title: Redefining the Approach to Cybersecurity

text: One of the most critical issues in cybersecurity is represented by social engineering attacks. These threats have been known for years, but it is very difficult to handle them effectively, because they are strictly related to human nature. Social engineering is not just a phishing email; indeed, it is possible to distinguish several forms of attack which combine different elements, from human to social to physical and technological. According to a psychological point of view, social engineering is a powerful means of gaining information exploiting individuals’ weaknesses. Moreover, due to the mechanisms of persuasion, widely studied in literature, it is easy to imagine how complicated the management of this threat is. Appropriate training of employees, especially of key roles of the company, can be an effective antidote to social engineering. Given the current scenario and the future perspective in cybersecurity, it is clear that the approach used to manage cybersecurity requires a radical change. Currently, the preferred cybersecurity strategy is still based on technological solutions, without brilliant results, since cyberthreats keep growing. Many are convinced that Artificial Intelligence (AI) will be an opportunity for managing cybersecurity; whether true or not, it is however evident that AI has also the power to generate new threats and to strengthen the existing ones. Therefore, we should be very prudent when technologies are presented as a miracle solution for cybersecurity problems. The starting point is that technology has to be deployed under full human control. Then, critical thinking is needed to develop alternatives to improve the current approach to cybersecurity. In short, we need to develop a multidisciplinary vision of cybersecurity, involving other disciplines and assuming different perspectives.


Mammografiescreening erst ab Mitte 70 weniger Nutzen


An Interview with Gordon D. Schiff


Österreichische Gesellschaft für Akupunktur


Deutsche Gesellschaft für Akupunktur und Neuraltherapie


title: Prevention and Control Strategies for SARS-CoV-2 Infection

text: The population of 168 countries all over the world is struggling with the outbreak of COVID-19. The outbreak is declared as pandemic and public health emergency of international concern declared by WHO. SARS-CoV-2 responsible for the present health emergency exhibited close resemblance with SARS-CoV. Both the viruses are zoonotic and belong to a large family of viruses Coronaviridae. The complete virus particle is made up of four major structural proteins, namely spikes (S), nucleocapsid (N), membrane (M), and envelope (E) encoded by virus genome. The S protein of virus shows similarity to S protein of SARS-CoV. COVID-19 spreads from person to person, and this makes it more vulnerable for causing infection. Several efforts are taken to find prevention strategies for COVID-19. Researchers across the globe are working to find effective vaccination for SARS-CoV-2. There is no vaccine or medication available till date for COVID-19. Preventive measures such as social distancing, awareness, maintenance of hygiene, isolation, and movement restrictions can help in control of COVID-19 spread. Proper sanitization and cleaned and sanitized public transport can be effective in inhibiting the spread of the virus. In the present situation of medical emergency, cooperation and support by following advices from the WHO and government only facilitate everyone to come over.


title: Transmission Cycle of SARS-CoV and SARS-CoV-2

text: Severe acute respiratory syndrome (SARS) is a pandemic that has shocked the world twice over the last two decades caused by a highly transmissible and pathogenic coronavirus (CoV). It causes disease in the lower respiratory tract in humans that was first reported in late 2002 in Guangdong province, China, and later on in December 2019 in Wuhan, China. The two viruses designated as SARS-CoV and SARS-CoV-2, respectively, originated probably from the bat and infected humans via carrier animals. The constant recombination and evolution in the CoV genome may have facilitated their cross-species transmission resulting in recurrent emergence as a pandemic. This chapter intends to accumulate recent findings related to CoV transmission and tentative molecular mechanisms governing the process.


title: Coronavirus Infection Among Children and Adolescents

text: Coronavirus infection is a global emergency. Over the past few months, there is a rapid increase in the number of cases and deaths due to coronavirus infection. It has been observed that elderly individuals and those with medical co-morbidities are maximally affected. In children and adolescents, coronavirus infection has low mortality as well as the severity of symptoms are less. Children and adolescents with immunocompromised state, malnutrition, medical co-morbidities and poor hygiene are at higher risk of contracting coronavirus infection. Minimizing this risk factors and adopting appropriate prevention measures will be helpful in limiting the spread of infection as there is no specific treatment and immunization available to date to address this serious issue. This chapter highlights the issues and challenges of coronavirus infection in children and adolescents.


title: Morphology, Genome Organization, Replication, and Pathogenesis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)

text: SARS-CoV-2 is a single-stranded RNA virus of ~30 kb genome size which belongs to genus Coronavirus and family Coronaviridae. SARS-CoV-2 has recently emerged and has been declared as a pandemic by the World Health Organization. Genomic characterization of SARS-CoV-2 has shown that it is of zoonotic origin. The structure of SARS-CoV-2 is found to be similar to SARS-CoV with virion size ranging from 70 to 90 nm. Spike, membrane, and envelope surface viral proteins of coronavirus are embedded in host membrane-derived lipid bilayer encapsulating the helical nucleocapsid comprising viral RNA. The genome comprises of 6–11 open reading frames (ORFs) with 5′ and 3′ flanking untranslated regions (UTRs). Sequence variation among SARS-CoV-2 and SARS-CoV revealed no significant difference in ORFs and nsps. The nsps includes two viral cysteine proteases including papain-like protease (nsp3), chymotrypsin-like, 3C-like, or main protease (nsp5), RNA-dependent RNA polymerase (nsp12), helicase (nsp13), and others likely to be involved in the transcription and replication of SARS-CoV-2. The structure of spike glycoprotein structure of SARS-CoV-2 resembles that of the spike protein of SARS-CoV with an root-mean-square deviation (RMSD) of 3.8 Å. Like SARS-CoV, SARS-CoV-2 uses the ACE2 receptor for internalization and TMPRSS2 serine proteases for S protein priming. Histopathological investigation of tissues from SARS-CoV-2 infected patients showed virus-induced cytopathic effect with signs of acute respiratory distress syndrome in lung cells. This chapter discusses about the morphology, genome organization, replication, and pathogenesis of SARS-CoV-2 that may help us understand the disease that may leads to identification of effective antiviral drugs and vaccines.


title: Preparing Children for Pandemics

text: COVID-19 has given us a food for thought that whether we are prepared for such pandemics or not. Developed nations may say that they have enough resources to tackle such situations, but when it comes to the physical and emotional security of the children, even they have to think manifolds because preparing children for such pandemics need lot of effort and apt planning. The purpose of this chapter is to reflect issues related to children during any infectious disease outbreak like COVID-19. Adults are mature enough to control their emotions and can act patiently, but immature minds are always perplexed and act in a very clingy way when some adverse situation is thrown to them. Children are ardent observers and act according to the reactions of the folks around them. It is difficult for them to conceal their behavior, and it is difficult for parents as well to manage their anxiety levels. During crisis period when social distancing and refrained outdoor activities have brought our children into a knotty situation, it is necessary that we understand their fears and myths, try to resolve their concerns in a polite way and strengthen their minds. At this stage the role of parents, teachers, educational institutes, social media, and international children’s organizations need to be redefined. The importance of the decisions taken by the governing bodies should be explained to the children in an effective way, so that they do not panic and reflect a brave attitude. UNICEF in collaboration with international health support systems and departments has a major role to play. Appropriate planning for preparing the children for pandemics has to be incorporated in our system, so that any future crisis can be dealt in an easier way. Schools colleges and other educational institutes should execute immunization and hygiene and health practices in advance to promote prevention.


title: Emergence and Reemergence of Severe Acute Respiratory Syndrome (SARS) Coronaviruses

text: The positive-strand RNA viruses, severe acute respiratory syndrome coronavirus (SARS-CoV) and recently emerged COVID-19 epidemics, demonstrated the transmission capability of the coronaviruses by crossing the species barrier and emergence in humans. The source of coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), firstly reported in December 2019 at Wuhan, China. COVID-19 is a kind of viral pneumonia. The outbreak of SARS-CoV-2 (COVID-19) has been reported as the introduction of the third highly pathogenic coronavirus which crossed the species barrier and spread into the human population. Severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) were the first two epidemic viruses, respectively, in the twenty-first century. Introduction of the 2019 novel coronaviruses (2019-nCoV) in human population is a worldwide concern, and this might have generated via RNA recombination among the previous reported coronaviruses. The COVID-19 is spreading in an alarming rate, and till date no vaccine or specific medicines are available in the market. The newly emerged coronavirus COVID-19 is strongly related to SARS-CoV except little dissimilarity. In this chapter, we will discuss about the alterations and variations in antigenicity, structural changes, and RNA recombination which might be responsible for the COVID-19 emergence.


title: COVID-19: An Ophthalmological Update

text: Ever since the newscast of the novel coronavirus outbreak in Wuhan and its subsequent spread to several countries worldwide, the possible modes of spread are being anticipated by various health care professionals. Tear and other conjunctival secretions, being one of the body fluids, can potentially help transmit the disease inadvertently. Conjunctival secretions from patients and asymptomatic contacts of COVID-19 cases may also spread the disease further into the community. Direct inoculation of body fluids into the conjunctiva of healthy individual is also postulated to be another mode of spread. The risk to heath care providers thus becomes strikingly high. A vigilant ophthalmologist can play a critical role in breaking the chain of transmission.


title: Coping with Mental Health Challenges During COVID-19

text: The ongoing pandemic of COVID-19 is a global challenge which resulted in significant morbidity and mortality worldwide. It has also adversely affected the economy and social integrity. There is rising concern about the mental health challenges of the general population, COVID-19-infected patients, close contacts, elderly, children and health professionals. This chapter focusses on various mental health challenges during the COVID-19 pandemic.


title: Classical Coronaviruses

text: In the last week of December 2019, few patients with the history of pyrexia of unknown origin and symptoms of lower respiratory tract infections were detected in Wuhan, a well-known area as the largest metropolitan city located in the province of Hubei, China. On further investigation, a novel coronavirus was identified as the causative pathogen, which later on provisionally named as 2019 novel coronavirus (2019-nCoV). Coronaviruses are predominantly found in warm-blooded animals and birds and cause various respiratory complications and multiorgan failure in the immunocompromised individuals. Human coronaviruses were first identified in 1965 and are responsible for the respiratory tract infections in major proportion of population worldwide; at least five new human coronaviruses have been identified, including severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002–2003 and Middle East respiratory syndrome coronavirus (MERS-CoV) in 2012. The background related to the origin and classification of coronaviruses is reviewed here.


title: Current Insight into the Novel Coronavirus Disease 2019 (COVID-19)

text: SARS-CoV-2 is a novel strain of coronavirus that has not been previously identified in humans. It has been declared a pandemic and has infected at least 1,844,683 individuals and caused 117,021 deaths as of 14th April 2020. Transmission among humans occurs via close contact with an infected individual that produces respiratory droplets. Patients have been shown to undergo acute respiratory distress syndrome, which is defined as cytokine storm. The diagnosis relies on detection of nucleic acid, IgG/IgM antibodies, and a chest radiograph of the suspected individuals. The genome of SARS-CoV-2 is similar to other coronaviruses that comprise of ten open reading frames (ORFs). SARS-CoV-2 spike protein exhibits higher affinity to ACE2 receptor as compared with SARS-CoV. Repurposing drugs like favipiravir, remdesivir, chloroquine, and TMPRSS2 protease inhibitors have been shown to be effective for the treatment of COVID-19. Personal protective measures should be followed to prevent SARS-CoV-2 infection. In addition, a clinical trial of SARS-CoV-2 vaccine, mRNA-1273, has been started. This chapter provides a glimpse of advancements made in the area of SARS-CoV-2 infection by proving recent clinical and research trials in the field.


title: Preparing for the Perpetual Challenges of Pandemics of Coronavirus Infections with Special Focus on SARS-CoV-2

text: COVID-19, arising from novel, zoonotic coronavirus-2, has gripped the world in a pandemic. The present chapter discusses the current internationally implemented pandemic preparedness strategies succeeding/recommended to curb the COVID-19 threat to humankind. The updated phase-wise categorization of a pandemic as recommended by the WHO is described, and associated innovations in surveillance, response, and medical measures/advisory in practice across the globe are elaborated. From a bird’s eye view, the COVID-19 pandemic management relies on revolutionizing the disease surveillance by incorporating artificial intelligence and data analytics, boosting the response strategies—extensive testing, case isolation, contact tracing, and social distancing—and promoting awareness and access to pharmaceutical and non-pharmaceutical interventions, which are discussed in the present chapter. We also preview the economic bearing of the COVID-19 pandemic.


title: Host Immune Response and Immunobiology of Human SARS-CoV-2 Infection

text: One of the most serious viral outbreaks of the decade, infecting humans, originated from the city of Wuhan, China, by the end of December 2019, has left the world shaken up. It is the successor infection of severe acute respiratory syndrome coronavirus (SARS-CoV) named as SARS-CoV-2 causing a disease called as COVID-19 (Coronavirus disease-19). Being one of the most severe diseases in terms of transmission, this disease agitates the immune system of an individual quite disturbingly which at times leads to death, which is why it has become the need of the hour to step forward to extensively involve in understanding the genetics, pathogenesis, and immunopathology of SARS-CoV-2 in order to design drugs to treat or to design a vaccine to prevent. In this chapter, we have tried to review and summarize the studies done so far to understand the host–pathogen relationship and the host immune response during COVID-19 infection. One of the recent developments regarding the understanding of SARS-CoV-2 infection is the mechanism of immune evasion involved during the pathogenesis and cytokine storm syndrome during infection in the patient against which a drug called as Hydroxychloroquine has been designed. Comprehensively, we have tried to give an immunological insight into the SARS-CoV-2 infection in order to understand the possible outcome for any therapeutic advancement.


title: Therapeutic Development and Drugs for the Treatment of COVID-19

text: SARS-CoV-2/novel coronavirus (2019-nCoV) is a new strain that has recently been confirmed in Wuhan City, Hubei Province of China, and spreads to more than 165 countries of the world including India. The virus infection leads to 245,922 confirmed cases and 10,048 deaths worldwide as of March 20, 2020. Coronaviruses (CoVs) are lethal zoonotic viruses, highly pathogenic in nature, and responsible for diseases ranging from common cold to severe illness such as Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) in humans for the past 15 years. Considering the severity of the current and previous outbreaks, no approved antiviral agent or effective vaccines are present for the prevention and treatment of infection during the epidemics. Although, various molecules have been shown to be effective against coronaviruses both in vitro and in vivo, but the antiviral activities of these molecules are not well established in humans. Therefore, this chapter is planned to provide information about available treatment and preventive measures for the coronavirus infections during outbreaks. This chapter also discusses the possible role of supportive therapy, repurposing drugs, and complementary and alternative medicines for the management of coronaviruses including COVID-19.


title: Clinical Characteristics and Differential Clinical Diagnosis of Novel Coronavirus Disease 2019 (COVID-19)

text: Novel Coronavirus Disease (COVID-19) has become a rapidly growing pandemic involving several nations. It is of serious concern and extreme challenge not only to the health personnel but also to the countries for containment. The causative organism is SARS-CoV-2, RNA virus of subgenus Sarbecovirus, similar to the SARS virus, and seventh member of the human coronavirus family responsible for this zoonotic infection. It binds to the human angiotensin converting enzyme (hACE-2) receptor and causes constitutional and respiratory symptoms. The major mode of transmission is human to human and the median incubation period is 4 days. The most common symptom as studied from various cohorts of COVID-19 patients are fever (83–98%) followed by fatigue (70%) and dry cough (59%); gastrointestinal symptoms are relatively uncommon differentiating it from SARS and MERS. Most of the SAR-CoV-2 infection are mild (80%) with a usual recovery period of 2 weeks. COVID-19 commonly affects males in the middle age and elderly age group, with highest case fatality (8–15%) among those aged >80 years. The disease begins with fever, dry cough, fatigue and myalgia progressing to dyspnoea and ARDS over 6 and 8 days post exposure, respectively. Underlying co-morbidities increase mortality in COVID-19. Poor prognostic factors are elderly, co-morbidities, severe lymphopaenia, high CRP and D-dimer >1 μg/L. The overall mortality rate ranges from 1.5 to 3.6%. COVID-19 has to be differentiated from other viral and bacterial pneumonias as they are more common among healthy adults. Despite constant and vigorous efforts by researchers and health agencies, we are far from containment, cure or prevention by vaccine; hence right information and stringent prevention and control measures are the only weapon in the armoury to combat the ongoing infection.


title: Laboratory Diagnosis of Novel Coronavirus Disease 2019 (COVID-19) Infection

text: Coronavirus disease 2019 (COVID-19) is an infection caused by the novel coronavirus severe acute respiratory coronavirus 2 (SARS-CoV-2). The infection manifests as a mild flu to severe acute respiratory infection. The World Health Organization (WHO) declared COVID-19 as a global pandemic on March 11, 2020. The disease spreads by droplet infection from person to person. Early diagnosis is the key for prompt management of cases and control of the spread of the virus. Currently, the laboratory diagnosis of SARS-CoV-2 is based on nucleic acid amplification tests (NAAT) like real-time reverse transcriptase (RT-PCR). Various genes like E, N, S, ORF and RdRp are targeted as a part of screening and confirmation of cases. Furthermore, nucleic acid sequencing may be done for the identification of mutation in the genome of SARS-CoV-2. The development of serological assays and point of care molecular test will further intensify the diagnostic modalities of SARS-CoV-2.


title: Global Trends in Epidemiology of Coronavirus Disease 2019 (COVID-19)

text: In December 2019, suddenly 54 cases of viral pneumonia emerged in Wuhan, China, caused by some unknown microorganism. The virus responsible for these pneumonia infections was identified as novel coronavirus of the family Coronaviridae. The novel coronavirus was renamed as COVID-19 by WHO. Infection from the virus has since increased exponentially and has spread all over the world in more than 196 countries. The WHO has declared a Public Health Emergency of International Concern due to the outbreak of COVID-19. The virus is highly infectious and can cause human-to-human transmission. Every 24 h, cases of COVID-19 increase severalfolds. The WHO is monitoring the SARS-CoV-2 spread very closely via a global surveillance system. The current situation demands the enforcement of strict laws which would help in inhibiting the further spread of COVID-19. Social distancing, international travel restrictions to affected countries, and hygiene are three important ways to nullify SARS-CoV-2.Government and private organizations need to come forward and work together during this pandemic. Public awareness, social distancing, and sterilization must be maintained to neutralize the viral infection, especially in major hot spots.


title: General Ear, Nose, and Throat Question and Answer Items

text: An overview of the general pediatric ear, nose, and throat topics necessary for ward knowledge, clinical acumen in practice, and board examination preparation is presented in an easy-to-study question & answer format.


title: Lung and Mediastinum

text: Fine needle aspiration and small tissue biopsies have become a primary modality to achieve a definitive diagnosis of a mass-like lesion of the lung and mediastinum. This chapter delineated cytologic and histologic features of common and rare neoplastic and nonneoplastic mass-like lesions of the lung and mediastinum. The utilities and pitfalls of commonly used diagnostic immunohistochemical (IHC) stains, such as TTF1, Napsin A, p40 and CK5/6, and small diagnostic IHC panels, were described. Multiple challenging and yet practical cases at the end of the chapter were used to reemphasize important points illustrated throughout the chapter.


title: Infectious Diseases of Children

text: Infections are the most common cause of acute illness in children. Most commonly these are respiratory infections which peak when the child starts to go to school or out-of-home day care. Although the majority of these diseases have benign course, they cause significant discomfort, anxiety, missed work, and stress to many families caring for children. Frequent office visits, and unnecessarily prescribed medications, and sometimes dubious home remedies can be reduced by following best evidence-based practice and having a good doctor-patient (and parent) relationship.


title: Considerations for Medications Commonly Utilized in the Oncology Population in the Intensive Care Unit

text: An increasing number of oncologic patients are presenting to the intensive care unit with complications from both their chronic disease states and cancer therapies due to improved survival rates. The management of these patients is complex due to immunosuppression (from the malignancy and/or treatment), metabolic complications, and diverse medication regimens with the potential for significant drug-drug interactions and overlapping adverse effects. This chapter will provide clinicians with an overview of non-chemotherapy medications frequently encountered in the critically ill oncologic patient, with a focus on practical considerations.


title: Recent advances in diagnostic testing for viral infections

text: Viral infectious diseases represent an important portion of global public health concerns with thousands of deaths annually. From serious pandemics and highly contagious infections to common influenza episodes, clinical prognosis often relies on early detection of the infectious agent. Thus, effective identification of viral pathogens is needed to help prevent transmission, set up appropriate therapy, monitor response to treatment and lead to efficient disease management and control. The aim of this review is to outline some of the recent technological advances in viral identification, including polymerase chain reaction, mass spectrometry and next-generation sequencing, and how they are applied in the diagnosis and management of viral infections. These powerful tools combine rapidity and efficiency in detecting viral pathogens and have revolutionized the field of clinical diagnostics. However, a number of drawbacks such as high cost have limited their use in many laboratories, particularly in resource-limited settings. On the contrary, the advent of microfluidic technology has attracted increasing interest from biomedical research groups, and could represent a challenging alternative to diagnose viral infections at lower cost.


title: Air Distribution Design in Negative Pressure Isolation Ward

text: The volume of the isolation ward is not large, so the air distribution is relative simple.


title: Inactivated Viral Vaccines

text: Inactivated vaccines have been used for over a century to induce protection against viral pathogens. This established approach of vaccine production is relatively straightforward to achieve and there is an augmented safety profile as compared to their live counterparts. Today, there are six viral pathogens for which licensed inactivated vaccines are available with many more in development. Here, we describe the principles of viral inactivation and the application of these principles to vaccine development. Specifically emphasized are the manufacturing procedure and the accompanying assays, of which assays used for monitoring the inactivation process and preservation of neutralizing epitopes, are pivotal. Novel inactivated vaccines in development and the hurdles they face for licensure are also discussed as well as the (dis)advantages of inactivation over the other vaccine production methodologies.


title: Principle and Technology of Dynamic Isolation

text: Based on the reflection on these three misunderstandings for the design of negative pressure isolation ward, as well as a series of experimental studies, both the concept and the effective technology for effective isolation of airborne transmission were formed under the dynamic condition during the common operation of negative pressure isolation ward.


title: Three Misunderstandings for Design of Negative Pressure Ward

text: With the severe situation for the appearance of SARS and the fear for the resultant consequence, at the early stage of the outbreak event wards were reconstructed with a simple way. Newly constructed isolation wards were designed according to related literatures issued by CDC in 1994, and the corresponding requirements were elevated blindly. In literatures, the technical measures related to negative pressure isolation ward was inclined to adopt high negative pressure, air-tight door and all fresh air, where it was considered safe only to increase the negative pressure as high as possible, to install air-tight door without infiltration air and to provide all fresh air.


title: Microbes and Environment

text: Microbes are omnipresent in the biosphere, and their presence invariably affects the environment in which they grow. The effects of microbes on their environment can be beneficial or harmful or inapparent with regard to human measure or observation. The most significant effect of the microbes on earth is their ability to recycle the primary elements that make up all living systems, especially carbon, oxygen, and nitrogen (N). Primary production involves photosynthetic organisms which take up CO(2) from the atmosphere and convert it to organic (cellular) material. The process is also called CO(2) fixation, and it accounts for a very large portion of organic carbon available for synthesis of cell material. Decomposition or biodegradation results in the breakdown of complex organic materials to other forms of carbon that can be used by other organisms. There is no naturally occurring organic compound that cannot be degraded by some microbe, although some synthetic compounds such as Teflon, plastics, insecticides, and pesticides are broken down very slowly or not at all. Through the microbial metabolic processes of fermentation and respiration, organic molecules are eventually broken down to CO(2) which is returned to the atmosphere for continuous process of primary production. Biological nitrogen fixation is a process found only in some bacteria which remove N(2) from the atmosphere and converts it to ammonia (NH(3)), for use by the plants and animals. Nitrogen fixation also results in replenishment of soil nitrogen removed by agricultural processes. Thus along with all these benefits, microbes greatly contribute in maintaining sustainability of environment. This chapter mainly focuses on beneficial and harmful impacts of microbes on environment and their role to maintain quality, health, and sustainability of environment.


Abstracts Programme


Philosophy and Pandemic in the Postdigital Era: Foucault, Agamben, Žižek


Keep Calm and Nightingale On


Revue de presse scientifique : spécial COVID-19


Mitteilungen der DGMKG


2020 International Year of Midwifery—In the Midst of a Pandemic


title: 3 Vragen over: Het Corona Thuisteam

text: Wie: Renate Groenewold, regisserend wijkverpleegkundige TSN Thuiszorg Wat: Renate werkt in Het Corona Thuisteam.(1) Dit is een samenwerking van bijna alle thuiszorgaanbieders in de provincie Groningen, Menzis, Zilveren Kruis en ROAZ. Het Corona Thuisteam neemt alle thuiszorg voor cliënten met (sterke verdenking van) corona tijdelijk over, meestal 2 tot 3 weken.


title: Wat zou Florence ervan vinden?

text: Barbara van Ede is medium-careverpleegkundige in een umc. Ze schrijft over haar werk aan het bed en wat haar zoal opvalt in de zorg. Twitter @GewoonBar


title: Hier hoef je je geen zorgen over te maken

text: Om het verpleegkundigen iets gemakkelijker te maken in coronatijd en ze te behouden voor de zorg, zijn er veel initiatieven om ze te informeren en te ontlasten. Een aantal initiatieven op een rij.


Abstracts from the 9th International Conference for Healthcare and Medical Students (ICHAMS): Dublin, Ireland. 6-8 February 2020


title: The Genus Calophyllum: Review of Ethnomedicinal Uses, Phytochemistry and Pharmacology

text: The species of genus Calophyllum have been reported for several ethnomedicinal uses in the traditional systems of medicine. The scientific study of the genus Calophyllum revealed that it is a rich source of bioactive secondary metabolites. These phytochemicals have shown a wide range of biological activities. Some of these have reached to the clinical developmental stage. The Calophyllum inophyllum seed oil has been proved to be an acceptable sustainable source of biodiesel. Few species of the genus are endangered and have been included in the red list of threatened species by the IUCN Red List. Owing to the importance of the genus a review of its ethnomedicinal uses, phytochemistry, and pharmacology has been carried out. It will further help to explore the molecular mechanism of phytochemicals for health benefits.


Mitteilungen der Deutschen Gesellschaft für Epileptologie e. V.


Letter from the Editor in Chief


Corporate growth, sustainability and business ethics in twenty-first century


title: Quantitative vegetation‐environment relationships in west norwegian tall‐fern vegetation

text: The aims of this paper are to detect floristic variation within different types of tall‐fern dominated vegetation and to interpret these patterns in terms of environmental variables. Numerical approaches have been applied to a large and varied vegetational data‐set with associated environmental data from stands dominated by Athyrium distentifolium, Thelypteris limbosperma, and Matteuccia struthiopteris in different parts of western Norway. The numerical procedures of two‐way indicator species analysis, simple discriminant functions, and canonical correspondence analysis have been used, and the strengths and weaknesses of these as tools in discerning vegetational‐environmental relationships are discussed. For each of the 96 quadrats investigated, 17 environmental variables were measured. The investigation shows that some of the observed differences in vegetational composition can be explained in terms of relatively simple soil and climatic variables measured for each quadrat. The ferns appear to be ecologically well separated. T. limbosperma‐dominaled stands are mainly characterised by low soil fertility, high January temperature, and high humidity. A. distentifolium‐dominated stands are associated with low winter temperatures, and M. struthiopteris‐dominated stands have high soil fertility and high summer temperatures.


title: Plant species diversity in an old, traditionally managed hay meadow compared to abandoned hay meadows in southwest Norway

text: A chronosequence, representing a successional series, was used for the comparison of a hay meadow site managed in an old traditional way for at least a hundred years, and hay meadow sites abandoned for about 10, 20 and 30 years, respectively. Old traditional management included grazing early and late in the growing season, mowing in August and light or no fertilizing. The tree cover was the most important factor deciding the composition of vegetation. Time since abandonment was not completely correlated to tree cover, as some plots had a dense canopy and others were situated in the open. The total species number decreased with number of years since abandonment in plots > 0.001 m(2)and <100 m(2). The highest species number in 1 m(2) plots was recorded in the managed site, with 38 species of phanerogams. Fourtyeight % of the indicators of traditional management present in the managed site was recorded in the site which had been abandoned for 30 years. Frequency — log area curves made it possible to group species according to persistence in the sward. As a result, a group of functional indicators of rare hay meadows in the region was distinguished.


title: Regional variation in SE Fennoscandian mire vegetation

text: The distribution in bogs is outlined for all species occurring in bogs only in part of their SE Fennoscandian area. The patterns displayed by these species are diverse, and different explanations are applicable to different patterns. Regional variation in SE Fennoscandian bog and extremely poor fen vegetation is described, based on all available published material. Carpets, lawns, and hummocks are considered separately. Four regional vegetational gradients are identified: (1) W‐E, (2) S‐N, (3) SW‐NE, and (4) NW‐SE. These are related to different underlying climatic gradients: (1) humidity (precipitation surplus), (2) temperature, (3) and (4) combinations of humidity and temperature. Effects of climatic gradients on the ground water regime are outlined. The decisive factor for the SW‐NE gradient is probably frequency of ground water table fluctuations, the NW‐SE gradient is likely to be caused by differences in water supply and ground water flow rates. The main gradient of carpets is S‐N (SE‐NW), of lawns SW‐NE (W‐E), and of hummocks partly SW‐NE, partly S‐N. The effects of the underlying ecological factors on the different plant groups are discussed in order to explain the patterns of regional variation in vegetation.


title: Versuche zur Entwicklung einer Immunprophylaxe gegen die übertragbare Gastroenteritis (TGE) der Schweine IV. Vermehrung und Ausscheidung des Impfvirus TGE Bl‐300 nach Vakzination von Sauen und Mastläufern

text: ZUSAMMENFASSUNG: Der TGE‐Impfstamm Bl‐300 vermehrt sich nach oraler Applikation im mittleren und distalen Teil des Jejunums bei erwachsenen Schweinen. Eine Ausscheidung des Impfvirus über Faezes und Nasensekret erfolgt nicht. Eine Übertragung des Virus konnte weder von drei geimpften Muttersauen auf neugeborene Ferkel noch von 78 zweimal geimpften Mastschweinen auf Kontakttiere beobachtet werden. Audi Versuche zur Isolierung von Impfvirus aus Faezes vakzinierter Tiere verliefen ergebnislos. SUMMARY: Attemps to develop an immunoprophylaxis for transmissible gastroenteritis virus infection in pigs IV. Growth and excretion of the vaccine virus TGE Bl‐300 after vaccination of sows and feeder pigs The TGE virus vaccine strain Bl‐300 grows in the middle and distal part of the jejunum of adult pigs after oral vaccination. Excretion of the vaccine virus via faeces and nasal secretions could not be demonstrated. Transmission of the virus did not occur either from three vaccinated sows to their newborn offspring or from 78 twice vaccinated feeder pigs to contact animals. In addition, virus could not be isolated in cell cultures from faeces of vaccinated pigs. RÉSUMÉ: Recherche sur le développement d'une immunoprophylaxie contre la gastro‐entérite transmissible (TGE) du pore IV. Multiplication et excrétion du virus vaccinal TGE‐Bl‐300 après la vaccination de truies et de porcelets d'engraissement La souche vaccinale TGE‐Bl‐300 se multiple après une application orale dans la partie médiane et distale du Jejunum chez les porcs adultes. Il n'y a pas d'excrétion du virus vaccinal par les matières fécales et les sécrétions nasales. On n'a pas observé de transmission du virus ni à partier de truies vaccinées sur les porcelets nouveauxnés ni de 78 porcs d'engraissement vaccinés à deux reprises sur les animaux de contact. Les essais d'isolement du virus vaccinal à partir des matières fécales des animaux vaccinés sont demeurés sans résultats. RESUMEN: Ensayos para desarrollar una profilaxis inmunológica contra la gastroenteritis transmisible (GET) de los cerdos IV. Propagación y eliminación del virus vacunal TGE‐Bl‐300 tras la vacunación de cerdas y granilleros La estirpe vacunal TGE Bl‐300 se multiplica tras aplicación oral en las partes media y distal del yeyuno en los cerdos adultos. El virus no se elimina a través de las heces ni de la secreción nasal. La transmisión del virus no se pudo observar ni de tres parideras vacunadas a lechones recién nacidos ni de 78 cerdos de engorde vacunados dos veces a animales de contacto. Tampoco fueron coronados por el éxito los ensayos encaminados a aislar virus vacunal de las heces de animales vacunados.


title: Versuche zur Entwicklung einer Immunprophylaxe gegen die Übertragbare Gastroenteritis (TGE) der Schweine: I. Pathogenität des Stammes Bl im Verlaufe von Serienpassagen

text: ZUSAMMENFASSUNG: Der TGE‐Virusstamm Bl wurde in 350 Serienpassagen in Schweineschilddrüsenzellkulturen attenuiert. Nach 2, 125, 250, 300 und 350 Passagen wurde die Pathogenität des Stammes für neugeborene Ferkel geprüft. Nach der 300. Zellkulturpassage ruft der Bl‐Stamm zwar keine klinische Erkrankung in einem infizierten Wurf, jedoch an isoliert gehaltenen Ferkeln noch die gleichen pathologischen Veränderungen hervor wie der virulente Feldstamm, wenn auch in einem verkürzten Bereich des Dünndarms. Nach 350 Passagen wird nur noch ein Viertel des mittleren Jejunumbereichs infiziert, ohne dabei klinische Symptome hervorzurufen. Die Ergebnisse werden im Hinblick auf die Verwendung des Stammes für eine Immunprophylaxe diskutiert. SUMMARY: Attempts to establish an immunoprophylaxis for transmissible gastroenteritis virus infection of pigs I. Pathogenicity of the Bl strain after serial passages The Bl strain of TGE virus was propagated for 350 passages in swine thyroid cell cultures. Pathogenicity for newborn piglets was tested after 2, 120, 250, 300 and 350 passages. Pathological lesions observed with passage number 300 were similar to those detected with the virulent field strain. however, in a shorter portion of the small intestine. It did not, however, produce clinical symptoms when administered to newborn piglets. After 350 passages only 1/4 of the middle part of the jejunum is infected without any clinical signs. The results are discussed with respect to the possibility of using the described strain for the development of an immune prophylaxis. RÉSUMÉ: Recherches sur le développement d'une immunoprophylaxie contre la gastroentérite transmissible (TGE) du porc I. Pathogénicité de la souche Bl durant des passages en séries La souche du virus TGE Bl a été atténuée lors de 350 passages en séries dans des cultures cellulaires de glande thyroide du porc. La pathogénicité de la souche a été testée sur des porcelets nouveaux‐nés après 2, 125, 250, 300 et 350 passages. Après le troiscentième passage en culture cellulaire, la souche Bl n'a plus provoqué de signe clinique dans une portée infectée, mais a donné par contre les mêmes lésions pathologiques chez des porcelets maintenus isolés; ces lésions furent toutefois localisées à un secteur raccourci de l'intestin grêle. Après 350 passages, seul un quart de la localisation moyenne du jejunum fut infecté, sans apparition de symptômes cliniques. Les résultats sont discutés en fonction de l'emploi de la souche pour une immunoprophylaxie. RESUMEN: Ensayos para implantar una inmunoprofilaxis frente a la infección por el virus de la gastroenteritis transmisible (GET) de los cerdos I. Patogeneidad de la estirpe Bl en el curso de pases seriados La estirpe Bl del virus de la GET se atenuó en 350 pases seriados por cultivos celulares de tiroides porcinos. Tras 2, 125, 250, 300 y 350 pases, se contrastó la patogeneidad de la cepa para lechones recién nacidos. Aunque tras el pase célulocultural 300° no ocasionaba la estirpe Bl ninguna enfermedad clínica en una ventrigada infectada, sí que aparecían en lechones mantenidos aislados las mismas modificaciones patológicas que con la cepa campal virulenta, aunque solo en un tramo abreviado del intestino delgado. Después de 350 pases solo se infectaba la cuarta parte del tramo mediano del yeyuno, sin llegar a evocar síntomas clínicos. Los resultados se discuten en atención al empleo de la estirpe para una profilaxis inmunológica.


title: Feststellung der Felinen Infektiösen Peritonitis (FIP) bei Hauskatzen und Leoparden in Deutschland

text: ZUSAMMENFASSUNG: Bei 3 aus einem Wurf stammenden Siamkatzen und 2 ebenfalls spontan erkrankten, verschwisterten, schwarzen Leoparden (Panthera pardus) sowie bei 3 experimentell mit unfiltrierter und filtrierter Organsuspension von einer der Siamkatzen infizierten Hauskatzen wurden epizootiologische, klinische, pathologische und mikrobiologische Befunde erhoben, die dem Bild der Felinen Infektiösen Peritonitis (FIP) entsprechen. Damit ist diese Infektionskrankheit erstmals auch in Deutschland nachgewiesen worden. SUMMARY: Demonstration of Feline Infectious Peritonitis (FIP) in Domestic Cats and Leopards in Germany Spontaneous cases of a disease resembling feline infectious peritonitis (FIP) with regard to epizootiological, clinical, pathological, and microbiological findings were demonstrated in 3 Siamese cats belonging to the same litter and in 2 black leopards (Panthera pardus) born in different litters of identical parents. Using unfiltered and filtered organ suspensions of one of the Siamese cats the disease was transmitted to 3 domestic cats. This is the first report on the occurence of FIP in Germany. RÉSUMÉ: Diagnostic de la péritonite infectieuse féline (FIP) chez des chats domestiques et des panthères en Allemagne Des résultats épizootologiques, cliniques, pathologiques et microbiologiques correspondant à l'image de la péritonite infectieuse féline (FIP) ont été trouvés chez 3 chats siamois malades de la même portée, chez 2 soeurs panthères noires (Panthera pardus) malades et chez 3 chats domestiques infectés expérimentalement avec une suspension d'organes filtrée et non filtrée d'un des chats siamois. Cette maladie infectieuse est trouvée pour la première fois en Allemagne. RESUMEN: Verificación de la peritonitis infecciosa felina (FIP) en los gatos domésticos y leopardos en Alemania En 3 gatos siameses procedentes de una camada y en 2 leopardos (Panthera pardus) negros hermanos, enfermos también espontáneamente, así como en 3 gatos domésticos, infectados experimentalmente con una suspensión no filtrada y filtrada de órganos de uno de los gatos siameses, se evidenciaron los hallazgos epizootológicos, clínicos, patológicos y microbiológicos, correspondientes al cuadro de la peritonitis infecciosa felina (FIP). Con ello, esta enfermedad infecciosa también ha sido diagnosticada por vez primera en la República Federal de Alemania.


title: Rotavirusnachweis in Faezes: Erfahrungen mit dem Enzyme Linked Immunosorbent Assay (ELISA)

text: ZUSAMMENFASSUNG: 313 Kälber‐, 47 Ferkel‐ und 100 menschliche Faezesproben von an Durchfall erkrankten neugeborenen Patienten wurden mit Hilfe einer modifizierten Immunelektronenmikroskopie‐Technik (IEM) und im Enzyme‐linked immunosorbent assay (ELISA) vergleichend untersucht. In 112 Kälber‐ (36%), 2 Ferkel‐ (4 %) und 21 (21 %) menschlichen Faezesproben konnte Rotavirus oder ‐antigen nachgewiesen werden. Die Sicherheit der Methodik wurde zusätzlich anhand der Virusausscheidung von drei experimentell infizierten, kolostrumfrei aufgezogenen Kälbern überprüft. Der ELISA, bei dem Meerrettichperoxidase als Enzym verwendet wurde, war spezifisch und erwies sich im Vergleich zur IEM als empfindlicher. Bei 18 von insgesamt 136 positiven Proben gelang der Virusnachweis nur mit der IEM, diese Proben waren negativ im ELISA. In diesen Proben werden Virus‐Antikörperkomplexe vermutet. Weitere Untersuchungen sind notwendig, bevor der ELISA zum Rotavirusnachweis in der Routinediagnostik empfohlen werden kann. SUMMARY: Demonstration of Rotavirus in Faeces: Experiences with the Enzyme linked immunosorbent assay (ELISA) 313 calf, 47 piglet and 100 human faecal samples from newborn patients with diarrhea were investigated comparing a modified immune electron microscopy method and the enzyme linked immunosorbent assay (ELISA). In 112 (36 %) calf, 2 (4 %) piglet and 21 (21 %) human samples rotavirus or its antigen could be demonstrated. The suitability of the method was also tested by studying virus shedding of three experimentally infected, colostrum‐deprived calves. The ELISA, using horse‐radish peroxidase as enzyme and 5 amino‐salicylic acid as indicator, was very specific and showed a higher sensitivity compared to IEM. In 18 out of the 136 positive samples rotavirus could only be demonstrated by IEM; these samples were negative in the ELISA. It is assumed that these samples contain virus‐antibody complexes. Further investigations are necessary before the ELISA can be recommended as a routine diagnostic test. RÉSUMÉ: Mise en évidence de Rotavirus dans des matières fécales: Expériences avec ELISA (Enzyme Linked Immunosorbent Assay) 313 maitères fécales de veaux, 47 de porcelets et 100 échantillons humains de patients nouveaux‐nés atteints de diarrhée ont été examinés en comparaison avec une technique immunologique modifiée en microscopie électronique (IEM) et avec ELISA. Rotavirus ou l'antigène ont pu être mis en évidence chez 113 veaux (36%), 2 porcelets (4%) et 21 enfants La fiabilité de la méthode a été en plus testée sur la base de l'excrétion du virus chez trois veaux infectés expérimentalement et privés de colostrum. (21 %). Le test ELISA, l'enzyme utilisée étant la peroxydase de Meerrettich, fut spécifique et s'est révélé plus sensible que IEM. La mise en évidence du virus a été possible dans 18 cas sur 136 positifs avec la méthode IEM, ces échantillons s'étant révélés négatifs avec ELISA. On a supposé l'existence de complexes virus‐anticorps dans ces échantillons. D'autres recherches sont nécessaires avant de pouvoir recommander le test ELISA pour la mise en évidence de Rotavirus dans le diagnostic de routine. RESUMEN: Identificación de virus Rota en heces: Experiencia con el Enzyme Linked Immunosorbent Assay (ELISA) Se examinaron comparativamente 313 muestras de heces de terneros, 47 de lechones y 100 de niños, pacientes recién enfermos de diarrea, con ayuda de una técnica modificada de inmunomicroscopía de electrones (IEM) y en el Enzyme Linked Immunosorbent Assay (ELISA). En 113 muestras de heces de terneros (36 %), 2 de lechones (4 %) y 21 de niños (21 %) se pudo identificar virus o antígeno Rota. La seguridad de la metodología se controló además con ayuda de la eliminación de virus por tres terneros infectados experimentalmente, criados sin calostro. El ELISA, en el que se utilizó peroxidasa de rábano rusticano como enzima, era específico, resultando ser más sensible en comparación con la IEM. Solo en 18 de un total de 136 muestras positivas se logró la identificación de virus con la IEM, siendo estas pruebas negativas en el ELISA. Se sospecha que en estas muestras había complejos de anticuerpos de virus. Se precisa proseguir con las experiencias antes de poder recomendar el ELISA para la identificación de virus Rota en el diagnóstico de rutina. An dieser Stelle möchte ich Dr. D. Ellens und Dr. P. de Leeuw, Central Diergeneeskundig Instituut, Leystad, Holland, sehr herzlich für die Überlassung von Referenzmaterial und die Hilfe bei der Entwicklung des ELISA in unserem Labor danken.


title: Möglichkeiten der Vakzinierung mit inaktiviertem Virus über den Respirationstrakt untersucht am System Aujeszky‐Virus — weiße Maus

text: ZUSAMMENFASSUNG: Mit einer Äthyläthylenimin‐inaktivierten und konzentrierten Aujeszky‐Virusvakzine wurden Mäuse i. m., i. n. und per Aerosol vakziniert. Mit allen drei Verabreichungsformen wurde eine unterschiedliche Immunität erzielt. Der Grad der induzierten Immunität und ihre Bestimmung waren abhängig von der Art der Applikation sowohl der Vakzinen als auch des Testinfektionsvirus. Gegenüber einer parenteralen Infektion erwies sich die i. m. Vakzination der i. n. Impfung deutlich überlegen, nach i. n. Testinfektion war die i. n. durchgeführte Immunisierung aber zumindest der i. m. gleichwertig. Eine Aerosolvakzination mit inaktiviertem Aujeszky‐Virus induzierte nur mit Adjuvanszusatz einen signifikanten Schutz, der aber im Vergleich zu den beiden anderen Applikationsarten wesentlich geringer war. Die i. n. Impfung reduzierte die Vermehrung und Ausbreitung des i. n. applizierten Testinfektionsvirus fast vollständig. Die Vakzination per Aerosol verringerte gegenüber den Kontrollen sowohl die Zahl der Lungen‐ und Gehirnisolate als auch die Virustiterhöhe in den Lungen. Neutralisierende Antikörper konnten nur im Serum i. m. und i. n. geimpfter Mäuse, aber nicht nach Aerosolvakzination nachgewiesen werden. In Lungenspülflüssigkeiten und Lungenextrakten wurden in keinem Fall neutralisierende Antikörper gefunden. SUMMARY: Possibilities of vaccination with inactivated virus via the respiratory tract studied in the Aujeszky virus — white mouse system Using an ethylethelenimin‐inactivated and concentrated Aujeszky disease virus vaccine, mice were vaccinated i. m., i. n. and by aerosol. A different immunity resulted from all three routes. The grade of immunity induced and its disposition depended both on the method of application of the vaccine and of the challenge virus. Against parenteral challenge i. m. vaccination was superior to i. n. vaccination. Using i. n. challenge i. n. vaccination was at least as good as i. m. vaccination. Aerosol vaccination with inactivated virus gave significant protection only when adjuvant was included and was in any case less effective than the other two methods of vaccination. I. n. vaccination reduced the spread and multiplication of the i. n. challenge dose almost completely. Aerosol vaccination reduced the number of lung and brain isolations and also the lung virus titres compared with the controls. Neutralizing antibodies could be found only in the sera of mice vaccinated i. m. and i. n. and not in mice vaccinated with aerosol. In lung washings and extracts no evidence of neutralizing antibodies was found on any occasion. RÉSUMÉ: Possibilité d'une vaccination par voie aérogène avec un virus inactivé de la maladie d'Aujeszky chez la souris blanche Des souris ont été vaccinées par voies i. m., i. n. et par aérosols avec un vaccin du virus d'Aujeszky concentré et inactivé à l'éthyléthylénimine. Une immunité différente fut obtenue avec les trois formes d'application. Le degré d'immunité induite et sa détermination ont dépendu du mode d'application, des vaccins et du virus de l'infection‐test. La vaccination i. m. fut supérieure à l'i. n. par rapport à une infection parentérale; l'immunisation i. n. faite après une infection‐test i. n. fut égale à l'i. m. La vaccination par aérosols avec un virus d'Aujeszky inactivé n'a donné une protection qu'avec l'addition d'un adjuvant et fut moins efficace que les deux autres méthodes. La vaccination i. n. diminua presque complètement la multiplication et l'extension du virus appliqué dans l'infection‐test. La vaccination par aérosols diminua le nombre des isolements à partir des poumons et du cerveau ainsi que la hauteur du titre viral dans les poumons par rapport aux témoins. Des anticorps neutralisants n'ont été trouvés que chez des souris vaccinées i. m. et i. n. et non chez celles vaccinées par aérosols. On n'a absolument pas trouvé d'anticorps neutralisants dans des lavages de poumons et des extraits de poumons. RESUMEN: Posibilidades de vacunación con virus inactivado a través del tracto respiratorio estudiadas en el sistema virus de Aujeszky‐ratón blanco Se vacunaron ratones blancos por las vías im., in. y con aerosoles mediante una virusvacuna de Aujeszky inactivada con etiletilenimina y concentrada. Con todas las tres formas de administración se logró una inmudidad diferente. El grado de inmunidad inducida y su valuación dependían del tipo de aplicación, tanto de las vacunas como del virus de infección de prueba. Frente a la infección parenteral se reveló la vacunación im. muy superior a la vacunación in., pero tras la infección in. de prueba era la inmunización lograda por vía in. equivalente al menos a la im. La vacunación aerosólica con virus inactivado de Aujeszky inducía solo con adición de adyuvante una protección significativa, la cual, sin embargo, era bastante inferior en comparación con los otros tipos de aplicación.äLa vacunación in. reducía asi por completo la multiplicación y difusión del virus de infección de prueba aplicado por vía in. La vacunación por medio de aerosoles disminuía frente a los testigos tanto el número de aislamientos en pulmones y cerebros como el nivel de los títulos virósicos pulmonares. Solo se pudieron identificar anticuerpos neutralizantes en el suero sanguíneo de ratones vacunados por las vías im. e in., ya que no tras vacunación aerosólica. En los líquidos de lavado pulmonar y en extractos pulmonares no se hallaron en ningún caso anticuerpos neutralizantes.


title: Buddhist-Christian Interreligious Dialogue for Spiritual Care for Transgender Hospital Patients

text: The Pastoral Care profession in public hospitals in the United States has been largely populated and led by Protestant Christians. Buddhist practitioners have entered the field creating opportunities for Christian-Buddhist dialogue. Transgender US citizens are especially vulnerable to medical, social, and spiritual neglect in health care settings due to policy changes in the Department of Health and Human Services. Christians are also vulnerable to the manipulation of basic Christian principles by Trump and Pence. Buddhist-Christian dialogue can strengthen compassionate care and promote public practical theology for transgender hospital patients.


title: Conclusions and Recommendations

text: The political context of religious freedom law enforcement in health care settings, in addition to hateful rhetoric and physical violence against transgender people, requires health care employees, specifically hospital chaplains and educators, to expand their traditional roles from bedside spiritual companions to practical public theologians. This expansion includes shocking the hospital system that has become “chilled” by religious freedom enforcement, becoming literate about religious freedom law, becoming active lobbyist against discrimination in the name of religious freedom, and becoming culturally competent. Buddhist-Christian dialogue can inspire and support the womb visualization practices and Buddhist gathas in the Thich Nhat Hanh tradition. It is recommended that chaplains and spiritual care professionals implement the practical and trans-culturally-specific instructions called “Special Considerations for Pastoral Care in Health Care Settings” by consultants Bradley and Metrick of Elements Consulting.


International News Letter - May 2020


Knowledge is (still) power


Enduring this unexpected time through mutual support and understanding


Job Pandemic 2020


title: Acute Neonatal Respiratory Failure

text: Acute respiratory failure requiring assisted ventilation is one of the most common reasons for admission to the neonatal intensive care unit. Respiratory failure is the inability to maintain either normal delivery of oxygen to the tissues or normal removal of carbon dioxide from the tissues. It occurs when there is an imbalance between the respiratory workload and ventilatory strength and endurance. Definitions are somewhat arbitrary but suggested laboratory criteria for respiratory failure include two or more of the following: PaCO(2) > 60 mmHg, PaO(2) < 50 mmHg or O(2) saturation <80 % with an FiO(2) of 1.0 and pH < 7.25 (Wen et al. 2004).


title: Clinical Use of Nonconventional Modes of Ventilator Support

text: High-frequency oscillatory ventilation (HFOV) is now a mainstay of respiratory care for the neonatal patient. In this chapter, we will define HFOV as those ventilators with a “true” active expiratory phase created by a piston or diaphragm. Jet ventilation and flow interrupters are discussed elsewhere in this book.


title: PCR Methodology

text: PCR methodologies have become firmly entrenched in many clinical laboratories for the detection of a wide range of organisms, because they offer major advantages of improved sensitivity and rapidity over traditional diagnostic methods. However, many variables need to be considered in performing a reliable PCR assay, ranging from nucleic acid extraction, storage, composition of the PCR reaction mix used, to the dynamics of the amplification reaction. To control for these variables, there is an obvious need for standardised reagents and quality assurance programmes to obtain reproducible and clinically significant results. The diagnostic potential of the PCR technology has been greatly enhanced with the development of multiplex, real-time, and quantitative PCR methods, and these are now routinely performed in many diagnostic laboratories. More recently, PCR has been applied to bacterial typing, and a reasonable prediction is that in the near future, bacterial typing will be performed by either some variant of next-generation sequencing, or by HRM analysis of selected markers, depending on the amount of information required.


title: Blood-Borne Disease

text: The use of nucleic acid tests (NAT) has dramatically enhanced the detection and management of blood-borne viruses. Some of the very first applications of NAT using polymerase chain reaction (PCR) were in the identification of HIV in blood. The recognition of other blood-borne viruses, in particular hepatitis B and hepatitis C, further prompted the application of molecular tests to clinical medicine. It was the ease of transmission of viruses through blood and blood products that was one of the main stimuli for the development of nucleic acid testing (NAT) in virology. The improvements in technology leading to automation, reduction in contamination, quantitation and increased sensitivity have enhanced this development and are likely to continue and expand, and so further improve patient management – hopefully with reductions in cost. The introduction of these more sensitive NAT assays has further reduced the likelihood of the acquisition of blood-borne viruses during transfusion or transplantation. The development of commercial viral load assays, or quantitative NAT, has revolutionised for example the clinical management of HIV infection and of other systemic diseases (e.g. cytomegalovirus, Epstein-Barr virus, HHV-6, BK polyomavirus) that are a particular clinical issue in immunocompromised individuals (Table 6.1). Also, resistance genotyping tests can now be performed by sequencing the relevant drug targets e.g. HIV – most commonly the reverse transcriptase and protease regions, but now including integrase and envelope gp 41. Infections in immunocompromised patients may occur in the absence of classical symptoms and the use of PCR to diagnose, in a targeted fashion, the most common infections has revolutionised treatment of these infections in the immunocompromised patient. Knowledge of the most likely agents – for example, CMV in the first 3 months following bone marrow transplant, is often used because such reactivation infection is extremely common (and often fatal) in this population. The availability of polyoma virus PCR means a clinical transplant service is able to monitor their patients for polyoma virus and adjust the level of immunosuppression appropriately. The availability of rapid diagnosis for fungi or Pneumocystis means transplant clinical services can often reduce the use of antimicrobial prophylaxis for these agents. Therefore, as a result of these rapid diagnostic nucleic acid testing services, clinical services can directly improve patient therapy, thereby reducing side effects and improving outcomes as well as saving money.


title: Transplantationsmedizin in der Intensivmedizin

text: Die Betreuung von Patienten vor und nach einer Organtransplantation gehört zum Gebiet der „speziellen Intensivmedizin“ des jeweiligen Fachbereichs. Die transplantationsspezifische Intensivmedizin setzt daher ein interdisziplinäres Management voraus. Neben der Organprotektion bzw. dem Monitoring von speziellen transplantationsrelevanten Problemen steht die Immunsuppression. Auf das Management mit Immunsuppressiva und von transplantationsassoziierten, intensivmedizinisch relevanten Problemen wird in diesem Kapitel eingegangen. Speziell werden Herz-, Lungen-, Leber-, Nieren- und Stammzelltransplantationen dargestellt.


title: Monitoring Lung Volumes During Mechanical Ventilation

text: Respiratory inductive plethysmography (RIP) is a non-invasive method of measuring change in lung volume which is well-established as a monitor of tidal ventilation and thus respiratory patterns in sleep medicine. As RIP is leak independent, can measure end-expiratory lung volume as well as tidal volume and is applicable to both the ventilated and spontaneously breathing patient, there has been a recent interest in its use as a bedside tool in the intensive care unit.


title: The Respiratory System

text: This chapter addresses upper airway physiology for the pediatric intensivist, focusing on functions that affect ventilation, with an emphasis on laryngeal physiology and control in breathing. Effective control of breathing ensures that the airway is protected, maintains volume homeostasis, and provides ventilation. Upper airway structures are effectors for all of these functions that affect the entire airway. Nasal functions include air conditioning and protective reflexes that can be exaggerated and involve circulatory changes. Oral cavity and pharyngeal patency enable airflow and feeding, but during sleep pharyngeal closure can result in apnea. Coordination of breathing with sucking and nutritive swallowing alters during development, while nonnutritive swallowing at all ages limits aspiration. Laryngeal functions in breathing include protection of the subglottic airway, active maintenance of its absolute volume, and control of tidal flow patterns. These are vital functions for normal lung growth in fetal life and during rapid adaptations to breathing challenges from birth through adulthood. Active central control of breathing focuses on the coordination of laryngeal and diaphragmatic activities, which adapts according to the integration of central and peripheral inputs. For the intensivist, knowledge of upper airway physiology can be applied to improve respiratory support. In a second part the mechanical properties of the respiratory system as a critical component of the chain of events that result in translation of the output of the respiratory rhythm generator to ventilation are described. A comprehensive understanding of respiratory mechanics is essential to the delivery of optimized and individualized mechanical ventilation. The basic elements of respiratory mechanics will be described and developmental changes in the airways, lungs, and chest wall that impact on measurement of respiratory mechanics with advancing postnatal age are reviewed. This will be follwowed by two sections, the first on respiratory mechanics in various neonatal pathologies and the second in pediatric pathologies. The latter can be classified in three categories. First, restrictive diseases may be of pulmonary origin, such as chronic interstitial lung diseases or acute lung injury/acute respiratory distress syndrome, which are usually associated with reduced lung compliance. Restrictive diseases may also be due to chest wall abnormalities such as obesity or scoliosis (idiopathic or secondary to neuromuscular diseases), which are associated with a reduction in chest wall compliance. Second, obstructive diseases are represented by asthma and wheezing disorders, cystic fibrosis, long term sequelae of neonatal lung disease and bronchiolitis obliterans following hematopoietic stem cell transplantation. Obstructive diseases are defined by a reduced FEV1/VC ratio. Third, neuromuscular diseases, mainly represented by DMD and SMA, are associated with a decrease in vital capacity linked to respiratory muscle weakness that is better detected by PImax, PEmax and SNIP measurements.


title: Infektiologie

text: Das Kapitel Infektiologie stellt die neue Sepsis-3-Definition, Management und die letzten Sepsisleitlinien von 2012 vor und beleuchtet auch die neuen Entwicklungen seitdem. Darüber hinaus werden Therapievorschläge für die wichtigsten infektiösen Erkrankungen (intraabdominelle Infektionen, akute Pankreatitis, Harnwegsinfekt mit Urosepsis, Pneumonie etc.) auf der Intensivstation gegeben und auch auf spezielle Erkrankungen wie komplizierte Malaria, opportunistische Infektionserkrankungen bei immunsupprimierten Patienten (u. a. HIV) eingegangen. Besonderer Wert wurde auf die mikrobiologische Erregerdiagnostik gelegt (Behälter, Transportmedien, Lagerung der Proben wie auch die richtige Probengewinnung). Zuletzt wird neben den Pilzinfektionen und deren Behandlung jedes der gängigsten Antibiotika und Antimykotika steckbriefartig zusammengefasst.


title: 14 Het gastro-intestinale systeem

text: Aandoeningen van het maag-darmkanaal kunnen zowel de oorzaak zijn van een kritieke situatie, die opname op een intensive care noodzakelijk maakt, als het gevolg ervan. In dit verband valt vooral een hoge-tractus-digestivusbloeding te noemen als een aandoening die soms intensieve zorg vereist. Met name een arteriële bloeding uit een maag- of duo-denumulcus en een bloeding uit slokdarmvarices kunnen in korte tijd leiden tot ernstige ondervulling en shock. Uit de lage tractus digestivus moet hier de divertikelbloeding genoemd worden. Aan de andere kant kunnen ook tijdens opname op de intensive care dergelijke complicaties optreden, eventueel als gevolg van het onderliggende lijden. Ook minder ernstig bloedverlies, soms gepaard gaande met diarree, veroorzaakt soms hoofdbrekens. In dit hoofdstuk wordt vooral ingegaan op de diagnostiek en de meest recente ontwikkelingen in de niet-chirurgische behandeling van dit soort bloedingen.


title: 4 Het bloed

text: In dit hoofdstuk wordt aandacht besteed aan een aantal onderwerpen die verband houden met het bloed, met infectie, met weerstand en met het milieu intérieur. Veel IC-patiënten hebben een verstoring van bloedwaarden, een infectie, een verminderde weerstand, of een verstoring van het milieu intérieur. Naast praktische aspecten, zoals het afnemen van bloed, worden in dit hoofdstuk ook de oorzaken en gevolgen van de betreffende verstoringen beschreven.


title: Human Avian Influenza A H5N1, H7N9, H10N8 and H5N6 Virus Infection

text: Avian influenza is an infectious disease induced by avian influenza viruses in poultry, commonly called genuine fowl plague or European fowl plague.


title: Respiratory Infections

text: Until recently, conventional culture techniques and immunofluorecence assays were considered the gold standard for the detection of respiratory viruses, even though results are mostly available too late or lacked specificity and sensitivity. These methods are now widely replaced with appropriate DNA- and RNA-based amplification techniques, in particular real time PCR amplification, for the detection of an extended number of agents responsible for acute respiratory infections. Real-time PCR offers rapid results, efficiencies in work flow and a reduced risk of false positive results due to contamination. As a result, better patient management or reduction of unnecessary antibiotic administration will be possible leading to enhanced efficiencies in health care. In applying molecular methods to diagnostic use, the laboratory can optimise its diagnostic strategy by applying a combination of real-time amplification tests for respiratory viruses and the non-viral respiratory bacterial pathogens. However this must be done within a context of resource availability, technical expertise available and clinical utility. It seems certain that molecular microbiology will continue to develop, leading to further applications in diagnostic technology, thereby improving our understanding of disease processes and enhancing our knowledge of the pathogens responsible.


title: Vasculitides

text: Despite the spatial closeness of blood vessels and inflammatory cells, blood vessel walls are infrequently targeted by inflammation. Giant cell arteritis (GCA) and Takayasu’s arteritis (TA) are characterized by inflammation directed against the vessel wall. GCA and TA display stringent tissue tropism and affect defined vascular territories in a preferential manner. GCA predominantly affects the second- to fifth-order aortic branches, often in the extracranial arteries of the head. The aorta itself may also be affected in GCA, albeit less often than other regions. In contrast, in TA, the aorta and its major branches are the prime disease targets.


title: Zystische Fibrose (Mukoviszidose)

text: Der genetische Defekt bei Mukoviszidose liegt auf dem langen Arm von Chromosom 7 mit autosomal-rezessivem Erbgang. Das CF-Gen umfasst 250.000 Basenpaare, die ein 1480 Aminosäuren enthaltendes Protein, das den „cystic fibrosis transmembrane regulator“ (CFTR) kodiert. Inzwischen sind über 1900 Mutationen (www.genet.sickkids.on.ca/cftr) bekannt. Die CFTR-Mutationen werden in 5 Klassen eingeteilt (Abb. 158.1): Klasse I: CFTR wird überhaupt nicht synthetisiert, Klasse II: aufgrund fehlerhafter Faltung im endoplasmatischen Retikulum findet kein Processing von funktionstüchtigem CFTR-Protein statt, Klasse III: gestörte Aktivierung und Regulation des CFTR-Proteins, Klasse IV: gestörter Ionenfluss, Klasse V: eine reduzierte Menge an intaktem Protein liegt vor. Die häufigste Mutation in Deutschland ist die Klasse-II-Mutation DF508 mit einer Prävalenz (je nach geographischer Region) von 62–77 %, ähnliche Zahlen gelten für Mitteleuropa und die europäisch-stämmigen Einwohner der USA. Bei DF508-Homozygoten findet sich eine Assoziation zur Pankreasinsuffizienz, aber keine zum pulmonalen Verlauf. Der progressive Untergang von Lungengewebe infolge von Inflammation und Infektion ist entscheidend für die Prognose der Mukoviszidose. Ausreichend gepowerte Studien aus den USA haben Mutationen im Transforming-growth-factor-β1-Gen (-509 und Codon-10-CC-Polymorphismen) als wichtigste Modifiergene für den pulmonalen Verlauf identifizieren können.


Case-Based Glossary with Tips and Tricks


title: Bakterielle Infektionen: Atypische Bakterien

text: Chlamydophila (früher Chlamydia) pneumoniae ist im Kindesalter ein seltener Erreger respiratorischer Infektionen, vor allem der Pneumonie, wenn die PCR als direkte Nachweismethode herangezogen wird. Die höhere Nachweisrate von Antikörpern gegen C. pneumoniae deutet auf eine hohe Rate asymptomatischer oder unspezifischer Infektionen durch C. pneumoniae hin. Der Mensch ist weltweit das einzige Erregerreservoir. Kranke, seltener auch asymptomatische Ausscheider (Wochen bis 1 Jahr) sind die Ansteckungsquelle. Die Übertragung erfolgt als „Tröpfcheninfektion“ mit respiratorischen Sekreten. Eine epidemische Krankheitshäufung ist beschrieben. In feuchtem Milieu können Chlamydien bis zu 30 h auf unbelebtem Material überleben. Im Erwachsenenalter haben 50–75 % der Bevölkerung Antikörper gegen C. pneumoniae. Die höchsten Titer werden in der Altersklasse der 5- bis 14-Jährigen gefunden – ein Indiz für das Hauptmanifestationsalter der Primärinfektion. Seroprävalenzdaten aus Deutschland decken sich mit den Angaben aus der internationalen Literatur (5 % der unter 10-Jährigen, 64 % der unter 18-Jährigen besitzen Antikörper gegen C. pneumoniae). Ambulant erworbene Pneumonien werden im Kindesalter möglicherweise in bis zu 18 % der Fälle (serologische Diagnose) durch C. pneumoniae verursacht. Untersuchungen mittels PCR hingegen weisen C. pneumoniae nur in sporadischen Fällen nach. Koinfektionen mit Mykoplasmen, aber auch Pneumokokken und Adenoviren sind keine Seltenheit.


title: Peptide Arrays

text: Despite the concern over the potential loss of structural information as a result of the use of peptides as opposed to proteins as molecular probes, peptide arrays have been implemented in a broad range of applications including antibody screening and epitope mapping, characterization of molecular interactions, and enzymatic activity profiling, and they have become a valuable tool for proteomics research. In this chapter, we first (Sect. 7.1) recapitulate the development of these arrays and highlight a couple of key improvements in the array production and the application in proteomics research. For clinical and biomarker development applications, it is important to measure entities that are directly related to physiological function (and dysfunction). In this respect, the assessment of enzymatic activities is obviously preferable to genotyping, expression profiling, or even measurement of protein amounts. In Sect. 7.2, an original technology based on peptides arrayed onto a porous support allows detailed profiling of kinase activities in a biological sample. The applications described range from kinase characterization to inhibition profiles, detection of off-target effects, and drug response prediction in a clinical setting, allowing rational choice of the drug to be used. Such directly functional approaches will have an important role in the transition to more personalized medicine. Finally, in Sect. 7.3, a recently developed method for “laser printing” of peptide arrays that will make these approaches much more practical is presented.


COVID-19 Infection Presenting with CT Halo Sign


title: Coronavirus Disease 2019: Initial Detection on Chest CT in a Retrospective Multicenter Study of 103 Chinese Subjects

text: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease that has recently emerged from China, becoming a pandemic. However, few studies have analyzed data regarding the clinical performance of chest computed tomography (CT) obtained in subjects with suspected COVID-19 at the initial presentation to medical facilities. OBJECTIVE: The purpose of the present study was to evaluate the performance of chest CT the initial presentation of patients with suspected COVID-19. METHODS: Data from 103 patients who were under investigation for COVID-19 based on inclusion criteria according to WHO Interim Guidance were retrospectively collected from January 21, 2020 to February 14, 2020. All patients underwent chest CT scanning and reverse transcription polymerase chain reaction testing (RT-PCR) for COVID-19 at hospital presentation. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (with 95% confidence intervals) were calculated to evaluate the performance of CT. Subgroup analyses were also performed based on the geographical distribution of these cases in the province of Henan, China. RESULTS: There were 88 /103 (85%) patients with COVID-19 confirmed by RT-PCR. The overall sensitivity, specificity, PPV, and NPV were 93% (85-97%), 53% (27-77%), 92% (83-96%), and 42% (18-70%), respectively. Similar results were shown in both geographic regions. The respective sensitivity, specificity, PPV, and NPV for chest CT in the districts of Xinyang and Zhumadian (n = 56) were 92% (80-97%), 63% (26-90%), 93% (81-98%), and 56% (23-85%), while these indicators in the district of Anyang (n = 47) were 95% (81-99%), 43% (12-80%), 90% (76-97%), and 60% (17-93%). There were no significant differences in the prevalence of positive exams in the two geographic subgroups for CT (P=0.423) or RT-PCR (P=0.931). CONCLUSION: Although initial chest CT obtained at hospital presentation showed high sensitivity in patients under investigation for COVID-19 in the two geographic regions in Henan province, the NPV was only modest, suggesting low value of CT as a screening tool.


title: Versuche zur Aerosolvakzinierung von Küken mit inaktivierten Impfstoffen gegen die Newcastle‐Kranlcheit

text: ZUSAMMENFASSUNG: Es wurde untersucht, ob und unter welchen Bedingungen mit Aerosolen aus inaktivierten Newcastle disease‐Vakzinen eine Immunität erzielt werden kann. Die Versuche ergaben, daß eine Schutzwirkung nur durch eine hohe Antigenkonzentration in der Vakzine erreicht wird und nicht durch die Verwendung eines größeren Volumens mit geringerer Antigenkonzentration. Weiterhin war in Hühnerembryonen gewonnenes Virus wegen seiner vermutlich größeren Stabilität überlegen. Die Schutzwirkung der vernebelten Vakzinen war proportional zu der Vakzinemenge, die in Tröpfchengrößen unter 5 μm vorlag. Optimale Immunität wurde erst durch Expositionszeiten von 2 Stunden und darüber erzielt. Dabei war der Schutz gegen die konjunktivale Infektion höher als gegen die i. m. Testinfektion. Antikörper wurden in der Regel auch in voll immunen Tiergruppen nur in Spuren und nur im Serum gefunden. Eine belastbare Immunität wurde erst durch Revakzination ausgebildet. In vergleichbaren Versuchen waren nach der ersten Aerosolvakzination nur 5 % der Tiere immun, nach der zweiten 70 % und nach der dritten 100 %. Die praktische Anwendbarkeit der Vakzination mit Aerosolen aus inaktivierter Vakzine gegen die ND wurde im Hinblick auf die einschränkenden Bedingungen diskutiert. Frau B. Nagel und Frl. C. Preuss möchten wir für die fleißige und gewissenhafte technische Mitarbeit danken. SUMMARY: Studies on aerosol vaccination of chicks with inactivated vaccines against Newcastle Disease A study was made of whether and under what conditions immunity can be achieved by aerosols of inactivated Newcastle Disease vaccines. It was found that protection could be conferred only if a high concentration of antigen was reached in the vaccine; protection was not obtainable with a large volume of lower antigen concentration. Furthermore virus from chick embryos was superior, on account of its probably greater stability. The protective effect of the various aerosol vaccines was proportional to the amount of vaccine present in droplets under 5 μm. in size. Optimal immunity results from an exposure time of two hours and longer. The resulting protection was greater against conjunctival infection than against intramuscular challenge. Even in fully immune groups of birds antibodies were present only in traces and only in serum. A lasting immunity was only achieved by revaccination. In comparative studies only 5 % of the birds were immune after a single vaccination, 70 % after a second, and 100 % after the third vaccination. The practical value of vaccination with aerosols made from inactivated vaccine against ND is discussed in the light of the various limitations. RÉSUMÉ: Recherches sur une vaccination par aérosol de poussins avec un vaccine inactivé contre la maladie de Newcastle On a voulu savoir dans quelle mesure une immunité pouvait être atteinte avec des aérosols de vaccin inactivé contre la maladie de Newcastle. Les recherches ont montré qu'une protection pouvait être atteinte avec une forte concentration d'antigène et non avec un grand volume d'une concentration antigénique plus faible. Le virus fut isolé sur embryon de poulet étant donné une plus grande stabilité probable. L'action de protection du vaccin‐aérosol fut proportionnelle à la quantité de vaccin, les gouttelettes étant de l'ordre de grandeur de 5 μm. Une immunité optimale fut obtenue seulement avec des temps d'exposition de 2 heures et plus. La protection contre l'infection conjonctivale fut plus élevée que contre l'infectiontest i/m. Des anticorps ne furent trouvés qu'en traces et dans le sérum dans des groupes d'animaux totalement immunisés. Une immunité measurable ne fut trouvée qu'après une revaccination. Des recherches comparées ont montré que le 5 % des animaux étaient immunisés après la première vaccination par aérosol, le 70 % après la deuxième et le 100 % après la troisième. L'application pratique de la vaccination par aérosol avec des vaccines inactivés contre la maladie de Newcastle est discutée en rapport avec les conditions limitées. RESUMEN: Ensayos sobre la vacunación aerosólica de pollitos con vacunas inactivadas contra la enfermedad de Newcastle Se estudió si y bajo qué clase de condiciones se puede conseguir una inmunidad contra la enfermedad de Newcastle con aerosoles de vacunas inactivadas. Los ensayos tuvieron por resultado que se consigue una acción protectora solo mediante una concentración antigénica elevada en la vacuna y no empleando un volumen mayor con concentración antigénica escasa. Además era superior el virus obtenido en embriones de pollo, debido, tal vez, a su gran estabilidad. La acción protectora de las vacunas atomizadas era proporcional a la cantidad de vacuna presente en gotas de tamaños inferiores a 5 μm. La inmunidad óptima se consigue solo mediante tiempos de exposición de 2 horas y más. De esta guisa era mayor la protección frente a la infección conjunctival que frente a la infección im. de prueba. Por regla general, no se encontraron anticuerpos más que en grupos de animales con inmunidad plena y sólo en el suero sanguíneo. La inmunidad gravable se formó únicamente por medio de revacunación. En ensayos comparativos sólo se hallaba inmunizado tras vacunación aerosólica primera el 5 % de los animales, tras la segunda el 70 % y tras la tercera el 100 %. Se discute la aplicabilidad práctica de la vacunación por atomización de una vacuna inactivada contra la EN con respecto a las condiciones restrictivas.


title: PALAEOBOTANY OF THE MESOPHYTIC III: PLANT MICROFOSSILS FROM THE UPPER BUNTER OF HENGELO, THE NETHERLANDS

text: The Upper Bunter palynological assemblage described includes 54 species, assigned to 29 genera. Seven genera (Scabratisporites, Guttatisporites, Lapposisporites, Pseudogravisporites, Paralundbladispora, Taeniaepollenites and Tubantiapollenites) and 39 species are new; three generic descriptions are emended (Apiculatasporites, Colpectopollis and Angustisulcites) and three new combinations are proposed. Bisaccate pollen grains average 84 %; within this group no Upper Permian elements could be demonstrated. The assemblage is compared with other European Lower and Middle Triassic assemblages; there are no close similarities to assemblages outside Europe.


THE PHLEBOTOMINAE OF THE ETHIOPIAN EEGION.


Some British species of Leiophron Nees (Hymenoptera: Braconidae, Euphorinae), with the description of two new species


ON THE ETHIOPIAN DIASPIDINI (COCCOIDEA)


title: The Geonemertes problem (Nemertea)

text: A new genus of monostiliferous hoplonemerteans, Pantinonemertes gen. nov., provides evidence for the separate evolution of terrestrial nemerteans. The genus is established for two new species found in Australia, P. enalios sp. nov., an intertidal form, and P. winsori sp. nov., which lives in fallen timber in the supralittoral brackish water regions of mangrove swamps. One only of the known species of land nemerteans, Geonemertes agricola from Bermuda, closely resembles these two species morphologically and is transferred to the new genus as Pantinonemertes agricola. A re‐examination of all the known species of Geonemertes has shown that two major groups can be distinguished on the basis of morphological characters. In one group the rhynchocoel musculature is in two distinct layers, a frontal organ is present, the mid‐dorsal blood vessel has a single vascular plug, and the flame cells are binucleate and reinforced with cuticular support bars. It comprises the genus Pantinonemertes gen, nov, and the Pelaensis or Indopacific group of terrestrial nemerteans, for which the generic name Geonemertes is retained. In the second major group the rhynchocoel musculature is composed of interwoven longitudinal and circular fibres, there is no frontal organ, the mid‐dorsal blood vessel bears two vascular plugs, and the flame cells are mononucleate and lack support bars. Five genera, three of which are new, are distinguished in this group. Australian species are united in the genus Argonemertes gen. nov., and New Zealand forms comprise the genus Antiponemertes gen. nov., while Acteonemertes bathamae from New Zealand and the Auckland and Ocean Islands remains in a separate genus. Geonemertes nightingaleensis is transferred to a new genus, Katechonemertes gen. nov., and for Geonemertes chalicophora a previously used generic name, Leptonemertes, is adopted. A key to the terrestrial, brackish‐water and marine nemertean species described in the present paper is provided.


title: Lactose malabsorption in Central Australian Aboriginal children hospitalized with acute enteritis

text: The prevalence and duration of lactose malabsorption was studied in 64 Central Australian Aboriginal children requiring hospitalization for acute enteritis. Lactose malabsorption was determined by the breath‐hydrogen test. Sixty‐nine per cent were shown to malabsorb lactose, a figure similar to that for well nourished urban European children, hospitalized for acute enteritis. Whereas 90 per cent of the European children became lactose‐tolerant 1 month later, only three of 32 aboriginal children were lactose‐tolerant after 3 months. Lactose malabsorption was also associated with more frequent hospitalizations in affected children. Coronavirus‐like particles were the commonest agent isolated from Aboriginal children. The majority of the Aboriginal children were malnourished (< 80% standard weight for age) which may have been contributed to by their lactose malabsorption and explain why this failed to recover in the same way as European children. The possibility of lactose malabsorption must be taken into consideration when managing Aboriginal children with acute diarrhoeal disease and undernutrition. The use of the breath‐hydrogen test allows an accurate diagnosis of lactose malabsorption to be made in Aboriginal children with diarrhoea so that appropriate dietary management can be instituted.


title: Monitoring exposure to avian influenza viruses in wild mammals

text: 1.. Avian influenza (AI) viruses primarily circulate in wild waterfowl populations and are occasionally transmitted to domestic poultry flocks. However, the possible roles of other wildlife species, such as wild mammals, in AI virus ecology have not been adequately addressed. 2.. Due to their habitat and behaviour, many wild mammals may be capable of transmitting pathogens among wild and domestic populations. Exposure to AI viruses has been reported in an array of wild and domestic animals. The presence of wild mammals on farms has been identified as a risk factor for at least one poultry AI outbreak in North America. These reports suggest the need for seroprevalence studies examining the exposure of wild mammals to AI viruses. 3.. Serological tests are routinely used to assess domestic poultry, domestic swine and human exposure to influenza A viruses, but these tests have not been validated for use in wild mammals. As such, some of these protocols may require adjustments or may be inappropriate for use in serology testing of wild mammals. Herein, we review these serological techniques and evaluate their potential usefulness in AI surveillance of wild mammals. We call for care to be taken when applying serological tests outside their original area of validation, and for continued assay verification for multiple species and virus strains.


From evidence into action - Using the planning system to promote healthy weight environments


Our New President—M. Bishr Omary, MD, PhD, AGAF


Commentary: Going beyond the septum for complete repair of obstructive hypertrophic cardiomyopathy


COVID-19: Crisis Management in Congenital Heart Surgery


China curbs chemicals production


We're more negative after five nights of less sleep


title: Testing times

text: We will understand this pandemic only when we have more data


title: Attenborough's rallying cry

text: David Attenborough's latest film A Life on Our Planet is a powerful and unusually personal call to action, finds Timothy Revell


International Society of Antimicrobial Chemotherapy (ISAC) News and Information Page


title: A cuckoo in the nest

text: A young couple in need of a starter home meet an estate agent who is very definitely not what he seems, and nor is the estate he shows them. Vivarium packs a powerful punch, says Simon Ings


Don't miss


title: Code kept on ice for 1000 years

text: Microsoft-owned firm to go ahead with work to safeguard commonly used data


A new paradigm for drug development


272 Streptococcus Oralis Peritonitis in Peritoneal Dialysis: A Truly Nail-Biting Experience


title: Endings are hard

text: Coming out of lockdown will require difficult decisions


title: STEM CAREERS IN THE BREXIT ERA

text: The UK's exit from the EU has had a mixed effect on scientists' assessment of their international mobility and future job market prospects, according to the 2020 STEM Survey


2001 Poultry Science Subject Index


Reflections during turbulent times


Methods for producing a national infection prevention and control manual (NIPCM) in Scotland


In This Issue/Research Watch/News in Brief


1-week hypofractionated adjuvant whole-breast radiotherapy: towards a new standard?


News and Announcements


title: E-cigarette, or Vaping, Product Use-associated Lung Injury (EVALI): Acute Lung Illness within Hours of Switching from Traditional to E-cigarettes

text: 2019 has been a landmark year in the world of electronic nicotine delivery systems (ENDS), specifically e-cigarette and vaping. Numerous state health departments across the United States have voiced their concerns in the growing number of lung injury cases from e-cigarettes and vaping. Over the past few decades, many agencies have brought into light the harmful effects of smoking cigarettes, and despite popular belief, a growing movement has started to recognize the harmful effects of ENDS. The Centers for Disease Control and Prevention have released recommendations and provided health practitioners a methodology to identify and diagnose e-cigarette, or vaping, product use-associated lung injury (EVALI). EVALI is a diagnosis of exclusion and comprises a variety of respiratory illnesses, with intubation rates nearing 32%. The most critical risk factor remains product use in the preceding 90 days, although a timeline on the development of symptoms or notable structural changes remains unknown. We present a case of acute lung injury in a traditional cigarette smoker that evolved within hours of switching to e-cigarettes.


AN EMERGING PARADIGM FOR PSYCHIATRIC PRACTICE IN INTEGRATED CARE AMIDST A CRISIS


268 Nonuremic Calciphylaxis—A Rare Case


title: UK advisers to be named

text: Criticism of the UK's Scientific Advisory Group for Emergencies has prompted a move to more transparency, reports Adam Vaughan


Reflecting on a future ready for digital health


Always the end of days


Trots op onze helden


Vijf vrije vragen aan: Jeroen Kistemaker


Dartelen


title: EU economic integration agreements, Brexit and trade

text: The effects of regionalism on trade have been extensively evaluated within a gravity model framework. With the expected exit of the United Kingdom (UK) from the European Union (EU), the prospect of regional disintegration has brought about a new impetus to studying trade policy effects. Using actual and forecast data for a panel of bilateral imports between the EU15 and the rest of the world, this paper examines the trade effects of EU economic integration agreements (EIAs), their evolution over time and the related counterfactual Brexit trade policy scenarios. Distinct trade effects are obtained for the EU trade related agreements; positive, significant and of similar magnitude for the EU and free trade agreement (FTA) coefficients, but negative and significant (and smaller in magnitude) for the regional economic partnership agreements (EPAs). The subperiod results suggest the positive coefficients of EU and FTA membership tend to diminish over time, implying earlier membership of EIAs came with greater trade benefits. Finally, in generating the predicted values for the trade effects of three alternative counterfactual Brexit scenarios (hard Brexit, hard Brexit plus, global Britain), the findings suggest an asymmetric effect depending on the perspective of the UK versus the EU. Whereas the UK’s trade would decline substantially with all three country groups (the EU, the FTAs and regional EPAs) and rise substantially with the rest of the world, only minor percentage changes are predicted for EU bilateral trade.


title: A review of open source ventilators for COVID-19 and future pandemics

text: Coronavirus Disease 2019 (COVID-19) threatens to overwhelm our medical infrastructure at the regional level causing spikes in mortality rates because of shortages of critical equipment, like ventilators. Fortunately, with the recent development and widespread deployment of small-scale manufacturing technologies like RepRap-class 3-D printers and open source microcontrollers, mass distributed manufacturing of ventilators has the potential to overcome medical supply shortages. In this study, after providing a background on ventilators, the academic literature is reviewed to find the existing and already openly-published, vetted designs for ventilators systems. These articles are analyzed to determine if the designs are open source both in spirit (license) as well as practical details (e.g. possessing accessible design source files, bill of materials, assembly instructions, wiring diagrams, firmware and software as well as operation and calibration instructions). Next, the existing Internet and gray literature are reviewed for open source ventilator projects and designs. The results of this review found that the tested and peer-reviewed systems lacked complete documentation and the open systems that were documented were either at the very early stages of design (sometimes without even a prototype) and were essentially only basically tested (if at all). With the considerably larger motivation of an ongoing pandemic, it is assumed these projects will garner greater attention and resources to make significant progress to reach a functional and easily-replicated system. There is a large amount of future work needed to move open source ventilators up to the level considered scientific-grade equipment, and even further work needed to reach medical-grade hardware. Future work is needed to achieve the potential of this approach by developing policies, updating regulations, and securing funding mechanisms for the development and testing of open source ventilators for both the current COVID19 pandemic as well as for future pandemics and for everyday use in low-resource settings.


title: Remembering people with dementia during the COVID-19 crisis.

text: This letter argues that we need to pay particular attention to people with dementia during this difficult time of the COVID-19 pandemic. Social distancing rules and cocooning for people aged 70 years and over are now in place in Ireland to slow down the rate of infection and protect vulnerable older people. This letter argues that we need, more than ever, to assert the personhood of people with dementia at this difficult time. That means more person-centred care and practical support structures for family carers to allow them to continue to care at home in a safe and life-enhancing way. New public broadcasting initiatives could create information and communication channels for people with dementia and their carers, as well as demonstrating empathy and solidarity with their predicament. Government, the Department of Health, the HSE and the voluntary sector have risen to the challenge of COVID-19 in all sectors of society. So too have ordinary citizens. Now we need to unite even more to create an unyielding commitment and adherence to the principles of decency, justice and equity in the allocation of scarce health and social care resources. By doing this, we will demonstrate our caring potential and capacity in a way that reflects our shared humanity, not only in the current crisis, but into the future.