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Amy constructs the prevalence of “authoritative” order atorlip-20 20 mg line cholesterol in shellfish chart, “punitive” prescribers as common (“a lot of doctors act just like parents”) and particularly evident when consumers are non- adherent (“a heavy hand buy generic atorlip-20 on-line cholesterol medication for diabetics, like it is often practiced today if patients aren’t compliant”). Amy could be seen to suggest that the power imbalance results from the consumer being non-adherent in the latter quote, whereas the alternative perspective is that consumers become non-adherent in response to an authoritative prescriber. She supports the need for prescribers to occasionally be “firm” with her to encourage adherence but indicates that such an approach is most effective when counterbalanced with “caring”. Below, Anna also highlights the importance of the consumer being “listened to” and contrasts this with her experience during a hospitalisation of being administered an exceptionally high dosage of medication which impeded her ability to contribute to treatment decisions (“And not have them so bombed so that they can make um decisions”): Anna, 18/02/2009 A: Hmm, I think too that the, the person needs to be listened to. That- 217 L: It’s like giving the client some control over their own treatment, or giving them- A: Could yeah, like give them like a small, a small dosage and maybe nice medications just to get them-, build them up slowly to a level rather than bombarding them with medication and you’re just left to it. Anna represents her experience of being over-medicated as compromising the capacity for collaboration in the therapeutic alliance. She reports an inability to recall consenting to another treatment, electroconvulsive therapy (“I can’t remember anything”), which she received in addition to medication in hospital, due to the effects of the medication. Anna reflects regret in relation to receiving the treatment, stating, “normally I would never have consented to that”. She suggests that rather than “bombarding” consumers with medication, initial treatment should involve a gradual increase in medication in order to ascertain optimum dosage. The extract raises concerns around the ethics of seeking the consent from inpatients who have been administered high dosages of medication, which in Anna’s case, reportedly compromised her decision-making and, thereby, undermined the capacity for a truly collaborative therapeutic alliance. Similarly, in the next extract, Amy talks about her limited control over her treatment as her psychiatrist experimented with different medications and dosages: Amy, 10/2/09 A: Not as a guinea pig, because too often people feel like guinea pigs with the medication, the psychiatrist’s, is all keen to, “oh I’ll give you new ones, oh 218 there’s this new one”. Amy likens her experiences of being encouraged to trial “new” medications and dosages (“They pump ‘em up”) to that of a “guinea pig”. By comparing consumers to guinea pigs, Amy works up a construction of consumers as psychiatrists’ subjects and thereby emphasises the significant power imbalance between prescribers and consumers. Amy suggests that her experiences of prescriber-directed experimentation are common amongst consumers “too often people feel like guinea pigs”. She could be seen to express frustration through the sarcastic remark “oh great, thanks” in relation to this practice. Whilst no direct linkages were made with adherence within the extract, it could be logically assumed that perceptions of oneself as being experimented on by psychiatrists may lead to non-adherence amongst some consumers. Indeed, Amy’s experience of experimentation with multiple medications was common amongst interviewees. Whilst Amy constructed experimentation as imposed by the psychiatrist, however, others indicated that they trialled various medications in collaboration with prescribers, as part of the process of finding a suitable medication and dosage. In the following extract, George talks about how his distrust of “doctors” due to his perception of them as having power over not only his treatment but his finances: George, 14/8/08 G: Coz like, I um, sorta lied, I said I wasn’t taking more marijuana, you know, thought I’d just gave it up because I was feeling sick and every time 219 she’d ask, I’d just tell her, no, no I don’t take it. Coz if you tell ‘em that you’re taking it they’ll just take your money off you, you know? George states that he is dishonest with his prescriber (“I um, sorta lied”) and strategically hides information relevant to his treatment due to fear of the consequences of not following his doctor’s orders, namely: “they’ll just take your money off you”. George could be seen to position prescribers as punitive when consumers use drugs in addition to their prescriptions.

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The function of mucin oligosaccharides is not fully understood but buy generic atorlip-20 20 mg on line cholesterol test vancouver, since certain bacteria bind specific oligosaccharide ligands purchase atorlip-20 20 mg amex ldl cholesterol level definition, it is thought that oligosaccharides may aid bacterial attachment to respiratory mucus. The accessibility of such bacteria to the underlying epithelium is thus prevented or limited and the microorganisms are subsequently destroyed by enzymatic attack and/or removed from the nasal cavity by the action of mucociliary clearance. Mucus possesses both solid-like (elastic) and liquid-like (viscous) attributes simultaneously and is therefore termed a viscoelastic gel. The viscoelastic properties arise from the non-covalent interactions (entanglements) between the predominantly anionic mucin molecules, although weak hydrogen-bonding and ligand-like attractions between protein regions of adjacent molecules may also play a role. Gel properties are affected by: • mucin size; • mucin polydispersiry; • the type of mucins present. It is widely held that mucus should possess specific rheological properties for clearance from the airway to occur. Any alteration in mucus rheology that compromises clearance can predispose the individual to airway disease and infection. In addition, the state of mucus hydration (or mucin concentration) will affect the properties of the gel. Two mucin subunits, each about 500 nm in length, are joined end to end via disulfide bonds (S-S) and consist of oligosaccharide-rich regions (represented by the thickened line) and folded domains stabilized by disulfide bonds (represented by the knots). An increase in mucus viscoelasticity is also thought to occur in asthma, chronic bronchitis, chronic obstructive pulmonary disease and acute respiratory distress syndrome. The mucus blanket (c) is always propelled in the same direction as the effective stroke (d) 9. Rest phase At the end of the effective stroke the cilium disengages from the mucus gel and enters the rest phase where it lies parallel to the epithelium pointing in the direction of mucus flow. Recovery stroke The cilium “unrolls” within the periciliary fluid ready for the next effective stroke. Undergoing the recovery stroke beneath the mucus layer prevents retrograde mucus transport (Figure 9. They are packed at a density of 6–8 cilia per μm2 and cannot move without affecting neighbouring cilia. In order to perform an unhindered beat cycle the movement of each cilium is slightly out of phase with that of its neighbor, leading to a phenomenon termed “ciliary metachrony”. Metachrony results solely from hydrodynamic coupling between adjacent cilia and provides the necessary cooperation within a field of cilia to permit them to transport mucus. Each cilium is bounded by an evagination of the plasma membrane and, as shown diagrammatically (Figure 9.

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The acute form appears within 2 months of the transplant; the chronic form usually appears within 3 months buy atorlip-20 20 mg on line xanthelasma/ cholesterol eyelid deposits. Its two types include natural active immunity cheap 20 mg atorlip-20 overnight delivery cholesterol kit, resulting from recovery from a disease, and artif icial active immunity, resulting from an immunizing vaccination. Two types of passive immunity include natural passive immunity, where medical intervention is not required (infant receiving antibodies through breast milk) and artif icial passive immunity, where antibodies, antitoxins, or toxoids (generally produced in sheep or horses) are transfused or injected into the patient to provide immediate protection. In systemic lymph: lymph lymphadenopathy, two or more noncontiguous areas of the body are affected. Diagnostic and Therapeutic Procedures This section introduces procedures used to diagnose and treat blood, lymph, and immune disorders. Descriptions are provided as well as pronunciations and word analyses for selected terms. The more elevated the sed rate, the more severe is erythr/o: red the inflammation. For example, anticoagulants are vent cellular replication to halt the spread of can- used to prevent clot formation but are ineffective cer in the body; antivirals prevent viral replication in destroying formed clots. Table 9-5 Drugs used to Treat Blood, Lymph, and Immune Disorders This table lists common drug classifications used to treat blood, lymph, and immune disorders, their therapeutic actions, and selected generic and trade names. Complete each activity and review your answers to evaluate your understanding of the chapter. Learning Activity 9-1 Identifying Lymph Structures Label the following illustration using the terms listed below. Enhance your study and reinforcement of word elements with the power of DavisPlus. We recommend you complete the flash-card activity before completing activity 9–2 below. Learning Activities 255 Learning Activity 9-2 Building Medical Words Use -osis (abnormal condition; increase [used primarily with blood cells]) to build words that mean: 1. Correct Answers 5 % Score Learning Activities 257 Learning Activity 9-4 Matching Procedures, Pharmacology, and Abbreviations Match the following terms with the definitions in the numbered list. Complete the termi- nology and analysis sections for each activity to help you recognize and understand terms related to the blood, lymph, and immune systems. Medical Record Activity 9-1 Discharge Summary: Sickle Cell Crisis Terms listed in the following table are taken from Discharge Summary: Sickle Cell Crisis that follows. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appendices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud. Certainly, we should obtain some information on his renal function and have his regular doctor assess this problem. Use a medical dictionary such as Taber’s Cyclopedic Medical Dictionary, the appen- dices of this book, or other resources to define each term. Then review the pronunciations for each term and practice by reading the medical record aloud.

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People with these symptoms often avoid phobic situations by rarely cheap 20mg atorlip-20 with mastercard cholesterol lowering foods wikipedia, if ever discount atorlip-20 20 mg mastercard cholesterol test triglyceride levels, leaving home Agranulocytosis – an acute disease in which the white blood cell count drops to extremely low levels, too low to fight infections. May be caused by drugs or radiation Akathisia – motor restlessness; intolerance of inactivity. An increased level in this enzyme in the blood indicates necrosis or disease in these tissues. Its measurement is most commonly used as part of the differential diagnosis of liver disease and in the tracking of the course of the disease process. Most alkaline phosphatase in normal serum is derived from the bone, but the enzyme is produced also in the liver, intestinal mucosa, placenta, breast, and other tissues. Levels are high in the first few months of life, again during bone growth in preadolescence, and then decrease in senility, anemia and malnutrition Alkalosis - an actual or relative increase in blood alkalinity due to an accumulation of alkalies or reduction of acids. An abnormal acid base condition in the body fluids, characterized by a tendency toward an increased pH, as from an excess of alkaline bicarbonate or a deficiency of acid. Respiratory alkalosis may be caused by hyperventilation, central nervous system disease, congestive heart failure, pulmonary embolism, or early salicylate intoxication. Amino acids are the building blocks of proteins and the end products of protein digestion. Approximately 80 amino acids are found in nature, but only 20 are necessary for human metabolism or growth. Of these, some can be produced by the liver, the rest, called the essential amino aids, must be supplied by food. These are histidine, isoleucine, leucine, lysine, methionine, cysteine, phenylalanine, tyrosine, threonine, tryptophan, and valine. The nonessential amino acids are alanine, aspartic acid, asginine, citrulline, glutamic acid, glycine, hydroxyglutamic acid, hydroxyproline, norleucine, praline, and serine. Oral preparations of amino acids may be used as dietary supplements Ammonia – a gas formed by decomposition of nitrogen containing substances such as proteins and amino acids. It will turn litmus paper blue Amphetamine – a central nervous stimulant, can be used in the treatment of alcoholism, narcolepsy (sleeping too much) and certain types of mental depression Amygdaloid – resembling the shape of an almond Amylase - a class of enzymes that split or hydrolyze starch. Those found in animals are called alpha amylases; those in plants are called beta amylases Analgesic – a medicine, which relieves pain Anaphylaxis – the reactions which cause anaphylactic shock occur suddenly (minutes to an hour), including increased irritability, shortness of breath, turning “blue”, sometimes convulsions, unconsciousness and death, death usually results from spasms of muscles or bronchioles 393 Anemia – a condition in which there is a reduction in number of circulating red blood cells (hemoglobin) may be caused from excessive blood loss, reduction in red blood cell formation Angina – pain around the heart can be radiating to shoulder, arm or hand, or occasionally to the stomach Angioedema – an allergic disorder characterized by swelling and a rash around the tissues Angioneurotic – a swelling characterized by development of local allergic rash (wheals) accompanied by swelling of the subcutaneous or submucous tissues. Acute cases require confinement due to the very contagious state in the respiratory system Anxiolytic – counteracting or relieving anxiety, a drug that relieves anxiety Apathy – indifference, without emotion, sluggish 394 Aphasia – inability to express oneself properly through speech, or loss of verbal comprehension, it is considered to be complete or total when both sensory and motor areas are involved Aplastic anemia – a defiency of all of the formed elements of the blood, representing a failure of the cell generating capacity of the bone marrow. It may be caused by neoplastic disease of the bone marrow, or more commonly by destruction of the bone marrow by exposure to toxic chemicals, ionizing radiation, or some antibiotics or other medications. Rarely, an idiopathic form of the disease occurs Apnea – temporary or permanent cessation of breathing and therefore, of the body’s intake of oxygen and release of carbon dioxide. It is a serious symptom, especially in patients with other potentially life threatening conditions Apoptosis - cell death as in what happens to the brains in Batten Disease Arrhythmia – irregular heart action caused by disturbances either physiological or pathological Arteriosclerosis – a disease of the arterial vessels marked by thickening, hardening, and loss of elasticity in the arterial walls. Three forms of arteriosclerosis are generally recognized: atherosclerosis, sclerosis of arterioles, and calcific sclerosis of the medial layer of arteries. An increased level in this enzyme in the blood indicates necrosis or disease in these tissues.