for the scale-free network. We also found that basic reproductive number R (0) defines a measurement of epidemic emergence universally applicable to networks of various degree distributions. These results are significant for public health design.
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7,456 |
Zoonotic Infections and Biowarfare Agents in Critical Care: Anthrax, Plague, and Tularemia
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Bacterial zoonotic infections are rare in developed countries in the twenty-first century but may cause major morbidity and mortality in developing regions of the world. In addition, their potential use as biological weapons makes early recognition and effective empiric therapy important for the critical care practitioner. Anthrax, plague, and tularemia share overlapping presenting syndromes, including fulminant respiratory infections and less severe but still highly morbid lymphocutaneous infections. Although all three may be transmitted as infectious aerosols, only plague has a risk of direct human-to-human transmission. Diagnostic testing will require special precautions for laboratory staff and most often involvement of regional and national reference laboratories. Empiric therapy with aminoglycosides may be life-saving for plague and tularemia, while the treatment of anthrax is complex and varies depending on the site of infection. In outbreaks or for post-exposure prophylaxis, treatment with doxycycline or a fluoroquinolone is recommended for all three diseases.
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7,457 |
Role of Analytics in Viral Safety
|
In summary, this chapter reviews the principles of how the current and routine tests detect adventitious agents, and reviews how novel and emerging methods differ in their detection principles. These facets may permit novel methods to emerge to supplement, refine, or replace the routine methods. We have suggested a framework for risk assessment to assure biosafety in vaccines and suggested quantitative modeling to help crystallize thinking about the place of testing, either routine or novel, in this assurance. We assert that testing for adventitious agents should not be the sole basis on which product biosafety is assured. Appropriate sourcing and quality control of raw and starting materials, adherence to principles of Good Manufacturing Practices, including environmental and personnel monitoring and process validation, and finally, testing as verification are the package needed for maximal assurance of biosafety. Thus, a pathway forward to a new paradigm for adventitious agent testing exists in which detection of a broader array of potential adventitious agents might be included in the testing, with adequate sensitivity to provide the needed assurance of verification that there has been no catastrophic breach, in the context of the overall process, design, and adherence to cGMP. Furthermore, it is our hope that we may be able to implement the 3 Rs policy to reduce, replace, and/or refine the use of animals in product safety testing, at the same time that we provide greater assurance of the biosafety of vaccines.
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7,458 |
Betaferon® – Ab Ovo
|
Es war einmal der Wunsch, die Replikation von Viren besser zu verstehen oder gar zu entschlüsseln, um wirksame Präparate gegen virale Erkrankungen zu entwickeln. Paul Ehrlich hatte bereits 1908 die antibakterielle Wirkung von Arsphenamin und damit das erste Medikament gegen Syphilis, Alexander Fleming 1928 das Penicillin und Gerhard Domagk 1935 die Sulfonamide entdeckt. Alle drei erhielten für ihre Entdeckungen Nobelpreise und retteten mit ihren Entwicklungen wahrscheinlich Millionen von Menschen das Leben.
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7,459 |
The Rationality of Science in Relation to its History
|
Many philosophers have thought that Kuhn’s claim that there have been paradigm shifts introduced a problem for the rationality of science, because it appears that in such a change nothing can count as a neutral arbiter; even what you observe depends on which theory you already subscribe to. The history of science challenges its rationality in a different way in the pessimistic induction, where failures of our predecessors to come up with true theories about unobservable entities is taken by many to threaten the rationality of confidence in our own theories. The first problem arises from a perception of too much discontinuity, the second from an unfortunate kind of continuity, in the track record of science. I argue that both problems are only apparent, and due to under-description of the history. The continuing appeal of the pessimistic induction in particular is encouraged by narrow focus on a notion of method that Kuhn was eager to resist.
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7,460 |
Cutaneous, Subcutaneous and Systemic Mycology
|
The first description of dermatophytosis was recorded by Celsus, a Roman encyclopaedist who described a suppurative infection of scalp (‘porrigo’ or ‘kerion of Celsus’) in De Re Medicina (30 A.D.). Throughout the middle ages, several descriptions of dermatophytosis were produced where it is described as ‘tinea’. The keratin-destroying moths which made circular holes in the woollen garments are known as Tinea. Due to similarity in the structure of circular lesion of dermatophytosis on the smooth skin with the circular hole made by moth, Cassius Felix introduced the term ‘tinea’ to describe the lesions. In 1806, Alibert used the term ‘favus’ to describe the honey-like exudate in some scalp infections. However, the fungal aetiology of tinea was first detected by Robert Remak, a Polish physician who first observed the presence of hyphae in the crusts of favus. This detection is also a landmark in medical history because this is the first description of a microbe causing a human disease. He himself did not publish his work, but he permitted the reference of his observations in a dissertation by Xavier Hube in 1837. Remak gave all the credits of his discovery to his mentor Schoenlein who first published the fungal etiological report of favus in 1839. He observed the infectious nature of the favus by autoinoculation into his own hands and also successfully isolated the fungus later (1945) and named Achorion schoenleinii (Trichophyton schoenleinii) in honour of his mentor. In 1844, Gruby described the etiologic agent of tinea endothrix, later became known as Trichophyton tonsurans. The genus Trichophyton was created and described by Malmsten (1845) with its representative species T. tonsurans. Charles Robin identified T. mentagrophytes in 1847 and T. equinum was identified by Matruchot and Dassonville in 1898. Raymond Jacques Adrien Sabouraud (France) first compiled the description of Trichophyton in his book (Les Teignes) in 1910 which was based on his observation in artificial culture. The sexual state of dermatophyte was described by Nannizzi (1927). Emmons (1934) first reported the classification of dermatophytes based on vegetative structures and conidia. Gentles (1958) established the successful treatment of tinea capitis with griseofulvin.
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7,461 |
Spatial Analysis of the 2008 Influenza Outbreak of Hong Kong
|
The deaths of three children amid a series of recent influenza outbreaks in early March 2008 resulted in the immediate shut down of all kindergartens and primary schools in Hong Kong. While many parents welcome the decision, others queried the judgment given that citizens lack sufficient information to evaluate whether there is an outbreak and must follow actions prescribed by the government. We demonstrated in this paper various techniques to visualize disease distribution and present outbreak data for public consumption. Our analyses made use of affected (case) and non-affected (control) schools with influenza cases in March 2008. A series of maps were created to show disease spread and concentration by means of standard deviational ellipses, grid-based spatial autocorrelation, and kernel density. The generalized data did not permit statistical analysis other than the nearest neighbor distance. We also made suggestions about requirements of additional data and possible directions of disease analysis.
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7,462 |
The Neutrophil
|
The neutrophil provides a crucial defence against fungal infections. This numerous phagocyte is recruited rapidly to sites of infection, where it detects pathogens through a range of pathogen-recognition receptors. Phagocytosis and the generation of a range of microbicidal molecules neutralises the pathogen, following which neutrophil death by apoptosis triggers an injury-limiting resolution process facilitating the restoration of normal tissue architecture
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7,463 |
Viruses in the Intensive Care Unit (ICU)
|
Whereas viruses are not usually considered to be important causes of ICU admission this review has demonstrated this perception to be incorrect. Viruses and their manifestations differ from continent to continent and hemisphere to hemisphere and it is essential that the intensivist be familiar with diagnosis and management of these ubiquitous organisms.
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7,464 |
Bushmeat
|
Since Homo erectus, an ancient ancestor of the modern human, was discovered to have evolved from Africa 2 million years ago, animals have been hunted for their skin and meat . Animal meat is a nutritious, a convenient, and an easily accessible source of protein in the diet. However, over the turn of the last century, a sharp increase in widespread human populations, clusters of extreme poverty in areas surrounded by wildlife, and highly profitable trade revenues have exploited bushmeat at an unprecedented level. It is at a point now whereby some species are on the brink of extinction, and others will follow suit unless a drastic change occurs. This case study will focus on the ethical demand for bushmeat, focusing on the UK and European markets, and zoonotic diseases that have caused a major threat to the existence of human and animals alike.
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7,465 |
Progettazione e sicurezza del paziente
|
Il termine design ha molti significati; più in generale si pensa al disegno di una forma, di una figura o di una struttura. Per i progettisti, tuttavia, il termine implica un significato più ampio: “creare e sviluppare concetti e caratteristiche che ottimizzino la funzione, il valore e l’aspetto di prodotti e sistemi” (Ulrich, Eppinger, 1995). La progettazione di un processo o di una tecnologia clinica implica, dunque, una fondamentale revisione di un prodotto o di un sistema. Più che cercare di apportare qualche miglioramento marginale, un progettista tende a raffigurarsi il prodotto partendo da zero, ricorrendo alla comprensione del modo naturale in cui gli esseri umani lavorano e interagiscono con la tecnologia. Per contro, l’espressione “miglioramento del processo” suggerisce che il processo in questione presenta alcune carenze, ma che è abbastanza robusto e funzionale. È chiaro, tuttavia, che alcuni processi e sistemi sanitari si sono sviluppati in maniera tale che il miglioramento non è più una soluzione sufficiente. È capitato, per esempio, che un team abbia desistito dall’analisi del sistema di gestione dei farmaci in uso nel proprio ospedale perché era talmente complicato che nessuno riusciva a comprenderlo effettivamente.
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7,466 |
Ergebnisse
|
Nachfolgend werden die Ergebnisse der vier einzelnen Untersuchungen zunächst wertfrei dargelegt, d. h. die Inhalte dieses Kapitels entsprechen den Sichtweisen der Behörden bzw. der Journalisten. Die Bewertung der Ergebnisse erfolgt in Kapitel 9. Zuerst werden die Ergebnisse zur behördlichen Risiko- und Krisenkommunikation (Kap. 8.1, 8.2) ausgeführt, anschließend die zur medialen Logik im Kontext von Risiken und Krisen (Kap. 8.3, 8.4). Die Ergebnisse werden in Anlehnung an die Forschungsfragen der Arbeit und die sich daraus ableitenden Kategoriensysteme dargestellt.
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7,467 |
Cytogenetic and Carcinogenic Effects of Exposure to Radiofrequency Radiation
|
Radiofrequency radiation (RFR) is a portion of the electromagnetic spectrum with frequencies of 3 kHz–300 GHz. RFR is produced by many man-made sources, including mobile phones and base stations, television and radio broadcasting facilities, radar, medical equipment, microwave ovens, radiofrequency heaters as well as a diverse variety of other electronic devices within our living and working environments. Owing to ongoing public concern and the increasing prevalence of RFR-emitting devices, a great deal of research has been conducted over the past 50 years to evaluate the biological and/or health effects of thermalizing and non-thermalizing RFR exposures. In the absence of decisive epidemiological evidence to support or refute an association between RFR exposure and cancer risk, laboratory studies of possible mechanisms of carcinogenesis by RFR are important. The scientific literature on this subject is full of conflicting results and the question of whether RFR exposure can contribute to cancer risk remains unresolved. This chapter contains a literature review of the evidence for RFR-induced cytogenetic effects, but also a critique of the literature, highlighting deficiencies in the design of some studies that should be taken into account when assessing the health risk of RFR.
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7,468 |
Parasitic Diseases of the Lung
|
Parasitic infection is a major healthcare problem that affects millions of the world’s population. Immigration and global warming have changed the natural distribution of parasitic diseases far removed from endemic areas. The respiratory system can be affected by a broad spectrum of helminthic and protozoal parasitic diseases. The diagnosis of parasitic infection of the respiratory system may be delayed due to myriad clinical and radiographic presentations of parasitic diseases which make the diagnosis of these entities challenging. Pulmonologists need to be familiar with the epidemiology, clinical presentation, pathophysiology, and bronchoscopic findings of parasitic lung diseases, in order to provide proper management in a timely fashion. This review provides a comprehensive view of both helminthic and protozoal parasitic diseases that affect the respiratory system, especially the central airways.
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7,469 |
Connectivity and Competition in Airline Networks: A Study of Lufthansa's Network
|
Air transport networks have exhibited a trend towards complex dynamics in recent years. Using Lufthansa's networks as an example, this paper aims to illustrate the relevance of various network indicators — such as connectivity and concentration — for the empirical analysis of airline network configurations. The results highlight the actual strategic choices made by Lufthansa for its own network, as well in combination with its partners in Star Alliance.
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7,470 |
Interactions among human behavior, social networks, and societal infrastructures: A Case Study in Computational Epidemiology
|
Human behavior, social networks, and the civil infrastructures are closely intertwined. Understanding their co-evolution is critical for designing public policies and decision support for disaster planning. For example, human behaviors and day to day activities of individuals create dense social interactions that are characteristic of modern urban societies. These dense social networks provide a perfect fabric for fast, uncontrolled disease propagation. Conversely, people’s behavior in response to public policies and their perception of how the crisis is unfolding as a result of disease outbreak can dramatically alter the normally stable social interactions. Effective planning and response strategies must take these complicated interactions into account. In this chapter, we describe a computer simulation based approach to study these issues using public health and computational epidemiology as an illustrative example. We also formulate game-theoretic and stochastic optimization problems that capture many of the problems that we study empirically.
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7,471 |
Bronchiolitis
|
Everyone on the planet is exposed to respiratory syncytial virus (RSV) infection by the age of 2 years. Most infants admitted to the pediatric intensive care unit (PICU) for respiratory support during this infection are previously healthy, but their principal risk for needing PICU treatment is young age. That is, if you are born in October/November in the northern hemisphere, then your first winter exposure to RSV is likely to be when you are less than 4 months of age and vulnerable because of poor respiratory mechanical reserve (Alonso et al. 2007). However, if you are born in May/June, then you will be 7–8 months during your first winter exposure to RSV, much bigger and stronger and have more efficient thoracic and diaphragmatic mechanics. In the PICU, the main predictors of severe outcome in previously well infants appear to be young age, presence of apnea, and pulmonary consolidation on admission chest radiograph (Tasker et al. 2000; Lopez Guinea et al. 2007). Taken together, we can say that more severe RSV bronchiolitis in PICU practice is typically a problem of pulmonary consolidation, poor respiratory mechanics, and poor reserve, in the younger infant.
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7,472 |
Acute nierinsufficiëntie en acute dialyse
|
Acute nierinsufficiëntie komt steeds vaker voor tijdens ziekenhuisopnames en zorgt naast een verlengde opnameduur ook voor een toegenomen sterfterisico.
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7,473 |
Mechanism of Action of Opioids and Clinical Effects
| null |
7,474 |
General Measures of Infection Control
|
A 72-year-old male patient with non-Hodgkin’s lymphoma was neutropenic after chemotherapy and presented to the ICU with breathlessness and hypotension. He was intubated and kept on a ventilator and received broad-spectrum antibiotics. He had a peripheral, central, and arterial line in place. A Foley’s catheter and a nasogastric tube were also placed.
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7,475 |
Resuscitation
|
Blast injuries can produce complex patterns of injury and can easily result in hemorrhagic shock. Adequate resuscitation of blast-injured patients is critical, as both under- and over-resuscitation can result in a number of fatal complications. Consideration must be given to the choice of resuscitative fluid, the volume of resuscitation, the timing of resuscitation relative to definitive surgical management, and the determination of endpoints at which resuscitation can be stopped. This chapter explores resuscitation of blast-injured patients, beginning in the prehospital phase with initial choice of fluid and continuing through definitive resuscitation at a higher echelon of care. Particular consideration is given to the effect of resuscitation on the unique physiologic derangements seen following blast injury. Drawing upon the enormous amount of literature on resuscitation from the recent coalition experiences in Iraq and Afghanistan, we advocate for the use of early hemostatic resuscitation with a high ratio of plasma, platelets, and packed red blood cells, with a transition to resuscitation guided by viscoelastic testing or coagulation status immediately following definitive control of hemorrhage.
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7,476 |
Transformation und Tumorbildung
|
Schon früh erkannte man, dass Viren bei Tieren Tumorerkrankungen hervorrufen können. Bereits 1911 beschrieb Peyton Rous, dass Viren bei Geflügel Sarkome verursachen. Das verantwortliche tumorauslösende Virus wurde später nach ihm Rous-Sarkomvirus benannt. In den folgenden Jahrzehnten entdeckte man eine Vielzahl von Viren, die bei Geflügel und Nagetieren unterschiedliche Krebserkrankungen wie Lymphome, Sarkome und Karzinome auslösen können. Viele von ihnen gehören zur Familie der Retroviridae und wurden den Gattungen der α-, β- und γ-Retroviren zugeordnet. Die Mehrzahl dieser Erreger wurde aus Inzuchtstämmen der jeweiligen Tierarten oder aus Zellkulturen isoliert; unter natürlichen Bedingungen sind sie als Verursacher von Tumorerkrankungen der jeweiligen Tierarten wahrscheinlich ohne Bedeutung. Eine Ausnahme sind die Leukoseviren der Katze (FeLV; ▸Abschnitt 18.1). Das tumorerzeugende Potenzial der onkogenen Retroviren beruht auf transformationsaktiven Proteinen (v-Onc).
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7,477 |
Diagnostic Imaging of Neonatal Pneumonia
|
Respiratory infections remain a significant and formidable threat to the health and well being of the neonate despite potent antibiotics, increasingly sophisticated laboratory detection methods and technologically advanced neonatal intensive care nurseries. Although the clinical and radiological definitions of pneumonia are variable throughout medical and governmental literature, quoted incidence rates for neonatal pneumonia range between 1.5–5.0 per 1,000 live births (Keyserling 1997; Webber et el 1990).
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7,478 |
Punica granatum
| null |
7,479 |
Die Rede von der Vertrauenskrise in China
|
Im ersten Teil dieser Arbeit wurden die Ergebnisse der ländervergleichenden Umfrageforschung zu Vertrauen thematisiert, wobei insbesondere das hohe gemessene Vertrauensniveau in der VR China im Zentrum des Interesses stand. In Anbetracht dieser Befunde mag es nun zunächst erstaunen, dass chinesische Soziologinnen und Soziologen im Gegensatz dazu von einer „Vertrauenskrise“ (xinren weiji) im gegenwärtigen China sprechen, obwohl die empirischen Befunde eigentlich genau auf das Gegenteil hinweisen. Andererseits ist es angesichts der politischen, wirtschaftlichen und gesellschaftlichen Umwälzungen Chinas im 20. Jahrhundert mit dem Zusammenbruch der letzten Kaiserdynastie 1911, der brutalen Besetzung von Teilen Chinas durch Japan im Zweiten Weltkrieg, dem Bürgerkrieg zwischen Kommunisten und Nationalisten, sowie den diversen Kampagnen und Bewegungen seit der Gründung der Volksrepublik 1949 und dem Übergang von einer Planwirtschaft in eine dezentralisierte, markt- und exportorientierte Wirtschaft neoliberalen Zuschnitts mit gleichzeitiger autokratischer Ein-Partei-Herrschaft seit Beginn der Politik von Reform und Öffnung (gaige kaifang) im Jahr 1978 nicht überraschend, dass das Vertrauen in der chinesischen Gesellschaft – wie in anderen Gesellschaften, die tiefgreifenden Transformationsprozessen unterworfen sind – in eine Krise gerät. Im Folgenden sollen nun die Ursachen für die Entstehung der Vertrauenskrise in China und ihre Manifestationen in der Gesellschaft näher beschrieben werden, ebenso wie die von chinesischer Seite her vorgeschlagenen Maßnahmen zur Wiederherstellung des Vertrauens.
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7,480 |
Alcohol, HIV/AIDS, and Liver Disease
|
Globally, there are over 33 million persons living with HIV/AIDS resulting in 1.8 million deaths annually. While the rate of HIV transmission is slowing, it is estimated that 2.6 million new infections occur yearly [1]. In the United States, there are approximately 1.2 million living with HIV/AIDS, with 50,000 new HIV infections and 17,000 deaths from the disease annually [2]. For those who can obtain effective antiretroviral therapy (ART), HIV/AIDS has become a chronic disease with life expectancies over 30 years [3]. Research in the last 10 years has revealed the importance of alcohol in the HIV/AIDS epidemic. Alcohol use, in moderate or hazardous amounts, has been associated with increased acquisition of HIV infection, progression of HIV infection, deleterious effects on HIV treatment, and acceleration in the comorbidities of HIV infection [4–9]. Yet alcohol remains the “forgotten drug” of the HIV/AIDS epidemic [10].
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7,481 |
Zika Virus and HIV/AIDS
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The first documented cases of HIV/AIDS in the United States bewildered physicians as they presented an unusual disease spectrum. Two young men were diagnosed with Kaposi sarcoma and Pneumocystis carinii pneumonia, which was inexplicable at that time, as these health outcomes were rare among their age, race/ethnicity, and individuals not living in nursing homes. Subsequently, it was found that after infection with HIV, individuals were asymptomatic up to 4 weeks and if symptoms developed, they appeared as a simple type of flu. The progression and global proliferation of the HIV pandemic is mirrored by the spread of Zika virus (ZikaV). Humans were probably first infected with HIV in the Kinshasa region in the 1940s and ZikaV was first detected in humans in the Zika forest in the 1950s. Aedes aegypti and Aedes albopictus mosquitoes transmit ZikaV, an arbovirus, as well as other related arboviruses. In addition to mosquito transmission, ZikaV transmission occurs through sexual risk and blood transfusions. The latter two risk factors were prominent modes of transmission during the early stages of HIV/AIDS epidemic and sexual transmission risk remains prominent. In addition, injection drug use is a risk factor to become HIV infected. For HIV, blood transfusion risk was reduced after appropriate testing of blood supplies. Unlike HIV, ZikaV does not produce significant symptoms that require medical attention among four-fifths of infected individuals. Indeed, initially considered a relatively benign virus, the unexpected emergence of ZikaV in the Americas since 2015, and continuing as a virulent and pathological virus for children and adults, created a sense of fear and distress. These emotional responses parallel the HIV/AIDS epidemic. Clinicians, epidemiologists, and other scientists are currently increasingly laboring to discern the full spectrum of risk, relative to vector and population behaviors, and as with HIV, to develop vaccines and chemotherapy against ZikaV. NIH and Walter Reed ZikaV vaccines are on the way.
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7,482 |
Nuclear Medicine in Acute Care
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1. What is the gold standard diagnostic test for cardiac transplant rejection? a. PET; b. (123)I-IPPA. c. MRI. d. Endomyocardial biopsy. 2. All of the following radionuclide imaging methods are examined for the diagnosis of cardiac transplant rejection EXCEPT: a. (99m)Tc-annexin V. b. Radiolabeled somatostatin analog; c. (111)In-antimyosin; d. (11)C-MQNB;
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7,483 |
Infectieproblematiek
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De overdracht van micro-organismen kan plaatsvinden van personeel op patiënt, van apparatuur op patiënt en vice versa. Er moeten hoge eisen worden gesteld aan een schone werkomgeving. Hiertoe behoort het schoonmaken van gecontamineerde oppervlakken van onder andere anesthesieapparatuur, vloeren en wanden van de operatiekamer en de operatietafel. Bij iedere wisseling van patiënten en bij eventuele contaminatie dienen de handen te worden gewassen met water en zeep en gedesinfecteerd chloorhexidi-ne-alcohol. Dit dient ook na het uittrekken van beschermende handschoenen te gebeuren.
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7,484 |
18 Zoönosen
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Een zoönose is een ziekte die van dier op mens kan overgaan of andersom. Mensen komen op diverse manieren in contact met dieren.
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7,485 |
The New Dynamics of Global Health Governance
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This chapter considers the impact of globalization on international health policies and the emergence of new approaches to Global Health Governance (GHG). The first part of the chapter describes the changes in institutional structures since the 1990s that have had a fundamental impact on GHG. These structural changes have occurred as the discourse on trans-boundary health has broadened and engaged more public, private and voluntary sector actors in the debate. This has brought greater recognition of the need to mobilize a range of financial and other resources and to adopt a more flexible approach to problem solving. But the proliferation of public and private actors has also brought greater complexity that could inhibit the effective application of these resources and solutions.
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7,486 |
Responsible Tourism: A Conservation Tool or Conservation Threat?
| null |
7,487 |
Sicherheitsregelkreis
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Alles fließ (παντα ρει [Heraklit]), d. h. alles verändert sich: Bedrohungen, Angriffsmöglichkeiten, Schutzbedarf, Prozesse, Ressourcen, Technologien, Organisation und last, but not least, das Personal. Dementsprechend unterliegen alle Elemente der Sicherheits- bzw. RiSiKo-Pyramide einer kontinuierlichen Anpassung, Veränderung und Weiterentwicklung.
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7,488 |
Liver Transplantation
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The field of liver transplantation has changed since the MELD scoring system became the most widely used donor allocation tool. Due to the MELD-based allocation system, sicker patients with higher MELD scores are being transplanted. Persistent organ donor shortages remain a challenging issue, and as a result, the wait-list mortality is a persistent problem for most of the regions. This chapter focuses on deceased donor and live donor liver transplantation in patients with complications of portal hypertension. Special attention will also be placed on donor-recipient matching, perioperative management of transplant patients, and the impact of hepatic hemodynamics on transplantation.
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7,489 |
Disinfection Policies in Hospitals and the Community
| null |
7,490 |
Hidden Cluster Detection for Infectious Disease Control and Quarantine Management
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Infectious diseases that are caused by pathogenic microorganisms can spread fast and far, from one person to another, directly or indirectly. Prompt quarantining of the infected from the rest, coupled with contact tracing, has been an effective measure to encounter outbreaks. However, urban life and international travel make containment difficult. Furthermore, the length of incubation periods of some contagious diseases like SARS enable infected passengers to elude health screenings before first symptoms appear and thus to carry the disease further. Detecting and visualizing contact–tracing networks, and immediately identifying the routes of infection, are thus important. We apply information visualization and hidden cluster detection for finding cliques of potentially infected people during incubation. Preemptive control and early quarantine are hence possible by our method. Our prototype Infectious Disease Detection and Quarantine Management System (IDDQMS), which can identify and trace clusters of infection by mining patients’ history, is introduced in this paper.
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7,491 |
Parasites and pest population management
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The presence of macroparasites can affect the pest status of small mammals and the damage they cause. Pest management of small mammal populations can also affect the macroparasite populations, in a positive as well as a negative way. Despite the effects of macroparasites on small mammal fitness, there is little hope for the near future that they can be used for biological control of small mammals, except perhaps for some bio-pesticides. Small mammals and macroparasites interact in complex ways, and the implications for pest management are equally complex.
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7,492 |
Nosocomial Infections and Ventilator-Associated Pneumonia in Cancer Patients
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Nosocomial infections or healthcare-acquired infections are a common cause of increased morbidity and mortality among hospitalized patients. Cancer patients are at an increased risk for these infections due to their immunosuppressed states. Considering these adverse effects on and the socioeconomic burden, efforts should be made to minimize the transmission of these infections and make the hospitals a safer environment. These infection rates can be significantly reduced by the implementing and improving compliance with the “care bundles.” This chapter will address the common nosocomial infections such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSI), including preventive strategies and care bundles for the same.
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7,493 |
A Framework of NLP Based Information Tracking and Related Knowledge Organizing with Topic Maps
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This paper presents a computational framework for information extraction and aggregation which aims to integrate and organize the data/information resources that spread throughout the Internet in the manner that makes them useful for tracking events such as natural disaster, and disease dispersion. We introduce a simple statistical information extraction technique for summarizing the document into a predefined structure. We apply the topic maps approach as a semantic layer in aggregating and organizing the extracted information for smart access. In addition, this paper also carries out a case study on disease dispersion domain using the proposed framework.
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7,494 |
Inflammatory Changes and Coagulopathy in Multiply Injured Patients
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Severe tissue trauma leads to an early activation of several danger recognition systems, including the complement and the coagulation system, often resulting in an overwhelming almost synchronic pro- and anti-inflammatory response of the host. Although the immune response is associated with beneficial effects at the site of injury including the elimination of exogenous and endogenous danger molecules as well as the initiation of regenerative processes, an exaggerated systemic inflammatory response significantly contributes to posttraumatic complications such as multiple organ failure (MOF) and early death. Besides pre-existing physical conditions, age, gender, and underlying comorbidities, surgical and anesthesiological management after injury is decisive for outcome. Improvements in surgical intensive care have increased number of patients who survive the initial phase after trauma. However, instead of progressing to normal recovery, patients often pass into persistent inflammation, immunosuppression, and catabolism syndrome (PICS). The characterization and management of PICS will require new strategies for direct monitoring and therapeutic intervention into the patient’s immune function. In this chapter, we describe various factors involved in the inflammatory changes after trauma and aim to understand how these factors interact to progress to systemic inflammation, MOF, and PICS.
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7,495 |
Cuff-Induced Neointimal Formation in Mouse Models
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Ischemic heart failure caused by atherosclerosis is a major cause of death worldwide. Although remarkable technological advances have been made in the treatment of coronary heart disease, there is as yet no treatment that can sufficiently suppress the progression of atherosclerosis, including neointimal thickening. Therefore, a precise understanding of the mechanism of neointimal hyperplasia will provide the development of new technologies. Both ApoE-KO and LDLR-KO mice have been employed to generate other relevant mouse models of cardiovascular disease through breeding strategies. Although these mice are effective tools for the investigation of atherosclerosis, development of a progressive atherosclerotic lesion takes a long time, resulting in increase of both the costs and the space needed for the research. Thus, it is necessary to develop simpler tools that would allow easy evaluation of atherosclerosis in mouse models. In this review, we discuss our experience in generating mouse models of cuff-induced injury of the femoral artery and attempt to provide a better understanding of cuff-induced neointimal formation.
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7,496 |
Introduction to 3D Immersive and Interactive Learning
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The concept of 3D is not new. But never like today, 3D is rapidly entering our life. Using 3D for education is an innovative yet challenging work. This chapter introduces the concept of 3D Immersive and Interactive Learning, which is also called In-depth Learning. In particular, the enabling technologies and the supporting learning environments behind 3D Immersive and Interactive Learning are discussed. The relationship between In-depth Learning and other Learning Paradigms, such as Visual Learning, Simulation-based Learning, Constructivism Learning, and Engaged Learning, etc., are studied. This chapter also serves as an overall introduction to the whole book which presents several efforts in Singapore using 3D for In-depth Learning. The book covers a wide spectrum of education including Gifted Program, Normal (technical) Stream, and Special Needs Education. The author(s) of each book chapter share their experiences from different angles on 3D In-depth Learning.
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7,497 |
Conclusion: Understanding the Elusive Nature of Objectivity
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An evaluation of research reported in this book shows the problematic nature of understanding some of the universal values associated with objectivity such as certainty, value neutral observations, facts, infallibility, and truth of scientific theories and laws. These results provide a detailed account (over a period of almost 25 years) of how the science education research community conceptualizes the difficulties involved in accepting objectivity as an unquestioned epistemic virtue of the scientific enterprise. Analyses of general chemistry textbooks are used to introduce the idea of “transgression of objectivity” and that scientific progress (nanotechnology) is at a crossroads. Given the importance of objectivity/subjectivity dichotomy in science education, it is plausible to suggest that objectivity has become an opiate of the academic. Although, achievement of objectivity in actual scientific practice is a myth, it still remains a powerful and useful idea. It seems that more work needs to be done in order to facilitate a transition toward a more nuanced understanding of objectivity and eventually the dynamics of scientific progress.
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7,498 |
Indicators of Waterborne Viruses
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Enteric viruses excreted by humans and animals may reach water resources and cause large outbreaks. Drinking water is one of the essential global life elements for humanity. However, some of our resources are contaminated with viruses and indicators for continuous monitoring have been developed. The classical ones are coliforms and fecal coliforms that are still the iron standard for water indicator monitoring (see Chap. 10.1007/978-94-017-9499-2_34). In the last decades, bacteriophages have been suggested as potential indicators of enteric viruses and many studies showed their potential as such mainly due to their comparable resistance to water processes such as disinfection. In this chapter, the indicator role of bacteriophages in water is critically reviewed and discussed.
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7,499 |
Emergency Mass Critical Care
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At any moment regular television programming could be interrupted with news of the emergence of a new strain of infective agent, a major industrial accident, or a terrorist event. Many devastating events are widespread and naturally occurring, like hurricanes, in which we have ample warning time to enact preparation plans; while others, like earthquakes, volcanoes, or tsunamis may kill or injure thousands before the news reports hit the airwaves. Industrial accidents and terrorist events are usually sudden and occur without any warning. Any of these events may have a local or regional effect; some may even have a global impact [1]. Regardless of the cause, after such an event, large amounts of the populace will be seeking medical care, whether from their primary care providers, public health departments, or local hospitals.
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