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Blood derived nurse-like cells protect chronic lymphocytic leukemia B cells from spontaneous apoptosis through stromal cell-derived factor-1 arrhythmia bigeminy buy triamterene in india. Extramedullary myeloid cell tumors in acute nonlymphocytic leukemia: a clinical review blood pressure log sheet purchase generic triamterene online. Leukemic Cells Create Bone Marrow Niches That Disrupt the Behavior of Normal Hematopoietic Progenitor Cells blood pressure medication gluten free triamterene 75mg without a prescription. Altered adhesive interactions with marrow stroma of haematopoietic progenitor cells in chronic myeloid leukaemia. In vitro behavior of hematopoietic progenitor cells under the influence of chemoattractants: stromal cell-derived factor-1, steel factor, and the bone marrow environment. Current understanding of stem cell mobilization: the roles of chemokines, proteolytic enzymes, adhesion molecules, cytokines, and stromal cells. Mobilized Hematopoietic Stem Cell Yield Depends on Species-Specific Circadian Timing. Dysregulated gene expression networks in human acute myelogenous leukemia stem cells. Proceedings of the National Academy of Sciences of the United States of America 106, 3396-3401 Matsunaga T, Takemoto N, Sato T, Takimoto R, Tanaka I, Fujimi A, Akiyama T, Kuroda H, Kawano Y, Kobune M, Kato J, Hirayama Y, Sakamaki S, Kohda K, Miyake K, & Niitsu Y (2003). Mohle R, Schittenhelm M, Failenschmid C, Bautz F, Kratz-Albers K, Serve H, Brugger W, & Kanz L (2000). Nagasawa T, Hirota S, Tachibana K, Takakura N, Nishikawa S, Kitamura Y, Yoshida N, Kikutani H, & Kishimoto T (1996). Peled A, Petit I, Kollet O, Magid M, Ponomaryov T, Byk T, Nagler A, Ben-Hur H, Many A, Shultz L, Lider O, Alon R, Zipori D, & Lapidot T (1999). Tachibana K, Hirota S, Iizasa H, Yoshida H, Kawabata K, Kataoka Y, Kitamura Y, Matsushima K, Yoshida N, Nishikawa S, Kishimoto T, & Nagasawa T (1998). Trentin L, Cabrelle A, Facco M, Carollo D, Miorin M, Tosoni A, Pizzo P, Binotto G, Nicolardi L, Zambello R, Adami F, Agostini C, & Semenzato G (2004). Homeostatic chemokines drive migration of malignant B cells in patients with non-Hodgkin lymphomas. Mechanisms underlying abnormal trafficking of malignant progenitors in chronic myelogenous leukemia. Introduction Mixed Lineage Leukemia constitutes a heterogeneous category of rare acute leukemias that are characterized by a mixed population of poorly differentiated lymphoid and myeloid progenitor cells. These chromosomal aberrations are associated with mechanistically distinct gain-of-function phenotypes that may be amenable to targeted therapeutic approaches. One such enzymatic activity is the methylation of lysine 4 of histone H3 (H3K4), an evolutionarily conserved epigenetic mark predominantly associated with transcriptional activation in eukaryotes (Bernstein et al. The epsilon amino group of lysine 4 can be mono-, di-, or trimethylated, with each modification correlating with distinct transcriptional outcomes (Bernstein et al. H3K4 dimethylation is spread more evenly across the coding regions of genes and is thought to be associated with a transcriptionally ?poised state of chromatin (Bernstein et al. These studies suggest that the degree of H3K4 methylation is a highly regulated process. Indeed eukaryotes have evolved a number of highly conserved enzymes whose function appears to precisely regulate the degree of H3K4 methylation. These studies have led to a model in which H3K4 methylation is sequentially catalyzed by a complex that contains multiple distinct active sites for the addition of each methyl group (Patel et al. The existence of a sequential mechanism utilizing several active sites for multiple lysine methylation suggests that the degree of H3K4 methylation is more highly regulated than previously appreciated. The translocation partners identified to date are diverse and do not share any biochemical function or structural motifs. For example, it has been suggested that second hit mutations are required to initiate the full leukemia phenotype (Dobson et al. These data suggest that epigenetic alterations may be just as important as genetic mutations in sources of so called ?2nd hit mutations that underlie the pathogenesis of leukemia.

The material consequences of the attitudes represented in the relentless pursuit of science are that women do not get to hypertension recommendations cheap triamterene 75mg online make decisions about their health care; that each birthing body is treated in terms of its potential for catastrophe hypertension x-ray triamterene 75 mg without prescription, rather than as an individual; and that physicians are constrained by the system they are in arteria linguae profunda generic triamterene 75mg online, rather than free to imagine a better, more healthful process. I felt the treatment this time was better than my last two deliveries when we had insurance even. I went online to find out if we qualified and it was too confusing so I just applied and we were approved for coverage. The gap between research and policy guidelines, practice standards, and hospital regulations is produced by a number of forces, including medical education, tradition, and, perhaps most importantly, economics. It would be easy to look at the conclusions of the last chapter and blame doctors: Why are they not practicing according to what the most current research suggests is most beneficial to mothers and babies? Why would they continue to utilize technologies that have been proven not to be 127 beneficial or even to cause harm? As this chapter will show, doctors are players in a much bigger system: they do not practice obstetrics in a vacuum, but under a host of cultural, professional, and economic pressures. Much of the literature on the medicalization of childbirth focuses on a disparate power dynamic in the doctor-patient relationship as the primary cause of continually skyrocketing rates of technological intervention with little measurable benefit to the health of women and children (B. What I will argue in this chapter is that focusing on that power dynamic alone misses an important opportunity for institutional critique: the current health care system in the United States is much bigger than practicing physicians, who are part, but not the totality of, a matrix of powerful corporate, government, and not-for-profit entities, especially the private health insurance industry and government funded maternity care programs under Medicaid. Looking at the narratives that undergird those systems helps to flesh out a more complicated picture of the institutional forces working to create knowledge about childbirth and its medical management. Additionally, because insurance discourse may be one of the first textual encounters pregnant women have that addresses them as patients, it plays an important role in positioning women within the other biomedical discourses we have looked at. Before I get to the analysis of such discourse, I will first explain a bit about how and why I arrived at the case studies that follow. Next, I will show how the theoretical perspective in this chapter fits within the rhetorical-cultural strategy I have employed so far, especially by adding the lens of professional and technical communication to illuminate the texts analyzed here. Situating Insurance on the Map: Methods and Theoretical Lenses Few rhetorical scholars have looked at health insurance discourse, and none, that I am aware of, have studied the particulars of maternity coverage. Because I am interested in the way 128 economics and discourse are working together to shape the conditions of maternity care, the work of former health care consultant and independent feminist scholar Barbara Bridgman Perkins provides a useful theoretical base for studying the economic factors at work in structuring maternity care. In the Medical Delivery Business: Health Reform, Childbirth, and the Economic Order, Perkins argues that at the heart of the core problems with health care in the United States lies the definition and organization of American medicine as a corporate business, modeled after industry, rather than as a service-provider. Further, she argues that maternity care provides an exemplary look at how that definition shapes care and the funding of care in ways that are not health-promoting, including ?running the labor and delivery unit like an assembly line, turning childbirth into an intensive care situation, managing labor pharmaceutically, and admitting well babies into intensive care units (156-57). All of these routine practices are primarily the result of business ideology, rather than the result of evidence that they improve the 35 health of women and babies, according to Perkins extensive research. As soon as the technology became ubiquitous in teaching hospitals, it became part of the standard way to practice almost by default because hospitals had invested financially in the technology and now they had to bill insurance companies to pay for its operation and to bring in new revenue. Perkins contention that ideology is neither determined by, nor exists apart from, the social milieu in which it operates is a good reminder for rhetoricians that focusing on discourse alone can miss an important opportunity to show how discourses function to produce material effects, as I argued in Chapter One. However, it is important not to discount the role discourse plays in shaping institutions and their practices. But, as with other paradigm/intervention associations, it was not that the metaphors drove practices. Oxytocin use itself shaped the metaphors; active management prescribed oxytocin to strengthen uterine contractions and correspondingly diagnosed dystocia as a problem of inadequate contraction. This focus on uterine contraction ignored other factors contributing to a prolonged labor, such as resistance of the cervix and birth canal. Metaphors of production were just as much the result of structuring labor and delivery units like production units and using technology to enhance productivity as they were its cause. Like the use of forceps, episiotomy, cesarean section, and intensive care before it, active management theory and practice coevolved with the economic organization of obstetrics. Put another way, I agree with Perkins that we cannot reform medical practice without re-forming its economic organization, but I would add that such reform might begin with destabilizing the discourse that undergirds and contributes to the continued dominance of such organization. To that end, analyzing how 130 commercial insurance and Medicaid rhetorically figure pregnant women in their policy discourse might be a way to start to unearth the assumptions and ideologies shoring up the current economic structure of maternity care. These kinds of texts are generally the purview of professional and technical communication?a field that deals with texts created in a professional environment with the express purpose of outlining the terms of use for the professional services rendered by that profession. Marika Seigel argues that as pregnancy has become increasingly technologically mediated?a mediation we saw in the popular culture representations discussed in Chapter Two?pregnant women correlatively ?need instructions in order to navigate the path from drugstore pregnancy test to electronic fetal monitor (11). She reads pregnancy manuals in particular as ?documentation, or ?written materials.

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Wertz were among the first to blood pressure rates chart 75mg triamterene amex produce a sustained historical critique of this kind blood pressure jumping around order triamterene 75mg line, and their 1977 study blood pressure medication ok for pregnancy purchase 75mg triamterene with mastercard, Lying-In: A History of Childbirth in America remains one of the most comprehensive narratives of how the shift from home to hospital came to be the norm. Their narrative works to revise what they call the ?success story of modern medicine to reveal a more complex web of power, economics, and a confluence of social forces that has resulted in a system where birth ?routinely requires the arts of medicine to overcome the processes of nature, often to the detriment of women (emphasis in original, xvi). Anthropologist Emily 8 For an overview of work they call the ?anthropology of birth, see Robbie Davis-Floyd and Carolyn F. Robbie Davis-Floyd, who has been writing about reproduction and medicine for nearly two decades, theorized what she called ?technocratic birth as an elaborate set of rituals, a ?rite of passage designed to communicate core cultural values to birthing women, especially that technology is superior and should be used to overcome the processes of nature, that their bodies are fundamentally flawed, and that physiological reproduction is inherently dangerous. Historian Judith Walzer Leavitt offered a revisionary history of the often-told story of medical men wresting control of birth from women by showing how women have always influenced the models of birth that rise to power. More recent work in the social sciences includes an ethnographic account of traditional African American midwifery in Virginia (G. Fraser), a history of anesthesia (Wolf), cultural analyses of specific obstetric practices like amniocentesis (Rapp) and fetal ultrasound (Taylor), and returns to earlier conceptions of power, knowledge, and medicine (Simonds, Rothman, and Norman; Davis-Floyd and Sargent). In the field of literary studies, scholarship particular to representations of childbirth is relatively sparse. Mothering has received a great deal of attention from feminist literary scholars, as has reproductive politics; far less attention has been paid to the maternal body. The unarticulated space of maternity exists largely because the maternal body occupies such a liminal space, 21 according to Kristeva: pregnancy is the ?threshold between culture and nature, unable to be subsumed by either the signified or the biological essence (182). The inability of existing discourses to speak to this condition are not inconsequential ?silence weighs heavily none the less on the corporeal and psychological suffering of childbirth and especially the self-sacrifice involved in becoming anonymous in order to pass on the social norm (183). As part of that project, she makes the case that dualism?especially the body/mind split?will never serve the interests of women, that we should be able to find ways to ?think through the body, without remaining trapped in patriarchal demands on it (284). In her attempt to make sense of her own bodily experience of maternity, she describes hospitalized childbirth as a metaphor for the oppression of women in general: ?No more devastating image could be invented for the bondage of woman: sheeted supine, drugged, her wrists strapped down and her legs in stirrups, at the very moment when she is bringing life into the world (171). Since Kristeva and Rich first articulated the need for more thinking about how to include the embodied experience of childbirth in feminist theorizing about maternity, relatively few scholars in literary studies have attended to that project. Part of the reason for that, according to some scholars, is that literature has often reproduced the cultural silences surrounding the birthing body of particular historical periods. Identifying the cultural forces and textual patterns that have 22 contributed to the persistence of such attitudes is one way some scholars have worked to reclaim the maternal body. Krista Ratcliffe, for instance, writes that the first step in liberating the maternal body from its marginalized position in discourse is to draw attention to the narrative silences surrounding birth, to dig into the ways that literary and cultural texts have evaded maternal experience. In literature, argues Ratcliffe, this silencing happens most often when male writers have ?remov[ed] birth from the physical realm and render[ed] it metaphorical (49) and when they have objectified birthing women and erased their perspective from the account (51). Patricia Yaeger also finds attending to the literary silences of birth an important component of establishing what she calls a ?poetics of birth. Another component of such a poetics would locate the spaces that unearth a ?reproductive unconscious, that point to reproductive anxiety or ?cultural contestation or struggle (267-68). Another way, and the one feminists interested in maternity have turned to most often, is to look to representations of birth by women writers. The edited collection, this Giving Birth, takes as its purpose this very recovery. This project will build on this small but rich body of scholarship on childbirth and extend the focus of analysis across disciplines and beyond the birthing room. As my review 24 shows, much of the scholarship specifically devoted to childbirth emerges out of a fairly static disciplinary boundary: the social sciences have produced research that has been primarily concerned with the material conditions of birth, while literary studies has been mostly concerned with the symbolic representation of childbirth; there has been little cross-over 9 between the two arenas. My project has been informed and enriched by much of this work, as it has taught us a great deal about the conditions and the representation of childbirth and medicine. Where I see my project intervening in this discussion is in connecting representation with its potential effects on material bodies, discourse with the knowledge it produces, and science and medicine with the narratives that give them meaning. A foundational premise for my study is that more purposeful interdisciplinarity can contribute to a fuller, richer understanding of childbirth and what it can mean for our engagement with medicine, science, and physiological human reproduction and can begin to unsettle the boundary between the ?real and the representational in order to bring them to bear on one another. Before I begin that project, of tracing the trajectory of childbirth and medicine through contemporary culture, I will briefly sketch the historical movements necessary to understand how we have arrived at the particular context of birth practices in the twenty-first century. Mazzoni and Adams also both use scientific and cultural discourses to illuminate their literary analyses in productive ways. However, this work is rarely taken up by scholars in other disciplines; though the individual texts themselves include some interdisciplinarity, the conversation, as I see it, has remained fairly enclosed within each disciplinary home. My hope is that by locating the conversation about childbirth squarely within medicine and science studies, rather than as a separate (and marginal) issue, those disciplinary boundaries will start to give way. Midwives attended 8% of all births, including certified nurse midwives attendance at hospital births, and traditional and nurse-midwives attendance at home and at freestanding birth centers (Martin et al.

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