As of 24 April 2020, the SARS-CoV-2 epidemic has resulted in over 830,000 confirmed infections in the United States
. The incidence of COVID-19, the disease associated with this new coronavirus, ...continues to rise. The epidemic threatens to overwhelm healthcare systems, and identifying those regions where the disease burden is likely to be high relative to the rest of the country is critical for enabling prudent and effective distribution of emergency medical care and public health resources. Globally, the risk of severe outcomes associated with COVID-19 has consistently been observed to increase with age
. We used age-specific mortality patterns in tandem with demographic data to map projections of the cumulative case burden of COVID-19 and the subsequent burden on healthcare resources. The analysis was performed at the county level across the United States, assuming a scenario in which 20% of the population of each county acquires infection. We identified counties that will probably be consistently, heavily affected relative to the rest of the country across a range of assumptions about transmission patterns, such as the basic reproductive rate, contact patterns and the efficacy of quarantine. We observed a general pattern that per capita disease burden and relative healthcare system demand may be highest away from major population centers. These findings highlight the importance of ensuring equitable and adequate allocation of medical care and public health resources to communities outside of major urban areas.
The twenty-first century has witnessed a wave of severe infectious disease outbreaks, not least the COVID-19 pandemic, which has had a devastating impact on lives and livelihoods around the globe. ...The 2003 severe acute respiratory syndrome coronavirus outbreak, the 2009 swine flu pandemic, the 2012 Middle East respiratory syndrome coronavirus outbreak, the 2013-2016 Ebola virus disease epidemic in West Africa and the 2015 Zika virus disease epidemic all resulted in substantial morbidity and mortality while spreading across borders to infect people in multiple countries. At the same time, the past few decades have ushered in an unprecedented era of technological, demographic and climatic change: airline flights have doubled since 2000, since 2007 more people live in urban areas than rural areas, population numbers continue to climb and climate change presents an escalating threat to society. In this Review, we consider the extent to which these recent global changes have increased the risk of infectious disease outbreaks, even as improved sanitation and access to health care have resulted in considerable progress worldwide.
It is the first monograph-length study of the force-feeding of hunger strikers in English, Irish and Northern Irish prisons. It examines ethical debates that arose throughout the twentieth century ...when governments authorised the force-feeding of imprisoned suffragettes, Irish republicans and convict prisoners. It also explores the fraught role of prison doctors called upon to perform the procedure. Since the Home Office first authorised force-feeding in 1909, a number of questions have been raised about the procedure. Is force-feeding safe? Can it kill? Are doctors who feed prisoners against their will abandoning the medical ethical norms of their profession? And do state bodies use prison doctors to help tackle political dissidence at times of political crisis?
Therapeutic Targeting of the Colorectal Tumor Stroma Fridman, Wolf H.; Miller, Ian; Sautès-Fridman, Catherine ...
Gastroenterology,
January 2020, 2020-01-00, 20200101, 2020, Letnik:
158, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Colorectal tumors have been classified based on histologic factors, genetic factors, and consensus molecular subtypes, all of which affect the tumor microenvironment. Elements of the tumor ...microenvironment serve as therapeutic targets and might be used as prognostic factors. For example, immune checkpoint inhibitors are used to treat tumors with microsatellite instability, and anti-angiogenic agents may be used in combination with other drugs to slow or inhibit tumor growth. We review the features of the colorectal tumor stroma that are associated with patient outcomes and discuss potential therapeutic agents that target these features.
The Dravet syndrome is a complex childhood epilepsy disorder that is associated with drug-resistant seizures and a high mortality rate. We studied cannabidiol for the treatment of drug-resistant ...seizures in the Dravet syndrome.
In this double-blind, placebo-controlled trial, we randomly assigned 120 children and young adults with the Dravet syndrome and drug-resistant seizures to receive either cannabidiol oral solution at a dose of 20 mg per kilogram of body weight per day or placebo, in addition to standard antiepileptic treatment. The primary end point was the change in convulsive-seizure frequency over a 14-week treatment period, as compared with a 4-week baseline period.
The median frequency of convulsive seizures per month decreased from 12.4 to 5.9 with cannabidiol, as compared with a decrease from 14.9 to 14.1 with placebo (adjusted median difference between the cannabidiol group and the placebo group in change in seizure frequency, -22.8 percentage points; 95% confidence interval CI, -41.1 to -5.4; P=0.01). The percentage of patients who had at least a 50% reduction in convulsive-seizure frequency was 43% with cannabidiol and 27% with placebo (odds ratio, 2.00; 95% CI, 0.93 to 4.30; P=0.08). The patient's overall condition improved by at least one category on the seven-category Caregiver Global Impression of Change scale in 62% of the cannabidiol group as compared with 34% of the placebo group (P=0.02). The frequency of total seizures of all types was significantly reduced with cannabidiol (P=0.03), but there was no significant reduction in nonconvulsive seizures. The percentage of patients who became seizure-free was 5% with cannabidiol and 0% with placebo (P=0.08). Adverse events that occurred more frequently in the cannabidiol group than in the placebo group included diarrhea, vomiting, fatigue, pyrexia, somnolence, and abnormal results on liver-function tests. There were more withdrawals from the trial in the cannabidiol group.
Among patients with the Dravet syndrome, cannabidiol resulted in a greater reduction in convulsive-seizure frequency than placebo and was associated with higher rates of adverse events. (Funded by GW Pharmaceuticals; ClinicalTrials.gov number, NCT02091375 .).
It is widely known that such Western institutions as the museum, the university, and the penitentiary shaped Japan’s emergence as a modern nation-state. Less commonly recognized is the role played by ...the distinctly hybrid institution—at once museum, laboratory, and prison—of the zoological garden. In this eye-opening study of Japan’s first modern zoo, Tokyo’s Ueno Imperial Zoological Gardens, opened in 1882, Ian Jared Miller offers a refreshingly unconventional narrative of Japan’s rapid modernization and changing relationship with the natural world. As the first zoological garden in the world not built under the sway of a Western imperial regime, the Ueno Zoo served not only as a staple attraction in the nation’s capital—an institutional marker of national accomplishment—but also as a site for the propagation of a new “natural” order that was scientifically verifiable and evolutionarily foreordained. As the Japanese empire grew, Ueno became one of the primary sites of imperialist spectacle, a microcosm of the empire that could be traveled in the course of a single day. The meaning of the zoo would change over the course of Imperial Japan’s unraveling and subsequent Allied occupation. Today it remains one of Japan’s most frequently visited places. But instead of empire in its classic political sense, it now bespeaks the ambivalent dominion of the human species over the natural environment, harkening back to its imperial roots even as it asks us to question our exploitation of the planet’s resources.
Evidence that climate change will impact the ecology and evolution of individual plant species is growing. However, little, as yet, is known about how climate change will affect interactions between ...plants and their pathogens. Climate drivers could affect the physiology, and thus demography, and ultimately evolutionary processes affecting both plant hosts and their pathogens. Because the impacts of climate drivers may operate in different directions at different scales of infection, and, furthermore, may be nonlinear, abstracting across these processes may mis-specify outcomes. Here, we use mechanistic models of plant-pathogen interactions to illustrate how counterintuitive outcomes are possible, and we introduce how such framing may contribute to understanding climate effects on plant-pathogen systems. We discuss the evidence-base derived from wild and agricultural plant-pathogen systems that could inform such models, specifically in the direction of estimates of physiological, demographic and evolutionary responses to climate change. We conclude by providing an overview of knowledge gaps and directions for future research in this important area. This article is part of the theme issue 'Infectious disease ecology and evolution in a changing world'.
Digital imaging andprocessing are shown to open new methods of paper research. Early Balticprinted books are the examples in Revealing Watermarks, which alsodescribes how to enhance security, by ...creating and archiving a digital'fingerprint'. Thus thefts are deterred and stolen items can be uniquelyidentified for return.
Objectives To establish standards for early, cost-effective and accurate diagnosis, optimal therapies for seizures, and recommendations for evaluation and management of comorbidities for children and ...adults with Dravet syndrome, using a modified Delphi process. Methods An Expert Panel was convened comprised of epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise as well as results of a literature review which was forwarded to each panelist. Three rounds of on-line questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. Results The Panel consisted of 13 physicians and 5 family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of EEG and MRI findings, need for genetic testing, critical information which should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for co-morbidity screening and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated co-morbidities. Beyond initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. Conclusions We were able to identify areas where there was strong consensus that we hope will (a) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (b) support reimbursement from insurance companies for genetic testing and Dravet-specific therapies, and (c) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies.
The Upper Cretaceous (Campanian Stage) Kaiparowits Formation of southern Utah, USA, preserves abundant plant, invertebrate, and vertebrate fossil taxa. Taken together, these fossils indicate that the ...ecosystems preserved in the Kaiparowits Formation were characterized by high biodiversity. Hundreds of vertebrate and invertebrate species and over 80 plant morphotypes are recognized from the formation, but insects and their associations with plants are largely undocumented. Here, we describe a new fossil leaf taxon, Catula gettyi gen et. sp. nov. in the family Lauraceae from the Kaiparowits Formation. Catula gettyi occurs at numerous localities in this deposit that represent ponded and distal floodplain environments. The type locality for C. gettyi has yielded 1,564 fossil leaf specimens of this species, which provides the opportunity to circumscribe this new plant species. By erecting this new genus and species, we are able to describe ecological associations on C. gettyi and place these interactions within a taxonomic context. We describe an extensive archive of feeding damage on C. gettyi caused by herbivorous insects, including more than 800 occurrences of insect damage belonging to five functional feeding groups indicating that insect-mediated damage on this taxon is both rich and abundant. Catula gettyi is one of the best-sampled host plant taxa from the Mesozoic Era, a poorly sampled time interval, and its insect damage is comparable to other Lauraceae taxa from the younger Late Cretaceous Hell Creek Flora of North Dakota, USA.
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