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Osmolarity is higher than standard formulas and the propensity for diarrhea is increased order extra super cialis us. Elemental/peptide-based formulas contain predigested proteins that may promote absorption in patients with malabsorption cheap extra super cialis online master card. Their higher osmolarity and lower fat content require a slower infusion rate initially order generic extra super cialis from india. Special formulas for organ dysfunction have been designed specifi- cally for patients with established or evolving organ failure. Novamine Travasol TrophAmine 15% 10% 6% Protein equivalent (g/100mL) 15 10 6 Total nitrogen (g/100mL) 2. Order laboratory tests to monitor complications and efficacy of nutritional therapy. Hold feedings for 4 hours if the residual is greater than the hourly rate, and notify physician if two consecutive measurements are excessive. Irrigate feeding tubes with 20mL of tap water after each intermittent feeding or t. Nutrition Support in the Surgery Patient 57 las for renal and hepatic failure as well as newly promoted “immune enhancing” products are available. These formulas may prove useful in managing the complications associated with specific conditions, although evidence that they prolong life is limited. Complications of Enteral Feeding: The most common complications of enteral feeding include diarrhea, aspiration, vomiting, distention, metabolic abnormalities, and tube dislodgment. Aspiration is reduced by avoiding intragastric feeding in patients with reflux or in those who must be recumbent. Gastric residual volumes should be checked regu- larly, and prokinetic agents may benefit some patients. Diarrhea may represent a more complex diagnostic dilemma, and patients should be evaluated for Clostridium difficile infection and other medications as an etiology. Attention always must be given to the new onset of pain or distention in patients with intestinal feeding tubes. Small-bowel intussuscep- tion, necrosis, perforation, and pneumatosis intestinalis have been reported in such patients. Parenteral Formulas The basic content and prescription of parenteral nutrition formulations are shown in Table 3. Central parenteral formulas are often standard- ized by hospital pharmacies and usually include a hypertonic (>10%) dextrose source combined with amino acids. Intravenous fat emulsions may be mixed with this solution or provided as a separate infusion. Electrolytes and trace minerals are added to these solutions before infu- sion, and virtually all such solutions are given via volume controlled pumps. Additional additives, such as insulin, may be included in the solutions or provided by other means, as needed. Peripheral parenteral contains lower concentrations of dextrose (<10%) in combination with amino acids. Peripheral vein nutrition is a less optimal form of feeding in that adequate caloric support cannot be achieved except in unusual circumstances. Consequently, it is seldom used except where there are no other options or during the transition phase to full enteral feeding status. Complications of Parenteral Feeding: Tolerance to parenteral feedings should be evaluated throughout the course. In that acute parenteral nutrition is most common in patients who are critically ill, considera- tion always must be given to fluid status as well as glucose intolerance and electrolyte abnormalities. An acute shift toward anabolism may unmask preexisting body electrolyte deficiencies (see Monitoring Progress and Complications, below. Abnormalities of acid–base balance also occur more frequently in such patients, and alterations in electrolyte compo- sition (such as acetate salts) of solutions may be indicated. As always, patients with indwelling catheters must be monitored carefully for 58 S. An abrupt change in glucose tolerance may indicate infection related to the catheter or another source. Problems Related to Access These problems can be life-threatening and include misadventures related to placement of enteral or parenteral feeding portals. Acute pneumothorax, inadvertent arterial puncture, air embolism, and per- foration of the vena cava or heart can accompany attempts at central venous access. Insertion of catheters by experienced personnel serves to minimize these complications. More frequently, however, it is the initial misplacement of the catheter or latent events such as insertion-site infection or vessel thrombosis that provide troubling morbidities to patients. These complications are monitored by a rigorous adherence to sterility guidelines and protocols and by regular physical examination of the patient. A constant awareness of the potential for these events promotes early intervention and treatment. Problems related to placement of enteral feeding portals arise with similar, if not greater, frequency. Although it is increasingly popular to return to intragastric feeding, proper tube placement and function also must be assured. Problems of aspiration, especially in patients prone to reflux, may preclude this route of enteral nutrient provision. Under such circumstances, the placement of small-bore feeding catheters either transgastrically or transcutaneously requires experienced per- sonnel. As noted above, enteral feeding tubes may cause abdominal distention or symptoms that must be investigated. Careful, daily physical examination is an essential component of the monitoring regimen. Problems related to access portals as well as organ dys- function and fluid imbalance may be detected initially, or solely, on this basis. A determination of red blood cell indices may help to define iron deficiency (not routinely provided in intravenous nutrition). Eval- uation of basic bleeding parameters is undertaken to detect the pres- ence of vitamin K deficiency, which also may develop in parenterally fed patients. Trace mineral deficiencies may be a latent problem, especially in patients with preexisting malnutrition and prolonged inflammatory conditions. Attention should be given to patients with previous compromise of intestinal absorption. Problems of Excess Significant changes in overall clinical status as well as specific organs may provoke a state of excess provision.

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Maintaining the Airway One of the most important nursing goals in the management of head injury is to establish and maintain an adequate airway order 100mg extra super cialis visa. The brain is extremely sensitive to hypoxia extra super cialis 100 mg overnight delivery, and a neurologic deficit can worsen if the patient is hypoxic generic extra super cialis 100 mg overnight delivery. Therapy is directed toward 410 maintaining optimal oxygenation to preserve cerebral function. Interventions to ensure an adequate exchange of air are discussed in Chapter 61 and include the following: Maintain the unconscious patient in a position that facilitates drainage of oral secretions, with the head of the bed elevated about 30 degrees to decrease intracranial venous pressure (Fan, 2004). The goal is to keep blood gas values within the normal range to ensure adequate cerebral blood flow. Monitoring Fluid and Electrolyte Balance Brain damage can produce metabolic and hormonal dysfunctions. Serial studies of blood and urine electrolytes and osmolality are carried out, because head injuries may be accompanied by disorders of sodium regulation. Hyponatremia is common after head injury due to shifts in extracellular fluid, electrolytes, and volume. Hyperglycemia, for example, can cause an increase in extracellular fluid that lowers sodium (Hickey, 2003). Hypernatremia may also occur as a result of sodium retention that may last several days, followed by sodium diuresis. Endocrine function is evaluated by monitoring serum electrolytes, blood glucose values, and intake and output. A record of daily weights is maintained, especially if the patient has hypothalamic involvement and is at risk for the development of diabetes insipidus. Promoting Adequate Nutrition Head injury results in metabolic changes that increase calorie consumption and nitrogen excretion. Early initiation of nutritional therapy has been shown to improve outcomes in patients with head injury. Parenteral nutrition via a central line or enteral feedings administered via a nasogastric or nasojejunal feeding tube should be started within 48 hours after admission (Bader, Littlejohns & March, 2003). Laboratory values should be monitored closely in patients receiving parenteral nutrition. Elevating the head of the bed and aspirating the enteral tube for evidence of residual feeding before administering additional feedings can help prevent distention, regurgitation, and aspiration. Enteral or parenteral feedings are usually continued until the swallowing reflex returns and the patient can meet caloric requirements orally. The patient emerging from a coma may become increasingly agitated toward the end of the day. It may indicate injury to the brain but may also be a sign that the patient is regaining consciousness. Strategies to prevent injury include the following: The patient is assessed to ensure that oxygenation is adequate and the bladder is not distended. Because prolonged use of an indwelling catheter inevitably produces infection, the patient may be placed on an intermittent catheterization schedule. Maintaining Body Temperature An increase in body temperature in the patient with a head injury can be the result of damage to the hypothalamus, cerebral irritation from hemorrhage, or infection. If the temperature increases, efforts are made to identify the cause and to control it using acetaminophen and cooling blankets to maintain normothermia (Bader & Littlejohns, 2004; Diringer, 2004). If infection is suspected, potential sites of infection are cultured and antibiotics are prescribed and administered. Use of mild hypothermia to 34° to 35° C (94° to 96° F) has been tested in small randomized controlled trials for at least 12 hours versus normothermia (control) in patients with closed head injury (Alderson, Gadkary & Signorini, 2005). The clinical trials with small samples showed improvement in patient outcomes but need to be repeated in larger trials. Because hypothermia increases the risk of pneumonia and has other side effects, this treatment is not currently recommended outside of controlled clinical trials. Maintaining Skin Integrity Patients with traumatic head injury often require assistance in turning and positioning because of immobility or unconsciousness. Prolonged pressure on the tissues decreases 412 circulation and leads to tissue necrosis. Potential areas of breakdown need to be identified early to avoid the development of pressure ulcers. Specific nursing measures include the following: Assessing all body surfaces and documenting skin integrity every 8 hours Turning and repositioning the patient every 2 hours Providing skin care every 4 hours Assisting the patient to get out of bed to a chair three times a day Improving Cognitive Functioning Although many patients with head injury survive because of resuscitative and supportive technology, they frequently have significant cognitive sequelae that may not be detected during the acute phase of injury. Cognitive impairment includes memory deficits, decreased ability to focus and sustain attention to a task (distractibility), reduced ability to process information, and slowness in thinking, perceiving, communicating, reading, and writing. Psychiatric, emotional, and relationship problems develop in many patients after head injury (Hsueh-Fen & Stuifbergen, 2004). Resulting psychosocial, behavioral, emotional, and cognitive impairments are devastating to the family as well as to the patient. A neuropsychologist (specialist in evaluating and treating cognitive problems) plans a program and initiates therapy or counseling to help the patient reach maximal potential (Eslinger, 2002). Cognitive rehabilitation activities help the patient to devise new problem-solving strategies. The retraining is carried out over an extended period and may include the use of sensory stimulation and reinforcement, behavior modification, reality orientation, computer-training programs, and video games. Even if intellectual ability does not improve, social and behavioral abilities may. The patient recovering from a traumatic brain injury may experience fluctuations in the level of cognitive function, with orientation, attention, and memory frequently affected. Many types of sensory stimulation programs have been tried, and research on these programs is ongoing (Davis & Gimeniz, 2004). When pushed to a level greater than the impaired cortical functioning allows, the patient may show symptoms of fatigue, anger, and stress (headache, dizziness). The Rancho Los Amigos Level of Cognitive Function is a scale frequently used to assess cognitive function and evaluate ongoing recovery from head injury. Progress through the levels of cognitive function can vary widely for individual patients. To allow the patient longer times of uninterrupted sleep and rest, the nurse can group nursing care activities so that the patient is disturbed less frequently. Back rubs and other measures to increase comfort can assist in promoting sleep and rest. Supporting Family Coping Having a loved one sustain a serious head injury can produce a great deal of prolonged stress in the family. Such changes are associated with disruption in family cohesion, loss of leisure pursuits, and loss of work capacity, as well as social isolation of the caretaker.

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Such flexibility requires openness to new experiences and the understanding that most of the time order extra super cialis toronto, truth is unknowable best extra super cialis 100mg. Armed with a more flexible attitude buy extra super cialis discount, you can handle the stress and anxiety of job loss and other changes by considering all your options and alternatives. Look at your past jobs and consider what skills, attributes, and characteristics you brought to the table above and beyond those that are obvious from your job titles — highlight these skills on your resume. And when you interview, mention the connection between the skills you’ve acquired and how you can use them to advantage in your new company, instead of focusing on the past. Considering careers with stability You’ll worry less if your career path stands on a concrete foundation rather than one made of sand. If you’re underemployed or unemployed, consider updating your skills or changing your career path to one that has more stabil- ity. If figuring out how to pay for classes is a concern, most postsecondary schools have student loans, grants, or other ways to help pay for their programs. Here are a few areas considered to be relatively stable in these unstable times: ✓ Healthcare: Almost all areas of healthcare will see growth over the next few decades. In addition to professionals like nurses, doctors, pharma- cists, physical therapists, and dentists, others, such as home healthcare workers, medical technologists, and healthcare case managers, will be in greater demand. Chapter 14: Facing a Career Crisis and Financial Woes 225 ✓ Law enforcement and security: Needs for police officers, correction officers, and security personnel are likely to increase in years to come. Many of those working in this field are slated for retirement in the coming decade or so. Thus, this emphasis will call for a vast pool of workers trained in areas such as engineering, chemistry, physics, hydrology, and ecol- ogy, as well as technological expertise in almost every imaginable type of alternative energy. These jobs will be available for both those with advanced degrees and those with manufacturing and technical skills. Traditionally used by school guidance and vocational counselors, the Occupational Outlook Handbook is available for free at www. It contains a comprehensive listing of jobs, educational requirements, job conditions, and salaries. Keeping the right focus Anxiety, fear, and dread can easily overwhelm you if you let them. When faced with the possibility of job or income loss, people fill their minds with images of living on the streets or dying of hunger. But you can do much to prevent this out- come, and it occurs a very small fraction of the time compared to the amount of time that people spend dwelling on this worry. If you worry about losing your job or you find yourself unemployed, you have a new job. That new job is to cut your expenses to the bone (we give you some guidance on making these cuts in the “Tallying up your financial bal- ance sheet” section later in the chapter). Cutting expenses helps you even if you haven’t yet lost your job, because it helps you hold out longer if you do lose your income. After you’ve reduced the amount of money you’re spend- ing, your next step is to maximize your ability to find a new job (more on that in the “Knowing your personal assets and liabilities” section). But go to your state unemployment office for the nuts and bolts of that kind of advice. From a psychological perspective, we suggest the following: ✓ Focus on the present, taking one day at a time. Taking Stock of Your Resources Personal resources include financial and psychological assets and liabilities. Assets are the money or skills that you have that are of great value; liabilities are the money you owe or the skills that you need to gain. The following sections outline some of the things that can help maximize your assets and minimize your liabilities. Tallying up your financial balance sheet Most lenders such as mortgage companies, banks, or car dealers require customers to fill out loan applications. A standard loan application includes a description of the purpose of the loan and information about the borrow- ers. The application often asks about money coming in each month as well as monthly expenses. We suggest that you review your income, expenses, assets, and liabilities whether or not you want to borrow money. Make a list for each of the four categories; the result is called your balance sheet. When you think about your assets, include everything — grandma’s silver, coin collections, and other prized possessions. You may not want to sell them, but you always know you could if things got really bad. Chapter 14: Facing a Career Crisis and Financial Woes 227 After you know your income, expenses, assets, and liabilities, take a moment to think about them. All too often, people make the mistake of assuming they need far more than they really do. Multiple research studies have found what most people have trouble believ- ing: Your income has a very small relationship to how happy you are. Many people find that once they start cutting expenses, they’re amazed at how much they can save without sacrificing their emotional well-being. Knowing your personal assets and liabilities Although you want to assess your financial strengths first when facing the possibility of a job loss, it’s also helpful to analyze your personal strengths and attributes. Start by asking yourself the following questions: ✓ Am I willing to learn new skills? In an interview, be prepared to talk about any of the preceding questions that you feel you can answer affirmatively; these represent your assets. Any of the questions that you feel don’t apply to you may represent areas for personal development. After writing out your answers to the preceding list of questions, write down as many of your personal strengths as you can think of. Committing to a New Game Plan You can reduce the amount of energy you spend worrying about jobs and money if you commit yourself to making some changes. In addition to the ideas in the previous sections, we suggest you develop a game plan for your money and your career. Setting short-term goals You’ll never get where you want to go unless you have a map. Lots of people go through their entire lives without ever thinking about what they want to accomplish. Look at your money and career, and ponder what you really want to achieve in the next couple of years. Chapter 14: Facing a Career Crisis and Financial Woes 229 Considering short-term career goals Take a vocational interest inventory at your local community college. Brainstorm job possibilities that can make use of your personal strengths and interests.

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Autosomal dominant alleles are relatively rare in populations buy extra super cialis 100 mg line, so the typical mating pattern is a heterozygous affected individual (Aa genotype) mating with a homozygous normal individual (aa genotype) order genuine extra super cialis online, as shown in Figure I1-1-3 extra super cialis 100mg overnight delivery. Note that, by convention, the dominant allele is shown in uppercase (A) and the recessive allele is shown inlowercase (a). The recurrence risk is thus 50%, and half the children, on average, will be affected with the disease. Autosomal Dominant Inheritance • Neurofibromatosis type 1 • Marfan syndrome Acute intermittent porphyria A a a aa a aa Attected offspring (Aa) are shaded. Recurrence Risk for the Mating of Affected Individual (Aa) with a Homozygous Unaffected Individual (aa) Autosomal Recessive Inheritance Important features that distinguish autosomal recessive inheritance: • Because autosomal recessive alleles are clinically expressed only in the homozygous state, the offspring must inherit one copy of the disease-causing allele from each parent. In contrast to autosomal dominant diseases, autosomal recessive diseases are typically. This mechanism, termed X inactivation, occurs in the i" chromosomes but one are blastocyst (-100 cells) during the development of female embryos. X inactivation has several important characteristics: o It is random-in some cells of the female embryo, the X chromosome inherited from Note the father is inactivated, and in others the X chromosome inherited from the mother is inactivated. Thus, as a condition in which cells • females are said to be mosaics with respect to the active X chromosome. For example, females with three X chromosomes in each cell (see Chapter 3) have two X chromosomes inacti- vated in each cell (thus, two Barr bodies can be visualized in an interphase cell). Inactivation of the X Chromosome During Embryogenesis Is a Random Process,I I I Properties of X-linked recessive inheritance! Skipped generations are commonly seen because an affected male can transmit the disease-causing mutation to a heterozygous daughter, who is unaffected but who can transmit the disease-causing allele to her sons. Male-to-male transmission is not seen in X-linked inheritance; this helps distinguish it from autosomal inheritance. Affected male-homozygous normal female: All of the daughters will be heterozygous carriers; all of the sons will be homozygous normal. Normal male-carrier female: On average, half of the sons will be affected and half of the daughters will be carriers. Affected male-homozygous normal female (X chromosome with mutation is in lower case) B. However, because X inactivation is a random process, a het- erozygous female will occasionally express an X-linked recessive mutation because; by random chance, most of the X chromosomes carrying the normal allele have been inactivated. Single-Gene Disorders X-Linked Dominant Inheritance Clinical Correlate There are relatively few diseases whose inheritance is classified as X-linked dominant. In this condition, females are differently affected than Males: 100% penetrance males, and whereas penetrance in males is 100%, that in females is approximately 60% (see margin note). Because females have two X chromosomes (and • Macro-orchidism (usually il thus two chances to inherit an X-linked disease-causing mutation) and males have only postpubertal) one, X-linked dominant diseases are seen about twice as often in females as in males. None of his sons will I be affected, but all of his daughters have the disease (assuming complete penetrance). X-Linked Dominant Inheritance Recurrence Risks Figure 11-1-10 shows the recurrence risks for X-linked dominant inheritance. Affected male-homozygous normal female (the mutation-carrying chromosome is upper case) B. X-linked Autosomal Autosomal May be X- recessive recessive dominant dominant Are all daughters of an affected male also affected? Note: If transmission occurs only through affected mothers and never through affected sons, the pedigree is likelyto reflect mitochondrial inheritance. Sometimes a specific muta- tion is seen in only some of the mitochondria, a condition known as heteroplasmy. She takes no prescription drugs although she does use tu:1; ill aspirin for the hip pain. A liver biopsy revealed stainable iron in all hepatocytes and initial indications of hepatic I,,I I cirrhosis. Subsequently Mary was tested and also proved to be homozygous for the I,I Q82Y mutation. The autosomal recessive disease xeroderma pigmentosum will be expressed more severely in individuals who are exposed more frequently to ultraviolet radiation. Different mutations in the disease-causing locus may cause more- or less-severe expression. Allelic heterogeneity usually results in phenotypic variation between families, not within a single family. Generally the same mutation is responsible for all cases of the disease within a family. In the example of hemochromatosis above, both Mary and her brother have inherited the same mutation; thus, allelic heterogeneity is not responsible for the variable expression in this case. It is relatively uncommon to see a genetic disease in which there is no allelic heterogeneity. Disease expression may be affected by the action of other loci, termed modifier loci. Incomplete Penetrance A disease-causing mutation is said to have incomplete penetrance when some individuals who have the disease genotype (e. In the pedigree shown in Figure 11-1-13, Individual 11-4must have the disease-causing allele (he passed it from his father to his son) but shows no symptoms. Notice that hereditary hemochromatosis is an example of incomplete penetrance and also an example of variable expression. Expression of the disease phenotype in individuals homozy- gous for the disease-causing mutation can run the gamut from severe symptoms to none at all. Among the 15% of individuals with at least some phenotypic expression, that expression can be more or less severe (variable expression). However, 85% of individuals homozygous for the disease-causing mutation never have any symptoms (nonpenetrance), The same factors that contribute to variable expression in hemochromatosis can also contribute to incomplete. In 10% of individuals who inherit this mutation, there is no additional somatic mutation in the normal copy and retinoblastoma does not develop; although they can pass the mutation to their offspring. Dilatation of the ascending aorta is seen in 90% of patients and frequently leads to aortic rupture or congestive heart failure. Although the features of this disease seem rather disparate, they are all caused by a mutation in the gene that encodes fibrillin, a key component of connective tissue.. Defective fibrillin causes the connective tissue to be "stretchy" and leads to all of the observed disease features. Locus Heterogeneity Locus heterogeneity exists when the same disease phenotype can be caused by mutations in different loci. Locus heterogeneity becomes especially important when genetic testing is per~ ~ formed by testing for mutations at specific loci. Two " members of the trimer are encoded by a gene on chromosome 17, and the third is encoded. Mutations in either of these genes give rise to a faulty collagen molecule, causing type 2 01. Often, patients with chromosome 17 mutations are clinically indistinguishable from those with chromosome 7 mutations.

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Te physician has requested prophylaxis (often sporadically) cheap extra super cialis 100 mg line, the number of blood for malaria; the laboratory would like to parasites on the blood smear will be reduced and have patient information regarding: examination of routine thick and thin blood films A cheap 100mg extra super cialis amex. Also specific geographic every 4 hours travel history may help to determine whether B generic 100 mg extra super cialis amex. Liver function tests and prophylactic medication chloroquine-resistant Plasmodium falciparum may history be a factor. Prophylactic medication history and specific has been implicated in cases of human diarrhea. The travel history recommended stains are modified acid-fast stains, Microbiology/Apply knowledge of life cycles, diagnostic and the organisms are quite variable in their staining techniques, and clinical presentation/Parasitology/3 characteristics. The oocysts are immature when passed (no internal morphology) and they measure about 8–10 μm. A patient has been diagnosed as having amebiasis Answers to Questions 58–60 but continues to be asymptomatic. A request for an additional three stools for trophozoites containing ingested red blood cells culture (E. Initiating therapy, regardless of the patient’s be differentiated on the basis of morphology. Because this patient is asymptomatic, Microbiology/Apply knowledge of the morphology of the organisms seen in the fecal smears are organisms and pathogenesis/Parasitology/3 probably E. Although a patient is strongly suspected of having report should have said “Entamoeba histolytica/ giardiasis and is still symptomatic, three routine E. Although a patient may have species giardiasis and be symptomatic, confirmation of the B. Giardia lamblia tends to adhere to the mucosal infection from stool examinations may require surface and more than three stool examinations more than the routine three stools or may require may be required to confirm a suspected the examination of duodenal contents. Te organisms present did not stain with specimens should be tested before indicating trichrome stain and therefore the morphology is the patient is negative. A transplant patient is currently receiving began to reactivate with penetration of the larvae steroids. The patient is now complaining of through the intestinal wall (abdominal pain) and abdominal pain and has symptoms of pneumonia larval migration through the lungs (pneumonia), and positive blood cultures with gram-negative and the patient may have presented with evidence rods. The individual has been living in the of sepsis (often with gram-negative bacteria carried United States for 20 years but grew up in with the larvae as they penetrate the intestinal Central America. Patients who become immunosuppressed causing these symptoms is: may see the life cycle of Strongyloides reactivated A. Trypanosoma brucei rhodesiense with serious illness resulting; this can occur many B. Schistosoma japonicum Microbiology/Apply knowledge of fundamental life cycles, pathogenesis, and immunosuppressives/ Parasitology/3 7. An oligonucleotide with a large number of done by breaking the hydrogen bonds between base repeating C-G-C codons pairs. D Restriction endonucleases are enzymes that cut a binding site for a restriction endonuclease? The point mutation changes an A to a T within the restriction site, causing loss of the normal-sized fragment. Cloning a human gene into a bacterium in order Answers to Questions 3–5 to make a large molecular probe requires which vector? The recombinant plasmid is added to a culture produce a fluorescent or chemiluminescent signal? Commercially available plasmids have terminal ends of the probe promoter and reporter genes such as lac and lacZ B. These can be used to nucleotides into the probe identify colonies with successful recombinants. Splicing the gene for β-galactosidase into the also carry antibiotic resistance genes that allow the probe recombinants to be purified. Heat denaturation of the probe followed by acid recombinant bacteria results in large amounts of the treatment gene, which can be harvested using the restriction Molecular/Apply principles of special procedures/ enzyme, denatured, and labeled to make the probe. After washing to remove unbound streptavidin, a colorimetric, fluorescent, or chemiluminescent substrate is added. D Mosaicism occurs when cells within the same individual contain different numbers of chromosomes and results from nondisjunction during early embryonic development. Chimeras are molecules created when translocation occurs between genes (exons) on different chromosomes. A Each phosphoric acid subunit within a phosphodiester separated by agarose gel electrophoresis. Since the charge is distributed evenly, smaller fragments move more rapidly through the gel. If the distance traveled is plotted against the log of molecular weight, the plot will be a straight line with a negative slope because the larger the molecule, the more slowly it moves through the pores of the gel. It is frequently added to molten agarose or capillary electrophoresis buffer at a A. Ethidium bromide is the binding of the complementary base sequence Molecular/Apply principles of basic laboratory of the probe to the target sequence. Which of the following types of mutation causes Answers to Questions 9–11 the premature termination of protein synthesis? D The human genome contains approximately 3 billion base pairs and approximately 25,000 genes. They are subject to selection pressures that cause genes to drift in the population. Over 350,000 such differences are present in the human genome, but very few are associated with human disease. Which of the following is the most common type Answers to Questions 12–13 of polymorphism? The sequence can repeat 3 to Molecular/Apply principles of special procedures/ 14 times, resulting in 12 different alleles. Unlike conventional electrophoresis, a stationary support such as agarose is not used. Instead, a small-bore open tubular column is immersed in buffer solution at its ends and subjected to an electric field. The negative nature of the glass capillary attracts cations that are pulled to the cathode when the voltage is applied. An ultraviolet light detector or laser-induced fluorescence detector is located near the cathode and detects the molecules as they migrate. Such high resolution is possible because very high voltage can be used, since the heat produced is lost through the capillary wall. Annealing→Denaturation→Extension steps that are repeated to double the number of C.

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