The one thing that has gone well for the offense? Running back Ezekiel Elliott.

The  Oleksandr Usyk vs. Tony Bellew to score points and the problem is  threatening to derail their playoff hopes. The Oleksandr Usyk vs. Tony  Bellew will try to unlock their near-dormant offense when they take on  the Oleksandr Usyk vs. Tony Bellew on Saturday on FOX, DirecTV 

Watch Usyk vs Bellew Full Fight LIVE Stream FREE 

  Oleksandr Usyk vs. Tony Bellew were held to one touchdown in their  loss to the Seattle Seahawks in Week 6. They have scored just four  touchdowns in 12 quarters of boxing
 

  this season and their 41 points scored is the second-worst of the  season behind the Iowa State. The  scoring average of 13.7 points a game  in 31st in the
 

  league.
   Oleksandr Usyk vs. Tony Bellew led by quarterback Matthew Stafford,  meet the Missouri led by quarterback Dak Prescott and running back  Ezekiel Elliott, in a
 

  Week 6 boxing game on Sunday, 2018 (10/14/18) at AT&T Stadium in Arlington, Texas.
 

  The scoring issues have increased pressure of offensive coordinator  Scott Linehan. Head coach Jason Garrett rebuffed talk about replacing  Linehan, at least for now.
 

  The one thing that has gone well for the offense? Running back  Ezekiel Elliott. Elliott rushed for a season-high 127 yards on 16  carries against the Seahawks, but he
 

  has been the offense. Quarterback Dak Prescott hasn’t thrown for  more than 170 in any game this season.The Lions posted a big and  much-needed win against the New
 

  England Patriots. The offense finally found some balance, including  a surprisingly effective running game. Rookie running back Kerron  Johnson ran for 101 yards, making
 

  the first Lions running to reach at least 100 yards since  2013.Quarterback Matthew Stafford, who threw for 262 yards and two  touchdowns against the Patriots, seems to
 

  have emerged from his Week 1 – four interceptions – issues. He has  thrown five touchdown passes and one interceptions in his past two  games. Watch The game is part of
 

  the early slate of games on FOX. Kevin Burkhardt and Charles Davis  will have the call on the national broadcast. If you live in the areas  in red on the map below
 

  (courtesy 506 Sports), the game will be on your local FOX  affiliate.You can get the latest score and stats from the game in the  box score provided above and here’s
 

 

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The Maryland vs Indiana to score points and the problem is threatening to derail their playoff hopes

The Maryland vs Indiana to score points and the problem is threatening to derail their playoff hopes. The Maryland vs Indiana will try to unlock their near-dormant offense when they take on the Maryland vs Indiana on Saturday on FOX, DirecT



Maryland vs Indiana were held to one touchdown in their loss to the Seattle Seahawks in Week 6. They have scored just four touchdowns in 12 quarters of boxing

this season and their 41 points scored is the second-worst of the season behind the Iowa State. The  scoring average of 13.7 points a game in 31st in the

league.
Maryland vs Indiana led by quarterback Matthew Stafford, meet the Missouri led by quarterback Dak Prescott and running back Ezekiel Elliott, in a

Week 6 boxing game on Sunday, 2018 (10/14/18) at AT&T Stadium in Arlington, Texas.

The scoring issues have increased pressure of offensive coordinator Scott Linehan. Head coach Jason Garrett rebuffed talk about replacing Linehan, at least for now.

The one thing that has gone well for the offense? Running back Ezekiel Elliott. Elliott rushed for a season-high 127 yards on 16 carries against the Seahawks, but he

has been the offense. Quarterback Dak Prescott hasn’t thrown for more than 170 in any game this season.The Lions posted a big and much-needed win against the New

England Patriots. The offense finally found some balance, including a surprisingly effective running game. Rookie running back Kerron Johnson ran for 101 yards, making

the first Lions running to reach at least 100 yards since 2013.Quarterback Matthew Stafford, who threw for 262 yards and two touchdowns against the Patriots, seems to

have emerged from his Week 1 – four interceptions – issues. He has thrown five touchdown passes and one interceptions in his past two games. Watch The game is part of

the early slate of games on FOX. Kevin Burkhardt and Charles Davis will have the call on the national broadcast. If you live in the areas in red on the map below

(courtesy 506 Sports), the game will be on your local FOX affiliate.You can get the latest score and stats from the game in the box score provided above and here’s

everything you need to know in order to watch the Titans-Steelers game:

 

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The Oleksandr Usyk vs. Tony Bellew

The Oleksandr Usyk vs. Tony Bellew to score points and the problem is threatening to derail their playoff hopes. The Oleksandr Usyk vs. Tony Bellew will try to unlock their near-dormant offense when they take on the Oleksandr Usyk vs. Tony Bellew on Saturday on FOX, DirecTV

Watch Usyk vs Bellew Full Fight LIVE Stream FREE 

Oleksandr Usyk vs. Tony Bellew were held to one touchdown in their loss to the Seattle Seahawks in Week 6. They have scored just four touchdowns in 12 quarters of boxing

this season and their 41 points scored is the second-worst of the season behind the Iowa State. The  scoring average of 13.7 points a game in 31st in the

league.

Oleksandr Usyk vs. Tony Bellew led by quarterback Matthew Stafford, meet the Missouri led by quarterback Dak Prescott and running back Ezekiel Elliott, in a

Week 6 boxing game on Sunday, 2018 (10/14/18) at AT&T Stadium in Arlington, Texas.

The scoring issues have increased pressure of offensive coordinator Scott Linehan. Head coach Jason Garrett rebuffed talk about replacing Linehan, at least for now.

The one thing that has gone well for the offense? Running back Ezekiel Elliott. Elliott rushed for a season-high 127 yards on 16 carries against the Seahawks, but he

has been the offense. Quarterback Dak Prescott hasn’t thrown for more than 170 in any game this season.The Lions posted a big and much-needed win against the New

England Patriots. The offense finally found some balance, including a surprisingly effective running game. Rookie running back Kerron Johnson ran for 101 yards, making

the first Lions running to reach at least 100 yards since 2013.Quarterback Matthew Stafford, who threw for 262 yards and two touchdowns against the Patriots, seems to

have emerged from his Week 1 – four interceptions – issues. He has thrown five touchdown passes and one interceptions in his past two games. Watch The game is part of

the early slate of games on FOX. Kevin Burkhardt and Charles Davis will have the call on the national broadcast. If you live in the areas in red on the map below

(courtesy 506 Sports), the game will be on your local FOX affiliate.You can get the latest score and stats from the game in the box score provided above and here’s

everything you need to know in order to watch the Titans-Steelers game:

 

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A pair of reigning conference champions face off at Thompson-Boling Arena on Friday night when No. 6 Tennessee plays host to Louisiana for a 7 p.m. ET tip on SEC Network

A pair of reigning conference champions face off at Thompson-Boling Arena on Friday night when No. 6 Tennessee plays host to Louisiana for a 7 p.m. ET tip on SEC Network

Watch Usyk vs Bellew Full Fight LIVE Stream FREE

Opponent: Louisiana Ragin’ Cajuns

Tipoff: Nov. 9, 7:01 p.m. ET

Venue: Thompson-Boling Arena

Watch Online: SEC Network+ (WatchESPN)

Radio: Vol Network

Online: Live Audio | Live Stats

RELATED LINKS Buy Tickets Game Day Information SEC Clubhouse Follow @Vol_Hoops TENNESSEE Roster Schedule 2018-19 Stats Game Notes (PDF) LOUISIANA Roster Schedule 2018-19 Stats Game Notes (PDF) THE LATEST FROM THE VOLS Vols Cruise to Season-Opening Win Over Lenoir-Rhyne, 86-41 Tennessee Tops Tusculum in Exhibition, 87-48 Vols Earn Highest AP Preseason Ranking Ever at No. 6 Basketball Single-Game Tickets on Sale Tuesday; Promotions Schedule Unveiled Walk-Through Metal Detectors in Use at Thompson-Boling Arena

Tickets are available at AllVols.com. Also, as part of Tennessee Athletics’ Salute to Service Weekend, current military members and veterans may present a Military ID or DD 214 at Gate C, Gate E or the ticket tent located on Phillip Fulmer Way prior to entering Thompson-Boling Arena for complimentary admission for themselves and any immediate family members.

Tennessee (1-0) opened the season with a victory, topping Lenoir-Rhyne 86-41 on Tuesday night. All five starters finished the game in double figures, led by Jordan Bone’s 18 points. Kyle Alexander chipped in a career-high 16 points while tallying four blocks in the contest.

The Ragin’ Cajuns (1-0) come to Knoxville off a 121-80, season-opening win over the University of the Virgin Islands. The reigning Sun Belt Conference champions had six players in double figures, led by a pair of 19-point performances from JaKeenan Gant and Malik Marquetti. As a team, ULL shot 67.1 percent from the field (including 58.3 percent from three) while forcing 22 turnovers.

ABOUT LOUISIANA

The Louisiana Ragin’ Cajuns (1-0) enter Friday night’s matchup in Thompson-Boling Arena with aspirations to improve upon an impressive 2017-18 campaign.Sun Belt Conference Coach of the Year Bob Marlin led the Ragin’ Cajuns to a record-breaking year as Louisiana won a school-record 27 games and earned its first outright Sun Belt Conference regular-season title since the 1999-2000 season. The Ragin’ Cajuns won 20 of 22 games from December through February while dominating the league statistics, finishing as the league leader in 10 categories, including scoring offense (83.2), field-goal percentage (.464), free-throw percentage (.761) and assists (17.4).While first-team All-Sun Belt Conference players Frank Bartley and Bryce Washington graduated, the Ragin’ Cajuns return three starters, including Sun Belt Conference Newcomer of the Year and Defensive Player of the Year JaKeenan Gant (13.7 ppg, 5.8 rpg, 2.3 bpg).With nine upperclassmen on the roster and three transfers from “Power Five” programs, Louisiana has the experience and talent to once again compete for a Sun Belt title in 2018-19 and will offer a good early-season test for the Volunteers.In their season opener against Virgin Islands, the Ragin’ Cajuns were lights out from the floor, knocking down 67 percent of their shots in a 121-80 victory. Gant finished with 19 points, four rebounds, three assists and three blocks in 25 minutes of action. Senior guard Marcus Stroman, a transfer from South Carolina, was on the cusp of recording a triple-double with 10 assists, eight points and eight rebounds.

Tennessee will make its fourth all-time appearance in the NIT Season Tip-Off later this month. The four-team field consists of the Vols, Kansas, Louisville and Marquette, taking place in Brooklyn, N.Y., at the Barclays Center.

Tennessee opens play with a matchup against Louisville on Nov. 21 at 5 p.m. ET. The other side of the bracket features a contest between Kansas and Marquette. The winners and losers of each game on Nov. 21 will meet two days later on Nov. 23.In its last NIT Season Tip-Off appearance, UT won the 2010 championship with victories over VCU and Villanova. The Vols also appeared in the 1992 and 2006 NIT Season Tip-Offs. The Big Orange defeated Rutgers before falling to Seton Hall in 1992. In 2006, UT suffered losses to Butler and North Carolina at Madison Square Garden.Both Tennessee (No. 6) and the Jayhawks (No. 1) enter the season ranked in the top 10 of the AP preseason poll. If the two teams were to face off and the rankings hold, the game would mark UT’s fifth contest against a top-10 non-conference foe during the last three seasons.

SCHOFIELD, WILLIAMS APPROACHING 1,000-POINT MILESTONE

Senior wing Admiral Schofield and junior forward Grant Williams enter the season less than 100 points away from eclipsing the 1,000-point mark for their careers.A total of 48 Vols have accomplished that feat during their time on Rocky Top, with Robert Hubbs III being the most recent addition to the 1K Club in 2016-17.

Schofield (960 points) and Williams (933 points) could both reach the milestone within the first month of the season. The last time a UT duo achieved the feat in the same season was during the 2013-14 campaign, as eventual NBA Draft picks Jordan McRae (1,521 points) and Jarnell Stokes (1,129 points) joined the club while helping lead Tennessee to a Sweet Sixteen appearance.

All-time, UT has had 10 duos reach 1,000 points in the same season, including Ernie Grunfeld and Bernard King in 1975-76.

Along with this year’s All-SEC duo, junior guard Lamonté Turner also could surpass 1,000 career points this season. At 644 career points, the 2018 SEC Co-Sixth Man of the Year needs just 356 points to reach 1,000. Last year, Turner finished the season with 381 points. If all three were to eclipse the mark, it would mark the first time a Tennessee trio has done so in the same year.

SCHOFIELD, WILLIAMS NAMED TO NAISMITH WATCH LIST

Tennessee’s All-SEC duo of Admiral Schofield and Grant Williams continued garnering preseason recognition Monday, as the Atlanta Tipoff Club announced its watch list for the 2019 Citizen Naismith Trophy Men’s Player of the Year.Tennessee was one of 11 schools to have multiple players on the list, including Duke, Gonzaga, Indiana, Kansas, Kansas State, Kentucky, Nevada, North Carolina, Villanova and Virginia. The Vols could also potentially face 13 players named to the list during the regular season.

WILLIAMS TABBED TO WOODEN AWARD PRESEASON WATCH LIST

Grant Williams racked up his third preseason national player of the year consideration, as the John R. Wooden Award presented by Wendy’s announced its Preseason Top 50 Watch List.Chosen by a preseason poll of national college basketball experts, the list is comprised of 50 student-athletes who are the early front-runners for the most prestigious honors in college basketball, the Wooden Award All American Team™ and Most Outstanding Player Award.The Wooden Award All American Team™ will be announced the week of the “Elite Eight” round of the NCAA Tournament. The winner of the 2019 John R. Wooden Award will be presented by Wendy’s during the ESPN College Basketball Awards on Friday, April 12, 2019

 

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Cultural Influences

Cultural Influences.” Please respond to the following:   You  are meeting with an international client in the Middle East and want to  make sure you have addressed any cultural issues that might impact the  success of your meeting.    Numerous  theorists discuss cultural concepts. Using this information as a basis,  discuss the concepts you would want to analyze and evaluate in order to  prepare you and other company executives for the upcoming meeting.   Which of the concepts you discussed would be the hardest to analyze? Why?   Describe  a worst case scenario involving the muddling of culture concepts. What  steps could you (or your company) take to ensure something similar never  happens to you?

 

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Radio commentary on BBC Radio 5 live

Venue: Twickenham Date: 10 November Kick-off: 15:00 GMT

Coverage: Radio commentary on BBC Radio 5 live (build-up from 14:30) and live text commentary on BBC Sport website. Highlights on BBC Two at 19:30 GMT.

All Blacks coach Steve Hansen says England’s New Zealand-born flanker Brad Shields will find it “tough” playing against his native country on Saturday.

Shields played for New Zealand Under-20s but ended his hopes of a senior cap when he opted to play for England, who he qualifies for through his parents.

“He is going to be going out facing the haka, facing a team that he has always wanted to play for,” said Hansen.

“It will tug at his heartstrings, you wouldn’t be human if it didn’t.”

Shields, who won the IRB Junior World Championships in 2011 with New Zealand’s age-grade team, said earlier this week that “there are going to be some emotions, there is no hiding from that”.

Hansen found going up against his native New Zealand “pretty raw” when he worked as Wales coach between 2002 and 2004, but backed Shields to keep his emotions in check.

“I think he’ll find it tough, but he is a quality man and a good rugby player so he will deal with it in his own way,” he added

 

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Virginia on Offense

Week after week, we’re getting more hyped about the Virginia Cavaliers football team. It took some time, as the early season schedule didn’t really give the team a chance to exceed expectations. But this team is getting better with experience, and they’re playing some outstanding football right now. On top of that, they’re fun to watch. The offense is fun, with run-pass-options and enough deep passes to keep the defense honest. The defense is fun with talented CBs playing a lot of man coverage and talented OLBs gunning for the QB.

Virginia is ranked for the first time since 2011, and has a real shot at winning the ACC Coastal Division. Sure, that doesn’t mean much considering how poor the division is. Even so, getting a chance to play in the ACC Championship Game would be a major accomplishment for a team that was picked dead last in the conference by the media in the pre-season.

This week, No. 23 Virginia takes on the Pitt Panthers in a Friday primetime game. Virginia played two Friday night games last season as they went to Boise State and hosted Virginia Tech. The weather prediction is for rain at kickoff, though that may taper off as the game continues.

The game takes place at Scott Stadium, kickoff time is 7:30 Eastern on Friday night. It will be televised by ESPN2. Let’s get on to the matchups.

Virginia on Offense

As I discussed last week, Virginia’s offense had fallen in the national ranks over the past few weeks, but it wasn’t really because the offense was bad, it was because they were facing better defenses. UNC’s defense isn’t great, and Virginia gashed them for 425 yards.

That was just the third most yards the Hoos have had this season, but it was the first time that Virginia has had over 200 yards rushing and 200 yards passing in a game since 2014. It was also the most yards Virginia has had against an ACC foe since facing Duke in 2015.

After last week, UNC’s defense ranks 82nd in the S&P ratings. Pitt’s ranks 98th. The Panthers are coming off a 54-45 win over Duke. Duke had 619 total yards in a game that was at Pitt. At home the previous week against Virginia, that same Duke offense had just 320 yards. Yeah, the Pitt defense isn’t very good. They’ve played in a few shootouts, which doesn’t help, but they’ve also been blown out a couple of times.

They rank 93rd nationally in pass defense and in pass efficiency defense, which is bad. They also rank 97th in rush defense, which is worse. The Panthers run a standard 4-3 defense. They call the weak-side LB “Money” and the strong-side LB “Star”. This is not a young or inexperienced defense. They ranked 75th in defensive S&P last year, so you’d expect them to improve after that, but they have gone the other way.

They aren’t bad at generating QB pressure, tied (with Virginia, among others) for 67th nationally in sacks. They aren’t bad at generating turnovers either, tied for 50th (Virginia is just one TO ahead of them). Where they really struggle is getting off the field. They rank 117th in 3rd down defense, giving up 47% conversions. That’s a scary proposition against Virginia, who rank 12th nationally in 3rd down conversions, also at 47%. If Virginia converts 47% of their 3rd downs, there’s a good chance that they end up on top.

It doesn’t help that Pitt has lost their starting MLB, Quintin Wirginis, for the season. Then again, it’s not like they were crushing it before he was injured. He was the leading tackler, and despite missing two games, is still second. The leading tackler now is FS Damar Hamlin. Wirginis is also second in sacks and

 

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Infections of the Cardiovascular and Lymphatic System

Case Study

Infections of the Cardiovascular and Lymphatic System

Toxoplasmosis……………..Don’t Blame Fluffy!

As part of their commitment to “going green,” Layla and Steve Jackson lived on a small farm in rural northwest Pennsylvania. Steve chopped wood from their forest to burn in their Franklin stove, and about 25% of their electricity was generated by the wind turbines on top of their mountain. They raised almost all of their own food between their small apple orchard, huge vegetable garden, and a berry patch. The couple reared numerous sheep, a few pigs, and one dairy cow. These animals plus the rabbit, turkey, and deer Steve hunted more than covered their meat and milk needs. Although the young couple loved working their farm, to make ends meet financially, they also taught at the local high school. Layla was a 10th grade math teacher and Steve served as both the choral and band directors for grades 7–12. Unless the roads were icy in the winter, the “green team” biked the four miles to work every day. While this lifestyle kept them extremely busy, Layla and Steve felt great satisfaction knowing their carbon footprint was significantly less than that of the average American.

As Layla picked the green beans and weeded around the squash one July morning, she pondered how their lifestyle would change in November when their first child was due to be born. She was pleased to be able to raise their child in the unpolluted environment of their country farm and nourish him with homegrown foods free of the pesticides and preservatives found in many commercially produced items. “Of course,” Layla said to herself while patting her belly, “I think we’ll have to break down and drive a little more this winter. You’ll be a bit too small for my baby bicycle seat.” As if on cue, the baby started “dancing.” Laughing, Layla collected the baskets of produce she had harvested and headed to the kitchen to start making lunch. After rinsing the fresh-picked fruits and vegetables, Layla used her garden’s bounty to assemble a delicious salad and homemade strawberry shortcake with cream from Josie, their cow. Later that afternoon, the couple went to Dr. Schneider’s office for Layla’s monthly prenatal examination. They watched with amazement as the obstetrician used ultrasound to measure the baby’s growth, confirming that Layla was 23 weeks pregnant. Dr. Schneider pointed out different features of their developing child. They saw a tiny beating heart and learned it was time to paint the nursery blue!

                Layla’s pregnancy progressed normally until her next appointment at 27 weeks gestation. Dr. Schneider was surprised to find Layla hadn’t gained any weight in four weeks. “At this stage of your pregnancy, you should be gaining about 0.5 to 1 pound per week,” Dr. Schneider said with concern. “Are you eating enough nutritious foods?”  Layla was happy to report a healthy appetite that she regularly indulged with the foods she and Steve raised. “I bet it’s the extra exercise I’m getting,” Layla explained. “I’ve been canning produce as fast as I can harvest the garden and orchard. I’m up and down the hillside a dozen times a day hauling a full bushel basket, so I bet I’m just burning off the calories with my gardening.”  Dr. Schneider cautioned Layla not to be lifting heavy baskets and encouraged her to add an afternoon snack to her usual diet. “I want to see you in two weeks to be sure your weight gain is back on track,” Dr. Schneider ordered. Exactly one week later, Layla called and scheduled an urgent appointment. For the previous 48 hours, Layla had experienced significant vomiting and diarrhea. By the time she arrived at Dr. Schneider’s, Layla was weak and slightly dehydrated. Frantic, Layla reported a decrease in fetal activity. Dr. Schneider admitted Layla to the hospital for IV fluids and prescribed medication to ease her GI distress.

  1. What infections manifest with these symptoms? Are any specifically associated with pregnancy?

An hour later Dr. Schneider performed an ultrasound to check on the progress of Layla’s developing son and was shocked to see no fetal growth since her week 23 examination. In the morning, Dr. Schneider arrived at the hospital early to examine Layla and her baby. Steve was asleep in a chair and Layla sat up in bed weeping gently. She hadn’t felt the baby move since midnight. Dr. Schneider confirmed Layla’s worst fears with another ultrasound, which showed no fetal heartbeat. Labor was induced to deliver Layla and Steve’s 28-week-old stillborn son. A fetal autopsy revealed elevated titers of toxoplasmosis antibodies, hydrocephalus and brain lesions.

  1. Describe the causative agent of toxoplasmosis. Outline the life cycle of this microorganism.

A week later, Layla and Steve met with Dr. Schneider to review the autopsy report and answer their long list of questions. “So, I got toxoplasmosis and that’s why I was so sick…and then I made the baby sick too,” Layla said dismally.

  1. Were Layla’s symptoms consistent with toxoplasmosis? Describe the usual signs and symptoms of this infection. What is a secondary infection?

“No,” Dr. Schneider replied, “not exactly. Your GI symptoms were coincidental and represent a secondary infection. They simply alerted us to the problem with the baby’s growth. It does; however, appear you’ve been infected with toxoplasmosis and the pathogen crossed the placenta to affect your baby. “Wait a minute,” Steve interjected. “How did Layla get toxoplasmosis? I’ve heard about this disease. Pregnant women get it from changing litter boxes. We don’t have a pet cat. In fact, we don’t even have strays in our barn!”

  1. Are litter boxes a source of pathogen transmission? Explain.
  2. What are the most common means of toxoplasmosis transmission? Based on this information, was Layla at high risk for infection? How can toxoplasmosis be prevented?
  3. What is the prevalence of toxoplasmosis?

“Dr. Schneider, was there any way to diagnose and treat my infection that might have saved our baby?” Layla asked. “There are different diagnostic tests for toxoplasmosis, but they aren’t routinely run in a prenatal panel in the U.S. unless we have reason to suspect infection,” Dr. Schneider explained. “If a pregnant woman is infected, several treatment protocols are available, but the benefits must be carefully weighed against the risks since the likelihood of transmission and fetal damage varies with the gestational age of the mother seroconversion

  1. How is toxoplasmosis typically diagnosed? What challenges are associated with interpreting test results? How can fetal infection be determined?
  2. Describe the principal treatment protocols for toxoplasmosis infection in a pregnant patient. Indicate the pros and cons of each treatment. When is the best time during the course of Toxoplasma gondii infection to administer treatment to a patient?
  3. Explain the correlation between the gestational age of maternal seroconversion for toxoplasmosis and the risk of fetal infection.
  4. What signs and symptoms are expressed by neonates with congenital toxoplasmosis? What symptoms are expressed by infected children within the first year of life? What is the miscarriage rate associated with fetal toxoplasmosis?

“Now that I’ve been infected with toxoplasmosis, do I need to be treated? If I’m cured can we still have other children, or will I infect them too, causing another miscarriage?” Layla asked hopefully. “Not to worry,” Dr. Schneider consoled the young couple. “You’ve suffered a devastating loss, but I’m confident you’ll soon be parents.”

  1. Is it necessary to treat Layla for toxoplasmosis? Can she have subsequent children without risking their infection?

Anderson, R. et.al. Case study in microbiology: A Personal Approach, Publisher: John Wiley & Sons Copyright year: © 2006. 

Case Study # 4

Sex, Drugs and Rock and Roll

Jim was a police officer and his wife Barb a nurse at the hospital that handled most of the city’s poor. It was inevitable that their paths would occasionally cross during work. Tonight, they were both at a community outreach meeting concerning the problems caused by the increase in crystal meth use. Methamphetamine, or crystal meth, is a powerfully addictive stimulant that has an intense euphoric

effect.  Jim saw its effect when chronic crystal meth users would embark on binges of constant meth use. The results were universally disastrous––intense paranoia, visual and auditory hallucinations, and violently out-of-control behavior. Barb saw another side of abuse of the drug. Crystal meth use has a potent effect of increasing the sex drive. As a result, crystal meth users were more likely than others

to engage in high-risk sexual behaviors and have more sexual partners than nonusers. Barb had seen a significant increase in cases of gonorrhea in general, and increases in syphilis and HIV disease among gay men. Long-term users of crystal meth build up a tolerance to the drug. As a result, many choose to inject the drug to continue to get high. Not unsurprisingly, intravenous drug use increases the spread of HIV as users share needles (and therefore exchange small amounts of blood). At counseling programs designed to help HIV-positive gay and bisexual men who use crystal meth, about half had injected meth during the last year. Neither Jim nor Barb was the type to sit back and hope for the best. They had much invested in their community where their children went to school. Both were consistent volunteers. Jim already coached soccer and led scouts. Barb was active at their church and volunteered to help students with reading and math at school. At the end of the meeting, both took part in the discussion and planning sessions on how to help the community stem the problems caused by widespread crystal

meth abuse.

  1. What types of behaviors are considered high risk for acquiring sexually transmitted infections?
  2. What pathogens are responsible for causing these STI’s? Describe each.
  3. What are the clinical signs and symptoms of gonorrhea? Compare them to those caused by syphilis.
  4. What other STIs would you expect to be increased following an increase in high-risk sexual behaviors and an increase in sexual partners?
  5. In general, how can the spread of STIs be reduced?
  6. Are the activities needed to prevent or reduce the spread of STIs likely to be followed by crystal meth users?
  7. What recommendations would you make to Jim and Barb’s community group to help reduce the spread of STIs among the crystal meth users?
 

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Infections of the Cardiovascular and Lymphatic System

Case Study

Infections of the Cardiovascular and Lymphatic System

Toxoplasmosis……………..Don’t Blame Fluffy!

As part of their commitment to “going green,” Layla and Steve Jackson lived on a small farm in rural northwest Pennsylvania. Steve chopped wood from their forest to burn in their Franklin stove, and about 25% of their electricity was generated by the wind turbines on top of their mountain. They raised almost all of their own food between their small apple orchard, huge vegetable garden, and a berry patch. The couple reared numerous sheep, a few pigs, and one dairy cow. These animals plus the rabbit, turkey, and deer Steve hunted more than covered their meat and milk needs. Although the young couple loved working their farm, to make ends meet financially, they also taught at the local high school. Layla was a 10th grade math teacher and Steve served as both the choral and band directors for grades 7–12. Unless the roads were icy in the winter, the “green team” biked the four miles to work every day. While this lifestyle kept them extremely busy, Layla and Steve felt great satisfaction knowing their carbon footprint was significantly less than that of the average American.

As Layla picked the green beans and weeded around the squash one July morning, she pondered how their lifestyle would change in November when their first child was due to be born. She was pleased to be able to raise their child in the unpolluted environment of their country farm and nourish him with homegrown foods free of the pesticides and preservatives found in many commercially produced items. “Of course,” Layla said to herself while patting her belly, “I think we’ll have to break down and drive a little more this winter. You’ll be a bit too small for my baby bicycle seat.” As if on cue, the baby started “dancing.” Laughing, Layla collected the baskets of produce she had harvested and headed to the kitchen to start making lunch. After rinsing the fresh-picked fruits and vegetables, Layla used her garden’s bounty to assemble a delicious salad and homemade strawberry shortcake with cream from Josie, their cow. Later that afternoon, the couple went to Dr. Schneider’s office for Layla’s monthly prenatal examination. They watched with amazement as the obstetrician used ultrasound to measure the baby’s growth, confirming that Layla was 23 weeks pregnant. Dr. Schneider pointed out different features of their developing child. They saw a tiny beating heart and learned it was time to paint the nursery blue!

Layla’s pregnancy progressed normally until her next appointment at 27 weeks gestation. Dr. Schneider was surprised to find Layla hadn’t gained any weight in four weeks. “At this stage of your pregnancy, you should be gaining about 0.5 to 1 pound per week,” Dr. Schneider said with concern. “Are you eating enough nutritious foods?” Layla was happy to report a healthy appetite that she regularly indulged with the foods she and Steve raised. “I bet it’s the extra exercise I’m getting,” Layla explained. “I’ve been canning produce as fast as I can harvest the garden and orchard. I’m up and down the hillside a dozen times a day hauling a full bushel basket, so I bet I’m just burning off the calories with my gardening.” Dr. Schneider cautioned Layla not to be lifting heavy baskets and encouraged her to add an afternoon snack to her usual diet. “I want to see you in two weeks to be sure your weight gain is back on track,” Dr. Schneider ordered. Exactly one week later, Layla called and scheduled an urgent appointment. For the previous 48 hours, Layla had experienced significant vomiting and diarrhea. By the time she arrived at Dr. Schneider’s, Layla was weak and slightly dehydrated. Frantic, Layla reported a decrease in fetal activity. Dr. Schneider admitted Layla to the hospital for IV fluids and prescribed medication to ease her GI distress.

What infections manifest with these symptoms? Are any specifically associated with pregnancy?

An hour later Dr. Schneider performed an ultrasound to check on the progress of Layla’s developing son and was shocked to see no fetal growth since her week 23 examination. In the morning, Dr. Schneider arrived at the hospital early to examine Layla and her baby. Steve was asleep in a chair and Layla sat up in bed weeping gently. She hadn’t felt the baby move since midnight. Dr. Schneider confirmed Layla’s worst fears with another ultrasound, which showed no fetal heartbeat. Labor was induced to deliver Layla and Steve’s 28-week-old stillborn son. A fetal autopsy revealed elevated titers of toxoplasmosis antibodies, hydrocephalus and brain lesions.

Describe the causative agent of toxoplasmosis. Outline the life cycle of this microorganism.

A week later, Layla and Steve met with Dr. Schneider to review the autopsy report and answer their long list of questions. “So, I got toxoplasmosis and that’s why I was so sick…and then I made the baby sick too,” Layla said dismally.

Were Layla’s symptoms consistent with toxoplasmosis? Describe the usual signs and symptoms of this infection. What is a secondary infection?

“No,” Dr. Schneider replied, “not exactly. Your GI symptoms were coincidental and represent a secondary infection. They simply alerted us to the problem with the baby’s growth. It does; however, appear you’ve been infected with toxoplasmosis and the pathogen crossed the placenta to affect your baby. “Wait a minute,” Steve interjected. “How did Layla get toxoplasmosis? I’ve heard about this disease. Pregnant women get it from changing litter boxes. We don’t have a pet cat. In fact, we don’t even have strays in our barn!”

Are litter boxes a source of pathogen transmission? Explain.

What are the most common means of toxoplasmosis transmission? Based on this information, was Layla at high risk for infection? How can toxoplasmosis be prevented?

What is the prevalence of toxoplasmosis?

“Dr. Schneider, was there any way to diagnose and treat my infection that might have saved our baby?” Layla asked. “There are different diagnostic tests for toxoplasmosis, but they aren’t routinely run in a prenatal panel in the U.S. unless we have reason to suspect infection,” Dr. Schneider explained. “If a pregnant woman is infected, several treatment protocols are available, but the benefits must be carefully weighed against the risks since the likelihood of transmission and fetal damage varies with the gestational age of the mother seroconversion

How is toxoplasmosis typically diagnosed? What challenges are associated with interpreting test results? How can fetal infection be determined?

Describe the principal treatment protocols for toxoplasmosis infection in a pregnant patient. Indicate the pros and cons of each treatment. When is the best time during the course of Toxoplasma gondii infection to administer treatment to a patient?

Explain the correlation between the gestational age of maternal seroconversion for toxoplasmosis and the risk of fetal infection.

What signs and symptoms are expressed by neonates with congenital toxoplasmosis? What symptoms are expressed by infected children within the first year of life? What is the miscarriage rate associated with fetal toxoplasmosis?

“Now that I’ve been infected with toxoplasmosis, do I need to be treated? If I’m cured can we still have other children, or will I infect them too, causing another miscarriage?” Layla asked hopefully. “Not to worry,” Dr. Schneider consoled the young couple. “You’ve suffered a devastating loss, but I’m confident you’ll soon be parents.”

Is it necessary to treat Layla for toxoplasmosis? Can she have subsequent children without risking their infection?

Anderson, R. et.al. Case study in microbiology: A Personal Approach, Publisher: John Wiley & Sons Copyright year: © 2006. 

Case Study # 4

Sex, Drugs and Rock and Roll

Jim was a police officer and his wife Barb a nurse at the hospital that handled most of the city’s poor. It was inevitable that their paths would occasionally cross during work. Tonight, they were both at a community outreach meeting concerning the problems caused by the increase in crystal meth use. Methamphetamine, or crystal meth, is a powerfully addictive stimulant that has an intense euphoric

effect. Jim saw its effect when chronic crystal meth users would embark on binges of constant meth use. The results were universally disastrous––intense paranoia, visual and auditory hallucinations, and violently out-of-control behavior. Barb saw another side of abuse of the drug. Crystal meth use has a potent effect of increasing the sex drive. As a result, crystal meth users were more likely than others

to engage in high-risk sexual behaviors and have more sexual partners than nonusers. Barb had seen a significant increase in cases of gonorrhea in general, and increases in syphilis and HIV disease among gay men. Long-term users of crystal meth build up a tolerance to the drug. As a result, many choose to inject the drug to continue to get high. Not unsurprisingly, intravenous drug use increases the spread of HIV as users share needles (and therefore exchange small amounts of blood). At counseling programs designed to help HIV-positive gay and bisexual men who use crystal meth, about half had injected meth during the last year. Neither Jim nor Barb was the type to sit back and hope for the best. They had much invested in their community where their children went to school. Both were consistent volunteers. Jim already coached soccer and led scouts. Barb was active at their church and volunteered to help students with reading and math at school. At the end of the meeting, both took part in the discussion and planning sessions on how to help the community stem the problems caused by widespread crystal

meth abuse.

What types of behaviors are considered high risk for acquiring sexually transmitted infections?

What pathogens are responsible for causing these STI’s? Describe each.

What are the clinical signs and symptoms of gonorrhea? Compare them to those caused by syphilis.

What other STIs would you expect to be increased following an increase in high-risk sexual behaviors and an increase in sexual partners?

In general, how can the spread of STIs be reduced?

Are the activities needed to prevent or reduce the spread of STIs likely to be followed by crystal meth users?

What recommendations would you make to Jim and Barb’s community group to help reduce the spread of STIs among the crystal meth users?

 

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