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Livestock diseases have devastating consequences economically, socially and politically across the globe. In certain systems, pathogens remain viable after host death, which enables residual transmissions from infected carcasses. Rapid culling and carcass disposal are well-established strategies for stamping out an outbreak and limiting its impact; however, wait-times for these procedures, i.e. response delays, are typically farm-specific and time-varying due to logistical constraints. Failing to incorporate variable response delays in epidemiological models may understate outbreak projections and mislead management decisions. We revisited the 2001 foot-and-mouth epidemic in the United Kingdom and sought to understand how misrepresented response delays can influence model predictions. Survival analysis identified farm size and control demand as key factors that impeded timely culling and disposal activities on individual farms. Using these factors in the context of an existing policy to predict local variation in response times significantly affected predictions at the national scale. Models that assumed fixed, timely responses grossly underestimated epidemic severity and its long-term consequences. As a result, this study demonstrates how general inclusion of response dynamics and recognition of partial controllability of interventions can help inform management priorities during epidemics of livestock diseases.Accidents with Animals While Hiking in the Swiss Alps Abstract. Mountain hiking is very popular. However, despite potential benefits, there are risks, also by animals. Retrospectively, all mountain hiking emergencies (n = 10 185) from the years 2009-2018 were analyzed using the registry of the Swiss Alpine Club (SAC), with 104 mountain emergencies caused by animals. The average NACA score was 3.2 ± 1.6, and more than half of the mountain emergencies had a NACA score >4, which can be associated with a life-threatening condition. More than half of the emergencies were caused by insects (bees, wasps, bumblebees, hornets), and just under a quarter each by hoofed animals and snakes, respectively. Three of these events were mortal, and all of these were caused by hoofed animals (mother cow herd, horse, bull). Therefore, it is recommended to keep a safe distance from these animals when passing them.Sonographic Wall Changes of the Stone-Free Gall Bladder - a Diagnostic and Therapeutic Dilemma Abstract. Various diseases frequently cause sonographic abnormalities of the gallbladder wall and its surroundings. The interpretation of these abnormalities is often a great challenge for the treating physician and will be briefly discussed here. In our patient these abnormalities are due to hepatitis A, which is responsible for multiple extrahepatic manifestations. Considering this etiology, gallbladder resection should be avoided in order to minimize unnecessary complications.Transient Loss of Consciousness at the Wheel - Helpful Tools to Support the Evaluation of Driving Ability and Fitness to Drive Abstract. After road accidents, the person responsible for the accident often declares a "blackout" at the wheel. Although this claim is often used as a protective claim, there are also numerous diseases that can indeed lead to a transient loss of consciousness at the wheel. In these cases the correct medical examination by the clinician as well as the initiating of specific examinations in the run-up to the medical traffic examination can support the subsequent assessment of the driving ability or driving suitability by the traffic physician. This article is intendedas a guide to these proceedings.CME/Answers Hypertension and the COVID-19 Pandemic What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.CME ECG 68 Gender Specificities in Heart Rhythm Disorders Abstract. Sex differences in heart rhythm disorders have been described, especially due to differences of hormone status in women and men. In general, women do have a higher baseline heart rate than men and shorter refractory periods of most structures in the conduction system, except the ventricles. This is particularly apparent in paroxysmal supraventricular tachycardias. The incidence of a dual AV nodal physiology is the same in both sexes. However, an AV-nodal reentry tachycardia is much more frequent in women than in men. The embryonal disposition for an accessory pathway, as well as the resultant AV reentry tachycardia is more common in men than in women. Focal atrial tachycardias do not reveal a clear dominance between the sexes. Knowledge about sex-related differences in heart rhythm disorders are relevant for its diagnostics. BAY 2416964 nmr Therefore, important aspects will be discussed in this article.CME Sonography 96/Answers Spleen Changes Abstract. The spleen is a somewhat neglected organ but there are some changes that must not be neglected. Splenomegaly, caused worldwide most commonly by malaria, can occur in other infections, in portal vein thrombosis or in portal hypertension in the context of liver cirrhosis. An accessory spleen is also often found. Sometimes after splenectomy, small remains are found which may later hypertrophy. Where focal changes are concerned, we differentiate between various forms of spleen cysts, lymphomas, metastases, and benign tumors.This case of ascending paralysis, following an episode of diarrhea, was initially misinterpreted as Guillain-Barré syndrome. The prominent hypokalemia led to the search for other differential diagnoses, initially interpreted as a rare case of periodic hypokalemic paralysis, which usually occurs in Asians after intake of large amounts of starch foods, such as Spaghetti, or rest after heavy exercise. In this case, the reason for the hypokalemia with associated paralysis was caused by a hyperhyreosis factitia through denied intake of T3.