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8,500 |
Non-viral Vector for Muscle-Mediated Gene Therapy
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Non-viral gene delivery to skeletal muscle was one of the first applications of gene therapy that went into the clinic, mainly because skeletal muscle is an easily accessible tissue for local gene transfer and non-viral vectors have a relatively safe and low immunogenic track record. However, plasmid DNA, naked or complexed to the various chemistries, turn out to be moderately efficient in humans when injected locally and very inefficient (and very toxic in some cases) when injected systemically. A number of clinical applications have been initiated however, based on transgenes that were adapted to good local impact and/or to a wide physiological outcome (i.e., strong humoral and cellular immune responses following the introduction of DNA vaccines). Neuromuscular diseases seem more challenging for non-viral vectors. Nevertheless, the local production of therapeutic proteins that may act distantly from the injected site and/or the hydrodynamic perfusion of safe plasmids remains a viable basis for the non-viral gene therapy of muscle disorders, cachexia, as well as peripheral neuropathies.
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8,501 |
Childhood’s End
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When things stop working in an organizational system—a firm, a nonprofit, or a political entity—people have two choices in addressing the failure: to leave or to protest. Both can be powerful. As the author of this thesis, economist Albert Hirschman, pointed out in his 1970 book Exit, Voice, and Loyalty, it is possible for even an entire country (e.g., the United States or Liberia) to be created by people who leave behind unhappy circumstances and start something new elsewhere. Likewise, examples of the success of protest (“voice” and related action) in achieving major changes are plentiful. Consider the French Revolution and the multitude of regime changes and coups d’état that dot human history—not to mention the many times that a regime has been replaced by popular demand of voters.
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8,502 |
Stumpfe Wunderwaffe(3)
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Bevor wir den Test für Krankheitserreger erklären, möchten wir noch eine andere Geschichte erzählen.
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8,503 |
Sendungen: Nachrichten
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Nachrichten sind knapp gefasste Informationen; sie enthalten nichts Überflüssiges. Nachrichten sind besonders glaubwürdig; sie unterscheiden sich grundsätzlich von meinungsbetonten journalistischen Beiträgen.
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8,504 |
Communicable and Non-Communicable Diseases and Health Communication in Mainland China and Hong Kong
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This chapter discusses how rapid development in China has caused a number of environmental hazards, food insecurity, and communicable health diseases. How the Chinese government has tackled pollution and major epidemics such as severe acute respiratory syndrome (SARS) and airborne diseases in major cities, and how Hong Kong has handled its major epidemics, are analyzed in depth. Also, non-communicable disease emerging from the change of lifestyle in China will be discussed. Health Communication Policies and Planning in China will be assessed with recommendations and lessons learned from China and Hong Kong. Political-economic policies will be considered together with health communication policies regarding communicable and non-communicable diseases.
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8,505 |
Fakten auf einen Blick
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8,506 |
The respiratory system
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8,507 |
Severe Epigastric Pain with Nausea and Vomiting
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A 41-year-old woman presents to the emergency department complaining of severe and continuous epigastric pain for the past 24 hours. The pain radiates straight through to her back. She has had progressive nausea with vomiting. The vomit is bile-stained and without blood. She has had similar but less severe episodes of abdominal pain in the past, usually after eating heavy meals, but they always resolved within a few hours. She is gravida two and para two, with last menses 2 weeks ago, and does not consume any alcohol. On exam, she is afebrile, heart rate is 115 beats/min, blood pressure of 128/86 mmHg, and respiratory rate is 18/min. Her abdomen is not distended. She has no surgical scars on her abdomen and no obvious masses visible. She has no bruising around her umbilicus or along her flank. Bowel sounds are hypoactive. She has marked tenderness to palpation in her epigastrium, without guarding or rebound. The remainder of her abdomen is soft and non-tender to palpation. No masses or organomegaly are appreciated. Laboratory examination reveals a white blood cell count of 17.2 × 10(3)cells/μL (normal 4.1–10.9 × 10(3) cells/uL), amylase of 1545 u/L (30–110 u/L), lipase of 1134 u/L (7–60 u/L), ALT of 245 u/L (7–56 u/L), AST of 263 u/L (5–35 u/L), serum glucose of 156 mg/dl (65–110 mg/dL), and LDH 180 u/L (0–250 u/L). An abdominal series demonstrates gas throughout the small and large bowel and a focal dilated loop of proximal small bowel without air fluid levels. There is no free air under the diaphragm.
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8,508 |
Network Structures of Multiple Sequences Induced by Mutation
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As fast multiple alignment (MA) algorithms become a reality, analyses and applications of their results become the central problem of genome research. In this chapter, we introduce the general methods of constructing the phylogenetic tree from multiple alignments, such as UPGMA, neighbor-joining, the maximum parsimony method, maximum-likelihood method and Bayesian methods. We then discuss the network structure theory of the multi-sequences induced by mutations. Using the distance matrix and the mutation information, we find the network structure of multi-sequences. Furthermore, we introduce the orthogonalization theorem for a mutation network. We may easily obtain the mutation relations for data structures among a multiple sequence from the network structure and the orthogonalization procedure of a mutation network. Finally, we give some examples of the network structure and explain the basic steps needed to analyze these multi-sequences.
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8,509 |
Definition and Overview of Emerging Threats
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The risks posed by bioterrorism and the proliferation of biological weapons capabilities have increased concern about how the rapid advances in genetic engineering and biotechnology could enable the production of biological weapons with unique and unpredictable characteristics. The nature of the biotechnology problem—indeed the nature of the biological research enterprise—is vastly different from that of theoretical and applied nuclear physics in the late 1930s. Evolving biotechnology presents an inextricably linked combination of opportunity and danger and that distinction turns on projected consequences and attributed intentions at the level of fundamental research. Matthew Meselson gave a stark warning of the potential dangers posed by the destructive applications of biotechnology at the annual meeting of the National Academy of Sciences in May 2000.
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8,510 |
The Human Nature of Infectious Disease
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Infectious disease raises questions about humans’ abilities to eliminate harm through the control of nature. People work to understand microbial life in order to manage the ways microbes mutate, adapt, and evolve, even while recognizing organisms’ essential nature. Public health practices from the past and present exemplify this ongoing quest to “solve” disease. Eradicating pathogens persists as a public health objective, even as new microbes emerge in the human environment. “Superbugs” and antibiotic resistance exemplify the problem-solution-problem cycle of disease. Moving from solutions-based thinking enables new imaginings of the microbial world in which humans reside.
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8,511 |
Obstruktive Atemwegserkrankungen
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In den folgenden Abschnitten werden die verschiedenen Formen der obstruktiven Atemwegserkrankungen erläutert, die je nach Alter, prädisponierenden Risikofaktoren und auch je nach Art der Auslöser verschiedenartige Ausprägungen und Verlaufsformen (Phänotypen) annehmen können.
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8,512 |
Perception, Amplification and Communication: A Case Study of Food Safety Risks
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In recent years, China has seen a rapid increase in public health incidents, among which food safety incidents have drawn the most attention. Every major food safety incident is a challenge to the safety warning line and leads to various social consequences in addition to economic losses. Food is the first necessity of the people, and food safety is of paramount importance. Any incident concerning food safety will spark public concern, and if not properly handled, may cause social panic.
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8,513 |
Alveolar Diseases
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Adenocarcinoma has surpassed squamous cell carcinoma as the leading histologic type, accounting for 30 % of all cases of lung cancer. The new 2015 WHO classification provided the basis for a multidisciplinary approach emphasizing the close correlation among radiologic and histopathologic pattern of lung adenocarcinoma. The term “bronchioloalveolar carcinoma” has been eliminated, introducing the concepts of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) and the use of descriptive predominant patterns in invasive adenocarcinomas (lepidic, acinar, papillary, solid, and micropapillary patterns). Invasive mucinous adenocarcinoma is the new definition for mucinous bronchioloalveolar carcinoma.
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8,514 |
Behavioral Health Support for Patients, Families, and Healthcare Workers
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During the 2014–2016 Ebola outbreak in West Africa, over 850 healthcare workers contracted Ebola, and over 500 died. These tragic numbers underscore the need for strict adherence to infection control precautions when caring for patients with Ebola and other diseases that are both highly infectious and potentially fatal. In addition to the use of personal protection equipment (PPE), such measures include source isolation of infected patients. In the process of confining infectious pathogens, however, it is essential that health systems do not overlook the psychological needs of patients nor that of the medical staff who care for them. This chapter is divided into two sections. The first explores the experiences of patients cared for in source isolation, highlighting the possible iatrogenic psychological consequences of treatment in a biocontainment unit. Strategies for mitigating the potentially harmful psychological effects of isolation are reviewed, including considerations for children. The second section considers the experiences of healthcare workers. The discussion outlines the psychological impact of treating patients with infectious diseases, risk factors for emotional distress, and strategies to promote psychological well-being and resilience.
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8,515 |
Hightech in der Infektiologie: Diagnose und Therapie
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Jeden Tag sterben weltweit etwa 13 Millionen Menschen an den Folgen viraler, bakterieller oder parasitärer Erkrankungen.
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8,516 |
Respiratory Infections
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The majority of respiratory tract infections (RTIs) are community acquired and are the single most common cause of physician office visits and among the most common causes of hospitalizations. The morbidity and mortality associated with RTIs are significant and the financial and social burden high due to lost time at work and school. The scope of clinical symptoms can significantly overlap among the respiratory pathogens, and the severity of disease can vary depending on patient age, underlying disease, and immune status, thereby leading to inaccurate presumptions about disease etiology. The rapid and accurate diagnosis of the causative agent of RTIs improves patient care, reduces morbidity and mortality, promotes effective hospital bed utilization and antibiotic stewardship, and reduces length of stay. This chapter focuses on the clinical utility, advantages, and disadvantages of viral and bacterial tests cleared by the Food and Drug Administration (FDA), and new promising technologies for the detection of bacterial agents of pneumonia currently in development or in US FDA clinical trials are briefly reviewed.
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8,517 |
Recombinant poxvirus vaccines in biomedical research
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In biomedical research recombinant poxviruses are investigated as important candidate medicines to derive advanced options for prevention and/or treatment of infectious diseases or cancer. Genetically engineered viruses can readily synthesize biologically active heterologous proteins, serve to determine relevant targets of cell-mediated and humoral immunity, and identify types of immune responses needed for protection against a multitude of different specific diseases. Substantial progress in vaccine development is based on the availability of exceptionally safe but efficient carrier viruses, on increasingly versatile vector technologies and on the feasibility of large scale manufacturing. Moreover, advances in deciphering the molecular pathways regulating poxvirus-host interactions will provide additional means to potently activate innate immune stimulation upon vaccination and to derive vectors with specifically targeted replicative capacity for experimental tumor therapy.
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8,518 |
An Unexpected Diagnosis of Pulmonary Tuberculosis
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Pulmonary tuberculosis is rare in critically ill cancer patients. We report the case of a man treated for Hodgkin’s lymphoma and admitted to the ICU for acute respiratory failure. All investigations were negative, and he died with a presumptive diagnosis of bleomycin-related pulmonary toxicity and Escherichia coli endocarditis. Several weeks after his death, cultures of sputum and BAL fluid samples were found positive for Mycobacterium tuberculosis. Postmortem pulmonary biopsies confirmed the diagnosis of pulmonary tuberculosis.
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8,519 |
Infections in the PICU
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8,520 |
Computer Network Vulnerabilities
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System vulnerabilities are weaknesses in the software or hardware on a server or a client that can be exploited by a determined intruder to gain access to or shut down a network. Donald Pipkin defines system vulnerability as a condition, a weakness of or an absence of security procedure or technical, physical, or other controls that could be exploited by a threat [1].
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8,521 |
Cytokines
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Cytokines, currently known to be more than 130 in number, are small MW (<30 kDa) key signaling proteins that modulate cellular activities in immunity, infection, inflammation, and malignancy. Key to understanding their function is recognition of their pleiotropism and often overlapping and functional redundancies. Classified here into 9 main families, most of the 23 approved cytokine preparations (19 different cytokines and 4 pegylated), all in recombinant human (rh) form, are grouped in the hematopoietic growth factor, interferon (IFN), platelet-derived growth factor (PDGF), and transforming growth factor β (TGFβ) families. In the hematopoietin family, approved cytokines are aldesleukin (rhIL-2), oprelvekin (rhIL-11), filgrastim and tbo-filgrastim (rhG-CSF), sargramostim (rhGM-CSF), metreleptin (rh-leptin), ancestim (rh-SCF), and the rh-erythropoietins, epoetin and darbepoetin alfa. Anakinra, a recombinant receptor antagonist for IL-1, is in the IL-1 family; recombinant interferons alfa-1, alfa-2, beta-1, and gamma-1 make up the interferon family; palifermin (rhKGF) and becaplermin (rhPDGF) are in the PDGF family; and rhBMP-2 and rhBMP-7 represent the TGFβ family. The main physicochemical features, FDA-approved indications, modes of action and side effects of these approved cytokines are presented. Underlying each adverse events profile is their pleiotropism, potency and capacity to release other cytokines producing cytokine “cocktails.” Side effects, some serious, occur despite cytokines being endogenous proteins, and this therefore demands caution in attempts to introduce individual members into the clinic. This caution is reflected in the relatively small number of cytokines currently approved by regulatory agencies and by the fact that 15 of the FDA-approved preparations carry warnings, with 10 being black box warnings.
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8,522 |
Role of Biomarkers in Health Care
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Study of biomarkers of various diseases will help to improve the management in three ways: 1. By providing a better understanding of the disease pathomechanism 2. By improving the diagnosis and determining the prognosis 3. By providing a basis for development of therapeutics and monitoring the effect of therapeutics on the disease
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8,523 |
Transmission of colds
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Rhinorrhea, nasal congestion, and sore throat herald the beginning of the cold season for both children and adults. Although the common cold is a self-limited infection, there are no effective treatments presently available and complications, missed time from work and school, and overall discomfort are not insignificant. Understanding how infections are transmitted may lead to interventions to reduce rates of infection. In order to establish a route of transmission, certain conditions must be met. The virus must be produced and shed at the site of infection. The virus must be deposited in the environment and be able to survive there. The virus must then be able to reach the portal of entry. Finally, interruption of the proposed route of transmission must reduce the incidence of infection under natural conditions. Applying this framework, there is clear evidence in both experimental and home settings that colds can be transmitted via self-inoculation. A small amount of evidence is available relating to large and small particle aerosol transmission. Because rhinovirus is responsible for half of all colds, it has been used as the model to understand how virus is transmitted from one person to another in experimental settings. Rhinovirus has been shown to infect via self-inoculation following hand-to-hand contact with contaminated hands or hand-to-surface contact with contaminated objects in the environment. Similarly, there is convincing evidence that the self-inoculation method of cold virus transmission occurs in the home environment, where colds arre most often transmitted. Aerosol transmission has been studied in the experimental setting and may provide another, albeit less common method for transmission of rhinovirus infection. As more is understood about the transmission of cold viruses, effective methods to interrupt transmission may be devised.
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8,524 |
Overview and Historical Review
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This book investigates and scrutinizes the lessons learned in the Republic of Korea during a five-decade swath of disasters – from 1948 to 2015 – and results in the disaster response policy change model in the wake of major disasters for resilience building. This book is structured of power-law relation between disaster loss and frequency in Korea from 1948 to 2015, focusing events in the power-law distribution, Disaster-Triggered Policy Change Model, and suggestions for resilient future. To start with the historical review, how to understand disaster throughout the ages was investigated: from an Act of God to Mother Nature’s will to societies’ inherent risk. As we journey through disaster’s history, we start to see the categorization of disasters by cause, principle, and risk – drawing to an understanding of risk through hazard and vulnerability.
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8,525 |
Rhinitis and Sinusitis
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Rhinitis is defined as inflammation of the nose, which can extend into and affect the sinuses. The term rhinosinusitis is used to describe inflammation of both the nose and the sinuses. An example of rhinitis is allergic rhinitis, caused by sensitization and exposure to aeroallergens, which, along with other allergic diseases, such as asthma, affect up to one-third of women in the childbearing age. The most common type of rhinosinusitis is infectious, either acute or chronic, which commonly occurs secondarily to a viral respiratory tract infection. Both rhinitis and rhinosinusitis significantly affect the quality of life. The purpose of this chapter is to introduce and describe the differential diagnosis and treatment of these two common clinical entities during pregnancy.
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8,526 |
The Effects of Network Relationships on Global Supply Chain Vulnerability
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In this chapter, we analyze the effects of levels of social relationship on the global supply chain networks vulnerability. Relationship levels in our framework are assumed to influence transaction costs as well as risk for the decision-makers. We propose a network performance measure for the evaluation of the global supply chain networks efficiency and vulnerability. The measure captures risk, transaction cost, price, transaction flow, revenue, and demand information in the context of the decision-makers behavior the network. The network consists of manufacturers, retailers, and consumers. Manufacturers and retailers are multicriteria decisionmakers who decide about their production and transaction quantities as well as the level of social relationship they want to pursue in order to maximize net return and minimize risk. The model allows us to investigate the interplay of the heterogeneous decision-makers in the supply chain and to compute the resultant equilibrium pattern of product outputs, transactions, product prices, and levels of social relationship. The results show that high levels of relationship can lead to lower overall cost and therefore lower price and higher product transaction. Moreover, we use the performance measure to assess which nodes in the supply networks are themost vulnerable in the sense that their removal will impact the performance of the network in the most significant way.
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8,527 |
Allografts in Anterior Cruciate Ligament Reconstruction
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Usual allograft sources for anterior cruciate ligament (ACL) reconstruction are patellar ligament, Achilles tendon, tibialis anterior, and posterior. The advantages of the use of allograft include reduced donor-site morbidity, shorter operative time, smaller incisions, and no size restrictions. The disadvantages include increased cost, slower graft embodiment, and the risk of viral or bacterial infection, which may occur either by transmission from an infected donor or by contamination by the healthcare provider. Careful donor selection, aseptic graft procurement and processing, and tissue sterilization, by irradiation or proprietary chemical processing, are the three major steps of the graft preparation procedure. Successful allograft implantation depends on sterility, reduction of antigenicity, and preservation of the biomechanical properties of the graft. To date, reports on the clinical and functional outcomes of allograft compared to autograft ACL reconstruction are controversial. Overall, graft choice depends on surgeon and patient preference, since no graft can perfectly match the properties of the native ACL.
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8,528 |
Pulmonary Manifestations of Predominantly Antibody Deficiencies
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Predominantly antibody deficiencies (PADs) are the most frequent forms of primary immunodeficiency diseases (PIDs). Commonly accompanied with complications involving several body systems, immunoglobulin substitution therapy along with prophylactic antibiotics remained the cornerstone of treatment for PADs and related complications. Patients with respiratory complications should be prescribed an appropriate therapy as soon as possible and have to be adhering to more and longer medical therapies. Recent studies identified a gap for screening protocols to monitor respiratory manifestations in patients with PADs. In the present chapter, the pulmonary manifestations of different PADs for each have been discussed. The chapter is mainly focused on X-linked agammaglobulinemia, common variable immunodeficiency, activated PI3K-δ syndrome, LRBA deficiency, CD19 complex deficiencies, CD20 deficiency, other monogenic defects associated with hypogammaglobulinemia, immunoglobulin class switch recombination deficiencies affecting B-cells, transient hypogammaglobulinemia of infancy, and selective IgA deficiency.
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8,529 |
Host–Symbiont Relationships: Understanding the Change from Guest to Pest
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The several meanings for the term “symbiosis” create confusion, which can be avoided when the author provides details of the interrelationships between the symbiotic organism and the “host” so that a reader can clearly understand what definition is implied in each case. For example, we, as opposed to many other mentioned readers, consider a symbiont as an organism living in an association with another regardless of whether it causes a pathologic response or not, but from our title, the reader may incorrectly infer that we consider a parasite to be different from a symbiont. A symbiont is an organism that uses another organism as a habitat. This chapter discusses the primary associations and associated conflicts involving the terminology. It also provides both differentiation between and conflicting views regarding the interpretation of the terms “infect” and “infest,” “infection” and “disease,” and other terms. Many seemingly harmless symbionts of a wide array of taxonomic groups are triggered to become pathogenic or virulent, and we provide several examples of the provoking (stimulating) triggers, with the understanding that in most cases, the conditions for the triggered activities are much more complex and complicated than presented. Examples of triggers follow: environmental ones like temperature, toxic chemicals (dose), chemotherapeutics, dietary changes, and geographic habits; internal ones like host site, host resistance or susceptibility, and host modifications; and combinations of these and other conditions. We provide examples involving multiple triggers for organisms associated with termites, for an endemic virus being affected by multiple factors and having multiple effects on its commercial penaeid shrimp hosts, and for contrasting variables associated with two exotic viruses in wild and cultured commercial penaeid shrimps with an emphasis on hypothesizing how the pathogenicity developed in these two viruses. The chapter ends by trying to answer the question of why would a symbiont become pathogenic in some hosts and not in others from an evolutionary perspective. It uses two hypotheses to explain the increased virulence.
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8,530 |
How Behaviour and the Environment Influence Transmission in Mobile Groups
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The movement of individuals living in groups leads to the formation of physical interaction networks over which signals such as information or disease can be transmitted. Direct contacts represent the most obvious opportunities for a signal to be transmitted. However, because signals that persist after being deposited into the environment may later be acquired by other group members, indirect environmentally-mediated transmission is also possible. To date, studies of signal transmission within groups have focused on direct physical interactions and ignored the role of indirect pathways. Here, we use an agent-based model to study how the movement of individuals and characteristics of the signal being transmitted modulate transmission. By analysing the dynamic interaction networks generated from these simulations, we show that the addition of indirect pathways speeds up signal transmission, while the addition of physically-realistic collisions between individuals in densely packed environments hampers it. Furthermore, the inclusion of spatial biases that induce the formation of individual territories, reveals the existence of a trade-off such that optimal signal transmission at the group level is only achieved when territories are of intermediate sizes. Our findings provide insight into the selective pressures guiding the evolution of behavioural traits in natural groups, and offer a means by which multi-agent systems can be engineered to achieve desired transmission capabilities.
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8,531 |
Upper Respiratory Infections and Acute Bronchitis
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Upper respiratory infections include the following: uncomplicated upper respiratory infections also known as the “common cold,” acute otitis media, pharyngitis/tonsillitis, and acute sinusitis. These conditions, along with acute bronchitis, are very common illnesses that are commonly seen in outpatient settings and are widely treated with antibiotics. In fact, these conditions are the primary indications for outpatient antibiotic prescriptions. These conditions tend to have overlapping clinical characteristics yet evidence regarding the utility of antimicrobial treatments varies across conditions.
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8,532 |
Knowledge-Based Tweet Classification for Disease Sentiment Monitoring
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Disease monitoring and tracking is of tremendous value, not only for containing the spread of contagious diseases but also for avoiding unnecessary public concerns and even panic. In this chapter, we present a near real-time sentiment analysis service of public health-related tweets. Traditionally, it is impossible for humans to effectively measure the degree of public health concerns due to limited resources and significant time delays. To solve this problem, we have developed a computational intelligence approach for Epidemic Sentiment Monitoring System (ESMOS) to automatically analyze the disease sentiments and gauge the Measure of Concern (MOC) expressed by Twitter users. More specifically, we present a knowledge-based approach that employs a disease ontology to detect the outbreak of diseases and to analyze the linguistic expressions that convey subjective expressions and sentiment polarity of emotions, feelings, opinions, personal attitudes, etc. with a sentiment classifier. The two-step sentiment classification method utilizes the subjective vocabulary corpus (MPQA), sentiment strength corpus (AFINN), as well as emoticons and profanity words that are often used in social media postings. It first automatically classifies the tweets into personal and non-personal classes, eliminating many tweets such as non-personal “retweets” of news articles from further consideration. In the second stage, the personal tweets are classified into Negative and non-Negative sentiments. In addition, we present a model to quantify the public’s Measure of Concern (MOC) about a disease, based on sentiment classification results. The trends of the public MOC are visualized on a timeline. Correlation analyses between MOC timeline and disease-related sentiment category timelines show that the peaks of the MOC are weakly correlated with the peaks of the News timeline without any appreciable time delay or lead. Our sentiment analysis method and the MOC trend analyses can be generalized to other topical domains, such as mental health monitoring and crisis management. We present the ESMOS prototype for public health-related disease monitoring, for public concern trending and for mapping analyses.
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8,533 |
Infectious Diseases in Cancer Patients: An Overview
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The predisposition of cancer patients to infectious diseases which contribute to the gravity of their prognosis is well documented. The current success in therapy of both malignancies and infections is unprecedented. However, the overall co-morbidity of these conditions is still a major problem in management of these patients. Paradoxically, to some degree the problem of containing infectious complications is directly associated with the vigor of the anti-cancer therapeutic regimens. The objective of this chapter is to provide an up to date overview of our understanding of the infectious complications in cancer patients based on the type of infection and immune responses.
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8,534 |
Microbiology, Antimicrobial Susceptibility, and Antibiotic Treatment
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Acute otitis media (AOM) is among the largest drivers of antibiotic use in children. As such, it is critical to understand the microbiology of this condition in detail to best delineate which antibiotics are most appropriate to use for patients with AOM and under what circumstances. Importantly, bacteria and/or viruses can be detected in the middle ear fluid in up to 96 % of AOM cases. The bacteriology of the condition has dramatically changed since the advent of universal pneumococcal vaccination. This chapter examines in detail the changing microbiology of otitis media (OM), along with guidelines for most appropriate antibiotic usage.
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8,535 |
Teschovirus
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Teschoviruses are emerging pathogens, belonging to the family Picornaviridae, and infects porcine population only. Among all, porcine teschoviruses (PTVs) are of high prominence leading to clinical illness and consequent economic loss to the livestock sector. These are associated with extremely lethal non-suppurative polioencephalomyelitis (Teschen disease) and are distributed world over. Its milder form, Talfan disease, inflicts low morbidity and mortality and general clinical disease. The first epizootics of Teschen disease occurred in 1929 in the Czech Republic. Mature virions are small (23–30 nm) and stable in environmental conditions (pH range 2–9, heat, lipid solvents). Genetic variations in the major surface protein, VP1, lead to the evolution of several new types. As of now, 13 genotypes in PTV are approved, namely PTV-1–13. Among all, PTV-1 is highly virulent and causes severe mortality and morbidity in the porcine population, domestic as well as wild. Ingestion is the main spreading route of infection, though intra-nasal infection and virus secretion in the urine are also noted. Along with encephalitis, PTVs are also responsible for reproductive disorders, diarrhoea, pneumonia, pericarditis and myocarditis. PTVs are also found as co-infection with several bacterial, viral and parasitic pathogens. Several conventional and modern diagnostics tools are available for their detection. Alternative of serological typing, VP1 and VP2 gene-based molecular typing is now preferred to know the epidemiological pattern. Although initially vaccines were used for its eradication in Europe, due to the sporadic reports of mild PTV infection in several countries, the approach was discontinued. Moreover, due to the presence of multiple serotypes, developing a multivalent PTV vaccine to protect against all strains is a major challenge.
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8,536 |
Flavonoids and Their Biological Secrets
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Flavonoids are tricyclic polyphenolic compounds naturally occurring in plants. Being nature’s antioxidants flavonoids have been shown to reduce the damages induced by oxidative stress in cells. Besides being an antioxidant, flavonols are demonstrated to have anti-infective properties, i.e., antiviral, antifungal, anti-angiogenic, anti-tumorigenic, and immunomodulatory bioproperties. Plants use them as one of their defense mechanisms against radiation-induced DNA damage and also for fungal infections. The use of flavonols for fabrication of new drugs has been underway with objectives to develop safer and effective therapeutic agents. This review covers 15 flavonols for their structure, biological properties, role in plant metabolisms, and current research focused on computational drug design using flavonols for searching drug leads.
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8,537 |
Selecting Accurate Classifier Models for a MERS-CoV Dataset
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The Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a viral respiratory disease that is spreading worldwide necessitating to have an accurate diagnosis system that accurately predicts infections. As data mining classifiers can greatly assist in enhancing the prediction accuracy of diseases in general. In this paper, classifier model performance for two classification types: (1) binary and (2) multi-class were tested on a MERS-CoV dataset that consists of all reported cases in Saudi Arabia between 2013 and 2017. A cross-validation model was applied to measure the accuracy of the Support Vector Machine (SVM), Decision Tree, and k-Nearest Neighbor (k-NN) classifiers. Experimental results demonstrate that SVM and Decision Tree classifiers achieved the highest accuracy of 86.44% for binary classification based on healthcare personnel class. On the other hand, for multiclass classification based on city class, the decision tree classifier had the highest accuracy among the remaining classifiers; although it did not reach a satisfactory accuracy level (42.80%). This work is intended to be a part of a MERS-CoV prediction system to enhance the diagnosis of MERS-CoV disease.
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8,538 |
RNA helicase 3.6.4.13
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EC number 3.6.4.13 Systematic name ATP phosphohydrolase (RNA helix unwinding) Recommended name RNA helicase Synonyms 1a NTPase/helicase <16> [5] ATP/dATP-dependent RNA helicase <1,42> [32] ATPase <10,12> [1,36] ATPase/RNA helicase <1,42> [32] ATPase/helicase <10> [36,41] BMV 1a protein <16> [5] BmL3-helicase <1,42> [32] Brr2p <6> [50] DBP2 <24> [30] DDX17 <33> [12] DDX19 <43> [56] DDX25 <23,34,35> [12,21] DDX3 <25> [8] DDX3X <25> (<25> the gene is localized to the X chromosome [12]) [12] DDX3Y <29> (<29> the gene is localized to the Y chromosome [12]) [12] DDX4 <30> [12] DDX5 <32> [12] DEAD box RNA helicase <1,2,3> [32,45,52] DEAD box helicase <2> [45] DEAD-box RNA helicase <4,5,7,38,47,48> [9,14,16,25,53,55] DEAD-box protein DED1 <38> [11] DEAD-box rRNA helicase <5> [26] DEAH-box RNA helicase <24> [30] DEAH-box protein 2 <24> [30] DED1 <38> [11,14] DENV NS3H <10> [41] DEXD/H-box RNA helicase <43> [56] DEx(H/D)RNA helicase <12> [23] DHX9 <44> [58] DbpA <5> [10,25,26] Dhx9/RNA helicase A <13> [61] EhDEAD1 <7> [16] EhDEAD1 RNA helicase <7> [16] FRH <9> [54] FRQ-interacting RNA helicase <9> [54] GRTH <3> [57] GRTH/DDX25 <3,35> [21,51] HCV NS3 helicase <12> [48] KOKV helicase <27> [7] Mtr4p <31> [22] NPH-II <8> [18,28] NS3 <10,12,17,20,39,41> (<12,39> ambiguous [27,42,44]) [1,2,4,27,35,36,39, 42,44,46] NS3 ATPase/helicase <10> [41] NS3 NTPase/helicase <17> (<17> ambiguous [46]) [46] NS3 helicase <10,12,17> [15,44,46] NS3 protein <10,12,17,18> (<12> ambiguous [39]) [15,39,40,41,62] NTPase/helicase <12> (<12> ambiguous [37]) [37,39] RHA <6> [31,49] RNA helicase <2> [45] RNA helicase A <6,44> [31,49,58] RNA helicase CrhR <14> [59] RNA helicase DDX3 <25> [8] RNA helicase Ddx39 <47> [53] RNA helicase Hera <4> [9] RNA-dependent ATPase <37> [34] RNA-dependent NTPase/helicase <12> [1] RTPase <10> [36] RhlB <5> [43] SpolvlgA <48> [55] Supv3L1 <46> [64] TGBp1 NTPase/helicase domain <22,28> [24] Tk-DeaD <15> [47] VRH1 <26> [33] YxiN <2> [45] eIF4A <36> [20] eIF4A helicase <36> [20] eIF4AIII <37> [34] eukaryotic initiation factor eIF 4A <36> [20] gonadotropin-regulated testicular RNA helicase <3> [51,57] helicase <10> [41] helicase B <5> [43] helicase/nucleoside triphosphatase <10> [4] non structural protein 3 <12> (<12> ambiguous [37,38]) [37,38] non-structural 3 <10> [36] non-structural protein 3 <17> [46] non-structural protein 3 protein <18> [40] nonstructural protein 3 <12,17,20,39,40,41> (<12,17,39,40> ambiguous [6,27, 39,42,44,46]) [1,2,6,27,35,39,42,44,46] nucleoside 5’-triphosphatase <10> [4] nucleoside triphosphatase/RNA helicase and 5’-RNA triphosphatase <20> [2] nucleoside triphosphatase/helicase <16> [5] p54 RNA helicase <45> [60] p68 RNA helicase <3,6> [52,63] protein NS3 <12> (<12> ambiguous [38]) [38]
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8,539 |
Prioritization of Risks in Supply Chains
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Modern supply chains are very complex, with physical, financial, and information flows occurring simultaneously in order to ensure that products are delivered in the right quantities, to the right place in a cost-effective manner. Maintaining uninterrupted supply chain flows is a prerequisite for the success of a supply chain in the marketplace. But there are always associated risks in each of these flows which require suitable strategies to mitigate them. The issue of risks in supply chains has assumed importance in wake of the understanding that supply chain failures are fatal to the existence of all the partners’ in a supply chain. The severity of supply chain failures are more felt by small and medium enterprises (SMEs) who form the majority at tier II and tier III levels of a supply chain. This is because of the limited resources and lack of adequate planning to counter supply chain risks. Management of risk in supply chains is a multi-criteria decision making problem. The research presented in this chapter proposes a Fuzzy-AHP based framework to prioritize various risks in supply chains. An exhaustive literature review complimented with the experts’ opinion was undertaken from the perspective of SMEs to formulate a hierarchical structure of risks in supply chains. A fuzzy analytic hierarchical process (F-AHP) is then utilized to ascertain the relative weightings which are subsequently used to prioritize these risks. Understanding the priorities would help the firms to accord importance and develop suitable strategies to manage supply chain risks according to their relative importance. This provides effective management of scarce resources available to SMEs to manage risks resident in their supply chains.
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8,540 |
The Political Economy of US Antibiotic Use in Animal Feed
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This chapter examines the evidence for antibiotic resistance in the United States and globally, the public health implications, and the impact of—and related industry and political responses to—antibiotic use in animal feed. In 1969, the Swann Report in the United Kingdom noted a dramatic increase in antibiotic-resistant bacteria in food animals receiving low levels of antibiotics in their feed. While the Food and Drug Administration of the United States sought to control antibiotics in animal feed as far back as 1977, only in 2016 were such regulations fully implemented. The farm-level costs of such controls are estimated by the US Department of Agriculture’s Economic Research Service to be minimal, while the Centers for Disease Control and Prevention’s estimates of the public health costs of antibiotic resistance without implementing controls are $7 billion annually. The complex interactions which exist between economic interests, regulatory policy, and human and animal health are explored in this chapter.
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8,541 |
China’s Belt and Road: An Evolving Network
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This chapter consolidates the accretive imagery presented by the proponents and managers of Beijing’s dynamic BRI vision, to enable an appreciation of the enterprise’s variegated, eclectic, even diffuse, nature. For an understanding of the physical manifestations of BRI’s ‘final’ impression as espoused by Xi Jinping, the CPC Politburo Standing Committee (PBSC), the State Council and the National Development and Reform Commission (NDRC), the chapter focuses on the Silk Road Economic Belt (SREB) undertaking, reviewing the narrative’s variations and modifications refined by successive Chinese leaders since 1994. It finally examines longitudinal SREB/MSR connectors in an empirical preview of BRI’s purposes and prospects.
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8,542 |
Acute Cough
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A 62-year-old man, Mr. M., comes to your office with a chief complaint of a cough. He states that it started about 1 week ago with a “runny nose and scratchy throat.” The cough is dry, nonproductive, and is interfering with the patient (and his wife) being able to get a full, restful night’s sleep. Mr. M. denies any other symptoms, such as headache, sinus pressure, chest pain, and shortness of breath, but thinks that he may have had a fever “off and on the last few days.” He has taken Tylenol® and has been drinking fluids, but his cough won’t go away. The patient is requesting an antibiotic to “get this thing kicked out of my system.” Mr. M. states that he is “tired of people at work looking at me like I have the plague.”
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8,543 |
Portale Hypertension
|
Während die Pathologie, die zur portalen Hypertension führt, im prähepatischen, hepatischen und posthepatischen venösen Gefäßbett liegen kann, machen die intrahepatischen Erkrankungen mit Abstand den Großteil aus. In unseren Breitengraden ist es die durch Alkoholabusus bedingte ethyltoxische Leberzirrhose, weltweit die durch Infektionen (HCV, HBV) bedingten Zirrhosen. Die chronische Hepatitis C mit ihren Komplikationen (Leberzellversagen, portale Hypertension und hepatozelluläres Karzinom) wird in den kommenden Jahren trotz moderner Therapieverfahren noch an Bedeutung gewinnen.
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8,544 |
Scrub Typhus and Its Causative Agent, Orientia tsutsugamushi
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The obligate intracellular bacterium Orientia tsutsugamushi is responsible for more than one million cases of scrub typhus annually throughout the Asia-Pacific region. Human infection occurs via the bite of the larval form (chigger) of several species of trombiculid mites. While in some patients the result of infection is a mild, febrile illness, others experience severe complications, which may even be fatal. This review discusses the genome and biology of the causative agent, the changing epidemiology of scrub typhus, the challenges of its diagnosis, and current treatment recommendations.
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8,545 |
Medical Ethics Education in China
|
Medical ethics education has a long history in China. At the same time, it is also a new field of study, along with the introduction of western medicine to China in the past two centuries. Due to the different cultural traditions, different Chinese medical ethics scholars hold various viewpoints on medical ethics and bioethics research and practice. This paper is organized as follows: In the first section, a brief historical review of the overall development of Chinese medical ethics is presented. The next section presents three different schools of scholars in Chinese medical ethics and research. Then, section three discusses the current popular research topics, which represent state of the art Chinese medical ethics research. The last section analyzes and evaluates the viewpoints from different schools and concluding remarks are offered.
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8,546 |
Arf Proteins and Their Regulators: At the Interface Between Membrane Lipids and the Protein Trafficking Machinery
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The Arf small GTP-binding (G) proteins regulate membrane traffic and organelle structure in eukaryotic cells through a regulated cycle of GTP binding and hydrolysis. The first function identified for Arf proteins was recruitment of cytosolic coat complexes to membranes to mediate vesicle formation. However, subsequent studies have uncovered additional functions, including roles in plasma membrane signalling pathways, cytoskeleton regulation, lipid droplet function, and non-vesicular lipid transport. In contrast to other families of G proteins, there are only a few Arf proteins in each organism, yet they function specifically at many different cellular locations. Part of this specificity is achieved by formation of complexes with their guanine nucleotide-exchange factors (GEFs) and GTPase activating proteins (GAPs) that catalyse GTP binding and hydrolysis, respectively. Because these regulators outnumber their Arf substrates by at least 3-to-1, an important aspect of understanding Arf function is elucidating the mechanisms by which a single Arf protein is incorporated into different GEF, GAP, and effector complexes. New insights into these mechanisms have come from recent studies showing GEF–effector interactions, Arf activation cascades, and positive feedback loops. A unifying theme in the function of Arf proteins, carried out in conjunction with their regulators and effectors, is sensing and modulating the properties of the lipids that make up cellular membranes.
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8,547 |
Hygiene und Arbeitsschutz
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Im Rettungsdienst werden unter dem Begriff »Hygiene« alle vorsorglichen Vorkehrungen und Maβnahmen zusammengefasst, die alle im Krankentransport und Rettungsdienst Tätigen, sowie die zu betreuenden Patienten, vor schädlichen und krankmachenden Einflüssen durch Mikroorganismen schützen sollen.
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8,548 |
Pleural Disorders
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This chapter provides an overview of both benign and malignant pleural disorders, starting with the relevant anatomy and physiology. The focus is on the management of pneumothoraces and pleural effusions—conditions that are commonly encountered on a general thoracic surgery service. The pleural cavity is lined by parietal and visceral pleura, which are smooth membranes that are continuous with one another at the hilum and pulmonary ligaments. Parietal Pleura: innermost chest wall layer, divided into cervical, costal, mediastinal and diaphragmatic pleura.
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8,549 |
The Use of a Bookclub to Enhance Science Literacy and Understanding of Infectious Disease Epidemiology
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This chapter describes the activities of the Bad Bugs Bookclub, which brings scientists and non-scientists together to read novels where infectious disease formed part of the plot, and considers how these novels could be used to promote a better understanding of disease, epidemiology and the work of the professional scientist. A particular focus of the bookclub was to suggest how teachers in Higher Education might use these novels in their practice, although this specialised format can be used to benefit a wide range of professional (and non-professional) audiences. The Bad Bugs Bookclub has also been targeted towards students reading for a degree in Biomedical Science, accredited by the Institute of Biomedical Sciences: graduates are professionally qualified to be employed as biomedical scientists.
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8,550 |
Mikrobiologische Untersuchungstechniken
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Ausgehend von den einzelnen Erregern werden im Folgenden Nachweismethoden vorgestellt und bewertet.
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8,551 |
China Takes Charge of a Changing Epidemic
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When the AIDS warriors in China’s academies and health institutions started experimenting with responses to the epidemic, their efforts were largely funded with foreign money. UN agencies; the international development wing of the governments of Australia, the United Kingdom, the United States and other nations; multilateral organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria; and private charities such as the Ford Foundation and the Bill and Melinda Gates Foundation – all of these provided support for HIV prevention and/or treatment activities in China. The Chinese government’s contribution to the response rose dramatically following the “tipping point” described in Chap. 10.1007/978-981-10-3746-7_4. But even then, most of the original funding for provision of treatment to people in areas with epidemics driven by plasma sales was provided by the Global Fund.
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8,552 |
Host Cell Proteases: Cathepsins
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Cathepsins are proteolytic enzymes with a broad spectrum of substrates. They are known to reside within endo-lysosomes where they acquire optimal conditions for proteolytic activity and substrate cleavage. However, cathepsins have been detected in locations other than the canonical compartments of the endocytotic pathway. They are often secreted from cells in either proteolytically inactive proform or as mature and active enzyme; this may happen in both physiological and pathological conditions. Moreover, cytosolic and nuclear forms of cathepsins have been described and are currently an emerging field of research aiming at understanding their functions in such unexpected cellular locations. This chapter summarizes the canonical pathways of biosynthesis and transport of cathepsins in healthy cells. We further describe how cathepsins can reach unexpected locations such as the extracellular space or the cytosol and the nuclear matrix. No matter where viruses and cathepsins encounter, several outcomes can be perceived. Thus, scenarios are discussed on how cathepsins may support virus entry into host cells, involve in viral fusion factor and polyprotein processing in different host cell compartments, or help in packaging of viral particles during maturation. It is of note to mention that this review is not meant to comprehensively cover the present literature on viruses encountering cathepsins but rather illustrates, on some representative examples, the possible roles of cathepsins in replication of viruses and in the course of disease.
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8,553 |
The role of animal models in influenza vaccine research
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A major challenge for research on influenza vaccines is the selection of an appropriate animal model that accurately reflects the disease and the protective immune response to influenza infection in humans. Vaccines for seasonal influenza have been available for decades and there is a wealth of data available on the immune response to these vaccines in humans, with well-established correlates of protection for inactivated influenza virus vaccines. Many of the seminal studies on vaccines for epidemic influenza were conducted in human subjects. Studies in humans are performed less frequently now than they were in the past. Therefore, as the quest for improved influenza vaccines continues, it is important to consider the use of animal models for the evaluation of influenza vaccines, and a major challenge for research on influenza vaccines is the selection of an appropriate animal model that accurately reflects the disease and the protective immune response to influenza infection in humans. The emergence of highly pathogenic H5N1 avian influenza (AI) viruses and the threat of a pandemic caused by AI viruses of this or another subtype has resulted in a resurgence of interest in influenza vaccine research. The development of vaccines for pandemic influenza presents a unique set of obstacles, not the least of which is that the demonstration of efficacy in humans is not possible. Since the correlates of protection from pandemic influenza are not known, we rely on extrapolation of lessons from seasonal influenza vaccines and on data from the evaluation of pandemic influenza vaccines in animal models to guide our decisions on vaccines for use in humans. The features and contributions of commonly used animal models for influenza vaccine research are discussed.
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8,554 |
Thoracoabdominal Injuries
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Trauma to the thorax and abdomen can occur during participation in sports. This chapter reviews some of the more common presentations of such injuries and how such injuries should be best managed. Thoracic injuries reviewed include internal injuries such as pneumothorax, pulmonary contusion, hemothorax, commotio cordis, and cardiac contusion. Chest wall injuries are also reviewed such as rib fractures, costochondritis, and slipping rib syndrome plus sternal and scapular fractures. Abdominal injuries reviewed are focused on internal organ trauma to the spleen and liver, kidney, pancreas, and bowel. There is attention to the effect of Epstein-Barr virus and infectious mononucleosis, seen very frequently in high school and collegiate athletes. Finally, groin pain and athletic pubalgia are described. In addition to anatomy and clinical presentation, imaging modalities that characterize such trauma are reviewed for each diagnosis. Prevention of thoracoabdominal injuries and return-to-play decisions are described at the chapter conclusion.
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8,555 |
Cost-Benefit Analysis for China’s Influenza A (H1N1) Prevention and Control
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The impact of a public health emergency on a society and economy depends upon two factors: one is the harmful nature of the event along with its duration, and the other is the effect of the social response and measures. Both of these factors are wrought with uncertainty. Firstly, the nature of the event itself is uncertain, for example there may be a lack of understanding regarding the virulence of the epidemic. Secondly, different intervention measures bring about varying uncertainties, such as the potentially infected cases reduced using the health campaigning measures to change people’s actions in an epidemic.
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8,556 |
Acute Respiratory Failure in Patients with Hematologic and Solid Malignancies: Global Approach
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Acute respiratory failure (ARF) is the principal cause for ICU admission and mortality in cancer patients. Early diagnosis and management of these patients entail unique challenges to the intensivist. This chapter reviews the common causes of ARF in cancer patients along with a global diagnostic and management approach. Oncologists and intensivists as a team must establish clear treatment goals for every cancer patient requiring mechanical ventilation.
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8,557 |
Internationale Gesundheitsrisiken
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Machtverhältnisse drücken sich in der Zuschreibung von Risiken aus. Spezifisches Wissen um Risiken dient dabei als Katalysator, Machtressourcen aufzubringen und steuernd in gesellschaftliche Prozesse einzugreifen. Dabei zeigt sich, dass die Steuerung trotz operativer Kooperation in internationalen Institutionen wie Europol oder geheimdienstlicher Zusammenarbeit noch weitgehend national organisiert ist, was die rechtlichen Rahmenbedingungen ebenso wie die diskursive Einbettung terroristischer Risiken betrifft. Weniger kontrovers sind ‚weiche‘ Themen wie Gesundheitsvorsorge und Management von Pandemien. Hier setzen internationale Institutionen Standards durch, die als Risikomanagement deutliche Eingriffe in staatliche Steuerungsautonomie bedeuten.
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8,558 |
Epidemiologische Grundlagen nosokomialer Infektionen
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Viele Faktoren tragen zu erhöhten nosokomialen Infektionsraten bei. Der Anteil alter Patienten mit chronischen Krankheiten und Immunsupprimierter steigt. Fortschritte in Diagnostik und Therapie resultieren immer häufiger in invasiven Eingriffen. Antibiotikaresistenzen und Folgen nosokomialer Infektionen erfordern daher eine verlässliche Epidemiologie. Konsequenzen nosokomialer Infektionen betreffen einerseits Patienten (Morbidität und Letalität), aber auch das Gesundheitswesen, dem zusätzliche, teilweise vermeidbare finanzielle Belastungen entstehen.
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8,559 |
Other Pediatric Accidental Deaths
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Injury, both intentional and accidental, is the most common cause of death in children throughout the world. Many injury patterns that are seen in children are similar to those in adult populations; however, others differ, reflecting the age, stature, and development of children. This chapter focuses on differences in injury patterns of children across the spectrum of childhood development and growth, including injuries and fatalities that primarily occur in infancy and early childhood. Risk factors for injury and death are identified within the context of childhood development. Topics covered include deaths associated with motorized and nonmotorized vehicles including pedestrian, occupant, and operator fatalities; farming and ranching deaths; drowning, boating, and diving deaths; fires and burns, including electrical deaths; animal-related deaths; falls; and airway-associated deaths. There are significant disparities in childhood injury and death among racial, ethnic, geographic, and socioeconomic groups. A brief consideration of these differences is provided to assist in forensic case examination.
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8,560 |
Pneumologie
| null |
8,561 |
Regulated Cell Death
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In this chapter, the various subroutines of regulated cell death are neatly described by highlighting apoptosis and subforms of regulated necrosis such as necroptosis, ferroptosis, pyroptosis, and NETosis. Typically, all forms of regulated necrosis are defined by finite rupture of the plasma cell membrane. Apoptosis is characterized by an enzymatic machinery that consists of caspases which cause the morphologic features of this type of cell death. Mechanistically, apoptosis can be instigated by two major cellular signalling pathways: an intrinsic pathway that is initiated inside cells by mitochondrial release of pro-apoptotic factors or an extrinsic pathway that is initiated at the cell surface by various death receptors. In necroptosis, the biochemical processes are distinct from those found in apoptosis; in particular, there is no caspase activation. As such, necroptosis is a kinase-mediated cell death that relies on “receptor-interacting protein kinase 3” which mediates phosphorylation of the pseudokinase “mixed lineage kinase domain-like protein.” While ferroptosis is an iron-dependent, oxidative form of regulated necrosis that is biochemically characterized by accumulation of ROS from iron metabolism, oxidase activity, and lipid peroxidation products, pyroptosis is defined as a form of cell death (predominantly of phagocytes) that develops during inflammasome activation and is executed by caspase-mediated cleavage of the pore-forming protein gasdermin D. Finally, NETosis refers to a regulated death of neutrophils that is characterized by the release of chromatin-derived weblike structures released into the extracellular space. The chapter ends up with a discussion on the characteristic feature of regulated necrosis: the passive release of large amounts of constitutive DAMPs as a consequence of final plasma membrane rupture as well as the active secretion of inducible DAMPs earlier during the dying process. Notably, per cell death subroutine, the active secretion of inducible DAMPs varies, thereby determining different immunogenicity of dying cells.
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8,562 |
Clinical Ethics and Professionalism
|
The act of confronting problems that are too large for the patients, helping them navigate their way through health, wellness, sickness, and dying, and trying to find a balance among conflicting values, beliefs, ethics, and morals can complicate the doctor–patient relationship. The doctor–patient relationship is complex and is built upon trust. That trust can be affected by many different factors, as discussed in Chap. 8. What happens when the ethical principles that create and strengthen the doctor–patient relationship conflict? In this chapter, we address many of the ethical principles that create a foundation for this relationship. Some of the principles that we explore include beneficence, acting in a patient’s best interests, and doing no harm. Balancing these principles with a patient’s right to make autonomous decisions to guide their own medical care, especially when a patient refuses a recommended treatment, can be difficult.
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8,563 |
Analysis of Codon Usage Bias in Interferon Alpha Gene of the Giant Panda (Ailuropoda Melanoleuca)
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The analysis on codon usage bias of IFN-a gene of giant panda (Ailuropoda melanoleuca) may provide a basis for understanding the evolution relationship of giant panda and for selecting appropriate host expression systems to improve the expression of target genes. In this paper, the codon usage bias in the mature IFN-a sequence of giant panda and 15 reference species have been analyzed. The results showed that the synonymous codons with G and C at the third codon position were widely used and the ENC-GC3S plot revealed that the genetic heterogeneity in IFN-a gene was main constrained by mutational bias. Contrastive analysis revealed that there were 40 codons showing distinct usage differences between GpIFN-a and Escherichia coli, 38 codons between GpIFN-a and yeast. and only 30 between GpIFN-a and Homo sapiens. Therefore the Homo expression system may be more suitable for the expression of GpIFN-a genes.
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8,564 |
Narratives in Healthcare
|
In this chapter, the narrative is defined and the elements of the narrative are elucidated. Three lenses through which one can view the role of narratives in healthcare are discussed. First, organizational narratives help to foster social capital in the organization and, therefore, contribute to the people aspect of the knowledge management initiative in the organization. Second, the recuperative and relationship building roles of illness narratives are described. Third, narratives from the practice of narrative medicine are explored. The chapter concludes by proposing four requirements for narratives to be effective, namely, effective listening skills, the availability of time and place for storytelling, and the codification of narratives.
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8,565 |
ARF-Like (ARL) Proteins
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The ARF-like (ARL) proteins, within the ARF family, are a collection of functionally diverse GTPases that share extensive (>40 %) identity with the ARFs and each other and are assumed to share basic mechanisms of regulation and a very incompletely documented degree of overlapping regulators. At least four ARLs were already present in the last eukaryotic common ancestor, along with one ARF, and these have been expanded to >20 members in mammals. We know little about the majority of these proteins so our review will focus on those about which the most is known, including ARL1, ARL2, ARL3, ARL4s, ARL6, ARL13s, and ARFRP1. From this fragmentary information we extract some generalizations and conclusions regarding the sources and extent of specificity and functions of the ARLs.
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8,566 |
Wastewater-Based Epidemiology for Early Detection of Viral Outbreaks
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The immense global burden of infectious disease outbreaks and the need to establish prediction and prevention systems have been recognized by the World Health Organization (WHO), the National Institutes of Health (NIH), the United States Agency of International Development (USAID), the Bill and Melinda Gates Foundation, and the international scientific community. Despite multiple efforts, this infectious burden is still increasing. For example, it has been reported that between 1.5 and 12 million people die each year from waterborne diseases and diarrheal diseases are listed within the top 15 leading causes of death worldwide. Rapid population growth, climate change, natural disasters, immigration, globalization, and the corresponding sanitation and waste management challenges are expected to intensify the problem in the years to come.
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8,567 |
Remaking Eco-civilization by Sustainable Decision-Making
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Is there something in humanity’s nature that makes us seek out unsafety and risk? Already in the hunter-gatherer society of prehistory, a pattern of communal living for the sake of survival and cooperation to obtain food, clothing, and shelter was universal. Well before recorded history, as humankind progressed from the New Stone Age to the Bronze Age and then the Iron Age, groups of people specialized in making farming tools, weapons, horse tackle, and other forms of metalworking and needed a system of cooperation at the level of the village, community, and state. Meanwhile, from the time of the first agricultural revolution, ruling the waters, for instance, by predicting the timing of river floods to assist with seed sowing, tilling, and harvesting, was the basis for the existence of the state.
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8,568 |
Convergence Toward the Pan-Canadian Electronic Health Record
| null |
8,569 |
Adverse Medication Reactions
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Cutaneous adverse drug reactions (ADRs) are among the most frequent adverse reactions in patients receiving drug therapy. They have a broad spectrum of clinical manifestations, are caused by various drugs, and result from different pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Severe cutaneous ADRs comprise a group of diseases with major morbidity and mortality, reaching 30 % mortality rate in cases of Toxic Epidermal Necrolysis. This chapter covers the terminology, epidemiology, pathogenesis and classification of cutaneous ADR, describes the severe cutaneous ADRs and the clinical and laboratory approach to the patient with cutaneous ADR and presents the translation of laboratory-based discoveries on the genetic predisposition and pathogenesis of cutaneous ADRs to clinical management guidelines.
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8,570 |
The Respiratory System
|
One of the most critical events of birth is the conversion of the fluid-filled lung, unimportant to fetal intrauterine existence, into a hollow organ distended with air and capable of gaseous exchange sufficient to support life. Indeed, it has been argued that the major determinant of perinatal survival is respiratory function (Wigglesworth and Desai 1982). The failure to make this conversion adequately may lead, directly or indirectly, to infant death, and the pathologist often needs to assess the contribution made by respiratory inadequacy to the sequence of events leading to death. In the preterm infant, problems are mainly related to pulmonary immaturity and associated therapy. In the mature infant, birth asphyxia primarily results in cerebral damage but can engender significant respiratory complications when associated with aspiration of meconium. Even in stillbirths, where primary pulmonary pathology is rarely a cause of death, lung pathology may provide clues to antecedent events. Poor lung growth and maturation may point to the presence of pathology elsewhere. Consequently, adequate pathological investigation of the fetal or infant respiratory system is critical in any perinatal autopsy.
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8,571 |
Pneumologie
|
Die Pneumologie als Teilgebiet der Inneren Medizin widmet sich den Erkrankungen des Lungenparenchyms, des Lungenkreislaufes, der Atmung und der Pleura. Entsprechend werden in diesem Kapitel die wesentlichen medizinischen Fakten zu folgenden Themen dargestellt: obstruktive Lungenerkrankungen (u. a. Asthma bronchiale, chronische Bronchitis, Mukoviszidose), Lungenparenchymerkrankungen (hierzu zählt das Lungenemphysem ebenso wie die Lungenfibrose, aber auch das ARDS und die Silikose etc.) und Störungen im kleinen Kreislauf (Embolie, Blutung, Ödem, Hypertonie). Darüber hinaus wird auf das Schlafapnoe-Syndrom, das Hyperventilationssyndrom, den Pneumothorax und die Pleuritis/den Pleuraerguss näher eingegangen.
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8,572 |
Spezifische Infektionen
| null |
8,573 |
Avian influenza viruses: a severe threat of a pandemic in children?
|
Influenza virus is a leading cause of human respiratory illnesses, causing significant annual morbidity and mortality. The greatest severity of illness due to seasonal influenza occurs in infants less than 6 months of age and the elderly. In recent years, avian influenza virus infections with high mortality have occurred in humans. Many of these avian influenza virus infections have occurred in children, and unlike seasonal influenza, the most severe disease and highest death rates have occurred in children and young adults. Treatment and prevention options for avian influenza viruses are limited at present, although much research effort is directed toward these areas. Avian-derived influenza viruses are potential causes of pandemic influenza that could have a dramatic impact on children worldwide.
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8,574 |
Hygiene und Arbeitsschutz
|
In diesem Kapitel wird ein Überblick über Impfungen, meldepflichtige Erkrankungen sowie allgemeine Hinweise zur Hygiene im notfallmedizinischen Umfeld gegeben.
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8,575 |
Pulmonary Arterial Hypertension
|
The first description of the circulation of blood through the lungs has been attributed to Ibn Nafis (1210–1288).1 The concept was rediscovered by Michael Servetus, a Spanish physician during the Renaissance (1511–1553) and recorded, oddly enough, in two pages of his religious treatise, Christianismi Restitutio (1553).2 The definitive exposition of the pulmonary circulation was made by William Harvey in DeMotu Cordis (1628).3 The first observation of the pulmonary capillaries was first reported by Marcellus Malpighi (1661).4 Heart catheterization in humans, driven by a desire to obtain the perfect mixed venous specimen and measure cardiac output, was first performed in 1929 by the German urologist Forssmann,5 using a ureteral catheter to access his own right atrium. Over a decade later, Cournand and Richards at Columbia University in New York subsequently used right heart catheterization to record pulmonary artery pressure (PAP) in patients with shock and secondary forms of pulmonary hypertension (PHT). For these accomplishments, which were inspired by an interest in the pulmonary circulation and PHT related to mitral stenosis, Forssmann, Cournand, and Richards received the Nobel Prize in 1956.
|
8,576 |
Coronaviridae: a review of coronaviruses and toroviruses
| null |
8,577 |
Conclusion
|
This book has discussed the history of disease in ancient times. The purpose of this book was to show that disease was a significant contributing causal factor in history; especially in ancient times and reflects the fact that history is not just made up of dates of battles and the list of monarchs and when they reigned. Second it looked at the possible diseases may of the era and third it questioned the status quo such as whether the 1322 bce Hittite epidemic ended the Hittite Empire.
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8,578 |
Assessment Considerations in Pediatric Patients
|
Pharmacy assessment of pediatric patients is similar in many ways to that of adults; however there are many specific nuances that need to be considered in addition to the typical aspects included in an adult assessment. There is a lack of pediatric-specific medication research and a much higher rate of “off label” medication use, so children are at higher risk of medication errors and related harm. Pharmacokinetic differences and other age-related differences result in highly variable responses to medications throughout childhood. Pharmacists need to be aware of this variability and use every patient encounter as an opportunity for assessment of many aspects of medication including dose, formulation, administration, and indication. Infants and children also have physiological differences that need to be considered especially when assessing efficacy, toxicity, and the patient’s overall response to medications through physical exam or use of laboratory values. Lastly, a lack of appropriate medication formulations for children creates a requirement for pharmacists to specifically assess the formulations, measurement, and administration of pediatric medications. This chapter provides an approach to pediatric assessment, highlights common sources of error, and provides strategies for managing pediatric medications.
|
8,579 |
Prioritätensetzung im Katastrophenschutz
|
Die Frage der „Prioritätensetzung bei Rettungsmaßnahmen“ lässt sich in unterschiedlichen Reichweiten betrachten. Sehr eng fokussiert kann man sie auf die Auswahl reduzieren, wer von mehreren Verletzten zuerst behandelt wird, wenn (zunächst) zu wenige Rettungskräfte vorhanden sind, um alle zugleich zu behandeln. Im Zusammenhang mit komplexen Schadenslagen stellt sich die Frage der Prioritätensetzung jedoch sehr viel umfassender dar. Sie betrifft bereits die Katastrophenvermeidung und -vorsorge. In der konkreten Lagebewältigung spielen verschiedene Rechtsgüter und die Wechselwirkungen zwischen ihnen eine erhebliche Rolle. Dabei existieren kaum rechtliche Regelungen, die die Prioritätensetzung steuern.
|
8,580 |
Introduction to Survival Analysis
| null |
8,581 |
Epidemiology of Acute Respiratory Failure in Patients with HM (ICU Only)
|
Pulmonary complications are common in hematological patients, particularly those receiving a hematological stem cell transplant (HSCT), and a significant percentage of them will require intensive care unit (ICU) admission. Acute respiratory failure in these patients is a threatening event, with a very poor outcome, particularly when mechanical ventilation (MV) is required. For many years, oncologists and intensivists had a pessimistic vision of the dismal outcome of those hematological patients requiring admission to the ICU. The bleak experience in this population led some authors to suggest early withdrawal of support, or even withholding the option of mechanical ventilation altogether. However, over the last years this vision seems to be changing. Great progress has been made in stem cell transplantation that can be ascribed to a better understanding of the human leukocyte antigen (HLA) system for donor selection, more effective and less toxic immunosupression for prevention and treatment of graft-versus host disease (GVHD), and significant advances in infectious disease therapy. Also improvements in ventilatory and supportive care, such as the early implantation of noninvasive ventilation (NIV), may avoid intubation in a significant percentage of patients suffering from acute respiratory failure. As a result of all this, the proportion of both hematological patients requiring management in the ICU and those requiring MV is decreasing. Also the survival rate of HSCT recipients admitted to the ICU has been steadily improving. In this chapter we will report on the epidemiology of acute respiratory failure in patients with hematological malignancies.
|
8,582 |
Consolidation
|
Consolidation refers to an area of homogeneous increase in lung parenchymal attenuation that obscures the margins of vessels and airway walls [1]. Air bronchograms may be present with consolidative area. Pathologically, consolidation represents an exudate or other product of disease that replaces alveolar air, rendering the lung solid [2, 3].
|
8,583 |
Fluorescence Observables and Enzyme Kinetics in the Investigation of PPI Modulation by Small Molecules: Detection, Mechanistic Insight, and Functional Consequences
|
The potential of fluorescence-based methods and kinetic analysis in the screening and molecular-scale mechanistic investigation of PPI modulation by small molecules is discussed through several representative examples collected and commented. These experimental approaches take advantage of a variety of observables. Changes in the protein aggregation pattern have been monitored through fluorescence properties such as spectra, intensities (related to quantum yields), time-decays, and anisotropies of intrinsic protein fluorophores, of extrinsic fluorescent tags and, even, of the same small molecules added to modulate PPIs, as well as through bimolecular excited-state processes such as static and collisional quenching, including electron and excitation-energy transfer, or exciton interaction, whose efficiencies are crucially structure dependent. Besides allowing for qualitative and quantitative information on the small-molecule induced PPI modulation, these approaches can take advantage from the sensitivity of fluorescence observables on fine structural details to shed light on the molecular-scale mechanisms of action and their functional consequences. Direct investigation of the latter by kinetic inhibition analysis represents a useful change in perspective whenever PPI are relevant for enzyme activity. Dissociative inhibition, that is, the ability of some small molecules to inhibit enzymes by disrupting their active oligomeric assembly is shortly reviewed.
|
8,584 |
Infection Prevention and Control Issues After Solid Organ Transplantation
|
Infections are an important cause of morbidity and mortality in solid organ transplant recipients. Consequently, infection prevention is an essential component of any organ transplant program. Given their frequent and often prolonged contact with the healthcare system, solid organ transplant recipients are at high risk for healthcare-associated infections, including those caused by antibiotic-resistant organisms. In this chapter we review several different healthcare-associated infections of importance to transplant recipients, including those caused by bacterial, viral, and fungal organisms. We also describe infection prevention and control strategies applicable to this patient population. These practices focus on clinical interventions and environmental controls designed to prevent the spread of potentially pathogenic organisms in the healthcare setting. We also describe post-exposure interventions applicable to solid organ transplant recipients exposed to potential pathogens in order to reduce their risk of subsequent infection.
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8,585 |
Krankheiten der Atmungsorgane
|
gereinigt (Filterwirkung der Nasenhaare, Partikelniederschlag auf dem Nasenschleim, rachenwärts gerichtete Zilienbewegung des Epithels); erwärmt (fast bis auf Körpertemperatur); befeuchtet (nahezu vollst.ndige Sättigung mit Wasserdampf).
|
8,586 |
Specialized Agencies of the UN
| null |
8,587 |
The Last Natural Brain
|
The work of the brain would be easy if we knew what we needed to remember or understand in the future. Life is full of surprises – new people whom we need to know, names we have to remember, problems we try to solve.
|
8,588 |
Vaccines, Sera and “New” Viruses: Ebola, Zika and Other Infectious Challenges for Human Health
|
Following the basic description of the immunological science, we may now go in more detail into the practical applications involving immunological prevention against infectious diseases (vaccine use, requiring availability of suitable antigenic preparations, safe and effective immunization schedules and time to allow for immunity to develop) and immunotherapy of dangerous infective conditions (serotherapy, involving availability of immune sera and their use for injection in subjects needing protection against infectious agents). All this is discussed with special regard of the many new micro-organisms described in human pathology and also in situations in which the deliberate use of them for biological warfare or related menace (bioterrorism) is realized.
|
8,589 |
Information Diffusion in Social Networks
|
In this chapter, we will discuss concepts of information diffusion in social networks. We are interested in knowing how a piece of information (knowledge) is spread through a network. These may be computer viruses spreading on the Internet or a network of computers, diseases through a social network, or rumors and ideas through a social network. Information diffusion methods are commonly used in viral marketing, in collaborative filtering systems, in emergency management, in community detection, and in the study of citation networks.
|
8,590 |
Effects of the West African Ebola Epidemic on Health Care of Pregnant Women: Stigmatization With and Without Infection
|
Following the end of the Ebola virus outbreak in West Africa in March 2016, the lingering effects of stigma on Ebola survivors, as well as children orphaned by the disease, have become evident. However, there was little scholarly attention paid to stigma while the outbreak was still active. This chapter explores the effects of stigmatization on the health care services that pregnant women, both with and without Ebola, were able to access and receive during the outbreak. We propose three primary ways in which stigma operated to reduce pregnant women’s access to health care services during the outbreak: (1) Women and their relatives were afraid to go to health facilities for fear of being infected with Ebola while there, i.e., stigmatization of health care facilities; (2) Health care workers frequently died due to their occupational exposure to EVD while caring for others, i.e., they were stigmatized as carriers or transmitters of Ebola; and (3) Pregnant women themselves were refused services at health facilities due to fears that they were infected with Ebola, i.e., the physiological processes of birth, which involve high levels of potential for exposure to bodily fluids, led to health care workers’ stigmatization of these women when they sought services during pregnancy or, particularly, at the time of giving birth. In several of the countries that experienced the worst of the outbreak, women already faced some of the world’s highest rates of pregnancy-related death even prior to the advent of the epidemic. We argue that the high fatality rate for pregnant women with Ebola, the drastic effects of the epidemic on countries’ health care workforce, and the inherent messiness of birth, all coalesced to create heightened discrimination and stigma around seeking care during pregnancy and birth.
|
8,591 |
Split Blood Products
|
The last 20 years have seen many advances in transfusion therapy and safety. Blood products are biological products engendering complex interactions with the immune system. Prestorage leukoreduction results in a reduced risk of febrile reactions, CMV transmission, and immune modulation, proving to be safer for patients than non-leuko reduced products. Simple patient identification issues and clerical error continue to be the primary causes of ABO-incompatible transfusions. Rigorous donor screening as well as serologic and nucleic acid testing for transfusion transmitted infection have brought the blood supply to a very safe level, although transmission of these agents continues to be a problem in underdeveloped countries. Emerging infectious diseases, beyond current laboratory detection capabilities, combined with global travel, pose unknown imminent risks everywhere. We also briefly discuss the current risks of transfusion-transmitted infections. We review currently available hemostatic blood products, their compositions, and their clinical indications; we mention product modifications currently in development; and we touch upon the hemostatic properties and drawbacks of whole blood, which is currently gaining popularity as an alternative to split blood products. We conclude with an in-depth overview of the risks associated with transfusion, including incompatibility, hemolytic transfusion reactions, transfusion-associated circulatory overload (TACO), and transfusion-related acute lung injury (TRALI).
|
8,592 |
Allgemeine Hygiene- und Präventionsmaßnahmen
|
a. Robert Koch gilt als Begründer der modernen Händehygiene in der Medizin. b. Der Einsatz von Wasser und Seife ist genauso effektiv wie die alkoholische Händedesinfektion. c. Die Händedesinfektion wird vor und nach jedem Patientenkontakt empfohlen. d. Die »Aktion Saubere Hände« richtet sich gegen Korruption in Ländern der Dritten Welt. e. Die Compliance mit der erforderlichen Händehygiene beträgt auf Intensivstationen je nach Beobachtungsstudie ca. 50 %, wobei der ärztliche Dienst tendenziell schlechter abschneidet als das Pflegepersonal.
|
8,593 |
A Survey of Social Web Mining Applications for Disease Outbreak Detection
|
Social Web Media is one of the most important sources of big data to extract and acquire new knowledge. Social Networks have become an important environment where users provide information of their preferences and relationships. This information can be used to measure the influence of ideas and the society opinions in real time, being very useful on several fields and research areas such as marketing campaigns, financial prediction or public healthcare among others. Recently, the research on artificial intelligence techniques applied to develop technologies allowing monitoring web data sources for detecting public health events has emerged as a new relevant discipline called Epidemic Intelligence. Epidemic Intelligence Systems are nowadays widely used by public health organizations like monitoring mechanisms for early detection of disease outbreaks to reduce the impact of epidemics. This paper presents a survey on current data mining applications and web systems based on web data for public healthcare over the last years. It tries to take special attention to machine learning and data mining techniques and how they have been applied to these web data to extract collective knowledge from Twitter.
|
8,594 |
Hepatic Failure
|
The progression of liver disease can cause several physiologic derangements that may precipitate hepatic failure and require admission to an intensive care unit. The underlying pathology may be acute, acute-on chronic, or chronic in nature. Liver failure may manifest with a variety of clinical signs and symptoms that need prompt attention. The compromised synthetic and metabolic activity of the failing liver affects all organ systems, from neurologic to integumentary. Supportive care and specific therapies should be instituted in order to improve outcome and minimize time of recovery. In this chapter we will discuss the definition, clinical manifestations, workup, and management of acute and chronic liver failure and the general principles of treatment of these patients. Management of liver failure secondary to certain common etiologies will also be presented. Finally, liver transplantation and alternative therapies will also be discussed.
|
8,595 |
The Current Bioweapons Threat
|
According to unclassified U.S. government sources, states of biological weapons (BW) proliferation concern include China, Iran, North Korea, Russia, and Syria. Assessing the BW threat is challenging, however, because illicit development and production can be concealed at dual-use industrial sites such as vaccine plants, and only tens of kilograms of an agent like dried anthrax spores can be militarily significant. The lack of unambiguous technical signatures of BW-related activity means that most estimates of foreign capabilities draw heavily on human intelligence sources, yet spies and defectors are notoriously unreliable. A key factor driving BW proliferation is the perceived military utility of biological weapons, which may include strategic deterrence, asymmetric warfare, or covert operations. Globalization of the biotechnology industry has expanded trade in dual-use materials and production equipment, increasing the risks of diversion and misuse for BW purposes. With the advent of flexible biological manufacturing systems, it has also become possible for countries to acquire a “latent” capacity for BW production during a crisis or war. Since the 2001 anthrax letter attacks, sub-state actors have become a prominent part of the threat matrix, but terrorist acquisition and use of BW requires both the motivation to use disease as a weapon and the technical capability to do so, a combination that is quite rare. At present the threat of mass-casualty BW attacks emanates primarily from nation-states, while terrorist use of biological weapons will likely remain limited in scale and impact. Nevertheless, the emergence of new biotechnologies with a potential for misuse could result in more damaging incidents of bioterrorism in the future.
|
8,596 |
Nephrologie
| null |
8,597 |
The Physical Burden of Immunoperception
|
The previous chapter introduced the ImmunoEmotional Regulatory System (IMMERS). Also, there was a brief discussion about psychological states/psychiatric disorders that so far have been linked to the IMMERS. The present chapter considers another aspect of the IMMERS in which physiological states/physical diseases can be fit to the IMMERS.
|
8,598 |
Making Universities Grow: The New Zealand Experience
|
The New Zealand tertiary education system consists of eight Universities, numerous polytechnical institutes and other smaller tertiary providers. Despite the preferential treatment for international doctoral students, the New Zealand sector suffered a serious drop in international student enrolments beginning in 2004, after the damaging closure of two English-language institutes which received significant negative media coverage in one of New Zealand’s most important markets for international students—the People’s Republic of China. New Zealand Universities have aspired to create stronger linkages with institutions overseas to access external research income that may be funnelled through principal investigators at overseas Universities. In November 2015, the New Zealand government asked the “Productivity Commission” to write a report with recommendations on how to create “new models” for tertiary education. The Commission was tasked to investigate “how trends in technology, internationalisation, population, tuition costs and demand for skills may drive changes in models of tertiary education”. For future growth, the Universities need to partner more effectively with industry and create a culture that truly believes that a country like New Zealand deserves a great University system, and that the Universities are a true asset, essential for the country to thrive. This kind of strategy will ensure that the Universities continue to grow despite the vicissitudes of chance events or geopolitical developments beyond the control of the New Zealand government or University administrators.
|
8,599 |
Mikrobiologie und Antiinfektiva
|
Bei einem 38-jährigen Patienten wurde eine Analfistel operiert. Am 3. postoperativen Tag kommt es zur akuten Verschlechterung des Gesundheitszustands mit hämodynamischer Instabilität und Fieber. Daraufhin wird der Patient in eine Klinik der Maximalversorgung verlegt. Beim Eintreffen im Schockraum ist der Patient somnolent und kaltschweißig. Der Blutdruck beträgt 70/40 mmHg, die Herzfrequenz 120/min und die Körpertemperatur 39,6°C. Das Hautkolorit ist blass-grau. Im Verlegungsbericht wird bei stark ödematös geschwollenem Skrotum der Verdacht auf eine Fournier-Gangrän nach Analfistel- OP gestellt. Der diensthabende Intensivmediziner muss nun parallel die hämodynamische Situation stabilisieren, mikrobiologisches Material gewinnen, eine kalkulierte antimikrobielle Therapie beginnen und weitere Maßnahmen zur Diagnosesicherung einleiten.
|
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