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8,200 |
A Model for Coupled Outbreaks Contained by Behavior Change
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Large epidemics such as the recent Ebola crisis in West Africa occur when local efforts to contain outbreaks fail to overcome the probabilistic onward transmission to new locations. As a result, there may be large differences in total epidemic size from similar initial conditions. This work seeks to determine the extent to which the effects of behavior changes and metapopulation coupling on epidemic size can be characterized. While mathematical models have been developed to study local containment by social distancing, intervention and other behavior changes, their connection to larger-scale transmission is relatively underdeveloped. We make use of the assumption that behavior changes limit local transmission before susceptible depletion to develop a time-varying birth-death process capturing the dynamic decrease of the transmission rate associated with behavior changes. We derive an expression for the mean outbreak size of this model and show that the distribution of outbreak sizes is approximately geometric. This allows a probabilistic extension whereby infected individuals may initiate new outbreaks. From this model we characterize the overall epidemic size as a function of the behavior change rate and the probability that an infected individual starts a new outbreak. We find good agreement between the analytical results and stochastic simulations leading to novel findings including critical learning rates that demarcate large and small epidemic sizes.
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8,201 |
Virtual Screening for RNA-Interacting Small Molecules
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Computational virtual screening is useful and powerful strategy for rapid discovery of small biologically active molecules in the early stage of drug discovery. The discovery of a broad range of important biological processes involved by RNA has increased the importance of RNA as a new drug target. To apply structure-based virtual screening methods to the discovery of RNA-binding ligands, many RNA 3D structure prediction programs and optimized docking algorithms have been developed. In this chapter, a number of successful cases of virtual screening targeting RNA will be introduced.
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8,202 |
Immunosuppression
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8,203 |
Conclusions
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The aim of this thesis was to explain different regime outcomes and the variance in the degree of democracy in post-Soviet space by studying the influence of the two main external actors, the EU and Russia. This thesis contributes to the increasing body of literature that studies the causes of democratic recession and authoritarian backlash in post-Soviet states and the role of external actors in these processes. The main focus of the study was on two most important regional actors – the EU and Russia – and on their interaction in the post-Soviet area.
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8,204 |
L-Type Lectins in ER-Golgi Intermediate Compartment
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L-type lectins possess a luminal carbohydrate recognition domain (CRD) that binds to high-mannose-type oligosaccharides in aCa(2+)-dependent manner. The L-type CRD is named after the lectins found in abundance in the seeds of leguminous plants, such as concanavalin A from jack beans. The history of L-type lectins is as old as discovery of plant lectins from seeds of leguminous plants in nineteenth century. The structural motifs of L-type lectins are now known to be present in a variety of glycan-binding proteins from other eukaryotic organisms. The domain is present in plant, fungal, and animal proteins, but plant and animal L-type lectins have divergent sequences and different molecular properties. While plant lectins are secreted-soluble proteins and found at high level in specialised tissues, animal L-type lectins are (often membrane-bound) luminal proteins that are found at low levels in many different cell types. This observation suggests that animal L-type lectins have different functions. The crystal structures of some of the legume seed lectins show structural similarities among these lectins and to some other lectins, including the galectins and a variety of other lectins. Therefore, the term “L-lectins” has been designated as a classification for all lectins with this legume seed lectin-like structure. The L-type lectin-like domain has an overall globular shape composed of a β-sandwich of two major twisted antiparallel β-sheets. The β-sandwich comprises a major concave β-sheet and a minor convex β-sheet, in a variation of the jelly roll fold (Velloso et al. 2002, 2003; Satoh et al. 2006, 2007).
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8,205 |
Cancer Treatment-Related Lung Injury
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Lung injury associated with cancer therapeutics is often the limiting factor that trumps otherwise successful cancer therapy. Thoracic radiation as well as cancer pharmacotherapeutics, including conventional chemotherapy, molecular targeted agents, and cancer immunotherapies, have been associated with a unique spectrum of histopathologic injury patterns that may involve the lung parenchyma, pleura, airways, and/or pulmonary vasculature. Injury patterns may be idiosyncratic, unpredictable, and highly variable from one agent class to the next. Variability in lung injury patterns within a specific therapeutic class of drugs also occurs, adding to the conundrum. Drug-induced toxicities to the thoracic cavity are infrequent, and early recognition of clinical clues portends a good outcome in most cases. Failure to recognize early clinical signs, however, may result in irreversible and potentially lethal consequences. This chapter provides an overview of our current knowledge of thoracic complications associated with cancer pharmacotherapies. The review is not intended to be a treatise of all cancer agents that adversely affect the lungs, but rather a discussion of established risk factors and histopathologic patterns of lung injury associated with broad classes of cancer agents. Optimal management strategies, based on existing clinical experience, will also be discussed. Complications associated with thoracic radiation are also reviewed. It is hoped that these discussions will facilitate early recognition and management of treatment-related thoracic complications and, ultimately, better patient outcomes.
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8,206 |
Management of Severe Malaria
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Imported malaria is the principal, preventable, life-threatening infection among US travelers. Using a base case scenario, we will discuss the most recent information on the management and treatment for Severe Malaria.
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8,207 |
ADAM 17 endopeptidase
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8,208 |
Methods to Determine the End of an Infectious Disease Epidemic: A Short Review
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Deciding the end of an epidemic is frequently associated with forthcoming changes in infectious disease control activities, including downgrading alert level in surveillance and restoring healthcare workers’ working shift back to normal. Despite the practical importance, there have been little epidemiological and laboratory methods that were proposed to determine the end of an epidemic. This short review was aimed to systematically discuss methodological principles of a small number of existing techniques and understand their advantages and disadvantages. Existing epidemiological methods have been mostly limited to a single-and-brief exposure setting, while the application to human-to-human transmissible disease epidemic with stochastic dependence structure in the observed case data has remained to be a statistical challenge. In veterinary applications, a large-scale sampling for laboratory testing has been commonly adapted to substantiate a freedom from disease, but such study has only accounted for binomial sampling process in estimating the error probability of elimination. Surveillance and mathematical modeling are two complementary instruments in the toolbox of epidemiologists. Combining their strengths would be highly beneficial to better define the end of an epidemic.
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8,209 |
Cardiovascular Risk Factors and Markers
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Cardiovascular risk is assessed for the prediction and appropriate management of patients using collections of identified risk markers obtained from clinical questionnaire information, concentrations of certain blood molecules (e.g., N-terminal proB-type natriuretic peptide fragment and soluble receptors of tumor-necrosis factor-α and interleukin-2), imaging data using various modalities, and electrocardiographic variables, in addition to traditional risk factors.
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8,210 |
Universal Participation Without Taiwan? A Study of Taiwan’s Participation in the Global Health Governance Sponsored by the World Health Organization
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This chapter focuses on the health risk of Taiwan’s absence in intergovernmental health governance networks. It provides a review of Taiwan’s bidding strategies for the World Health Organization between 1997 and 2009. The country’s participation in the World Health Assembly (WHA) and the International Health Regulations (IHR) network since 2009 was a significant improvement, but this experience failed to extend to other governing bodies. The chapter goes on to discuss the global public health risk of excluding Taiwan from cross-national health cooperation, and why such a conundrum remains difficult to resolve. Taiwan’s compliance regarding health governance relies heavily on self-regulation and the help of its allies. The United States has played a key role in enforcing global health regulations on Taiwan. Unlike other sources of threat in health governance, Taiwan currently does not represent a high health risk to other countries. As a result, Taiwan finds it difficult to persuade WHO members to manifest “universal participation” by including Taiwan in various intergovernmental health networks. This pattern of governance, however, lacks transparency. Other countries will find it difficult to monitor or intervene in the event Taiwan’s health authority is unable to deal with a transnational health emergency.
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8,211 |
Catastrophic Anachronisms: The Past, Present and Future of Disaster Medicine
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There is a worldwide spiraling risk for more frequent catastrophic events involving multiple casualties, not only in terms of acute injury and illness, but also subsequent psychological and public health concerns. Today, such events will likely be multinational in nature, even when localized to a particular venue and this require international cooperation in terms of prevention, mitigation and relief. The best approach to preparing for disasters is to expand, modify and enhance current local ∖Jobname: S34055 Batch number: 00060 infrastructures and capabilities for managing the multiple types of disaster scenarios and create a number of inter-facility cooperative agreements in advance. Aside from safer internal locations for ICUs and surgical theaters, certain structural changes will need to be installed such as modified ventilation systems, protected water supplies, decontamination mechanisms and security renovations. A key strategy will be to proliferate interoperable, multi-disciplinary, all-hazards training initiatives such as the AMA National Disaster Life Support courses. Purchases of cadres of antidotes, antibiotics and hemoglobin-based oxygen carriers should be coordinated regionally, stored in secure locations and made readily-available for the applicable disaster scenario.
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8,212 |
The Context of Tropical Rainforest Deforestation and Degradation
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The author begins Chap. 10.1007/978-3-319-63236-0_2 with the general locations of rainforests (Afrotropical, Neotropical, and Indo-Pacific region) and outlines the specific countries that host rainforests. The author then provides a historical and current context of tropical rainforest deforestation and degradation. Maps are provided showing the forest cover loss from 2000 to 2014 in these select regions. The author then presents a more detailed discussion about the role of cattle, soybeans, and palm oil, along with the role of timber, pulp and paper, forest fires, population and consumption, and infrastructure. The author then concludes with an explanation of why tropical rainforests are important, such as due to their provisioning services, regulating services, habitat or supporting services, and cultural services.
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8,213 |
Travel Medicine
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Before travelling to other countries, thorough travel advice should be provided. Not only information about diseases of specific countries but also general advice for travelling should be given on this consultation.
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8,214 |
Fate of the Mongooses and the Genet (Carnivora) in Mediterranean Europe: None Native, All Invasive?
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The Mediterranean Basin (MB), connected by cultural exchanges since prehistoric times, provides an outstanding framework to study species introductions, notably in mammals. Carnivores are among the most successful mammalian invaders. As such, a number of middle-sized representatives (“mesocarnivores”) such as the domestic cat and mongooses have been pinpointed for their deleterious impact on the native fauna. In the MB, three species of mongooses (Herpestidae) and one genet (Viverridae) are or have recently been recorded and none of them has been considered native: the Indian grey mongoose Herpestes edwardsii, the small Indian mongoose H. auropunctatus, the Egyptian mongoose H. ichneumon, and the common genet Genetta genetta. In order to clarify the history of introduction and status of the mongooses and genet in Europe, I review various bodies of evidence including (1) their natural history and relationships with humans in their native ranges, (2) their history of introduction in Europe, (3) the enlightenments—and sometimes contradictions—brought by recent genetic analyses on their dispersal histories, and (4) their range dynamics and ecological interactions with the European fauna. The species of herpestids and viverrids present in Europe fall into three categories: (1) introduced and spreading (G. genetta, H. auropunctatus), (2) introduced and extinct (H. edwardsii), and (3) natural disperser and spreading (H. ichneumon). In view of the reviewed evidence, there is weak support for a deleterious impact of the mongooses and genet on the European fauna (except possibly on the herpetofauna of small Adriatic islands in the case of H. auropunctatus), notably in comparison with genuine invasive species such as the black rat and the domestic cat. Rather than inefficient control programs such as those targeting H. ichneumon in Portugal and H. auropunctatus in Croatia, we suggest that a greater attention is focused on the restoration of large Carnivores (the natural regulators of mesocarnivore populations), mesocarnivore communities and natural habitats, to contribute to a more sustainable way of “managing” the mongooses and genet in Europe.
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8,215 |
History of Discovery of Parasitic Crustacea
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Parasitic Crustacea have been present in scientific literature since Linnaeus introduced the first classification system (binomial nomenclature). Crustaceans are considered to be the most morphologically diverse arthropods, with currently 19 parasitic orders known to science. This chapter reviews the history of discovery for each of the major parasitic Crustacea groups, highlighting some of the key developments that have influenced our current understanding of these parasites. Each taxonomic group is briefly introduced, followed by a synopsis on some of the outstanding contributions within that group. Knowledge development is followed, from the first parasites discovered to other historical highlights that influenced the groups up to this point. Other important discoveries (both taxonomic and ecological) are also noted, serving as a preview to the host-parasite interactions covered in the subsequent chapters. Additionally, several researchers who have added significant contributions to our knowledge of the parasitic Crustacea (specifically in taxonomy and discovery) are introduced, along with photographs of a select few. This historical review of the crustacean parasites provides a background to these diverse and abundant organisms and will contribute to a better understanding of their unique niche in the aquatic environment.
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8,216 |
Mikrobiologische Diagnostik und Infektiologie
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Die Gewinnung mikrobiologischer Proben ist ein wichtiger Schritt in der Diagnostik und Therapie von Infektionskrankheiten. Fehler, die bei der Probengewinnung gemacht werden, kann auch das beste Labor nicht ausgleichen. Dieses Kapitel beschreibt Indikationen für, Abnahme und richtigen Umgang mit, und die Bewertung von mikrobiologischen Proben.
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8,217 |
Fibrosing Alveolitis in Hematologic Malignancy Patients Undergoing Hematopoietic Cell Transplantation
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Although advances in antineoplastic therapy have considerably improved the survival of patients with hematological malignancies, current treatment modalities increase the risk of late complications. Several forms of chronic pulmonary dysfunction due to infectious or noninfectious causes commonly occur in the months to years after chemo-radiotherapy and can be fatal or result in long-term morbidity. The judicious use of prophylactic antimicrobial agents has tipped the balance toward noninfectious etiologies. Hence, while opportunistic infections still contribute to chronic lung disease, late sequelae resulting from antineoplastic therapy have been identified and reported. Patients who proceed to receive hematopoietic cell transplantation (HSCT) are particularly prone to developing lung complications. Pulmonary dysfunction occurring after HSCT may manifest with obstructive or restrictive pulmonary mechanics and may range in severity from subtle, subclinical functional changes to frank respiratory failure. Insights generated using animal models suggest that the immunologic mechanisms contributing to lung inflammation after HSCT may be similar to those responsible for graft-versus host disease. In sum, chronic fibrotic pulmonary dysfunction is a frequent and significant complication facing survivors of hematologic malignancies and their practitioners. The high incidence and suboptimal response to current support care and immunosuppressive therapy underscore the need for heightened awareness and continued research in this area.
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8,218 |
Präeklampsie, Eklampsie und HELLP-Syndrom
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Schwangerschaftshypertonie: Erstmanifestation einer Hypertonie nach der 20. Schwangerschaftswoche (SSW) mit systolischen und/oder diastolischen Blutdruckwerten >140 bzw. >90 mm Hg, die 2-mal im Abstand von mindestens 6 h bei Fehlen einer Proteinurie gemessen werden. Schwangerschaftskomplikationen sind selten. Meist steigt der Blutdruck im Verlauf der Schwangerschaft nicht weiter an, bisweilen wird ein progredienter Anstieg ohne weitere Präeklampsiesymptome (außer einer möglichen fetalen Wachstumsrestriktion) beobachtet, selten die Progression in eine Präeklampsie. Postpartal normalisiert sich der Blutdruck wieder. Chronische Hypertonie: Hypertonie, die bereits vor der Schwangerschaft oder später als 12 Wochen nach der Entbindung besteht. Bei einer Pfropfpräeklampsie mit einer Inzidenz von etwa 25% sind die Risiken der Frühgeburtlichkeit, der fetalen Wachstumsrestriktion, der vorzeitigen Plazentalösung und des akuten Nierenversagens höher als bei der neu aufgetretenen Präeklampsie. Präeklampsie/Eklampsie: Schwangerschaftshypertonie mit Proteinurie, die durch >300 mg Protein im 24-h-Sammelurin bzw. durch zwei qualitative Bestimmungen (Uristix) mindestens einfach positiv im Abstand von mehr als 4 h definiert ist. Die Eklampsie als Komplikation einer schweren Präeklampsie äußert sich in tonisch-klonischen Krämpfen.
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8,219 |
Die Medizinische Mikrobiologie im 21. Jahrhundert
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Die Medizinische Mikrobiologie befasst sich mit der ursächlichen Rolle von pathogenen (d. h. krankheitserzeugenden) Mikroorganismen bei der Entstehung von Störungen im Funktionsablauf des menschlichen Organismus. Störungen dieser Art entstehen durch Ansiedlung und Vermehrung von Mikroorganismen im Sinne des Parasitismus; sie treten als Infektionskrankheit in Erscheinung. Demgemäß betrachtet man die parasitierenden Mikroorganismen als Krankheitserreger; das befallene Individuum wird als “Wirt„ oder als “Makroorganismus„ bezeichnet. Da bei der Betrachtung von Infektionen sowohl der Wirt mit seinen Reaktionen als auch die krankheitserzeugenden Eigenschaften eines Mikroorganismus (d. h. seine Pathogenität) im Vordergrund stehen, lässt sich die Medizinische Mikrobiologie am ehesten als Infektionslehre begreifen — als Lehre von der Auseinandersetzung des Wirts mit den krankheitserzeugenden Eigenschaften des Erregers.
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8,220 |
Immune Response in Human Pathology: Infections Caused by Bacteria, Viruses, Fungi, and Parasites
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In the middle of the nineteenth century, it became clear that micro-organisms could cause disease. Effective treatment, however, was not possible at that time; prevention and spread of infectious diseases depended solely on proper hygienic means. At the beginning of the twentieth century, passive and active vaccination procedures were developed against a number of these PATHOGENIC MICRO-ORGANISMS to prevent the diseases in question (rabies, diphtheria, tetanus, etc.). Thanks to the discovery of antimicrobial chemicals (by Paul Ehrlich) and antibiotics (by Sir Alexander Fleming), the threat of infectious diseases seemed to be minimised. Large-scale vaccination programmes against childhood diseases (diphtheria, whooping cough, and polio), started in the early 1950s, raised hopes of finally being able to eradicate these diseases from the planet. This approach was successful for smallpox (1980). However, new infectious diseases have emerged [e.g., Legionella, HUMAN IMMUNODEFICIENCY VIRUS (HIV), Helicobacter, SARS, etc.], and new vaccines and antibiotics are needed. Furthermore, due to intensive medical treatment with antibiotics and immunosuppressive drugs, hospital infections are a growing problem. Bacteria hitherto deemed harmless are causing OPPORTUNISTIC INFECTIONS in immunocompromised patients. The pathogens have developed resistance to many antibiotics, and sometimes no effective antibiotics are available to treat these patients.
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8,221 |
Pharmacology of Glutamate Transport in the CNS: Substrates and Inhibitors of Excitatory Amino Acid Transporters (EAATs) and the Glutamate/Cystine Exchanger System x(c)(−)
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As the primary excitatory neurotransmitter in the mammalian CNS, l-glutamateparticipates not only in standard fast synaptic communication, but also contributes to higher order signalprocessing, as well as neuropathology. Given this variety of functional roles, interest has been growingas to how the extracellular concentrations of l-glutamate surroundingneurons are regulated by cellular transporter proteins. This review focuses on two prominent systems, eachof which appears capable of influencing both the signaling and pathological actions of l-glutamatewithin the CNS: the sodium-dependent excitatory amino acid transporters (EAATs) and the glutamate/cystineexchanger, system x (c) (−)(Sx (c) (−)). Whilethe family of EAAT subtypes limit access to glutamate receptors by rapidly and efficiently sequesteringl-glutamate in neurons and glia, Sx(c) (−)provides a route for the export of glutamate from cells into the extracellular environment. The primaryintent of this work is to provide an overview of the inhibitors and substrates that have been developedto delineate the pharmacological specificity of these transport systems, as well as be exploited as probeswith which to selectively investigate function. Particular attention is paid to the development of smallmolecule templates that mimic the structural properties of the endogenous substrates, l-glutamate,l-aspartate and l-cystine andhow strategic control of functional group position and/or the introduction of lipophilic R-groups can impactmultiple aspects of the transport process, including: subtype selectivity, inhibitory potency, and substrateactivity.
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8,222 |
Toward a Realistic Modeling of Epidemic Spreading with Activity Driven Networks
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Models of epidemic spreading are widely used to predict the evolution of an outbreak, test specific intervention scenarios, and steer interventions in the field. Compartmental models are the most common class of models. They are very effective for qualitative analysis, but they rely on simplifying assumptions, such as homogeneous mixing and time scale separation. On the other end of the spectrum, detailed agent-based models, based on realistic mobility pattern models, provide extremely accurate predictions. However, these models require significant computing power and are not suitable for analytical treatment. Our research aims at bridging the gap between these two approaches, toward time-varying network models that are sufficiently accurate to make predictions for real-world applications, while being computationally affordable and amenable to analytical treatment. We leverage the novel paradigm of activity driven networks (ADNs), a particular type of time-varying network that accounts for inherent inhomogeinities within a population. Starting from the basic incarnation of ADNs, we expand on the framework to include behavioral factors triggered by health status and spreading awareness. The enriched paradigm is then utilized to model the 2014–2015 Ebola Virus Disease (EVD) spreading in Liberia, and perform a what-if analysis on the timely application of sanitary interventions in the field. Finally, we propose a new formulation, which is amenable to analytical treatment, beyond the mere computation of the epidemic threshold.
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8,223 |
Macrophage Activation Syndrome
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Hemophagocytic lymphohistiocytosis (HLH), or termed macrophage activation syndrome (MAS) when associated with rheumatic disorders, is a frequently fatal complication of infections, rheumatic disorders, and hematopoietic malignancies. Clinically, HLH/MAS is a life-threatening condition that is usually diagnosed among febrile hospitalized patients (children and adults) who commonly present with unremitting fever and a shock-like multiorgan dysfunction scenario. Laboratory studies reveal pancytopenia, elevated liver enzymes, elevated markers of inflammation (ESR, CRP), hyperferritinemia, and features of coagulopathy. In about 60% of cases, excess hemophagocytosis (macrophages/histiocytes engulfing other hematopoietic cell types) is noted on biopsy specimens from the bone marrow, liver, lymph nodes, and other organs. HLH/MAS has been hypothesized to occur when a threshold level of inflammation has been achieved, and genetic and environmental risk factors are believed to contribute to the hyperinflammatory state. A broad variety of infections, from viruses to fungi to bacteria, have been identified as triggers of HLH/MAS, either in isolation or in addition to an underlying inflammatory disease state. Certain infections, particularly by members of the herpesvirus family, are the most notorious triggers of HLH/MAS. Treatment for infection-triggered MAS requires therapy for both the underlying infection and dampening of the hyperactive immune response.
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8,224 |
Adventure Tourism in the Canadian Arctic
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The Canadian Arctic is defined and described and the numbers of tourists for the various regions estimated. The impact of adventure tourism on wildlife is documented, such as polar bear hunting and polar bear viewing, and the management approaches to conserve this iconic species are outlined; the possible spread of Giardia by tourists is discussed; and the impact of tourism on marine mammals and their management is described for beluga, narwhal and seals. There are impacts on birds too and on terrestrial vegetation in the tundra. Examples of aboriginal tourism are documented, including the development of the world-class Carcross mountain bike trails. Pleasure craft and cruise tourism have impacts, and the management approaches to minimise these are discussed. Finally the maintenance of the rich and diverse archaeological and historical sites in the face of tourist impacts is discussed.
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8,225 |
Evaluating Protective Effects of Vaccination
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Evaluating the direct protective effects of vaccines in the individuals who were vaccinated has been the focus of vaccine studies over the past century. Generally, interest has been in the ability of vaccination to prevent or to ameliorate disease rather than to prevent infection (Clements-Mann 1998). Ascertainment of cases is often done by finding suspected cases in the population under study in people who exhibit a set of symptoms. The suspected cases are then tested for biological confirmation of the infectious agent of interest. Alternatively, surveillance can ascertain cases reported in central registries. However they are ascertained, with most vaccines, clinical disease is the primary outcome of interest. When ascertainment is on clinical cases, most asymptomatic infections may go undetected. A different situation arises when infection is the primary outcome. To ascertain infections in asymptomatic people, an active follow-up method of testing asymptomatic people is needed. In this chapter we consider estimation and inference for direct protective effects of vaccination, VE(S) and VE(SP), in studies that do not condition on exposure to infection.We consider aspects of the design of such studies. Several examples of randomized, double-blind (double-masked) controlled vaccine trials illustrate the standard approach to design and analysis of such studies. Our choice of studies to present was motivated largely because of their use as illustrations in other sections of the book. Most randomized and pivotal studies of vaccines have been based on VE(SP) or VE(S). Much has been written on studies to meet the approval of the regulatory agencies, and the design of clinical trials generally. Our goal here is to consider how VE(S) and VE(SP) relate to other measures of vaccine effects within the dependent happening context, and consider a few design considerations. Because VE(S) and VE(SP) do not condition on exposure to infection, assumptions about the relative exposure opportunity in the vaccine and control groups are important.
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8,226 |
Epidemiologie und Prävention von nosokomialen Infektionen
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Eine nosokomiale Infektion (griechisch: nosokomeíon = Krankenhaus) ist laut Infektionsschutzgesetz definiert als eine „Infektion mit lokalen oder systemischen Infektionszeichen als Reaktion auf das Vorhandensein von Erregern oder ihrer Toxine, die im zeitlichen Zusammenhang mit einer stationären oder einer ambulanten medizinischen Maßnahme steht, soweit die Infektion nicht bereits vorher bestand“. Bei länger hospitalisierten Kindern bestehen häufig Grundkrankheiten, die invasive diagnostische und therapeutische Maßnahmen erfordern. Dies und die Exposition gegenüber einer Vielzahl potenziell pathogener Mikroorganismen bei evtl. noch unreifem Immunsystem bestimmen das Risiko, eine nosokomiale Infektion zu erwerben. Mit unterschiedlichen Altersgruppen sind unterschiedliche Übertragungswege bzw. klinische Manifestationen von Infektionskrankheiten verbunden. Die Inzidenz von Atemwegsinfektionen, Gastroenteritiden sowie Meningitiden ist im Säuglingsalter höher als bei älteren Kindern.
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8,227 |
Multiple Sklerose
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Die multiple Sklerose (MS) ist eine der häufigsten neurologischen Erkrankungen, für deren Ursache es bislang keine einheitliche Erklärung gibt. Grundpfeiler der Diagnostik ist die Klinik, ergänzt durch die Magnetresonanztomographie (MRT). Eine Liquoruntersuchung zum Nachweis der entzündlichen Genese nachgewiesener multifokaler Störungen ist bei allen unklaren Fällen und bei älteren Patienten erforderlich. Zur Bestätigung und Verlaufskontrolle sind elektrophysiologische Verfahren hilfreich.
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8,228 |
Case Study – United States of America
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The United States (US) considers the intentional use of a biological agent a serious national security threat. Over the last decade, federal, state, and local governments in the US have made concerted efforts to enhance preparedness within the public health, medical, and emergency response systems to address this threat. These activities span a wide range of areas from the enactment of new legal authorities and legislative changes to significant financial investments to enhance multiple detection and response system capabilities and the adoption of a national command and control structure for response. Many of these investments, although prompted by the concern for bioterrorism, have served to strengthen public health, medical, and emergency response systems overall and have proven invaluable in responses to other large-scale emergencies, such as the 2009 H1N1 influenza pandemic.
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8,229 |
Vaccines and Prevention
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I was in my first week as a newly graduated doctor when I encountered a vaccine-skeptic – a patient who was convinced vaccines were dangerous and could weaken the human race. I remember thinking – as a doctor, I am supposed to take a detailed history, but I hope you forgive me if I switch off just for a little bit, because right now isn’t the time for this debate. You learn something at medical school and immediately try to tell people about it, but you can’t convince them – not easily, anyway. Especially if you have been indoctrinated with factual information along the lines of this: an estimated 1.5 million children die each year—one every 20 s—from vaccine-preventable diseases such as diarrhea and pneumonia.
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8,230 |
Adenoiditis
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Synonyms: Nasopharyngitis, coryza. Definition: Acute manifestation of an initially afebrile catarrhal (predominantly viral) infection of the mucosa of the nasopharynx, adenoids and mostly also of the nose.
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8,231 |
Cough
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Pharmacists play an important role in the assessment and management of patients with cough. By obtaining a focused clinical history from the patient, they can identify patients who need to be referred to their physician or to the emergency room, as well as which patients can be managed at home. Red flags that prompt referral include severe systemic illness, respiratory distress, hemoptysis, and altered level of consciousness. Patients with underlying chronic illnesses such as chronic obstructive pulmonary disease, asthma, and heart failure who present with cough should be assessed for possible exacerbation of their illness and should be referred if this is suspected. Determining the duration of cough is an important step, as this helps identify possible etiologies. Cough <3-week duration is categorized as acute, 3- to 8-week duration is subacute, and > 8-week duration is a chronic cough. Patients with cough lasting >3 weeks should generally be referred for further evaluation and management. Acute cough is often infectious but can also be due to exacerbation of underlying illness or could be medication-related. Upper airway cough syndrome (UACS) is one of the most common causes of subacute and chronic cough. Several different etiologies lead to UACS, which is thought to be caused by postnasal drip ± sensitization of cough receptors in the respiratory tract. First-generation antihistamines or decongestants are therapeutic options when UACS is suspected. It is important to note that antitussive medications such as dextromethorphan can actually prolong illness in patients with a productive cough and are thus not recommended. Monitoring parameters and frequency of follow-up depend on underlying cause, severity of illnesses, past medical history, as well as medication changes.
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8,232 |
Genus: Calanthe to Cyrtosia
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This large chapter describe the herbal usage and pharmacology of 73 species in 12 genera (Calanthe, Callostylis, Cephalanthera, Cleisostoma, Coelogyne, Conchidium, Corymborkhis, Cremastra, Crepidium, Cymbidium, Cypripedium and Cyrtosia). A good percentage of the orchids are commonly cultivated as ornamental plants and many hybrids have been produced with Calanthe and Cymbidium. TCM makes use of 14 species of Calanthe and Rumphius who authored Hut Amboinesche Kruidboek [the Amboinese Herbal, Volumes 1–6 (1741–1750), published posthumously] described Calanthe triplicata. Calanthe species contain compounds with antitumour and hair-restoring properties. Fourteen species of Coelogyne are medicinal and several have been studied phytochemically by Majumder’s group in Calcutta. Another large group, Cymbidium, with 17 medicinal species, is also much studied. Lectins present in some species suppress replication of coronaviruses, toroviruses and viruses. An interesting compound that suppresses angiogenesis has been discovered in Cremastra appendiculata and it may find a role in preventing blindness and spread of cancers. Cyrtosia is a homomycotrophic genus and should be an interesting subject for phytochemical studies.
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8,233 |
Impact of Non-cardiac Comorbidities in Adults with Congenital Heart Disease: Management of Multisystem Complications
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The prevalence and impact of non-cardiac comorbidities in adult patients with congenital heart disease increase over time, and these complications are often specifically a consequence of the long-term altered cardiovascular physiology or sequelae of previous therapies. For the ACHD patient admitted to the intensive care unit (ICU) for either surgical or medical treatment, an assessment of the burden of multisystem disease, as well as an understanding of the underlying cardiovascular pathophysiology, is essential for optimal management of these complex patients. This chapter takes an organ-system-based approach to reviewing common comorbidities in the ACHD patient, focusing on conditions that are directly related to ACHD status and may significantly impact ICU care.
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Bioaerosols Over the Indo-Gangetic Plain: Influence of Biomass Burning Emission and Ambient Meteorology
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Bioaerosols (particles of biological origin) can be produced from living or dead plants and animals. They can potentially serve as the cloud condensation and ice nuclei (CCN and IN). Their role in global carbon cycle further highlights importance of studying their variability to link up with climate relevance parameters. Focusing on tropical region reveals that it holds wealthy number of human population and has massive vegetation cover-area. From Indian region, production estimates of bioaerosols from human population (current: ~1.25 billion; of which over 45% resides in Indo-Gangetic Plain: IGP) and Wildlife Sanctuaries and National Parks (100 in numbers, situated from north to south and east to west) is not known. Most of the forest fires in India occur during March–June (hot and drier season). The detailed information on chemical composition, fingerprinting and radiative forcing from regional forest fires is also lacking. Unlike natural sources (forest cover and fires), the seasonal variability of pollutants emission characteristic and chemical, optical and radiative forcing are relatively well studied from anthropogenic biomass (post-harvest paddy- and wheat-residue and biofuels) burning emission in India. However, the abundance of bioaerosols and their variability over a large stretch of IGP (north-west to north-east) was not well documented. Towards this, we have undertaken a year-long campaign to study and document (first-attempt) bioaerosols variability over a complete annual cycle from central IGP. We observed a parallel enhancement in concentrations of fine-particulate matter (PM(2.5) in October–November: 158 ± 89 µg m(−3) as compared to June–September months: 40 ± 18 µg m(−3); two-tailed t = 8.2, p < 0.05) and bioaerosols (particularly Gram-negative bacteria: GNB, a source of endotoxin in ambient air; 186 ± 87 CFU/m(3) during October-November as compared to 114 ± 58 CFU/m(3); t = 4.0, p < 0.05) with the biomass burning emissions intensification period. The abundance of bioaerosols exhibits influence of ambient meteorology, for example GNB exhibited negative correlations with T, wind speed and heavy (>4 mm daily) precipitation, whereas it showed positive correlations with RH and low precipitation amount (<4 mm). Studying bioaerosols and establishing its linkage to health and climate appear to be of utmost importance.
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Influenzapandemieplanung: Eine Herausforderung für die Arbeitsmedizin, den öffentlichen Gesundheitsdienst und Unternehmen
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The term pandemic refers to an international or worldwide outbreak of an infectious disease which is limited in time. Due to their high infectiousness and easy person-to-person transmission, flu viruses repeatedly lead to pandemics (approx. 3 pandemics per century.). In contrast to an epidemic, a pandemic is not restricted to one area. The mortality of an influenza pandemic is greater than the seasonal flu wave, and is not restricted to the classical risk groups: high rates of infection can occur in all age groups, with peaks frequently occurring amongst young adults. The specific virological characteristics of the influenza virus represent a great challenge for the health system. In principle, any influenza virus which has never before — or at least not for a long time — circulated within the population can develop into a pandemic virus. One possible candidate amongst others appears to be the influenza virus A-H5N1. Influenza pandemics usually occur at intervals of 11 to 39 years, and 30 years have now passed since the last pandemic. At the moment, the national and international pandemic plans have in most cases not yet been completely worked out. The co-operation between the individual countries should be intensified, and in Germany in particular, efforts should be made — in view of the different concepts of the individual federal states — to arrive at a uniform action plan. The consequences of a pandemic affect both the economic and the social sphere. Hospitals, practicing doctors and public health services must jointly develop action plans in order to be able to care for large numbers of patients within a very short time. Occupational medical specialists should form a link between health services, companies and doctors and hospitals, and already be developing plans and their communication for the companies under their care.
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Critical Illness Stress-induced Immune Suppression
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Despite the use of Centers for Disease Control and Prevention (CDC) recommended practices to minimize infection risk, nosocomial sepsis and multiple organ failure (MOF) remain a leading cause of morbidity and mortality in critically ill patients. It is well documented that the use of immunosuppressant therapies dramatically increases this risk in patients with cancer, transplantation, and immunologic disease. Although immune monitoring has yet to be universally embraced, withdrawal of immunosuppressant therapies and use of immune restoration therapies is the standard of care when these patients develop sepsis. Critical illness stress can also induce a level of immunosuppression which is as life-threatening as is seen in the purposefully immunosuppressed patient. This chapter reviews the role of critical illness stress-induced immunosuppression in the development of nosocomial sepsis and MOF, and outlines clinical strategies which can be employed to maintain and restore immune function, and reduce morbidity and mortality in critically ill patients.
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8,237 |
Pediatric infectious diseases — Quo vadis 2015?
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In modern medicine the discipline pediatric infectious diseases is an essential medical specialty. The challenging and complex tasks in the next years include meticulous consolidation and careful extension of existing activities aiming at conducting high level research, offering high standard teaching, and providing high quality patient management. This can only be accomplished by exquisitely dedicated individuals with extraordinary communication and integrative skills following painstaking continued training and formation. Potential careers in the discipline can be envisioned not only in academics, but also in government, public health, and industry, whilst less likely in private practice.
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Key Global Organizations
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Community-acquired pneumonia: paving the way towards new vaccination concepts
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Despite the availability of antimicrobial agents and vaccines, community-acquired pneumonia remains a serious problem. Severe forms tend to occur in very young children and among the elderly, since their immune competence is eroded by immaturity and immune senescence, respectively. The main etiologic agents differ according to patient age and geographic area. Streptococcus pneumoniae, Haemophilus influenzae, respiratory syncytial virus (RSV) and parainfluenza virus type 3 (PIV-3) are the most important pathogens in children, whereas influenza viruses are the leading cause of fatal pneumonia in the elderly. Effective vaccines are available against some of these organisms. However, there are still many agents against which vaccines are not available or the existent ones are suboptimal. To tackle this problem, empiric approaches are now being systematically replaced by rational vaccine design. This is facilitated by the growing knowledge in the fields of immunology, microbial pathogenesis and host response to infection, as well as by the availability of sophisticated strategies for antigen selection, potent immune modulators and efficient antigen delivery systems. Thus, a new generation of vaccines with improved safety and efficacy profiles compared to old and new agents is emerging. In this chapter, an overview is provided about currently available and new vaccination concepts.
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8,240 |
Knowledge Dissemination and Best Practice Transfer on Biosafety, Biosecurity and Biorisk Management Through a Sustainable and Effective Education and Awareness System
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Education is the first step to create a society that respects the others and the environment and that works to design and build a peaceful future. An effective and sustainable education system could rely on a tailored methodology that synergizes self-evaluation, gap-analysis, and train-the-trainers methods. This combination allows gathering information about real needs and expectations of training targets, elaborating a made-to-measure educational program and training future educators on topics of interest, making education and awareness system sustainable. Using these methodologies, we set up a knowledge development and transfer of best practice system on biosafety/biosecurity/biorisk management, in order to spread awareness and know-how on these topics. Twenty-two countries, in four different regions (South East Europe, South East Asia, North and West Africa) were involved in the project titled “Knowledge development and transfer of best practice on biosafety, biosecurity and biorisk management”. National Experts (NEs) from each country have been trained by intensive and e-learning courses to improve learning efficacy, to raise awareness and to foster networking as well as best practice sharing within each region. Consequently, the trained NEs disseminated the knowledge in their own countries, tailoring the courses on their local needs and expectations, amplifying the educational impact of the project. Here, we review the methodologies applied to develop a sustainable education and awareness system and the training contents related to biosafety/biosecurity/biorisk management.
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8,241 |
Mikrobiologische Labordiagnostik – Verlässlichkeit und Grenzen
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Fieber ist ein wichtiges Leitsymptom für viele Infektionskrankheiten, das einen ersten Hinweis auf eine bestehende Infektion geben kann. Hierbei spielen sowohl die Höhe der Temperatur als auch der Verlauf der Fieberkurve eine Rolle, wie z. B. bei der Malaria mit zyklisch auftretenden Fieberanfällen. Bei Infektionen mit Exanthem, wie z. B. Varizellen, ist das klinische Bild des Sternenhimmelphänomens mit Erythem, Papeln und Pusteln richtungweisend und bedarf nur in Ausnahmefällen einer weiteren labordiagnostischen Abklärung. Eine Schwellung der peripheren Lymphknoten und der Milz kann jedoch bei vielen Infektionskrankheiten auftreten und sollte labordiagnostisch näher untersucht werden.
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8,242 |
Biologische Waffen — eine Herausforderung an Diagnostik, Therapie, Klinik und Prävention
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Die im Oktober 2001 erfolgten Milzbrandattacken in den USA haben biologische Waffen zu Bewusstsein gebracht, Mediziner und Wissenschaftler müssen die Gefahren, die von solchen Waffen ausgehen, kennen und über mögliche vorsätzlich freigesetzte Mikroorganismen informiert sein, um Bevölkerung und Patienten behandeln und ggf. beruhigen zu können.
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8,243 |
Cordycepin: A Biotherapeutic Molecule from Medicinal Mushroom
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Cordyceps is one of the most well-known mushroom with numerous bioactive compounds possess wide range of biotherapeutic activities. This mushroom has been used for many years as medicinal food particularly in China and in different regions of south East Asia. Cordycepin is a nucleoside compound extracted from different species of Cordyceps and considered as one of the most important bioactive metabolites of this fungus. This low molecular weight compound exhibit several medicinal functions as anticancer, antitumor, antioxidant, anti-inflammatory, hypoglycemic, immunomodulatory agent. In this chapter we reviewed recent published research on the cordycepin chemistry, production, extraction, isolation, purification, biotherapeutic activities and applications.
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8,244 |
Donor-Derived Infections: Incidence, Prevention, and Management
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Organ donors reflect the diverse US population, and there are an increasing number of donors born in, who have resided in, or who have traveled to underdeveloped areas of the world or areas with geographically restricted infections. As such, these donors are exposed to pathogens that can potentially be transmitted to recipients of the donor’s organs. Additionally, there are newer techniques to identify many pathogens that may be transmitted from the donor to the transplant recipients. Finally, high-profile reports of several donor-derived infections have heightened awareness of donor-derived infections and have likely contributed to increased recognition. In this chapter, the incidence, methods of identification and prevention, and management of unexpected donor-derived infections will be reviewed.
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8,245 |
Microbiology
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Microbial contamination of pharmaceutical preparations may cause health hazard to the patient (e.g. infection, pyrogenic or allergic reaction), altered therapeutic activity of the product, or other decrease in quality (turbidity, loss of consistency, altered pH). This chapter provides a general introduction on pharmaceutical microbiology by focusing on the essential properties of micro-organisms. First of all the basic characteristics of life and the types of biological contaminants and potentially infectious agents of pharmaceutical products will be discussed: viz. prions, viruses, mollicutes, bacteria, fungi, and endotoxins. In the next section factors affecting survival and growth of micro-organisms are discussed. In addition to well-known factors such as time, temperature, and chemical and physical characteristics of the environment, attention will be paid to biofilm formation. Primary microbiological contamination is prevented by implementing an adequate microbiological quality control and quality assurance program and by following cGMPs during production. Microbiological quality control of pharmaceutical preparations and monitoring of production areas depend on the detection and quantification of micro-organisms. The classical, growth based, methods and some of the commercially available alternative methods are discussed. Understanding essential microbiological concepts is necessary in designing both microbiologically stable pharmaceutical products and ensuring an effective quality control and monitoring program within the manufacturing or preparation facility.
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8,246 |
Common Respiratory Viruses and Pulmonary Mucosal Immunology
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8,247 |
Emerging Infectious Diseases: A Historical and Scientific Review
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The chapter defines Emerging Infectious Diseases (EIDs) and provides an historical and scientific overview, to illustrate how emerging diseases have evolved over the last few decades. For various reasons, including to control and curb the spread of these diseases, global funders, researchers and epidemiologists have established in Africa, and together with African governments set up research centers both during the pre- and post-colonial era to better understand the causative agents, epidemiology and control of infectious diseases. The chapter provides historical and current perspectives of some of these research centers, including their role in the detection and control of human and animal diseases in Africa. Given the immense health and economic burdens of EIDs on both the human and animal populations in Africa, there is an urgent need for African countries to own the means and processes of disease prevention and control, and invest in preparedness measures against the outbreak of diseases.
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8,248 |
President R. Gerald Ford
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President Ford, when faced with the emergence of a virus that appeared to be related to the one that caused the horrendous pandemic of 1918, moved vigorously to prepare for the possibility of another such onslaught. There was widespread agreement that the possibility of another such pandemic existed, and that prudence demanded quick action. Securing quick approval from a Democratic Congress, the Republican president launched the National Influenza Immunization Program to vaccinate virtually the entire population.
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8,249 |
Globalized Perspectives on Infectious Disease Management and Trade in Africa: A Conceptual Framework for Assessing Risk in Developing Country Settings
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In the era of globalization, internationalized representations of infectious disease threats have profound implications for understandings of infectious disease problems and their management in developing countries, particularly in Sub-Saharan Africa. By examining the policy implications of the key narratives around public health, animal health and trade, it becomes possible to clarify the relationship between global understandings of infectious disease risk and their impact on the development of local responses to disease problems. We highlight the tensions that resource-constrained countries face in the nexus of animal health-public health and trade, including the perception that resource-constrained countries are both source and victims of potential infectious disease threats. Given this scenario, it is important to think about how developing countries, particularly those in Sub-Saharan Africa, can approach infectious disease risk management as it relates to pandemic scale threats such as avian and pandemic influenza. We outline some of the key considerations in defining and assessing disease risk using avian and pandemic influenza in Zambia as an example. We conclude that the key to the feasibility of the analysis of the risk of multi-sectoral affecting emerging infectious diseases such as zoonotic avian influenza is flexibility in how risk is framed across the public health, animal health and trade systems.
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8,250 |
Proteomics Defines Protein Interaction Network of Signaling Pathways
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Protein interactions play fundamental roles in signaling transduction. Analysis of protein–protein interaction (PPI) has contributed numerous insights to the understanding of the regulation of signal pathways. Different approaches have been used to discover PPI and characterize protein complexes. In addition to conventional PPI methods, such as yeast two-hybrid (YTH), affinity purification coupled with mass spectrometry (AP-MS) is emerging as an important and popular tool to unravel protein complex and elucidate protein function through the interaction partners. With the AP-MS method, protein complexes are prepared first by affinity purification directly from cell lysates, followed by characterization of their components by mass spectrometry. In contrast to most PPI methods, AP-MS reflects PPI under near physiological conditions in the relevant organism and cell type. AP-MS is also able to probe dynamic PPI dependent on protein posttranslational modifications, which is common for signal transduction. AP-MS mapping protein interaction network of various signal pathways has dramatically increased in recent years. Here, I’ll present the strategies toward obtaining an interactome map of signal pathway and the methodology, detailed protocols, and perspectives of AP-MS.
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8,251 |
The Kidney and the Tropics
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In this age of rapid globalization and travel, diseases that were previously prevalent in warmer countries within the tropics are increasingly found in other countries with more temperate climates. A sound knowledge of such “tropical” renal diseases is essential for the practicing general pediatrician or nephrologist. This chapter describes tropical renal diseases as broadly divided into “infectious” conditions such as malaria, rickettsial infections, and viral hemorrhagic fevers, among others, and “toxic” conditions including snakebite and use of indigenous medicines which result in renal injury. In general, severe and progressive renal damage is preventable with early diagnosis and treatment of the underlying condition and provision of supportive care.
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8,252 |
Living Together
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The social life of bats is a complex and multifaceted one of constant interaction between males and females, between females and their pups, and between rivals, relatives, and other bats. Bats can form lasting friendships, they groom each other, they alert each other to danger, they form a united front against inquisitive owls, they steal and share food, and they look after each other’s young. The strategies of co-existence are almost as many as there are bat species. While some form stable, monogamous couples, others live in colonies of millions of individuals. Some live in small family groups or harems that stick together throughout the year (sometimes year after year), others change their groupings according to season.
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8,253 |
AIDS Policy: China’s Tipping Point
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China’s pioneering AIDS researchers were not content simply to build up evidence about HIV and the programmes that might prevent its spread. From early on, they worked actively to get the nation’s leaders to pay attention to the threat that a widespread HIV epidemic would pose to the country. As early as 1996, an inter-ministerial body called the State Council Coordination Mechanism Committee for AIDS/STD Control and Prevention was created under the chairmanship of Vice Premier Li Lanqing. The State Council is the highest administrative body in China, and the coordinating mechanism was able to bring together 21 ministries, providing each with guidance on its roles and responsibilities, to work on HIV prevention.
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8,254 |
Bats and Buildings: The Conservation of Synanthropic Bats
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Humans have shared buildings with bats for thousands of years, probably as early as first humans built primitive huts. Indeed, many bat species can be defined as synanthropic, i.e., they have a strong ecological association with humans. Bats have been observed using buildings as roosting and foraging sites, temporary shelters, for reproduction and hibernation. A synanthropic lifestyle may result in direct fitness benefits owing to energetic advantages in warmer roosts, which may ultimately lead to more rapid gestation and faster development of juveniles, or by being less exposed to natural predators in urban environments. All these benefits may allow bats to use buildings as stepping stones to exploit habitats otherwise devoid of roosting structures and may even lead to the expansion of geographic ranges. Yet, the coexistence with humans also comes with some risks. Bats may be exposed to chemical pollutants, particularly preservation chemicals used on lumber or during pest control measures. Bats may also be at risk of direct persecution or they may die accidently if trapped within buildings. In general, eviction of bats from buildings should follow the general rule of avoidance–mitigation–compensation. When considering conservation measures for synanthropic bats, it is most important to assess the role of the building for different life stages of bats. Construction work at buildings should be conducted in a manner that minimizes disturbance of bats. Artificial roosts can replace lost roosts, yet bats will often not accept alternative roosts. Demographic changes in human populations may lead to the abandonment of buildings, for example, in rural areas and to increased conflicts in urban areas when old buildings are replaced by new buildings or when previously unoccupied space in buildings is renovated. We advocate maintenance and enhancement of roosts for synanthropic bats, in addition to outreach and education campaigns, to improve the tolerance of humans for synanthropic bats.
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8,255 |
Neonatologie
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Noch vor 20 Jahren war die häufigste Todesursache Frühgeborener das akute Lungenversagen. Die sensationellen Ergebnisse von Mary Ellen Avery ebneten dann den Weg für eine kausale Therapie des Atemnotsyndroms. M.E. Avery beobachtete, dass die Lungen eines verstorbenen Frühgeborenen luftleer und »schwer« waren und kein »schäumendes Material« (»foam«) enthielten. Wie sie durch Experimente belegen konnte, fehlte diesen Lungen in der Tat eine Substanz, die die Oberflächenspannung in den Alveolen vermindert: das pulmonale Surfactant. Die 1959 publizierten Ergebnisse ihrer Untersuchungen fanden zunächst nicht die ihnen gebührende Aufmerksamkeit. Um die weitere Resonanz auf ihre Entdeckung zu beschreiben, verweist M.E. Avery gerne darauf hin, dass sich neues Wissen in 3 Phasen verbreitet: Die 1. Phase, in der neue Ergebnisse bekannt gegeben werden, wird meist ignoriert. In der 2. Phase rufen die inzwischen von anderen nicht mehr zu leugnenden Ergebnisse Feindseligkeiten hervor, in der 3. und letzten Phase besteht eine generelle Übereinstimmung darüber, dass man schon immer von dieser Tatsache ausgegangen sei.
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8,256 |
Epidemiology and etiology of Kawasaki disease
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Kawasaki disease was first reported in Japan in 1967 by Dr. Tomisaku Kawasaki. It has since been recognized worldwide, and in at the United States and Japan is the most important cause of acquired heart disease in children, surpassing other more recognized conditions such as rheumatic fever, endocarditis and myocarditis. It is primarily a disease of children less than 5 years of age but has been reported in older children and adults. Risk factors for the illness include Asian ancestry, male gender and certain familial predispositions. Observations such as similarity to certain exanthematous infectious diseases, temporal-geographic clustering of cases and seasonality in incidence favors an infectious etiology. Pathology and pathogenesis of the disease indicate that it is a medium-sized artery vasculitis that results from a dramatic immune activation that in most cases reversed by immune modulating agents such as intravenous immunoglobulin. Unfortunately, the etiology of the illness remains obscure, although recent studies favor a possible viral etiology.
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8,257 |
Introduction: Origins of Human Security
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Human security denotes a human-denominated, as opposed to State, focus for security. It highlights the duality of individual, universal—universalizable—human rights. This duality is central to the notion of human rights tied to human security. The idea of human security beyond borders is fundamentally an exercise in reimagining the traditionally State-based loci of responsibility for those individual but also universal human rights. This chapter introduces the challenges of geopolitical shifts compounded by unprecedented impacts of climate change, migration, and pandemic (potential). It makes a case for rethinking human security of citizens and non-citizens alike—beyond borders.
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8,258 |
SIRS, Sepsis und Multiorganversagen
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8,259 |
Lessons Learned and Reordering Policy Prescriptions
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The final Chapter 8 offers practical policy suggestions towards (re)ordering health. It takes into account that not all health rights and threats are of the same caliber, that prioritization is a necessity. It also acknowledges that not all risks and threats can be anticipated or annulled. Bearing these limitations in mind, the chapter re-frames health risks in terms of a re-ordering of health security at the level of local, national, and global policy. It also offers theoretical as well as concrete suggestions on how it might be possible to conceptualize, communicate, and confront health risks and threats with states, non-state actors and other agents to facilitate health rights responsibility within and across borders.
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8,260 |
Genetic Polymorphisms in Critical Care and Illness
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8,261 |
Computational Fluid and Particle Dynamics (CFPD): An Introduction
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Computational Fluid Particle Dynamics (CFPD) is an emerging research field that involves interdisciplinary research areas with a broad range of applications. Fluid-particle flows can be found all around us, from the airborne particles we breathe to industrial applications such as fuel spray in internal combustion engines, fluidised bed combustors, and mineral processing to name a few. In the health, pharmaceutical, and biomedical fields, interest is increasing in the use of computational modelling for inhalation toxicology analysis, effectiveness of drug delivery systems, respiratory and physiological flows. Computational modelling is being used in many industries as a valuable tool for cost and cycle time reductions during product development, and it can provide proof of concept for model designs. This technique has been encouraged by the rapid developments in computational models to reflect the physics, which is in line with the increase in computing power.
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8,262 |
Cardiovascular Disease: An Introduction
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Cardiovascular disease (CVD) is a collective term designating all types of affliction affecting the blood circulatory system, including the heart and vasculature, which, respectively, displaces and conveys the blood.
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8,263 |
Leadership and Health in Africa
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A second generation of leaders has now assumed power in Africa, replacing those who inherited the colonial state following independence during the 1960s and 1970s and, in a few cases thereafter. Since independence, two or three governing trends have become clear on the continent. Foremost, it seems that, to the committed first group of leaders who inherited the colonial state, the most important goal was to eliminate ethnic divisions and create new nations, where the state was sacrosanct.
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8,264 |
Gastroenterologie
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8,265 |
Komplementsystem und Komplementdefekte
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Unter den Mechanismen, die zum Selbstschutz des Körpers beitragen, ist das Komplementsystem von herausragender Bedeutung. Als Teil der angeborenen Abwehr ist es jederzeit verfügbar und somit bereits in der Präimmunphase von unschätzbarem Wert, bevor es zur Bereitstellung spezifischer Antikörper und T-Lymphozyten kommt. Zu seinen Effektorfunktionen zählen neben der lytischen Zerstörung pathogener Mikroorganismen die Beseitigung von Immunkomplexen, die Opsonisierung nicht nur von Krankheitserregern, sondern auch von autoantigenem Material für eine effiziente Phagozytose sowie die Rekrutierung und Aktivierung von Entzündungszellen. Darüber hinaus moduliert das Komplementsystem aber auch die Antwort des erworbenen Immunsystems. Außerdem wird in zunehmendem Maße die Rolle des Komplementsystems in so unterschiedlichen biologischen Prozessen wie der Hämatopoese, Fortpflanzung und der Organregeneration deutlich, so dass die Vorstellung von Komplement als reinem Abwehrsystem erweitert werden muss zu einem mit vielen biologischen Funktionen vernetzten und steuernden System zur Aufrechterhaltung der Homöostase. Etwa 5 % aller Plasmaproteine sind Komplementfaktoren, die zum überwiegenden Teil in der Leber und durch Makrophagen synthetisiert werden. Aber auch Fibroblasten, Epithelzellen der Lunge und des Magen-Darmtraktes und weitere Gewebszellen, wie Astrozyten, Haut-und Muskelzellen, sind prinzipiell zur Synthese zumindest bestimmter Komplementproteine fähig.
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8,266 |
Risk of Globalization of the Disease in Europe
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Risk of dissemination of ZIKV disease is based on multiple factors, including environmental (climate, socioeconomically, deforestation or industrialization) and travel/traveller factors. Both the disease (viremic travellers) and vector movement to mosquito-free area contributes to the introduction and establishment of autochthonous ZIKV transmission. Mass gathering events can contribute to magnify transmission due to close crowd life in a confined area. Also, multitudinary events can promote the introduction of an infectious disease to a previously naïve area when returning home. Although mathematical models estimate a low risk for introduction of ZIKV in Europe, specific European regions (mainly Portuguese Island of Madeira) account with suitable and efficient vector and opportune climate conditions to harbour the disease. Clinicians should be aware to enable early detection of autochthonous ZIKV cases. International and local guidelines can help clinicians on how to handle suspicious cases, how to confirm the infection and how to report suspected and confirmed cases. In case of autochthonous ZIKV detection, public authorities should perform surveillance and provide adequate resources to sustain enhanced mosquito control.
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8,267 |
Historical Aspects of Polyclonal IgG Preparations
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Today we can choose between several polyclonal IgG products for both replacement and immunomodulation. However, it was a long way to go to reach this stage. In this chapter, we try to illustrate the major stages of IgG product development which began more than 70 years ago.
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8,268 |
Switching Control Strategies
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This chapter is motivated by the application of control strategies to eradicate epidemics. In part, the previous switched epidemic models are reintroduced with continuous (e.g., vaccination of newborns continuously in time) or switching control (i.e., piecewise continuous application of vaccination or treatment schemes) for evaluation and optimization. As discussed earlier, infectious disease models are a crucial component in designing and implementing detection, prevention, and control programs (e.g., the World Health Organization’s program against smallpox, leading to its global eradication by 1977). The switched SIR model is first returned to for consideration and analysis of vaccination of the susceptible group (e.g., newborns or the entire cohort). Subsequently, the developed theoretical methods are applied to the switched SIR model with a treatment program in effect. Common Lyapunov functions are used to provide controlled eradication of diseases modeled by the so-called SEIR (Susceptible-Exposed-Infected-Recovered) model with seasonal variations captured by switching. A screening process, where traveling individuals are examined for infection, is proposed and studied for the switched multi-city model of the previous chapter. Switching control of diseases such as Dengue and Chikungunya which are spread via mosquito–human interactions, is investigated.
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8,269 |
Viszeralchirurgie
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8,270 |
Bioterrorism
| null |
8,271 |
Animal Health Policy
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The EU remains under threat of communicable diseases of livestock that may have a severe economic impact or that are of public health significance or both. Such diseases may be introduced and spread by the trading of animals and their products. Measures in line with international agreements are required to prevent the introduction of disease, to control its spread and to protect animal and human health, and to provide safe, wholesome food for European consumers. The EU’s Animal Health Strategy 2013–2017, the Common Financial Framework and the Animal Health Law contributed to the recent update of the EU’s animal health policy. Although the EU’s animal health policy is evaluated to be clearly effective, its cost-effectiveness (efficiency) is difficult to determine.
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8,272 |
Safety and Efficacy of Hemoglobin-Vesicles and Albumin-Hemes
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Keio University and Waseda University have worked together on artificial O(2) carrier research for 20 years in close cooperation. Two candidate materials have been selected from the viewpoints of safety, efficacy, and cost performance. One is Hemoglobin-vesicles (HbV) and the other is albumin-heme (rHSA-heme). This chapter summarizes our video presentation that introduced the recent results of our research into HbV and rHSA-heme.
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8,273 |
China’s Prevention and Control and Policy Changes to the Influenza A (H1N1) Pandemic
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The first case of Influenza A (H1N1) in China was found in Hong Kong, on May 1st, 2009, where the patient had flown from Mexico to Hong Kong via Shanghai. On May 11th, Sichuan Province reported the first imported Influenza A (H1N1) case in mainland China, and the first domestic case was reported on May 29th.
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8,274 |
The Synthetic Nature of Biology
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For centuries, biology was centred on the analysis of the microscopic and macroscopic worlds, but since the end of the 19th century it progressively adopted synthesis as a means to understand biological systems, strengthened recently by the dawn of synthetic biology. Contemporary synthetic biology is essentially composed of various “research tribes” with different methods, languages, metaphors and agendas willing to understand biological systems and—in particular—to engineer them for solving health, food, energy and environmental problems. Synthetic biology is not only an extension of traditional genetic engineering where Genetically Modified Organisms (GMOs) are produced, but it is also endowed of various elements that allow the emergence of new artificial life forms. In this chapter, a brief history of synthetic biology is presented, followed by a description of its most prominent “tribes” and a proposition for categorising the various engineering approaches currently practiced in the field. An overview of existing and nascent GMOs is also given, including some of their applications as well as biosafety and biosecurity risks. Finally, some challenges, dilemmas and paradoxes in synthetic biology beyond the bench are very briefly examined, particularly with regard to global social justice, democratization of molecular biology, environmental concerns, policy regulation, the GMO debate, media hype, public acceptance, and the issue of resurrecting extinct life.
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8,275 |
Transplantation
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The intensive care unit (ICU) is integral in any successful transplant program, as the care of these transplant recipients requires exhaustive multidisciplinary care. After transplantation, these patients have a host of hemodynamic changes that affect both the allograft and global end-organ function. All organ systems remain intricate in the ICU and must be monitored closely as the acuity remains high even after the immediate postoperative period. Managing these patients requires an in-depth understanding of immunosuppressive medications as well as their side effect profiles and drug interactions to safely navigate the care of these patients. Not surprisingly, given these patients have an innate immunosuppressive state in addition to these medications, they remain susceptible to aggressive post-transplant infections. Communication between the ICU and the transplant team remains key to the success of each individual transplanted graft and patient.
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8,276 |
Respiratory Syncytial Virus and Human Metapneumovirus Infection in Transplant Recipients
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Respiratory viral infections due to respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) cause infections in immunocompromised transplant patients ranging from mild upper respiratory infections to severe lower respiratory tract disease with respiratory failure. These viruses are more readily diagnosed due to improvements in sensitive molecular diagnostic methods. The epidemiology of RSV and hMPV is similarly becoming more readily appreciated in hematopoietic stem cell transplant (HSCT) patients of all ages as well as solid organ transplant (SOT) patients, with lung transplant recipients having evidence of more frequent and severe complications related to these viruses. RSV and hMPV infection typically but not always present with upper respiratory signs and symptoms that progress to lower respiratory tract disease. Treatment options for RSV are limited, with aerosolized, intravenous, and oral ribavirin all studied in HSCT and lung transplant patients. No antiviral therapy for the treatment of hMPV is available, although ribavirin has shown some effectiveness in vitro. New antiviral agents including RSV fusion inhibitors and nucleoside analogs are being developed, with some under clinical evaluation.
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8,277 |
Aeromedical Evacuation of Patients with Contagious Infections
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Most patients with infectious diseases, including biologic warfare casualties, can be safely transported by aeromedical evacuation (AE) using standard precautions. However, certain contagious diseases (e.g., tuberculosis, pneumonic plague, viral hemorrhagic fever) require transmission-based precautions to protect the other patients, medical personnel, and aircrew. AE planning for these patients must take into account international public health regulations. Given adequate resources, foresight, and expertise, the AE of infected patients and biologic warfare casualties can be safely accomplished. This chapter provides a review of the aeromedical evacuation of patients with communicable diseases. Topics include a review of the ecology of aircraft cabins and engineering features of aircraft ventilation systems that minimize the risk of disease transmission; examples of point source outbreaks related to air travel; in-flight preventive measures including the use of patient isolators; and US military and international policy and legal aspects of transporting patients with communicable diseases. Examples include in-flight transmission of tuberculosis, severe acute respiratory syndrome (SARS), smallpox, and measles.The chapter will also discuss experience in transporting patients with contagious diseases including viral hemorrhagic fevers and new patient isolation technologies that were used for the long-distance transport of patients with Ebola virus disease during the 2014–2016 West African epidemic.
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8,278 |
Acute Right Heart Failure
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Heart failure is defined as a life-threatening complex clinical syndrome with exacerbation of symptoms signifying decompensation and requires emergent treatment. In its acute state it presents within 24 hours with symptoms such as shortness of breath, volume overload including pulmonary edema, sometimes forward failure and even cardiogenic shock. Two forms of acute heart failure exist: newly diagnosed “de novo” or acutely decompensated chronic heart failure. This chapter summarizes the clinical and prognostic classification of acute right heart failure, epidemiology, diagnostic work-up and the principles behind treatment and management options that focus on preload optimization, afterload reduction and improvement of contractility.
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8,279 |
Low-cost Paper Analytical Devices for Environmental and Biomedical Sensing Applications
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Over the last decade, the fabrication of analytical devices utilizing microfluidic structures and lab-on-a-chip platforms has shown breakthrough advancements, both for environmental and biological applications. The ASSURED criteria (affordable, sensitive, specific, user-friendly, robust, equipment-free, delivered), developed by the WHO for diagnostics devices, point towards the need of paper-based analytical devices (PAD) for diagnostics. On the other hand, cost-effective PADs owing the great advantage of affordable applicability in both resource-rich and -limited settings are recently employed for on-site environmental monitoring. In this book chapter, we will discuss about the brief history of paper analytical devices, fabrications, need, and its environmental and biomedical applications.
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8,280 |
Other Potentially Life-Threatening Conditions with Mucocutaneous Findings (Leptospirosis, Typhoid Fever, Dengue, Diphtheria, Murine Typhus)
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There are several conditions with mucocutaneous findings that are potentially life-threatening, particularly in certain vulnerable populations. In this chapter, leptospirosis, typhoid fever, dengue, diphtheria, and murine typhus are reviewed. The disease time course of classic and atypical presentations is detailed to assist making the diagnosis in subtle cases. Associated symptoms are discussed as well as a comparison with disease mimics and differential diagnoses. Key diagnostic features are emphasized, and evidence-based management of each condition is detailed in this chapter.
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8,281 |
Risk, Health and Medicine in The New York Times
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The study provides evidence for the increasing usage of risk words in reporting on health and illness. Chronic and civilisation illnesses are well represented and contribute to this trend. Infectious diseases often inform short risk hypes. AIDS’ long-term presence has become a less prominent topic, as treatment improves and panic subsides. An epidemiological worldview and strong references to scientific studies carry the instantiation of risk. There is less conscious and/or agentive risk-taking in the reporting on health and illness than in other social domains. While women and children (for example) are frequently represented in relation to risk, they are less likely to be presented as taking risks, and more likely to experience them.
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8,282 |
ER Stress, UPR and Virus Infections in Plants
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The endoplasmic reticulum (ER) endomembrane is a central site for protein synthesis. Perturbation of ER homeostasis can result in an accumulation of unfolded proteins within the ER lumen, causing ER stress and the unfolded protein response (UPR). In humans, ER stress and UPR are closely associated with a vast number of diseases, including viral diseases. In plants, two arms that govern the UPR signaling network have been described: one that contains two ER membrane–associated transcription factors (bZIP17 and bZIP28) and the other that encompasses a dual protein kinase (RNA-splicing factor IRE1) and its target RNA (bZIP60). Although early studies mainly focus on the essential roles of the UPR in abiotic stresses, the significance of UPR in plant diseases caused by virus infections has recently drawn much attention. This chapter summarizes the latest scenario of ER stress and UPR in virus-infected plant cells, highlights the emerging roles of the IRE1 pathway in virus infections, and outlines exciting future directions to spark more research interest in the UPR field in plants.
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8,283 |
Hämotherapie und Patient Blood Management
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Blutprodukte können Leben retten, z. B. bei schwerverletzten Patienten oder großen Operationen, aber ihre Anwendung kann auch mit teilweise erheblichen Risiken verbunden sein, z. B. Infektionsrisiko, akute Lungenschädigung oder ggf. sogar ein erhöhtes Tumorrisiko. Daher müssen die Indikationen zur Fremdblutgabe genau bekannt sein, aber auch das richtige Vorgehen bei der Bluttransfusion sowie alle Maßnahmen, um eine Transfusion bestmöglich zu verhindern. Das vorliegende Buchkapitel befasst sich mit den Grundlagen und allen praktischen Aspekten der Bluttransfusion, der maschinellen Autotransfusion und stellt auch das Konzept »Patient Blood Management« dar.
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8,284 |
Physiology, Benefits and Risks of Red Blood Cell Transfusion
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8,285 |
Performance evaluation of a Bayer Healthcare Diagnostics research-based SARS coronavirus assay
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8,286 |
Chapter 1
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“I have Japanese Encephalitis,” a woman on the phone told her. “Really? Have you been to a doctor?” Eliza scratched the letters JE on her purple notepad and began to take the report. “No, I just think, I mean, I am pretty sure that’s what I have.” “Ok. Why do you think that? Have you traveled outside of the country recently?” “No, I think I must be the first person to get it in the United States. I looked up my symptoms on the internet and that sounds exactly like what I have.”
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8,287 |
Exploitation of Bats for Bushmeat and Medicine
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Bat hunting for consumption as bushmeat and medicine is widespread and affects at least 167 species of bats (or c. 13 % of the world’s bat species), in Africa, Asia, across the islands of Oceania, and to a lesser extent in Central and South America. Hunting is particularly prevalent among the large-bodied fruit bats of the Old World tropics, where half (50 %, 92/183) the extant species in the family Pteropodidae are hunted. Pteropodids that are hunted are six times more likely to be Red Listed as threatened: 66 % of species in IUCN threatened categories (CR, EN, VU, NT), compared to 11 % of species in the ‘Least Concern’ (LC) category. However, there still appears to be an information gap at the international level. One third of the hunted species on the Red List are not considered threatened by that hunting, and nearly a quarter of the bat species included in this review are not listed as hunted in IUCN Red List species accounts. This review has resulted in a comprehensive list of hunted bats that doubles the number of species known from either the IUCN Red List species accounts or a questionnaire circulated in 2004. More research is needed on the impacts of unregulated hunting, as well as on the sustainability of regulated hunting programs. In the absence of population size and growth data, legislators and managers should be precautionary in their attitude towards hunting. Roost site protection should be a priority as it is both logistically simpler than patrolling bat foraging grounds and reduces the comparatively larger scale mortality and stress that hunting at the roost can cause. Education and awareness campaigns within local communities should demonstrate how bats are a limited resource and emphasize characteristics (nocturnal, slow reproducing and colonial) that make them particularly vulnerable to hunting pressure.
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8,288 |
Hämatologie
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8,289 |
Minimally Invasive Diagnostic Strategy in Immunocompromised Patients with Pulmonary Infiltrates
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Acute respiratory failure (ARF) is the main reason for ICU admission in patients with haematological malignancies. High mortality rates of up to 50% are reported in this situation, and mortality is highest when mechanical ventilation is needed. Rapid and accurate diagnostic methods are needed in these vulnerable patients to ensure the prompt initiation of effective treatment. However, the broad array of possible cause of ARF raises diagnostic challenges. In this review, we discuss the DIRECT strategy, which identifies the most plausible diagnosis in each patient based on the type of immune deficiency and clinical presentation. We will focus on non-invasive laboratory tests developed in recent years, discussing their sensitivity and specificity. We also discuss the usefulness in cancer patients with specific organ dysfunctions of biomarkers introduced over the past few years.
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8,290 |
Building the Infrastructure and Regulations Needed for Public Health and Fitness
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1. To recognize the importance to the maintenance of good health of adequate public health regulations and an infrastructure that provides clean water and appropriate waste management. 2. To see the lack of such amenities over many centuries, but the progressive development of public health bureaucracies dedicated to provision of an appropriate infrastructure for healthy cities, beginning during the Victorian Era. 3. To observe how responsibility for the provision of adequate housing for poorer city dwellers has been shared between government, benevolent entrepreneurs and charities. 4. To note the new challenges to public health presented by such current issues as the abuse of tobacco and mood-altering drugs, continuing toxic auto-emissions, the epidemic of HIV/AIDS, a decreased acceptance of MMR vaccinations, and the ready spread of infectious diseases by air travel.
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8,291 |
Centralising Information: Predicting and Managing the Risk of Pandemics at the WHO
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In order to analyse the centralisation of information, the research team went to the SHOC Room of the World Health Organization (WHO) in Geneva, a critical hub through which passes all information destined to managing worldwide epidemic risks. The description of the WHO’s surveillance device for epidemic diseases has brought to our attention the fact that an information becomes ‘alive’ only if seized, translated and transmitted to the next level, which in turn, undertakes the same process, and so on, thus creating a succession of ‘captures’. Furthermore, the socio-technical intermediaries, which are constantly being perfected by technological advancements, have allowed to broaden, in response to the SARS crisis, the notion of risk and to display the emergence of a novel spatiality on the scene of world affairs. This broadening also tampers with temporality. The WHO must now not only come to terms with the ‘during’, but must also invest in the analysis of all potentially sensitise information, such as rumours.
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8,292 |
Postoperative Liver Failure
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Technical innovations in surgical techniques, anaesthesia, critical care and a spatial understanding of the intra-hepatic anatomy of the liver, have led to an increasing number of liver resections being performed all over the world. However, the number of complications directly attributed to the procedure and leading to inadequate or poor hepatic functional status in the postoperative period remains a matter of concern. There has always been a problem of arriving at a consensus in the definition of the term: postoperative liver failure (PLF). The burgeoning rate of living donor liver transplants, with lives of perfectly healthy donors involved, has mandated a consensual definition, uniform diagnosis and protocol for management of PLF. The absence of a uniform definition has led to poor comparison among various trials. PLF remains a dreaded complication in resection of the liver, with a reported incidence of up to 8 % [1], and mortality rates of up to 30–70 % have been quoted [2]. Several studies have quoted a lower incidence of PLF in eastern countries, but when it occurs the mortality is as high as in the West [3].
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8,293 |
Respiratory Viruses
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The respiratory viruses as a group are the most common cause of an acute infectious illness in developed societies. The immunocompromised state of many cancer patients constitutes the basis for the frequent failure of the host to promote a normal and rapid recovery from an acute respiratory viral infection and results in a more severe and prolonged infection that causes significant morbidity and mortality in these patients. Those respiratory viruses that are most prevalent and most prone to produce lower respiratory illnesses and pneumonia in healthy hosts, RSV, influenza viruses, and parainfluenza viruses, are those most likely to cause severe illness and pneumonia leading to hospitalization in immunocompromised persons. However, viruses less prone to produce a lower respiratory illness but that are highly prevalent, such as rhinoviruses, may frequently be associated with severe illness. The limited availability of antivirals and vaccines for the acute respiratory viruses means that these infections will continue to be important for many years and dictate a need for utilizing infection control procedures as much as possible, particularly in hospitals and institutions, so as to minimize spread. Efforts to develop specific vaccines are important as their use could prevent as well as reduce exposure of cancer patients to these viruses. Development of specific antivirals is important for use in immunocompromised patients as normal recovery mechanisms may be seriously impaired.
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8,294 |
A Security Culture
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Since the events of 11 September 2001, there have been several attempts against the security of aircraft in flight. These threats have ranged from shoe bombs to dirty bombs to explosives that can be assembled in flight with liquids, aerosols and gels. In every instance the global community has reacted with pre emptive and preventive measures which prohibit any material on board which might seemingly endanger the safety of flight. Some jurisdictions have even gone to extremes in prohibiting human breast milk and prescriptive medications on board.
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8,295 |
Croup
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Case 1 A 20-month-old boy is brought to his family practitioner by his mother. The boy has a 12-hour history of a loud cough, slight fever to 101°F, and a hoarse voice. The mother reports that the child had a difficult time sleeping the previous night because of the harsh cough. On examination, the boy is playful and smiling with a temperature of 99°F. It is noticed that he has a seal-like barking cough and subtle evidence of audible stridor.His chest is clear on auscultation with a normal respiratory rate.No chest wall recession is noted. The rest of the exam is unremarkable. The patient is sent home with a suspected upper respiratory infection. Later that evening, the family practitioner receives a phone call from the emergency department informing him that the patient has had worsening respiratory difficulty with visible signs of inspiratory stridor and is being admitted to the hospital for further observation.
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8,296 |
Virale Gastroenteritiserreger
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Gastroenteritiden gehören zu den häufigsten Erkrankungen des Menschen und sind verbunden mit einer hohen Krankheitslast und Mortalität. Besonders betroffen sind Säuglinge und Kleinkinder in den Tropen, wo jährlich schätzungsweise 1–2 Mio. Kinder an einer Gastroenteritis versterben. Viren gehören zu den häufigsten Auslösern dieser Erkrankungen. Seit der elektronenmikroskopischen Entdeckung des Norwalkvirus 1972 wächst die Zahl der bekannten Erreger (◘ Tab. 65.1).
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8,297 |
Design and Simulation of Isolation Room for a Hospital
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Heating, ventilation and air conditioning (HVAC) of hospitals is a highly specialized field and critical care units like isolation rooms and operation theatres deserve special attention, as infected patients must be isolated from ambient environment in order to prevent the infection from spreading and to save the life of the patient. This manuscript aims to optimize the ventilation strategy towards contaminant suppression in the isolation room. 3D Navier-Stokes and energy equation using finite volume method (FVM) with a domain of isolation room is solved for appropriate boundary conditions. The patient’s body is approximated as a semi-cylindrical shape resting on a bed and is treated as a constant heat source. Velocity and temperature profile inside the isolation room for various configurations are simulated. Our results suggest that immune-suppressed patients should be kept near the air supply and infectious patients near the exhaust.
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8,298 |
Similarity and Diversity in Chemical Design
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Following a simple introduction to drug discovery research, this chapter presents some mathematical formulations and approaches to problems involved in chemical database analysis that might interest mathematical/physical scientists. With continued advances in structure determination, genomics, and high-throughput screening and related (more focused) techniques, in silico drug design is playing an important role as never before. Thus, traditional structure-directed library design methods in combination with newer approaches like fragment-based drug design [496, 1447], virtual screening [453, 1179], and system-scale approaches to drug design [236, 278, 649] will form important areas of research.
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8,299 |
Acute Viral Rhinitis
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Rhinitis refers to any kind of inflammatory condition of the nasal mucosal linings. Generally, acute rhinitis is associated with environmental allergies or respiratory viral infections. Viral microbes with numerous types and subtypes can infect the respiratory epithelium of the nasal cavity in a repetitive fashion throughout the year, or during a specific period of time such as winter or fall. Among all forms of inflammatory diseases of the nasal mucosa, acute viral rhinitis (AVR) has unique epidemiological, clinical, and therapeutic characteristics. As the most prevalent type of rhinitis, AVR is also the most common form of any infectious disease of the human body. Although it is almost always self-limiting, in rare circumstances disease might progress and the clinical scenario could become complicated. Common complaints and physical findings related to AVR are similar to those seen with other types of rhinitis such as allergic, hormonal, senile, or drug induced. The clinician must interpret these symptoms and findings in the context of other parameters such as “duration, environmental factors, and patient characteristics” to establish an accurate diagnose and appropriate therapeutic management. In this chapter, we aim to discuss the epidemiology, pathogenesis, clinical findings, differential diagnosis, and therapeutic management of AVR in light of the recent literature knowledge. It is our hope that this chapter may aid medical professionals who encounter AVR in daily practice.
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