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8,600 |
Pneumologie
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—. : —. allergisches Asthma („extrinsic asthma“): IgE-vermittelte Sofortreaktion vom Typ I auf Inhalationsallergene; —. : • Analgetikaasthma: pseudoallergische Reaktion bei erhöhter Aktivität der LTC(4)-Synthetase in Mastzellen und eosinophilen Granu- lozyten, ausgelöst durch ASS oder andere NSAR, meist auch Intoleranz gegenüber Sulfit (Wein), Tyramin (Käse), Glutamat; • Infektasthma; • durch Exposition gegenüber chemisch-toxischen Stoffen; • infolge gastroösophagealen Refluxes; —. unspezifische Stimuli: kalte Luft, körperliche Belastung, Aerosole, Rauche, Gase und Stäube; —. Prävalenz 5-10%; <30. Lebensjahr meist allergisches Asthma, >40. Lebensjahr überwiegend nicht-allergisches Asthma; —. bei allergischem Asthma polygene Anlage auch für andere atopische Erkrankungen, z. B. allergische Rhinitis, Neurodermitis; —. bei 25% der Patienten „Etagenwechsel“ nach allergischer Rhinitis; —. Allergenexposition/Infektion → Degranulation bzw. Aktivierung von Mastzellen, eosinophilen Granulozyten, T-Lymphozyten → Entzündung der Bronchialschleimhaut → Freisetzung von Mediatoren (Histamin, Leu- kotriene, Bradykinin) → bronchiale Hyperreaktivität → Bronchokonstriktion (Sofortreaktion) → Schleimhautödem (Spätreaktion) → Hyperkrinie/ Dyskrinie (chronische Entzündungsreaktion);
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8,601 |
Coronavirus main proteinase: target for antiviral drug therapy
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8,602 |
Neusverstopping
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Acute neusverstopping is een frequente aandoening. Meestal is het geen geïsoleerd symptoom, maar treedt zij gecombineerd op met andere klachten van de neus. In overgrote meerderheid is de oorzaak een virale infectie die vanzelf overgaat, en heeft verdere diagnostiek geen consequenties voor de therapie. Bij chronische klachten is verdere diagnostiek wel zinvol; een allergie of hyperreactiviteit is het meest waarschijnlijk. Bij chronische neusverstopping is aandacht voor chronisch gebruik van decongestieve neusdruppels van belang. Persisterende eenzijdige neusverstopping, zeker wanneer dit gepaard gaat met bloederige afscheiding, is een alarmsymptoom. ELEKTRONISCH AANVULLEND MATERIAAL: De online versie van dit hoofdstuk (doi:10.1007/978-90-368-1274-0_15) bevat aanvullend materiaal, dat beschikbaar is voor geautoriseerde gebruikers.
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8,603 |
Seltene Infektionen und Hygiene auf der Intensivstation
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Ein Patient wird seit 2 Wochen auf der Intensivstation aufgrund einer infektexazerbierten chronisch obstruktiven Lungenerkrankung beatmet. Der Verlauf wurde durch eine nosokomiale Pneumonie kompliziert. Bei der Morgenvisite wird berichtet, dass der Patient innerhalb der letzten 2 h 4-mal massiv wässrig abgeführt hat. Die Temperatur beträgt 38,7°C, die Leukozyten 16.000/μl. Der Intensivarzt und seine Oberärztin besprechen die möglichen Ursachen und überlegen, ob spezielle Hygienemaßnahmen erforderlich sind.
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8,604 |
Komplexe Gerinnungsstörungen
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Die thrombotisch-thrombozytopenische Purpura (TTP) und das hämolytischurämische Syndrom (HUS) sind thrombotische Mikroangiopathien, gekennzeichnet durch eine Endothelzellschädigung mit nachfolgender Bildung von Thromben in der Mikrozirkulation mit intravasaler Hämolyse und Thrombozytopenie. Ischämische Organdysfunktionen im Gehirn, den Nieren und anderen Organen Prägen das klinische Bild. Während bei Erwachsenen das Auftreten einer neurologischen Symptomatik zur Diagnose TTP führt, wird bei Kindern mit dem Leitsymptom Nierenversagen die Diagnose HUS gestellt.
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8,605 |
SARS Coronavirus Pathogenesis and Therapeutic Treatment Design
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Emerging pathogens are either new or newly recognized or those that are increasing in incidence and spread. Since the identity of emerging pathogens from animal reservoirs is difficult to predict, the development for pathogen-specific therapeutics and vaccines is problematic. The highly pathogenic SARS coronavirus (SARS-CoV) emerged from zoonotic pools in 2002 to cause a global epidemic of severe acute respiratory syndrome (SARS). Many patients with SARS-CoV experienced an exacerbated form of disease called acute respiratory distress syndrome (ARDS) requiring mechanical ventilation and supplemental oxygen and half of these patients died. Similar to other viral pathogens like influenza and West Nile Virus, the severity of SARS-CoV disease increased with age. Unfortunately, successful vaccination in the most vulnerable populations is a difficult task because of immunological deficiencies associated with aging (immune senescence). Due to the rapidity of virus emergence, technologies like synthetic biology can be harnessed to facilitate rapid recombinant virus construction for studying the novel virus biology, pathogenesis and the evaluation of therapeutic interventions. Since predicting the antigenic identity of future emergence is difficult, candidate vaccines and therapeutics should have a maximal breadth of cross-protection, and panels of antigenically divergent synthetically reconstructed viruses can be used as tools for this evaluation. We discuss how synthetic reconstruction of many animal and human SARS-CoV has provided a model to study the molecular mechanisms governing emergence and pathogenesis of viral diseases. In addition, we review the evolution, epidemiology, and pathogenesis of epidemic and zoonotic SARS-CoV with focus on the development of broadly reactive therapeutics and vaccines that protect aged populations from the zoonotic pool.
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8,606 |
Artificial Intelligence Applications in Tracking Health Behaviors During Disease Epidemics
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The threat of emerging and re-emerging infectious diseases to global population health remains significantly enormous, and the pandemic preparedness capabilities necessary to confront such threats must be of greater potency. Artificial Intelligence (AI) offers new hope in not only effectively pre-empting, preventing and combating the threats of infectious disease epidemics, but also facilitating the understanding of health-seeking behaviors and public emotions during epidemics. From a systems-thinking perspective, and in today’s world of seamless boundaries and global interconnectivity, AI offers enormous potential for public health practitioners and policy makers to revolutionize healthcare and population health through focussed, context-specific interventions that promote cost-savings on therapeutic care, expand access to health information and services, and enhance individual responsibility for their health and well-being. This chapter systematically appraises the dawn of AI technology towards empowering population health to combat the rise of infectious disease epidemics.
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8,607 |
Recombinant Live Vaccines to Protect Against the Severe Acute Respiratory Syndrome Coronavirus
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The severe acute respiratory syndrome (SARS) coronavirus (CoV) was identified as the etiological agent of an acute respiratory disease causing atypical pneumonia and diarrhea with high mortality. Different types of SARS-CoV vaccines, including nonreplicative and vectored vaccines, have been developed. Administration of these vaccines to animal model systems has shown promise for the generation of efficacious and safe vaccines. Nevertheless, the identification of side effects, preferentially in the elderly animal models, indicates the need to develop novel vaccines that should be tested in improved animal model systems. Live attenuated viruses have generally proven to be the most effective vaccines against viral infections. A limited number of SARS-CoV attenuating modifications have been described, including mutations, and partial or complete gene deletions affecting the replicase, like the nonstructural proteins (nsp1 or nsp2), or the structural genes, and drastic changes in the sequences that regulate the expression of viral subgenomic mRNAs. A promising vaccine candidate developed in our laboratory was based on deletion of the envelope E gene alone, or in combination with the removal of six additional genes nonessential for virus replication. Viruses lacking E protein were attenuated, grew in the lung, and provided homologous and heterologous protection. Improvements of this vaccine candidate have been directed toward increasing virus titers using the power of viruses with mutator phenotypes, while maintaining the attenuated phenotype. The safety of the live SARS-CoV vaccines is being increased by the insertion of complementary modifications in genes nsp1, nsp2, and 3a, by gene scrambling to prevent the rescue of a virulent phenotype by recombination or remodeling of vaccine genomes based on codon deoptimization using synthetic biology. The newly generated vaccine candidates are very promising, but need to be evaluated in animal model systems that include young and aged animals.
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8,608 |
Carbon Nanostructures for Enhanced Photocatalysis for Biocidal Applications
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In the last few decades, the demand for safer environmental conditions has increased dramatically. The burden of infectious diseases worldwide, related to contamination via contact with contaminated surfaces (fomites), is a growing issue. Globally, these infections are linked to an estimated 1.7 million deaths a year from diarrheal disease and 1.5 million deaths from respiratory infections [1]. Apart from hospitals, the problem has become a growing liability at places where food is prepared and handled [2], where there is a growing risk associated with the cross-contamination of edible goods and where large amounts are handled by a single facility [3]. Already many E. coli and Salmonella outbreaks have been recorded and linked to single a facility [2, 4, 5]. The problem of cross-contamination via surfaces can also be traced, in smaller scale, to households where common areas can accumulate pathogens that can potentially become a threat, especially to more sensitive population groups [6]. There are also biological threats in forms of dangerous epidemic outbreaks (Ebola and SARS) and biological warfare weapons (anthrax and smallpox). The need for effective and efficient disinfection is driving the industry in the development of a wide range of products. These products can currently be divided into three major categories:
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8,609 |
Pulmonary and Hepatic Complications of Hematopoietic Cell Transplantation
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Significant advances have been made in allogeneic transplantation for both adults and pediatric transplant recipients over the past 20 years, corresponding with dramatic declines in treatment-related mortality (TRM). The cumulative incidence of TRM at 1 year following unrelated donor transplants has decreased from 40 to 15 % between 1987 and 2006 for children with acute leukemia, the primary indication for transplant in the pediatric population (MacMillan et al., Biol Blood Marrow Transpl 14(9 Suppl):16–22, 2008). Improvements in conditioning regimen, supportive care, and human leukocyte antigen (HLA) testing have all been associated with incremental improvements in survival during this period. In particular, the management of both infectious and noninfectious organ complications has changed dramatically, with improved sensitivity for diagnostic testing for pathogens and tremendous improvements in our understanding of organ complications. Two organ complications in particular, pulmonary and hepatic, have been a major focus of investigation over the past several decades. The introduction of tumor necrosis factor (TNF) inhibitors for the management of acute, noninfectious lung injury and the introduction of an endothelial stabilizing agent (defibrotide) for the management of hepatic veno-occlusive disease have been major advances in the past decade.
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8,610 |
Probabilistic Reasoning for Closed-Room People Monitoring
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In this chapter, we present a probabilistic reasoning approach to recognizing people entering and leaving a closed room by exploiting low-level visual features and high-level domain-specific knowledge. Specifically, people in the view of a monitoring camera are first detected and tracked so that their color and facial features can be extracted and analyzed. Then, recognition of people is carried out using a mapped feature similarity measure and exploiting the temporal correlation and constraints among each sequence of observations. The optimality of recognition is achieved in the sense of maximizing the joint posterior probability of the multiple observations. Experimental results of real and synthetic data are reported to show the effectiveness of the proposed approach.
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8,611 |
Antimicrobial Agents in Ophthalmology
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Many types of antimicrobial agents have been introduced for the treatment of ocular infectious diseases. Some ocular infections have been eradicated such as smallpox, while others have been controlled by public health measures such as trachoma. The resilience of viruses and the tenacity of bacteria have led to the evolution of old diseases and the emergence of new infections. Continuous search for new antimicrobial agents for the treatment of infectious diseases is, therefore, highly desirable. New infectious agents are discovering the human race, and the ecological changes are exposing mankind to new viruses and bacteria. In addition, air travel and disruption of geographic barriers are leading to new forms of infectious diseases. In the twentieth century, there was a widespread false optimism that infectious diseases are eradicated by antimicrobial agents. It was soon discovered that many infections require new strategies for the treatment of ocular infections. The new antimicrobial agents that have been introduced over the past century can be classified into four major categories including (1) antibiotics that inhibit cell wall synthesis and integrity, (2) antibiotics that inhibit and suppress cell membrane functions, (3) antibiotics that interfere the protein synthesis, and (4) antibiotics that modulate nucleic acid synthesis. The selection of antimicrobial agents for the treatment of ocular infectious diseases is based on the most frequently encountered organisms, the pharmacokinetics of the antibiotics, the dosage required, the ocular penetration, and the cost of therapy. The stumbling blocks to safe and effective antimicrobial therapy in ocular infections include the resistance of the microorganisms, toxicity of the drug, and poor ocular penetration of antimicrobial agents.
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8,612 |
Kawasaki Disease
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Kawasaki disease (KD) is the commonest cause of acquired heart disease in children in the developed world and is increasingly being reported from developing countries. KD has a predilection for the coronary arteries. Etiology of this disorder is remains an enigma. Diagnosis of KD is essentially clinical with the help of set of clinical criteria. Incomplete KD is said to occur when these criteria are not fulfilled. However, incomplete KD should not be considered as a milder form of the disease. 2D-echocardiography remains the imaging modality of choice for evaluation and monitoring of cardiac complications but often needs to be supplemented by CT coronary angiography. Intravenous immunoglobulin along with aspirin is the gold standard therapy of treatment for KD. However, there is no consensus on treatment of resistant forms of KD. Patients with KD should be on long-term follow-up especially if they have developed coronary artery abnormalities during the acute stage.
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8,613 |
Bushmeat and Emerging Infectious Diseases: Lessons from Africa
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Zoonotic diseases are the main contributor to emerging infectious diseases (EIDs) and present a major threat to global public health. Bushmeat is an important source of protein and income for many African people, but bushmeat-related activities have been linked to numerous EID outbreaks, such as Ebola, HIV, and SARS. Importantly, increasing demand and commercialization of bushmeat is exposing more people to pathogens and facilitating the geographic spread of diseases. To date, these linkages have not been systematically assessed. Here we review the literature on bushmeat and EIDs for sub-Saharan Africa, summarizing pathogens (viruses, fungi, bacteria, helminths, protozoan, and prions) by bushmeat taxonomic group to provide for the first time a comprehensive overview of the current state of knowledge concerning zoonotic disease transmission from bushmeat into humans. We conclude by drawing lessons that we believe are applicable to other developing and developed regions and highlight areas requiring further research to mitigate disease risk.
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8,614 |
Antibiotic Resistance of Non-pneumococcal Streptococci and Its Clinical Impact
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The taxonomy of streptococci has undergone major changes during the last two decades. The present classification is based on both phenotypic and genotypic data. Phylogenetic classification of streptococci is based on 16S rRNA sequences [1], and it forms the backbone of the overall classification system of streptococci. Phenotypic properties are also important, especially for clinical microbiologists. The type of hemolysis on blood agar, reaction with Lancefield grouping antisera, resistance to optochin, and bile solubility remain important for grouping of clinical Streptococcus isolates and therefore treatment options [2]. In the following chapter, two phenotypic classification groups, viridans group streptococci (VGS) and beta-hemolytic streptococci, will be discussed.
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8,615 |
THE INTERCONNECTION BETWEEN THE BUILT ENVIRONMENT ECOLOGY AND HEALTH
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The built environment (BE) affects ecosystems, ecosystem services and human health and well being. While, formally, the BE ranges from the smallest hut to the largest city, this chapter focuses upon the health effects of urban areas, which increasingly are the preferred human habitat. Urban areas have many attractive and beneficial influences to human well‐being. But at the same time, many effects of urban areas are harmful to well‐being, and many are not even recognized as such. Most publications about these topics have described the effects of the BE separately, on either ecosystems or on human health. The interconnectivity between these two effects relative to BE is rarely studied. This paper focuses on the mutual influence and interactions between three related aspects of the BE which can impact ecosystems and human health: transportation, land use, and life style. It also explores some of the links between the BE, human health, and human security.
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8,616 |
Of Ducks and Men: Ecology and Evolution of a Zoonotic Pathogen in a Wild Reservoir Host
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A hallmark of disease is that most pathogens are able to infect more than one host species. However, for most pathogens, we still have a limited understanding of how this affects epidemiology, persistence and virulence of infections—including several zoonotic pathogens that reside in wild animal reservoirs and spillover into humans. In this chapter, we review the current knowledge of mallard (Anas platyrhynchos) as host for pathogens. This species is widely distributed, often occupying habitats close to humans and livestock, and is an important game bird species and the ancestor to domestic ducks—thereby being an excellent model species to highlight aspects of the wildlife, domestic animal interface and the relevance for human health. We discuss mallard as host for a range of pathogens but focus more in depth of it as a reservoir host for influenza A virus (IAV). Over the last decades, IAV research has surged, prompted in part to the genesis and spread of highly pathogenic virus variants that have been devastating to domestic poultry and caused a number of human spillover infections. The aim of this chapter is to synthesise and review the intricate interactions of virus, host and environmental factors governing IAV epidemiology and evolution.
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8,617 |
Flashes
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Because punctuated reality is episodic—waves come and go—the social structure of modern life is also episodic. Social groups form spontaneously and often without obvious reasons. Flashmobs ravage innocent bystanders, online raves spring up and just as quickly die out, protesters flair-up on Wall Street and then disappear. Why? These bursts occur because of the increasingly connected super hive we call the Internet. More importantly, they rise and fall because of how society is wired together. Ever-tightening self-organization and the resulting hub-like structure of society magnifies the impact and spreads these events like a wildfire. If you want to control the Internet animali, seek out and control the center.
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8,618 |
A Global Ethical Framework for Public Health Disasters
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Public health disasters reflect a class of global problems that generate moral quandaries and challenges. As such, they demand a global bioethical response involving an approach that is sufficiently nuanced at the local, trans-national, and global domains. Using the overlapping ethical issues engendered by Ebola and pandemic influenza outbreaks, atypical drug-resistant tuberculosis, and earthquakes, this chapter develops a global ethical framework for engaging PHDs. This framework exhibits sufficient responsiveness to local, global, microbial, and metaphysical realities as well as scientific concerns.
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8,619 |
Immunität und Ansteckung: Roberto Espositos Kritik des Sicherheitsdenkens
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Todd Haynes’ Film [SAFE] (USA 1995) erzählt die Geschichte von Carol White, die in einer US-amerikanischen Vorstadt ein sehr tristes und einsames Leben als Hausfrau führt, bis sie plötzlich an immer stärker werdenden körperlichen (Über-) Reaktionen auf chemische Stoffe und Abgase zu leiden beginnt. Sie bricht beim Baby shower einer Freundin und im Waschsalon zusammen oder bekommt im Straßenverkehr keine Luft mehr. Ihre immer schlimmer werdenden Attacken bringen sie dazu, dass sie sich bei verschiedenen Stellen Hilfe sucht, wodurch sie erfährt, dass sie in ihrem Leiden nicht allein ist: „Multiple Chemical Sensitivity“ sei eine „environmental illness“ oder auch „die Krankheit des 20. Jahrhunderts“, die mittlerweile pandemische Ausmaße angenommen habe.Todd Haynes’ Film [SAFE] (USA 1995) erzählt die Geschichte von Carol White, die in einer US-amerikanischen Vorstadt ein sehr tristes und einsames Leben als Hausfrau führt, bis sie plötzlich an immer stärker werdenden körperlichen (Über-) Reaktionen auf chemische Stoffe und Abgase zu leiden beginnt. Sie bricht beim Baby shower einer Freundin und im Waschsalon zusammen oder bekommt im Straßenverkehr keine Luft mehr. Ihre immer schlimmer werdenden Attacken bringen sie dazu, dass sie sich bei verschiedenen Stellen Hilfe sucht, wodurch sie erfährt, dass sie in ihrem Leiden nicht allein ist: „Multiple Chemical Sensitivity“ sei eine „environmental illness“ oder auch „die Krankheit des 20. Jahrhunderts“, die mittlerweile pandemische Ausmaße angenommen habe. Ihr wird geraten, sich von Umwelteinflüssen möglichst fern zu halten und ihren Körper weitestgehend zu „reinigen“, so dass sich Carol letztlich entschließt, in eine Art spirituelles Sanatorium zu ziehen, das in der Wüste liegt und von der Außenwelt abgeschieden ist. Doch auch hier hören ihre Anfälle nicht auf, am Ende bewegt sich Carol nur noch mit einer Sauerstoffflasche umher und bewohnt schließlich ein Porzellan-Iglu, das sie in größtmöglichem Maße vor allen schädlichen Umwelteinflüssen schützen soll. Die letzten Szenen von [SAFE] wirken, als zeigten sie eine surreale Mondlandschaft. Während also der Film die Existenz der Gefahr, der Carol ausgesetzt ist, nicht leugnet, macht er auf eine grundlegende Ironie aufmerksam: Das exzessive Streben nach Sicherheit für das Leben führt letztlich in eine Isolation, die selbst absolut unlebbar ist.
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8,620 |
Brief History of Pandemics (Pandemics Throughout History)
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Intermittent outbreaks of infectious diseases have had profound and lasting effects on societies throughout history. Those events have powerfully shaped the economic, political, and social aspects of human civilization, with their effects often lasting for centuries. Epidemic outbreaks have defined some of the basic tenets of modern medicine, pushing the scientific community to develop principles of epidemiology, prevention, immunization, and antimicrobial treatments. This chapter outlines some of the most notable outbreaks that took place in human history and are relevant for a better understanding of the rest of the material. Starting with religious texts, which heavily reference plagues, this chapter establishes the fundamentals for our understanding of the scope, social, medical, and psychological impact that some pandemics effected on civilization, including the Black Death (a plague outbreak from the fourteenth century), the Spanish Flu of 1918, and the more recent outbreaks in the twenty-first century, including SARS, Ebola, and Zika.
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8,621 |
Plant Nanobionics: Application of Nanobiosensors in Plant Biology
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Nanobiosensors (NBSs) are a class of chemical sensors which are sensitive to a physical or chemical stimulus (heat, acidity, metabolism transformations) that conveys information about vital processes. NBSs detect physiological signals and convert them into standardized signals, often electrical, to be quantified from analog to digital. NBSs are classified according to the transducer element (electrochemical, piezoelectric, optical, and thermal) in accordance with biorecognition principle (enzyme recognition, affinity immunoassay, whole sensors, DNA). NBSs have varied forms, depending on the degree of interpretation of natural processes in plants. Plant nanobionics uses mathematical models based on qualitative and less quantitative records. NBSs can give information about endogenous concentrations or endogenous fluxes of signaling molecules (phytohormones). The properties of NBSs are temporal and spatial resolution, the ability of being used without significantly interfering with the system. NBSs with the best properties are the optically genetically coded NBSs, but each NBS needs specific development efforts. NBS technologies using antibodies as a recognition domain are generic and tend to be more invasive, and there are examples of their use in plant nanobionics. Through opportunities that develop along with technologies, we hope that more and more NBSs will become available for plant nanobionics. The main advantages of NBSs are short analysis time, low-cost tests and portability, real-time measurements, and remote control.
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8,622 |
Translational Recoding and RNA Modifications
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During protein synthesis, codons in mRNA are translated sequentially in frame on the ribosome following strict decoding rules. This process is usually very accurate. However, in some cases, recoding events occur at selected codons, leading to a high frequency of frameshifting or stop codon readthrough. The factors influencing these noncanonical decoding events are very diverse; among them are the codon usage and context, the presence of a stable mRNA secondary structure downstream of the decoding sites and the type and relative abundance of normally modified tRNA. Here, we discuss the role of certain modified nucleotides of tRNAs in a few cases of frameshifting and readthrough that occur in Bacteria and Eukarya. While in some cases the effect of a given modified nucleotide in a tRNA is to increase accuracy of the recoding process, in a few other cases the reverse has been observed. This review illustrates the power of using well characterized recoding systems, coupled with specific defects of RNA modification enzymes to assay for translational fidelity under in vivo conditions.
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8,623 |
The Changing Landscape for New Drug Development: Medical Countermeasures (MCMs) as a Case Study
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This chapter is comprised of materials adapted from previous publications authored by the Center for the Study of Drug Development at Tufts University School of Medicine (Tufts CSDD) over a ten-year period from 2010 through 2019. In addition, there are occasional infusions of updated commentary to “connect the dots” of how we got to where we are today. These publications may be requested from Tufts CSDD (if originally published in-house) or through the usual channels for requesting articles published in the public domain (permission to reprint the articles having been granted, where required). The text of the chapter is structured basically in a chronological fashion beginning with Tufts CSDD analysis of the early era of MCM evolution as a sub-sector from various extant therapeutic areas. It then chronicles the changes to the R&D paradigm in response to the challenges that emerged for both MCMs and biopharma in general. Finally, it ends with an exploration of the devolution of the MCM sub-sector back into its roots in the infectious disease area as an increase in actual outbreaks as well as other signals of global vulnerability to pandemic threats have minimized the MCM emphasis on biodefense against a wide range of CBRN agents in favor of public health tactics to address humankind’s maladaptation to a world in which it is constantly assailed by its microbial competitors and symbionts, or to novel public health crises of its own making.
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8,624 |
Pathologie
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Im Rahmen der Pathologie („Lehre der Leiden“) werden Krankheiten aller Fachgebiete und deren grundlegende Prinzipien diagnostiziert und erforscht. Die vitale Diagnostik (am Lebenden) steht dabei immer mehr im Vordergrund.
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8,625 |
Neuroimaging
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Imaging of infection in the CNS has been handled using cross-sectional imaging for more than two decades now resulting in a large array of descriptive diagnostic criteria, capable, in most circumstances of narrowing the differential diagnosis, detecting life-threatening complications and establishing baseline for assessment of treatment response. Limitations however exist, and in many circumstances, both cross-sectional imaging and nonspecific molecular imaging, such as (18)F-FDG, fail to establish a diagnosis. The availability of pathogen-specific imaging agents/ligands would have a great effect on the management of patients with CNS infection. Besides early diagnosis, avoidance of diagnostic brain biopsies can have significant effect on the mortality and morbidity of patients.
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8,626 |
Pandemic
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Pandemics such as the Black Death have altered the course of history. The ravages of the Spanish Flu pandemic were so terrible that at least one culture decided the most humane way of dealing with the aftermath was simply to ignore it—to pretend the disease had not happened. Could a new pandemic possibly be worse than the Black Death or the Spanish Flu? Could it be as bad as the Scarlet Plague of Jack London’s story?
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8,627 |
Acute Respiratory Distress Syndrome in Cancer Patients
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Acute respiratory distress syndrome (ARDS) is a heterogeneous form of acute, diffuse lung injury that is characterized by dysregulated inflammation, increased alveolar-capillary interface permeability, and non-cardiogenic pulmonary edema. In the general population, the incidence and mortality associated with ARDS over the last two decades have steadily declined in parallel with optimized approaches to pneumonia and other underlying causes of ARDS as well as increased utilization of multimodal treatment strategies that include lung-protective ventilation. In the cancer settings, significant declines in the incidence and mortality of ARDS over the past two decades have also been reported, although these rates remain significantly higher than those in the general population. Epidemiologic studies identify infection, including disseminated fungal pneumonias, as a major underlying cause of ARDS in the cancer setting. More than half of cancer patients who develop ARDS will not survive to hospital discharge. Those who do survive often face a protracted and often incomplete recovery, resulting in significant long-term physical, psychological, and cognitive sequelae. The residual organ dysfunction and poor functional status after ARDS may delay or preclude subsequent cancer treatments. As such, close collaboration between the critical care physicians and oncology team is essential in identifying and reversing the underlying causes and optimizing treatments for cancer patients with ARDS. This chapter reviews the diagnosis and common causes of ARDS in cancer and gives an update on the general management principles for cancer patients with ARDS in the ICU.
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8,628 |
Arena-Viren
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Die Gruppe der Arena-Viren (arenosus = körnig) umfasst das LCM-Virus (Meningitis des Menschen), das Virus des Lassa-Fiebers, eines nur in den Tropen vorkommenden schweren hämorrhagischen Fiebers sowie das Virus einer Reihe von südamerikanischen hämorrhagischen Fieber (z. B. Bolivianisches (Machupo-Virus) und Argentinisches (Jun-in-Virus) Hämorrhagisches Fieber).
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8,629 |
Blut und Blutprodukte
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die Blutgruppe richtet sich nach der Antigeneigenschaft der Erythrozyten; die Blutgruppenantigene A und B des AB0-Systems befinden sich an der Erythrozytenoberfläche. Das Antigen 0 gibt es nicht, man spricht allenfalls vom Merkmal H; die Blutgruppe A lässt sich in A(1) und A(2) unterteilen. Der Hauptunterschied zwischen den Untergruppen besteht darin, dass die Agglutination von A(1)-Erythrozyten bei Kontakt mit Anti-A-Serum wesentlich stärker und rascher verläuft. Für die Transfusion ist diese Unterteilung nicht von Bedeutung, da Antigen-Antikörper-Reaktionen zwischen A(1) und A(2) sehr selten auftreten und nur sehr schwach sind (Verteilung: A(1) ≈ 20%, A(2) ≈ 80%);
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8,630 |
Application of Service Robots for Disinfection in Medical Institutions
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Service robots are increasingly present in all fields of medicine. This paper presents a review of the service robots in medicine with an emphasis on service robots for disinfection in medical institutions. It is shown and described how more and more disinfectant service robots are contributing to a very simple, fast and effective disinfection in medical institutions. Work of the service robot with all necessary components for its function as well as its good and bad sides are in details elaborated and clarified. The aim is to demonstrate the application and use these service robots in medical institutions. Use of these service robots reduces the risk of infection, cost of traditional cleaning and disinfection, and most importantly acquires confidence and security in medical facilities.
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8,631 |
Seltene Infektionen und Hygiene auf der Intensivstation
|
Ein Patient wird seit 2 Wochen auf der Intensivstation aufgrund einer infektexazerbierten chronisch obstruktiven Lungenerkrankung beatmet. Der Verlauf wurde durch eine nosokomiale Pneumonie kompliziert. Bei der Morgenvisite wird berichtet, dass der Patient innerhalb der letzten 2 h 4-mal massiv wässrig abgeführt hat. Die Temperatur beträgt 38,7°C, die Leukozyten 16.000/μl. Der Intensivarzt und seine Oberärztin besprechen die möglichen Ursachen und überlegen, ob spezielle Hygienemaßnahmen erforderlich sind.
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8,632 |
Perspectives on Global Public Health Informatics
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Public health professionals’ functions are rapidly expanding beyond their countries’ borders. Many academic centers are recognizing the importance of global health and are creating programs to train students to meet this growing demand. Global health centers and institutes also are being created to focus on the research and programmatic efforts needed to understand the burden of disease worldwide, as well as the financial, political, medical, policy, workforce, and infrastructure issues surrounding any solutions. Due to this emerging interest by the public health community, we need to understand where the intersection between global health and informatics occurs. For many years, the promise of what technology can do to alleviate suffering and support disease surveillance and other public health activities took precedence over understanding the environment in which the technology has to function. People and their participation in the implementation of the technological solution are critical for success. In resource-poor environments, the deployment of technological solutions faces other challenges for success. Lack of stable electrical power, availability of Internet connections, and a workforce that can support the information technology remain barriers to successful implementation. Yet, through experiences in the implementation of information technology as supported by international donors and the US President’s Emergency Plan for AIDS Relief, lessons are being learned to move forward towards the benefits that global health informatics can bring.
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Posttransplant Complications and Comorbidities
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Infectious complications cause significant acute morbidity and mortality after pediatric lung transplantation. With the lung graft in direct communication with the environment, it is susceptible to a variety of bacterial, fungal, and viral pathogens. Appreciation for pretransplant risk factors in addition to perioperative and posttransplant exposures is necessary to anticipate, diagnose, and treat infections in this population. Further, epidemiologic associations between infection and chronic allograft dysfunction have been reported and suggest consequences of infectious events may have substantial impact.
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Expected and Unexpected Effects of Vaccination
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Vaccination is widely considered to be one of the greatest medical achievements of civilization and one of the top major breakthroughs of humanity.
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Pulmonology
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The pleura are composed of two layers, parietal and visceral layers, separated by a pleural space. The parietal pleuron is supplied by systemic vessels and drains into the right atrium via the azygos, hemiazygos, and internal mammary veins. The visceral pleuron is supplied by bronchial and pulmonary vessels and drains into the pulmonary veins.
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Zoonoses in Cancer Patients
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Prevention of zoonoses in cancer patients is the theme of this chapter and it is hoped that it will encourage and help doctors caring for such patients to educate them to avoid the infections. Avoidance need not include separation from a pet or occupation or recreation, but the use of caution conditioned by knowledge of the sources of infection and the ways we contact them should lead to effective prevention.
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Gastroenterology
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organic—infections, tumors, multiple sclerosis, vestibular nerve or brain stem lesions
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Beauveria bassiana: Biocontrol Beyond Lepidopteran Pests
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Beauveria bassiana has been extensively employed since the last century for biocontrol of lepidopteran pests. B. bassiana has also been explored for diverse functions including bioremediation of toxic industrial effluents and heavy-metal polluted soils. Investigations on multifarious applications of chemically diverse secondary metabolites of this entomopathogenic fungus offer promising implications in pharmaceutical and agricultural sectors. In addition, the development of eco-friendly bioremediation strategies using abiotic stress-tolerant strains of B. bassiana will contribute to maintain the sustainability of agroecosystem.
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Pharmaceutical Intellectual Property Rights in China
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Recalling the history of China’s pharmaceutical intellectual property right (IPR) protection in the past 20 years, China adopted many international standards for pharmaceutical IPR protection. At the same time, China also issued a series of national regulatory policies to encourage domestic drug innovations (Ding, J Technol Manage Innov 6(2):1–13, 2011) . Therefore, both those policies for incentive innovations and the IPR laws have played important roles in drug development in China. As declared by the 17th National Congress in 2006, China’s national development core strategy has prioritized the adherence to regulatory policies in order to construct a technologically innovative country and the country also wishes to become a global leading country for the implementation of the intellectual properties by 2020 as declared in the “National Intellectual Property Strategy Compendium” by Chinese State Council in 2008. In this chapter, we’ll briefly introduce the basic knowledge of the Chinese IPR system, the key regulatory policies, and the differences between China and western countries. We hope this section for Pharmaceutical Patent Protection may help overseas and multinational pharmaceutical companies gain basic knowledge of IPR, design an optimized IPR protection strategy to best fit their products, and achieve a successful product protection for their intellectual property in China.
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Abdominalchirurgische Intensivmedizin
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Die Intensivmedizin in der Allgemeinchirurgie umfasst v. a. die Behandlung akuter Abdominalerkrankungen, wie z. B. der akuten Pankreatitis, gastrointestinaler Blutungen, Ileus und Peritonitis sowie postoperativer Komplikationen bei bauchchirurgischen Eingriffen, wie z. B. Peritonitis, Ileus oder Nachblutungen. Hinzu kommen die postoperative Intensivüberwachung und -behandlung größerer Operationen, bei denen in der Frühphase bestimmte Komplikationen zu erwarten sind. Nicht selten treten zu den spezifischen Risiken allgemeinchirurgischer Eingriffe postoperative Störungen einzelner oder mehrerer Organe hinzu und komplizieren den postoperativen Verlauf.
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Sessile Innate Immune Cells
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In this chapter, sessile cells of the innate immune system are briefly introduced. Defined as cells equipped with diverse pattern recognition molecules capable of detecting MAMPs and DAMPs, they encompass cells such as epithelial cells, fibroblasts, vascular cells, chondrocytes, osteoblasts, and adipocytes. Located at the body surfaces, epithelial cells represent the first line of innate immune defense against invading microbial pathogens. They are significant contributors to innate mucosal immunity and generate various antimicrobial defense mechanisms. Also, epithelial cells critically contribute to tissue repair via the phenomenon of re-epithelialization. Fibroblasts operate as classical sentinel cells of the innate immune system dedicated to responding to MAMPs and DAMPs emitted upon any tissue injury. Typically, fibroblasts synthesize most of the extracellular matrix of connective tissues, thereby playing a crucial role in tissue repair processes. Vascular cells of the innate immune system represent an evolutionarily developed first-line defense against any inciting insult hitting the vessel walls from the luminal side including bacteria, viruses, microbial toxins, and chemical noxa such as nicotine. Upon such insults and following recognition of MAMPs and DAMPs, vascular cells react with an innate immune response to create an acute inflammatory milieu in the vessel wall aimed at curing the vascular injury concerned. Chondrocytes, osteoblasts, and osteoclasts represent other vital cells of the skeletal system acting as cells of the innate immune system in its wider sense. These cells mediate injury-promoted DAMP-induced inflammatory and regenerative processes specific for the skeletal systems. Finally, adipocytes are regarded as highly active cells of the innate immune system. As white, brown, and beige adipocytes, they operate as a dynamic metabolic organ that can secrete certain bioactive molecules which have endocrine, paracrine, and autocrine actions.
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Blut und Blutprodukte
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Infantile Viral Illnesses
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Viruses are the predominant cause of lower respiratory tract illness in infants and a major cause of hospitalization in this vulnerable population. This chapter will review the common respiratory viral agents in infants and young children, including epidemiology and clinical and radiographic features. The role of the laboratory in diagnosis is emphasized with respect to rapid diagnostic techniques and histopathologic features in tissue sections. A brief summary of each of the major infantile respiratory viruses is provided, including respiratory syncytial virus, parainfluenza virus, adenovirus, and influenza virus, as well as the more recently detected and increasingly significant lower respiratory tract viruses, such as human metapneumovirus, coronavirus, rhinovirus, and bocavirus. Congenital and neonatal forms of viral pneumonia, such as cytomegalovirus, herpes simplex virus, and measles virus, are also discussed. Postinfectious complications of viral bronchiolitis are included in this chapter due to the significant persistent morbidity during infancy in many patients.
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Zoonoses Animal and Human Diseases Endo and Ectoparasites Mainly Mammal I
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The definition of a zoonosis is that it must affect man but the term is used often outside of medical terminology of animal diseases where man is not involved. Zoonoses are diseases naturally transmitted between animals and man and comprise in total about 80% of all described human infections. Attempts have been made to define different classes of zoonoses according to the man-animal relationship but generally this does not seem to have been accepted. Elton in 1927 stressed the field of wild animal pathology was still virtually untouched, and in 1968 McDiarmid reiterated the view that it remained one of the most neglected aspects of animal ecology. There is now an extensive literature but it is rarely incorporated into ecological texts although disease is often the driving force in population dynamics. The primary driver of infectious disease dynamics is transmission between individuals, yet in most important respects remarkably little is known about the subject (Craft et al. 2008, Haydon 2008). Occasionally, under high population densities, an organism may infect a host outside of its normal range with highly pathogenic effect in its adventitious host.
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Corticosteroids
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CORTISOL secretion by the cortex of e adrenal glands (Fig. 32.1) increases in response to any stress in the body, whether physical (such as illness, trauma, surgery or temperature extremes) or psychological. However, this hormone is more than a simple marker of stress levels—it is necessary for the correct functioning of almost every part of the body. Excesses or deficiencies of this crucial hormone also lead to various physical symptoms and disease states [1]. Although cortisol is not essential for life per se, it helps an organism to cope more efficiently with its environment with particular metabolic actions on glucose production and protein and fat catabolism. Nevertheless, loss or profound diminishment of cortisol secretion leads to a state of abnormal metabolism and an inability to deal with stressors, which, if untreated, may be fatal [1, 2].
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Cell Defence and Survival
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Central to immune defence mechanisms is the role of transcription factor nuclear factor kappa B (NF-kB). This is a complex biochemical topic with ever more controls revealed. NF-kB determines the production of proinflammatory cytokines and chemokines. Pharmacologists step in with possible means of control. Other systems involved in defence include the cyclooxygenase 2 (Cox-2) enzyme and perioxisome proliferator-activated receptors. Insulin receptor activation needs to be seen in context. The mTOR system directs uptake of nutrients by cells. mTOR is suppressed by rapamycin, whose usage is now quite considerable in the control of transplant rejection.
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An Innovative Big Data Predictive Analytics Framework over Hybrid Big Data Sources with an Application for Disease Analytics
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Nowadays, big data are everywhere. Examples of big data include weather data, web-search data, disease reports, as well as epidemic data and statistics. These big data can be easily generated and collected from a wide variety of data sources. A data science framework—such as predictive analytics framework—helps mining data from various big data sources to find useful information and discover knowledge, which can then be transformed into wisdom for appropriate actions. In this paper, we present an innovative big data predictive analytics framework over hybrid big data sources. To demonstrate the effectiveness and practicality of our framework, we conduct several case studies, including one on applying the framework to disease analytics. More specifically, we integrate, incorporate and analyze weather data and web-search data to predict and forecast dengue cases based on a hybrid of three kernels in support vector machine (SVM) ensemble. Results show how our predictive analytics framework benefits health agencies in disease control and prevention.
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Atomic Force Microscopy: Interaction Forces Measured in Phospholipid Monolayers, Bilayers and Cell Membranes
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Atomic force microscopy (AFM) is a powerful technique which is commonly used to image surfaces at the nanoscale and single-molecule level, as well as to investigate physical properties of the sample surface using a technique known as force spectroscopy. In this chapter, we review our recent research where we used AFM to investigate physical properties of phospholipid monolayers, bilayers, and cell membranes. We describe the experimental procedures for AFM imaging, force measurements, and theoretical models to analyze force spectroscopy data. The data obtained allowed correlations between AFM topography and local adhesion and mechanoelastic properties of supported lipid bilayers in water, supported pulmonary surfactant films in air, and the plasma membrane of epithelial type II cells. Finally, AFM was applied to help elucidate the effect of anesthetics and cholesterol present in the lipid films.
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Therapeutic Strategies for DLI: How Should DLI Be Treated?
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The lungs are vulnerable to toxins because of their large surface area and act as a metabolic site for some substances. Drugs may induce specific respiratory reactions, or the lungs may be affected as part of a generalized response. Drug-induced lung injury (DLI) can involve the airways, lung parenchyma, mediastinum, pleura, pulmonary vasculature, and/or the neuromuscular system. The most common form of DLI is drug-induced interstitial lung disease. There are no disease types specific to DLI, and DLIs are diagnosed on the basis of clinical findings, chest CT images, and histopathologic findings. The first principle of management of DLI is early detection and cessation of treatment with the suspected drug. Response to corticosteroid therapy depends on the histopathologic pattern of drug-induced interstitial lung disease. Prognosis depends on the specific drug and underlying clinical, physiologic, and pathologic severity of lung disease. To minimize DLI morbidity and mortality, all health-care providers should be familiar with the possible adverse effects of medications they prescribe. Individual variability in drug response is an important concern in clinical practice and drug development. Such variability is multifactorial and includes extrinsic factors such as environmental features and genetic and intrinsic factors that affect the pharmacokinetics and pharmacodynamics of drugs.
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Vaccines Against Viral Infections
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Vaccines are one of the miracles of modern medicine. Without vaccines, the population—particularly children—would be troubled with multitudinous infectious diseases such as diphtheria, scarlet fever, whooping cough, and measles, just to name a few. Vaccines are available against both viral and bacterial infections; they have saved millions of lives and continue to do so. The World Health Organization hopes to have vaccinated all children under a year old against most infectious diseases by 2020. The history of the public’s acceptance of vaccines has been a stormy one. Anti-vaccination movements have been active since the creation or development of the smallpox vaccine in the eighteenth century and in government-mandated vaccination until the present. An example of this is the fabricated information spread about the relationship between measles vaccine and autism. A successful polio vaccine was developed in the 1950s thanks to the research of three groups, led by Koprowski, Salk and Sabin, although each of these vaccines has its advantages and disadvantages. An oral vaccine has the advantage of ease of administration and a herd effect. Polio vaccine workers have become targets of extremists in Nigeria and Pakistan. Recently, recombinant DNA technology, was used to develop new vaccines in order to avoid the side effects, since live virus is not involved. The future may see the production of vaccines in edible plants, allowing for cheap production and ease in worldwide distribution.
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Sequential stages of clinical trials and overview of issues to be considered
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Emerging and Enabling Technologies in Biodefense
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The emergence of new biotechnologies provides great promise for biodefense, especially for key objectives of biosurveillance and early warning, microbial forensics, risk and threat assessment, horizon scanning in biotechnology, and medical countermeasure (MCM) development, scale-up, and delivery. Understanding and leveraging the newly developed capabilities afforded by emerging biotechnologies require knowledge about cutting-edge research and its real or proposed application(s), the process through which biotechnologies advance, and the educational and research infrastructure that promotes multi-disciplinary science. Innovation in research and technology development are driven by sector-specific needs and the convergence of the physical, chemical, material, computer, engineering, and/or life sciences. Biotechnologies developed for other sectors could be applied to biodefense, especially if the individuals involved are able to innovate in concept design and development. Of all biodefense objectives, biosurveillance seems to have reaped the most benefit from emerging biotechnologies, specifically the integration and analysis of diverse clinical, biological, demographic, and other relevant data. More recently, scientists have begun applying synthetic biology, genomics, and microfluidics to the development of new products and platforms for MCMs. Unlike these objectives, investments in microbial forensics have been few, limiting its ability to harness biotechnology advances for collecting and analyzing data. Looking to the future, emerging biotechnologies can provide new opportunities for enhancing biodefense by addressing capability gaps.
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Biodiversity and the Ecology of Emerging Infectious Diseases
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The question of how biodiversity influences the emergence of infectious diseases is the subject of ongoing research. A set of nonlinear differential equations is been used to explore the interactions between ecology and epidemiology. The model allows for frequency-dependent transmission of infection within host species, and density-dependent transmission between species, via the environment or a vector. Three examples are discussed. It is shown that removing a pathogen may increase a consumer population, decreasing its resource. It is then shown that the presence of a pathogen could enable a predator and a prey species to coexist. Finally the dilution effect, by which increasing biodiversity reduces the transmission of an infectious disease, is investigated.
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Cervical: Lymphadenopathy
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The neck region contains around 300 lymph nodes (LNs) out of 800 LNs in the whole body. The detailed study of LNs by Rouviere in 1932 [1] and the later illustration of metastatic predilection of head and neck malignancies to certain LN regions by Lindberg et al. [2] paved the road to a clinically sound classification. The American Academy of Otolaryngology and Head and Neck Surgery (AAO-HNS) and the American Joint Committee on Cancer (AJCC) developed the currently widely accepted levels classification of the cervical LNs (Table 8.1, Figs. 8.1 and 8.2).
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Update on Avian Influenza for Critical Care Physicians
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Human influenza pandemics over the last 100 years have been caused by H1, H2, and H3 subtypes of influenza A viruses. More recently, avian influenza viruses have been found to directly infect humans from their avian hosts. The recent emergence, host expansion, and spread of a highly pathogenic avian influenza (HPAI) H5N1 subtype in Asia has heightened concerns globally, both in regards to mortality of HPAI H5N1 in humans and the potential of a new pandemic. In response, many agencies and organizations have been working collaboratively to develop early detection systems, preparedness plans, and objectives for further research. As a result, there has been a large influx of published information regarding potential risk, surveillance, prevention and control of highly pathogenic avian influenza, particularly in regards to animal to human and subsequent human to human transmission. This chapter will review the current human infections with avian influenza and its public health and medical implications.
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Quantitative Reverse Transcriptase Polymerase Chain Reaction
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Since the first documentation of real-time polymerase chain reaction (PCR),(1) it has been used for an increasing and diverse number of applications, including mRNA expression studies, DNA copy number measurements in genomic or viral DNAs,(2–7) allelic discrimination assays,(8,9) expression analysis of specific splice variants of genes(10–13) and gene expression in paraffin-embedded tissues,(14,15) and laser captured microdissected cells.(13,16–19) Therefore, quantitative reverse transcriptase polymerase chain reaction (Q-RT-PCR) is now essential in molecular diagnostics to quantitatively assess the level of RNA or DNA in a given specimen. QRT-PCR enables the detection and quantification of very small amounts of DNA, cDNA, or RNA, even down to a single copy. It is based on the detection of fluorescence produced by reporter probes, which varies with reaction cycle number. Only during the exponential phase of the conventional PCR reaction is it possible to extrapolate back in order to determine the quantity of initial template sequence. The “real-time” nature of this technology pertains to the constant monitoring of fluorescence from specially designed reporter probes during each cycle. Due to inhibitors of the polymerase reaction found with the template, reagent limitation or accumulation of pyrophosphate molecules, the PCR reaction eventually ceases to generate template at an exponential rate (i.e., the plateau phase), making the end point quantitation of PCR products unreliable in all but the exponential phase.
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Food Security: Microbiological and Chemical Risks
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Food Security within a health security context relates to systems dealing with the prevention and control of not only acute but also sporadic and chronic foodborne diseases. The description of food security and safety systems in this chapter will hence include oversight of both microbiological and chemical hazards, which both can cause acute as well as chronic disease events. The Chapter includes a description of existing national and international surveillance systems for foodborne diseases and regulatory systems enabling risk mitigation action for both chemical and microbiological hazards, with specific inclusion of the concerning increase in antimicrobial resistance (AMR) of foodborne microorganisms also related to the animal production systems. The Chapter also includes descriptions of methodology for the quantitative assessment of sustainability of food production systems.
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Coronaviren
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Man unterscheidet 5 humanpathogene Coronaviren, die entweder zum Genus Alpha-Coronavirus oder zum Genus Beta-Coronavirus gehören (Subfamilie Coronavirinae, Familie Coronaviridae). Humane Coronaviren (◘ Tab. 58.1) verursachen akute Erkrankungen des oberen Respirationstraktes, die meist problemlos verlaufen, jedoch gelegentlich zu schweren Pneumonien führen. Eine ursächliche Beteiligung an Gastroenteritiden ist möglich, spielt jedoch klinisch und zahlenmäßig keine große Rolle. Zahlreiche animale Coronaviren sind vor allem an respiratorischen und gastrointestinalen Erkrankungen von Säugetieren und Vögeln beteiligt (◘ Tab. 58.1).
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Cell Regeneration in Lung Injury
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The acute respiratory distress syndrome (ARDS) is a lethal inflammatory disorder of the lung. Its incidence is estimated at 75 cases per 100,000 population and appears to be increasing [1]. Even with optimal treatment, mortality is about 30% [1–3]. As such, ARDS represents a major public health problem. The effects of two recent crises created by unusual viral infections of the respiratory tract — the severe acute respiratory syndrome (SARS) epidemic caused by the novel SARS coronavirus [4], [5] and the bird flu [6] highlight the importance of research into ARDS. Both viruses cause an ARDS-like picture. Because lung repair and regeneration contribute substantially to the pathophysiology of ARDS, understanding these processes is essential [7]. This chapter focuses on specific cell populations and markers involved in cell division and regeneration. In addition, a brief review of two pathways intimately associated with cell division is provided because of their potential for pharmacologic manipulation.
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Kawasaki Disease
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Kawasaki disease is an acute systemic vasculitis syndrome in infants and young children of unknown etiology, which mainly affects small and medium-sized arteries, particularly the coronary artery. Clinical features include an acute febrile illness associated with mucocutaneous involvements and lymphadenopathy. The coronary aneurysms develop in about 10% to 20% of patients, some of which may cause myocardial infarction or lead to ischemic heart disease. Combinations of high-dose gamma globulin and aspirin are the essential treatments for acute Kawasaki disease patients. Bypass surgery and the catheter intervention are the optional treatments for the coronary artery sequelae of Kawasaki disease. Some patients with coronary artery sequelae may develop into adult coronary artery disease.
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Changing Resource-Based Manufacturing Industry: The Case of the Rubber Industry in Malaysia and Thailand
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This chapter explores the development potential of the rubber industry in Malaysia and Thailand, which have been leaders in the production of natural rubber (NR) since the 20th century. The analysis of NR producing (upstream segment), processing (midstream segment) and rubber-based manufacturing (downstream segment) in Malaysia and Thailand will find the different timing and sectoral composition in the development of the rubber sector of two countries. It will become clear that in spite of such differences, the two countries share a development pattern in one important respect: The public sector played a crucial role in the development of the upstream segment, while the successful development of the downstream segment largely depends on innovative activities of private entrepreneurs to explore niche international markets for specialized rubber products.
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The Role of Informal Digital Surveillance Systems Before, During and After Infectious Disease Outbreaks: A Critical Analysis
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Background One of the main limitations of traditional surveillance systems for disease detection is their inability to detect epidemics in real-time. In addition to syndromic surveillance, a number of informal digital resources have been developed. These systems are based on data collected through media sources such as news reports on the Internet, mailing lists, and RSS (Really Simple Syndication) feeds. The role of such systems at all stages of the epidemic remains unclear. Methods A literature review was carried out on informal digital resources for infectious disease surveillance. We examined the source of information, the manner in which they process and disseminate the information, their role in each phase of disease outbreaks, and whether and to what extent these systems are capable of early detection and management of infectious disease epidemics. Results Informal digital resources use similar sources of data for surveillance. However, they use different algorithms to create their output, and cover different geographic areas. In this regard, they complement each other with respect to information completeness. There is evidence in the literature on the systems’ usefulness in communicating information to public health professionals, as well as to the general public during and after previous epidemics. Retrospective studies of some systems have shown a theoretical decrease in the time of epidemic detection compared to conventional surveillance. However, there is no evidence of the ability for real-time detection. Conclusions Currently, there is little prospective evidence that existing informal systems are capable of real-time early detection of disease outbreaks. Most systems accumulate large amounts of information on a wide variety of diseases, making it difficult to extract critical information. Presenting critical information clearly and precisely remains a challenge.
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Extracorporeal Membrane Oxygenation in the Treatment of Novel Influenza Virus Infection: A Multicentric Hospital-Based Health Technology Assessment in Lombardy Region
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ECMO or Extracorporeal Membrane Oxygenation is a specialized heart-lung bypass machine used to take over the body’s heart and lung function while the body heals from injury or illness. One of the disturbing hallmarks of the novel A/H1N1 flu virus is that it produces severe lung damage resulting in ARDS (Acute Respiratory Distress Syndrome). Normally, patients with ARDS are placed on mechanical ventilation in Intensive Care Units (ICUs) and treated with a variety of pharmacological agents to reduce infection and lung inflammation. With A/H1N1 viral pneumonia, mechanical ventilation often does not result in adequate oxygenation so with ECMO the burden of pumping and oxygenating the blood is taken from the heart and lungs, and they are given time to heal. San Matteo Polyclinic Hospital was nominated by the Lombardy Region and the Ministry of Health as national reference for the installation of ECMO to deal severe heart failure and pulmonary caused by novel A/H1N1 flu virus. Clinical Engineering Department of the hospital had a fundamental coordination role in biomedical technology-related issues. It supported high-level management decisions (strategy, management, planning, procurement and maintenance) to answer to Lombardy’s guidelines about the organization of ECMO machines in the region. Moreover it had an important role in the assessment, by the use of HTA procedures, of ECMO alternative technologies.
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Rituximab-Related Pulmonary Toxicity
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We report the case of an 80-year-old man treated for follicular grade 3B non-Hodgkin’s lymphoma (NHL). Immunochemotherapy consisted of rituximab (375 mg/m(2)) and CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) every 21 days. Since the patient complained of mild dyspnea on effort with bilateral basilar crackles audible on auscultation, PET-CT was performed and showed disappearance of the initial 18F-FDG uptake, but new abnormal sites of 18F-FDG uptake were evident in the sub-pleural areas of the lung, mostly on the right side. After starting the fifth cycle of rituximab-CHOP, the dyspnea worsened. Chest-X ray and HRCT were consistent with an interstitial infiltration, including sub-pleural air-space consolidation, and “ground-glass” opacities, small pulmonary cysts and thickening of the interlobular septa were also seen. Trans-bronchial biopsy was performed and revealed interstitial inflammation of the lung parenchyma, as well as swelling and hyperplasia of atypical type II alveolar cells. Alternative diagnoses than drug-related pulmonary toxicity are discussed, and a literature review is provided.
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Krankheitsbilder
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Das Spektrum der pneumologischen Krankheitsbilder ist groß und oft fächerübergreifend. Neben den häufigsten Erkrankungen wie COPD, Asthma bronchiale oder Tumoren des Thorax werden hier weitere häufige und seltene Erkrankungen dargestellt, die im Alltag das Bild einer pneumologischen Station prägen. Die führende Symptomatik, der diagnostische Weg und auch therapeutische Vorgehensweisen werden verständlich erörtert, um so den Umgang mit pneumologischen Erkrankungsbildern zu erleichtern.
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Pulmonary Hypertension in an Oncologic Intensive Care Unit
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Pulmonary hypertension (PH) is the condition of elevated pressures in the pulmonary circulation. PH can develop acutely in patients with critical illness such as acute respiratory distress syndrome, sepsis, massive pulmonary embolism, left ventricular dysfunction, or after surgery. In a cancer patient, unique etiologies such as myeloproliferative disorders, tyrosine kinase inhibitors, or tumor emboli may result in PH. Early recognition and treatment of the causative condition may reverse acute PH or return chronic PH to its baseline status. Progression of the disease or its decompensation due to infection, a thromboembolic event, or other triggers can lead to admission to an intensive care unit. Regardless of etiology, the development or worsening of PH may precipitate hypoxemia, hemodynamic instability, or right ventricular failure, which can be challenging to manage or even fatal. In select cases, rapid institution of advanced treatment modalities may be warranted. This chapter reviews the etiology, epidemiology, pathophysiology, clinical features, diagnosis, and prognosis of PH and presents a comprehensive analysis of PH and right heart failure management strategies in the critical care setting. In particular, a unique perspective on oncologically relevant PH is provided.
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Bakterielle Infektionen
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Vor der Einführung von Antibiotika führten schwere bakterielle Infektionen wie Sepsis, Diphtherie und Meningitis fast zwangsläufig zum Tod. Heute meist folgenlose Erkrankungen wie Typhus, Scharlach oder bakterielle Gelenksinfektionen führten früher zu Tod oder schweren Behinderungen. Gefahren gehen heute v. a. durch Resistenzentwicklungen gegen Antibiotika (z. B. bei der Tuberkulose) und durch mangelnde Impffreudigkeit (z. B. bei Diphtherie) aus. So sind bakterielle Infektionen weiterhin nicht zu verharmlosen.
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DNA Damaging Drugs
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The classical anti-cancer agents comprise cytotoxic compounds. Mostly, these drugs act by exerting DNA damage. In essence, there are two major response phenotypes available to a cell upon DNA damage, such as a chemotherapeutic drug action, to arrest the cell cycle and repair the damage, to initiate a pathway to apoptosis (programmed cell death).
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Adeno-Viren
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Adeno-Viren erzeugen akute Erkältungskrankheiten, Konjunktivitis, Keratitis, Meningitis, Zystitis und Gastroenteritis. Sie wirken immunmodulatorisch und persistieren lange Jahre in den Tonsillen und können bei Immundefekten reaktiviert werden. Das Virus wurde erstmals 1953 in Explantaten von Tonslllengewebe anhand seines zytopathischen Effekts in vitro nachgewiesen. 1956 erhielten die Isolate die Bezeichnung “Adeno-Viren„ (Tonsillen = adenoides Gewebe). Der Typ 12 war das erste Human-Virus, bei dem man Tumorigenität im Tier beobachtete, beim Menschen gibt es keine entsprechenden Hinweise.
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Advances in Molecular Diagnostic Approaches for Biothreat Agents
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The advancement in Molecular techniques has been implicated in the development of sophisticated, high-end diagnostic platform and point-of-care (POC) devices for the detection of biothreat agents. Different molecular and immunological approaches such as Immunochromatographic and lateral flow assays, Enzyme-linked Immunosorbent assays (ELISA), Biosensors, Isothermal amplification assays, Nucleic acid amplification tests (NAATs), Next Generation Sequencers (NGS), Microarrays and Microfluidics have been used for a long time as detection strategies of the biothreat agents. In addition, several point of care (POC) devices have been approved by FDA and commercialized in markets. The high-end molecular platforms like NGS and Microarray are time-consuming, costly, and produce huge amount of data. Therefore, the future prospects of molecular based technique should focus on developing quick, user-friendly, cost-effective and portable devices against biological attacks and surveillance programs.
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Antimicrobial Use in Surgical Intensive Care
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Judicious antimicrobial use is essential in modern surgical intensive care. This requires careful clinical assessment and aggressive diagnostics to identify sources of infection as well as their noninfectious mimics. Because antimicrobial agents affect the ecology of resistant organisms in neighboring patients and the wider environment, as well as cause other common adverse effects, restrained initiation of antibiotics may be as valuable among hemodynamically stable patients with possible infection as is urgent empiric coverage in those threatening septic shock. Early collaboration with infectious disease and pharmacy consultants yields more appropriate treatment and improved morbidity, duration of hospital care, costs, and survival.
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Infection Prevention and Control: A Biodefense Measure
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Infection prevention and control (IPC) is the foundation for preventing the spread of infectious diseases, regardless of source, during medical treatment. Biological attacks will inevitably involve the medical management of sick individuals, which will not only tax the healthcare system, but also highlight the vital importance of infection control. Reducing the capacity for disease transmission will be pivotal in not only the early stages of an outbreak or biological attack, but also during times of crisis. Infection control programs also conduct disease surveillance and reporting to public health departments, which is crucial during an attack or outbreak. Infection control failures, like those in the 2013–2016 Ebola virus disease outbreak and continued Middle East respiratory syndrome (MERS) outbreaks, act as amplifiers for pathogen transmission. In the event of a biological attack, the strength and stamina of a hospital’s infection control program will be critical to early recognition, isolation, treatment, and reducing the spread of infection.
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8,673 |
China Declares Global State of Emergency: An Urgent Telegram from Taihu
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May 18th, 2013, China’s 4th most powerful politician, Yu Zhengsheng, Chairman of the National Committee of the CPPCC (Chinese People’s Political Consultative Conference) opened the Second Conference of the (carbon-neutralized) Taihu World Cultural Forum in Hangzhou, a city 1 h by speed train southwest of Shanghai. “What kind of a planet will we leave to our descendants? This is an urgent subject which deserves the collective attention of the whole world,” he said with a sincere air of emergency.
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8,674 |
Disaster Response Policy Change in the Wake of Major Disasters, Labeled Focusing Events
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Responding to the will of the people or the will of the government after a focusing event is complex and fraught with perils; this is none more so than after a major disaster that has brought on the sudden death of many people or the initial incalculable destruction of property or the environment. Korea has experienced several of these types of focusing events that have had major social and policy implications between the years 1948 and 2015. We analyzed them to glean their impact on disaster response policy, organizational and law reform, and first response and national countermeasures – and presented them in a clear and logical array so that the information could lead to a new type of disaster management model. Additionally, we look at how these focusing events altered the political, policy alternative and problem streams, as well as media coverage and policy change in the wake of the focusing event. And finally, we analyze disaster-triggered policy change in Korea to find out if the relation between the focusing event and institutional reforms for disaster response is path-dependent.
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8,675 |
Bio-Gefahren und Seuchen
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Zukunftsvorstellungen basieren gemeinhin auf Utopien, auf nur in der Vorstellung möglichen Szenarien. In diesen kommen haufenweise super-intelligente, metallisch glänzende neuartige Gegenstände, Roboter, fliegende Autos, Raumanzüge und Speisen in Pillenform vor. Es gibt aber auch Schreckensvisionen wie die von der Wiederkehr der Pest, die einst ein Drittel der europäischen Bevölkerung dahinraffte, oder von einer Influenza- Pandemie, wie sie 1918-19 wütete, und die 20 bis 40 Millionen Menschen das Leben kostete.
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8,676 |
Targeted Delivery of Surface-Modified Nanoparticles: Modulation of Inflammation for Acute Lung Injury
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Nanocarriers have been widely employed in the diagnosis and treatment of various diseases. The drug release kinetics and pharmacodynamics could be adjusted by changing the materials, designs, and physicochemical properties of the carriers. Furthermore, the carrier surface could be modified to minimize the particle clearance, increase the circulation duration, escape the biological protective mechanisms, penetrate through physical barriers, and prolong the residence of the drug at the target site. Among lung diseases, acute lung injury has been considered life-threatening with approximately 190,000 cases and 74,500 deaths per year in the USA. Numerous researches have reported the efficacy of drug-encapsulated nanoparticles in the treatment of acute lung injury. The use of nanoparticles could help minimize the effect of airway defenses in the lung, thus provides a prolonged retention, sustained drug release, and targeted delivery to the lung tissues. Meanwhile, the toxicity of nanoparticles in the lungs needs to be investigated thoroughly to alleviate the safety concerns. In this chapter, we discuss the targeted pulmonary delivery of surface-modified nanocarriers to efficiently treat acute lung injury.
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8,677 |
Gastrointestinal Infections
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Establishing a specific etiology for gastrointestinal infections can be challenging because of the common clinical features and wide variety of causative microorganisms. In many cases, the etiologic agent cannot be determined using traditional diagnostic methods and may result in unnecessary antibiotic use or prolonged periods of illness. Molecular tests provide many advantages over traditional laboratory methods but, with the exception of a few analytes, are still largely in the developmental phase for gastrointestinal pathogens and are not widely used. The main advantages of molecular tests include increased sensitivity and the ability to detect agents which will not grow in culture. To test for all possible gastrointestinal pathogens at one time would require a large panel that would include a variety of bacterial, viral and parasitic agents. Challenges inherent in developing diagnostic molecular panels include ensuring that all variants of a particular microorganism can be detected as well as the rapid evolution of pathogens. In this chapter, the diagnostic merit of molecular tests as well as available tests will be presented for the major groups of gastrointestinal pathogens.
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8,678 |
The Indonesian Construction Industry
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This chapter describes an overview of the Indonesian construction industry. It starts with introducing a general profile of the country, its location, demography, form of state and legal system, and its economic performance. This section is then followed by an overview of the Indonesian construction industry. It describes the industry’s activities, contribution to the national’s economic growth, its stakeholders and support infrastructure, regulations and management systems, latest developments and lessons learned. The third section is a description about Indonesian construction firms, which focuses on the contractors and their business activities. The last section of this chapter links the Indonesian contractors with the background of this study, which is a review of the crises faced by the Indonesian contractors.
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8,679 |
Antiviral Host Defence Peptides
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The ongoing global mortality and morbidity associated with viral pathogens highlights the need for the continued development of effective, novel antiviral molecules. The antiviral activity of cationic host defence peptides is of significant interest as novel therapeutics for treating viral infection and predominantly due to their broad spectrum antiviral activity. These peptides also display powerful immunomodulatory activity and are key mediators of inflammation. Therefore, they offer a significant opportunity to inform the development of novel therapeutics for treating viral infections by either directly targeting the pathogen or by enhancing the innate immune response. In this chapter, we review the antiviral activity of cathelicidins and defensins, and examine the potential for these peptides to be used as novel antiviral agents.
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8,680 |
Emerging and Transboundary Animal Viral Diseases: Perspectives and Preparedness
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The epidemics and pandemics of a few infectious diseases during the past couple of decades have accentuated the significance of emerging infectious diseases (EIDs) due to their influence on public health. Although Asia region has been identified as the epicentre of many EIDs and upcoming infections, several new pathogens have also emerged in the past in other parts of the world. Furthermore, the emergence of new viral diseases/infections, such as Rift Valley fever, West Nile fever, SARS coronavirus, Hendra virus, avian influenza A (H5N1), Nipah virus, Zika virus and swine influenza A (H1N1) virus, from time to time is a glaring example threatening adversely both animal and public health globally. Infectious diseases are dynamic and concerning due to their epidemiology and aetiological agents, which is manifested within a host, pathogen and environment continuum involving domestic animals, wildlife and human populations. The complex relationship among host populations and other environmental factors creates conditions for the emergence of diseases. The factors driving the emergence of different emerging infectious disease (EID) interfaces include global travel, urbanisation and biomedical manipulations for human EIDs; agricultural intensification for domestic animal EIDs; translocation for wildlife EIDs; human encroachment, ex situ contact and ecological manipulation for wildlife–human EIDs; encroachment, new introductions and ‘spill-over’ and ‘spill-back’; and technology and industry for domestic animal–human EIDs. The concepts of sanitary and phytosanitary (SPS) measures and biosecurity have gained recognition globally in almost all the realms of human activities, including livestock health and production management. This chapter provides the experience gained in the control and management of a few important TADs and EIDs along with the successes, constraints, limitations and future research needs for developing better control approaches.
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8,681 |
Natural Virucidal Compounds in Foods
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Many plant essential oils, extracts, and individual chemical components have been demonstrated to possess antiviral efficacy against enveloped and/or non-enveloped viruses. In general, plant antimicrobials exhibit greater antiviral efficacy against enveloped viruses than non-enveloped viruses (though not in all cases). There appear to be multiple mechanisms of antiviral action for plant antimicrobials; nevertheless, the majority of antimicrobials appear to act either directly on the virus itself (e.g., on the envelope or capsid) or during the early stages of virus replication following internalization of the virus into its host cell.
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8,682 |
Fuzzy Decision Making in Public Health Strategies
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Making decision is one of the most fundamental activities of human beings (Klir & Yuan, 1995; Yager & Filev, 1994; Zadeh, 1973). This is particularly true in Public Health where decisions usually have relevance for millions of people. In the field of vaccination strategies design, decision making concerning the target population for the immunization program, the proportion of susceptibles to be vaccinated, the optimal age to immunize children and the nature of the strategy, e.g. selective or indiscriminate, are examples of the variables to be optimized, subject to a set of constraints. As an example, we present in this chapter a fuzzy model to decision making applied to the design of the vaccination campaign against measles in São Paulo, Brazil (Massad et al., 1999)
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8,683 |
Disasters as Extreme Events and the Importance of Network Interactions for Disaster Response Management
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We discuss why disasters occur more frequently and are more serious than expected according to a normal distribution. Moreover, we investigate the interaction networks responsible for the cascade-like spreading of disasters. Such causality networks allow one to estimate the development of disasters with time, to give hints about when to take certain actions, to assess the suitability of alternative measures of emergency management, and to anticipate their side effects. Finally, we identify other fields where network theory could help to improve disaster response management.
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8,684 |
Influenzavirus A/H1N1/2009 – ein Überblick vom Ausbruch bis zur Vakzination
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Influenzaepidemien und Influenzapandemien treten immer wieder auf, unterscheiden sich aber deutlich im Schwergrad der klinischen Symptome. Ein Beispiel hierfür ist der Ausbruch von Influenza A/H1N1/2009, der im April 2009 in Mexiko und Kalifornien beschrieben wurde und vermutlich schon einige Wochen zuvor aufgetreten war. Dieses Virus ist genetisch nicht näher mit der zirkulierenden saisonalen Influenza aber mit zirkulierenden Schweineviren verwandt. Der neue Virusstamm ist eine Reassortante zwischen zwei verschiedenen Virusstämmen, die bei Schweinen vorkommen, und kann nun auch von Mensch zu Mensch übertragen werden. Entsprechend den Leitlinien der WHO handelt es sich um ein pandemisches Virus, bis Juli 2010 wurden weltweit insgesamt ca. 18.000 Todesfälle gemeldet.
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8,685 |
Infektionskrankheiten
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Erreger. Morbilli-Virus, ein RNA-Virus aus der Familie der Paramyxoviren.
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8,686 |
Isolation Precautions for Visitors to Healthcare Settings
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Visitors may be involved in infection transmission within healthcare settings; however, there is currently limited published data on this subject. This chapter describes situations in which visitor-associated infection transmission occurred and highlights the potential role of visitors in the transmission of pathogenic organisms that can lead to outbreaks in healthcare settings. Infection prevention measures, including isolation precautions and visitor restriction, may be utilized and potentially adapted in order to protect patients and their visitors as well as healthcare personnel. The practical and ethical challenges regarding the use of isolation precautions among visitors to healthcare facilities are discussed.
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8,687 |
Adult Still’s Disease
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1. The clinical features of adult Still’s disease resemble the systemic form of JRA a. Seronegative chronic polyarthritis associated with a systemic inflammatory illness b. Initially described in 1897 by George F. Still (pathologist) c. Subsequently detailed in adults in 1971 by Eric Bywaters 2. Epidemiology a. Rare b. Affects both genders equally c. Exists worldwide d. Majority present at age 16–35 years i. 75% before age 35
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8,688 |
Adverse Drug Reactions
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Adverse events and adverse drug reactions are common in clinical practice. Side effects range from the common to the rare and may be confused with other mucocutaneous manifestations resulting from several medications to treat infections, other medical conditions, and in the clinical setting of oncologic treatment. The objective of this chapter to review current data on adverse drug reactions, here classified as (i) severe adverse drug reactions, (ii) uncomplicated cutaneous adverse drug reactions, and (iii) adverse drug reactions caused by chemotherapy drugs, particularly those cases whereby the dermatologist is requested to issue a report and asked to comment on the safety and viability of readministration of a specific drug. We describe aspects associated with these events, presenting a detailed analysis of each of them.
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8,689 |
Special Engineering Aspects
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The specific characteristics of mammalian cells discussed in Chap. 2 require adapted solutions for bioreactor design and operation. Especially, cell damage by shear stress and aeration has to be considered. Therefore this chapter starts with a detailed discussion of shear stress effects on mammalian cells (anchorage-dependent and suspendable cells) in model systems and bioreactors, respectively, and consequences for reactor design. Appropriate oxygen supply is another critical issue, as adapted oxygen supply systems are required. Techniques for immobilization of cells, either grown on microcarriers in suspension culture or within macroporous carriers in fixed bed or fluidized bed reactors, are discussed as well. With respect to the operation of bioreactors, the characteristics of different culture modes (batch, fed-batch, chemostat, perfusion) are introduced and practical examples are given. Finally, concepts for monitoring of bioreactors, including offline and online methods as well as control loops (e.g. O(2), pH), are considered.
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8,690 |
Clinical Management of Patients Infected with Highly Pathogenic Microorganisms
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The clinical management of high consequence infectious diseases (HCID) poses an immense challenge, seen largely varying standards in terms of infection prevention control (IPC) as well as in quality of clinical care. This chapter gives an overview of possible treatment as well as IPC options. Lessons learned within the German Permanent Working Group of Competence and Treatment Centres for highly infectious, life-threatening diseases (STAKOB) are taken into account.
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8,691 |
Spezielle Erreger und Infektionen
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MRE, MRSA, VRE und andere Erreger bis hin zu den viralen hämorrhagischen Fiebererregern erfordern spezielle Risikoanalysen und risikoadaptierte Maßnahmen. Dieses Kapitel fasst die Empfehlungen zusammen und gibt tabellarische Übersichten, was wann zu tun ist.
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8,692 |
Major Advances in the Development of Synthetic Oligosaccharide-Based Vaccines
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Because of their involvement in a variety of different biological processes and their occurrence onto pathogens and malignant cell surface, carbohydrates have been identified as ideal candidates for vaccine formulation. However, as free oligosaccharides are poorly immunogenic and do not induce immunological memory in the most at risk population (infants and young children, elderly and immunocompromised patients), glycoconjugate vaccines containing the same carbohydrate antigen covalently linked to an immunogenic carrier protein have gained a prominent role. Accordingly, a number of glycoconjugate vaccines mostly directed against infections caused by bacterial pathogens have been licensed and are currently available on the market. However, also glycoconjugate vaccines suffer from significant drawbacks. The challenging procedures required for the isolation and purification of the carbohydrate antigen from its natural source often lead to poor homogeneity and presence of biological contaminants, resulting in batch-to-batch variability. Moreover, in some cases, the overwhelming immunogenicity of the carrier protein may induce the carbohydrate epitope suppression, causing hyporesponsiveness. The development of synthetic oligosaccharide-based vaccine candidates, characterized by the presence of pure and well-defined synthetic oligosaccharide structures, is expected to meet the requirement of homogeneous and highly reproducible preparations. In the present chapter, we report on the major advances in the development of synthetic carbohydrate-based vaccines. First of all, we describe different strategies developed during the last years to circumvent the inherent difficulties of classical oligosaccharide synthesis, such as the one-pot glycosylation and the solid-phase synthesis, and their application to the preparation of carbohydrate antigens apt to conjugation with protein carriers. Next, we discuss the most representative methodologies employed for the chemical ligation of oligosaccharide structures to proteins. Finally, in the last section, we report significant examples of fully synthetic vaccines exploiting the multivalency effect. These constructs are based on the concept that the conjugation of multiple copies of synthetic oligosaccharide antigens to multivalent scaffolds, such as dendrimers, (cyclo)peptides, gold nanoparticles, and calixarenes, raises cooperative interactions between carbohydrates and immune receptors, leading to strong enhancement of the saccharide antigen immunogenicity.
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8,693 |
Study on the Law of Diffusion of Sudden Pollutants in Subway Ventilation Shaft
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The underground subway stations have become the targets of terrorism due to the features of staff-intensive and poor ventilation. In the present study, the dynamic mesh model was used to predict the dynamic change of the flow field in the tunnel induced by the train motion. The DPM model was employed to simulate the interaction between the continuous phase of the air and the discrete phase of pollution particles. Accordingly, the dispersion of sudden pollutants released in the ventilation shaft was investigated. The results show that the submicron particles have a good following performance with the air. The dispersion characteristics of the particles highly depend on the unsteady flow field in the tunnel, which is significantly affected by the piston effect induced by the train motion. It can be concluded that particle diffusion experiences three stages: vertical forward and reverse diffusion in the wind shaft, vertical positive diffusion in the wind shaft, and longitudinal stable diffusion in the interval tunnel. It hopes that the study can provide guides for future biochemical protection in the subway system.
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8,694 |
Migration of NK cells
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NK cells were initially thought to be endowed with a particular migratory pattern and to mainly circulate in the blood. The recent findings reviewed here highlight that NK cells can exhibit different predilictions for tissue compartments, i.e., lymph nodes, inflamed tissues, etc., where they can play an important role as active participants in directing DC maturation and T cell response polarization and/or as cytotoxic effector cells. The mechanisms regulating tissue-selective NK cell homing and functional specialization are just starting to be unraveled, but the importance of tissue microenvironment is becoming increasingly clear. An example is given by decidual NK cells whose differentiation, accumulation and functional program are under hormonal influence.
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8,695 |
Infektionen
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Trotz Weiterentwicklung moderner Antibiotika in den letzten Jahren sind die Letalitätszahlen der bakteriellen (eitrigen) Meningitis weiterhin hoch; Überlebende haben häufig neurologische Residuen. Die ungünstigen klinischen Verläufe der bakteriellen Meningitis sind meist Folge intrakranieller Komplikationen, wie z. B. eines generalisierten Hirnödems, einer zerebrovaskulären arteriellen oder venösen Beteiligung oder eines Hydrozephalus.
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8,696 |
Koorts bij volwassenen
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Koorts wordt bij niet-immuungecompromitteerde volwassenen in de eerste lijn zonder recent verblijf in het buitenland meestal veroorzaakt door een luchtweginfectie. Bij ouderen vormen urineweginfecties een relatief frequente oorzaak van koorts. Bij ontbreken van richtinggevende voorgeschiedenis, klachten of verschijnselen volstaat men in eerste instantie met lichamelijk onderzoek van KNO-gebied en longen. Bij negatieve bevindingen volgt urineonderzoek. Wanneer geen afwijkingen gevonden worden, gaat men uit van een onschuldige virale oorzaak. Bij een ernstig zieke indruk of verminderd bewustzijn is het lichamelijk onderzoek allereerst gericht op eventuele stoornissen in de vitale functies, omdat deze onmiddellijke therapeutische implicaties hebben. Als de koorts een week aanhoudt of eerder bij verandering van het beeld, dient een uitgebreide anamnese en algemeen lichamelijk onderzoek plaats te vinden om diagnostische aanknopingspunten op te sporen. Ook kan de arts dan aanvullend onderzoek laten verrichten: in eerste instantie bloed-, urine- en fecesonderzoek en een X-thorax, eventueel gevolgd door X-sinussen en een mantoux-reactie. Medicatie wordt zo veel mogelijk gestaakt om een allergie aan te tonen of uit te sluiten. Na enkele dagen herhaalt men anamnese en lichamelijk onderzoek. Twee weken onbegrepen koorts is reden voor verdere (poli)klinische evaluatie. Concrete aanwijzingen op grond van steeds herhaalde anamnese en lichamelijk onderzoek zijn richtinggevend voor de inzet van complex aanvullend onderzoek. Dit bestaat onder meer uit bloedkweken, uitgebreider bloedonderzoek, leverbiopsie, beenmergpunctie en CT-scan buik en thorax. Bij patiënten ouder dan 55 jaar met koorts en een verhoogde bezinking is een biopsie van de arteria temporalis zinvol. ELEKTRONISCH AANVULLEND MATERIAAL: De online versie van dit hoofdstuk (doi:10.1007/978-90-368-1274-0_5) bevat aanvullend materiaal, dat beschikbaar is voor geautoriseerde gebruikers.
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8,697 |
Introduction to 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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8,698 |
Plant Virus Diversity and Evolution
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Historically, the majority of plant virology focused on agricultural systems. Recent efforts have expanded our knowledge of the true diversity of plant viruses by studying those viruses that infect wild, undomesticated plants. Those efforts have provided answers to basic ecological questions regarding viruses in the wild, and insights into evolutionary questions, regarding the origins of viruses. While much work has been done, we have merely scratched the surface of the diversity that is estimated to exist. In this chapter we discuss the state of our knowledge of virus diversity, both in agricultural systems as well as in native wild systems, the border between these two systems and how viruses adapt and move across this border into an artificial, domesticated environment. We look at how this diversity has affected our outlook on viruses as a whole, shifting our past view of viruses as purely antagonistic entities of destruction to one where viruses are in a mutually beneficial relationship with their hosts. Additionally, we discuss the current work that plant virology has put forth regarding the evolutionary mechanisms, the life histories, and the deep evolution of viruses.
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8,699 |
Phyllospheric Microbiomes: Diversity, Ecological Significance, and Biotechnological Applications
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The phyllosphere referred to the total aerial plant surfaces (above-ground portions), as habitat for microorganisms. Microorganisms establish compositionally complex communities on the leaf surface. The microbiome of phyllosphere is rich in diversity of bacteria, fungi, actinomycetes, cyanobacteria, and viruses. The diversity, dispersal, and community development on the leaf surface are based on the physiochemistry, environment, and also the immunity of the host plant. A colonization process is an important event where both the microbe and the host plant have been benefited. Microbes commonly established either epiphytic or endophytic mode of life cycle on phyllosphere environment, which helps the host plant and functional communication with the surrounding environment. To the scientific advancement, several molecular techniques like metagenomics and metaproteomics have been used to study and understand the physiology and functional relationship of microbes to the host and its environment. Based on the available information, this chapter describes the basic understanding of microbiome in leaf structure and physiology, microbial interactions, especially bacteria, fungi, and actinomycetes, and their adaptation in the phyllosphere environment. Further, the detailed information related to the importance of the microbiome in phyllosphere to the host plant and their environment has been analyzed. Besides, biopotentials of the phyllosphere microbiome have been reviewed.
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