This was a 4-week, prospective, observational study that was conducted in the MICU of an academic medical centre. Lexi-Interact and Micromedex interaction databases were utilized daily to screen patients’ medication profiles for DDIs, and severity was assessed using each database’s severity rating scale. Of 240 patient medication profiles evaluated, 457 DDIs were identified. The rate of DDIs check details was 190.4 DDIs/100 patient days with 297 of these interactions being unique

drug pairs. About 25% (114/457) were considered major DDIs. The most commonly involved medications were antihypertensive medications (106/457) and anticoagulants/antiplatelet agents (80/457). DDIs occur frequently in the MICU. Severity and drug combinations related to DDIs in the MICU differ from DDIs published in other ICU settings. When developing a DDI alerting system, patient characteristics and location should be considered. “
“Product

standardisation GSK2118436 order involves promoting the prescribing of pre-selected products within a particular category across a healthcare region and is designed to improve patient safety by promoting continuity of medicine use across the primary/secondary care interface, in addition to cost containment without compromising clinical care (i.e. maintaining safety and efficacy). To examine the impact of product standardisation on the prescribing of compound alginate preparations within primary care in Northern Ireland. Data were obtained on alginate prescribing from the Northern Ireland Central Services Agency (Prescription Pricing Branch), covering a period of 43 months. Two standardisation promotion interventions were carried out at months 18 and 33. In addition to conventional statistical analyses, a simple interrupted time CHIR-99021 price series analysis approach, using graphical

interpretation, was used to facilitate interpretation of the data. There was a significant increase in the prescribed share of the preferred alginate product in each of the four health boards in Northern Ireland and a decrease in the cost per Defined Daily Dose for alginate liquid preparations overall. Compliance with the standardisation policy was, however, incomplete and was influenced to a marked degree by the activities of the pharmaceutical industry. The overall economic impact of the prescribing changes during the study was small (3.1%). The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland. “
“Context  Electronic prescribing (EP) systems are advocated as a solution to minimise medication errors. Benefits in patient safety are often as a result of some clinical decision support (CDS) within the system.

35% of the total responses each from Australia, France, India, Daporinad chemical structure Israel and Switzerland; however,

25% of respondents did not disclose which country they lived in. About 88% of the survey respondents were below the age of 34 at diagnosis of diabetes; 36.4% were between the ages of 0–11 years, 27.5% between the ages 12–21, and 24.4% between 22–34 years of age and are thus likely to have T1DM.14 All responses collected from respondents under the age of 17 were completed by their parents. Insulin pump users’ current approach to glucose management. Figure 2a shows the most commonly used pump was the Medtronic Paradigm device (57.6%), and insulin aspart (Novorapid) and insulin lispro (Humalog) were the insulins most commonly infused (Figure 2b). Respondents were asked whether the pump they used was chosen by them, or had been given to them by their medical advisors. As 44% had been given the pump by their medical advisors, this suggests that the choice was made by diabetes physicians and/or diabetes specialist nurses rather than patient choice. When insulin pump users were asked about the

amount of insulin they infused over a 24-hour period 50.6% used 20–40 units, 24.4% used 40–60 units and 12.7% have used more than 60 units. Most (57.3%) reported infusing a basal rate of 0.5–1 units/hr, with 20.3% using 1–2 units/hr and 18.4% using www.selleckchem.com/products/3-methyladenine.html 0.5 units/hr. Only 3.2% of respondents infused a basal rate of more than 2 units/hr. Most respondents (52.2%) used the standard or ‘spike’ bolus to cover meals. The majority of respondents (65.7%) had an ioxilan HbA1c value between 42–64mmol/mol (6.0–8.0%), a broadly acceptable range;1,15 13.9% had HbA1c values between 32–42mmol/mol (5.1–6.0%), indicative of overly tight control, associated with

a significant risk of hypoglycaemia; 2.8% had HbA1c values >76mmol/mol (9.1%) and 0.3% had values >86mmol/mol (10.0%) which indicates very poor glucose control. In all, 77.8% of people could recall their HbA1c result before starting CSII; 57.3% reported that it had improved subsequently. About 70% of the respondents reported having a hypoglycaemic episode at least once a week. In most cases (39.9%) respondents were able to sense that they were hypoglycaemic and 51.6% of these respondents confirmed that this occurred at BG <4mmol/L. In all, 79.4% of the respondents reported BG values >10mmol/L more than three times in the month preceding the survey, and most (68.7%) claimed that they would respond by taking a correction bolus straightaway. However, 9.8% reacted to elevated BG by waiting 60–90 minutes before re-testing their BG and 10.1% by drinking water. Some respondents would change their infusion set, in case it had become blocked. Insulin pump users’ reaction to a description of an implantable closed loop insulin device (INSmart).

1 The General Medical Council’s EQUIP Study, involving 19 Trusts in North-West England, found 11,077 errors from 124,260 medication orders (8.9% prescribing error rate).2 The error rate varied according to prescriber: 8.4% Foundation Year 1 doctors, 10.3% Foundation Year

2 doctors, consultants 5.9%, nurses 6.1% and pharmacists 0%.2 It is well recognised that involving pharmacists in the prescribing pathway reduces the risk of an error reaching the patient. What is less well understood is the actual error rate of pharmacist prescribers. This study aimed to quantify prescribing www.selleckchem.com/products/BIRB-796-(Doramapimod).html by pharmacists and determine the error rate. The study was undertaken across three district general hospitals. Part one assessed prevalence of prescribing by pharmacists and part

two assessed the prevalence of prescribing errors made by pharmacists. In part one, prevalence of prescribing by pharmacists was assessed by counting the number of items prescribed by a pharmacist compared with all items prescribed. LBH589 nmr Data were collected for all patients on the ward, one ward at a time from September to October 2012. In part two, a clinical check of prescribing by pharmacists was undertaken by other pharmacists, recording errors as categorised by the EQUIP study.2 EQUIP used clinical pharmacists to clinically assess prescribing by doctors; 29 error categories (e.g. missing signature, interaction) were defined and these categories were used to identify errors in this study. Data for part two were collected over two consecutive weeks in November 2012, across three hospitals. Advice

on Ethical Approval was sought from the Trust’s Research Development Unit. A total of 457 patients (on 26 wards) were included in part one of the study with the pharmacist prescribing for 182 (39.8%) of patients. Pharmacists prescribed 12.9% of all items (680 from 5274 items). Pharmacists prescribed a wide variety of medication from 12 out of the 15 BNF categories (no prescribing of drugs used in malignancy, immunology and anaesthetics). The majority of prescribing was for central nervous system, cardiovascular and respiratory medicines. In part two, pharmacists prescribed for 155 patients on 31 wards Megestrol Acetate across three hospitals. 1,413 pharmacist prescribed items were clinically checked, with 4 errors (0.3%) noted. Two errors were interactions, the wrong analgesic was prescribed in one instance and one prescribing entry was not signed. This study has shown that two fifths of patients admitted to three district general hospitals were prescribed a medicine by a pharmacist, with one in eight of all items being prescribed by pharmacists. This study also shows that pharmacists are not focusing on a limited formulary of medicines but are prescribing from all but three sections of the BNF. This study has shown a low error rate associated with pharmacist prescribing of 0.3% compared with 8.

1 The General Medical Council’s EQUIP Study, involving 19 Trusts in North-West England, found 11,077 errors from 124,260 medication orders (8.9% prescribing error rate).2 The error rate varied according to prescriber: 8.4% Foundation Year 1 doctors, 10.3% Foundation Year

2 doctors, consultants 5.9%, nurses 6.1% and pharmacists 0%.2 It is well recognised that involving pharmacists in the prescribing pathway reduces the risk of an error reaching the patient. What is less well understood is the actual error rate of pharmacist prescribers. This study aimed to quantify prescribing buy Ku-0059436 by pharmacists and determine the error rate. The study was undertaken across three district general hospitals. Part one assessed prevalence of prescribing by pharmacists and part

two assessed the prevalence of prescribing errors made by pharmacists. In part one, prevalence of prescribing by pharmacists was assessed by counting the number of items prescribed by a pharmacist compared with all items prescribed. Erastin supplier Data were collected for all patients on the ward, one ward at a time from September to October 2012. In part two, a clinical check of prescribing by pharmacists was undertaken by other pharmacists, recording errors as categorised by the EQUIP study.2 EQUIP used clinical pharmacists to clinically assess prescribing by doctors; 29 error categories (e.g. missing signature, interaction) were defined and these categories were used to identify errors in this study. Data for part two were collected over two consecutive weeks in November 2012, across three hospitals. Advice

on Ethical Approval was sought from the Trust’s Research Development Unit. A total of 457 patients (on 26 wards) were included in part one of the study with the pharmacist prescribing for 182 (39.8%) of patients. Pharmacists prescribed 12.9% of all items (680 from 5274 items). Pharmacists prescribed a wide variety of medication from 12 out of the 15 BNF categories (no prescribing of drugs used in malignancy, immunology and anaesthetics). The majority of prescribing was for central nervous system, cardiovascular and respiratory medicines. In part two, pharmacists prescribed for 155 patients on 31 wards Rebamipide across three hospitals. 1,413 pharmacist prescribed items were clinically checked, with 4 errors (0.3%) noted. Two errors were interactions, the wrong analgesic was prescribed in one instance and one prescribing entry was not signed. This study has shown that two fifths of patients admitted to three district general hospitals were prescribed a medicine by a pharmacist, with one in eight of all items being prescribed by pharmacists. This study also shows that pharmacists are not focusing on a limited formulary of medicines but are prescribing from all but three sections of the BNF. This study has shown a low error rate associated with pharmacist prescribing of 0.3% compared with 8.

72.[18] Problems with medications were assessed on the child interview and caregiver questionnaire immediately after the medical visit and then 1 month later at a home visit. Children were asked if they had had a problem in using asthma medications in each of the following areas: side effects, hard to remember Anti-cancer Compound Library screening when to take, hard to use medications at school, not sure they are using

their inhalers correctly, hard to understand the directions on the medications, hard to read the print on the package and other problems/concerns. Response options included: none, a little, or a lot. Caregivers were asked if they perceived their child had a problem in using asthma medications in each of the following areas: child has side effects, hard to remember when the child is supposed to take, hard to pay for medications, not sure child is using his/her inhaler correctly, hard to get the child’s refills

on time, hard to understand the directions on the medications, hard to read the print on the package and other problems/concerns. All of the medical visit audiotapes were transcribed verbatim, and a detailed coding tool was developed to assess provider, child and caregiver communication about asthma. This tool was refined and tested over a 1-year period. The categories used in the coding tool for communication about asthma medications were adapted from the categories used in prior studies of provider–patient communication about medications.[19-22] The transcripts were reviewed by two research assistants who met twice a month with the investigators to develop and refine the coding see more rules until saturation of themes was achieved. Two research assistants coded 20 of the same transcripts throughout the study period to assess inter-coder reliability. Using the coding tool for transcribed medical visits, coders recorded the following: whether children asked one or more medication questions, whether caregivers asked one or more medication

questions, the number of questions providers asked about control medications, whether provider ID-8 asked (yes/no) for child input into the asthma treatment regimen and whether the provider asked (yes/no) for caregiver input into the asthma treatment regimen. Inter-rater reliability ranged from 0.88 to 1.0 for the communication variables. Areas of overlap between the problems with medications measure and actual medication questions that children and caregivers asked were: asthma medication device technique, frequency of use/timing of medication use, quantity/supply of medication (caregivers only), side effects, and school use (children only). Each of the child and caregiver reported problem areas were recoded into dichotomous variables (no or a little problem versus a lot of a problem) and a summary score was created and then dichotomized to express whether each child and caregiver reported one or more asthma medication problems/concerns.

Hajj, the pilgrimage to Mecca, Kingdom of Saudi Arabia (KSA), is one of the obligatory rituals of worship in Islam. Muslims with good health and sufficient financial status are required to visit Mecca at least once in their lifetime. Hajj is the largest, most diverse mass gathering of people in the world and attracts more than 2.5 million Muslims from more than 160 countries each year. Mecca is also the setting for a less critical ritual called Umrah, which can be done at any time during the year.1 Cabozantinib ic50 In the Netherlands, the Saudi

Arabia Embassy issues about 5,000 to 6,000 visas for Hajj every year (personal communication, April 17, 2010). Hajj lasts for 5 days, and it takes place from the 8th to the 12th day of the last month of the

Islamic calendar. As the Islamic calendar is lunar, the precise Gregorian calendar dates of the Hajj season vary each year.2 This continuous seasonal movement has implications for the spread of disease and other health risks.3 Transmission of infectious disease during mass gatherings has a global effect when visitors return to their country of origin. Individuals going on Hajj contributed to a global cholera outbreak in the 19th century.1 Several outbreaks of meningococcal serogroup A disease occurred during the 1987 Hajj season. For the following Hajj of 1988, the Saudi Arabian government required RAD001 order compulsory Histamine H2 receptor divalent AC vaccination to

issue a Hajj visa. During the Hajj seasons 2000–2002, there was a shift in the epidemic pattern of the meningococcal disease with a predominance of Neisseria meningitidis serogroup W135. In the year 2002, the Ministry of Health decided to demand the tetravalent ACYW135 polysaccharide vaccine. These interventions have quelled meningococcal disease since 2002.4 The travelers’ advice and vaccination clinic (TAVC) of the Public Health Service (PHS) Amsterdam, administers vaccinations including meningitis ACYW135 vaccine and provides about 25,000 travelers annually with individual recommendations for all their travels. Each year a large number of Muslims, in preparation for Hajj, visit the TAVC for the required tetravalent ACYW135 vaccine whereby they also receive standard recommendations. Although most travelers who visit the TAVC follow our advice, many Hajj pilgrims only take meningitis vaccination, and not the other recommended vaccinations. The aim of this study is to investigate the acceptance of non-required, but advised, vaccinations by the Mecca travelers who visit the PHS before departure for a mandatory vaccine. Further, we investigated predictors for this acceptance.

This gum was triturated with methanol upon which it partly

solidified. Decanting off the methanol and repeating the procedure with fresh methanol led finally to a complete solidification. The 1H-NMR spectrum, analogous to that of Roy & Hewlins (1997), showed an enrichment of SQ as a mixture of its anomers over p-toluenesulfonic acid (≤ 10%) and no other organic impurities. Data from MALDI-TOF-MS in the negative ion mode gave m/z = 443 = [M−1]−1, which is consistent with SQ (M = 444). The syntheses of DHPS and racemic sulfolactate were described elsewhere (Roy et al., 2003; Mayer et al., 2010). Other chemicals were available commercially from Sigma-Aldrich, Fluka, Merck or Biomol. Burkholderia phymatum STM815 (DSM 17167) (e.g. Elliott et al., 2007), Burkholderia xenovorans LB400 (e.g. Chain et al., 2006), Cupriavidus necator H16 (DSM 428) (e.g. Pohlmann et al., 2006), Cupriavidus selleck chemicals llc pinatubonensis JMP134 (DSM 4058) (Sato et al., 2006), K. oxytoca TauN1 (DSM 16963) (Styp von Rekowski see more et al., 2005), Paracoccus pantotrophus NKNCYSA (DSM 12449) (e.g. Rein et al., 2005), Sinorhizobium meliloti Rm1021 (e.g. Finan et al., 2001), Rhodopseudomonas palustris CGA009 (e.g. Larimer et al., 2004), Rhodobacter sphaeroides

2.4.1 (e.g. Mackenzie et al., 2001), P. putida F1 (e.g. Zylstra & Gibson, 1989), and P. putida KT2440 (e.g. Nelson et al., 2002) were grown aerobically at 30 °C in a phosphate-buffered mineral salts medium, pH 7.2 (Thurnheer et al., 1986). Roseobacter

litoralis Och 149 (DSM 6996) (e.g. Kalhoefer et al., 2011) and Roseovarius sp. those strain 217 (Schäfer et al., 2005) were cultured in a Tris-buffered artificial seawater medium (Krejčík et al., 2008). Strain Och 149 was grown at 25 °C and strain 217 required the addition of vitamins (Pfennig, 1978). Roseovarius nubinhibens ISM (González et al., 2003) was grown in modified Silicibacter basal medium (Denger et al., 2006) and needed a supplement of 0.05% yeast extract (Denger et al., 2009). The sole carbon source was 5 mM sulfoquinovose or as a control 20 mM acetate or taurine or 10 mM succinate or 5 mM 4-toluenesulfonate or 5 mM glucose. Cultures on the 3-mL scale in 30-mL screw-cap tubes were incubated in a roller. For growth experiments, 12-mL cultures were grown in a beaker on a shaker, and 0.8 mL samples were taken at intervals to measure the optical density at 580 nm and to analyze concentrations of substrate and product. Enrichment cultures were set up in a 3-mL scale in the freshwater mineral salts medium with 5 mM SQ as sole added carbon source. If turbidity developed and bacteria could be seen under the microscope, subcultures in fresh selective medium were inoculated. After four or five transfers, cultures were streaked on LB-agar plates and colonies were picked into fresh selective medium. After three rounds of plating and picking from homogeneous plates, cultures were considered pure.

The relative lower anti-Candida activity of the shorter lipopeptides could be related to their reduced ability to permeate fungal membranes, because of their low hydrophobic character to drive oligomerization (Malina

& Shai, 2005). The effect of various concentrations of the purified anti-Candida compounds on human erythrocytes is reported in Table 4. The compound a1 showed a weak hemolytic activity (50% hemolysis at 68.26 μM) compared with a2 and a3 (50% hemolysis at 37.41 and 22.14 μM, respectively). This could be due to their low hydrophobicity, and therefore, limited ability to oligomerize, which is an important requirement for both the hemolytic and antifungal activity of an antimicrobial peptide. Prior studies showed Small molecule library research buy a direct correlation between the fatty acid chain length of surfactin lipopeptides and hemolytic activity (Kracht et al., 1999). It is noticeable that the hemolytic activity of the lipopeptide bacircines is also dependent on the length of the aliphatic side chain and that hemolysis is provoked by the insertion of the fatty acid chain into the phospholipid bilayer (Prokof’eva et al., 1999). Similarly, iturins A are able to lyse human erythrocytes in a dose-dependent manner (100% Sirolimus hemolysis at 25 μM) (Quentin et al., 1982; Aranda et al., 2005). This

limits their potential usage in clinical therapy (Besson & Michel, 1984; Aranda et al., 2005; Oleinikova et al., 2005; Ramarathnam et al., 2007; Chen et al., 2009). Nevertheless, we found that compound a3 with a long fatty acid chain exhibited a strong inhibitory effect (MFC value between 7.38 and 14.76 μM) against 5-Fluoracil solubility dmso most tested strains

of C. albicans causing mucous and cutaneous infections. Note that at these concentrations a3 compound showed a reduced hemolytic activity (17% and 35%). However, when tested against some pathogenic C. albicans strains causing finger nail candidiasis (C. albicans sp. 265 FN and C. albicans sp. 311 FN), compound a3 exhibited both higher MFC values (between 29.53 and 59.07 μM) and hemolytic activity (between 65.91% and 99.64%). Overall, for the treatment of such pathogenic strains causing cutaneous candidiasis, a local application of the a3 compound rather than a systemic or an oral administration is possible. In conclusion, our data have indicated that B. subtilis produce anti-Candida lipopeptides that might be used to treat cutaneous infections. This work was supported by grants from the ‘Ministère de l’Enseignement Supérieur et de la Recherche Scientifique’ of Tunisia. We thank Prof. E. Aouani for valuable discussion and critical reading of the manuscript. “
“The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK.

Although the expression levels of the eight genes were 0.17–0.63-fold in the ΔsdrP strain relative to that in wild type, their q-values except that of TTHA1128 were 0.061–0.242, which were greater than the threshold value used in the experiment (0.06). As for TTHA1128, identification of a SdrP-binding site in the promoter region was missed in the previous study. Conversely, expression of four out of 14 SdrP-regulated genes identified in the previous study showed lower correlation to that of sdrP (Spearman’s correlation

coefficients≤0.51). Some unknown factors such as promoter activity and affinity of SdrP to DNA in vivo, and unidentified transcriptional regulator(s) that might act together with SdrP, might influence the results of the experimental screenings for SdrP-regulated Selleckchem RO4929097 genes. Thus, a combination of comparative expression analysis and expression pattern analysis was appropriate for screening of SdrP-regulated genes. Among the environmental and chemical stresses examined in this study, the diamide and H2O2 stresses were the

most effective in enhancing the expression of sdrP and its target genes in the wild-type strain. Furthermore, an excess amount of CuSO4 was JAK inhibitor a strong inducer of sdrP gene expression in the ΔcsoR strain, in which excess Cu(I) ions may accumulate (Sakamoto et al., 2010). In this strain, excess Cu(I) ions, which have the potential to drive oxidation/reduction to form free radicals (Touati, 2000; Imlay, 2002), may trigger expression of sdrP. As for the possible cellular functions of the 22 SdrP-regulated gene products, at least nine, i.e. TTHA0425, TTHA0557, TTHA0654, TTHA0986, TTHA1028, TTHA1215, TTHA1625, TTHA1635, and TTHB132, are possibly involved in redox control (Table 2) (Agari et al., 2008). UvrB (TTHA1892) Ergoloid may be involved in the repair of oxidized DNA. The altered expression levels of sdrP and its target genes in the stationary growth phase were similar to those caused by diamide treatment. These

results suggest that the main inducer of sdrP expression is oxidative stress, and support the previous finding that SdrP functions in the response to oxidative stress. Because SdrP does not have a cysteine residue or cofactor that could be a sensor of an oxidative signal [unlike in the case of other oxidative stress-responsive transcriptional regulators such as OxyR, PerR, and SoxR (Storz & Imlay, 1999; Pomposiello & Demple, 2001; Lee & Helmann, 2006)], and it does not require any effector molecule for its transcriptional activation (Agari et al., 2008), there may be some unidentified factor(s) sensing oxidative stress and causing induced expression of SdrP. It has been demonstrated that the bacterial response to a specific stress can increase the resistance to other stresses, probably because stresses are not encountered in isolation in nature (Tesone et al., 1981; Jenkins et al., 1988; Jenkins et al., 1990; Hengge-Aronis et al., 1993; Storz & Imlay, 1999; Canovas et al.

Although the expression levels of the eight genes were 0.17–0.63-fold in the ΔsdrP strain relative to that in wild type, their q-values except that of TTHA1128 were 0.061–0.242, which were greater than the threshold value used in the experiment (0.06). As for TTHA1128, identification of a SdrP-binding site in the promoter region was missed in the previous study. Conversely, expression of four out of 14 SdrP-regulated genes identified in the previous study showed lower correlation to that of sdrP (Spearman’s correlation

coefficients≤0.51). Some unknown factors such as promoter activity and affinity of SdrP to DNA in vivo, and unidentified transcriptional regulator(s) that might act together with SdrP, might influence the results of the experimental screenings for SdrP-regulated BEZ235 datasheet genes. Thus, a combination of comparative expression analysis and expression pattern analysis was appropriate for screening of SdrP-regulated genes. Among the environmental and chemical stresses examined in this study, the diamide and H2O2 stresses were the

most effective in enhancing the expression of sdrP and its target genes in the wild-type strain. Furthermore, an excess amount of CuSO4 was Bortezomib nmr a strong inducer of sdrP gene expression in the ΔcsoR strain, in which excess Cu(I) ions may accumulate (Sakamoto et al., 2010). In this strain, excess Cu(I) ions, which have the potential to drive oxidation/reduction to form free radicals (Touati, 2000; Imlay, 2002), may trigger expression of sdrP. As for the possible cellular functions of the 22 SdrP-regulated gene products, at least nine, i.e. TTHA0425, TTHA0557, TTHA0654, TTHA0986, TTHA1028, TTHA1215, TTHA1625, TTHA1635, and TTHB132, are possibly involved in redox control (Table 2) (Agari et al., 2008). UvrB (TTHA1892) GNA12 may be involved in the repair of oxidized DNA. The altered expression levels of sdrP and its target genes in the stationary growth phase were similar to those caused by diamide treatment. These

results suggest that the main inducer of sdrP expression is oxidative stress, and support the previous finding that SdrP functions in the response to oxidative stress. Because SdrP does not have a cysteine residue or cofactor that could be a sensor of an oxidative signal [unlike in the case of other oxidative stress-responsive transcriptional regulators such as OxyR, PerR, and SoxR (Storz & Imlay, 1999; Pomposiello & Demple, 2001; Lee & Helmann, 2006)], and it does not require any effector molecule for its transcriptional activation (Agari et al., 2008), there may be some unidentified factor(s) sensing oxidative stress and causing induced expression of SdrP. It has been demonstrated that the bacterial response to a specific stress can increase the resistance to other stresses, probably because stresses are not encountered in isolation in nature (Tesone et al., 1981; Jenkins et al., 1988; Jenkins et al., 1990; Hengge-Aronis et al., 1993; Storz & Imlay, 1999; Canovas et al.