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Glucotrol XL

By Q. Leif. Williams College.

The challenge to the role of HIV in Aids from the retrovirologist Peter Duesberg and others buy discount glucotrol xl 10 mg on-line diabetes symptoms type 1 adults, together with criticisms of the official line of exaggerating the risk to heterosexuals discount 10mg glucotrol xl mastercard diabetes prevention book, provoked some wider questioning of the Aids panic in the early 1990s. In relation to cot death and malignant melanoma, we have already quoted dissident paediatricians and dermatologists. The scares about the Pill and the MMR vaccine were unusual in that most experts in both fields were bemused by the scares from the outset. In the case of the Pill, most family planning authorities did not believe that the reports of increased risk were clinically significant, and in the case of the MMR vaccine, neither gastroenterologists nor child psychiatrists were, in general, much impressed by the evidence adduced by Wakefield and his colleagues. Doubts about the BSE-nvCJD link were even more profound, as the prion theory on which the whole concept of ‘transmissible spongiform encephalopathies’ is based remains controversial, and various alternative hypotheses concerning the aetiology of these conditions are in circulation. The media, always alert to a new angle, and particularly keen on controversy, soon pick up the views of critical experts and provide them with a platform from which to expound their views. To some extent the resulting debate helps to keep the panic alive when the public may be beginning to tire of the same old scare story. However, at the same time, it begins to cause some irritation as people become confused by rival arguments, often of an increasingly esoteric character. The popular view that ‘if the experts can’t agree about these problems, how are we supposed to make up our minds? This is seriously to overestimate the scale of the backlash and to underestimate the extent to which even the most sceptical individuals have discreetly modified their lifestyles as a result of the anxieties generated by these scares. As the reactive character of the term backlash implies, it is more of an expression of anger than a systematic attempt to roll back the influence of the phenomenon against which it is reacting. If you examine the influence of any of the major scares we have listed, taking account of the backlash that followed the initial impact, you find that, far from being neutralised by the backlash, the scare continues to have a significant effect, perhaps less than at its peak, but substantial nonetheless. The most obvious example of this is the Aids panic, which has seen off Duesberg and the other dissidents and continues to exert a powerful influence. Perhaps even more significant is the on-going effect of the Pill and MMR scares: even though it emerged that the balance of medical authority was strongly opposed to both scares, the number of women on ‘third generation’ pills five years later remains substantially reduced and the uptake of the MMR vaccine has yet to reach its pre-scare level. Once a health scare has established a particular fear in the popular consciousness it can readily be re-activated, either as a matter of deliberate policy or as result of some incident. Thus, for example, in 1999 the government launched a programme for routine testing all pregnant women for HIV. Official statistics show that in 1997 there were 265 births in Britain to women infected with HIV, producing 71 HIV positive babies. These figures are low, and declining, and the vast majority are to be found among refugees from Africa living in London. Irrational from a public health point of view, the universal screening policy was, according to one critic, ‘a useful re-affirmation of the politically correct, if not factually correct, mantra that we are all of us at risk of HIV and had better behave with appropriate sexual and social caution’ (Bradley 1999). The re-appearance of the sun every spring provides the occasion for a booster of the skin cancer scare. Scares without a seasonal component are obliged to rely on events such as a celebrity death or fall back on the artificial annual ‘national awareness’ day (or week). For many, if not most, people life will never be the same as it was before the great health scares of the 1990s. It is, of course, still 27 HEALTH SCARES AND MORAL PANICS possible to have sex without using a condom, but as numerous patients have told me, it is not easy to remove from the back of the mind the worry that this might result in a lethal contamination. It is no longer possible to put a baby in a cot without thinking about which way around they should be lying, and without the occasional shiver running down the spine at the thought that they might not survive the night. People still lie in the sun on those rare occasions it appears in Britain’s cloudy skies, but usually not without applying their sunscreen cream (even if they do not consult the daily Solar UV Index, and adjust their cream and exposure time according to their skin type, as the summer 1999 official campaign advised). Scarcely a week goes by without somebody asking me whether some harmless mole or minor skin blemish is the first sign of a malignant melanoma (in the ten years I have been running a minor surgery clinic, I have seen only two). Women still take the Pill, but now in a state of heightened awareness of a risk of sudden death from thrombosis that is much less than that of dying in a road accident. The proportion of meat eaters has never returned to the level before the mad cow scare, but even a lifetime of vegetarianism cannot be guaranteed to protect you from nvCJD. Most parents still choose to have their babies vaccinated against measles, mumps and rubella, but none now without a twinge of anxiety that this may destine them to a devastating disability. People who were fiercely critical of the government’s 1998 ban on ‘beef-on-the-bone’, because of a notional risk of transmission of BSE, may well endorse the government’s cot death campaign or refuse to take their child for the MMR vaccine. Others who reject the major scares may find themselves in the grip of the panic over mobile phones or microwaves.

Soluble antigens that can dissolve across substances such as toxins or bacteria) generic glucotrol xl 10 mg amex diabetic banana bread. Scientists have worked the cell membranes are able to equilibrate safe 10 mg glucotrol xl diabetes insipidus thiazide, but more bulky to develop a method to extract large amounts of specific anti- antigens that do not go into solution cannot. The second phase bodies from clones (exact copies) of a cell created by fusing of antigen processing is known as the catabolic decay phase. Those antibodies are called mono- Here, cells such as macrophages take up the antigen. The final phase American pathologist Karl Landsteiner found that animal anti- of antigen processing is called the immune elimination phase. Research by the American biochemists occurs, and the complex is degraded. The presentation of a pro- work they received the 1972 Nobel prize in physiology or tein target stimulates the lymphocyte to divide. By the 1960s, scientists who studied cells needed large Some of the daughter cells will then produce antibody to the amounts of specific antibodies for their research, but several protein target. With time, there will be many daughter lym- problems prevented them from obtaining these antibodies. During Animals can be injected with antigens so they will produce the this log or exponential phase, the quantity of antibody desired antibodies, but it is difficult to extract them from increases rapidly. Attempts to reproduce vari- For a while, the synthesis of antibody is balanced by the ous antibodies in an artificial environment encountered some breakdown of the antibody, so the concentration of antibody complications. Milstein and Köhler shared part of the 1984 Nobel prize in physiology or medicine for their invention. Today pure antibodies are made using the Milstein- Köhler technique and also through genetic engineering, which adds the gene for the desired antibody to bacteria that can pro- duce it in large amounts. Monoclonal antibodies are instru- mental in the performance of sensitive medical diagnostic tests such as: determining pregnancy with chorionic gonadotropin; determining the amino acid content of sub- stances; classifying antigens; purifying hormones; and modi- fying infectious or toxic substances in the body. They are also important in cancer treatment because they can be tagged with radioisotopes to make images of tumors. See also Antibody-antigen, biochemical and molecular reac- tions; Antibody and antigen; Immunity, cell mediated; Immunogenetics; Immunologic therapies; Immunological analysis techniques; In vitro and in vivo research ANTIGEN • see ANTIBODY AND ANTIGEN Antigenic mimicryANTIGENIC MIMICRY Antigenic mimicry is the sharing of antigenic sites between microorganisms and mammalian tissue. An immune response Mice used to develop the monoclonal cells that secret a specific can be directed both at the microorganism and at the host site antibody. This autoimmune response due to antigenic mimicry is known to be a crucial factor in the development of certain ailments in humans. A protein, which is made up of a sequence and could, therefore, be crossed with lymphocytes to produce of amino acids strung together, will fold up in various ways, specific antibodies. These hybrid cells are called hybridoma, and they produce monoclonal antibodies. After receiving a doctorate in biochemistry, Proteins that adopt a similar three-dimensional configu- specializing in enzymes, from the University of Buenos Aires ration can stimulate a common response from the immune sys- in 1957, he continued this study at the University of tem. Typically, proteins that have a similar amino acid Cambridge in England. There he worked under the biochemist sequence will adopt the similar folded structures. This protein is similar in amino where Sanger suggested that he work with antibodies. In mice, an immune reac- received his doctorate from the University of Freiburg for tion to Chlamydia triggers a condition known as inflammatory work performed at the Institute for Immunology in Basel, heart disease. To produce the needed antibodies, Milstein and the heart, leading to cardiac malfunction. After shown that a significant number of patients with heart disease extracting the resulting lymphocytes from the mouse’s blood, have antibodies to Chlamydia in their blood, indicative of a they fused one of them with a myeloma cell. As Milstein soon realized, their tech- that is the consequence of an autoimmune reaction. Other bacteria, viruses, fungi and In the example of the injection, alcohol swabbing of the injec- protozoa share the antigenic similarity with the mouse anti- tion site will kill the bacteria on the skin, so that living bacte- genic region. The bacteria include Borrelia burgdorferi (the ria are not carried into the body upon insertion of the needle. Pure alcohol rapidly Antigenic mimicry may also be the basis of the ulcers coagulates surface proteins, producing a coagulated crust formed upon infection of humans with Helicobacter pylori.

If he had spent more time thinking about the research proven glucotrol xl 10mg diabetes test when pregnant, especially coming to terms with the difference between qualitative and quantitative research discount glucotrol xl 10 mg mastercard diabetic diet 55, he would have saved himself a lot of time and energy (see Chapter 2). THE FIVE ‘WS’ When you start to think about your research project, a useful way of remembering the important questions to ask is to think of the five ‘Ws’: X What? Once you have thought about these five ‘Ws’ you can move on to think about how you are going to collect your data. One of the hardest parts in the early stages is to be able to define your project, so much research fails because the researcher has been un- able to do this. If you are unable to do this, the chances are your research topic is too broad, ill thought out or too obscure. Okay, you might have been told to do some research by your tutor or by your boss, but there should be another reason why you have chosen your particular subject. It might be solely to do with the fact that you are interested in the topic. This is a good start as you need to be inter- ested in your research if you are to keep up your enthu- siasm and remain motivated. Or you might have identified a gap in the research literature – this is good as it shows you have carried out careful background re- search. Or perhaps you want to try to obtain funding for a particular service or enterprise and you need to do some research first to find out if there is demand for what you are proposing. Whatever your reason, think very carefully about why you are doing the research as this will affect your topic, the way you conduct the research and the way in which you report the results. If you’re doing it for a university dis- sertation or project, does your proposed research provide the opportunity to reach the required intellectual stan- 6 / PRACTICAL RESEARCH METHODS dard? Will your research generate enough material to write a dissertation of the required length? Or will your research generate too much data that would be impossible to summarise into a report of the required length? If you’re conducting research for funding purposes, have you found out whether your proposed funding body re- quires the information to be presented in a specific for- mat? If so, you need to plan your research in a way which will meet that format. However, you should think about the type of people with whom you will need to get in touch with and whether it will be possible for you to contact them. If you have to conduct your research within a par- ticular time scale, there’s little point choosing a topic which would include people who are difficult or expensive to contact. Also, bear in mind that the Internet now pro- vides opportunities for contacting people cheaply, espe- cially if you’re a student with free internet access. Thinking about this question in geographical terms will help you to narrow down your research topic. Also, you need to think about the resources in terms of budget and time that are HOW TO DEFINE YOUR PROJECT / 7 available to you. If you’re a student who will not receive travel expenses or any other out of pocket expenses, choose a location close to home, college or university. If you’re a member of a community group on a limited bud- get, only work in areas within walking distance which will cut down on travel expenses. Also, you need to think about where you’ll be carrying out your research in terms of venue. If you’re going to con- duct interviews or focus groups, where will you hold them? Is there a room at your institution which would be free of charge, or are you going to conduct them in par- ticipants’ own homes? If you’ve answered ‘no’ to either of these last two questions, maybe you need to think again about your research topic. In 15 years I have encountered only one uncomfortable situation in a stranger’s home. Think very carefully about whether your chosen topic and method might have an influence on personal safety. Thinking about this question will help you to sort out whether the research project you have proposed is possible within your time scale. It will also help you to think more about your par- ticipants, when you need to contact them and whether they will be available at that time. For example, if you want to go into schools and observe classroom practice, you wouldn’t choose to do this research during the sum- mer holiday.

I examined her hands and feet and listened for symptoms of carpal tun- nel or tarsal tunnel syndrome glucotrol xl 10mg amex diabetes symptoms at 30, but she didn’t complain about any of the clas- sic symptoms for those glucotrol xl 10mg on-line diabetes test strips costco. There had to be other clues to this mystery, so I referred back to her notebook. Four things popped out as I marked up her notebook with a yellow highlighter. Her rings were tight and she couldn’t button her clothes—the swelling again. Also, her pain and swelling improved after she lay down and when she swam. Finally, she indicated that two of her existing physical problems were hypothyroidism and food allergies. I was beginning to see a picture now—one that was really quite obvi- ous. But in searching for a complicated answer everyone, including myself, had missed it. I asked Ruth if she had ever mentioned these things to her other doctors. She responded that she’d reported her thyroid issues, but no one had ever asked her about the other four things and she hadn’t thought about them before she worked on the Eight Steps. The picture that was forming as the puzzle pieces of Ruth’s story were put together finally compelled me to ask about her weight. I had not wanted to pursue what I already knew from Ruth’s psychiatrist was a painful sub- ject, but it was impossible to avoid it now if she really wanted an answer to her mystery malady. I asked her specifically if her weight at night was dif- ferent from her weight in the morning. Ruth seemed angry at me for hav- ing raised this issue that haunted her every waking hour. She was reticent until I told her I was uninterested in the actual number of pounds she weighed; I simply wanted to know if she weighed more at night than in the morning and how much. She reluctantly agreed to observe this before her next visit, which we scheduled for a week later. I called her psychiatrist and enlisted his help because I wasn’t sure she would come back after this discussion, and I had a strong inkling I might Is Your Weight Problem Really Diet-Related? At her next appointment, Ruth indicated there was somewhere between a four- and six-pound difference between her night- time and morning weight! I asked her to raise her lower leg for me and said I was going to tell her what was wrong and how she could definitely lose some weight. When she extended her leg, I pressed on her lower leg and showed her the indentation mark it left for several seconds after I released it. This physical finding, together with all her other symptoms, indicated a medical condition known as edema, or the abnormal buildup and reten- tion of fluid. It is often associated with pregnancy (when it’s known as preeclampsia). It is commonly seen in the feet and ankles, usually because of the effect of gravity. As the fluid accumulates, it often pinches off the nerves temporarily to the hands and feet, causing neurological symptoms such as numbness. Fluid also builds up in the front of the shins where it makes the skin tight and causes pain. It also accumulates in the hands— which is why Ruth’s rings were sometimes tight and she couldn’t perform fine motor functions. Clearly, this condition was also the reason for her constant urination during the night. As fluids build up during the day, the body naturally tries to rid itself of all this extra fluid at night. Difficulty in sleeping is common, since the bladder needs to be emptied frequently.

Glucotrol XL
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