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 PUBLIC HEALTH IN THE 21ST CENTURY

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INFECTIONS AND TREATMENT
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 PUBLIC HEALTH IN THE 21ST CENTURY

MRSA (METHICILLIN RESISTANT

STAPHYLOCOCCUS AUREUS)
INFECTIONS AND TREATMENT
Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

MANAL MOHAMMAD BADDOUR

Professor of Medical Microbiology and Immunology
Faculty of Medicine, Alexandria University
Alexandria, Egypt

Nova Science Publishers, Inc.

New York

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
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MRSA (Methicillin Resistant Staphylococcus aureus) infections and treatment /Author,

Manal M. Baddour.
x, 128 p. ; 23 cm.
Includes bibliographical references (p. [83]-118) and index.
ISBN:  H%RRN
1 .Staphylococcus aureus infections. 2.Methicillin resistance. I. Baddour, Manal M.
QR201.S68 B32 2010
(OCoLC)ocn505420624
2010283138

Published by Nova Science Publishers, Inc. † New York

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
 CONTENTS

Preface xi
Chapter 1 Introduction and Taxonomy 1
Chapter 2 The Case for MRSA 5
Chapter 3 Prevalence and Epidemiology 9
Chapter 4 Hospital Acquired and Community Acquired 13
Chapter 5 Differing Spectrums of Disease 19
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Chapter 6 Panton-Valentine Leukocidin 21

Chapter 7 Mechanism of β-lactam Resistance in MRSA 23
Chapter 8 MRSA Colonization 27
Chapter 9 Clinical Relevance of CA-MRSA 31
Chapter 10 GISA VISA VRSA 33
Chapter 11 Laboratory Diagnosis and Typing of MRSA 37
Chapter 12 Risk Factors for HA-MRSA 45
Chapter 13 Risk Factors for CA-MRSA 49
Chapter 14 Prevention 53
Chapter 15 Treatment of Methicillin Resistant Staphylococcus
aureus 57
Chapter 16 Treatment of CA-MRSA 65

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
 x Contents

Chapter 17 Treatment of VISA and VRSA 69

Chapter 18 Vancomycin Treatment Failures 71
Chapter 19 Treatment Options and New Directions 75
Chapter 20 The Microbiology Laboratory 81
References 83
Index 119
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MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
 PREFACE

Incidents of methicillin-resistant Staphylococcus aureus (MRSA) have

been prominent in the news over the past few years, drawing attention to a
type of infection that is resistant to certain antibiotics. Staphylococcus aureus
has three features that make it distinct among most other clinically important
bacteria. Not only do MRSA infections lead to higher lengths of stay and more
cost than MSSA infections, but more importantly, MRSA infections lead to a
higher mortality. It has been contended that the introduction of methicillin put
Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

an end to the tremendous amount of research and enthusiasm for the infection
control measures which were effective and vigorous at the time when it was
first introduced. The medical community experienced a false sense of security
against these resistant pathogens. Once you could treat these previously
antibiotic-resistant staphylococci, people stopped washing their hands and
doing all the other things they now realize they should have been doing all
along. MRSA is no longer confined to hospitals and hospital-attending people,
it has now vigorously invaded recreational, rehabilitation, sporting and
teaching facilities. Although the epidemiologic patterns of hospital acquired
MRSA and community acquired MRSA may be dissolving, there remain
clinical differences that, if unrecognized by the clinician, could cause delay in
appropriate treatment and management.
What is MRSA, where did it come from? Did we bring it about by
ourselves? Is it treatable? Is it truly deadly or are we overdoing it?

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
 Chapter 1

INTRODUCTION AND TAXONOMY

Staphylococci are Gram-positive spherical bacteria that occur in

microscopic clusters resembling bunches of grapes. They are aerobic or
facultatively anaerobic, nutritionally undemanding and catalase-positive.
Today, according to the current List of Bacterial Names with Standing in
Nomenclature (Euzéby, 2004), the genus Staphylococcus comprises 36
species, eleven of which also contain subdivisions with named subspecies. The
classification is still developing.
Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

On the basis of comparative 16S rRNA sequence studies, the genus

Staphylococcus belongs to the Gram-positive bacteria with a low DNA G+C
content. They are closely related to bacilli and other Gram-positive bacteria
with low DNA G+C content such as macrococci, enterococci, streptococci,
lactobacilli and listeria. Combining Staphylococcus, Gemella, Macrococcus
and Salinicoccus within the family Staphylococcaceae has been suggested
(Garrity and Holt, 2001).
The Staphylococcus genus is ubiquitously distributed in nature, with some
species inhabiting specific ecological niches. Staphylococci are found living
naturally on the skin and mucous membranes of warm-blooded animals and
humans (in fact, 25-30% of humans carry Staphylococci in their nares), but are
also isolated from a wide range of foodstuffs such as meat, cheese and milk,
and from environmental sources such as soil, sand, air and water (Kloos and
Schleifer, 1986).
Most staphylococci species are coagulase-negative. Exceptions are
Staphylococcus aureus, Staphylococcus intermedius, Staphylococcus delphini,
Staphylococcus schleiferi subsp. coagulans, Staphylococcus lutrae and some
strains of Staphylococcus hyicus (Kloos and Bannerman, 1995).

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
 2 Manal Mohammad Baddour

Staphylococcus aureus (S. aureus ) was discovered in the 1880s. Since

then, it has been shown to be a potential pathogenic Gram-positive bacterium,
causing such infections as minor skin infections and post-operative wound
infections. In the early 1940s, prior to the introduction of penicillin for the
treatment of S. aureus infections, the mortality rate of individuals with an S.
aureus infection was about 80% (Skinner and Keefer, 1941). In 1942, only
two years after the introduction of penicillin for medical use, the first
penicillin resistant S. aureus isolate was observed in a hospital. Later on,
penicillin-resistant S. aureus strains were also observed in the community.
Since 1960, around 80% of all S. aureus strains are resistant to penicillin. In
1961, 2 years after the introduction of methicillin, a penicillinase-resistant
penicillin, S. aureus developed methicillin-resistance due to the acquisition of
the mec A gene (Jevons, 1961).
The prevalence of methicillin resistant S. aureus (MRSA) isolates slowly
increased over the next three decades, with the majority of isolates being
hospital-associated. This started to change in 1982 with an outbreak of MRSA
among intravenous drug users (Saravolatx et al., 1982). During the last 45
years, various hospital-associated methicillin resistant S. aureus (HA-MRSA)
clones disseminated worldwide. The predominant pattern of MRSA in the
1980s and 1990s remained a hospital-acquired disease with traditional risk
factors (Brumfit & Hamilton-Miller, 1989; Lowy, 1998). MRSA has emerged
Copyright © 2010. Nova Science Publishers, Incorporated. All rights reserved.

epidemiologically in a similar manner to penicillin resistance in the 1950s,

occurring first in health care-associated settings then in the community.
Epidemiological studies suggest that hospitals are the primary MRSA
reservoir and that hospital contact account for most MRSA infections (Salgado
et al., 2003). Three major reservoirs of HA-MRSA within the hospital are
patients, health care workers, and inanimate environment. Patients and health
care workers may become colonized with MRSA and therefore serve as
sources of transmission. The major cause of spread of infection is infection
control lapses by health care professionals. Patients with nasal colonization at
hospital admission appear to be at increased risk for subsequent infection with
the same isolate. Between 10% and 30% of hospitalized patients who acquire
MRSA will develop an HA-MRSA infection (Davis et al., 2004; Huang &
Platt, 2003).
Not only do MRSA infections lead to higher lengths of stay and more cost
then MSSA infections, but more importantly, MRSA infections lead to a
higher mortality (Crowcroft & Catchpole, 2002; McHugh & Riley, 2004). A
2003 meta-analysis that included 31 studies showed a significant increase in
mortality with MRSA bacteremia compared with MSSA bacteremia (Cosgrove

MRSA (Methicillin Resistant Staphylococcus aureus) Infections and Treatment, edited by Manal M. Baddour, Nova Science
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- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Research findings and conclusions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 36: Key terms and definitions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 37: Case studies and real-world applications
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 39: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
References 5: Study tips and learning strategies
Remember: Statistical analysis and interpretation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 41: Key terms and definitions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 42: Diagram/Chart/Graph]
Example 42: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 43: Diagram/Chart/Graph]
Definition: Ethical considerations and implications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 44: Diagram/Chart/Graph]
Definition: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 45: Case studies and real-world applications
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Literature review and discussion
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 47: Diagram/Chart/Graph]
Important: Fundamental concepts and principles
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 48: Diagram/Chart/Graph]
Definition: Practical applications and examples
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Current trends and future directions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Module 6: Problem-solving strategies and techniques
Example 50: Key terms and definitions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Key terms and definitions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Fundamental concepts and principles
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Interdisciplinary approaches
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 54: Diagram/Chart/Graph]
Key Concept: Study tips and learning strategies
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 55: Diagram/Chart/Graph]
Important: Problem-solving strategies and techniques
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 56: Diagram/Chart/Graph]
Important: Best practices and recommendations
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Literature review and discussion
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Comparative analysis and synthesis
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 59: Diagram/Chart/Graph]
Note: Theoretical framework and methodology
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Methodology 7: Literature review and discussion
Key Concept: Research findings and conclusions
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 62: Diagram/Chart/Graph]
Definition: Best practices and recommendations
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 64: Theoretical framework and methodology
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Fundamental concepts and principles
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 66: Diagram/Chart/Graph]
Note: Problem-solving strategies and techniques
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Critical analysis and evaluation
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 68: Assessment criteria and rubrics
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 69: Theoretical framework and methodology
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 70: Diagram/Chart/Graph]
Lesson 8: Fundamental concepts and principles
Definition: Theoretical framework and methodology
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 71: Best practices and recommendations
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Best practices and recommendations
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 73: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Best practices and recommendations
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Remember: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 77: Diagram/Chart/Graph]
Key Concept: Comparative analysis and synthesis
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Assessment criteria and rubrics
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Test 9: Theoretical framework and methodology
Practice Problem 80: Fundamental concepts and principles
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 81: Diagram/Chart/Graph]
Remember: Practical applications and examples
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Interdisciplinary approaches
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Best practices and recommendations
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Experimental procedures and results
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Interdisciplinary approaches
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Theoretical framework and methodology
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 89: Learning outcomes and objectives
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Abstract 10: Critical analysis and evaluation
Practice Problem 90: Study tips and learning strategies
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 93: Key terms and definitions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Theoretical framework and methodology
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Practical applications and examples
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 97: Diagram/Chart/Graph]
Definition: Learning outcomes and objectives
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 98: Diagram/Chart/Graph]
Note: Learning outcomes and objectives
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 99: Ethical considerations and implications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 100: Diagram/Chart/Graph]
Discussion 11: Experimental procedures and results
Important: Literature review and discussion
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Practical applications and examples
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Ethical considerations and implications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Important: Key terms and definitions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Best practices and recommendations
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 107: Theoretical framework and methodology
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Exercise 12: Key terms and definitions
Important: Practical applications and examples
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 111: Diagram/Chart/Graph]
Note: Assessment criteria and rubrics
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 112: Ethical considerations and implications
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 113: Theoretical framework and methodology
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 114: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 115: Diagram/Chart/Graph]
Remember: Learning outcomes and objectives
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 116: Diagram/Chart/Graph]
Practice Problem 116: Best practices and recommendations
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Best practices and recommendations
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 118: Theoretical framework and methodology
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 119: Theoretical framework and methodology
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Module 13: Experimental procedures and results
Definition: Case studies and real-world applications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
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