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VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF LANGUAGES AND INTERNATIONAL STUDIES - FACULTY OF POST-GRADUATE STUDIES VŨ THỊ MẪU GRAMMATICAL METAPHOR IN ENGLISH PHARMACEUTICAL DISCOURSE ẨN DỤ NGỮ PHÁP TRONG NGÔN BẢN DƯỢC TIẾNG ANH M.A MINOR PROGRAMME THESIS Field: English Linguistics Code: 60 22 15 HANOI - 2011 z VIETNAM NATIONAL UNIVERSITY, HANOI UNIVERSITY OF LANGUAGES AND INTERNATIONAL STUDIES - FACULTY OF POST-GRADUATE STUDIES VŨ THỊ MẪU GRAMMATICAL METAPHOR IN ENGLISH PHARMACEUTICAL DISCOURSE ẨN DỤ NGỮ PHÁP TRONG NGÔN BẢN DƯỢC TIẾNG ANH M.A MINOR PROGRAMME THESIS Field: English Linguistics Code: 60 22 15 Supervisor: Đỗ Tuấn Minh, Ph.D HANOI - 2011 z iv TABLE OF CONTENTS ACKNOWLEDGEMENTS i ABSTRACT iii TABLE OF CONTENTS iv LIST OF ABBREVIATIONS AND ACRONYMS vi LIST OF FIGURES AND TABLES vii PART 1: INTRODUCTION 1 Rationale 1.1 Why English pharmaceutical discourse? 1.2 Why systemic functional grammar? 1.3 Why grammatical metaphor? 2 Aims of the study 3 Scope of the study Research questions Methods and data of the study Format of the study PART 2: DEVELOPMENT CHAPTER 1: THEORETICAL BACKGROUND 1.1 Introduction 1.2 Language and social context 1.3 Metafunctions 1.4 Nominal group 1.5 Concluding remarks 10 CHAPTER 2: THEORETICAL FRAMEWORK OF GRAMMATICAL METAPHOR IN ENGLISH 11 2.1 Introduction 11 2.2 What is grammatical metaphor? 11 2.3 Classification of grammatical metaphor 14 2.3.1 Ideational metaphor 14 2.3.2 Interpersonal metaphor 15 2.3.3 Textual metaphor 17 2.4 Concluding remarks 17 z v CHAPTER 3: GRAMMATICAL METAPHOR IN ENGLISH PHARMACEUTICAL DISCOURSE 18 3.1 Introduction 18 3.2 The authors and the chosen discourses 18 3.3 Linguistic features of English pharmaceutical discourse 19 3.3.1 Lexical features of English pharmaceutical discourse 20 3.3.2 Grammatical features of English pharmaceutical discourse 21 3.4 Nominalization and English pharmaceutical discourse 24 3.5 Frequency of use of grammatical metaphor in English pharmaceutical discourse 25 3.6 Types of grammatical metaphor in English pharmaceutical discourse 26 3.6.1 Ideational metaphor 26 3.6.2 Interpersonal metaphor 35 3.6.3 Textual metaphor 37 3.7 Concluding remarks 37 PART 3: CONCLUSION 38 Reiteration 38 Implications of the study 39 2.1 To teachers 39 2.2 To translators 40 Limitations of the study 41 Prospects for further studies 42 REFERENCES 43 SOURCES OF DATA 46 APPENDICES I APPENDIX 1: THE DISCOURSES FOR ANALYSIS I APPENDIX 2: CLAUSES AND CLAUSE COMPLEXES X APPENDIX 3: IDEATIONAL GRAMMATICAL METAPHOR XXVII APPENDIX 4: GRAMMATICAL METAPHOR OF MOOD XXXVI APPENDIX 5: NOMINALIZATIONS XXXVII APPENDIX 6: LEXICAL DENSITY XLVI APPENDIX 7: TRANSITIVITY PATTERN LV APPENDIX 8: MOOD PATTERN LXIV APPENDIX 9: THEMATIC PATTERN LXXIII z vi LIST OF ABBREVIATIONS AND ACRONYMS CFL : College of Foreign Languages CUP : Cambridge University Press Dr : Doctor Ed(s) : Editor(s) ELT : English Language Teaching ESP : English for Specific Purpose EPD(s) : English Pharmaceutical Discourse(s) GM(s) : Grammatical Metaphor(s) GMC : Grammatical Metaphors per Clause LM : Lexical Metaphor M.A : Master of Arts No : Number OUP : Oxford University Press PD(s) : Pharmaceutical Discourse(s) Ph.D : Doctor of Philosophy Prof : Professor SF : Systemic Functional SFG : Systemic Functional Grammar SFL : Systemic Functional Linguistics Vol : Volume VNU : Vietnam National University, Hanoi ULIS : University of Languages and International Studies USA : The United States of America [2: 1] : Example number 1, Chapter z vii LIST OF FIGURES AND TABLES Figure 1.1: Language as the realization of social context Figure 1.2: Language as tri-stratal system Figure 2.1: Mapping of components 12 Figure 3.1: Distribution of types of logico-semantic relation in EPD 22 Figure 3.2: Distribution of types of process in EPD 23 Figure 3.3: Distribution of types of theme in EPD 23 Figure 3.4: Direction of metaphorization 28 Figure 3.5: Distribution of types of ideational GM in EPD 29 Table 1.1: Process types, their meanings and key participants Table 2.1: Congruent relationship between semantics and lexicogrammar 11 Table 2.2: Two perspectives on metaphorical variation 13 Table 3.1: Frequency of use of grammatical metaphor in EPD 25 Table 3.2: Types of grammatical metaphor 27 Table 3.3: Types of ideational metaphors in EPD 28 z 1 Rationale 1.1 Why English pharmaceutical discourse? Since language has always mirrored society, the emphasis on pharmacy in the recent decades has given rise to the growth of pharmaceutical literature As English is an international language and the United States of America (USA for short) has got big achievements in pharmacy, most pharmaceutical papers are only available in English In Vietnam, the study of pharmaceutical literature has been playing a greater role However, making sense of English pharmaceutical discourse (hereafter abbreviated EPD) is not an easy task for readers of general English, language students, and even readers of ESP (English for Specific Purpose) as these EPDs require both linguistic and subject knowledge Meanwhile, most of them may not have high level of English and pharmacy competence Obviously, as a kind of scientific and technical writing, EPD is not transparent to the laymen Therefore, an analysis of EPD sounds important as it draws insights from both pharmaceutical expertise and English language expertise Such insights are likely to be of potential value in improving reading, writing and translating competence of language students coming new to the discipline Besides, EPD has been always of my personal interest I have taught English for many pharmacist students and helped my pharmacist-student sister deal with EPD; it is apparent to me that this kind of discourse is extremely complicated and need studying Although previous research has studied scientific discourse (Đỗ Tuấn Minh, 2001, Briones et al, 2003, and etc.), different branches, namely, biology, literature, pharmacy, etc perform distinct functions, have a distinct set of users, pursue different pace of development and, therefore, may present dissimilar characteristics Nguyễn Thị Vân Hạnh (2008) says that medico-pharmaceutical English differs much from others in terms of lexical features Also, my own EPD study has found evidence for the claim of complexity in this particular genre Hence, study on language used in EPD is undeniably of necessity 1.2 Why systemic functional grammar? Different from formalism which views language as a set of rules and concentrates on language forms and structures, systemic functional grammar (SFG afterward) considers language as limitless resources used to carry out, to a limitless level, a mode of an action z SF linguistics (SFL from now on) is particularly concerned with describing the relationship between language and social context and its primary aim is to understand how the grammar serves as a resource for making and exchanging meanings A SFG provides language teachers with tools for understanding why a discourse is the way it is; thus, good SFG can help language teachers be more effective teachers In addition, some studies have already investigated medico-pharmaceutical language (Nguyễn Thị Ánh Hồng, 2005, Nguyễn Thị Vân Hạnh, 2008 and Lưu Trọng Tuấn, 2008); however, these papers are simply based on the structural approach (Hồng studies its terminologies and translation, Hạnh pays attention to its lexical and morphological characteristics and Tuấn investigates its syntactic features) and not enough research has been carried out to investigate lexicogrammatical features of EPD None of the papers found uses SFL to analyze PD Thus, an analysis of PD which uses SFG as framework is important since it fills the gap in pharmaceutical literature This thesis focuses on both the wording and the meaning of EPD within SF framework and specifically on one interesting and powerful feature, GM 1.3 Why grammatical metaphor? There is a great number of factors that help make PD what it is; and due to the limitation of time and effort as well as within the scope of an M.A minor thesis, I was forced to investigate one of these aspects only Although grammatical metaphor (GM for short) is one of the most interesting and important concept within SFL and is considered vitally important in creating scientific discourse (Halliday, 1994, Halliday & Matthiessen, 1999 & 2004, and Đỗ Tuấn Minh, 2001), it has not attracted enough attention paid by Vietnamese researchers GM, a lexicogrammatical phenomenon which first involves the transcategorization of various elements in a clause, and second is a mapping of the semantic and lexicogrammatical components in a way which deviates from the usual one (Halliday & Matthiessen, 1999), appears considerably frequently in the EPD constructed by pharmaceutical specialists and the use of GM in EPD contributes to its complexity and ambiguity Thus, it may cause difficulties for readers in understanding what is really meant or referred to As a result, GM should be taken into account in EPD z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 With all the above mentioned, I was inspired into the study of GM used in EPD in the light of SFG The EPDs taken into consideration are from specialized pharmaceutical books published in the USA by worldwide famous publishers Hopefully, this thesis will provide an insight into the nature and the role of GM in EPD, contribute to a fuller understanding of EPD, help readers to realize its importance in comprehending and manipulating EPD and translators of this specialized language can, to some extent, benefit Aims of the study The ultimate aim of the study is to make an inquiry into the nature of GM and to examine its use in EPD To achieve this aim, the paper will examine how semantics and lexicogrammar are related since their relationship provides environment for the occurrence of GM The study also takes the use of GM, including its frequency and types, in EPD into consideration and attempts to answer the question of how writers of this genre fully exploit the potential of a natural process of linguistic change to meet their scientific goals It is hoped that the investigation into GM in EPD will provide an insight into EPD Research questions The study aims to give answer to the following research questions: What is the nature of grammatical metaphor? What are linguistic features of English pharmaceutical discourse? Which types of grammatical metaphor are used in English pharmaceutical discourse? What is the ratio of grammatical metaphor (number of grammatical metaphor instances per clause) in English pharmaceutical discourse? Scope of the study In this study, I not have an ambition to cover all aspects of SFG Only issues related to GM such as framework, elements and features are taken into consideration Types of PD may be lessons in textbook, newspaper articles, magazine articles, reports, journals, presentations, speeches, etc However, this study does not explore all kinds of PD Only one type is chosen, that is, discourse in English specialized advanced books for pharmacists and pharmacist students Specifically, these discourses are centered mainly on pharmacology, a branch of pharmacy studies Other kinds will not be studied in this 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37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 investigation Besides, PD may range from spoken type to written one Since GM happens more often in written discourse (Halliday, 1994, Halliday & Matthiessen, 1999 & 2004, and Đỗ Tuấn Minh, 2001), the analysis focuses on the written discourse It is predicted that this kind of discourse exploits many instances of GM Also, this paper does not attempt to investigate Vietnamese PD concurrently, so only English discourses are analyzed In addition, even the researcher is well aware of the fact that PD is not solely communicated through verbal language, the analysis solely focuses on the verbal record of the discourses Therefore, the graphs, tables, figures, diagrams, imagines, photographs, and etc included in those discourses are ignored All the titles and headings in those discourses are also not analyzed The writer desires to focus on the nature of GM, its occurrence and types in written EPD Special emphasis is put into analyzing ideational GM, which plays the key role in construing meaning in the discourse An attempt is also made to explain how GM is deployed in EPD with special concern about nominalization, which is „the single most powerful resource for creating [GM]‟ (Halliday, 1994: 352) Since there is not enough space for a minor M.A thesis to investigate the whole three pharmaceutical books of more than a thousand pages, seven written EPDs of eight pages (in its authentic papers) seem to be more feasible Those papers are written by American professional pharmaceutical specialists The English language used in these documents is authentic and is named in the Sources of Data This study is confined to an analysis at clause level of 132 clauses concerned and rank-shifted clauses within these 132 clauses are excluded in the analysis of linguistic features and GM It is also hoped that the limitations of this work would be good starting points for further studies on this issue Methods and data of the study As the study sets its main aim of investigating the nature, functions and use of GM in EPD, the methods used are mainly descriptive, explanatory, statistical, analytical and corpusbased The study begins with a phenomenon and seeks to describe, explain and analyze it The descriptive method is used to describe theories related to GM and to build up a framework for the study The theoretical background relies on the published research of various authors on social context, strata, metafunctions, nominal group, and GM We base ourselves on the GM theory and framework proposed by some most influential systemicists: Halliday, Matthiessen, Martin, Thompson, and etc Explanation is also added 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXVII DISCOURSE OVERVIEW OF MENTAL ILLNESS Clause Subject Finite Mood Modality I Most people experience declarative II They are declarative III the effect of these can vary emotions on a person’s ability declarative possibility/positive IV The duration and can range intensity of these emotions declarative possibility/positive that interferes with declarative There is declarative which can make declarative possibility/positive Complicating this issue is further declarative different patients experience declarative 10 a patient will have declarative 11 that meet declarative 12 Such patients may be said declarative possibility/positive 14 research shows declarative 15 one third have declarative X 16 Mentally ill people may be declarative possibility/positive XI 17 obesity is declarative XII 18 that may preclude declarative possibility/positive 19 many patients will self-medicate declarative 20 This worsens declarative V VI VII VIII 13 IX XIII 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXVIII DISCOURSE GENDER Clause Subject Finite Mood Modality I women may require declarative possibility/positive II these differences may necessitate declarative possibility/positive III There may be declarative possibility/positive IV adipose tissue represents declarative water (represents) declarative differences in drug appear to be effects attributable to gender declarative the use of all drugs should except those essential approached to maintain pregnancy V VI VII be declarative advice/positive almost any agent in may cross maternal blood declarative possibility/positive 10 drugs with little may be potential for producing adverse effects in the mother declarative possibility/positive 11 Drugs given to the may have mother at parturition declarative possibility/positive 12 the latter may lack declarative possibility/positive 13 (the latter) loses declarative 14 contact with the is severed maternal circulation declarative 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXIX DISCOURSE THERAPEUTIC DRUG MONITORING Clause I Subject Finite Modality the multiple factors measurement of the can assist concentration in body fluids declarative possibility/positive Determination of the is concentration of a drug in blood, serum, or plasma declarative well-defined criteria declarative III A demonstrated exists relationship declarative IV The range of plasma is designated levels between that required for efficacy and that at which toxicity occurs for a given individual declarative V There is declarative the level cannot predicted The drug produces declarative 10 that are declarative 11 The concentration is required to produce the therapeutic effect declarative 12 that causes declarative 13 there is declarative 14 A clear demonstration is not of the relation of drug concentration to efficacy or toxicity 15 such a relationship II VI VII VIII alter Mood are fulfilled can determined declarative be declarative possibility/negative declarative be declarative possibility/positive 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37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXX IX X 16 it predicts 17 such a high proportion respond to of patients declarative 18 it declarative 19 The end points may not prove defining drug effect declarative possibility/negative A digoxin level of was selected ng/ml initially declarative 23 As subsequent revealed retrospective examination of the data from a clinical trial of the effect of digoxin versus placebo on clinical outcome in patients with heart failure declarative 24 patients had declarative 25 most data that link declarative 26 this was not declarative 27 an alternative is explanation declarative 28 these data provide declarative 29 controlled data become declarative is declarative 20 XI 21 22 XII XIII XIV 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXXI DISCOURSE BINDING OF DRUGS TO PLASMA PROTEINS AND OTHER TISSUE COMPONENTS AND ACCUMULATION IN FAT Clause Subject Finite Mood Modality I One of the assumptions is made in developing the general picture of the distribution of drugs declarative II the rate of movement of a is determined drug across biologic barriers declarative it exists declarative III This ideal behavior is declarative IV The same kinds of bonds are formed declarative The same kinds of bonds can be formed that are formed when a drug interacts with its receptor declarative possibility/positive The major difference declarative binding with nonreceptor substance The binding sites that 10 The binding sites that are referred to not function as true receptors declarative 11 The last declarative 12 the molecules of a drug are bound to that declarative 13 the molecules of a drug are that are bound to nonreceptor macromolecules declarative 14 the molecules of a drug (are) that are bound to nonreceptor macromolecules declarative 15 The importance of these will depend on interactions with sites of loss declarative V VI VII VIII is a does not not function is declarative declarative 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.C.33.44.55.54.78.655.43.22.2.4.55.2237.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.66 LXXII DISCOURSE PATIENT-CENTERED THERAPEUTICS Clause I Subject Finite treatment are based Mood Modality Optimal decisions that II Interindividual can influence differences in drug delivery to its site(s) of action declarative possibility/positive III Pharmacodynamic differences in response to a drug declarative possibility/positive will determine may result from declarative declarative the IV precision in diagnosis governs and prognosis declarative V Some of the are indicated determinants of interindividual variation declarative VI therapeutic success and are determined safety declarative 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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unmarked VI 10 Drug levels in breast milk unmarked VII 11 The actual amount of drug unmarked that a breast-feeding infant 12 (ellipsis) 13 The ultimate decision as to unmarked whether a breast-feeding mother 14 (ellipsis) 15 The risks of transfer of unmarked maternal medication to the infant vs the benefits of continuing breast-feeding and the therapeutic benefits to the mother IV VIII IX drug unmarked 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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providone-iodine because the nurse unmarked these unmarked IV 10 Patients being treated with unmarked peroxide agents V 11 The risk of reactions to the unmarked antibacterial topical agents VI 12 Should a patient marked 13 that specific agent unmarked VII 14 Culture and sensitivity reports unmarked VIII 15 Nursing diagnoses unmarked appropriate for the use of antiseptics IX 16 Risk for infection related to unmarked compromised skin integrity X 17 Risk for infection related to unmarked skin trauma or injury resulting 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XXII 31 Patient unmarked the physician unmarked 32 when 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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emotions unmarked on a person’s ability to engage in normal daily activities and to interact with others However and this issue marked X 16 Mentally ill people unmarked XI 17 For example, obesity unmarked XII 18 Because of the variety of unmarked economic, educational, and psychosocial issues that 19 many patients unmarked 20 This unmarked XIII 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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with little unmarked potential for producing adverse effects in the mother 11 Drugs given to the unmarked mother at parturition 12 the latter unmarked 13 but also (ellipsis) 14 as soon as contact with the unmarked maternal circulation 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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unmarked 11 The concentration unmarked required to produce the therapeutic effect 12 that unmarked 13 there unmarked 14 A clear demonstration of unmarked the relation of drug concentration to efficacy or toxicity VI VII VIII 15 IX even when such a relationship unmarked 16 it unmarked 17 In trials of antidepressant unmarked drugs 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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Nonetheless these data unmarked 29 until controlled data unmarked 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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with a unmarked nonreceptor substance The binding sites that 10 (ellipsis) 11 The last 12 VIII whereas unmarked since unmarked unmarked the molecules of a drug unmarked that 13 (ellipsis) 14 (ellipsis) 15 The importance of these unmarked interactions with sites of loss 37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.55.77.77.99.44.45.67.22.55.77.C.37.99.44.45.67.22.99 z 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