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pestis fulminans [keywords]
- Medical Liability and Orthopaedic Trauma: History and Current State of Affairs. [JOURNAL ARTICLE]
- J Orthop Trauma 2014 Oct.:S17-S19.
Orthopaedic trauma has been associated with the history of medical liability all the way back to the dark ages and the bubonic plague. Caps on noneconomic damages and other reforms have been challenged in many states, and an innovative approach to medical liability reform must be developed within the medical profession and the various legislatures. Orthopaedic trauma surgeons have a unique perspective in that they perform a critical service to the community, however they are often deprived of the benefit of preoperative risk reduction best practices because of the critical needs of the patients. Orthopaedic trauma surgeons must advocate for effective medical liability reforms.
- A comparative study on koii (public doctor) system and its effect on public health in colonial taiwan and Korea. [Journal Article]
- Uisahak 2014 Aug; 23(2):157-202.
Koii(Public Doctor) System introduced into Taiwan in 1896 for the purpose of filling up medical vacuum of rural area and therefore spreading modern medical system all over Taiwan, was transplanted in 1913 into Colonial Korea for the same purpose. In terms of system itself Koii system in both areas were almost the same, but quite different in practices. First, Koiis in Taiwan was forced to write concrete medical report every month on the medical situation in the area under jurisdiction, whereas to those in Korea writing monthly report was not so compulsory. This difference resulted in some gaps in the quality of medical statistics of the two areas. Second, Unlike their counterparts in Korea, Koiis in Taiwan organized their own associations both locally and nationally and it helped to build up their own networks and share informations on medical situation including informations on infectious diseases. Third, Koiis in Taiwan formed more harmonious relationship between Taiwanese Police than their counterparts in Korea, which helped them to execute various medical activities in more comfortable environment. Taiwanese People went to medical institutions a lot more frequently than Korean People, and this difference was basically derived from the quite different density of Koii assignment in both areas. Korean People had to spend more time and money to utilize modern medical institutions than Taiwanese People did. The different density of Koii assignment also affected the results of prevention and eradication of infectious diseases; in Taiwan plague and small-pox has been successfully controled, whereas Chosun Governmentgeneral was not so successful in controling infectious diseases including small-pox. Small-pox infectee in Korea was about 6 times to Taiwan, and the number of death by small-pox was 9 times to Taiwan. One of the keys to this difference is the different role of Koiis. In Korea, Koiis could do little thing about infectious diseases mainly because of manpower shortage, thus shifting their duties like vaccination onto police officers who was inevitably inferior to doctors in medical terms, whereas vaccination was led by Koiis in Taiwan, with the help of police officers and traditional doctors. The difference between Korea and Taiwan in terms of Koii system and its effect implies that public health network in colonial Taiwan was better organized and more stable than that in colonial Korea, and therefore we should be careful about applying the concept of disciplinary power or modernization theory to colonial medical history of Korea.
- Enhancing the Teaching of Evolution in Public Health. [JOURNAL ARTICLE]
- Evolution (N Y) 2011 Dec; 4(4):567-573.
Public health courses are emerging as popular undergraduate offerings, especially at universities with schools of public health. It is important to note that evolution has shaped the burden of disease in the modern world in which we practice and educate for public health. Human cultures and technologies have modified life on Planet Earth and have co-evolved with myriad other species, including microorganisms, plant and animal sources of food, invertebrate vectors of disease, and intermediate bird, mammal, and primate hosts. Molecular mechanisms of evolution have produced differential resistance or susceptibility to infectious agents, including malaria, plague, smallpox, TB, measles, and diarrheal and respiratory diseases. The domestication of sheep and cattle led to natural selection in favor of human populations able to digest milk throughout life through persistence into adulthood of lactase enzyme expression in the intestine, a major story of anthropology. The emergence of a "Western diet" of dairy, refined cereal grains, refined sugars, vegetable oils, alcoholic beverages, salt, and omega-6-rich meats has dramatically altered glycemic load, fatty acid composition, macro-nutrients, acid-base balance, sodium/potassium ratio, and fiber content. This is a major story of nutrition and disease. The results include epidemics of atherosclerotic cardiovascular disease, obesity, diabetes, high blood pressure, osteoporosis, certain cancers, and bowel, inflammatory, and autoimmune disorders. Another interesting phenomenon is the selection of excessive hemostatic activity from platelets and the plasma clotting proteins; what was protective against death from bleeding after injuries among hunter-gatherers or from pregnancy-related hemorrhage now contributes to thrombosis underlying heart attacks and strokes. Conversely, there is little pressure against hemostasis and thrombosis since deaths from these causes occur mostly after the reproductive years of life. Learning about evolution over millennia for humans and over hours or days for microbes enlivens the experience of understanding evolutionary biology in public health context.
- Synchrony in schizophrenia: a window into circuit-level pathophysiology. [REVIEW]
- Curr Opin Neurobiol 2014 Sep 9.:17-23.
As a complex neuropsychiatric disease with both hereditary and environmental components, schizophrenia must be understood across multiple biological scales, from genes through cells and circuits to behaviors. The key to evaluating candidate explanatory models, therefore, is to establish causal links between disease-related phenomena observed across these scales. To this end, there has been a resurgence of interest in the circuit-level pathophysiology of schizophrenia, which has the potential to link molecular and cellular data from risk factor and post-mortem studies with the behavioral phenomena that plague patients. The demonstration that patients with schizophrenia frequently have deficits in neuronal synchrony, including deficits in local oscillations and long-range functional connectivity, offers a promising opportunity to forge such links across scales.
- Production of Outer Membrane Vesicles by the Plague Pathogen Yersinia pestis. [Journal Article]
- PLoS One 2014; 9(9):e107002.
Many Gram-negative bacteria produce outer membrane vesicles (OMVs) during cell growth and division, and some bacterial pathogens deliver virulence factors to the host via the release of OMVs during infection. Here we show that Yersinia pestis, the causative agent of the disease plague, produces and releases native OMVs under physiological conditions. These OMVs, approximately 100 nm in diameter, contain multiple virulence-associated outer membrane proteins including the adhesin Ail, the F1 outer fimbrial antigen, and the protease Pla. We found that OMVs released by Y. pestis contain catalytically active Pla that is competent for plasminogen activation and α2-antiplasmin degradation. The abundance of OMV-associated proteins released by Y. pestis is significantly elevated at 37°C compared to 26°C and is increased in response to membrane stress and mutations in RseA, Hfq, and the major Braun lipoprotein (Lpp). In addition, we show that Y. pestis OMVs are able to bind to components of the extracellular matrix such as fibronectin and laminin. These data suggest that Y. pestis may produce OMVs during mammalian infection and we propose that dispersal of Pla via OMV release may influence the outcome of infection through interactions with Pla substrates such as plasminogen and Fas ligand.
- Bullying and lower urinary tract symptoms: why the pediatric urologist should care about school bullying. [JOURNAL ARTICLE]
- J Urol 2014 Sep 4.
Bullying has become a social plague associated with various deleterious outcomes. We hypothesized that pediatric lower urinary tract symptoms (LUTS) would be associated with bullying exposure.We assessed exposure to school bullying via "Setting the Record Straight" bullying questionnaire in children 8-11 years old being evaluated for LUTS in our pediatric urology clinic. LUTS was quantified with the Vancouver Symptom Score (VSS). Children 8-11 years old at pediatric well-visits also completed the same questionnaires. Linear regression assessed the relationship between VSS and bullying scores. Categorical variables were compared with chi-square test while continuous variables were compared using Student's t-test.A total of 113 children in the urology clinic and 63 children in the primary care setting consented to participate. There were significant differences between the two populations such as gender and race, with significantly more perpetrators of bullying in the primary care group (7.9% vs. 0.9%, p=0.02). When looking specifically at the urology group, there was a significant association between VSS and self and peer perceived victimization scores (p<0.001 and <0.001). In the primary care group, there was a significant association between VSS and self and peer perceived bullying perpetrator scores (p=0.01 and 0.001). 33% of children seen in the primary care office had significant VSS.Although bullying exposure is multi-factorial, we found that VSS can be associated with both bullying victimization and perpetrator score.
- Fleas of small mammals on reunion island: diversity, distribution and epidemiological consequences. [Journal Article]
- PLoS Negl Trop Dis 2014 Sep; 8(9):e3129.
The diversity and geographical distribution of fleas parasitizing small mammals have been poorly investigated on Indian Ocean islands with the exception of Madagascar where endemic plague has stimulated extensive research on these arthropod vectors. In the context of an emerging flea-borne murine typhus outbreak that occurred recently in Reunion Island, we explored fleas' diversity, distribution and host specificity on Reunion Island. Small mammal hosts belonging to five introduced species were trapped from November 2012 to November 2013 along two altitudinal transects, one on the windward eastern and one on the leeward western sides of the island. A total of 960 animals were trapped, and 286 fleas were morphologically and molecularly identified. Four species were reported: (i) two cosmopolitan Xenopsylla species which appeared by far as the prominent species, X. cheopis and X. brasiliensis; (ii) fewer fleas belonging to Echidnophaga gallinacea and Leptopsylla segnis. Rattus rattus was found to be the most abundant host species in our sample, and also the most parasitized host, predominantly by X. cheopis. A marked decrease in flea abundance was observed during the cool-dry season, which indicates seasonal fluctuation in infestation. Importantly, our data reveal that flea abundance was strongly biased on the island, with 81% of all collected fleas coming from the western dry side and no Xenopsylla flea collected on almost four hundred rodents trapped along the windward humid eastern side. The possible consequences of this sharp spatio-temporal pattern are discussed in terms of flea-borne disease risks in Reunion Island, particularly with regard to plague and the currently emerging murine typhus outbreak.
- Yersinia Murine Toxin is Not Required for Early-phase Transmission of Yersinia pestis by Oropsylla montana (Siphonaptera: Ceratophyllidae) or Xenopsylla cheopis (Siphonaptera: Pulicidae). [JOURNAL ARTICLE]
- Microbiology 2014 Sep 3.
Plague, caused by Yersinia pestis, is characterized by quiescent periods punctuated by rapidly spreading epizootics. The classical "blocked flea" paradigm, by which a blockage forms in the flea's proventriculus on average 1-2 weeks post infection, forces starving fleas to take multiple blood meals, thus increasing opportunities for transmission. Recently the importance of early-phase transmission (EPT), which occurs prior to blockage formation, has been emphasized during epizootics. While the physiological and molecular mechanisms of blocked flea transmission are well characterized, the pathogen-vector interactions have not been elucidated for EPT. Within the blocked flea model, Yersinia murine toxin (Ymt) has been shown to be important for facilitating colonization of the midgut within the flea. One proposed mechanism of EPT is the regurgitation of infectious material from the flea midgut during feeding. Such a mechanism would require bacteria to colonize and survive for at least brief periods in the midgut, a process that is mediated by Ymt. Two key bridging vectors of Y. pestis to humans, Oropsylla montana and Xenopsylla cheopis, were used in our study to test this hypothesis. Fleas were infected with a mutant strain of Y. pestis containing a nonfunctional ymt that was previously shown to be incapable of colonizing the midgut, and were then allowed to feed on SKH-1 mice 3 days post infection. Our results show that Ymt is not required for EPT by either flea species.
- On Arsenic and Plague. [LETTER]
- Clin Infect Dis 2014 Sep 2.
- The economics, financing and implementation of HIV treatment as prevention: What will it take to get there? [Journal Article]
- Afr J AIDS Res 2014 Jun; 13(2):109-19.
The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a "grand convergence" of health initiatives to reduce both infectious diseases, and child and maternal mortality - diseases that still plague low income countries - would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1 000 live births, reducing deaths due to HIV/AIDS to 8 per 100 000 population, and reducing annual TB deaths to 4 per 100 000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS - and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrolment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient programme management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations.