bluuebunny/crossref_metadata_2025 huggingface dataset:
Context Matters: Financial, Psychological, and Relationship Insecurity Around Personal Finance Is Associated With Financial Exploitation
Authors: Lichtenberg Peter A , Campbell Rebecca , Hall LaToya , Gross Evan Z
Published: February 2020

Background and Objectives

Context can influence or overwhelm the intellectual and cognitive aspects of financial decision making but has only recently received increased attention. The construct validity of conceptual subscales from a financial decision-making scale was examined in the context of their relationship to financial exploitation.

Research Design and Methods

Two hundred forty-two community-based participants were recruited into the study. The final sample contained 242 participants. Measures included demographic variables, conceptually derived contextual items, and neurocognitive measures. Seventeen of the 34 contextual items investigated differentiated financially exploited and nonexploited older adults. Combining these 17 contextual items led to the creation of a new scale: the Financial Exploitation Vulnerability Scale (FEVS). Correlational analyses and area under the curve analyses were used to examine the relationship between this new scale of contextual items and other measures and to determine how clinically meaningful the scale was in the current sample.

Results

Contextual items were powerful discriminators between those who were exploited and those who were not. The new scale of contextual items (the FEVS) demonstrated good internal consistency (Cronbach’s alpha = 0.82) and a strong area under the curve (receiver operating characteristic = 0.80), thereby indicating good clinical significance and evidence for construct validity.

Discussion and Implications

We examined the conceptually derived subscales of financial awareness, psychological vulnerability, and relationship strain and how these relate to financial exploitation. Our major finding is that contextual items differentiated between exploited and nonexploited adults, which demonstrate the importance of measuring context in financial decision making and exploitation. A new scale for measuring contextual items was introduced.
Denoising of seismic data in desert environment based on a variational mode decomposition and a convolutional neural network
Authors: Zhao Y X , Li Y , Yang B J
Published: February 2020

One of the difficulties in desert seismic data processing is the large spectral overlap between noise and reflected signals. Existing denoising algorithms usually have a negative impact on the resolution and fidelity of seismic data when denoising, which is not conducive to the acquisition of underground structures and lithology related information. Aiming at this problem, we combine traditional method with deep learning, and propose a new feature extraction and denoising strategy based on a convolutional neural network, namely VMDCNN. In addition, we also build a training set using field seismic data and synthetic seismic data to optimize network parameters. The processing results of synthetic seismic records and field seismic records show that the proposed method can effectively suppress the noise that shares the same frequency band with the reflected signals, and the reflected signals have almost no energy loss. The processing results meet the requirements of high signal-to-noise ratio, high resolution and high fidelity for seismic data processing.
Feasibility and preliminary effectiveness of group antenatal care in Senegalese health posts: a pilot implementation trial
Authors: McKinnon Britt , Sall Mohamadou , Vandermorris Ashley , Traoré Mahamadou , Lamesse-Diedhiou Fatma , McLaughlin Katie , Bassani Diego
Published: February 2020

Almost all pregnant women in Senegal receive some antenatal care (ANC), yet only around half receive four or more visits and provision of education and counselling during ANC is often inadequate and, in some cases, non-existent. This results in missed opportunities to provide support and to counsel women regarding appropriate care-seeking practices and health behaviours during pregnancy and across the continuum of care. This pilot effectiveness–implementation randomized controlled trial explored whether group ANC (G-ANC), a model that integrates standard individual pregnancy care with facilitated participatory group education activities and peer support, could potentially address some of these challenges. The G-ANC model adapted for Senegal builds on local healthcare delivery systems and aligns with World Health Organization recommendations for a shift towards women-centred models of maternity services. It was implemented at the health post level, and a total of 330 pregnant women participated in the study, of whom 85% were followed up at 6–10 weeks post-delivery. We assessed implementation outcomes (e.g. acceptability, cost) to establish the feasibility of the model in Senegal and explored effectiveness outcomes related to maternal and infant health for the planning of a large-scale trial. Results indicate that women and ANC providers were overwhelmingly enthusiastic about the G-ANC model, and exploratory analyses suggested improvements in exclusive breastfeeding, intention to use family planning, birth preparations and knowledge around maternal and newborn danger signs. This article provides timely and relevant evidence on the feasibility of G-ANC as an alternative model of care during pregnancy and a solid basis for recommending the conduct of a large-scale implementation study of G-ANC in Senegal.
Investor Obligations for Human Rights
Authors: Choudhury Barnali
Published: February 2020

Despite progress being made in the business and human rights field in defining corporate responsibility for human rights, defining foreign investors roles vis-à-vis human rights remains mainly stagnant. The idea that businesses have responsibility for human rights is well ensconced in global norms and is based on society's expectations of business in the 21st century. Yet despite this widespread recognition, international investment law is silent on the matter. This leaves a disconnect between the norms dictating the corporate responsibility for human rights in public international law and those found in international investment law.

One way to better align progress in the business and human rights movement with international investment law is to introduce investor obligations for human rights. These obligations can be located both in investment treaties as well as in non-treaty sources. Moreover, investment arbitration provides multiple entrypoints for tribunals to consider such obligations, for example through counterclaims, jurisdictional claims, or admissibility claims, among others.

Two primary benefits arise from introducing investor obligations for human rights. First, it can act as vehicle by which business and human rights norms, generally, can be enforced. Second, and more importantly, introducing investor obligations for human rights can help to better contextualize the interpretation of IIAs. Introducing such obligations can be used to remind tribunals that international investment law operates in a system that includes non-investment concerns such as human rights.

Considering such obligations, in and of themselves, however, are unlikely to prompt wider changes in international investment law. Nevertheless, including investor obligations in international investment law may prompt tribunals to give more balanced interpretations to international investment agreements. This can work towards ensuring that international investment law serves its ultimate aim of promoting a state’s development.
Vertex Algebras Associated with Hypertoric Varieties
Authors: Kuwabara Toshiro
Published: February 2020

We construct a family of vertex algebras associated with a family of symplectic singularity/resolution, called hypertoric varieties. While the hypertoric varieties are constructed by a certain Hamiltonian reduction associated with a torus action, our vertex algebras are constructed by (semi-infinite) BRST reduction. The construction works algebro-geometrically, and we construct sheaves of $\hbar $-adic vertex algebras over hypertoric varieties, which localize the vertex algebras. We determine when it is a vertex operator algebra by giving an explicit conformal vector. We also discuss the Zhu algebra of the vertex algebra and its relation with a quantization of the hypertoric variety. In certain cases, we obtain the affine ${\mathcal{W}}$-algebra associated with the subregular nilpotent orbit in $\mathfrak{s}\mathfrak{l}_N$ at level $N-1$ and simple affine vertex operator algebra for $\mathfrak{s}\mathfrak{l}_N$ at level $-1$.
Antibiofilm and intraosteoblastic activities of rifamycins against Staphylococcus aureus: promising in vitro profile of rifabutin
Authors: Abad Lélia , Josse Jérôme , Tasse Jason , Lustig Sébastien , Ferry Tristan , Diot Alan , Laurent Frédéric , Valour Florent
Published: February 2020

Background

Targeting biofilm-embedded and intraosteoblastic Staphylococcus aureus, rifampicin gained a pivotal role in bone and joint infection (BJI) treatment. Two other rifamycins, rifabutin and rifapentine, may represent better-tolerated alternatives, but their activity against bacterial reservoirs associated with BJI chronicity has never been evaluated.

Objectives

To evaluate the activities of rifampicin, rifabutin and rifapentine in osteoblast infection models.

Methods

Using three S. aureus isolates, rifamycins were compared regarding: (i) their intracellular activity in ‘acute’ (24 h) and ‘chronic’ (7 days) osteoblast infection models at 0.1× MIC, 1× MIC, 10× MIC and 100× MIC, while impacting infection-induced cytotoxicity (MTT assay), intracellular phenol-soluble modulin (PSM) secretion (RT–PCR), resistance selection and small colony variant (SCV) emergence; and (ii) their minimal biofilm eradication concentration (MBEC) and their MIC to prevent biofilm formation (bMIC).

Results

At 0.1× MIC, only rifabutin significantly reduced intracellular inoculum and PSM secretion. All rifamycins allowed a 50% reduction of intraosteoblastic inoculum at higher concentrations, with no difference between acute and chronic infection models, while reducing infection-induced cytotoxicity and PSM secretion. Dose-dependent emergence of intracellular SCVs was observed for all molecules. No intracellular emergence of resistance was detected. bMICs were equivalent for all molecules, but MBEC90s of rifapentine and rifabutin were 10- to 100-fold lower than those of rifampicin, respectively.

Conclusions

All rifamycins are efficient in reducing the S. aureus intraosteoblastic reservoir while limiting infection-induced cytotoxicity, with a higher activity of rifabutin at low concentrations. All molecules prevent biofilm formation, but only rifapentine and rifabutin consistently reduce formed biofilm-embedded bacteria for all isolates. The activity of rifabutin at lower doses highlights its therapeutic potential.
Investigation of the effect of the adsorbent DAV131A on the propensity of moxifloxacin to induce simulated Clostridioides (Clostridium) difficile infection (CDI) in an in vitro human gut model
Authors: Chilton C H , Crowther G S , Miossec C , de Gunzburg J , Andremont A , Wilcox M H
Published: February 2020

Background

Clostridioides difficile infection (CDI) remains a high burden worldwide. DAV131A, a novel adsorbent, reduces residual gut antimicrobial levels, reducing CDI risk in animal models.

Objectives

We used a validated human gut model to investigate the efficacy of DAV131A in preventing moxifloxacin-induced CDI.

Methods

C. difficile (CD) spores were inoculated into two models populated with pooled human faeces. Moxifloxacin was instilled (43 mg/L, once daily, 7 days) alongside DAV131A (5 g in 18 mL PBS, three times daily, 14 days, Model A), or PBS (18 mL, three times daily, 14 days, Model B). Selected gut microbiota populations, CD total counts, spore counts, cytotoxin titre and antimicrobial concentrations (HPLC) were monitored daily. We monitored for reduced susceptibility of CD to moxifloxacin. Growth of CD in faecal filtrate and medium in the presence/absence of DAV131A, or in medium pre-treated with DAV131A, was also investigated.

Results

DAV131A instillation reduced active moxifloxacin levels to below the limit of detection (50 ng/mL), and prevented microbiota disruption, excepting Bacteroides fragilis group populations, which declined by ∼3 log10 cfu/mL. DAV131A delayed onset of simulated CDI by ∼2 weeks, but did not prevent CD germination and toxin production. DAV131A prevented emergence of reduced susceptibility of CD to moxifloxacin. In batch culture, DAV131A had minor effects on CD vegetative growth, but significantly reduced toxin/spores (P < 0.005).

Conclusions

DAV131A reduced moxifloxacin-induced microbiota disruption and emergence of antibiotic-resistant CD. Delayed onset of CD germination and toxin production indicates further investigations are warranted to understand the clinical benefits of DAV131A in CDI prevention.
Unsuccessful Host Stinging by Aphelinus asychis (Hymenoptera: Aphelinidae) Impacts Population Parameters of the Pea Aphid (Hemiptera: Aphididae)
Authors: Jia Yu-Jie , Wang Bo , Liu Tong-Xian
Published: February 2020

The biocontrol values of natural enemies are strongly correlated to their ability to regulate the density of their host/prey. For parasitoids, apart from parasitism and host feeding, unsuccessful host stinging (i.e., stings that were aborted, abandoned, or discontinued without oviposition or host feeding) can also negatively affect their hosts and host populations. Although several studies have reported unsuccessful host stinging and its impacts on hosts, the effects of this type of attack on host life table parameters are still unclear. In the present study, we used the parasitoid Aphelinus asychis Walker (Hymenoptera: Aphelinidae) and its host Acyrthosiphon pisum (Harris) (Hemiptera: Aphididae) to investigate the influence of unsuccessful host stinging on host populations under laboratory conditions at. Biological parameters of A. pisum were analyzed using an age stage, two-sex life table. The results of this study showed that unsuccessful host stinging was prevalent under laboratory conditions, and the frequency of this type of attack on third- and fourth-instar hosts was higher than the frequencies of parasitism and host feeding. Unsuccessful host stinging adversely impacted aphid populations, by decreasing aphid survival and reproduction, and impacts were greatest in hosts attacked at the first and fourth instars. These results indicate that unsuccessful host stinging enhances the biological control impact of A. asychis attacking A. pisum, and its effect on host populations should also be considered when selecting and mass rearing of parasitoids for biological control.
Young-Onset Colon Cancer and Recurrence Risk by Gene Expression
Authors: Chang George J , You Y Nancy Y , Russell Christy A , Tierno Marni B , Turner Michelle , Bennett John P , Lau Anna , Hochster Howard S
Published: February 2020

The incidence and mortality from colorectal cancer in younger adults (younger than 55 years) is increasing. We reviewed the complete database of a gene-expression test, Oncotype DX Colon Recurrence Score test, to determine age-related differences in recurrence score (RS) and single-gene results (7 cancer-related of the 12-gene assay). We included 20 478 stage II and III A and B colon cancer patients submitted to Genomic Health. RS results were grouped by low-, intermediate-, and high-risk groups. Single-gene scores were described using median and interquartile range. Of all patients 72.5% and 72.6% of those younger than 40 years had low-risk RS. Comparing older with younger patients, RS or single-gene expression did not differ by age group or stage. Young-onset colon cancer does not differ by expression of the RS component genes. Most patients with stage II and III colon cancer have low-risk disease as measured by the 12-gene assay, regardless of age.
Nursing and the Good Society
Authors: Lazenby Mark
Published: February 2020

The sine qua non of a good society is that people have the freedom to be and to do that of which they are capable. However, people cannot have this freedom when caring for others is pitted against self-interest. Self-interest devolves into a care-lessness that is antithetical to the good society. Caring for others, by contrast, is a necessary condition for this freedom. Caring for others is the sine qua non of the profession of nursing. With the match between the sine qua non of a good society and of nursing, the profession has the power to address political and social barriers people face in having the freedom to be and to do that of which they are capable.
Functional (Psychogenic) Movement Disorders
Authors: Shibasaki Hiroshi , Hallett Mark , Bhatia Kailash P. , Reich Stephen G. , Balint Bettina
Published: February 2020

Functional movement disorders are any type of movement disorder due to a brain network disorder where normal function is possible. The terminology of functional movement disorders has changed; in the recent past, these disorders were most frequently called psychogenic. Characteristics of functional movements include incongruity with a known type of involuntary movement; inconsistency in the pattern, degree, and distribution during the clinical course; improvement with distraction; and possible psychogenic background. While the movements are said to be fully involuntary, there is often some suggestibility. In the case of unilaterally predominant tremor, if the patient is requested to repeat voluntary movements with the intact or less affected hand at a certain pace, the tremor frequency might be replaced by the frequency of the voluntary movement, the phenomenon called entrainment.
Why do patients attend and what do they want from the consultation?
Authors: Spence Des
Published: February 2020

Contrary to traditional thinking and teaching, it is not illness that dictates the health-seeking behaviour of a population but the healthcare system itself, and—most importantly—our actions as healthcare professionals. A scourge affecting clinical practice in the developed world today is the medicalization of all interactions, accompanied by overinvestigation, overdiagnosis, and overtreatment. The medical profession retains its traditional duty, wherever possible, to diagnose disease and treat or cure illness appropriately, also to comfort the sick, irrespective of the ability to cure. At the same time, a long-held principle of medicine at all levels is to do no harm, while at the same time supporting the maintenance of health and protecting those who are well. This chapter explains how maintaining the balance between these apparent conflicting precepts is a scarce skill that needs to be taught by example during the education and training of the modern doctor.
Medical ethics
Authors: Parker Mike , Suleman Mehrunisha , Hope Tony
Published: February 2020

Medicine is both a scientific and a moral enterprise. It is as important to give reasons for the ethical aspects of clinical decisions as it is for the scientific aspects. The corollary of evidence-based medicine is reason-based ethics. Two concepts central to many ethical aspects of clinical practice are autonomy and best interests. Evidence-based medicine emphasizes the importance of critical assessment: interventions should be evaluated on the basis of evidence, not tradition. Critical skills are therefore crucial to modern scientific medicine. Importantly, medicine is a moral enterprise as well as a scientific one. Many clinical decisions involve a combination of factual and ethical aspects. It is as important to be able to give good reasons for the ethical aspects of clinical decisions as it is for the science. Society increasingly expects this from doctors as part of transparent decision-making.
Clinical decision-making
Authors: Peto Timothy E.A. , Peto Philippa
Published: February 2020

Clinicians make decisions at every stage of the patient pathway. In routine practice complex decisions are often made rapidly using ‘intuition’ or common sense, but this can lead to suboptimal management plans. Clinical decision analysis is a way of formalizing the logical process behind decision-making, and when combined with evidence from medical research is described as the practice of evidence-based medicine. In practice, most clinicians do not have the time, intellectual energy, or training to perform a formal clinical decision analysis and they tend to use short cuts and go for the ‘safe’ decision which is suitable for the ‘average patient’ and often in keeping with guidelines for local practice. However, clinicians who follow the logical process of clinical decision analysis find it easier to live with the uncertainty of an inexact science and subjective wishes of the patient.
Science in medicine: When, how, and what
Authors: Bynum William F.
Published: February 2020

Science has always been part of Western medicine, although what counts as scientific has changed over the centuries, as have the content of medical knowledge, the tools of medical investigation, and the details of medical treatments. This brief overview develops a historical typology of medicine since antiquity. It divides the ‘kinds’ of medicine into five sections: bedside medicine, developed by the Hippocratic doctors in classical times; library medicine, associated with the scholastic mentality of the Middle Ages; hospital medicine, central to French medicine of the early 19th century; social medicine, which is about prevention, both communal and individual; and laboratory medicine, which has its natural home in the research establishment and is a critical site for the creation of medical knowledge, setting the standards for both medical science and scientific medicine.
Large-scale randomized evidence: Trials and meta-analyses of trials
Authors: Baigent Colin , Peto Richard , Gray Richard , Staplin Natalie , Parish Sarah , Collins Rory
Published: February 2020

Clinical trials generally need to be able to detect or to refute realistically moderate (but still worthwhile) differences between treatments in long-term disease outcome. Large-scale randomized evidence should be able to detect such effects, but medium-sized trials or medium-sized meta-analyses can, and often do, yield false-negative or exaggeratedly positive results. Hundreds of thousands of premature deaths each year could be avoided by seeking appropriately large-scale randomized evidence about various widely practicable treatments for the common causes of death, and by disseminating this evidence appropriately. This chapter takes a look at the use of large-scale randomized evidence—produced from trials and meta-analysis of trials—and how this data should be handled in order to produce accurate result.
Financing healthcare in low-income developing countries: A challenge for equity in health
Authors: Sambo Luis G. , Simões Jorge , do Rosario O. Martins Maria
Published: February 2020

Low-income developing countries remain challenged by the increasing demand for essential healthcare combined with governments’ inability to mobilize and allocate adequate financing to health systems. According to their country specific contexts, they need to improve the equity and efficiency of their health systems, in particular their public sector management, and increase their governmental health spending through enhanced domestic resource mobilization and more efficiency in public spending. They need to sustain external assistance and implement social protection policies that decrease out-of-pocket payments, thereby preventing people with catastrophic illness from becoming impoverished. Economic growth and increased health spending alone are not enough to scale-up healthcare coverage and achieve better health outcomes. These must be combined with accountability of results, transparent management of public funds, and multisectoral efforts with community involvement at implementation level.
Intracellular signalling
Authors: Floto R. Andres
Published: February 2020

This chapter outlines the general principles of intracellular signalling. Focusing on cell surface receptors, the requirements for effective transmission of information across the plasma membrane are outlined. The principal mechanisms utilized in mammalian signal transduction are described. For each, the pathological consequences of aberrant signalling and means by which pathways can be pharmacologically targeted are described in molecular terms.

Intracellular signalling pathways permit the transmission and integration of information within cells. Mammalian receptor signalling relies on only a small number of distinct molecular processes which interact to determine cellular responses. Rapid advances in our knowledge of the mechanisms of intracellular signalling has greatly increased understanding of how cells function physiologically, how they malfunction pathologically, and how their behaviour might be manipulated therapeutically.
The evolution of therapeutic antibodies
Authors: Waldmann Herman , Winter Greg
Published: February 2020

The development of rodent monoclonal antibodies opened the door to the creation of antibodies specific to soluble and cell-surface antigens. ‘Humanized’ therapeutic antibodies have emerged as major blockbuster drugs for the treatment of cancer, immune, and inflammatory disorders—the so-called biologics. Much of this revolution was spearheaded in Cambridge, England, initiated by the research of Cesar Milstein and George Köhler at the MRC Laboratory of Molecular Biology and who, with N.K. Jerne, shared the 1984 Nobel Prize for Medicine or Physiology. As related in this personal perspective, Cambridge scientists and clinicians took up the challenge to develop the original murine antibodies into powerful pharmaceuticals that can be administered repeatedly without the dire consequences of alloimmunization. In this short chapter, two scientists who made seminal contributions to this field and remain actively engaged in its development give a personal account of how these remarkable developments came about.
Adaptive immunity
Authors: Klenerman Paul
Published: February 2020

The adaptive immune response is distinguished from the innate immune response by two main features: its capacity to respond flexibly to new, previously unencountered antigens (antigenic specificity), and its enhanced capacity to respond to previously encountered antigens (immunological memory). These two features have provided the focus for much research attention, from the time of Jenner, through Pasteur onwards. Historically, innate and adaptive immune responses have often been treated as separate, with the latter being considered more ‘advanced’ because of its flexibility. It is now clear this not the case, and in recent years the molecular basis for these phenomena has become much better understood.
Immunodeficiency
Authors: Hambleton Sophie , Marshall Sara , Kumararatne Dinakantha S.
Published: February 2020

Immunodeficiency is caused by failure of a component of the immune system and results in increased susceptibility to infections. The possibility of an underlying immunodeficiency should be considered if a patient has: serious, persistent, unusual, or recurrent infections; failure to thrive in infancy; known family history of immunodeficiency; unexplained lymphopenia in infancy; or a combination of clinical features characteristic of a particular immunodeficiency syndrome. The nature of the microbial infection in a particular patient provides a clue to the likely cause of immunodeficiency. Primary immunodeficiency diseases are heritable disorders that result in defects in an intrinsic component of the immune system. Secondary immunodeficiencies are caused by conditions that impair the normal function of the immune system and include viral infections, myelomatosis, non-Hodgkin’s lymphoma, severe renal or liver failure, and use of therapeutic agents which impair immunity.
The genetics of inherited cancers
Authors: Eeles Rosalind A.
Published: February 2020

All cancer can be termed ‘genetic’ as the disease is caused by somatic cell mutations (alterations in the DNA code), which result in abnormal cellular growth and/or proliferation. Most of these mutations are sporadic (only occurring in the cancer cell), but some are due to the inheritance of a germline mutation in a cancer predisposition gene. Cancer predisposition genes can be rare and confer a high cancer risk (about 10-fold lifetime relative risk), or common and confer a low to moderately increased risk (from just over onefold, up to two- to threefold). They have been shown to be involved in causing some of most common cancers as well as some rare cancers. Cancer genetics will become part of mainstream clinical pathways for cancer care in the coming years and is likely to contribute to healthcare that is tailored to individual patients.
Care of the dying person
Authors: Kite Suzanne , Hurlow Adam
Published: February 2020

The care a patient receives in the last hours to days of life is important: it has a significant impact on their quality of life and death, and on the psychological well-being of their loved ones and the team delivering care. Most deaths are not sudden or unexpected, but recognition that a patient is dying is challenging. Clinicians’ estimates of survival are often inaccurate, with a tendency towards over-optimism, yet clinical teams must be able to agree goals and care plans with patients and their loved ones while acknowledging and communicating the uncertainty inherent to prognostication. Shared individualized decision-making is essential: patients must be offered the opportunity to participate in decisions, but a preference not to be involved should be respected. The aim must be to agree an individual plan of care that incorporates the needs and preferences of the person and those close to them.
Clinical approach
Authors: Ellis Christopher J.
Published: February 2020

The clinical approach to patients with likely infection begins with a focused history, leading on to a clinical examination which assesses the extent of the physiological derangement and looks for a focus of infection. Standard physiological measures define likely sepsis (see Chapter 8.1.2), which is the commonest reason for their sudden derangement in hospitalized patients. Investigations should be phased and must not delay the start of potentially life-saving treatment, the response to which must be carefully followed, especially when treatment has to be started before a complete or certain diagnosis is possible, and compared with the likely speed of response for the putative condition being treated. There is increasing evidence that delays in initiating appropriate therapy, especially antimicrobial medication and circulatory support, increase mortality.
Rhabdoviruses: Rabies and rabies-related lyssaviruses
Authors: Warrell Mary J. , Warrell David A.
Published: February 2020

The Rhabdoviridae are a large family of RNA viruses, two genera of which infect animals: the genus Lyssavirus contains rabies and rabies-related viruses that cause at least 55,000 deaths annually in Asia and Africa. The risks and problems posed by rabies and other lyssaviruses vary across the world. Viruses can penetrate broken skin and intact mucosae. Humans are usually infected when virus-laden saliva is inoculated through the skin by the bite of a rabid animal, usually a dog. Although the greatest threat to man is the persistent cycle of infection in stray dogs, several other terrestrial mammal species are reservoirs of infection. In the Americas, bat viruses and also classic type 1 rabies and insectivorous bats have become the principal vectors of infection to humans in the United States of America. Elsewhere in the world, there is increasing evidence of widespread rabies-related lyssavirus infection of bats.
HIV/AIDS
Authors: Fidler Sarah , Peto Timothy E.A. , Goulder Philip , Conlon Christopher P.
Published: February 2020

Since its discovery in 1983, the human immunodeficiency virus (HIV) has been associated with a global pandemic that has affected more than 78 million people and caused more than 39 million deaths. Globally, 36.9 million (34.3–41.4 million) people were living with HIV at the end of 2013. An estimated 0.8% of adults aged 15–49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected, with nearly 1 in every 20 adults living with HIV and accounting for nearly 71% of the people living with HIV worldwide. The impact of HIV in some African countries has been sufficient to reverse population growth and reduce life expectancy into the mid-30s, although HIV incidence has declined in some of these high-prevalence countries. However, there are large-scale HIV epidemics elsewhere (e.g. India, the Russian Federation, and Eastern Europe).
HIV in low- and middle-income countries
Authors: Grant Alison D. , De Cock Kevin M.
Published: February 2020

The HIV pandemic has disproportionately affected people in low- and middle-income countries. In many countries in sub-Saharan Africa, HIV infection is established in the general population: in southern Africa, which is particularly severely affected, adult HIV prevalence has reached 30% in some areas. Local epidemiology depends on the balance between incidence (due to sexual contact, mother-to-child transmission, or exposure to blood or blood products) and mortality, and the effect of antiretroviral therapy on both mortality and transmission. The main route of transmission is sex between men and women. The manifestations of HIV disease vary by geographical region, reflecting increased frequency of exposure in low- and middle-income countries to common pathogens such as tuberculosis, non-typhoid salmonellae, and Streptococcus pneumoniae. People with advanced immunosuppression are also at risk of disease due to geographically restricted opportunistic pathogens (e.g. leishmania and Tarolomyces marneffei).
Meningococcal infections
Authors: Brandtzaeg Petter
Published: February 2020

Neisseria meningitidis is an obligate human Gram-negative diplococcus. It is carried in the nasopharynx by about 3–10% of people, with most strains being harmless and inducing immunity. Pathogenic strains usually belong to specific clones that are encapsulated, express pili, and the major porin, PorA. Serogroups A, B, and C usually account for more than 90% of all invasive isolates. Meningitis is the commonest presentation; preceded by low-grade meningococcaemia. After transition to the subarachnoid space the meningococci proliferate to high levels in the cerebrospinal fluid. Clinically the patients develop fever, subsequently a petechial rash and increasing symptoms of meningitis. If adequately treated with antibiotics, case fatality is less than 1–2% in industrialized countries, but higher in developing countries. Brain oedema leading to herniation of the cerebellum is the main cause of death. Neurosensory hearing loss is the major complication.
Cholera
Authors: Lima Aldo A.M. , Guerrant Richard L.
Published: February 2020

Cholera, the dreaded scourge causing death from dehydrating diarrhoea, existed for centuries in South Asia until, in 1817, it broke out along trade routes; since then there have been seven pandemics across all six inhabited continents. Vibrio cholerae is a Gram-negative organism that can be subdivided into over 200 serogroups based on the somatic O antigen, with only serogroups O1 and O139 causing epidemic and pandemic disease. Historically it has killed millions from dehydrating diarrhoea, encouraged the birth of modern epidemiology, the sanitary revolution, and oral rehydration therapy; it persists today as a glaring reminder of poverty and inadequate water/sanitation. Contaminated food (especially undercooked seafood) is the usual route of transmission in developed countries; contaminated water and street food vendors are more common vehicles in less developed countries.
Haemophilus ducreyi and chancroid
Authors: O’Farrell Nigel
Published: February 2020

Haemophilus ducreyi is a Gram-negative, facultative anaerobic bacillus that is the cause of chancroid. The condition was endemic in sub-Saharan Africa and the Caribbean, but the overall global incidence of the condition has decreased dramatically since the mid-1990s. After an incubation period of 4–10 days, presentation is with a tender genital papule that develops into a pustule and then an ulcer with a ragged undermined edge and a yellow base that bleeds readily. The usual sites of infection in men are the prepuce and coronal sulcus, and in women the labia minora and fourchette. Inguinal lymphadenopathy is found in about half the male cases. Chancroid is an important risk factor for the transmission of HIV infection. HIV infection may result in atypical manifestations of chancroid.

Nucleic acid amplification tests are the optimal method of diagnosing H. ducreyi. Treatment is with either ciprofloxacin, erythromycin, azithromycin, or ceftriaxone.
Plague: Yersinia pestis
Authors: Prentice Michael
Published: February 2020

Bubonic plague is a flea-borne zoonosis caused by the Gram-negative bacterium Yersinia pestis, which mainly affects small burrowing mammals including domestic rats. Human disease occurs in endemic countries—currently mainly in Africa (including Madagascar)—following bites from fleas recently hosted by a bacteraemic animal. Historical use of Y. pestis as a biological warfare agent has raised fears of its future use in bioterrorism. The commonest presentation is acute painful lymphadenitis (80–95% of suspected cases), with sudden onset of fever, chills, weakness, headache, and development of an intensely painful swollen lymph node (bubo). Primary septicaemia with no bubo occurs in 10% of cases. Spread to the lungs occurs in less than 10% of cases, resulting in pneumonia which can result in onward respiratory transmission by droplet infection. Overall mortality without treatment is 50–90%.
Pasteurella
Authors: Morgan Marina S.
Published: February 2020

Pasteurella multocida is an important human Gram-negative pathogen residing primarily in the oropharynx of mammals and transmitted through bites and scratches. Presentation is typically within 12 h of injury with rapidly spreading cellulitis or sepsis, leading to serious morbidity and mortality (up to 40%) if untreated. Diagnosis is clinical: fresh bite wound cultures are unhelpful, but the organism is usually cultured in cases with established infection, especially if presenting within 24 hours of the injury. Treatment requires thorough wound debridement, with delayed closure if possible, along with antimicrobials to provide empirical cover against pasteurellae and all the other expected pathogens (e.g. amoxicillin-clavulanate plus ciprofloxacin, or meropenem plus clindamycin). Prevention is by avoidance of animal bites or scratches and prompt hygienic management of wounds: antibiotic prophylaxis (amoxicillin-clavulanate or—for the penicillin allergic—doxycycline or azithromycin) should be reserved for high-risk bites (e.g. cat bites) or high-risk wounds that are difficult to debride.
Anthrax
Authors: Brown Arthur E.
Published: February 2020

Anthrax is primarily a disease of herbivorous mammals, caused by the Gram-positive rod Bacillus anthracis, which causes human infection when its spores enter the body, most commonly from handling infected animals or animal products. The disease occurs in most countries of the world, but is only sporadic where the condition is controlled in livestock by vaccination programmes. Anthrax is a leading agent of biological warfare. After entry into the body, anthrax spores are phagocytosed by macrophages and carried to regional lymph nodes, where they germinate to produce vegetative bacilli that enter the bloodstream. These produce anthrax toxins, which have effects including impairment of cellular water homeostasis and of many intracellular signalling pathways.
Leprosy (Hansen’s disease)
Authors: Lockwood Diana N.J.
Published: February 2020

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae, an acid-fast intracellular organism not yet cultivated in vitro. It is an important public health problem worldwide, with an estimated 4 million people disabled by the disease. Transmission of M. leprae is only partially understood, but untreated lepromatous patients discharge abundant organisms from their nasal mucosa into the environment. It was first identified in the nodules of patients with lepromatous leprosy by Hansen in 1873. M. leprae preferentially parasitizes skin macrophages and peripheral nerve Schwann cells. A second agent of leprosy M. lepromatosis which diverged form M. leprae 10 million years ago has also been recognized as causing leprosy in 40 + patients and the main focus of origin is Mexico. The importance of this organism will be determined over the next few years.
Lyme borreliosis
Authors: Wormser Gary P. , Nowakowski John , Nadelman Robert B.
Published: February 2020

Lyme borreliosis is a zoonotic bacterial infection caused by Borrelia burgdorferi sensu lato, a spirochaetal agent transmitted by certain species of Ixodes ticks. Small rodents and birds serve as reservoirs. It is the most common vector-borne infection in the United States of America and an important infection in many countries throughout the temperate regions of Europe and northern Asia, where a wider variety of borrelia species account for differences in clinical manifestations in Eurasia compared with the United States. The most common and earliest clinical manifestation is erythema migrans, a distinctive cutaneous lesion that occurs at the site of deposition of the spirochaete by the vector tick. Most people treated for Lyme borreliosis respond well to a 2-week course of antibiotic therapy. Symptomatic treatment is recommended for patients who have or develop subjective complaints of unclear aetiology despite successful resolution of the objective manifestation of Lyme borreliosis following antibiotic therapy.
Nonvenereal endemic treponematoses: Yaws, endemic syphilis (bejel), and pinta
Authors: Marks Michael , Mitjà Oriol , Mabey David
Published: February 2020

The endemic treponematoses are chronic, granulomatous diseases caused by morphologically and serologically identical spirochaetes of the genus Treponema. They are spread by intimate but non-sexual contact and possibly by fomites, mainly among children. Treponema pallidum subsp. pertenue causing yaws (framboesia), T. pallidum subsp. endemicum causing endemic syphilis (bejel) and T. carateum causing pinta (carate) are distinguishable from T. pallidum subsp. pallidum, causing venereal syphilis, by their epidemiology and pathological effects and genomic structure (e.g. the arp gene). Despite the successful WHO/UNICEF mass penicillin treatment campaign (1952–1964), there has been a resurgence of yaws, mainly in West Africa, Southeast Asia, and the Pacific. Children living in rural areas in warm, humid climates in tropical countries are most affected by yaws. About 10% of untreated cases develop late, disfiguring, or crippling lesions of skin, bone, and cartilage.
Listeriosis
Authors: Hof Herbert
Published: February 2020

Listeriosis is caused by the Gram-positive bacillus Listeria monocytogenes, whose natural habitat is the soil. Consumption of soft cheeses, other dairy products, meat products, seafood, and vegetables is the principal route of infection. Patients at particular risk include those who are immunocompromised, very young, or very old. Pregnant women are also at risk, although they develop only mild disease, but the bacteria can be transmitted to the child either in utero or during birth, causing serious systemic disease. The disease varies from a mild, influenza-like illness to fatal septicaemia and meningoencephalitis. Purulent, localized infections of any organ are sometimes seen. Aside from supportive care, the usual treatment of choice is high-dose intravenous ampicillin, which must be administered for at least 2 weeks. The prognosis is poor, with mortality of up to 30%. Prevention depends upon those that are vulnerable avoiding high-risk foods. There is no vaccine.
Bartonellas excluding B. bacilliformis
Authors: Chomel Bruno B. , Boulouis Henri-Jean , Stuckey Matthew J. , Rolain Jean-Marc
Published: February 2020

Bartonellae are Gram-negative bacilli or coccobacilli belonging to the α-2 subgroup of Proteobacteria. A given Bartonella species usually persists within a given mammalian host, with transmission between hosts by haematophagous arthropods. A single species, such as B. henselae or B. quintana, can cause acute or chronic infection, with vascular, proliferative, or suppurative features depending on the host’s immune response. Many new Bartonella species isolated from various mammals have been identified as zoonotic.

Cat-scratch disease—caused by B. henselae and commonly associated with a cat scratch, presents with a discrete papule or vesicle typically developing at the site within a week, followed by regional lymphadenopathy, sometimes with fever and constitutional symptoms. Disseminated infection can cause neuro-retinitis and (rarely) encephalopathy.
Chlamydial infections
Authors: Horner Patrick , Mabey David , Taylor-Robinson David , Unemo Magnus
Published: February 2020

Chlamydiae are pathogenic bacteria that likely evolved from host-independent, Gram-negative ancestors. Chlamydiae depend on a eukaryotic host cell for their replication which takes place in an inclusion inside the host cell, and for their dispersal, cell lysis, or extrusion subsequently occurs. Although the phylum Chlamydiae (order Chlamydiales) was originally thought to only contain one family, the Chlamydiaceae, a total of nine families are now recognized. The genus Chlamydia remains the most widely studied. The species Chlamydia trachomatis was proposed some decades ago on the basis of 16S rRNA and 23S rRNA sequences, to belong to the genus Chlamydia together with C. muridarum and C. suis. This chapter primarily focuses on the species C. trachomatis, which causes disease of ocular trachoma (serovars A–C), oculo-anogenital tract infection (serovars D–K) and lymphogranuloma venereum (serovars L1–L3). However, infections caused by C. pneumoniae and C. psittaci are also discussed.
Amoebic infections
Authors: Knight Richard
Published: February 2020

Two very different groups of amoebic species infect humans. (1) Obligate anaerobic gut parasites, including the major pathogen Entamoeba histolytica, which causes amoebic dysentery and amoebic liver abscess. Infection is especially common in Mexico, South America, Africa and South-east Asia; nearly all cases in temperate countries is acquired elsewhere. Other gut amoebae are Dientamoeba fragilis (which causes relatively mild colonic involvement with diarrhoea), and eight non-pathogenic species including Entamoeba dispar. (2) Aerobic free-living, water and soil amoebae– Naegleria, Acanthamoeba and Balmuthua, which can become facultative tissue parasites in humans after cysts or trophozoites are inhaled, ingested, or enter damaged skin, cornea or mucosae: they may cause primary amoebic meningo-encephalitis, amoebic keratitis or brain abscess.
Babesiosis
Authors: Brasseur Philippe
Published: February 2020

Babesia are intraerythrocytic, tick-transmitted, protozoan parasites that infect a broad range of wild and domesticated mammals including cattle, horses, dogs, and rodents. Human babesial infection is uncommon, mainly caused by B. microti in North America and B. divergens in Europe, with most infections occurring in asplenic people. Presentation is typically with non-specific ‘viral-type’ symptoms. Haemolytic anaemia is a characteristic feature and can be severe, particularly with B. divergens. Diagnosis is by discovering babesia organisms in Giemsa-stained blood smears, or detection of its DNA in blood by polymerase chain reaction. Aside from supportive care, treatment is usually with combinations of clindamycin and quinine or atovaquone and azithromycin. Mortality ranges from 5 to 40%. Prevention is by use of repellents, removing ticks from the skin, and avoidance of exposure in asplenic and immunocompromised individuals: there is no vaccine.