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1

Nesler, Thomas P. Boreal toad, Bufo boreas boreas: Recovery plan. Denver, Colo. (6060 Broadway, Denver 80216): Colorado Division of Wildlife, 1994.

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2

Pierce, Leland J. S. Boreal toad (Bufo boreas boreas) recovery plan. [Santa Fe, N.M.]: New Mexico Dept. of Game & Fish, 2006.

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3

Engel, Charles. How wide is the border? Cambridge, MA: National Bureau of Economic Research, 1994.

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4

Coronado, Roberto Quirós. The impact of illegal immigration and enforcement on border crime rates. [Dallas, Tx.]: Federal Reserve Bank of Dallas, 2003.

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5

Gorodnichenko, Yuriy. A re-examination of the border effect. Cambridge, Mass: National Bureau of Economic Research, 2005.

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6

Gorodnichenko, Yuriy. A re-examination of the border effect. Cambridge, MA: National Bureau of Economic Research, 2005.

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7

Campbell, Jeffrey R. Real exchange rate fluctuations and the dynamics of retail trade industries on the U.S.-Canada border. Cambridge, MA: National Bureau of Economic Research, 2001.

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8

Ponto, R. L. Fireline construction: Bulldozer production rates and guidelines for constructing fireguards in boreal forest cover types. Edmonton, Alta: Foresty Canada, Northern Forestry Centre, Regional Development, 1990.

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9

Hanson, Gordon H. Birth rates and border crossings: Latin American migration to the US, Canada, Spain, and the UK. Cambridge, MA: National Bureau of Economic Research, 2010.

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10

Hanson, Gordon H. Birth rates and border crossings: Latin American migration to the US, Canada, Spain, and the UK. Cambridge, MA: National Bureau of Economic Research, 2010.

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11

Kádár, Judit Ágnes, and András Tarnóc, eds. La Frontera. Szeged, Hungary: Department of American Studies, University of Szeged, 2016. http://dx.doi.org/10.14232/americana.books.2016.frontera.

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The essays in this book have one common denominator, the discussion of the concept of the border in American culture. Partly motivated by a symposium held on this very topic in late 2014 at Eszterházy Károly University of Applied Sciences of Eger, Hungary, the subsequent call for papers resulted in a variety of submissions. The starting point of all essays was Gloria Anzaldua’s statement: “[B]orderlands are not specific to the [American] Southwest. In fact the borderlands are physically present wherever two or more cultures edge each other, where people of different races occupy the same territory, where under, lower, middle and upper classes touch, where the space between two individuals shrinks with intimacy.”As a whole the nine articles involved treat issues related to the actual U.S.-Mexico border and U.S.-Canadian border, investigate the consequences of the encounter of different cultures, and examine the borderlines discernible in popular culture including film and music, literature, i.e. slave narratives and history.
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12

Fitzgerald, John D. The effects of differences in rates of indirect taxation on trade in consumer goods across the Republic of Ireland - Northern Ireland border. Dublin: Economic and Social Research Institute, 1987.

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13

Nayʻ capʻ Desa nhaṅʻʹ Tuiṅʻʺ raṅʻʺ sāʺ Lū myuiʺ myāʺ e* Phvaṃ phruiʺ Tuiʺ takʼ mhu ʼA koṅʻ ʼa thaññʻ Phoʻ reʺ Ba hui Koʻmatī (Burma). Nay cap desa nhaṅʻʹ Tuiṅʻʺ raṅʻʺ sāʺ lū myuiʺ myāʺ phvaṃʹ phruiʺ tuiʺ takʻ reʺ , Caññʻ paṇʻ sā yā reʺ, Paññā reʺ nhaṅʻʹ Leʹ kyaṅʻʹ reʺ lupʻ ṅanʻʺ ʼA koṅʻ ʼa thaññʻ phoʻ choṅʻ rvakʻ mhu myāʺ (1989-2001) =: Measures undertaken for the development of border areas and national races, development affairs and education and training. [Rangoon]: Published by the Ministry for Progress of Border areas and National Races and Development Affairs, 2001.

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14

(Burma), Nayʻ capʻ Desa nhaṅʻʹ Tuiṅʻʺ raṅʻʺ sāʺ Lū myuiʺ myāʺ e* Phvaṃ phruiʺ Tuiʺ takʼ mhu ʼA koṅʻ ʼa thaññʻ Phoʻ reʺ Ba hui Koʻmatī. Nay cap desa nhaṅʻʹ Tuiṅʻʺ raṅʻʺ sāʺ lū myuiʺ myāʺ phvaṃʹ phruiʺ tuiʺ takʻ reʺ , Caññʻ paṇʻ sā yā reʺ, Paññā reʺ nhaṅʻʹ Leʹ kyaṅʻʹ reʺ lupʻ ṅanʻʺ ʼA koṅʻ ʼa thaññʻ phoʻ choṅʻ rvakʻ mhu myāʺ (2001-2002) =: Measures taken for the development of border areas and national races, development affairs and education and training (2001-2002). (Rangoon): Published by the Ministry for Progress of Border Areas and National Races and Development Affairs, 2002.

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15

TOT CE NU ȚI-AM SPUS. Coresi, 2019.

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16

Nayʻ capʻ Desa nhaṅʻʺ Tuiṅʺ raṅʻʺ sāʺ Lū myuiʺ myāʺ e* Phvaṃ phruiʺ Tuiʺ takʻ mhu ʼA koṅʻ ʼa thaññ Phoʻ reʺ Ba hui Koʻmati (Burma), ed. Measures taken for border areas and national races development. [Rangoon: Central Committee for Development of Border Areas and National Races, Public-Relations Sub-Committee, 1991.

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17

Burma. Work Committee for Development of Border Areas and National Races. and Burma. Work Committee for Development of Border Areas and National Races. Public Relations Sub-Committee., eds. Measures taken for development of border areas and national races, 1989-1992. [Rangoon]: The Sub-Committee, 1992.

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18

Study on the Impact of Liberalization of Inward Cross-Border Mail on Provision: Final Report. European Communities, 1995.

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19

Thomas London, W., Jessica L. Petrick, and Katherine A. McGlynn. Liver Cancer. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190238667.003.0033.

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Primary liver cancer is the sixth most frequently occurring cancer in the world and the second most common in terms of cancer deaths. The global burden of liver cancer is borne principally by countries in East Asia and Africa, where 80% of liver cancer arises. Incidence rates of liver cancer, however, have begun to decline in Asia, while rates are increasing in low-rate areas such as Europe and North America. The dominant histology of liver cancer in almost all countries is hepatocellular carcinoma (HCC). The major risk factors for HCC—chronic infection with either hepatitis B virus (HBV) or hepatitis C virus (HCV), aflatoxin B1 (AFB1) contamination of foodstuffs, excessive alcohol consumption, and diabetes/obesity/fatty liver disease—all result in chronic inflammation in the liver. HBV infection is preventable by immunization, and HCV infection is largely preventable by public health measures and now is curable with new antiviral therapies.
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20

Mueller, Dana. Malaria and Dengue Fever. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199976805.003.0052.

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Malaria is a vector-borne parasitic illness characterized by acute fever, headache, chills, and vomiting. Medications must target both the parasite’s active and inactive forms. During pregnancy, treatment regimens should consist of quinine and clindamycin. Person-to-person transmission can occur via sharing of blood products or during pregnancy. It is possible to contract malaria even while on prophylactic medications because resistance is widespread. Country-specific recommendations for prophylaxis can be found in the CDC’s annual Health Information for International Travel Protection against mosquito bites. Dengue Fever is a vector-borne viral infection that causes a flu-like illness with occasional lethal complications. It occurs primarily in tropical and subtropical regions. All treatment is supportive, ranging from oral rehydration to intravenous fluid administration and vasopressor support. Aspirin and NSAIDs are contraindicated in this population. Person-to-person transmission can occur via sharing of blood products or during pregnancy, although vertical transmission is rare.
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21

Joshi, Mahesh K., and J. R. Klein. Technological Disruption in Global Finance. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198827481.003.0004.

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Will the currency of the future be bitcoins or cryptocurrencies? With Fintech and Digital ecosystems growing rapidly, what is the future of banks? Technology is fast replacing paper currency with electronic transactions. Finance has become sophisticated with complex and diversified products. New technology and instruments have enabled growth of global financial assets to more than $160 trillion. Geographical boundaries for financial transactions have disappeared with transactions taking place seamlessly across the globe. Due to the global connectedness of financial markets, any event in one country can impact the whole world instantaneously. The effects of the last decade’s financial crisis are still being felt in major economies. Financing is being used both as a weapon in the balance of power and as a facilitator of cross-border acquisitions. Governments are competing with tax rates to attract global corporations. Individual investors have the opportunities and tools available for geographical diversification of their investments.
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22

Neeley, Tsedal. The Language of Global Success. Princeton University Press, 2019. http://dx.doi.org/10.23943/princeton/9780691196121.001.0001.

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For nearly three decades, English has been the lingua franca of cross-border business, yet studies on global language strategies have been scarce. Providing a rare behind-the-scenes look at the high-tech giant Rakuten in the five years following its English mandate, this book explores how language shapes the ways in which employees in global organizations communicate and negotiate linguistic and cultural differences. Drawing on 650 interviews conducted across Rakuten's locations around the world, the book argues that an organization's lingua franca is the catalyst by which all employees become some kind of “expat”—detached from their native tongue or culture. Demonstrating that language can serve as the conduit for an unfamiliar culture, often in unexpected ways, the book uncovers how all organizations might integrate language effectively to tap into the promise of globalization.
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23

Krause, Andreas, and Volker Fingerle. Lyme borreliosis. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0101.

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Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.
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24

Krause, Andreas, and Volker Fingerle. Lyme borreliosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199642489.003.0101_update_001.

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Lyme borreliosis (LB) is a multisystem infectious disease caused by the tick-borne spirochete Borrelia burgdorferi. The most frequent clinical manifestations include erythema migrans, meningoplyneuritis, and arthritis. Diagnosis of LB is made on clinical grounds and usually supported by a positive serology. Early diagnosis and treatment almost always leads to a rapid healing of the disease. However, in late manifestations gradual remission of symptoms may take several weeks to months. In rare cases, the pathogen can persist for many years or induce a persisting immunopathological response that may cause acrodermatitis chronica atrophicans, chronic neuroborreliosis of the central nervous system, or antibiotic resistant Lyme arthritis. However, even these chronic manifestations usually slowly regress after thorough antibiotic and symptomatic therapy, although in part with irreversible organ defects.
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25

Chávez-García, Miroslava. Migrant Longing. University of North Carolina Press, 2018. http://dx.doi.org/10.5149/northcarolina/9781469641034.001.0001.

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Drawing upon a personal collection of more than 300 letters exchanged between her parents and other family members across the U.S.-Mexico border, Miroslava Chávez-García recreates and gives meaning to the hope, fear, and longing migrants experienced in their everyday lives both "here" and "there" (aqui y alla). As private sources of communication hidden from public consumption and historical research, the letters provide a rare glimpse into the deeply emotional, personal, and social lives of ordinary Mexican men and women as recorded in their immediate, firsthand accounts. Chávez-García demonstrates not only how migrants struggled to maintain their sense of humanity in el norte but also how those remaining at home made sense of their changing identities in response to the loss of loved ones who sometimes left for weeks, months, or years at a time, or simply never returned. With this richly detailed account, ranging from the Mexican Revolution of the 1910s to the emergence of Silicon Valley in the late 1960s, Chávez-García opens a new window onto the social, economic, political, and cultural developments of the day and recovers the human agency of much maligned migrants in our society today.
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26

Geddes, Andrew. Global and Regional Cooperation on Migration. Oxford University Press, 2017. http://dx.doi.org/10.1093/acrefore/9780190846626.013.200.

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The problem of international migration is that global cooperation is somewhat rare. If international cooperation is to develop, then it will depend on states; but effective cooperation would also impose real constraints on states. Moreover, as states and their borders give meaning to international migration, it follows that the development, consolidation, and transformation of the state system is a key factor determining the possibilities for the global and regional governance of migration to develop. Existing forms of regional integration and their migration provisions as well as regional consultation processes (RCPs) can serve as a mechanism for intraregional communication, the sharing of knowledge, and for the dissemination of policy ideas and practices. The EU has already been discussed as the world’s most highly developed form of regional integration. It is the only international organization with the power and capacity to make and implement laws through its own institutional system that must be implemented by member states. The EU moreover has a highly developed system of internal free movement for nationals of its own states and has developed a border-free travel area for participating states. These developments constitute the hallmark of a highly developed intra-EU migration framework linked to the creation of the “single market.”
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27

Malik, Hassan. Bankers and Bolsheviks. Princeton University Press, 2018. http://dx.doi.org/10.23943/princeton/9780691170169.001.0001.

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Following an unprecedented economic boom fed by foreign investment, the Russian Revolution triggered the worst sovereign default in history. This book tells the dramatic story of this boom and bust, chronicling the forgotten experiences of leading financiers of the age. Shedding critical new light on the decision making of the powerful personalities who acted as the gatekeepers of international finance, the book explains how they channeled foreign capital into Russia in the late nineteenth and early twentieth centuries. While economists have long relied on quantitative analysis to grapple with questions relating to the drivers of cross-border capital flows, this book adopts an historical approach, drawing on banking and government archives in four countries. It provides rare insights into the thinking of influential figures in world finance as they sought to navigate one of the most challenging and lucrative markets of the first modern age of globalization. The book reveals how a complex web of factors—from government interventions to competitive dynamics and cultural influences—drove a large inflow of capital during this tumultuous period in world history. The book demonstrates how the realms of finance and politics—of bankers and Bolsheviks—grew increasingly intertwined, and how investing in Russia became a political act with unforeseen repercussions.
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28

Suddler, Carl. Presumed Criminal. NYU Press, 2019. http://dx.doi.org/10.18574/nyu/9781479847624.001.0001.

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Presumed Criminal is a provocative analysis of youth, race, and crime in New York City from the 1930s to the 1960s that shows how shifts in the criminal justice system bolstered authoritative efforts that criminalized black youths. Grounded in extensive research, it is a startling examination of a historical past that appears to be anything but past.The criminalization of black youth is inseparable from its racialized origins. Thus, when the federal government entered the debate on how to address juvenile delinquency in the United States, it occurred at a critical juncture when Progressive-era modes of rehabilitation were being replaced by disparate means of punishment. Black youths bore the brunt of the transition. In New York City, increased state surveillance of predominantly black communities compounded arrest rates into the post–World War II period, which gave reason to become tough on crime. Extreme police practices, such as stop-and-frisk, combined with media sensationalism, cemented black youths as the primary cause for concern. Consequently, before the War on Crime, black youths already faced a punitive justice system that restricted their social mobility and categorically branded them as criminal—a stigma they continue to endure.
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29

McLauchlin, J. Listeriosis. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0014.

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Listeriosis occurs in a variety of animals including humans, and most often affects the pregnant uterus, the central nervous system (CNS) or the bloodstream. During pregnancy, infection spreads to the foetus, which will either be born severely ill or die in-utero. In non-pregnant animals, listeriosis usually presents as meningitis, encephalitis. In humans, infection most often occurs in the immunocompromised and elderly, and to a lesser extent the pregnant woman, the unborn, or the newly delivered infant. Infection can be treated successfully with antibiotics, however 20–40% of human cases are fatal..In domestic animals (especially in sheep and goats) listeriosis usually presents as encephalitis, abortion, or septicaemia, and is a cause of considerable economic loss.The genus Listeria comprises six species of Gram-positive bacteria. Almost all cases of listeriosis are due to Listeria monocytogenes although up to 10% of cases in sheep are due to Listeria ivanovii.Listeriae are ubiquitous in the environment worldwide, especially in sites with decaying organic vegetable material. Many animals carry the organism in the faeces without serious infection. The consumption of contaminated food or feed is the principal route of transmission for both humans and animals, however other means of transmission occur.Human listeriosis is rare (<1 to > 10 cases per million people in North America and Western Europe), but because of the high mortality rate, it is amongst the most important causes of death from food-borne infections in industrialized countries. In the UK, human listeriosis is the biggest single cause of death from a preventable food-borne disease. Listeriosis in domestic animals is a cause of considerable economic loss. Control measures should be directed towards both to exclude Listeria from food or feed as well as inhibiting its multiplication and survival. Silage which is spoiled or mouldy should not be used, and care should be taken to maintain anaerobic conditions for as long as possible.Dietary advice is available for disease prevention, particularly targeted at ‘at risk’ individuals to modify their diet to avoid eating specific foods such as soft cheese and pâté.
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30

Swanepoel, R., and J. T. Paweska. Rift Valley fever. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0043.

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Rift Valley fever (RVF) is an acute disease of domestic ruminants in mainland Africa and Madagascar, caused by a mosquito borne virus and characterized by necrotic hepatitis and a haemorrhagic state. Large outbreaks of the disease in sheep, cattle and goats occur at irregular intervals of several years when exceptionally heavy rains favour the breeding of the mosquito vectors, and are distinguished by heavy mortality among newborn animals and abortion in pregnant animals. Humans become infected from contact with tissues of infected animals or from mosquito bite, and usually develop mild to moderately severe febrile illness, but severe complications, which occur in a small proportion of patients, include ocular sequelae, encephalitis and fatal haemorrhagic disease. Despite the occurrence of low case fatality rates, substantial numbers of humans may succumb to the disease during large outbreaks. Modified live and inactivated vaccines are available for use in livestock, and an inactivated vaccine was used on a limited scale in humans with occupational exposure to infection. The literature on the disease has been the subject of several extensive reviews from which the information presented here is drawn, except where indicated otherwise (Henning 1956; Weiss 1957; Easterday 1965; Peters and Meegan 1981; Shimshony and Barzilai 1983; Meegan and Bailey 1989; Swanepoel and Coetzer 2004; Flick and Bouloy 2005). In September 2000, the disease appeared in south-west Saudi Arabia and adjacent Yemen, and the outbreak lasted until early 2001 (Al Hazmi et al. 2003; Madani et al. 2003; Abdo-Salem et al. 2006). The virus was probably introduced with infected livestock from the Horn of Africa, and it remains to be determined whether it has become endemic on the Arabian Peninsula.
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31

Vaheri, Antti, James N. Mills, Christina F. Spiropoulou, and Brian Hjelle. Hantaviruses. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198570028.003.0035.

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Hantaviruses (genus Hantavirus, family Bunyaviridae) are rodent- and insectivore-borne zoonotic viruses. Several hantaviruses are human pathogens, some with 10-35% mortality, and cause two diseases: hemorrhagic fever with renal syndrome (HFRS) in Eurasia, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. Hantaviruses are enveloped and have a three-segmented, single-stranded, negative-sense RNA genome. The L gene encodes an RNA-dependent RNA polymerase, the M gene encodes two glycoproteins (Gn and Gc), and the S gene encodes a nucleocapsid protein. In addition, the S genes of some hantaviruses have an NSs open reading frame that can act as an interferon antagonist. Similarities between phylogenies have suggested ancient codivergence of the viruses and their hosts to many authors, but increasing evidence for frequent, recent host switching and local adaptation has led to questioning of this model. Infected rodents establish persistent infections with little or no effect on the host. Humans are infected from aerosols of rodent excreta, direct contact of broken skin or mucous membranes with infectious virus, or rodent bite. One hantavirus, Andes virus, is unique in that it is known to be transmitted from person-to-person. HFRS and HCPS, although primarily affecting kidneys and lungs, respectively, share a number of clinical features, such as capillary leakage, TNF-, and thrombocytopenia; notably, hemorrhages and alterations in renal function also occur in HCPS and cardiac and pulmonary involvement are not rare in HFRS. Of the four structural proteins, both in humoral and cellular immunity, the nucleocapsid protein appears to be the principal immunogen. Cytotoxic T-lymphocyte responses are seen in both HFRS and HCPS and may be important for both protective immunity and pathogenesis. Diagnosis is mainly based on detection of IgM antibodies although viral RNA (vRNA) may be readily, although not invariably, detected in blood, urine and saliva. For sero/genotyping neutralization tests/RNA sequencing are required. Formalin-inactivated vaccines have been widely used in China and Korea but not outside Asia. Hantaviruses are prime examples of emerging and re-emerging infections and, given the limited number of rodents and insectivores thus far studied, it is likely that many new hantaviruses will be detected in the near future.
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32

Holmes, Jonathan, and Philipp Hoelzmann. The Late Pleistocene-Holocene African Humid Period as Evident in Lakes. Oxford University Press, 2017. http://dx.doi.org/10.1093/acrefore/9780190228620.013.531.

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From the end of the last glacial stage until the mid-Holocene, large areas of arid and semi-arid North Africa were much wetter than present, during the interval that is known as the African Humid Period (AHP). During this time, large areas were characterized by a marked increase in precipitation, an expansion of lakes, river systems, and wetlands, and the spread of grassland, shrub land, and woodland vegetation into areas that are currently much drier. Simulations with climate models indicate that the AHP was the result of orbitally forced increase in northern hemisphere summer insolation, which caused the intensification and northward expansion of the boreal summer monsoon. However, feedbacks from ocean circulation, land-surface cover, and greenhouse gases were probably also important.Lake basins and their sediment archives have provided important information about climate during the AHP, including the overall increases in precipitation and in rates, trajectories, and spatial variations in change at the beginning and the end of the interval. The general pattern is one of apparently synchronous onset of the AHP at the start of the Bølling-Allerød interstadial around 14,700 years ago, although wet conditions were interrupted by aridity during the Younger Dryas stadial. Wetter conditions returned at the start of the Holocene around 11,700 years ago covering much of North Africa and extended into parts of the southern hemisphere, including southeastern Equatorial Africa. During this time, the expansion of lakes and of grassland or shrub land vegetation over the area that is now the Sahara desert, was especially marked. Increasing aridity through the mid-Holocene, associated with a reduction in northern hemisphere summer insolation, brought about the end of the AHP by around 5000–4000 years before present. The degree to which this end was abrupt or gradual and geographically synchronous or time transgressive, remains open to debate. Taken as a whole, the lake sediment records do not support rapid and synchronous declines in precipitation and vegetation across the whole of North Africa, as some model experiments and other palaeoclimate archives have suggested. Lake sediments from basins that desiccated during the mid-Holocene may have been deflated, thus providing a misleading picture of rapid change. Moreover, different proxies of climate or environment may respond in contrasting ways to the same changes in climate. Despite this, there is evidence of rapid (within a few hundred years) termination to the AHP in some regions, with clear signs of a time-transgressive response both north to south and east to west, pointing to complex controls over the mid-Holocene drying of North Africa.
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33

Shaw, Pamela, and David Hilton-Jones. The lower cranial nerves and dysphagia. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0429.

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Disorders affecting the lower cranial nerves – V (trigeminal), VII (facial), IX (glossopharyngeal), X (vagus), XI (accessory) and XII (hypoglossal) – are discussed in the first part of this chapter. The clinical neuroanatomy of each nerve is described in detail, as are disorders – often in the form of lesions – for each nerve.Trigeminal nerve function may be affected by supranuclear, nuclear, or peripheral lesions. Because of the wide anatomical distribution of the components of the trigeminal nerve, complete interruption of both the motor and sensory parts is rarely observed in practice. However, partial involvement of the trigeminal nerve, particularly the sensory component, is relatively common, the main symptoms being numbness and pain. Reactivation of herpes zoster in the trigeminal nerve (shingles) can cause pain and a rash. Trigeminal neuralgia and sensory neuropathy are also discussed.Other disorders of the lower cranial nerves include Bell’s palsy, hemifacial spasm and glossopharyngeal neuralgia. Cavernous sinus, Tolosa–Hunt syndrome, jugular foramen syndrome and polyneuritis cranialis are caused by the involvement of more than one lower cranial nerve.Difficulty in swallowing, or dysphagia, is a common neurological problem and the most important consequences include aspiration and malnutrition (Wiles 1991). The process of swallowing is a complex neuromuscular activity, which allows the safe transport of material from the mouth to the stomach for digestion, without compromising the airway. It involves the synergistic action of at least 32 pairs of muscles and depends on the integrity of sensory and motor pathways of several cranial nerves; V, VII, IX, X, and XII. In neurological practice dysphagia is most often seen in association with other, obvious, neurological problems. Apart from in oculopharyngeal muscular dystrophy, it is relatively rare as a sole presenting symptom although occasionally this is seen in motor neurone disease, myasthenia gravis, and inclusion body myositis. Conversely, in general medical practice, there are many mechanical or structural disorders which may have dysphagia as the presenting feature. In some of the disorders, notably motor neurone disease, both upper and lower motor neurone dysfunction may contribute to the dysphagia. Once dysphagia has been identified as a real or potential problem, the patient should undergo expert evaluation by a clinician and a speech therapist, prior to any attempt at feeding. Videofluoroscopy may be required. If there is any doubt it is best to achieve adequate nutrition through the use of a fine-bore nasogastric tube and to periodically reassess swallowing. Anticholinergic drugs may be helpful to reduce problems with excess saliva and drooling that occur in patients with neurological dysphagia, and a portable suction apparatus may be helpful. Difficulty in clearing secretions from the throat may be helped by the administration of a mucolytic agent such as carbocisteine or provision of a cough assist device.
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