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Influenza Health Impact  Influenza disease burden varies year to year  Millions of cases and average of 226 purchase genuine colospa on line spasms medicine,000 hospitalizations annually 1 with >75% among adults 2 purchase 135 mg colospa fast delivery muscle relaxant yellow pill v,4  3 cheap colospa 135 mg overnight delivery muscle relaxant with least side effects,000-56,000 deaths annually, >90% among adults 3  Direct medical costs in U. Estimates of deaths associated with seasonal influenza – United States, 1976-2007. Published by Oxford University Press for the Infectious Diseases Society of America 2016. American College of Cardiology recommendations for secondary prevention of atherosclerotic cardiovascular disease. Acute myocardial infarction and influenza: a meta-analysis of case–control studies. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. Association between influenza vaccination and cardiovascular outcomes in high-risk patients: a meta-analysis. Outcome rates (per 10000 person-weeks) for each of 3 influenza outcomes, by influenza season and during periods of high, medium, and low influenza activity. Published by Oxford University Press for the Infectious Diseases Society of America 2017. Effectiveness of adjuvanted influenza vaccination in elderly subjects in northern Italy. Influenza Vaccine during Pregnancy Protects Infants < 6 Months of Age from Laboratory-Proven Influenza Zaman et al. Excluded from this definition are in vitro studies that utilize human tissues that cannot be linked to a living individual. Patient-oriented research includes: (a) mechanisms of human disease, (b) therapeutic interventions, (c) clinical trials, and (d) development of new technologies). Additionally, up to 3 publications may be included that are not publically available. Format for Attachments Designed to maximize system-conducted validations, multiple separate attachments are required for a complete application. When the application is received by the agency, all submitted forms and all separate attachments are combined into a single document that is used by peer reviewers and agency staff. Applicants are encouraged to submit in advance of the deadline to ensure they have time to make any application corrections that might be necessary for successful submission. They must make required changes to the local copy of their application and submit again through Grants. Once you can see your application in the Commons, be sure to review it carefully as this is what the reviewer will see. This process and email notifications of receipt, validation or rejection may take two (2) business days. Applicants are strongly encouraged to allocate additional time prior to the submission deadline to submit their applications and to correct errors identified in the validation process. Applicants are encouraged also to check the status of their application submission to determine if the application packages are complete and error-free. Applicants who encounter system errors when submitting their applications must attempt to resolve them by contacting the Grants. After submission of your application package, applicants will receive a “submission receipt” email generated by Grants. A third and final e-mail message is generated once the applicant’s application package has passed validation and the grantor has confirmed receipt of the application. Unsuccessful Submissions: If an application submission was unsuccessful, the applicant must: 1. Track his/her submission and verify the submission status (tracking should be done initially regardless of rejection or success). If there is time before the deadline, he/she should correct the problem(s) and resubmit as soon as possible. Due Date for Applications: 02/22/2017 Electronically submitted applications must be submitted no later than 5:00 p. For more information on expanded authority and pre-award costs, go to: http://www. The cost of sharing or archiving public health data may also be included as part of the total budget requested for first-time or continuation awards. Applicants must complete all required registrations before the application due date. For assistance with your electronic application or for more information on the electronic submission process, visit Applying Electronically (http://grants. See more resources to avoid common errors and submitting, tracking, and viewing applications: http:// grants. Criteria Only the review criteria described below will be considered in the review process. 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In an analysis of the experiences of 10 women with chronic pain generic colospa 135mg visa muscle relaxant liquid form, Werner and Malterud (2005) sought to examine issues related to patient empowerment and how doctors can help patients deal with their difficult to diagnose symptoms order 135 mg colospa with visa spasms after gall bladder removal. The researchers 68 discussed the feelings of helplessness doctors experience when faced with patients who have conditions about which little is understood order discount colospa muscle relaxant constipation. Additionally, the authors noted that the way in which women are encountered and their symptoms addressed can have an effect on their level of empowerment in coping with their medical issues. Even in cases where diagnoses are uncertain, physicians who take women’s complaints seriously can help the patients overcome feelings of vulnerability that exacerbate their difficulties. As is the case with lupus and fibromyalgia, there are no standard diagnostic criteria and the treatments developed to date have limited success. These include placing an exaggerated importance on rest and mistakenly assuming that they are more impaired than they are. The authors drew attention to the role of gender dynamics in explaining the differences between physicians’ and patients’ perceptions of the disease. Review of Literature Related to Methodology Quantitative Research Although it can be difficult to quantify issues like gender bias and doctor-patient relationships as they pertain to chronic illness, a good deal of quantitative research literature exists on these topics. Existing quantitative studies can generally be placed into one of three common categories. The majority of quantitative studies are descriptive or correlational in nature, employing self-report surveys to measure specific variables and examining whether relationships exist between them (e. The results indicated that patient-centered approaches resulted in higher patient satisfaction with the doctor-patient relationship. In general, results from such studies are strongly conclusive and provide the clearest direction for future research. This indicates that, although survey-based quantitative studies can yield strong data, careful analysis of research design is necessary. Another common method uses survey instruments in conjunction with coding of recorded observations, such as physician visits (e. The doctors’ behaviors during the visits were coded according to a predesigned instrument and analyzed alongside data from surveys completed by both the patients and the doctors. The researchers noted that, although they found significant correlations, physicians may have behaved differently in consultations knowing that they were being recorded. This is an issue that affects studies with similar designs; findings from such studies can be difficult to interpret due to the quasi-experimental nature of recording research environments. Coded variables included those related to lifestyle advice, colon X-rays, proposed diagnoses, and others. The results showed that there existed significant gender differences in the treatment plans. Although this research design has the potential to reveal novel and unexpected aspects of the research topic, quantitatively coding and analyzing open-ended narrative data can be complicated and controversial (Hamberg et al. One of the primary strengths of quantitative research is its ability to accommodate large sample sizes. The quantitative studies reviewed for this chapter had sample sizes ranging from 30 to 387 participants. By contrast, qualitative studies reviewed had sample sizes as small as four participants. Most quantitative methods do not require researchers to spend much time with each participant, and participants can self-administer surveys simultaneously, allowing researchers to gather and analyze a large amount of data. This also allows study samples to be more diverse, contributing to the generalizability of data. The researchers synthesized a number of small studies related to gender effects in medical communication. By gathering data from smaller studies, the researchers were able to discover a broad tendency for female physicians to spend more time in communication with patients. This method allows researchers to draw more generalizable conclusions from existing data. Although quantitative studies like those reviewed above can be useful in determining general trends and providing information about the effectiveness of general practices understood broadly, quantitative research methods do not yield rich narrative data (Creswell, 2007). Qualitative research methods, on the other hand, produce the rich narrative data necessary for discovering information related to complex interactions between individuals and complex associations between illness and psychosocial factors. As mentioned previously, from a social constructionist perspective, concepts of health and illness are socially constructed and subject to varying degrees of consensus and interpretation based on cultural factors and social norms (Hearn, 2009; Lupton, 2003). In addition, patients’ interpretations of their illness influence their feelings, reactions, and behaviors (Docherty & McColl, 2003; Fernandes et al. Thus, a qualitative research approach is most appropriate for exploring the treatment experiences of women with thyroid disease. Such an understanding could prove helpful in better determining the needs of female thyroid patients and therefore lead to prompt, accurate diagnosis and effective treatment. One reason for the prevalence of qualitative methods in research related to chronic illness and therapeutic experience is the ability of qualitative studies to yield descriptive, narrative data that includes nuances and complexities of individual situations. Docherty and McColl (2003) conducted a study examining the use of narrative as a way to understand chronic illness. The study used a phenomenological methodology, eliciting descriptions of experiences from the participants and interpreting them under a social constructionist framework. The researchers identified issues that commonly arose in patients’ narrative accounts of their illness: emotional reactions to diagnoses, impact of stress, views of death, and the meaning of the illness. Such themes often do not arise in quantitative research, but can be instrumental to understanding the disease experience among people with chronic illnesses such as thyroid disease. A number of qualitative studies related to female patients’ experiences with chronic illness have been conducted (e. Qualitative methods have also been used frequently to study doctor-patient relationships and women’s healthcare experiences (e. Of the qualitative methods used in literature reviewed for this chapter, phenomenology is the most common by a wide margin. Because phenomenology is used to study individuals’ personal experiences, this is a logical choice for research related to 74 doctor-patient relationships, a topic that is closely connected with how those involved experience their interactions. Furthermore, much research related to chronic illness adopts the specific goal of understanding how patients experience illness in order to improve treatment. Within the phenomenological research reviewed, several specific approaches were used. The most common type of design employed structured, semi-structured, or open-ended interviews (Docherty & McColl, 2003; Kralik et al. Interviews allow participants to share their views about the research topic directly with researchers and allow researchers to be flexible in the specific aspects of the topic that they address, probing each participant in order to reveal complex information. Two participants were male, three were Caucasian, and they ranged in age from 29 to 74. From the interviews, the researchers identified four themes relevant to understanding the experience of people with chronic illness.

The (‘flesh-eating bacteria’) is typically caused by coincidence of the acquisition of methicillin Streptococcus pyogenes but can be caused by S purchase colospa from india muscle relaxant constipation. This fasciitis typically presents with mediated evolution of a virulent community- severe pain in a moderate infection purchase generic colospa on-line kidney spasms after stent removal, pain that acquired strain has focused much public and is typically out of proportion to the physical medical concern on drug-resistant strains of signs of infection order colospa 135mg with visa muscle relaxant for tmj. These of vancomycin has also resulted in the infections may occur due to infected appearance of increasingly vancomycin- intravenous lines or intravenous drug abuse, resistant and -intermediate-resistant strains. Penicillin-sensitive Two forms of disseminated skin in- strains, however, are rarely seen except in fections are associated with the production of recrudescence of infections that originally exfoliative toxins including prophage- occurred before the antibiotic era, such as in encoded exfoliative toxin A. It presents as an nasopharynx of humans and animals and can area with small sores that may be eroded produce a variety of diseases, from relatively (non-bullous) or fluid filled (bullous, i. Each sore is a site of localized threatening infections such as deep abscesses, staphylococcal infection. The blisters in osteomyelitis and bone infections (see Loc- bullous impetigo are fluid filled, painless and Carrillo et al. Most people are familiar with an bullae that give the appearance of scalded infected wound, hair follicle or fingernail skin. Milk and cheese have Further challenges occur as the patient also been sources of infection. Because improves with antibiotic treatment, but Staphylococcus is salt tolerant, salted foods desquamation of the superficial layer of skin such as ham or fish may be a source of typically occurs. Even cooked foods may remain protect the exposed skin layers from contaminated with staphylococcal toxins, secondary infections as well as from fluid some of which are heat stable, although the loss. Symptoms can thought to relate to the specific toxins also include prostration, hypotension, head- excreted by particular infecting strains. Treatment is high fever, hypotension (low blood pressure) rehydration, orally if possible, intravenously and sometimes fatigue and confusion if severe. With only a few ofen with macules, or spots), and ofen with exceptions, these are all encoded by genes the involvement of other organ systems found in prophages (see Christie et al. Spes are believed to renal insufficiency and/or hepatic inflam- be particularly associated with streptococcal mation. Streptococcus, like Streptococcus Infection Staphylococcus, can also present with bacteraemia and/or superantigen-mediated Members of the genus Streptococcus are activation of a cytokine response. Other and spread of streptococci through tissue streptococcal skin and sof-tissue infections planes. Scarlet fever results from streptococcal species containing toxigenic infections with strains that secrete these prophages include group C and G streptococci pyrogenic exotoxins. These species typically ofen associated with streptococcal pharyn- colonize the respiratory and gastrointestinal gitis or sore throat, but can follow wound or tract, but can cause infections similar to those other infections. In cases of such as some cases of cholera, the profuse severe streptococcal infection, such as amounts of watery diarrhoea can cause necrotizing fasciitis, the protein synthesis profound and sometimes fatal dehydration. The failure of penicillin in cases of rehydration, antibiotics and in some cases high inoculum (the inoculum effect) is renal dialysis due to toxin effects on the thought to be due to the ineffectiveness of kidneys. Cholera Pasteurella Infection Cholera is considered to be one of the great Pasteurella are Gram-negative bacteria that plagues that has had a tremendous impact on are responsible for zoonotic infections of human history (Bray, 1996; Sherman, 2006). In humans, including afer bites by pets or by the recent cholera epidemic in Haiti, patients wild animals (Zurlo, 2010). Infections are became rapidly dehydrated in as litle as 2 h, sometimes seen afer licking of the patient’s resulting in death when rehydration was not skin by a pet, especially where there is a break available. Cholera stools are described as ‘rice in the skin such as afer injury or surgery, water’ stools because the flecks of mucous, including afer knee or hip replacement intestinal epithelial cells and bacteria appear (Heydemann et al. In cases, or in severe cases with an intravenous parts of the world with seasonal flooding, antibiotic such as a -lactam/-lactamase regular outbreaks are seen when flooding inhibitor or a carbapenem. There also appears to be a role of phages in at least some Diarrhoeal diseases of these outbreaks. Seasonal epidemics of cholera in the waters of Bangladesh, for Diarrhoeal diseases are the second leading example, appear to be controlled by lytic cause of worldwide morbidity and mortality bacteriophages (Faruque et al. One of due to infectious diseases, afer pneumonia the earliest applications of phages to and other lower respiratory tract diseases. Renal tetracyclines and fluoroquinolones will failure can become chronic, requiring dialysis shorten the duration of diarrhoea by about or kidney transplantation. Macrolide typically located in the genome of one of antibiotics are typically used in children and several lambdoid prophages. The recent cholerae O1 plus recombinant cholera toxin B outbreak of a Stx-producing E. Dukoral producing phage infecting an entero- also provides some protection against aggregative E. These combination with supportive care along with vaccines are licensed in India and Vietnam, antibiotic treatment, typically with ampicillin respectively, and appear to be safe and or trimethoprim-sulfamethoxazole. Pseudomonas, however, can prophages encoding bacterial pathogenicity cause severe wound and post-surgical in- factors including exotoxins (see Christie et al. It is important to are seen especially with patients undergoing note, however, that these bacterial pathogens respiratory therapy or on ventilators. These acquisition of these too, if a consequence of infections are complicated by the innate horizontal transfer, can be due to the phage- antibiotic resistance of P. The respiratory tracts Chapter 2, this volume), scheming anarchists of these patients are ofen colonized first by S. In these cases, behaviour’ in the guise of prophages Pseudomonas usually develops a mucoid encoding bacterial virulence factors. In some phenotype due to increased production of cases, such as infection by opportunistic soil alginate, which causes a chronic lung bacteria such as C. In more professional pathogens resistance and are becoming increasingly such as C. See, however, Burrowes and Harper monograph is the idea that bacteria in fact (Chapter 14, this volume) for discussion of can be very bad indeed, although as recounted the use of phage therapy against various particularly in Chapters 6–17, much good can Pseudomonas infections. Conclusion Phages can be viewed as playing at least four References roles in humans and other environments. Evolutionary Bioinformatics evolution of bacteria (see Hendrickson, Online 1, 97–110. Clinical Infectious Diseases 46 Suppl Mandell, Douglas, and Bennett’s Principles and 5, S350-S359. Kropinski6 1Molecular Biology and Genetics, School of Medicine, Virginia Commonwealth University; 2Department of Functional and Comparative Genomics, University of Liverpool; 3Department of Microbiology and Immunology, Queen’s University; 4Department of Pharmaceutical Sciences, The University of Oklahoma; 5Department of Medicine, Brigham and Women’s Hospital; 6Department of Molecular and Cellular Biology, University of Guelph; and, Public Health Agency of Canada, Laboratory of foodborne Zoonoses. Lysogenic conversion has been recently discuss in this chapter is the impact of non- defined as a ‘phage-associated heritable essential temperate phage genes, variously change in the host cell’s genotype and described as morons (Juhala et al. In expression that leads to a phenotypic change other words, phenomena that are directly in virulence or in surface chemistry. We now realize that this definition the concept of phage-mediated transfer of is inadequate, as transcriptomic analysis has bacterial genes, or transduction.

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Zinc functions with cytosol superoxide dismutase inactivating free radicals; it is a free radical quencher order colospa canada spasms muscle. It is associated with the synthesis of proteins cheap 135 mg colospa with visa spasms hamstring, the stabilization of cell membranes purchase genuine colospa online muscle relaxant rx, and the function of receptor molecules. Zinc deficiency affects leukocyte functions, impairing phagocytosis; however, its impact is most marked on the specific immune system. Zinc deficiency rapidly diminishes antibody- and cell-mediated responses in both humans and animals. Zinc deficiency adversely affects lymphocyte proliferation and decreases inter- leukin-2 production by helper T lymphocytes. Glucocorticoid-mediated apoptosis induced by zinc deficiency causes downregulation of lym- phopoiesis and ensures that the lymphopenia persists. Consequently, impaired immune function resulting from dietary zinc deficiency is charac- terized in part by a reduction in the number of lymphocytes and depressed cell-mediated (i. Research suggests deficiencies of zinc and other essential nutrients such as methionine; cysteine; arginine; vitamins A, B, C, and E; and selenium promote the proliferation of Th2 cells at the expense of Th1 cells. On the other hand, adequate Zn2+ and nitrogen oxide prevents a shift of the Th1/Th2 balance toward Th2. Nitrogen oxide appears to be able to liberate Zn2+ from metallothionein, an intracellular storage molecule for metal ions. In view of the impact that zinc deficiency has on cell-mediated immunity, it is not surprising that zinc deficiency may promote cancer. Under the influ- ence of Th1 cells, zinc inhibits the growth of tumors by activating the endogenous tumor-suppressor endostatin, which inhibits angiogenesis. Furthermore, dysregulation of the Th1/Th2 balance is also believed respon- sible for autoimmune disorders such as diabetes mellitus. On the other hand, zinc supplementation may help to prevent diabetic complications through its intracellular activation of the enzyme sorbitol dehydrogenase. Animal studies suggest even a marginal zinc deficiency could affect lep- tin secretion and serum leptin concentrations. Foods stored in uncoated tin cans may reduce the amount of zinc available for absorption from that food. Absorption from lean beef is 50%, com- pared with vegetable sources or whole meal bread, in which it drops to 15%. Phosphorus-containing foods such as milk or poultry, whole grains, and fiber-rich foods impair zinc absorption. To correct zinc deficiency 220 mg three times daily (tds) plus 2 mg copper daily has been suggested. Zinc supplements are most effective if they are taken at least 1 hour before or 2 hours after meals. Assays of zinc in granulocytes and lymphocytes provide better diagnos- tic criteria for marginal zinc deficiency than plasma zinc. When used, serum zinc should be measured in the fasting state and interpreted in conjunction with albumin. Zinc deficiency, in addition to lethargy and retarded mentation, causes anorexia and reduced taste sensa- tion. However, analysis of randomized, controlled trials comparing oral zinc sulphate with placebo or no treatment in patients with arterial or venous leg ulcers concluded there was no evidence that zinc sulphate increased ulcer healing. A randomized, double-blind, placebo-controlled, clinical trial found treatment of the common cold with zinc gluconate lozenges significantly reduced the duration of cold symptoms. In fact, routine zinc supplementation may deserve consideration in certain population groups. Chronic zinc supplementation in excess of 50 mg/day can induce copper deficiency in humans. In iron- deficient animals, zinc absorption only reached a plateau at a ratio of 7. Zinc may reduce the effectiveness of therapies that rely on dopamine receptor antagonists22 and reduce absorption of penicillamine, folic acid, and tetracyclines. Thetracyclines, copper, iron, and zinc supplements should consequently be taken at least 2 hours apart to maximize the full benefit from each supplement. In humans, early evidence of zinc deficiency is anorexia, anosmia, and impaired taste (hypogeusia and dysgeusia). Dietary zinc deprivation causes brain dysfunctions such as learning impairment, enhanced susceptibility to epileptic seizures, and olfactory dysfunction. Persons with good zinc status experience a strong unpleasant taste immediately on taking a swig of the zinc tally solution. Those with a marginally adequate zinc status report a definite taste almost immediately. In contrast, moder- ately zinc-deficient persons report no specific taste after 10 seconds of hold- ing the solution in their mouth; those mildly deficient report no immediate taste, but a furry, dry mineral taste develops. Mild to moderate zinc deficiency presents with cold extremities, slow wound healing, male hypogonadism, and slow mentation. Severe zinc defi- ciency is associated with skin disorders, white spots on nails, alopecia, weight loss, psychiatric disorders, and intercurrent infection. Deficiency 758 Part Three / Dietary Supplements during growth periods results in growth failure and predisposes to congen- ital abnormalities. Acrodermatitis enteropathica, a genetic disorder, is fatal if the severe zinc deficiency is not controlled. Brighthope I: Nutritional medicine tables, J Aust Coll Nutr Env Med 17:20-5, 1998. Brighthope I: Nutritional medicine—its presence and power, J Aust Coll Nutr Env Med 17:5-18, 1998. Zinc lozenges reduce the duration of common cold symptoms, Nutr Rev 55(3):82-5, 1997. Rink L, Gabriel P: Extracellular and immunological actions of zinc, Biometals 14:367-83, 2001. Mocchegiani E, Muzzioli M, Giacconi R: Zinc and immunoresistance to infection in aging: new biological tools, Trends Pharmacol Sci 21(6):205-8, 2000. Takeda A: Zinc homeostasis and functions of zinc in the brain, Biometals 14:343-51, 2001. Although there are no recommended daily allowances for herbs, guide- lines for their clinical use as suggested in this text are derived from reputable sources3-6 (see Table A-1). The concept of dried herb equivalent may be used as a guideline, with the product ratio expressing the weight of original dried herb starting material to the volume or weight of the finished product. Subcommittee on Upper Reference Levels of Nutrients, Food and Nutrition Board, Institute of Medicine: Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline/a report of the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline, Washington, D.