Tuberculosis has shown a resurgence in nonendemic populations in recent years, a phenomenon that has been attributed to factors such as increased migration and the human immunodeficiency virus epidemic. Although the thorax is most frequently involved, tuberculosis may involve any of a number of organ systems (eg, the respiratory, cardiac, central nervous, musculoskeletal, gastrointestinal, and genitourinary systems), and timely diagnosis of the disease is paramount, since delayed treatment is associated with severe morbidity. Unfortunately, a history of infection with or exposure to tuberculosis may or may not be present, and evidence of active tuberculosis is present in less than 50% of cases. A negative tuberculin skin test does not in itself exclude infection. Furthermore, the clinical and radiologic features of tuberculosis may mimic those of many other diseases. Therefore, although in many cases biopsy or culture specimens are required to make the definitive diagnosis, it is imperative that radiologists and clinicians understand the typical distribution, patterns, and imaging manifestations of tuberculosis.
This study examines the early adoption and dissemination of emerging technology tools in campaigns by analyzing which candidates were the most likely to adopt and use Facebook in the 2006 and 2008 elections to the US House of Representatives. The research hypotheses draw primarily from the diffusion of innovation literature. Our analysis of 802 candidates in 2006 and 816 candidates in 2008 indicates that Facebook adoption diffused rapidly between 2006 and 2008, with party (Democrats), competition, money and the level of education in the district explaining both adoption and implementation.Challengers and candidates for open seats were more likely to be early adopters, but incumbents used Facebook more extensively. Both higher adoption rates by peers or competitors in the candidate's own state and a propensity to adopt earlier campaign technologies are strong positive motivators for early adoption, but irrelevant to usage.
Between 1 June 2016 and 31 May 2017, 17 European Union (EU) and European Economic Area countries reported 4,096 cases associated with a multi-country hepatitis A (HA) outbreak. Molecular analysis identified three co-circulating hepatitis A virus (HAV) strains of genotype IA: VRD_521_2016, V16–25801 and RIVM-HAV16–090. We categorised cases as confirmed, probable or possible, according to the EU outbreak case definitions. Confirmed cases were infected with one of the three outbreak strains. We investigated case characteristics and strain-specific risk factors for transmission. A total of 1,400 (34%) cases were confirmed; VRD_521_2016 and RIVM-HAV16–090 accounted for 92% of these. Among confirmed cases with available epidemiological data, 92% (361/393) were unvaccinated, 43% (83/195) travelled to Spain during the incubation period and 84% (565/676) identified as men who have sex with men (MSM). Results depict an HA outbreak of multiple HAV strains, within a cross-European population, that was particularly driven by transmission between non-immune MSM engaging in high-risk sexual behaviour. The most effective preventive measure to curb this outbreak is HAV vaccination of MSM, supplemented by primary prevention campaigns that target the MSM population and promote protective sexual behaviour.
Measurements of body weight, total body water and total body potassium (*OK) * Measurements periods (in weeks): 1 = 10 to 14; 2 = 24 to 28; 3 = 36 to 38.
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