title: Comparative Considerations and Conclusions

text: The noteworthy success of a small embargoed island in scientific development, and in particular in a typically US-dominated and capital-intensive sector like biotechnology, has attracted considerable interest and discussion among the analysts and specialists, since it shows features that are unique in the panorama of developing countries. Cuba’s achievements in science and technology seem an exception with respect to what usually happens in other underdeveloped countries, excluded probably the biggest and richest ones. Even more exceptional is the development of biotechnology in Cuba. Some concepts are summarized, inspired form the most competent specialists in the field.


title: Infectieziekten

text: In dit hoofdstuk komen kliniek, diagnostiek en behandeling van de belangrijkste infectieziekten bij kinderen aan de orde.


Sarkosporidiose


title: Gene Therapy for Lung Diseases

text: Gene therapy is under development for a variety of lung disease, both those caused by single gene defects, such as cystic fibrosis and α(1)-antitrypsin deficiency, and multifactorial diseases such as cancer, asthma, lung fibrosis, and ARDS. Both viral and nonviral approaches have been explored, the major limitation to the former being the inability to repeatedly administer, which renders this approach perhaps more applicable to conditions requiring single administration, such as cancer. Progress in development and clinical trials in each of these diseases is reviewed, together with some potential newer approaches for the future.


title: Efficient Parameterized Algorithm for Biopolymer Structure-Sequence Alignment

text: Computational alignment of a biopolymer sequence (e.g., an RNA or a protein) to a structure is an effective approach to predict and search for the structure of new sequences. To identify the structure of remote homologs, the structure-sequence alignment has to consider not only sequence similarity but also spatially conserved conformations caused by residue interactions, and consequently is computationally intractable. It is difficult to cope with the inefficiency without compromising alignment accuracy, especially for structure search in genomes or large databases. This paper introduces a novel method and a parameterized algorithm for structure-sequence alignment. Both the structure and the sequence are represented as graphs, where in general the graph for a biopolymer structure has a naturally small tree width. The algorithm constructs an optimal alignment by finding in the sequence graph the maximum valued subgraph isomorphic to the structure graph. It has the computational time complexity O(k (t) N (2)) for the structure of N residues and its tree decomposition of width t. The parameter k, small in nature, is determined by a statistical cutoff for the correspondence between the structure and the sequence. The paper demonstrates a successful application of the algorithm to developing a fast program for RNA structural homology search.


title: Noninvasive Ventilation in Patients with Severe Acute Respiratory Syndrome

text: Severe acute respiratory syndrome first emerged in Guangdong, China in November 2002 and then spread rapidly to many countries through Hong Kong in 2003 [1–4]. A 64-year-old physician from southern China, who had visited Hong Kong on February 21, 2003 and died 10 days later of severe pneumonia, is believed to have been the source of infection causing subsequent outbreaks of severe acute respiratory syndrome (SARS) in Hong Kong, Vietnam, Singapore, and Canada [1–4]. By the end of the epidemic in July 2003, there had been 8,096 cases reported in 29 countries and regions, with a mortality incidence of 774 (9.6 %) [5]. Among the 8,096 cases, 1,706 were health care workers (HCWs). A novel coronavirus (CoV) was responsible for SARS [6]. Bats are likely the natural reservoirs of SARS-like CoV [7, 8].


title: Imaging of Lung Transplantation

text: Lung transplantation has become a viable treatment option for end-stage lung disease. Common indications for lung transplantation are chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, alpha-1 antitrypsin deficiency, and pulmonary arterial hypertension. Either single or bilateral lung transplantation can be performed, but bilateral lung recipients appear to have a better median survival than single lung recipients. Complications after lung transplantation are common and may have nonspecific clinical and radiologic manifestations. The time point at which these complications occur relative to the date of transplant is crucial in formulating a differential diagnosis and recognizing them accurately. Significant advances in imaging techniques and recognition of air trapping in exhalation images and other patterns /distribution of parenchymal abnormalities have led to routine use of HRCT for diagnostic evaluation in patients manifesting respiratory decline in the lung transplant recipient.


title: 3 Infecties van de onderste luchtwegen en tuberculose

text: Tot de onderste luchtwegen behoren alle onderdelen van de luchtwegen en longen onder de stembanden (trachea, bronchi en bronchioli).


title: Infections: The Emergency of the New Millennium

text: The New Millennium opened with alarming data on infections and antimicrobial resistance. Viral infections (SARS, MERS-CoV, Zika, Chikungunya, West Nile, Ebola virus infection, etc.) emerged or re-emerged with threatening outbreaks. However, viral emerging infections in some instances represented marginally a concern for developed countries that were just lapped by them. Currently, the new emergency is represented by antimicrobial resistance in bacterial infections, that is, a matter of extreme importance in developed and developing countries, where this issue has become a top priority for global policy makers and public health authorities. New mechanisms of resistance continue to emerge and spread globally, threatening our ability to treat common infections. The overuse and misuse of antimicrobials both in the human and animal field, and their dispersion in the environment pose a risk for selection of mechanisms of resistance of germs. Some settings, like the healthcare facilities, where the use of antimicrobials is obviously intense and infection prevention and control can be poor, represent the reservoir for multidrug-resistant organisms and, sometimes, the melting pot for pan-resistant strains.


title: Hematologic Complications

text: Critically ill patients are at high risk of developing various hematologic complications that may be present on admission or occur during their stay in the Intensive Care Unit (ICU). Often times the etiology of specific hematologic abnormalities is unclear and the diagnosis may be challenging due to the complexity of critically ill patients. This chapter will focus on diagnosis and management of the most commonly encountered hematologic problems in the critically ill such as anemia, neutropenia, thrombocytopenia, coagulopathy and thrombotic complications, with specific focus on diagnosis and management of these conditions.


title: Molecular Virology

text: Traditional viral isolation by cell culture assays and conventional serological methods have been previously used to detect and identify various virus infections


Schützengrabenfieber


title: Advanced Immunotechnological Methods for Detection and Diagnosis of Viral Infections: Current Applications and Future Challenges

text: Diagnosis and identification of viruses is an important component of diagnostic virology laboratory. Although various modes of diagnostic methods are now available at disposal, a vast majority of the diseases across the globe remain undiagnosed. This is largely due to the overlapping undifferentiated set of symptoms across myriad set of RNA and DNA viral diseases. As such, it becomes critical to take into consideration several factors for viral diagnosis ranging from the type and quality of specimen collected, time of specimen collection, mode of transport, accuracy, specificity, sensitivity, and the type of diagnostic method used. This chapter broadly emphasizes various methods on diagnostic virology ranging from the classical methods of diagnosis to the most recently developed molecular methods of detection of virus.


title: Il versamento pleurico: aspetti eziologici, diagnostici e clinici

text: Il coinvolgimento della pleura puÒ comparire nel corso di molteplici e differenti patologie. Le cause che sottendono un versamento pleurico possono essere intra-toraciche o sistemiche e, se in alcuni casi queste appaiono facilmente individuabili grazie a segni clinici patognomonici, in altri casi l’inquadramento nosografico di un versamento puÒ risultare complesso, dovendosi basare su elementi clinici e reperti laboratoristico-strumentali spesso aspecifici.


title: Bioinformatics Applications in Advancing Animal Virus Research

text: Viruses serve as infectious agents for all living entities. There have been various research groups that focus on understanding the viruses in terms of their host-viral relationships, pathogenesis and immune evasion. However, with the current advances in the field of science, now the research field has widened up at the ‘omics’ level. Apparently, generation of viral sequence data has been increasing. There are numerous bioinformatics tools available that not only aid in analysing such sequence data but also aid in deducing useful information that can be exploited in developing preventive and therapeutic measures. This chapter elaborates on bioinformatics tools that are specifically designed for animal viruses as well as other generic tools that can be exploited to study animal viruses. The chapter further provides information on the tools that can be used to study viral epidemiology, phylogenetic analysis, structural modelling of proteins, epitope recognition and open reading frame (ORF) recognition and tools that enable to analyse host-viral interactions, gene prediction in the viral genome, etc. Various databases that organize information on animal and human viruses have also been described. The chapter will converse on overview of the current advances, online and downloadable tools and databases in the field of bioinformatics that will enable the researchers to study animal viruses at gene level.


Current Capabilities of First Responders in Different Countries


title: 25 Keel-, neus- en oorheelkunde

text: Bovensteluchtweginfecties, recidiverende middenoorontstekingen en tonsillitiden behoren tot de meest frequent voorkomende ziektebeelden bij kinderen. Mede door het veranderde beloop, de verminderde morbiditeit en vernieuwde inzichten zijn de behandelstrategieën de afgelopen jaren veranderd. Een afwachtend beleid, watchful waiting, lijkt nu veelal aangewezen.


title: Recent Advances in Real-time Mass Spectrometry Detection of Bacteria

text: The analysis of bio-aerosols poses a technology challenge, particularly when sampling and analysis are done in situ. Mass spectrometry laboratory technology has been modified to achieve quick bacteria typing of aerosols in the field. Initially, aerosol material was collected and subjected off-line to minimum sample treatment and mass spectrometry analysis. More recently, sampling and analysis were combined in a single process for the real-time analysis of bio-aerosols in the field. This chapter discusses the development of technology for the mass spectrometry of bio-aerosols, with a focus on bacteria aerosols. Merits and drawbacks of the various technologies and their typing signatures are discussed. The chapter concludes with a brief view of future developments in bio-aerosol mass spectrometry.


title: Pneumonia

text: The lung is constantly exposed to airborne infectious agents due to the large surface area of approximately 100 m(2). Therefore pneumonia is one of the most common lung diseases. Understanding infection requires understanding the routes of infections, the way invading organisms infect epithelial cells, as well as defense mechanisms of the lung tissue acquired during evolution. Different variants of infectious and non-infectious pneumonias are discussed; special types of pneumonias such as granulomatous and fibrosing pneumonias are presented under separate sections. Causing organisms and other causes of pneumonias are included, and their mode of action is included as far as understood.


title: Acute Exacerbation of COPD

text: Acute exacerbations of COPD involve increased symptoms such as cough, dyspnea and sputum production. These exacerbations are associated with increased mortality as well as decline in lung function. Non-invasive positive-pressure ventilation (NIPPV) is the preferred method of ventilatory support in respiratory failure secondary to AECOPD. NIPPV reduces work of breathing, improves oxygenation and ventilation and decreases both mortality and the risk of invasive ventilation. Other therapies for AECOPD include inhaled bronchodilators and systemic glucocorticoids. Antibiotics are recommended for severe exacerbations. Future areas of interest in treatment for AECOPD include utilization of biomarkers and extracorporeal carbon dioxide removal.


Tuberculosis in the Intensive Care Unit: The North American Perspective


title: Infectious Complications of Cancer Therapy

text: Advances in the management of cancer, particularly the development of new chemotherapeutic agents, have greatly improved the survival and outcome of patients with hematologic malignancies and solid tumors; overall 5-year survival rates in cancer patients have improved from 39% in the 1960s to 60% in the 1990s.1 However, infection, caused by both the underlying malignancy and cancer chemotherapy, particularly myelosuppressive chemotherapy, remains a persistent challenge.


Globalisation and its Effects on Educational Leadership, Higher Education and Educational Policy


Sarcoptes scabiei


title: The Origin and Evolution of Viruses

text: The lecture covers three main topics: (i) Viruses: properties, place in the living world, and possible origin; (ii) Molecular basis of viral variability and evolution; and (iii) Evolution of viral pathogenicity and emerging viral infections.


title: Quasispecies Dynamics of RNA Viruses

text: RNA viruses, such as human immunodeficiency virus, hepatitis C virus, influenza virus, and poliovirus replicate with very high mutation rates and exhibit very high genetic diversity. The extremely high genetic diversity of RNA virus populations originates that they replicate as complex mutant spectra known as viral quasispecies. The quasispecies dynamics of RNA viruses are closely related to viral pathogenesis and disease, and antiviral treatment strategies. Over the past several decades, the quasispecies concept has been expanded to provide an adequate framework to explain complex behavior of RNA virus populations. Recently, the quasispecies concept has been used to study other complex biological systems, such as tumor cells, bacteria, and prions. Here, we focus on some questions regarding viral and theoretical quasispecies concepts, as well as more practical aspects connected to pathogenesis and resistance to antiviral treatments. A better knowledge of virus diversification and evolution may be critical in preventing and treating the spread of pathogenic viruses.


title: Ungewissheit, Uneindeutigkeit, Unsicherheit – Braucht die Theorie reflexiver Modernisierung eine neue Handlungstheorie?

text: Moderne Zeiten sind unsichere Zeiten – so lautet der Befund soziologischer Gegenwartsdiagnosen. Die Theorie reflexiver Modernisierung hat diesen Befund weiter zugespitzt. Sie diagnostiziert, dass die Gesellschaft, in der wir leben – die Zweite Moderne – durch Ungewissheit, Uneindeutigkeit und Unsicherheit gekennzeichnet ist: Entscheidungen beruhen nicht mehr auf gesichertem Wissen, soziale Lagen lösen sich auf und vertraute Institutionen wie der Nationalstaat oder die Erwerbsarbeit verlieren ihre Konturen. Während Institutionen, Organisationen und Individuen mehr denn je dazu gezwungen sind, Entscheidungen zu treffen, wird dies gleichzeitig immer schwieriger, denn institutionalisierte Entscheidungskonventionen produzieren Nebenfolgen, die die Basisinstitutionen moderner Gesellschaften bedrohen. „Die Turbulenzen, die … auf allen Handlungsebenen und in allen Handlungskontexten entstehen, bilden das Schlüsselproblem für Gegenwart und Zukunft der Zweiten Moderne und das zentrale Thema ihrer Erforschung“ (Beck/Bonß/Lau 2004: 15).


title: Systemic Syndromes with Biomedicines

text: Since the introduction of biomedicines in human therapy, a number of systemic reactions have been more frequently reported as important adverse events following treatment. Some monoclonal antibodies, interleukins, receptor inhibitors, and growth factors may preferably induce acute, violent, early events with an overall low frequency, but with serious and life-threatening capacity. .


title: Pandemic Risk Modelling

text: This chapter will explore the nature of communicable diseases, a brief history of pandemics, and will introduce the mathematical models used to evaluate the risk pandemics pose to human populations. Such modelling is used in a public health context, where modelling past and current events provides insight in how to respond most effectively to a new outbreak. It is also used in the context of risk mutualisation and transfer. As recently as 2013, a survey of 30,000 insurance executives placed global pandemic as the biggest extreme risk facing insurers (Towers Watson. 2013. Insurers Rate Global Pandemic as the Major Extreme Risk. 3 December). The chapter will introduce the principles used to model these events in the insurance industry and will conclude with a review of the way these models are applied in an unconventional risk transfer context.


Management of Malignant Pleural Effusions


title: Clinical Application of Stem/Stromal Cells in COPD

text: Chronic obstructive pulmonary disease (COPD) is a progressive life-threatening disease that is significantly increasing in prevalence and is predicted to become the third leading cause of death worldwide by 2030. At present, there are no true curative treatments that can stop the progression of the disease, and new therapeutic strategies are desperately needed. Advances in cell-based therapies provide a platform for the development of new therapeutic approaches in severe lung diseases such as COPD. At present, a lot of focus is on mesenchymal stem (stromal) cell (MSC)-based therapies, mainly due to their immunomodulatory properties. Despite increasing number of preclinical studies demonstrating that systemic MSC administration can prevent or treat experimental COPD and emphysema, clinical studies have not been able to reproduce the preclinical results and to date no efficacy or significantly improved lung function or quality of life has been observed in COPD patients. Importantly, the completed appropriately conducted clinical trials uniformly demonstrate that MSC treatment in COPD patients is well tolerated and no toxicities have been observed. All clinical trials performed so far, have been phase I/II studies, underpowered for the detection of potential efficacy. There are several challenges ahead for this field such as standardized isolation and culture procedures to obtain a cell product with high quality and reproducibility, administration strategies, improvement of methods to measure outcomes, and development of potency assays. Moreover, COPD is a complex pathology with a diverse spectrum of clinical phenotypes, and therefore it is essential to develop methods to select the subpopulation of patients that is most likely to potentially respond to MSC administration. In this chapter, we will discuss the current state of the art of MSC-based cell therapy for COPD and the hurdles that need to be overcome.


title: Transfusion and Acute Respiratory Distress Syndrome: Clinical Epidemiology, Diagnosis, Management, and Outcomes

text: Transfusion related acute lung injury (TRALI) is a life-threatening complication of blood product transfusion. It is the leading cause of blood product transfusion related death in the USA. The syndrome is defined by hypoxemic respiratory failure with bilateral infiltrates on chest X-ray in the setting of a blood transfusion and absence of cardiac failure. The exact incidence of TRALI is unknown, but the incidence is higher in the critically ill patient population. Multiple patient and donor related risk factors for TRALI exist, including critically illness, alcohol use, and receiving transfusions with high plasma volumes. Practitioners should have a low index of suspicion for the diagnosis of TRALI, and blood bank reporting is vital to aid in diagnosis and future prevention. Management is primarily supportive care, with supplemental oxygen as the mainstay for therapy. Despite the transient course of TRALI, its morbidity is severe with the majority of patients requiring mechanical ventilation and treatment in the intensive care unit. For patients that survive TRALI, outcomes are promising without residual pulmonary deficits. Prevention strategies over the past 10 years have helped to decrease the incidence of TRALI and have led to increased awareness of this condition in the medical field.


title: The RPE Cell and the Immune System

text: The RPE cell plays a pivotal role in retinal immunity. In fact, the RPE cell orchestrates both innate and adaptive immunity and contains a plethora of factors to regulate the immune response. Many immunoregulatory activities of the RPE cell are accomplished through cytokine production, toll-like receptor (TLR) activation, complement regulation and antigen presentation. The RPE cells immune regulatory network plays an essential role in retinal immunity and autoimmunity, retinal infections and in a variety of retinal degenerative disorders. Understanding the immune regulatory properties of this cell may provide additional clues to disease mechanisms that may lead to future treatments for many human retinal diseases.


title: Fibrinogen (FI)

text: Das Hauptsubstrat der Gerinnung ist Fibrinogen (FI). Bei akuter Blutung ist es zumeist der erste Gerinnungsfaktor, der kritische Grenzwerte erreicht (150–200 mg/dl). FI kann hervorragend mittels point-of-care-tauglicher viskoelastischer Methoden (Thrombelstographie oder Thrombelastometrie) monitiert werden. Die Substitution kann mittels Frischplasma, Cryopräzipitat oder Fibrinogenkonzentrat erfolgen. Frischplasma ist nicht besonders effektiv, mit einer erhöhten Morbidität, insbesondere bei kritisch Kranken, sowie mit Volumenbelastung assoziiert. Cryopräzipitat wird in einigen europäischen Ländern nicht angeboten. Die Gabe von Fibrinogenkonzentrat wird in verschiedenen Leitlinien empfohlen. Als Akut-Phase-Protein kann FI physiologischerweise bei Entzündungsprozessen, schweren Verletzungen sowie nach großen Operationen in kurzer Zeit auf über 1000 mg/dl ansteigen; wobei hier Fibrinogenspaltprodukte anti-inflammatorische und sogar antibakterielle Eigenschaften haben.


title: Healthy Cities: Old and New Solutions

text: Cities have had historically higher mortality and morbidity rates than rural areas. These spiked dramatically after the Industrial Revolution, which led to the first health of cities movement that stimulated the adoption of new public health measures to improve the built-environment in the developed countries. Together with such additional factors as increasing prosperity, hygiene and especially medical advances, the old health disadvantages of cities was reversed. But a new set of medical challenges threatening to reverse previous progress has emerged. These include such problems as bacterial resistances to many of the drugs that reduced communicative diseases, to the effects of indoor living and aging, all of which require urgent attention. In addition, a review of the various health determinants that contribute to ill-health shows that since many of these factors are not within the prevue of current medical practice, they must be addressed if the health and well-being of people in cities are to be improved. A series of other problems that were previously overlooked are being tackled by the new Healthy Cities movement, such as the need for more political and citizen involvement in planning and delivering health care, better ways of promoting health rather than just curing ill-health with a new emphasis on wellness, as well as more effective measures to reduce the persistent pockets of ill-health in many cities.


title: A New Method of Differentiation Between a Biological Attack and Other Epidemics

text: The main obstacle in identifying a biological attack (BA), while preventing false alarms, epidemics of panic and unnecessary expenditures is the insufficient data on which to rely. Тhis new method of outbreak analysis is based on our original model of bioterrorism risk assessment. The intention was to develop a model of quick and accurate evaluation of an unusual epidemiologic event (UEE) that would save time, money, human and material resources and reduce confusion and panic. This UEE analysis is a subtle and detailed differentiation through assessment of BA feasibility in comparison with three other types of outbreak scenarios. There are two types of differences between these four scenarios: qualitative and quantitative. Qualitative and quantitative differences are defined with 23 and 10 indicators, respectively. Both types of indicators can have three different values: N/A, 0 or 1. We have carried out a feasibility analysis for subtle and detailed differentiation among four outbreak scenarios. As a tool for feasibility analysis we have introduced a “system of elimination”. System elimination is applied if one component contains all indicators scored with 0 or as N/A – the related scenario is then eliminated from further consideration. The system was applied to four UEEs: (1) an intentional attack by a deliberate use of a biological agent (Amerithrax), (2) a spontaneous outbreak of a new or re-emerging disease (“swine flu”), (3) a spontaneous outbreak by an accidental release of a pathogen (Sverdlovsk anthrax), and (4) a spontaneous natural outbreak of a known endemic disease that may mimic bioterrorism or biowarfare (Kosovo tularemia). It was found that “agent” was the most important and the most informative UEE component of the new scoring system. This system might be helpful in the analysis of unusual epidemic events and a quick differentiation between biological attacks and other epidemics.


title: Metabolische Störungen

text: Bei fortgeschrittenem Organversagen von Niere, Herz, Leber oder Lunge stellt eine Organtransplantation meist das einzige kurative Therapieverfahren dar. Auch eine Knochenmarktransplantation wird bei sonst unheilbaren Leukämien oder Lymphomen eingesetzt. Nach Organtransplantation treten bei 30–60% der Patienten neurologische Komplikationen auf. Differenzialdiagnostisch müssen vorbestehende, durch die Grunderkrankung bedingte, Störungen von intraoperativen Komplikationen, von metabolisch bedingten neurologischen Störungen und von Nebenwirkungen der notwendigen immunsuppressiven Medikation abgegrenzt werden. Immunsuppressiva können dabei sowohl eine direkte Neurotoxizität als auch indirekt vermehrt Infektionen des Zentralnervensystems (ZNS) und sekundäre ZNS-Malignome verursachen. Während metabolische Enzephalopathien oder opportunistische ZNS-Infektionen bei allen Patienten nach Transplantation etwa gleich häufig auftreten können, sind andere neurologische Syndrome für bestimmte Organtransplantationen typisch.


title: Infectious Diseases

text: This chapter contains four tables on infectious diseases. It features tables on common causes of fever in the ICU, prevention and management of hospital-acquired and ventilator-associated pneumonias.


title: Mykobakterien, nichttuberkulöse (NTM)

text: Atypische, ubiquitäre, Umwelt-Mykobakterien, „Mycobacteria other than Mycobacterium tuberculosis“ MOTT


title: Molecular Epidemiology, Genomics, and Phylogeny of Crimean-Congo Hemorrhagic Fever Virus

text: Crimean-Congo hemorrhagic fever virus (CCHFV) constitutes a group of viruses of the genus Nairovirus (family Bunyaviridae). Like all members of the Bunyaviridae, the genome of CCHFV is composed of tripartite single-stranded RNA. These segments, designated small (S), medium (M), and large (L), minimally encode the nucleocapsid (N), envelope glycoproteins (Gn and Gc), and RNA-dependent RNA polymerase (RdRp), respectively [38].


title: Infektionen des Respirationstrakts

text: Infektionen des Respirationstrakts sind die meistverbreiteten Infektionserkrankungen des Menschen. Vor allem eine Erkältungserkrankung stellt sicherlich eine der häufigsten Ursachen für eine ärztliche Konsultation dar.


title: Glocal English in Singapore? A Re-exploration of the Localization of English

text: This chapter re-considers the notion of ‘glocal English’ or ‘glocalism’ in discussing the use of English in Singapore. As a global language, English has developed in interesting ways via social media and the Internet all over the world. However, it is only in special polities such as Singapore where it is used as the ‘working language’ of the country for a multilingual population base, that English has developed into a phenomenon that has to be studied, better understood and perhaps given a label such as ‘glocal English.’ The chapter will contribute to the ongoing discussions of what it means for English to be a global language and how it adapts as ‘a communicative tool of immense political, ideological, and economic power’(Kachru, Kontalinguistik, 1996, pp. 906–913) in global-local tensions (e.g. commerce, trade, finance, industry, science and technology versus intra-ethnic and inter-ethnic communication within Singapore). In the shifting perspectives of what English is (really global or truly local?), what it does (for and in education), and how it is used in this country (globally and/or locally), the paper hopes to elucidate the dimensions of teaching and learning English in the Singapore context and perhaps more widely in an Asia-Pacific context.


title: Old and New Pestilences

text: a. “Any fatal epidemic disease, affecting man or beast, and destroying many victims.” The Oxford Universal Dictionary, 3(rd) edition, 1955, Oxford Press, 2515 pp. b. “A contagious or infectious epidemic disease that is virulent and devastating.” Webster’s Seventh New Collegiate Dictionary, 1965. G. & C. Merriam Co., Springfield, Mass., 1221 pp. Accordingly, a pestilence should be an infectious disease, devastating (killing) a large number of people (or animals).


title: On Viruses, Bats and Men: A Natural History of Food-Borne Viral Infections

text: In this chapter, cross-species infections from bats to humans are reviewed that do or do not use intermediate animal amplification hosts and that lead to human-human transmissions with various efficiencies. Rabies infections, Hendra virus infections in Australia, Nipah virus infections in Malaysia and Bangladesh and SARS coronavirus infection in China are explored from the public health perspective. Factors of bat biology are discussed which make them ideal virus reservoirs for emerging diseases. In line with the book theme, it is asked whether even in these epidemic conditions, viruses can be seen as essential agents of life where host species use their viruses to defend their ecological position against intruders. It is asked whether another essential function of animal viral infections could be the “killing the winning population” phenomenon known from phage biology which would stabilize species diversity in nature.


title: Importziekten

text: In dit hoofdstuk worden de ziektebeelden op het gebied van de importziekten op een beknopte, heldere wijze behandeld. Het zijn allemaal infectieziekten die in eigen land (= inheems) niet voorkomen, maar tijdens een verblijf in het buitenland (= uitheems) zijn opgelopen. De volgorde van de paragrafen is alfabetisch.


title: Bilateral and Multilateral Financing of HIV/AIDS Programs: The World Bank, the International Monetary Fund, the Global Fund, Bilateral Donors and the Private Sector

text: This chapter examines the operations of the World Bank (a multilateral development institution), the International Monetary Fund (a multilateral financial institution) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (a multilateral fundraising and financing institution) to fight HIV/AIDS. We also examine the role of bilateral donors and the private sector in financing the fight against HIV/AIDS. We examine the relationships among bilateral donors and international organizations, what distinguishes their roles in the global HIV/AIDS pandemic and the extent to which their activities overlap. In addition, we consider how funding strategies and parameters may affect the effectiveness of AIDS funding in preventing transmission and providing treatment.


title: Risk Perception, Heuristics and Epidemic Spread

text: During an outbreak of an infectious disease, people often change their behaviour to reduce their risk of infection. In a given population, the levels of perceived risk of infection vary greatly among individuals. The difference in perception could be due to a number of different factors including varying levels of information regarding the pathogen, quality of local healthcare, availability of preventive measures, individual and group usage of heuristics in the decision-making process. First we discuss the rigorous assessment of the risk, then we describe how our brain assesses the risk through the use of heuristics that are still rooted in animal evolution. Then we discuss the impact and the role of mass media and social networks in modulating risk perception. Next, we show how mathematical modelling is challenged by multi-scale epidemiological problems where the risk perception level is coupled with all the other microscopic and macroscopic levels. Finally, we draw future scenarios of personal risk evaluation through self-monitoring devices and personal genomics. The aim of this chapter is to discuss the importance of risk perception related to the spreading of a disease and to present a variety of ideas that could be fruitfully explored through modelling.


title: Alignment-Free Analyses of Nucleic Acid Sequences Using Graphical Representation (with Special Reference to Pandemic Bird Flu and Swine Flu)

text: The exponential growth in database of bio-molecular sequences have spawned many approaches towards storage, retrieval, classification and analyses requirements. Alignment-free techniques such as graphical representations and numerical characterisation (GRANCH) methods have enabled some detailed analyses of large sequences and found a number of different applications in the eukaryotic and prokaryotic domain. In particular, recalling the history of pandemic influenza in brief, we have followed the progress of viral infections such as bird flu of 1997 onwards and determined that the virus can spread conserved over space and time, that influenza virus can undergo fairly conspicuous recombination-like events in segmented genes, that certain segments of the neuraminidase and hemagglutinin surface proteins remain conserved and can be targeted for peptide vaccines. We recount in some detail a few of the representative GRANCH techniques to provide a glimpse of how these methods are used in formulating quantitative sequence descriptors to analyse DNA, RNA and protein sequences to derive meaningful results. Finally, we survey the surveillance techniques with a special reference to how the GRANCH techniques can be used for the purpose and recount the forecasts made of possible metamorphosis of pandemic bird flu to pandemic human infecting agents.


title: Respiratory Diseases

text: Upper respiratory tract infections are the most common type of infectious diseases and a leading cause of outpatient illness (1,2).


title: Disaster Studies at 50: Time to Wear Bifocals?

text: Other writers have cataloged the many contributions to understanding and practice that disaster studies have produced over the years, many of them, and the earliest, coming from sociology. The Disaster Research Center at the University of Delaware was founded in 1963 by, and is still inhabited by sociologists, but has embraced an interdisciplinary approach over time, including core and affiliated faculty from English, history, political science, civil engineering, and environmental policy). My thoughts in this essay are not confined to the DRC’s corpus of work, but ‘disaster studies’ more broadly defined below. This said, the roots of disaster studies in sociology are deep, the classic Ur-source being an unpublished PhD study of the 1917 explosion in Halifax, Nova Scotia. This disaster continues to be a source of continuing research that provide lessons for our time. My own essay will mention some of these contributions, and they are truly something to celebrate; however, the central theme I will emphasize is what has been missed and could be added to the research agenda over the next decade or so. I employ an optical metaphor that has as much to do with philosophy of science (‘vision’ and Mao’s famous question, ‘Where do ideas come from?’) as it does with optics, optometry and the detailed application of methods at micro and macro scale. The lens is a remarkable human invention. Glass shaped and polished in one way opened up the microscopic world. Treated in another, the lens gave us the telescope. I will argue that politics – the creation, use and maintenance of power to influence other people and to control space and resources – has been a largely missing raw material, like glass, from which disaster studies could shape lenses for its own tools of inquiry. Consideration of power has not been totally missing. Yet lenses fashioned from an understanding of power have not been used sufficiently in a number of critical areas of research.


title: Potentiality of DNA Sensors in Activating Immune System in Emerging Viral Infectious Diseases

text: Viruses are obligatory intracellular parasites and hijack the host cell machinery to make more identical copies of it and continue self-propagation. They attach and replicate in the susceptible and permissive hosts and host derived cell lines. They enter the cells either through direct attachment, receptor-mediated endocytosis, or phagocytosis. Hence, to thwart the invasion by viruses, hosts have developed immunity in ascending stages—intrinsic, innate and adaptive immunity. A robust intrinsic and innate immune response governs an effective adaptive immune response, should that be needed. Both enveloped as well as non-enveloped viruses are subject to distinct types of DNA sensors, subject to their site of replication. DNA sensors of viral PAMPs can be classified into three types, based on the location of their PAMPs in the host cellular compartment viz. cell surface, cytoplasmic and nuclear. The host cell membrane both, surface as well as intra cellular, is continuously monitored for the non-host, pathogenic components or PAMPs. Among the intracellular sensors of the viral genome, there are two types—essentially due to the two types of major viral genomes i.e. RNA and DNA sensors. The cytosolic DNA sensors include AIM2, IFI16, cGAS, RNA Pol III, DNA-PK, DDX9, DHX36, DDX41, DDX60, DAI, LRRFIP1, HMGB, ABCF1 and MRE11. PYHIN family of sensors include AIM2, IFI16, IFIX and MNDA. Another recently discovered family of sensor called stimulator of interferon (IFN) genes (STING), specifically houses on the endoplasmic reticulum (ER) and functions in association with its upstream sensor, cGAS. Some DNA sensors shuttle between the cytosol and nucleus pre- and post-extraneous DNA binding. These include IFI16, IFIX, RNA Pol III, etc. There is no exclusive nuclear DNA sensor. Many enzymes known to be present in the cells for their obvious primary functions also additionally function as DNA sensors. The DNAse family of sensors include DNAse II and TREX1, which are ubiquitously present in the cell for their housekeeping functions. The RNAse family of sensor includes one member—RNA Pol III. Additionally, DNA-PK also functions to cater to viral DNA sensing. The endosomal DNA sensors include TLR7 and TLR9, which belong to the Toll-like receptor (TLR) family. The DExD/H-box helicase family include the putative DNA sensors recently discovered including DDX9, DHX36, DDX41 and DDX60. Several other sensors remain to be characterised or are less classified viz. DAI, LRRFIP1, HMGB, ABCF1, MRE11. In general, response to a viral RNA or DNA produces three types of responses, namely, production of antiviral cytokines including Types I and III IFNs, release of pro-inflammatory and inflammatory cytokines and chemotactic factors. This chapter discusses the structure, function and mechanism of action of the viral DNA sensors explored till date.


title: Life-Threatening Diseases of the Upper Respiratory Tract

text: Acute airway obstruction is one of the most common causes of acute respiratory failure in children. Left untreated, it can rapidly progress to cardiopulmonary arrest and death. There are several important anatomical differences between pediatric and adult patients that render children more susceptible to acute airway obstruction. In addition, there are several diseases that can cause life-threatening acute airway compromise. An understanding of the developmental anatomy and physiology, as well as the myriad diseases that can cause airway compromise in children is therefore essential for all healthcare personnel that provide care for critically ill children.


title: Nuclear Proliferation and Terrorism

text: In a dramatic moment before the United Nations, Bernard Baruch described the American plan to internationalize and control the atom. He described in biblical fashion the choice between “the quick from the dead” (taken from the Apostle’s Creed) resulting from the global spread of nuclear weapons. This prediction came to fruition 15 years later when presidential candidate John F. Kennedy gave a warning in the third debate with Vice President Richard Nixon:


title: Emergencies/Resuscitation

text: This chapter discusses neonatal infection, the different causes of shock, hypoglycemia, acid-base balance, and resuscitation. The etiology, signs, investigations, and treatment of these items are addressed. A large number of Tables are added for clinical use to list signs, normal values and treatment guides. Resuscitation is subdivided into clinical assessment of neonates, clinical assessement of children and infants, airway management, ventilation, circulatory resuscitation, and defibrillation. Advices of Advanced Paediatric Life Support (APLS) are the basis of the guide lines for resuscitation in this chapter. Next to ventilatory support without equipment, various types of mechanical ventilation with advantages and disadvantages listed. A large number of figures and drawings visualise the techniques for airway management, ventilation and cardiac compression so that the clinical application of described techniques becomes clear with one glance.


title: FIV as a Model for HIV: An Overview

text: Animal models for human immunodeficiency virus (HIV) infection play a key role in understanding the pathogenesis of AIDS and the development of therapeutic agents and vaccines. As the only lentivirus that causes an immunodeficiency resembling that of HIV infection, in its natural host, feline immunodeficiency virus (FIV) has been a unique and powerful model for AIDS research. FIV was first described in 1987 by Niels Pedersen and co-workers as the causative agent for a fatal immunodeficiency syndrome observed in cats housed in a cattery in Petaluma, California. Since this landmark observation, multiple studies have shown that natural and experimental infection of cats with biological isolates of FIV produces an AIDS syndrome very similar in pathogenesis to that observed for human AIDS. FIV infection induces an acute viremia associated with Tcell alterations including depressed CD4 :CD8 T-cell ratios and CD4 T-cell depletion, peripheral lymphadenopathy, and neutropenia. In later stages of FIV infection, the host suffers from chronic persistent infections that are typically self-limiting in an immunocompetent host, as well as opportunistic infections, chronic diarrhea and wasting, blood dyscracias, significant CD4 T-cell depletion, neurologic disorders, and B-cell lymphomas. Importantly, chronic FIV infection induces a progressive lymphoid and CD4 T-cell depletion in the infected cat. The primary mode of natural FIV transmission appears to be blood-borne facilitated by fighting and biting. However, experimental infection through transmucosal routes (rectal and vaginal mucosa and perinatal) have been well documented for specific FIV isolates. Accordingly, FIV disease pathogenesis exhibits striking similarities to that described for HIV-1 infection.


title: Intellectual Property and Human Security

text: This chapter discusses the interrelatedness between intellectual property and human security. There are two sides of this interrelationship. In the first place, IP issues are closely related to the hard security of nations. In the second place, the application of the regime of international intellectual property laws can help promote economic and social development and, at the same time, can result in major hardships when it comes to protection of the right to life and realization of the rights to health, food, and education. In the pages that follow, different aspects of these issues are explored.


title: Minimizing the Impact of Complex Emergencies on Nutrition and Geriatric Health: Planning for Prevention is Key

text: Complex emergencies (CEs) can occur anywhere and are defined as crisis situations that greatly elevate the risk to nutrition and overall health (morbidity and mortality) of older individuals in the affected area. In urban areas with high population densities and heavy reliance on power-driven devices for day-to-day survival, CEs can precipitate a rapid deterioration of basic services that threatens nutritionally and medically vulnerable older adults. The major underlying threats to nutritional status for older adults during CEs are food insecurity, inadequate social support, and lack of access to health services. The most effective strategy for coping with CEs is to have detailed, individualized pre-event preparations. When a CE occurs, the immediate relief efforts focus on establishing access to food, safe water, and essential medical services.


title: Mining Semantic Descriptions of Bioinformatics Web Resources from the Literature

text: A number of projects (myGrid, BioMOBY, etc.) have recently been initiated in order to organise emerging bioinformatics Web Services and provide their semantic descriptions. They typically rely on manual curation efforts. In this paper we focus on a semi-automated approach to mine semantic descriptions from the bioinformatics literature. The method combines terminological processing and dependency parsing of journal articles, and applies information extraction techniques to profile Web services using informative textual passages, related ontological annotations and service descriptors. Service descriptors are terminological phrases reflecting related concepts (e.g. tasks, approaches, data) and/or specific roles (e.g. input/output parameters, etc.) of the associated resource classes (e.g. algorithms, databases, etc.). They can be used to facilitate subsequent manual description of services, but also for providing a semantic synopsis of a service that can be used to locate related services. We present a case-study involving full text articles from the BMC Bioinformatics journal. We illustrate the potential of natural language processing not only for mining descriptions of known services, but also for discovering new services that have been described in the literature.


title: Multidimensional Analysis of the News Consumption of Different Demographic Groups on a Nationwide Scale

text: Examining 103,133 news articles that are the most popular for different demographic groups in Daum News (the second most popular news portal in South Korea) during the whole year of 2015, we provided multi-level analyses of gender and age differences in news consumption. We measured such differences in four different levels: (1) by actual news items, (2) by section, (3) by topic, and (4) by subtopic. We characterized the news items at the four levels by using the computational techniques, which are topic modeling and the vector representation of words and news items. We found that differences in news reading behavior across different demographic groups are the most noticeable in subtopic level but neither section nor topic levels.


title: Severe Acute Respiratory Syndrome

text: Early in 2003, an outbreak of the until then unknown severe acute respiratory syndrome (SARS) was reported in southeastern People’s Republic of China. The outbreak was thought to have first emerged in the Guangdong province in November 2002. Subsequently, the infections spread to Hong Kong (February 2003) and other countries of Southeast Asia, including Vietnam, Taiwan, and Singapore, as well as to Canada and the United States (http://www.fda.gov/oc/opacom/hottopics/sars/).


title: Noninvasive Mechanical Ventilation in Patients with High-Risk Infections and Mass Casualties in Acute Respiratory Failure: Pediatric Perspective

text: Respiratory problems are common symptoms in children and common reason for visits to the pediatric emergency department (PED) and admission to the pediatric intensive care unit (PICU). Although the great majority of cases are benign and self-limited, requiring no intervention, some patients need respiratory support. Invasive mechanical ventilation (IMV) is a critical intervention in many cases of acute respiratory failure (ARF), but there are absolute risks associated with endotracheal intubation (ETI). On the other hand, noninvasive ventilation (NIV) is an extremely valuable alternative to IMV. A major reason for the increasing use of NIV has been the desire to avoid the complications of IMV. It is generally much safer than IMV and has been shown to decrease resource utilization. Its use also avoids the complications and side effects associated with ETI, including upper airway trauma, laryngeal swelling, postextubation vocal cord dysfunction, nosocomial infections, and ventilator-associated pneumonia. There are a number of advantages of NIV including leaving the upper airway intact, preserving the natural defense mechanisms of the upper airways, decreasing the need for sedation, maintaining the ability to talk while undergoing NIV, and reducing the length of hospitalization and its associated costs [1–3].


title: What the Intensivist Needs to Know About Hematopoietic Stem Cell Transplantation?

text: Hematopoietic stem cell transplantation (HSCT) is a potential curative therapy for some patients with hematologic conditions. There are two main types of HSCT. This includes autologous HSCT, for which the stem cells are obtained from the patient, and allogeneic HSCT, for which the stem cells are obtained from a related or unrelated donor. The most common indications for autologous stem cell transplant are multiple myeloma and relapsed/refractory lymphoma, whereas leukemia and bone marrow failure syndromes remain the most common indications for allogeneic stem cell transplant. This chapter will review the different types, indications, processes, and main complications of HSCT. This chapter will also discuss end-of-life issues that patients and providers face when transplant patients are admitted for the intensive care unit.


title: Research and Application on Key Technologies of J2EE-Oriented Urban Emergency Response System

text: With experience of Emergency Response System implement, the exist problem and research status in china is analyzed. Based on these conclusions, the Emergency Response System is constructed which used the J2EE tool, faced to small and medium-size cities, moreover, the research on key technologies related in this architecture are introduced in detail.


title: Optimization of Ligand Surface Concentration for Biosensor based on Imaging Ellipsometry

text: the biosensor based on imaging ellipsometry for bio-molecular interactions has been developed for more than ten years and used to several biological applications successfully, such as detection of five markers of Hepatitis B, tumor markers and virus infection. Ligand surface concentration which might be related with its spatial configuration and bioactivity is an important factor to affect the biosensor sensitivity and dynamic range. In this investigation, IgG and its corresponding antibody are selected as a couple of model molecules for the optimization of ligand surface concentration. The optimization result of ligand surface concentration is achieved by analyzing the surface concentration increase of antigenantibody complex on sensing surface with various ligand surface concentrations.


title: Walging: ‘Het went nooit helemaal’

text: ‘Toen ik verzorgingsassistente werd, moest ik erg wennen aan al die onaangename geuren. Maar na een poosje raakte ik er meer mee vertrouwd. De poep van sommige patiënten vond ik stinken, maar van de uitwerpselen van anderen had ik weer geen enkele last. Dat was te vergelijken met de poep-en pieslucht van mijn kinderen toen die nog klein waren.’


title: Chikungunya Virus and Zika Virus Expansion: An Imitation of Dengue Virus

text: Dengue viruses are the most important arboviral pathogens in the world, which have adapted to human transmission and replication over several hundred years and were initially recognized to cause outbreaks of clinical disease in tropical and subtropical countries by Aedes aegypti mosquitoes. Subsequent global expansion of dengue infection outbreaks has occurred, with millions of cases yearly, probably from a combination of factors including proliferation of international travel and trade, possibly global climate changes, adaptation of the vectors to new environment, and emergence of a new mosquito vector, Aedes albopictus. Chikungunya virus, also transmitted by Aedes mosquitoes, causes a very similar clinical disease but with more prominent arthralgia or arthritis and was originally described in Africa in the 1960s. After a quiescent period of several decades, it reemerged in Africa in 2004 and rapidly spread across the Indian Ocean to involve Asian countries and parts of Europe. However, the past 2 years have seen the emergence of chikungunya virus in the western hemisphere with major outbreaks in the Caribbean and the Americas. Similar to dengue virus, chikungunya virus has adapted to Ae. albopictus mosquitoes which can transmit the disease. Although dengue infection is a more deadly disease especially in young children, chikungunya infection can cause prolonged severe disability and occasionally rare fatalities from encephalitis. No specific treatment is available for either diseases, but development of an effective vaccine for dengue infection is in progress. Until 2007, Zika virus [also transmitted by Aedes species] was associated with only sporadic mild infections in Africa and Asia. In 2007, Zika virus for the first time caused an outbreak beyond Africa and Asia to the Yap Island in the Federated States of Micronesia. Since then Zika virus has spread to French Polynesia, New Caledonia, Cook Islands, and Easter Island in the southeastern Pacific Ocean [Chile] in 2014 and by 2015 to Brazil. By January 2016, it became evident that Zika virus had caused an explosive outbreak in the Americas and the Caribbean with over 30 countries affected. On February 1, 2016, the World Health Organization declared Zika outbreak a global public health emergency. Zika virus infection is most commonly asymptomatic, and 20% of patients may develop a mild viral disease, but of major concern is the reported association of microcephaly in infected pregnant women in Brazil. This chapter explores the history, epidemiology, pathogenesis, clinical features, treatment, and prevention of these rapidly emerging zoonoses.


title: Impacts and Challenges of Advanced Diagnostic Assays for Transplant Infectious Diseases

text: The advanced technologies described in this chapter should allow for full inventories to be made of bacterial genes, their time- and place-dependent expression, and the resulting proteins as well as their outcome metabolites. The evolution of these molecular technologies will continue, not only in the microbial pathogens but also in the context of host-pathogen interactions targeting human genomics and transcriptomics. Their performance characteristics and limitations must be clearly understood by both laboratory personnel and clinicians to ensure proper utilization and interpretation.


title: Adsorption of Proteins at Solid Surfaces

text: Ellipsometry has a very high thin film sensitivity and can resolve sub-nm changes in the thickness of a protein film on a solid substrates. Being a technique based on photons in and photons out it can also be applied at solid-liquid interfaces. Ellipsometry has therefore found many in situ applications on protein layer dynamics but studies of protein layer structure are also frequent. Numerous ex situ applications on detection and quantification of protein layers are found and several biosensing concepts have been proposed. In this chapter, the use of ellipsometry in the above mentioned areas is reviewed and experimental methodology including cell design is briefly discussed. The classical ellipsometric challenge to determine both thickness and refractive index of a thin film is addressed and an overview of strategies to determine surface mass density is given. Included is also a discussion about spectral representations of optical properties of a protein layer in terms of a model dielectric function concept and its use for analysis of protein layer structure.


title: Case Study – Bulgaria

text: The aim of this paper is to map the current situation in Bulgaria’s public healthcare system with regard to bioterrorism response. It explores the main public health threats and focuses specifically on the changing perception of bioterrorism as a potential threat to the country. Furthermore, it explains how this perception is reflected in the existing legal framework and administrative structures. The paper makes the case for the further development of an integrated, flexible and sustainable national management system to respond effectively to emergencies and presents the major challenges for the country in this field. It makes a comparison between military and civilian agencies in their preparedness to respond to naturally occurring emergencies and threats of biological attack. This review points out the higher but still limited capacity of the military medical facilities in Bulgaria. The overall evaluation underlines the need for further strengthening of the relationship between military and civil capabilities and between public healthcare and security and law enforcement structures. As a result the authors make the case for stronger cooperation between military and civil medical facilities as well as for inter-institutional and interdisciplinary dialogue on the expert and political level on biopreparedness in Bulgaria.


title: Cisplatin Derivatives as Antiviral Agents

text: The use of polymeric derivatives of cisplatin as antiviral drugs is reviewed. Some of these drugs inhibit a wide variety of both RNA and DNA viruses including those responsible for herpes, common colds, chickenpox, and smallpox. The desirability of polymeric drugs is described as is the mode(s) of action of cisplatin itself. A description of viruses and methods of combating viruses is presented. Included is a review of current antiviral agents as well as modes of action of these antiviral agents.


title: Relevante Nebenerkrankungen zu Notfallindikationen und Notfalloperationen in der Viszeral- und Allgemeinchirurgie

text: Die Adipositas ist eine über das Normalmaß hinausgehende Vermehrung des Körperfetts und wird über den Body-Mass- Index (BMI = kg/m) bestimmt. Ab einem BMI von 30 kg/m liegt definitionsgemäß eine Adipositas vor. Der Krankheitswert ergibt sich aus der Assoziation von Folgeerkrankungen, deren Risiko mit der Prävalenzdauer und dem Schweregrad der Adipositas ansteigt (Tab. 28.1). Dabei korreliert das kardiovaskuläre Risiko besonders mit dem Vorliegen einer viszeralen Adipositas (>88/102 cm Taillenumfang bei Frauen/ Männern). Die Prävalenz der Adipositas steigt in Deutschland kontinuierlich an. Derzeit ist knapp ein Viertel der deutschen Bevölkerung als adipös einzustufen.


Pesticides


title: Predicting RNA Secondary Structures: One-grammar-fits-all Solution

text: RNA secondary structures are known to be important in many biological processes. Many available programs have been developed for RNA secondary structure prediction. Based on our knowledge, however, there still exist secondary structures of known RNA sequences which cannot be covered by these algorithms. In this paper, we provide an efficient algorithm that can handle all RNA secondary structures found in Rfam database. We designed a new stochastic context-free grammar named Rectangle Tree Grammar (RTG) which significantly expands the classes of structures that can be modelled. Our algorithm runs in O(n (6)) time and the accuracy is reasonably high, with average PPV and sensitivity over 75%. In addition, the structures that RTG predicts are very similar to the real ones.


title: Infectious Complications of Transplantation

text: Post-transplant infection is a common cause of graft deterioration, morbidity and mortality. It is also responsible for delayed discharge, multiple, often prolonged admissions and thus a significant clinical challenge. Infections can be donor derived, pre-existing in the recipient, nosocomial and opportunistic. For each of these categories, it is often possible to significantly reduce hazard and thus the adverse consequences by first identifying patients at high risk. As always, clinical vigilance is vital, but equally important is the establishment of robust clinical systems for prevention, screening and rapid treatment.


title: Immunohistochemical Staining for Detection of Porcine Epidemic Diarrhea Virus in Tissues

text: Porcine epidemic diarrhea virus (PEDV), a member of the genus Alphacoronavirus, has resulted in significant economic losses in the European, Asian, and North American swine industries in previous years. PEDV infection causes acute diarrhea/vomiting, dehydration, and high morbidity and mortality in seronegative neonatal piglets. In this chapter, materials and methods for performing immunohistochemistry (IHC) for the detection of PEDV antigens in frozen or formalin-fixed, paraffin-embedded (FFPE) tissues are provided. In IHC of frozen tissues where viral antigens are well preserved, the use of specific antibodies labeled with fluorescence dyes provides excellent advantages and convenience, resulting in high sensitivity and specificity of IHC and reduction of operation time. In IHC of FFPE tissues where tissue or cell morphology is well preserved, the use of specific antibodies labeled with enzymes, such as alkaline phosphatase, also gives rise to significant advantages in defining the correlation of viral antigens with histopathologic lesions. PEDV antigens in frozen tissues are visualized as green staining in the cytoplasm of infected cells by fluorescent dyes conjugated with antibodies when activated by exciting light of a specific wavelength under a fluorescence microscope. In FFPE tissues, PEDV antigens are visualized as red staining in the cytoplasm of infected cells by the deposition of the substrate chromogen, Fast Red.


title: Systemic and Systematic Risk

text: The main goal of any risk management practice is to be able to insure an acceptable level of predictability in order to gain a lead-time to mitigate a possible risk. However, until new risk management approaches are employed to fill the gap between the known and unknown, most crises will continue to come as a surprise. Risk is latent until an external event or an internal process will reveal its existence. Predictive analysis is an indispensable tool that can help decision makers preemptively test all possible or even some perceived impossible operational scenarios before a risk transforms into crisis or disaster. To be prepared is a better position than to discover the risk too late for business continuity or disaster recovery measures. In this way, predictive emulation becomes necessary for appropriate risk mitigation.


title: Diseases with Limited Research of Plant-Based Vaccines

text: There are a number of diseases which are important globally in terms of the effect they have on livestock but for which the development of recombinant plant-produced vaccines is preliminary. For many of these diseases such as bovine viral diarrhoea (BVD), bovine rotavirus (BRV), bovine herpes (BoH), transmissible gastroenteritis (TGE) in pigs, infectious bronchitis (IB) in chickens, bluetongue (BT) in sheep, Rift Valley fever (RVF) in sheep and coccidiosis in chickens, commercially available live-attenuated or killed vaccines are available. Although most are effective to varying degrees, there are numerous issues with manufacture and potential reassortment of the vaccine strains. For some diseases such as bovine papillomavirus (BPV) infections and Crimean-Congo haemorrhagic fever (CCHF), there are no commercially available vaccines, and limited studies have been conducted on their development. This chapter discusses some of the research developments in plant-produced vaccine candidates which have potential for further development towards commercialisation.


title: IDENTIFICATION AND CHARACTERIZATION OF BIOLOGICAL RISKS FOR WATER

text: Life on this planet is dependent on water but our health is greatly impacted by the quality of that water. The global water crisis is clear, one only needs to quote the statistics on the billions of people without access to safe water, sanitation and the global estimates of the burden of waterborne disease. The greatest sources of biological contaminants associated with this disease burden in water remains human and animal feces. There is a critical need to develop a science-based program to address both water quantity and quality of water, water uses and discharges. Recommendations to achieve better access to scientific information for decision making include: 1) develop watershed approaches for determining the source and the behaviour of water-borne biological contaminants which can be used within Water Safety Plans, 2) utilize new tools and technologies for measuring the hazards and the exposure within a risk assessment framework and 3) develop a global data base and goals for biological contaminant loading for achieving safe water.


title: Viral bioinformatics

text: Pathogens have presented a major challenge to individuals and populations of living organisms, probably as long as there has been life on earth. They are a prime object of study for at least three reasons: (1) Understanding the way of pathogens affords the basis for preventing and treating the diseases they cause. (2) The interactions of pathogens with their hosts afford valuable insights into the working of the hosts’ cells, in general, and of the host’s immune system, in particular. (3) The co-evolution of pathogens and their hosts allows for transferring knowledge across the two interacting species and affords valuable insights into how evolution works, in general. In the past decade computational biology has started to contribute to the understanding of host-pathogen interaction in at least three ways which are summarized in the subsequent sections of this chapter.


title: History of Influenza Pandemics

text: Influenza pandemics have been amongst the largest and the deadliest epidemics in the history of man, and were observed already in ancient times. For example, records from the fifth century B.C. suggest that influenza pandemics were observed in ancient Greece. In Europe, during the Middle Ages and the Renaissance, numerous concordant reports from different countries describe epidemics of respiratory infections that resemble influenza pandemics. However, it is not possible to be certain that these epidemics were due to influenza. In the twentieth century, three influenza pandemics have occurred, including the deadly Spanish flu pandemic. Modern virology has unravelled the mechanisms of emergence of pandemic viruses, and considerable knowledge on influenza viruses has been accumulated. The picture is now clear: influenza A is a zoonotic virus whose reservoir is in wild birds. In rare cases, these avian viruses are introduced into man and, eventually, become pandemic viruses. Although these mechanisms are now understood, the time frame required for adaptation of the avian virus to its new host remains unknown. Maybe the next pandemic will show us how rapid this adaptation can be.


title: Environmental Toxicology: Children at Risk

text: Children today live in a world that is vastly different from a few generations ago. While industrialization has maximized (for many) children’s opportunities to survive, develop and enjoy high levels of health, education, recreation, and fulfillment, it has also added significant challenges to their development.


title: Viral Infections of the Central Nervous System

text: Viral-mediated central nervous system (CNS) disease is a complex spectrum of clinical syndromes that result from viral tropism and individual immune responses and genetic susceptibility of patients. The epidemiology of the pathogens is constantly influenced by the availability, or non-availability, of health care services; preventative strategies; and the process of globalization, with rapid movement of people, animals and products. It is further complicated by natural disasters, wars and changes in lifestyle. The effects of the neurotropic viruses are discussed against the background of the epidemiology. The pathogenesis is a chain of events with the point of departure when the virus enters the body to spread and reach the different sites of the CNS. The blood-brain barrier and blood-cerebrospinal fluid barrier are then overcome by captivating mechanisms. Once the different viruses have settled at the preferred site or sites, and have sidestepped the initial immune surveillance, the phases of injury commence. The cytopathic effect of the viruses elicits a para- and post-infectious inflammatory response and a vicious circle of continued damage, viral entry and inflammation results in a process not merely of inflammation, but of intense inflammation. The different clinical syndromes are then identifiable and should be interpreted against their own specific and appropriate epidemiological backgrounds. Clinicians face the challenge of problematic management decisions while awaiting results on gravely ill patients and differential diagnostic considerations have to be taken into account. Establishing a diagnosis is a two-tier process: first it requires the integration of cerebrospinal fluid findings, imaging results, electrophysiological studies, serology and ancillary blood tests, for example full blood count, liver function tests and other appropriate microbiological investigations, and then these should be correlated with the clinical condition of the patient. Treatment should be initiated as soon as possible. General treatment principles for stabilizing and maintaining vital functions are crucial and empiric treatment should be initiated as soon as possible. This usually includes a broad-spectrum antibiotic, such as third-generation cephalosporin and acyclovir. As soon as specific etiologies have been excluded antibiotics can be stopped. The use of acyclovir is discussed. In the last section of the chapter specific characteristics of the neurotropic viral families are summarized.


title: Infectious Diseases and the Kidney in Children

text: The kidney is involved in a wide range of bacterial, viral, fungal, and parasitic diseases. In most systemic infections, renal involvement is a minor component of the illness, but in some, renal failure may be the presenting feature and the major problem in management. Although individual infectious processes may have a predilection to involve the renal vasculature, glomeruli, interstitium, or collecting systems, a purely anatomic approach to the classification of infectious diseases affecting the kidney is rarely helpful because most infections may involve several different aspects of renal function. In this chapter, a microbiological classification of the organisms affecting the kidney is adopted. Although they are important causes of renal dysfunction in infectious diseases, urinary tract infections and hemolytic uremic syndrome (HUS) are not discussed in detail because they are considered separately in chapters XX and XX, respectively.


title: Oligonucleotide and DNA Microarrays: Versatile Tools for Rapid Bacterial Diagnostics

text: The rapid and unambiguous detection and identification of microorganisms, historically a major challenge of clinical microbiology, gained additional importance in the fields of public health and biodefence. These requirements cannot be well addressed by classical culture-based approaches. Therefore, a wide range of molecular approaches has been suggested. Microarrays are molecular tools that can be used for simultaneous identification of microorganisms in clinical and environmental samples. Main advantages of microarrays are high throughput, parallelism and miniaturization of the detection system. Furthermore, they allow for both high specificity and high sensitivity of the detection. Microarrays consist of set of probes immobilized on a solid surface. Even though the first application of the microarrays can be seen as relatively recent (Schena et al. 1995), the technology developed rapidly reaching the milestone of 5,000 published papers in 2004 (Holzman and Kolker 2004). This development encompasses both the successful transfer of various technological aspects as well as the expansion of the application scope. The most important technological elements of custom-made platforms as well as the characteristics of the commercially available formats are reviewed in this chapter. Furthermore, application potential is presented together with considerations about quality control.


title: Industrial Production of Therapeutic Proteins: Cell Lines, Cell Culture, and Purification

text: A central pillar of the biotechnology and pharmaceutical industries continues to be the development of biological drug products manufactured from engineered mammalian cell lines. Since the hugely successful launch of human tissue plasminogen activator in 1987 and erythropoietin in 1988, the biopharmaceutical market has grown immensely. In 2014, biotherapeutics made up a significant portion of global drug sales as 7 of the top 10 and 21 of top 50 selling pharmaceuticals in the world were biologics with over US$100 billion in global sales (Table 1, [1]).


title: The Lung and Its Transplantation and Artificial Replacement

text: The human thoracic cavity houses a pair of lungs, the left lung and the right lung. The left lung is slightly smaller (since the heart is placed a bit to the left in the body) and has two lobes, and the right lung is bigger, with three lobes. They are spongy and elastic organs that are broad at the bottom and taper at the top. They consist of air sacs, the alveoli. Many alveoli group together and open into a common space. From this space arise the alveolar ducts, which join together to form bronchioles. The bronchioles connect them to the respiratory tract. The lungs also have blood vessels, the branches of the pulmonary artery and veins (Fig. 15.1).


title: Angiotensin II Signaling in Vascular Physiology and Pathophysiology

text: Initially recognized as a physiologic regulator of blood pressure and body fluid homeostasis, angiotensin (Ang) II has now been shown in innumerable experiments and clinical studies to contribute to the development and maintenance of cardiovascular disease. Dissection of its signaling mechanisms over the past decades has led to the discovery of several novel concepts, such as tissue-specific metabolism of Ang peptides. Identification and cloning of the various receptors through which Ang II acts on almost all tissues has led to the development of specific pharmacologic inhibitors with proven clinical benefit in patients with cardiovascular disorders. Work on the G-protein-coupled Ang II Type 1 receptor has demonstrated that different receptors interact through oligomerization, compartmentalization, and transactivation, and may explain how Ang II can activate G-protein-independent pathways. Unraveling the downstream effects of Ang II in specific cell types corroborates the importance of the cellular redox state on certain signaling pathways. Finally, the effects of Ang II on cell function and phenotype, such as the expression of inflammatory cytokines and receptors promoting the recruitment of inflammatory cells into vascular tissues, have indicated its role in local inflammation as a general pathogenetic basis of cardiovascular disease. The recognition of Ang II as a contributor to such fundamental pathophysiologic mechanisms, which are believed to be a common pathway for diverse cardiovascular risk factors like hypertension and diabetes, has greatly advanced our knowledge of pathologic signaling in vascular tissues and may help to eventually define novel targets for pharmacologic interventions.


title: Hemorrhage and Transfusions in the Surgical Patient

text: Hemorrhage is the leading cause of intraoperative deaths. Many cardiovascular and hepatobiliary procedures result in massive hemorrhage and postpartum hemorrhage events in labor and delivery place the patient at a high risk for mortality. Gastrointestinal bleeding from diverticulosis, varices, and ulcer disease can result in significant blood loss requiring massive transfusion and resuscitation from hemorrhagic shock. Timely and effective transfusion of blood products is of critical in these scenarios. The frequency in which blood component products are transfused in surgical patients begs for a greater understanding of them. The aim of this chapter is to provide clinicians with a discussion of the current literature on the various blood component products, their indications, and unique hemostatic conditions in the surgical patient. While the majority of data concerning optimal management of acquired coagulopathy and hemorrhagic shock resuscitation is based on trauma patients, many of the principles can and should be applied to the surgical patient (or likely any patient) with profound hemorrhage.


title: Blood Products Transfusion

text: Transfusion of blood products may be required during the perioperative period. Despite a well-established safety record, transfusion of blood and its components is not risk free. Indication for each of the blood components needs to be established based on the laboratory investigation and/or clinical picture. In general terms, when there is a clinical evidence of a deficiency in oxygen-carrying capacity, red cell transfusion should be considered; and in the situations of clinically significant coagulopathy, hemostatic blood products (frozen plasma, platelets, cryoprecipitate, factor concentrates) transfusion should be considered. Complications of blood administration range from rare but severe reactions (hemolytic transfusion reactions) to more common, and also associated with significant morbidity and mortality, such as transfusion-related acute lung injury (TRALI), transfusion-related circulatory overload (TACO), and changes in immune system (transfusion related immunomodulation [TRIM]).


title: Medical Management of Acute Liver Failure

text: Pediatric acute liver failure is a rapidly progressive, life-threatening, and devastating illness in children without preexisting liver disease. Due to the rarity and heterogeneity of this syndrome, there is a significant lack of data to guide evaluation and management of this disease. Most of our practice is extrapolated from adult literature and guidelines. This leads to significant controversies in medical management of acute liver failure in children. With advances in critical care, there has been a tremendous improvement in outcomes with decreased morbidity and mortality; however, there is a dire need for more research in this field. This chapter discusses challenges as well as controversies in diagnostic evaluation and management of this rare but potentially fatal disease. Latest developments in supportive care of liver failure, including advances in the area of liver support systems, are also discussed.


title: Corynebacterium diphtheriae

text: Diphtheriebakterium


title: Medical Classifications and Terminologies

text: This chapter presents the different medical classifications and terminologies as ICD diagnosis codes, SNOMED CT, MeSH, UMLS, ATC etc.


title: Replication Cycle of Astroviruses

text: Astrovirus infections cause gastroenteritis in mammals and have been identified as causative agents of diverse pathologies in birds such as hepatitis in ducks and poult enteritis mortality syndrome (PEMS), which causes enteritis and thymic and bursal atrophy in turkeys. Human astroviruses are recognized as the second leading cause of childhood viral gastroenteritis worldwide. Eight traditional astrovirus serotypes have been identified in humans, but recently novel astrovirus strains isolated from humans have been associated with diseases other than gastroenteritis. Herein we summarize our current knowledge of the astrovirus life cycle. Though there are gaps in our understanding of astrovirus replication, similarities can be drawn from Picornaviridae and Caliciviridae virus families. There are, however, unique characteristics of the astrovirus life cycle, including intracellular proteolytic processing of viral particles by cellular caspases, which has been shown to be required for the maturation and exit of viral progeny.


title: 1 Inleiding

text: In augustus 2011 wijdde de Journal of the American Medical Association (JAMA) een redactioneel commentaar aan het groeiende probleem van morbide obese kinderen: kinderen die aan een dusdanig ernstige obesitas lijden dat hun gezondheid er direct door wordt bedreigd. In toenemende mate wordt bij deze kinderen zogenoemde bariatrische chirurgie toegepast, waarbij een maagband of een maagbypass wordt aangebracht om de voedselopname te verminderen. In het redactionele commentaar werd de vraag opgeworpen of voor deze kinderen niet een alternatieve benadering moet worden overwogen, namelijk het uit de ouderlijke macht ontzetten van hun ouders. In de Verenigde Staten is dit al een aantal malen daadwerkelijk gebeurd, zoals bij het 4 jaar oude en 138 pond wegende meisje Cory Andis.


title: RNA Interference: RNAid for Future Therapeutics?

text: RNA interference (RNAi) is an evolutionarily conserved phenomenon of double-stranded (ds)RNA-mediated mRNA degradation that leads to the posttranscriptional silencing of the corresponding gene. First reports on RNAi emerged in 1998, and since then, it has become one of the most fascinating fields of molecular biology. RNAi has provided important insights about the diversity of RNA molecules and their implication in many biological processes such as the regulation of developmental genes in eukaryotic organisms. Furthermore, RNAi has rapidly developed into a powerful instrument with a great potential for functional genomics and therapeutic applications by silencing normal and disease-related gene functions. To date, the use of RNAi for genetic-based therapies is widely studied, especially in viral infections, cancers, and inherited genetic disorders. Despite the many unanswered questions on how this technology can be efficiently applied to humans, the development of novel approaches, such as vaccines or novel delivery agents, is certainly one of the major goals in RNAi research.


title: Advancements in Parasite Diagnosis and Challenges in the Management of Parasitic Infections: A Mini Review

text: Intestinal parasitic infections (IPIs) remain a widespread public health concern causing severe implications in both developed and developing countries. Globally, numerous studies have been carried out ranging from various communities to schoolchildren as well as indigenous communities. The infections are commonly caused by helminths (e.g. Ascaris lumbricoides, Trichuris trichiura and hookworm) and protozoa (e.g. Blastocystis hominis, Cryptosporidium sp., Entamoeba histolytica and Giardia duodenalis). Poor sanitation and poverty are some of the factors associated with IPIs. With the ever-increasing impact of IPIs, newer detection approaches have been developed and studied. The efficacy of diagnostic method is crucial to give an accurate identification of these parasites. Recent developments of diagnostic tools such as serology- and molecular-based assays are assisting the conventional method of microscopy in detecting and further confirming current or past infections and the specific species of parasites. Ongoing investigations in parasitic infections using these advanced tools will provide useful information that will enable the evaluation of the effectiveness of the current control program and thus, assist future planning for improved strategies in eradicating these parasitic infections.


title: 22 Levertransplantatie

text: In 1963 verrichtte Thomas Starzl in Denver de eerste levertransplantatie bij de mens. In 1966 werden in Nederland de eerste twee (auxiliaire, zie par. 22.3.6) levertransplantaties verricht in Leiden en Arnhem, in 1968 startte Cambridge. Helaas resulteerden de eerste levertransplantaties niet in langetermijnoverleving als gevolg van niet-optimale operatietechniek, matige immuunsuppressie en onbekendheid met complicaties.


title: Bronchitis and Pneumonia

text: The incidence, morbidity, and mortality of both bronchitis and pneumonia are high in older adults and increase with age. The clinical manifestations of bronchitis and pneumonia in older adults may not be typical (e.g., cough, fever, dyspnea). Many older adults, particularly nursing home residents, may present with altered mental status and with or without fever. Obtaining a chest X-ray is often critical to make the distinction between the two clinical entities. Unique risk factors for pneumonia in older adults include multiple comorbidities (e.g., COPD, DM, CHF), poor oral hygiene, lack of vaccinations (e.g., S. pneumoniae, influenza), and swallowing difficulty. Empirical treatment decisions for pneumonia should be based on site of care. Recent information suggests that in-home therapy for community dwellers and therapy within the nursing home for long-term care residents is feasible with good outcomes in selected patients. Prevention strategies for pneumonia should be targeted towards providing vaccinations, improving oral hygiene, and improving swallowing difficulty.


title: Viruses Present Indoors and Analyses Approaches

text: Through human history viruses have shown enormous epidemiological and pandemic potential as the occurrence and spread of viruses in pandemic dimensions poses a threat to the health and lives of seven billion people worldwide. Scientific evidence has associated harmful health effects to indoor air hazards recognizing the existence of a vital concern in public health sector. Thus the assessment of human exposure to biological aerosols and droplets indoor became an imperative requirement of investigation. Environmental bioburden assessment of viruses relies in both culture-dependent approaches that comprise classical methodologies, still prominent and vital in the field of modern biotechnology, and culture-independent approaches based on nucleic acid amplification techniques, which are considered the gold standard in clinical virology. The main factor influencing indoor microbiology is the human being and their activities. Indoor environments to be considered are those regularly occupied by humans: residences, offices, schools, industrial buildings, health care facilities, farming activities and other settings occupied all the time, or in which occupant density is high. It’s well known that approximately 60% of total human respiratory and gastrointestinal infections are acquired indoor, since viruses have a rapid spread in the community and can be transmitted easily, especially in crowded and poorly ventilated environments, causing high morbidity and decline in quality of life and productivity. Studies have shown that respiratory syncytial virus, rhinovirus, metapneumovirus, influenza and parainfluenza virus, and human enterovirus infections may be associated with virus-induced asthma, leading to diseases such as pneumonia. Gastroenteritis infectious (about 30±40% of cases) is attributable to viruses. Rotavirus, Astrovirus, Norwalk-like viruses and other caliciviruses are responsible for 48% of all reported outbreaks of infectious intestinal disease. Safe working conditions are essential for healthy living, that’s why the programmes conceived as a result of strategic and preventive policy maintenance, in refrigeration and ventilation systems, are the determining factor for the control of biological pollutants. Moreover, the development of highly sensitive and specific detection and identification methodologies with capacity to be used in diverse applications, such as diagnosis, public health risk assessment, research and for the implementation of preventive measures and protocols are imperative.


title: Diagnosis and Monitoring of Infections

text: As molecular techniques for identifying and detecting microorganisms in the clinical microbiology laboratory have become routine, questions about the cost of these techniques and their contribution to patient care need to be addressed. Molecular diagnosis is most appropriate for infectious agents that are difficult to detect, identify, or test for susceptibility in a timely fashion with conventional methods. During the last 10 years, the detection of infectious disease agents has begun to include the use of nucleic acid-based technologies. Diagnosis of infection caused by parasitic organisms is the last field of clinical microbiology to incorporate these techniques and molecular techniques (e.g., PCR and hybridization assays) have recently been developed for the detection, species differentiation, and phylogenetic analysis.


title: Management of Burns and Anesthetic Implications

text: Burn injuries are highly complex and affect almost every major organ system in the body. The treatment of burn patients requires the presence of a well-organized team of caregivers who understand the multifaceted consequences of burn injuries and who are adept at coordinating care. An understanding of the multitude of abnormalities that must be addressed helps to guide therapy in these patients. Careful anesthetic and perioperative management of these patients carries special importance in this fragile patient population as a part of their often lengthy recovery and rehabilitation.


title: Case Study – Italy

text: After the peak of interest in 2001, the threat of bioterrorism is now considered just one of the diverse risks Italy’s society faces endangering public health. Without major investments, the effort has been to integrate existing resources, to implement tight links among national and supranational agencies and to make plans for their most efficient involvement in case of need. The mainstay for the response to a biological attack is represented by the public health system, entrusted to Italy’s national health service, centrally coordinated but put into action by the Regions. The emerging threat of emerging infectious diseases and of bioterrorism has shown the need for a change in the education curricula of sanitary professions and for specific training of first line operators. Specific courses have been activated by universities and other bodies, but attendance has been limited by the lack of ad hoc funds.


title: Viren überlisten: Globale Virusinfektionen werden beherrschbar – aber neue Gefahren drohen

text: Infektionen begleiten und beschäftigen die Menschheit seit vielen Jahrhunderten. Derzeit zählen allein fünf von den zehn häufigsten Todesursachen weltweit zu den Infektionskrankheiten. Oft ausbruchsartig haben besonders Viruserkrankungen seit dem Beginn aufgezeichneter Historie viele Todesopfer gefordert, so zum Beispiel die „Spanische Grippe“ 1918 (Influenzavirus), AIDS (Human Immunodeficiency Virus) und erst vor Kurzem in bisher nie gesehenem Ausmaß das Ebolavirus. Warum besonders virale Erreger für die Wissenschaft ein große Herausforderung darstellen und wie virale Erreger das menschliche Immunsystem überlisten, zeigen die folgenden Überlegungen. Das Kapitel beschreibt darüber hinaus an konkreten Beispielen erfolgreiche Gegenmaßnahmen im Kampf gegen Viren.


title: Population and Public Health

text: The role of public health is to contribute to the health of the public through assessment of health and health needs, policy formulation, and assurance of the availability of services. While the scope of a medical manager’s work and training is different from that of a public health physician, most will often find that their work overlaps quite significantly, especially when the manager’s influence starts to go beyond his or her own organisation. It is thus important for medical managers who contribute to the development of health systems, to understand key public health issues that face Australia in the coming years.


title: 5 Koorts bij volwassenen

text: Koorts wordt bij niet-immuungecompromitteerde volwassenen in de eerste lijn zonder recent verblijf in het buitenland meestal veroorzaakt door een luchtweginfectie. Bij ouderen vormen urineweginfecties een relatief frequente oorzaak van koorts. Bij ontbreken van richtinggevende voorgeschiedenis, klachten of verschijnselen volstaat men in eerste instantie met lichamelijk onderzoek van KNO-gebied en longen. Bij negatieve bevindingen volgt urineonderzoek. Wanneer geen afwijkingen gevonden worden, gaat men uit van een onschuldige virale oorzaak. Bij een ernstig zieke indruk of verminderd bewustzijn is het lichamelijk onderzoek allereerst gericht op eventuele stoornissen in de vitale functies, omdat deze onmiddellijke therapeutische implicaties hebben. Als de koorts een week aanhoudt of eerder bij verandering van het beeld, dient een uitgebreide anamnese en algemeen lichamelijk onderzoek plaats te vinden om diagnostische aanknopingspunten op te sporen. Ook kan de arts dan aanvullend onderzoek laten verrichten: in eerste instantie bloed-, urine- en fecesonderzoek en een X-thorax, eventueel gevolgd door X-sinussen en een mantouxreactie. Medicatie wordt zoveel mogelijk gestaakt om een allergie aan te tonen of uit te sluiten. Na enkele dagen herhaalt men anamnese en lichamelijk onderzoek. Twee weken onbegrepen koorts is reden voor verdere (poli)klinische evaluatie. Concrete aanwijzingen op grond van steeds herhaalde anamnese en lichamelijk onderzoek zijn richtinggevend voor de inzet van complex aanvullend onderzoek. Dit bestaat onder meer uit bloedkweken, uitgebreider bloedonderzoek, leverbiopsie, beenmergpunctie en CT-scan buik en thorax. Bij patiënten ouder dan 55 jaar met koorts en een verhoogde bezinking is een biopsie van de arteria temporalis zinvol.


title: Identity Health

text: Identity health has especially specific meanings for social relationships in contemporary digital age. First, computerized digital communication makes many citizens in severe maladaptation. The WHO often warns mental addictions of internet usages and online gaming among the youth. The advent of social media and online networking has endangered them in ambiguous situations which are not stabilizing in those basic grounds for human relationships. Further, because social networking sites and social gaming frequently enforce each member to interconnect with the others, many of participating members often hold harder mental debts to respond and maintain their interconnections. In this situation, in other words, it can say that all of users simultaneously might share common conditions under mental illness.


title: The Role of T Cells in Corona-Virus-Induced Demyelination

text: Mice infected with neurotropic strains of coronavirus develop acute encephalomyelitis and eliminate infectious virus. However, control of acute infection is incomplete resulting in persistence of viral RNA in the central nervous system (CNS) associated with ongoing primary demyelination. A high prevalence of virus specific CD8 and CD4 T cells within the CNS correlates with ex vivo cytolytic activity and IFN-γ secretion, which are both required for virus reduction during the acute infection. Although most infected cell types are susceptible to perforin mediated clearance, IFN-γ is required for controlling infection of oligodendrocytes. Furthermore, by enhancing class I expression and inducing class II expression within resident CNS cells IFN-γ optimizes T cell receptor dependent functions. In addition to its direct anti viral activity, these multifactorial effects make IFN-γ more essential than perforin for viral control. CD4 T cells enhance CD8 T cell expansion, survival and effectiveness. Although both CD8 and CD4 T cells are retained within the CNS during persistence, they cannot control viral recrudescence in the absence of humoral immunity. Demyelination can be mediated by either CD8 or CD4 T cells; however, although a variety of effector molecules have been excluded, a dominant common denominator remains elusive. Thus concerted efforts to control infection coincide with a variety of potential mechanisms causing chronic demyelinating disease.