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Influenza A viruses are characterized by a unique genome structure, causing genetic instability, especially to the genes of haemagglutinin and neuraminidase. The objectives of this research was molecular and phylogenetic analysis of influenza A(H3N2) strains that circulated in Northern Greece since 2004, particularly the identification of sequence variations and the comparison of circulating viruses with vaccine strains. Since 2004 in Northern Greece, a total of 216 clinical samples were positive for influenza virus infections, of which 83 (38.4%) were attributed to influenza A(H3N2). Molecular analysis of the HA genes of 23 isolates showed that all circulating strains had variations at antigenic sites. Receptor binding sites were conserved in 2004-2005 and 2005-2006 strains whereas a variation was observed in all 2006-2007 strains (H195Y). Furthermore, alternative amino acids for sialic acid receptor binding sites were observed in most of the 2004-2006 isolates. Some amino acid substitutions were also observed at the neuraminidase sequences, which however had no effect on the antigenicity of the viruses. Phylogenetic analysis of each year's circulating strains revealed a relatively low match with the vaccine strains A/Fujian/411/02 and A/California/7/04 for 2004-2005 and 2005-2006, respectively, whereas most 2006-2007 isolates match with the vaccine strain, A/Wisconsin/67/05. This year, unique variations were observed at antigenic and glycosylation sites of A/Serres/77/07-like stains. Constant surveillance of yearly variations is of great importance, so that vaccine strains can be evaluated.

Television viewing by infants has become very common, yet relatively little is known about infants' reactions to video compared to live events. We conducted two experiments in order to compare 9- or 10-month-old infants' behavioral reactions to live events and video presentations of those events. In the first experiment, infants' were shown video and live presentations shown consecutively; their affective reactions were consistent, indicating that video conveys meaning and emotional impact even in infancy. However, infants generally looked longer at, reached more to, showed more interest in, and exhibited more fear to the real stimuli. In a second experiment, infants were shown identical live and video events simultaneously; they looked much longer at the live presentations, further confirming that they distinguished live events from video and preferred to watch real events. Implications for infants' television viewing and the use of video images in infancy research are discussed.

Human cowpox, a rare zoonotic infection, evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become severe. The causative agent, cowpox virus, is distributed in Europe, west former USSR, and adjacent areas of Northern and Central Asia, with an increasing number of reports in Europe. The purpose of this paper is to review cowpox with an emphasis on its epidemiology and management.Numerous reports of human cowpox affecting young people in Europe indicate that lack of smallpox vaccination, which has been abandoned since 1977, may render the population more vulnerable to cowpox virus. The ownership of wild and exotic animal pets is becoming more popular, and the range of recognized wild and domestic animal hosts is expanding,Cowpox as a human emerging zoonotic hazard raises public health concerns as well as a question about the production of effective vaccine and antiviral agents.

Crimean-Congo hemorrhagic fever is a tick-borne viral zoonosis with the potential of human-to-human transmission, affecting wide areas in Asia, Southeastern Europe, and Africa. Hemorrhagic manifestations constitute a prominent symptom of late stage disease with case fatality rates from 10% to 50%. The purpose of this article is to review recent literature on Crimean-Congo hemorrhagic fever with emphasis on its epidemiology and management.Climate and environmental changes may affect Crimean-Congo hemorrhagic fever epidemiology and trigger community outbreaks. Risk factors for acquisition of infection have been well studied. In the hospital, high-risk activities include interventions for gastrointestinal bleeding and needle stick injuries. Reverse transcription-polymerase chain reaction may rapidly diagnose Crimean-Congo hemorrhagic fever with high sensitivity and specificity. Ribavirin is the only promising therapeutic agent currently available but case-control studies have not been conducted. Recently, the Mx proteins have been found to act against Crimean-Congo hemorrhagic fever virus and deserve further research.Clinicians should be aware of the potential of importation of Crimean-Congo hemorrhagic fever cases from endemic areas and nosocomial transmission. Studies on the efficacy of ribavirin are needed.

Influenza vaccination rates are generally low among healthcare workers (HCWs) worldwide. In September 2005, the Hellenic Center for Disease Control and Prevention conducted a nationwide campaign to promote influenza vaccination in hospital HCWs. During the 2005-2006 influenza season, the overall vaccination rate among HCWs was 16.36% (range: 0-85.96%). The self-reported vaccination rate during the previous season was 1.72%, indicating a 9.5-fold increase. Compared with physicians, significantly fewer technical personnel were vaccinated, whereas administrative personnel were more likely to receive the vaccine. Among clinicians, rates for internal medicine departments exceeded those of surgical departments by a factor of 2.71 and laboratory medicine departments by a factor of 2.36. Multivariate analysis showed lower vaccination rates in large hospitals (>200 beds) than in smaller hospitals and lower rates in hospitals with specialist services (intensive care unit, psychiatry or dermatology) than in general hospitals. Factors associated with higher rates included working in northern Greece, in a paediatric or an oncology hospital, or in a prefecture with avian influenza H5N1 activity. In conclusion, in Greece influenza vaccination rates among HCWs remain low, but the implementation of a nationwide campaign had a considerable impact. Efforts should focus on hospital- and HCW-associated factors to increase vaccination uptake.

Cross‐border mergers are rising in number and scope even though, on average, firms do not profi t from them. In this article, we use interviews and secondary data to assess a historic merger between two global consulting giants ‐ Cap Gemini and Ernst & Young Consulting. The two fi rms had well‐articulated strategic reasons for merging. Nevertheless, their integration strategy failed to address key differences in business models, core competencies, and organizational practices. As a result, the combined firm suffered five years of diminished financial and competitive performance. Our study highlights the organizational complexities affecting mergers between human capital‐intensive firms.

Pictorial competence, which refers to the many factors involved in perceiving, interpreting, understanding, and using pictures, develops gradually over the first few years of life. Although experience is not required for accurate perception of pictures, it is necessary for understanding the nature of pictures. Infants initially respond to depicted objects as if they were real objects, and toddlers are remarkably insensitive to picture orientation. Only gradually do young children figure out the nature of pictures and how they are used.

In two studies, 9-month-old infants were shown a video of a series of stationary and moving objects. The infants directed the same kinds of behaviors toward objects on a video monitor as children of this age in earlier research directed toward color photographs: They hit at and attempted to grasp the items depicted on the screen. As with pictures, a decline in manual behaviors and an increase in pointing and vocalizing toward the video were found with 15- and 19-month-olds. These results support the notion that very young children must learn about the dual nature of depictions (that pictures are both objects in themselves and representations of something else) and the typical ways in which adults respond to such symbols.

In previous research, we established that 9-month-old infants manually investigate pictured objects by hitting, rubbing, and grasping as if to pluck them off the page. This behavior suggests that infants do not understand the 2-dimensional nature of pictures. Although they can perceive depth cues and distinguish pictures from objects, they do not appreciate the significance of these cues; that is, they do not realize how depicted objects differ from real ones. We report 2 studies that support the idea that infants' manual response to pictures is driven by the resemblance of depicted objects to the real objects they represent. In Study 1, we report that infants' manual investigation of pictures is directly related to how realistic they are: The more depicted objects look like real objects, the more manual investigation they evoke. In Study 2, we show that 9-month-old infants' manual behaviors are concentrated on depicted objects even when there are areas of greater perceptual contrast on the page. The resu...

The very strong, natural-seeming preference that adults and older children have for looking at pictures in their canonical orientation is not shared by very young children. In 3 studies with 18- to 30-month-old children, several different assessments were made of the degree to which the children behaved differentially to upright versus inverted picture books. The 18-month-olds in these studies did not exhibit a strong orientation preference: They usually (a) looked at a picture book that was handed to them upside down without reorienting it, (b) did not acknowledge or protest when an adult read to them while holding a book upside down, and (c) selected randomly between upright and inverted picture books. In addition, they were equally accurate at identifying depicted objects in upside-down and right-side-up pictures. In contrast, a group of 30-month-olds consistently preferred to interact with canonically oriented picture books. The 24-month-old participants generally behaved like the 18-month-olds, but g...

We conducted a nationwide survey to investigate reasons for influenza vaccine uptake or refusal among health-care workers (HCWs) in Greece. Vaccination rates increased with increasing age, and among HCWs working in Northern Greece, in direct contact with patients, and with influenza vaccination in the past. Self-protection was the main reason for vaccination (89.1%), whereas 55.2% of HCWs reported vaccination to protect patients. Main reasons for refusing vaccination were perception of not being at risk for influenza (43.2%) and fear of vaccine adverse effects (33.4%).

0036-5548 (paper) The aim of the current study was to investigate the contribution of various strategies to increase influenza vaccine uptake among health care workers (HCWs) working in hospitals in Greece during the 2005-2006 season. A total of 132 Greek public hospitals participated in the study. The mean HCWs vaccination rate against influenza during 2005-2006 was 16.36% compared with 1.72% during the previous season. Logistic regression analysis showed that the implementation of the following strategies was significantly associated with influenza vaccination rates above the mean vaccination rate: a mobile vaccination team (OR 2.942, 95% CI 1.154-5.382, p-value 0.016) and lectures on influenza and influenza vaccine (OR 2.386, 95% CI 0.999-5.704, p-value 0.036). In conclusion, in Greece influenza vaccination rates among HCWs remain low; however, the implementation of specific strategies was associated with increased vaccine uptakes.

Research on the symbolic functioning of very young children has important implications for educational materials. We argue that there are no transparent symbols; one can never assume that what seems to be an obvious symbolic relation is obvious to young children. We have discovered that young children have particular difficulty understanding and using symbols that are themselves interesting objects. A symbol, such as a scale model of a room, that is salient and appealing as an object, requires a dual representation: To use a model, one must simultaneously represent both the model itself and its referent. Research on young children's understanding and use of models indicates that they have particular difficulty achieving dual representation. This work has clear implications for the use of symbolic objects for educational purposes. We discuss several examples of commonly used symbolic objects, suggesting that they may be less helpful to young learners than is generally assumed.

The role of experience in the development of pictorial com- petence has been the center of substantial debate. The four studies pre- sented here help resolve the controversy by systematically documenting and examining manual exploration of depicted objects by infants. We report that 9-month-old infants manually investigate pictures, touching and feeling depicted objects as if they were real objects and even trying to pick them up off the page. The same behavior was observed in babies from two extremely different societies (the United States and the Ivory Coast). This investigation of pictures occurs even though infants can discriminate between real objects and their depictions. By the time infants are 19 months of age, their manual exploration is replaced by pointing at depicted objects. These results indicate that initial uncer- tainty about the nature of pictures leads infants to investigate them. Through experience, infants begin to acquire a concept of "picture." This concept includes the fact that a picture has a dual nature (it is both an object and a representation of something other than itself), as well as knowledge about the culturally appropriate use of pictures. Most people think they know what a picture is, anything so familiar must be simple. They are wrong. (Gibson, 1980, p. xvii)

Pre-travel services are underused by travellers visiting friends and relatives (VFRs). The objective of this study was to define the proportion and the profile of VFRs who seek pre-travel counselling in Greece. The study was conducted prospectively, from July, 2005 to December, 2007, in seven Health Departments of the Prefectures in Athens and Attica, where 35.6% of the Greek population resides; migrants account for 17% and 8% of the population in these areas, respectively. 2548 travellers seeking pre-travel advice were studied; 23 (0.9%) were identified as VFRs. Children younger than 15 years accounted for 30.4% of VFRs, compared to 2.3% among non-VFRs. VFRs were younger than non-VFRs (mean ages: 29.9 versus 40.4 years, respectively). A comparison of VFRs with non-VFRs revealed that VFRs travelled for longer periods of time, stayed at local people's home more frequently (87% versus 15.5%), and travelled on an organized trip less frequently (4.3% versus 54.6%). Considering the fact that 36,056 VFRs travelled from Greece to Africa and Asia during 2005-2007, and that only 1 out of 700 VFRs to these destinations pre-travel advice in Greece, communication strategies to access efficiently this group of travellers should be explored urgently.

The prevention and control of influenza with vaccines and antiviral drugs is of great importance. M2 inhibitors, amantadine and rimantadine have been extensively used in some countries. The next generation of antiviral drugs, neuraminidase (NA) inhibitors oseltamivir and zanamivir, are being stockpiled for a potential influenza pandemic. The emergence of resistant strains is thus an important issue. The purpose of this study was to examine the sensitivity to M2 and NA inhibitors of Greek influenza A(H3N2) strains isolated during three influenza seasons between 2004 and 2008 and to determine the phylogenetic clades of those strains. M2 and NA sequences of 34 patient isolates were checked for known resistance mutations. In addition, haemagglutinin (HA) sequences were used to determine the phylogenetic relationship between resistant and sensitive strains. All influenza A(H3N2) strains isolated during the season 2004-5 were found susceptible to adamantanes, bearing the S31N mutation, compared to 88% of the strains isolated in 2005-6 and 75% of the strains isolated in 2006-7. Molecular analysis of the HA gene showed a correlation of the mutants with specific phylogenetic clades. No known mutations in the NA or HA gene that have been implicated in resistance to NA inhibitors were found in the A(H3N2) strains isolated in the three influenza seasons. Despite the fact that amantadine is the only drug approved for prophylaxis in Greece, it has not been extensively used. So it seems that resistant strains circulating in the area after 2005 followed the global trend of replacement of susceptible strains by resistant ones. Oseltamivir and zanamivir are currently approved only for therapeutic use in Greece and has not been extensively used either.

SUMMARY. Hepatitis B virus infection (HBV) has been recognized as a major health problem worldwide. Greece belongs to the intermediate endemicity countries with a trend of decreasing prevalence of HBV infection during the last decade. However, the recent massive immigration to our country may have led to alterations of HBV epidemiology. In this study, we evaluated the epidemiological features of HBV infection in a sample of 3480 patients followed up during the years 1997–2006. Immigrants mainly from Albania represented the 18.6% of the total study population and 56.6% of children. The majority of the patients had no family history of HBV infection (67.3%) or of acute hepatitis (95.4%), no known source of infection (64.6%), with intrafamilial spread accounting for 16.9% of the HBV transmission in adults and 33.9% in children. HBeAg(-) hepatitis B was the predominant form of hepatitis (92.1%) among the Greek patients in contrast to the immigrants where 16.6% were HBeAg(+). Liver cirrhosis was diagnosed in 8.8% of the total population and 0.9% had hepatocellular carcinoma. A high proportion of children were HBeAg(+) (62%), 55% from immigrant families, 25.2% were infected in the perinatal period and had no evidence of disease complications. In conclusion our results showed (a) a changing pattern in the epidemiology of HBV infection in Greece due to the significant number of HBeAg(+) patients, especially among children and (b) a considerable number of patients although aware of their infection, present with advanced disease.

The prevention and control of influenza with vaccines and antiviral drugs is of great importance. M2 inhibitors, amantadine and rimantadine have been extensively used in some countries. The next generation of antiviral drugs, neuraminidase (NA) inhibitors oseltamivir and zanamivir, are being stockpiled for a potential influenza pandemic. The emergence of resistant strains is thus an important issue. The purpose of this study was to examine the sensitivity to M2 and NA inhibitors of Greek influenza A(H3N2) strains isolated during three influenza seasons between 2004 and 2008 and to determine the phylogenetic clades of those strains. M2 and NA sequences of 34 patient isolates were checked for known resistance mutations. In addition, haemagglutinin (HA) sequences were used to determine the phylogenetic relationship between resistant and sensitive strains. All influenza A(H3N2) strains isolated during the season 2004-5 were found susceptible to adamantanes, bearing the S31N mutation, compared to 88% of the strains isolated in 2005-6 and 75% of the strains isolated in 2006-7. Molecular analysis of the HA gene showed a correlation of the mutants with specific phylogenetic clades. No known mutations in the NA or HA gene that have been implicated in resistance to NA inhibitors were found in the A(H3N2) strains isolated in the three influenza seasons. Despite the fact that amantadine is the only drug approved for prophylaxis in Greece, it has not been extensively used. So it seems that resistant strains circulating in the area after 2005 followed the global trend of replacement of susceptible strains by resistant ones. Oseltamivir and zanamivir are currently approved only for therapeutic use in Greece and has not been extensively used either.

Hepatitis B virus infection (HBV) has been recognized as a major health problem worldwide. Greece belongs to the intermediate endemicity countries with a trend of decreasing prevalence of HBV infection during the last decade. However, the recent massive immigration to our country may have led to alterations of HBV epidemiology. In this study, we evaluated the epidemiological features of HBV infection in a sample of 3480 patients followed up during the years 1997-2006. Immigrants mainly from Albania represented the 18.6% of the total study population and 56.6% of children. The majority of the patients had no family history of HBV infection (67.3%) or of acute hepatitis (95.4%), no known source of infection (64.6%), with intrafamilial spread accounting for 16.9% of the HBV transmission in adults and 33.9% in children. HBeAg(-) hepatitis B was the predominant form of hepatitis (92.1%) among the Greek patients in contrast to the immigrants where 16.6% were HBeAg(+). Liver cirrhosis was diagnosed in 8.8% of the total population and 0.9% had hepatocellular carcinoma. A high proportion of children were HBeAg(+) (62%), 55% from immigrant families, 25.2% were infected in the perinatal period and had no evidence of disease complications. In conclusion our results showed (a) a changing pattern in the epidemiology of HBV infection in Greece due to the significant number of HBeAg(+) patients, especially among children and (b) a considerable number of patients although aware of their infection, present with advanced disease. © 2008 Blackwell Publishing Ltd.

Brucellosis is a zoonosis resulting in reproductive failure in wild and domestic animals and febrile disease and occasionally severe infections of the central nervous system and endocarditis in humans. In animals and humans alike, it is found worldwide, including southeastern Europe, the Mediterranean basin (Portugal, Spain, southern France, Italy, Greece, Turkey, northern Africa), parts of Mexico, Central and Latin America, Asia, and Africa [1]. Human brucellosis represents a professional hazard, being acquired via ingestion, inhalation in laboratories or abattoirs, conjunctiva and skin trauma contamination with infected animal tissues and products [1,2]. Symptoms can appear as acute or insidious onset, after five to 60 days and last for days, months and occasionally as long as a year. Relapses can also occur. Treatment is effective with antibiotics. Untreated brucellosis can lead to death (case-fatality ratio around 2%), usually by heart complications.

Traditional accounts of motor development have described the development of grip configurations in terms of a global maturational change from immature to mature grips. We present data that demonstrate that the grip configurations of preschool-aged children are greatly influenced by task demands and are more variable than previous research has suggested. Grip configurations were most variable during free drawing. Three- to 4-year-olds with highly variable grips produced poorer quality drawings in a shape copying task than children with relatively stable grips. It is argued that the study of the development of drawing skills may best be captured by an approach which emphasizes the role of task requirements and various external and internal constraints which shape variability in grip configurations. ©2007 Wiley Periodicals, Inc. Dev Psychobiol 49: 216–225, 2007.

In two experiments on very young children's response to the orientation of pictures and objects, 18-, 24- and 30-month-old children showed no preference for upright pictures over inverted ones. More importantly, we found that children in all three age groups were equally accurate and equally fast at identifying depicted objects regardless of orientation. These studies further established that young children's insensitivity to picture orientation does not extend to objects. These results, in combination with the earlier ones, indicate that only gradually do young children come to share the picture orientation preference of adults and older children and that their adoption of the orientation convention is not based on changes in their ability to process upright and inverted images.

Publisher Summary This chapter deals with the two very influential theorist of Picture perception–the “innocent eye” and the “intelligent eye.” It argues that the process of developing an “intelligent eye” to interpret and understand pictures is a very complex and protracted process, a process infants begin with a relatively (but not a fully) “innocent eye.” Understanding and using pictures is not only a complex process, but it is also a very important one. Pictures are ubiquitous in most modem societies. It is illustrated that, aspects of picture-referent relations that seem transparent to adults are not obvious to young children, even when the picture depicts an array currently visible or even the child himself or herself. Young children do not even share the very strong, and natural-seeming, preference older individuals have for viewing pictures in an upright orientation. Thus, it is concluded that, an important part of the development of pictorial competence is figuring out how pictures and the reality they represent are related.