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The non-lytic phage molecules could also serve as chemical equivalent of the phage protein then antibacterial compounds themselves or they could provide the basis for a novel antibacterial can form the basis for a phage protein-derived (Liu et al purchase warfarin 5 mg without a prescription blood pressure of 12080. Although inspired platform to identify new targets and not all phage–host interactions are detri- antibacterials in the Gram-positive S generic 2 mg warfarin fast delivery blood pressure limits. This can be explained by a and the helicase loader DnaI order warfarin 5mg with mastercard heart attack fever, which is number of factors purchase 1 mg warfarin blood pressure 140 80. This First purchase 2 mg warfarin mastercard hypertension hypotension, the bacteriophage research field phage–host interaction was confirmed to be remains strongly genome oriented and only a specific and direct using four independent limited number of research groups analyse assays: yeast two-hybrid analysis, far Western the intracellular phage–host interactions analysis with immobilized DnaI and (several of them focusing on model hosts and 32P-labelled gp104, biomolecular interaction not pathogens). Moreover, fundamental research to product develop- DnaI was shown to be essential for viability of ment is great, as an extensive body of the host cell. These results were then used to evidence is necessary to obtain a suitable screen for small synthetic molecule inhibitors, bacterial target candidate and relevant phage- mimicking the phage protein. Furthermore, neither straightforward but contains genome and compound was significantly cytotoxic to expression-based assays, protein interaction human primary hepatocytes or to the cell assays, crystallography and small-molecule lines Hep G2 and HeLa. Although high-throughput sequenc- compounds were proposed to form a basis for ing and protein expression can now be a new phage-based antibiotic (Liu et al. Thirdly, from an industry Although microbial resistance is probably perspective, one could state that major an unavoidable consequence of antibiotic pharmaceutical companies are cautious to- therapy, a bacteriophage-based platform has wards new antibacterial strategies in view of great potential with respect to identifying the limited profit margin and highly novel mechanisms and targets to treat competitive market for antibiotics. This bacterial infections (Falconer and Brown, implies the necessity of small biotech company 2009). In fact, known phage–host interactions initiatives (vulnerable to economic circum- illustrate the potential for phage systems to stances) to generate a substantial (and costly) be used for the identification of points in host body of material for product development. The most efficient and antibiotics nevertheless remains a strong vulnerable targets are selected and validated option for the future. One can anticipate a through billions of years of co-evolution shif in the general research focus from between phages and their hosts (Brown, genome-based research to proteome- and 2004). We can in nature, the quest for lethal phage proteins anticipate that technological developments of as well as their cognate bacterial targets protein interaction and mass spectrometry should be continued in order to expedite the approaches will be revolutionized further, in research on antibacterial drug discovery (Sau much the same way as we have seen at the et al. Despite the body of available genomics level, with the advent of next- research and the vast untapped potential, generation and single-molecule sequencing Phages and Their Hosts: a Web of Interactions 129 techniques. Proteome- and metabolomics- expression of the Thermus thermophilus based research will rely on these develop- bacteriophage P23-45. Brock Biology of Microorganisms, 11th review in the Virology Journal series on edn. Annual Review of Micro- (2001) Bacteriophage T7 protein kinase biology 57, 301–322. Molecular object of desire – interactions of bacteriophages Microbiology 42, 767–776. Journal of Molecular Biology transcription elongation complexes containing 320, 11–22. Clin Microbiological Reviews 24, procedure for systematic identification of 71–109. Molecular cytotoxic early proteins of mycobacteriophage Genetics of Bacteria, 2nd edn. Journal of Escherichia coli thioredoxin confers processivity Molecular Biology 377, 774–789. Journal of Molecular Biology (2002) Identification of 113 conserved essential 207, 1–13. Nucleic (2001) Cell toxicity caused by products of the Acids Research 30, 3152–3162. Journal of protect against the host-killing activity of the E3 Bacteriology 188, 3470–3476. Journal of Molecular Biology 330, 735– protein requires a discrete contact site on the C 748.
Ingestion must occur within 24 hours of eclosion because the coracidium loses its infectiveness rapidly; however generic warfarin 2 mg with amex blood pressure monitors at walmart, the embryo of the species that use marine fish as intermediate hosts can tolerate the semi-brackish water of estuaries or briny sea water purchase 5 mg warfarin otc blood pressure in the morning. This embryo lodges in the coelomic cavity of the crustacean and purchase warfarin 2 mg amex ulterior motive meaning, in 10 to 20 days buy warfarin 5mg online hypertension united states, turns into a procercoid buy warfarin 5mg with amex blood pressure reading, a solid, elongated larva 6 to 10 mm long with a circu- lar caudal appendage. When the crustacean and larva are ingested by the second intermediate host, any one of a variety of fish, the procercoid migrates to the mus- cles and other organs of the fish and becomes a plerocercoid or sparganum in about a month. If the first fish is eaten by a larger fish, the transport or paratenic host, the plerocercoid simply migrates from one fish to the other. When the infected fish is eaten by a definitive host, the ple- rocercoid lodges in the small intestine and starts to grow until it matures, and it begins to release eggs after 25 to 30 days. The first intermediate host is an almost-microscopic copepod crustacean of the genera Diaptomus (the Americas), Eudiaptomus (Asia and Europe), Acanthodiaptomus (Alpine region, the Carpathians, Scandinavia, Tibet, and Turkestan), Arctodiaptomus (Ural Mountains region), Eurytemora (North America), Boeckella (Australia), or Cyclops (Africa, Asia, and Europe) (von Bonsdorff, 1977). The most important fish that act as second intermediate hosts in the transmission of D. The usual definitive hosts are carnivores and the intermediate hosts are fish of the genera Oncorhynchus and Salvelinus (Muratov, 1990). In southern Argentina, Revenga (1993) found that 9% of brook trout are hosts to D. But it also infects other fish-eating mammals, such as dogs, cats, swine, bears, and wild carnivores. The other diphyllobothrids seem to be predominantly zoophilic, because infections in man generally persist a few months and the cestode is expelled by itself. Its natural definitive hosts are pinnipeds such as the sea lion Otaria byronia (O. The intermediate hosts, as yet uniden- tified, would be planktonic copepods and marine fish. The species has also been found in other pinnipeds of the family Otariidae along the northern Pacific coast and in fur seals (Arctocephalus australis) on San Juan Fernández Island, Chile. The most appropriate biotopes are lakes, river banks, and reser- voirs, where the cestode finds the intermediate hosts it needs to continue its life cycle; but for humans to become infected they must eat raw or undercooked fish. The areas of greatest prevalence of this parasitosis are eastern and northeastern Finland, northern Norway, and northern Sweden. The prevalence of infection has decreased notably in almost all Eurasian countries. Notwithstanding, it was estimated that in 1973 more than 9 million persons were infected worldwide (5 million in Europe, 4 million in Asia, and 0. Petersburg, Russian Federation, where lakes are abundant; impor- tant foci are also found in Siberia. In the Republic of Korea, 37 cases of diphyllobothriasis were reported in 1997, in addi- tion to 21 cases in which the eggs were found in feces (Chung et al. Examination of the feces of 52,552 patients between 1984 and 1992 in a hospital in Seoul, Republic of Korea, revealed that 0. In Australia, the cestode has been found only in European immigrants and, apparently, the parasite does not occur naturally in that country. In North America, the highest prevalence of diphyllobothri- asis is found among Eskimos, with rates between 30% and 80% in some localities. Plerocercoids have been found in several species of fish in the Great Lakes in North America, but the infection does not seem to exist in the area.
More specifically buy generic warfarin 5mg on-line pulse pressure points body, Kim stated discount warfarin 5mg arrhythmia recognition posters, “I’m more likely to argue with a female doctor if I think her approach is wrong order warfarin 5 mg mastercard blood pressure chart good and bad. If I feel a male doctor’s approach to thyroid care is wrong for me warfarin 5 mg pulse pressure under 25, I simply don’t go back to him and begin looking for another doctor cheap warfarin 5mg fast delivery blood pressure medication alcohol. Both Karen and Kim demonstrated autonomous behaviors when they sought health information and eventually switched doctors. However, Kim’s differing reactions to female versus male doctors’ approaches suggest an internalization of status beliefs (culture-based beliefs in which a higher status is associated with one group over another; Peck & Connor, 2011; Rashotte & Webster, 2005). In other words, Kim may be more willing to tolerate a paternalistic approach from a male doctor than from a female doctor because, on a subconscious level, she believes that male doctors are 179 higher in status than female doctors. In addition, older patients are more likely to accept their doctor’s advice without question (Kennelly & Bowling, 2001). However, research also indicates that female patients with a higher educational attainment tend to desire active involvement in the decision making process with their doctors (Flynn et al. Although Kim is less likely to argue with a male doctor than a female doctor, both Karen and Kim appeared to move from passive to autonomous roles when they sought health information and new doctors when they became dissatisfied with their treatment. Theme 3: Doctor-Patient Communication Participants’ responses to interview questions regarding communication indicated that their experiences with thyroid disease treatment were impacted by their ability to communicate with their doctors. Doctor-patient communication appeared to be influenced by the participant’s desire to be informed, the participant’s level of trust in her doctor, and by being female. The subthemes within Theme 3: Doctor-Patient 180 Communication are Subtheme 1: Desire to Be Informed, Subtheme 2: Role of Trust (lack of trust in doctor, treatment refusal, secret-keeping, and self-treatment), and Subtheme 3: Role of Gender (no preference for specific doctor gender, preference for female doctor, being taken seriously, and presence of emotion). Six of the 16 total participants expressed a desire for their doctors to inform them about the results of lab work and treatment options. Research indicates that although the majority of patients seek information about their diagnoses and treatment options from external sources (e. She stated, “I will tell them what I know, what I want to know and [learn] what their opinion is and their thoughts. Similarly, Emily conducted her own research but did not seek a new doctor despite expressing frustration that her doctor “doesn’t come forward with all she’s thinking unless [Emily] push[es] the conversation. In addition, patients believe that their doctors need to know their entire medical history in order to provide good care (Flynn et al. Regarding Anne’s desire for information exchange with her doctor, she explained, “I have some work to do to figure out how I can either get her to make me understand where she is coming from…or if I can get her to understand that I am backsliding again. Furthermore, almost 40% of the participants felt less informed regarding their treatment options than about diagnostic information. Research suggests that individuals with chronic illness keep current with information regarding their illness in an attempt to gain control over their health (Leach & Schoenberg, 2008; Mirzaei et al. Of particular importance to patients with chronic illness is information about recent treatment advances and the potential outcomes and side effects of treatments (Mirzaei et al. Kim explained that she is in a “wait- and-see mode” regarding how she feels after switching from a synthetic medication to a natural thyroid medication. She stated, “I need to get the testing done to see where my frees are on the new product. Murtagh (2006) asserted that doctors demonstrate respect for their patients’ autonomy by ensuring that they are fully informed. According to Carlsen and Aakvik’s (2006) study, patients prefer doctors who readily offer them health information. As previously mentioned, patient satisfaction and trust in one’s doctor are common in patient-centered approaches in which doctors respect patient autonomy, listen attentively, and answer questions (Copeland et al. In responding to interview questions regarding communication, nine out of the 16 total participants indicated that their ability to communicate with their doctors was influenced by their level of trust in their doctors.
Self-medication is defined by Verma best 2mg warfarin hypertension pamphlet, Mohan purchase 5 mg warfarin with amex blood pressure medication blue pill, and Pandey (2010) as “the use of medication by a patient on his own initiative or on the advice of a pharmacist or a lay person instead of consulting a medical practitioner” (p generic 1mg warfarin with visa pulse pressure over 80. Fainzang (2013) argued that patient self-medication is a form of self-advocacy that involves a thoughtful process of “self-examination generic 1 mg warfarin otc narrow pulse pressure uk, self-diagnosis cheap 1 mg warfarin with amex blood pressure 200 over 100, and self-prescription” (p. Because female patients in particular often need to prove the validity of their complaints (Hoffman & Tarzian, 2001; Munch, 2004) and patients who challenge their doctors tend to be thought of as “difficult” (Frosch et al. In the current study, the term “self-treatment” was chosen instead of “self- medication” due to its negative connotation in the majority of the literature. In the current study, six participants chose to either stop or start taking a medication or supplement without consulting their doctors. For example, Jenna shared that she was struggling with symptoms from thyroid cancer, which remained undiagnosed 191 for approximately four months because her blood work continued to show as “normal. During the fourth month period before her diagnosis, Jenna spoke with a friend “who has thyroid issues [and] got [her] on a multivitamin and 10k units of vitamin D3. As a result, Carla explained, “I started self- treating in July of 2002 and pretty much consider myself to still be self-treating [and] the current doc/insurance just run my labs. Research conducted by Holtgräfe and Zentes (2012) revealed a correlation between patient self-treatment and distrust in the opinion of health professionals. In a study of individuals with gastrointestinal disorders, patients with a graduate-level education were more likely to self-treat than those with a secondary 192 education or below (Kua, Ng, Lhode, Kowalski, & Gwee, 2012). Educational attainment is positively correlated with “health literacy,” or “the degree to which individuals have the capacity to obtain, process, and understand basic health information to make appropriate health decisions (Lubetkin et al. White and colleagues argued that patients who are highly health literate are less likely to trust their doctors’ recommendations without verifying the information and exploring additional options. Regardless of patients’ reasons for self-treatment, there are potential risks to stopping or starting medications and supplements without consulting a doctor. According to Ruiz (2010), potential risks include incorrect self-diagnosis, adverse reactions, and dangerous drug interactions. In Shawna’s experience, her choice to self-treat with iodine supplements may have caused a significant spike in her level of thyroid antibodies— which worsens the symptoms of Hashimoto’s disease. Shawna explained, I thought since the doctors kept saying my thyroid was okay, maybe I just needed something natural as a boost, not really having a lot of information. I also was clicking on ads on the internet and read some doctor that insisted we are all iodine deficient and promoting his pills. Considering that most patients want to be involved in the decision making process (Barry & Edgman-Levitan, 2012; Chin, 2002; Flynn et al. As previously discussed, patients trust doctors who listen to them without interrupting (Hedberg & Lynoe, 2013; Skirbekk et al. The majority of participants’ responses to questions regarding the potential influence of gender on treatment experiences revealed that the doctors’ gender had little influence on doctor-patient communication. However, participant responses indicated that being female influenced doctor-patient communication, particularly regarding the participants’ perceptions of being taken seriously and when the participants expressed emotion. Within Subtheme 3: Role of 194 Gender are the following subthemes: no preference for specific doctor gender, preference for female doctor, being taken seriously, and presence of emotion. When asked if it mattered whether their doctors were male or female, the majority of participants (13 out of 16) indicated no preference for their doctor to be a specific gender. Michelle shared that she has been treated by both male and female doctors and she believes that the “Dr. Although Alicia’s and Jessica’s responses suggested an initial preference for a female doctor, they ultimately expressed no preference for their doctor to be a specific gender. When asked if it mattered whether their doctors were male or female, Alicia responded, “I’m not sure. I wonder if a woman might be more understanding, but I feel that my [male] physician is very understanding.
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